4 Clinical applications of aspirin

This article reviews the recent advancements and future potential of optical surface imaging (OSI) in clinical applications as a four-dimensional (4D) imaging modality for surface-guided radiotherapy (SGRT), including OSI systems, clinical SGRT applications, and OSI-based clinical research. The OSI is a non-ionizing radiation imaging modality, offering real-time 3D surface imaging with a large field of view (FOV), suitable for in-room interactive patient setup, and real-time motion monitoring at any couch rotation during radiotherapy. So far, most clinical SGRT applications have focused on treating superficial breast cancer or deep-seated brain cancer in rigid anatomy, because the skin surface can serve as tumor surrogates in these two clinical scenarios, and the procedures for breast treatments in free-breathing (FB) or at deep-inspiration breath-hold (DIBH), and for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT) are well developed. When using the skin surface as a body-position surrogate, SGRT promises to replace the traditional tattoo/laser-based setup. However, this requires new SGRT procedures for all anatomical sites and new workflows from treatment simulation to delivery. SGRT studies in other anatomical sites have shown slightly higher accuracy and better performance than a tattoo/laser-based setup. In addition, radiographical image-guided radiotherapy (IGRT) is still necessary, especially for stereotactic body radiotherapy (SBRT). To go beyond the external body surface and infer an internal tumor motion, recent studies have shown the clinical potential of OSI-based spirometry to measure dynamic tidal volume as a tumor motion surrogate, and Cherenkov surface imaging to guide and assess treatment delivery. As OSI provides complete datasets of body position, deformation, and motion, it offers an opportunity to replace fiducial-based optical tracking systems. After all, SGRT has great potential for further clinical applications. In this review, OSI technology, applications, and potential are discussed since its first introduction to radiotherapy in 2005, including technical characterization, different commercial systems, and major clinical applications, including conventional SGRT on top of tattoo/laser-based alignment and new SGRT techniques attempting to replace tattoo/laser-based setup. The clinical research for OSI-based tumor tracking is reviewed, including OSI-based spirometry and OSI-guided tumor tracking models. Ongoing clinical research has created more SGRT opportunities for clinical applications beyond the current scope.

Why Are Peer Review Outcomes Less Favorable for Clinical Science than for Basic Science Grant Applications?

Aim: A fast activation time of hemostatic agents with blood must be sufficient to effectively stop bleeding within surgical procedures. However, there are no functional in-vitro tests of hemostatic agents which mimick such a clinical application. Method: The efficacy of two common hemostatic agents was examined with heparinised human whole blood (0.7 IU/ml) and a contact time of only three minutes between blood and hemostatic agents. Traditional biochemical assays were compared with a new rheometric method for measuring clot formation. Results: Blood without previous material contact (negative control) induced a basal thrombin-antithrombin (TAT, 240 ± 85 μg/l) or s-thromboglobulin (TG, 1000 ± 216 U/ml) complex formation. Stainless steel (positive control) or a thrombin coated equine collagen fleece failed to increase TAT or s-TG. However, a bovine collagen fleece significantly increased formation of TAT (1426 ± 378 μg/l) or s-TG (3829 ± 857 U/ml). In rheometric measurements of the negative control the clotting time (CT) was 17 ± 4 min and the clot strength (CS) was 71 ± 45Pa. In the positive control CT (stainless steel) was 9 ± 3 min and CS was 298 ± 68Pa. The equine collagen fleece caused no detectable stimulation of CT and CS whereas the bovine collagen fleece (CT 13 ± 3 min, CS 186 ± 86Pa) was almost as effective as stainless steel. Conclusion: Traditional biochemical parameters fail to indicate thrombogenicity under the tested conditions but oscillatory shear rheometry is a sensitive tool to analyse blood coagulation in vitro. Furthermore, mimicking the clinical relevant application times, the rheometric method detects functional differences of hemostatic agents. Since these differences correlate with in vivo data, the rheometric method is a valuable tool during the development of hemostatic agents.Aim: A fast activation time of hemostatic agents with blood must be sufficient to effectively stop bleeding within surgical procedures. However, there are no functional in-vitro tests of hemostatic agents which mimick such a clinical application. Method: The efficacy of two common hemostatic agents was examined with heparinised human whole blood (0.7 IU/ml) and a contact time of only three minutes between blood and hemostatic agents. Traditional biochemical assays were compared with a new rheometric method for measuring clot formation. Results: Blood without previous material contact (negative control) induced a basal thrombin-antithrombin (TAT, 240 ± 85 μg/l) or s-thromboglobulin (TG, 1000 ± 216 U/ml) complex formation. Stainless steel (positive control) or a thrombin coated equine collagen fleece failed to increase TAT or s-TG. However, a bovine collagen fleece significantly increased formation of TAT (1426 ± 378 μg/l) or s-TG (3829 ± 857 U/ml). In rheometric measurements of the negative control the clotting time (CT) was 17 ± 4 min and the clot strength (CS) was 71 ± 45Pa. In the positive control CT (stainless steel) was 9 ± 3 min and CS was 298 ± 68Pa. The equine collagen fleece caused no detectable stimulation of CT and CS whereas the bovine collagen fleece (CT 13 ± 3 min, CS 186 ± 86Pa) was almost as effective as stainless steel. Conclusion: Traditional biochemical parameters fail to indicate thrombogenicity under the tested conditions but oscillatory shear rheometry is a sensitive tool to analyse blood coagulation in vitro. Furthermore, mimicking the clinical relevant application times, the rheometric method detects functional differences of hemostatic agents. Since these differences correlate with in vivo data, the rheometric method is a valuable tool during the development of hemostatic agents.

Part I: Basic Principles of Parallel Acquisition Techniques: Introduction to k-Space and Parallel Imaging.- Basic Reconstruction Algorithms for Parallel Imaging.- The g-Factor and Coil Design.- Measurement of Signal-to-Noise Ratio and Parallel Imaging.- Special Applications of Parallel Imaging.- Parallel-Imaging Reconstruction of Arbitrary k-Space-Sampling Data.- Complementary Techniques for Accelerated Imaging.- Part II: Sequence design for (auto-calibrated) parallel imaging: Measurement of Coil Sensitivity Profiles.- Conventional Spin-Echo and Gradient-Echo Pulse Sequences.- Single-Shot Pulse Sequences.- Fast Sequences for Dynamic and Time-Resolved Imaging.- The Development of TSENSE.- Part III: Technical implementation in clinical MRI: Design of Dedicated MRI Systems for Parallel Imaging.- Dedicated Coil Systems from Head to Toe.- Design of Imaging Protocols.- General Advantages of Parallel Imaging.-Limitations of Parallel Imaging.- Part IV: Clinical Applications: Imaging of Morphology: High-Resolution Imaging of the Brain.- High-Resolution Imaging of the Skull Base and Larynx.- Lung Imaging.- Liver Imaging.- High-Resolution Imaging of the Bililary Tree and the Pancreas.- Inflammatory Bowel Disease.- Musculoskeletal Imaging: Knee and Shoulder.- Advanced Methods of Fat Suppression and Parallel Imaging.- Part V: Clinical Applications: Angiography: MRA of Brain Vessels, of the Carotid Arteries, and of the Pulmonary Ciculation.- High-Resolution MRA of the Renal Arteries.- Peripheral MR Angiography.- Pediatric Congenital Cardiovascular Disease High-Resolution Whole-Body MRA.- Part VI: Clinical Applications: Function Imaging of CNS Diffusion and Perfusion: Diffusion Tensor Imaging of the Brain.- Imaging of Cardiac Function.- Imaging of Cardiac Perfusion.- Imaging of Pulmonary Perfusion.- Oxygen Imaging of the Lung.- Imaging of Renal Perfusion.- Part VII: Comprehensive Protocols: Cardiovascular Screening.- Tumor Staging.- Imaging of Bronchial Carcinoma.- Imaging of Pulmonary Hypertension.- Part VIII: Future Developments: New Coil Systems for Highly Parallel MR Acquisition Strategies.- Paralell-Excitation Techniques for Ultra-High-Field MRI.- Future Software Developments.- Future Imaging Protocols with Parallel Imaging.- Subject Index.- List of Contributors.

This issue of Physiological Measurement follows the successful 13th ICEBI conference held at the Graz University of Technology, Austria, from 29 August to 2 September 2007. It was organized jointly with the 8th Conference on Electrical Impedance Tomography. The conference was co-organized by the Impedance Imaging Research Centre (IIRC) in Seoul and the Austrian Society for Biomedical Engineering (ÖGBMT), and it was kindly endorsed by the IFMBE. The combined conferences created a platform for investigators from both research communities of bio-impedance and EIT to engage in common areas of interest whilst also allowing an opportunity for the community to broaden its outlook in the areas of bio-sensors, clinical applications and new technologies. This upholds the tradition of successful conferences on biomedical applications of electrical impedance tomography and bio-impedance. It follows the 7th Conference on Biomedical Applications of Electrical Impedance Tomography combined with the World Congress 2006, which took place in Seoul from 27 August to 1 September 2006. The next EIT conference is scheduled to take place in Dartmouth College, USA, in June 2008.This issue contains papers produced from discussion and feedback during the conference in both bio-impedance and EIT research areas. It was also an opportunity for new researchers to join the community and propose recent innovations. Of the 259 papers presented at the conference, Springer Verlag published 207 in the IFMBE proceedings. All authors were invited to prepare new papers for inclusion in this issue of Physiological Measurement. The manuscripts were put through a process of careful review before selection. A total of 43 were accepted, covering an important range of topics from bio-impedance, hardware, algorithms, new technologies and clinical applications.From the scientific point of view, bio-impedance has a very long tradition that dates back to the days of Maxwell. Nevertheless, until the end of the 20th century, research was focused on the development of methods and basic experimental work while clinical or other practical applications remained limited. Consequently, there were not so many companies interested enough to produce professional equipment for easy and reliable data collection and interpretation. This may appear surprising as bio-impedance reflects so many (patho-) physiological processes, but on the other hand, a number of proposed applications, though sensitive, still exhibit low specificity, especially when aimed at processes far from the body surface. The 2007 conference may have shown a slight change of tendency. From 2000 to 2006, the number of papers cited in Medline and containing the keywords 'bio-impedance' or 'impedance tomography' increased by 56%. At the same time, we face an increasing number of applications related to micro- and nano-technologies that have emerged along with the tremendous growth of biochemical and cellular engineering. In recent years both the number of newly founded companies for bio-impedance devices and the involvement of established companies in bio-impedance research have increased.The papers included in this year's issue clearly reflect this. New developments and trends are visible, such as non-contact methods using magnetic fields; MREIT, bringing together EIT and magnetic resonance imaging; and magnetic induction tomography (MIT), clinical applications, bio-impedance spectroscopy, new hardware and algorithms. The presentations of these new technologies continue to grow and it will be interesting to see how these contribute to future clinical applications.At this conference, clinical applications were strongly represented; they included brain function, breast imaging, and thorax and gastric applications. It is important that researchers do not neglect the challenges of clinical applications of bio-impedance and EIT as there are still many technical difficulties that the technology needs to overcome in order to provide valuable clinical tools; however, there are promising signs that these tools are close to realization.The future of both EIT and bio-impedance continues to provide researchers with new challenges. The high quality of research papers in this special issue shows clear evidence of significant advances in this research field.

An innovative biomedical engineering (BME) laboratory course was developed to integrate wireless biotechnology with a hands on learning approach. In recent years the need for biomedical engineers in research and industry has increased dramatically. This requires novel strategies for training BME students in both engineering principles and clinical applications. BME students should be prepared with an appropriate skill set for real-world problems. BME education requires hands on learning with cutting edge technology to produce students ready to solve clinical problems in both research and industry. Including a wide range of BME clinical and rehabilitation applications increases student interest. A wide range of BME laboratories was designed to encompass both the basics of physiological signals and how to effectively utilize them in clinical applications. These clinical application interfaces are critical for students to understand how physiological signals may be manipulated to extract meaningful benefits for various medical disorders and rehabilitation needs. The biomedical engineering laboratory course presented in this paper was implemented and evaluated at several universities. Utilizing a virtual environment for practical applications bridges the gap between fundamentals and real world designs.

COVID-19 pandemic has significantly impacted the field of medical training, necessitating innovative approaches to education and practice. During this period, the use of novel technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) has become increasingly vital. These technologies offer the advantage of transcending the limitations of time and space, thus enabling medical professionals to access various personalized programs for both education and service delivery. This shift is particularly relevant in the realm of pediatric medicine, where traditional training and clinical methods face unique challenges. The primary aim of this study is to explore the application of VR, AR, and MR technologies in pediatric medical settings, with a focus on both clinical applications and the training of pediatric medical professionals. We aim to comprehensively search and review studies that have utilized these technologies in the treatment of pediatric patients and the education of healthcare providers in this field. Peer-reviewed articles published in PubMed, the Cochrane Library, ScienceDirect, Google Scholar, and Scopus from January 1, 2018, to March 1, 2023, were comprehensively searched. The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. Among the 89 studies, 63 investigated the clinical applications of VR (n=60) or AR (n=3) in pediatric patients, and 25 investigated the applications of VR (n=19), AR (n=5), or MR (n=1) for training medical professionals. A total of 36 randomized controlled trials (RCTs) for clinical application (n=31) and medical training (n=5) were retrieved. Among the RCTs, 21 reported significant improvements in clinical applications (n=17) and medical training (n=4). Despite a few limitations in conducting research on innovative technology, such research has rapidly expanded, indicating that an increasing number of researchers are involved in pediatric research using these technologies.

Beginning of percutaneous coronary interventions: Zurich 1976–1977

BackgroundFour-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR. MethodsA systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Structured searches were carried out on Medline, EMBASE and the Cochrane Library in October 2016. A modified Critical Skills Appraisal Programme (CASP) tool was used to objectively assess and score the included studies. Studies were categorised as ‘highly clinically applicable’ for scores of 67–100%, ‘potentially clinically applicable’ for 34–66% and ‘less clinically applicable’ for 0–33%. ResultsOf the 1608 articles screened, 44 studies met eligibility for systematic review. The included literature consisted of 22 (50%) mechanistic studies, 18 (40.9%) pilot studies and 4 (9.1%) diagnostic studies. Based on the modified CASP tool, 27 (62%) studies were ‘highly clinically applicable’, 9 (20%) were ‘potentially clinically applicable’ and 8 (18%) were ‘less clinically applicable’. ConclusionsThere are many proposed methods for using 4D flow CMR to quantify intra-cardiac flow. The evidence base is mainly mechanistic, featuring single-centred designs. Larger, multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices.PROSPERO=CRD42016051438.

Cylindrical transducer elements, with sizes and operating frequencies favorable for applications in hyperthermia, are characterized. The effects of cutting these elements from whole cylinders down to halves and quarters (cuts parallel to axis), as well as the resonant frequency of operation (0.5, 1.0, and 1.6 MHz), were investigated. These results were used to develop clinical applicators consisting of multiple elements, one device for each frequency. These clinical applicators were operated with the controlled cooling of the tissue/applicator interface. The efficacy of these applicators were tested in vivo in the canine prostrate, rectal wall, and vaginal wall. The ability of these clinical applicators to provide controlled heating for different tumor geometries is discussed. >

Background: Ventricular tachycardia (VT) can broadly be categorised into ischemic heart disease, non-ischemic structural heart disease, and idiopathic VT. There are few studies related to the application of machine learning for the etiological diagnosis of VT, and the interpretable methods are still in the exploratory stage for clinical decision-making applications. Objectives: The aim is to propose a machine learning model for the etiological diagnosis of VT. Interpretable results based on models are compared with expert knowledge, and interpretable evaluation protocols for clinical decision-making applications are developed. Methods: A total of 1305 VT patient data from 1 January 2013 to 1 September 2023 at the Arrhythmia Centre of Fuwai Hospital were included in the study. Clinical data collected during hospitalisation included demographics, medical history, vital signs, echocardiographic results, and laboratory test outcomes. Results: The XGBoost model demonstrated the best performance in VT etiological diagnosis (precision, recall, and F1 were 88.4%, 88.5%, and 88.4%, respectively). A total of four interpretable machine learning methods applicable to clinical decision-making were evaluated in terms of visualisation, clinical usability, clinical applicability, and efficiency with expert knowledge interpretation. Conclusions: The XGBoost model demonstrated superior performance in the etiological diagnosis of VT, and SHAP and decision tree interpretable methods are more favoured by clinicians for decision-making.

Background: The biotechnological advances that guide pluripotent neural stem cells to stimulate corticogenesis and spontaneously mimic the architecture of the immature human brain have extensive clinical and commercial applications. Known as organoids, these human neural tissue derivatives present a complex network of challenges, which include cryopreservation, donor consent, classification as hybrids and the creation of chimeras. The possibility that neural organoids may develop some form of consciousness is a critical issue, which includes the perception of pain and sensory deprivation. In the wider sense, organoid research also has relevance within space exploration and palaeoanthropology. Objectives: This article explores ethical issues regarding informed consent, clinical applications and the future of organoid research. Method: This review examines current research and the complex research protocols pertaining to brain organoids, along with the various attempts to formulate an appropriate ethical model. Results: Research on organoids represents a significant biotechnological advancement with enormous potential to enhance various scientific endeavours both now and in the future. Conclusion: The necessity to proactively deliberate, assess and responsibly guide the complex ethical issues surrounding the use and manipulation of human neural tissue is widely recognised. This is important to avoid unduly obstructing valid research programmes, which offer significant benefits to both humans and non-human animals, as discussed in the text. Contribution: Organoid research is currently one of the most promising revolutions in biomedical research, with clear benefits for both human and non-human animals.

Clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR-Cas9), an emerging gene-editing technology, has recently gained rapidly increasing attention. However, the lack of efficient delivery vectors to deliver CRISPR-Cas9 to specific cells or tissues has hindered the translation of this biotechnology into clinical applications. Chemically synthesized nanoparticles (NPs), as attractive non-viral delivery platforms for CRISPR-Cas9, have been extensively investigated because of their unique characteristics, such as controllable size, high stability, multi-functionality, bio-responsive behavior, biocompatibility, and versatility in chemistry. In this review, the key considerations for the precise design of chemically synthesized-based nanoparticles include efficient encapsulation, cellular uptake, the targeting of specific tissues and cells, endosomal escape, and controlled release. We discuss cutting-edge strategies to integrate chemical modifications into non-viral nanoparticles that guide the CRISPR-Cas9 genome-editing machinery to specific edits. We also highlighted the rationale of intelligent nanoparticle design. In particular, we have summarized promising functional groups and molecules that can effectively optimize carrier function. In addition, this review focuses on advances in the widespread application of NPs delivery in the biomedical fields to promote the development of safe, specific, and efficient NPs for delivering CRISPR-Cas9 systems, providing references for accelerating their clinical translational applications.

Medical devices are essential to the practice of modern healthcare services. Their benefits will increase if clinical software applications can seamlessly acquire the medical device data. The need to represent medical device observations in a format that can be consumable by clinical applications has already been recognized by the industry. Yet, the solutions proposed involve bilateral mappings from the ISO/IEEE 11073 Domain Information Model (DIM) to specific message or document standards. Considering that there are many different types of clinical applications such as the electronic health record and the personal health record systems, the clinical workflows, and the clinical decision support systems each conforming to different standard interfaces, detailing a mapping mechanism for every one of them introduces significant work and, thus, limits the potential health benefits of medical devices. In this paper, to facilitate the interoperability of clinical applications and the medical device data, we use the ISO/IEEE 11073 DIM to derive an HL7 v3 Refined Message Information Model (RMIM) of the medical device domain from the HL7 v3 Reference Information Mode (RIM). This makes it possible to trace the medical device data back to a standard common denominator, that is, HL7 v3 RIM from which all the other medical domains under HL7 v3 are derived. Hence, once the medical device data are obtained in the RMIM format, it can easily be transformed into HL7-based standard interfaces through XML transformations because these interfaces all have their building blocks from the same RIM. To demonstrate this, we provide the mappings from the developed RMIM to some of the widely used HL7 v3-based standard interfaces.

3D printing restorative materials using a stereolithographic technique: a systematic review