Present and Future of Digital Health in Diabetes and Metabolic Disease

The use of information and communication technology (ICT) in medical and healthcare services goes beyond everyday life. Expectations of a new medical environment, not previously experienced by ICT, exist in the near future. In particular, chronic metabolic diseases such as diabetes and obesity, have a high prevalence and high social and economic burden. In addition, the continuous evaluation and monitoring of daily life is important for effective treatment and management. Therefore, the wide use of ICTbased digital health systems is required for the treatment and management of these diseases. In this article, we compiled a variety of digital health technologies introduced to date in the field of diabetes and metabolic diseases.

Individualized medicine of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common disease worldwide, and its prevalence is increasing in both developed and developing countries. GERD is divided into three subtypes, namely, erosive esophagitis, nonerosive reflux disease (NERD), and Barrett's esophagus. The etiology, pathogenesis, clinical manifestations, and response to treatment of GERD invariably show high heterogeneity or significant individual difference, especially NERD and refractory GERD. On the other hand, advanced technology has currently provided a wide range of methods for the diagnosis and treatment of GERD patients; however, the long-term efficacy and quality of life of some patients are unsatisfactory. Therefore, each GERD patient needs a specialized management strategy aiming at his/her own condition, which is known as individualized medicine or personalized medicine. The goal of GERD treatment is to relieve the symptoms, while symptomatic remission is directly related to the quality of life. In other words, health-related quality of life and patient satisfaction may be reasonable criteria for GERD. In this paper, we will discuss the individualized medicine of GERD.

Diffusion MRI of cancer: From low to high b-values

Following its success in early detection of cerebral ischemia, diffusion-weighted imaging (DWI) has been increasingly used in cancer diagnosis and treatment evaluation. These applications are propelled by the rapid development of novel diffusion models to extract biologically valuable information from diffusion-weighted MR signals, and significant advances in MR hardware that has enabled image acquisition with high b-values. This article reviews recent technical developments and clinical applications in cancer imaging using DWI, with a special emphasis on high b-value diffusion models. The article is organized in four sections. First, we provide an overview of diffusion models that are relevant to cancer imaging. The model parameters are discussed in relation to three tissue properties-cellularity, vascularity, and microstructures. An emphasis is placed on characterization of microstructural heterogeneity, given its novelty and close relevance to cancer. Second, we illustrate diffusion MR clinical applications in each of the following three categories: 1) cancer detection and diagnosis; 2) cancer grading, staging, and classification; and 3) cancer treatment response prediction and evaluation. Third, we discuss several practical issues, including selection of image acquisition parameters, reproducibility and reliability, motion management, image distortion, etc., that are commonly encountered when applying DWI to cancer in clinical settings. Lastly, we highlight a few ongoing challenges and provide some possible future directions, particularly in the area of establishing standards via well-organized multicenter clinical trials to accelerate clinical translation of advanced DWI techniques to improving cancer care on a large scale. Level of Evidence: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:23-40.

The New Age of -omics in Urothelial Cancer - Re-wording Its Diagnosis and Treatment

Unmet needs in urothelial cancer management represent an important challenge in our effort to improve long-term overall and disease-free survival rates with no significant compromise in quality of life. Radical cystectomy with pelvic lymph node dissection is the standard for the management of muscle-invasive, non-metastatic cancers. In spite of a 90% local disease control, up to 50% of patients ultimately die of distant metastasis. Bladder preservation using chemo-radiation is an acceptable alternative, but optimal patient selection remains elusive. Recent research is focused on the employment of tailored-made strategies in urothelial cancer exploiting the potential of theranostics in patient selection for specific therapies. Herein, we review the current knowledge on molecular theranostics in urothelial cancer and we suggest that this is the time to move toward imaging theranostics, if tailored-made disease management and patient stratification is envisaged.

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Urothelial cancer management represents an important challenge.

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Optimum patient stratification and tailored-made theranostics remain elusive.

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Imaging theranostics is envisaged as a cancer roadmap.

Next revolution in molecular theranostics: personalized medicine for urologic cancers

Extensive lists of molecular biomarkers are currently evaluated as potential targets for directed cancer therapies. We reviewed three potential candidate biomarkers to play a role in the near future as molecular theranostics for urologic malignancies. Carbonic anhydrase type IX is a surrogate marker of hypoxia highly expressed in cancer cells. Their expression and clinical significance in kidney and urothelial bladder cancer are discussed as well as the main therapeutic approaches that are currently under evaluation. For prostate cancer, available evidence on the use of prostate-specific membrane antigen and neuropeptide receptors radiolabeled analog and the undergoing clinical studies are also analyzed and discussed at different stages of prostate cancer.

P4 radiology of hepatobiliary diseases with gadoxetic acid-enhanced MRI as a biomarker

A recent paradigm shift in radiology has focused on the globalization of so-called P4 radiology. P4 radiology represents delivery of imaging results that are predictive, personalized, pre-emptive and participatory. The combination of the P4 approach and biomarkers is particularly pertinent to MRI, especially with technological advances such as diffusion-weighted imaging. The development of new liver-specific MRI contrast media, particularly gadoxetic acid, demonstrate specific pharmacokinetic properties, which provide combined morphologic and functional information in the same setting. The evaluation of hepatobiliary pathology beyond morphology gives rise to the possibilty of using gadoxetic acid-enhanced MRI as an imaging biomarker of hepatobiliary diseases. The integration of functional imaging with an understanding of complex disease mechanisms forms the basis for P4 radiology, which may ultimately lead to individualized, cost-effective, targeted therapy for patients. This will enable radiologists to determine the prognosis of the disease and estimate early response to treatment, with the participation of all the required medical disciplines.