Marios Spanakis

ECG in your hands: a multi-vendor ECG viewer for personal digital assistants

In the context of HYGEIAnet, the regional health network of Crete, numerous information systems have been developed to support the management of patient related data. In all these systems the digital acquisition and storage of clinical examinations and various vital signs play a major role in the provision of continuity of care to each patient in the region through the integrated electronic health record (IEHR). In such environment, personal digital assistants (PDAs) can be of great value to doctors on the move. The long-term goal is to extend the access to e-Health and m-Health services and to the citizens multimedia IEHR through the use of such devices. PDAs have already been used worldwide for the display and editing of textual information, while their graphic capabilities are also continuously improving. The development of new software components for the display of specific multimedia clinical information on PDAs should speed up our long-term goal. As a first step, a multi-vendor ECG viewer for PDAs has been developed and successfully evaluated by cardiologists and general practitioners.

Enabling personalized cancer medicine decisions: The challenging pharmacological approach of PBPK models for nanomedicine and pharmacogenomics (Review)

The existing tumor heterogeneity and the complexity of cancer cell biology critically demand powerful translational tools with which to support interdisciplinary efforts aiming to advance personalized cancer medicine decisions in drug development and clinical practice. The development of physiologically based pharmacokinetic (PBPK) models to predict the effects of drugs in the body facilitates the clinical translation of genomic knowledge and the implementation of in vivo pharmacology experience with pharmacogenomics. Such a direction unequivocally empowers our capacity to also make personalized drug dosage scheme decisions for drugs, including molecularly targeted agents and innovative nanoformulations, i.e. in establishing pharmacotyping in prescription. In this way, the applicability of PBPK models to guide individualized cancer therapeutic decisions of broad clinical utility in nanomedicine in real-time and in a cost-affordable manner will be discussed. The latter will be presented by emphasizing the need for combined efforts within the scientific borderlines of genomics with nanotechnology to ensure major benefits and productivity for nanomedicine and personalized medicine interventions.

Designing a digital patient avatar in the context of the MyHealthAvatar project initiative

The digital avatar is a vision for the digital representation of personal health status in body centric views. It is designed as an integrated facility that allows collection of, access to and sharing to life-long and consistent data. A number of Virtual Physiological Human (VPH) communities have started the movement to this direction by creating a digital patient road-map and by supporting data sharing infrastructures. As an innovative concept, the impact of digital patient and avatar to personalized medicine and treatment is yet to be clear. This requires a focused and concerted effort in addressing various questions regarding user perspective, use cases and scenarios. This paper presents use cases and future scenarios realizing the vision for the digital avatar as well as architectural consideration for the envisaged platform.

Exploitation of patient avatars towards stratified medicine through the development of in silico clinical trials approaches

The generation of “virtual twins” of patients (Avatars) through integration of multiscale data gained from both the clinical profile of the patient and - omics tools, could create an appropriate environment for stratification of patients in fitting cohorts of “virtual populations”. Physiologically based pharmacokinetic & pharmacodynamic (PB/PK/PD) models as in silico clinical trial tools can estimate the PK/PD profiles in specific populations. In this work we discuss examples of how patient Avatars could be exploited in the context of in silico clinical trials and help in identifying novel biomarkers for personalized diagnosis. The PB/PK/PD models, neuroimaging and - omics data, may be fused together to further advance current decision making processes in clinical practice.

ASXL1/EZH2 mutations promote clonal expansion of neoplastic HSC and impair erythropoiesis in PMF

Primary myelofibrosis (PMF) is a hematopoietic stem cell (HSC) disease, characterized by aberrant differentiation of all myeloid lineages and profound disruption of the bone marrow niche. PMF samples carry several mutations, but their cell origin and hierarchy in regulating the different waves of clonal and aberrant myeloproliferation from the prime HSC compartment is poorly understood. Genotyping of >2000 colonies from CD133+HSC and progenitors from PMF patients confirmed the complex genetic heterogeneity within the neoplastic population. Notably, mutations in chromatin regulators ASXL1 and/or EZH2 were identified as the first genetic lesions, preceding both JAK2-V617F and CALR mutations, and are thus drivers of clonal myelopoiesis in a PMF subset. HSC from PMF patients with double ASXL1/EZH2 mutations exhibited significantly higher engraftment in immunodeficient mice than those from patients without histone modifier mutations. EZH2 mutations correlate with aberrant erythropoiesis in PMF patients, exemplified by impaired maturation and cell cycle arrest of erythroid progenitors. These data underscore the importance of post-transcriptional modifiers of histones in neoplastic stem cells, whose clonal growth sustains aberrant myelopoiesis and expansion of pre-leukemic clones in PMF.

Secure access to patient's health records using SpeechXRays a mutli-channel biometrics platform for user authentication

The most commonly used method for user authentication in ICT services or systems is the application of identification tools such as passwords or personal identification numbers (PINs). The rapid development in ICT technology regarding smart devices (laptops, tablets and smartphones) has allowed also the advance of hardware components that capture several biometric traits such as fingerprints and voice. These components are aiming among others to overcome weaknesses and flaws of password usage under the prism of improved user authentication with higher level of security, privacy and usability. To this respect, the potential application of biometrics for secure user authentication regarding access in systems with sensitive data (i.e. patients data from electronic health records) shows great potentials. SpeechXRays aims to provide a user recognition platform based on biometrics of voice acoustics analysis and audio-visual identity verification. Among others, the platform aims to be applied as an authentication tool for medical personnel in order to gain specific access to patients electronic health records. In this work a short description of SpeechXrays implementation tool regarding eHealth is provided and analyzed. This study explores security and privacy issues, and offers a comprehensive overview of biometrics technology applications in addressing the e-Health security challenges. We present and describe the necessary requirement for an eHealth platform concerning biometric security.The most commonly used method for user authentication in ICT services or systems is the application of identification tools such as passwords or personal identification numbers (PINs). The rapid development in ICT technology regarding smart devices (laptops, tablets and smartphones) has allowed also the advance of hardware components that capture several biometric traits such as fingerprints and voice. These components are aiming among others to overcome weaknesses and flaws of password usage under the prism of improved user authentication with higher level of security, privacy and usability. To this respect, the potential application of biometrics for secure user authentication regarding access in systems with sensitive data (i.e. patients data from electronic health records) shows great potentials. SpeechXRays aims to provide a user recognition platform based on biometrics of voice acoustics analysis and audio-visual identity verification. Among others, the platform aims to be applied as an authentication tool for medical personnel in order to gain specific access to patients electronic health records. In this work a short description of SpeechXrays implementation tool regarding eHealth is provided and analyzed. This study explores security and privacy issues, and offers a comprehensive overview of biometrics technology applications in addressing the e-Health security challenges. We present and describe the necessary requirement for an eHealth platform concerning biometric security.

Addressing drug-drug and drug-food interactions through personalized empowerment services for healthcare

Personalized healthcare systems support the provision of timely and appropriate information regarding healthcare options and treatment alternatives. Especially for patients that receive multi-drug treatments a key issue is the minimization of the risk of adverse effects due to drug-drug interactions (DDIs). DDIs may be the result of doctor prescribed drugs but also due to self-medication of conventional drugs, alternative medicines, food habits, alcohol or smoking. It is therefore crucial for personalized health systems, apart from assisting physicians for optimal prescription practices, to also provide appropriate information for individual users for drug-drug interactions or similar information regarding risks for modulation of the ensuing treatment. In this manuscript we describe a DDI service including drug-food, drug-herb and other lifestyle-related factors, developed in the context of a personalized patient empowerment platform. The solution enables guidance to patients for their medication on how to reduce the risk of unwanted drug interactions and side effects in a seamless and transparent way. We present and analyze the implemented services and provide examples on using an alerting service to identify potential DDIs in two different chronic diseases, congestive heart failure and osteoarthritis.