Medical Advances Research Articles

Responding to epidemics: the case of the Nguyễn Dynasty, focusing on the period 1802–1883

Abstract In the past, Vietnam was impacted by numerous epidemics, particularly during the Nguyễn Dynasty from 1802 to 1883. Based on data from the Đại Nam Thực Lục (1961) (The Veritable Records of the Great South), this article investigates the frequency and nature of these epidemics, identifies the types of common diseases at that time, and explores the underlying causes of these outbreaks. The study further examines the Nguyễn Dynasty's strategies for managing these health crises. During these outbreaks, the dynasty faced significant challenges, with frequent epidemics leading to high death rates, widespread social disruption, and economic decline. The dynasty's primary preventive measures, heavily reliant on spiritual practices like prayer, highlight the limited medical understanding at the time and the constraints of its socio-political framework. However, there was a progressive shift towards the incorporation of Western medical innovations, particularly in the vaccine approach to treat diseases like smallpox. This transition not only marked a critical evolution in the local healthcare approach but also set the stage for more systematic medical advancements in Vietnam during the colonial period (1884–1945).

Evolution of heart transplant donor characteristics in the 21st century: A United States single center's experience.

Despite a record setting number of heart transplants performed annually, the national donor shortage continues to plague transplant teams across the United States. Here we describe the barriers to adaptation of numerous "non-traditional" orthotopic heart transplant donor characteristics including donors with hepatitis C virus, those meeting criteria for donation after cardiac death, donors with coronavirus disease 19 infection, donors with the human immunodeficiency virus, and grafts with left ventricular systolic dysfunction. Our center's objective was to increase our transplant volume by expanding our donor pool from "traditional" donors to these "non-traditional" donors. We detail how medical advances such as certain laboratory studies, pharmacologic interventions, and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.

Педиатрическая рентгенография: проблемы и решения

Background: Because of children's distinct physiological and anatomical features, pediatric radiography necessitates particular techniques. Recent advances in medical physics have considerably improved the accuracy and safety of pediatric radiological procedures. However, these developments bring new obstacles. Objective: This article evaluates the most recent advances in medical physics relevant to pediatric radiography, highlights the accompanying problems, and provides feasible solutions to improve clinical results and patient safety. Methods: A thorough literature analysis focused on current research and technology advancements in pediatric radiology. The main advances in imaging technology, radiation dose control, and diagnostic accuracy were examined. Expert comments and case studies were also analyzed for common issues and solutions. Results: Low-dose imaging methods, such as digital radiography, pediatric-specific computed tomography (CT), and magnetic resonance imaging (MRI), have advanced significantly. These enhancements have resulted in better image quality and lower radiation exposure. However, patient size heterogeneity, motion artifacts, and the necessity for age-specific procedures remain common. Conclusion: Medical physics advancements have significantly enhanced pediatric radiology, allowing for higher diagnostic capabilities while reducing hazards. To address the remaining difficulties, radiologists must continue research, adopt standardized methods, and get continual education. Future advances should focus on lowering radiation exposure and enhancing imaging technologies' flexibility to meet pediatric patients' demands.

Based on Medicine, The Now and Future of Large Language Models.

This review explores the potential applications of large language models (LLMs) such as ChatGPT, GPT-3.5, and GPT-4 in the medical field, aiming to encourage their prudent use, provide professional support, and develop accessible medical AI tools that adhere to healthcare standards. This paper examines the impact of technologies such as OpenAI's Generative Pre-trained Transformers (GPT) series, including GPT-3.5 and GPT-4, and other large language models (LLMs) in medical education, scientific research, clinical practice, and nursing. Specifically, it includes supporting curriculum design, acting as personalized learning assistants, creating standardized simulated patient scenarios in education; assisting with writing papers, data analysis, and optimizing experimental designs in scientific research; aiding in medical imaging analysis, decision-making, patient education, and communication in clinical practice; and reducing repetitive tasks, promoting personalized care and self-care, providing psychological support, and enhancing management efficiency in nursing. LLMs, including ChatGPT, have demonstrated significant potential and effectiveness in the aforementioned areas, yet their deployment in healthcare settings is fraught with ethical complexities, potential lack of empathy, and risks of biased responses. Despite these challenges, significant medical advancements can be expected through the proper use of LLMs and appropriate policy guidance. Future research should focus on overcoming these barriers to ensure the effective and ethical application of LLMs in the medical field.

The Impact of the COVID-19 Pandemic on Aesthetic Procedures

Throughout human history, the appearance of the body has affected the way people perceive themselves and the way they are perceived. Consequently, people have developed ways of changing it to conform to societal standards of beauty. Medical advancements and progress in aesthetic medicine have made beauty more accessible. In modern society, people increasingly think of the body as a “project and process,” making it a long-term investment in social status. Various studies on the relationship between individuals’ personal social status and external appearance have shown the two to be tightly interconnected. The outbreak of the worldwide COVID-19 pandemic triggered the widespread use of online meeting platforms, e.g., Zoom, Skype, Teams, etc. This has brought about the “Zoom effect,” individuals’ stronger awareness of their looks, which has raised more interest in aesthetic treatments. Researchers emphasize the positive effect of aesthetic treatments in lifting moods and improving depression. This paper discusses socially-motivated behavior and the effect of individuals’ external appearance on their social status.

Traditional Cancer Treatments in West Africa: Historical Practices, Current Approaches, and Future Directions

Cancer treatment in West Africa is shaped by a rich tapestry of traditional practices and modern approaches, reflecting both cultural heritage and contemporary medical advancements. This review explores the historical and current landscape of traditional cancer treatments in the region, emphasizing herbal remedies, spiritual practices, and the integration of traditional and modern medical approaches. Traditional cancer treatments often involve plant-based remedies such as African horned cucumber, baobab tree, and soursop, known for their antioxidant, anti-inflammatory, and potential anti-cancer properties. Spiritual and ritualistic practices, including prayer, energy healing, and sacred rituals, offer holistic support, addressing the psychological and emotional aspects of illness. The review examines the integration of traditional and modern practices, highlighting the potential benefits of a collaborative approach while addressing challenges such as safety, efficacy, and cultural sensitivity. Research efforts are focused on validating traditional treatments through scientific studies, standardizing remedies, and ensuring safety. Socioeconomic and cultural factors significantly influence treatment choices, with traditional medicine often serving as a more accessible and culturally resonant option for many patients. Case studies and community experiences provide valuable insights into the practical application of these treatments and underscore the importance of respecting cultural contexts. This review aims to provide a comprehensive understanding of traditional cancer treatments in West Africa, offering recommendations for future research and practice to enhance cancer care through an integrative and culturally sensitive approach. Keywords: Traditional Cancer Treatments, West Africa: Historical Practices.

Development of Tissue-Engineered Model of Fibrotic Scarring after Spinal Cord Injury to Study Astrocyte Activation and Neurite Outgrowth In Vitro.

Traumatic spinal cord injuries (SCI) are debilitating injuries affecting twenty-seven million people worldwide and cause functional impairments. Despite decades of research and medical advancements, current treatment options for SCI remain limited, in part due to the complex pathophysiology of spinal cord lesions including cellular transformation and extracellular matrix (ECM) remodeling. Recent studies have increased focus on fibrotic scarring after SCI, and yet much remains unclear about the impact of fibrotic scarring on SCI lesion progression. Here, using collagen and decellularized spinal cord-based composite hydrogels, a three-dimensional (3D) cell culture model mimicking the fibrous core of spinal cord lesions was implemented to investigate its influence on the surrounding astrocytes. To mimic the fibrotic milieu, collagen fibril thickness was tuned using previously established temperature-controlled casting methods. In our platforms, astrocytes in fibro-mimetic hydrogels exhibited increased levels of activation markers such as glial fibrillary acidic protein and N-cadherin. Furthermore, astrocytes in fibro-mimetic hydrogels deposited more fibronectin and laminin, further hinting that astrocytes may also contribute to fibrotic scarring. These markers were decreased when Rho-ROCK and integrin β1 were inhibited via pharmacological inhibitors. Mechanistic analysis of Yes-associated protein reveals that blocking integrin β1 prevents mechanosensing of astrocytes, contributing to altered phenotypes in variable culture conditions. In the presence of these inhibitors, astrocytes increased the secretion of brain-derived neurotrophic factor, and a greater degree of dorsal root ganglia neurite infiltration into the underlying hydrogels was observed. Altogether, this study presents a novel tissue-engineered platform to study fibrotic scarring after SCI and may be a useful platform to advance our understanding of SCI lesion aggravation.

Regulating advanced biomedical technologies: A modern criminal law perspective

This study explores the urgent need for criminal law to address the advancements in biomedical technologies, particularly focusing on cloning. It highlights the dichotomy between the potential therapeutic benefits of cloning technologies, such as combating hereditary diseases, and their possible misuse. The paper discusses international legal frameworks and declarations, such as the United Nations Declaration on Human Cloning and the Council of Europe Convention on Human Rights and Biomedicine, which seek to navigate the ethical and legal challenges of cloning. The distinction between therapeutic and reproductive cloning is emphasized, with therapeutic cloning offering significant medical advancements raising profound ethical concerns, particularly regarding the moral status of the embryo. The paper critiques the current legislative landscape in the Republic of Armenia, which it finds insufficient in addressing the complexities introduced by these technologies, suggesting a need for comprehensive legal reform to safeguard human dignity and genetic integrity within the context of modern medicine.

Green synthesis of multifunctional bamboo-based nonwoven fabrics for medical treatment

Medical nonwovens fabrics are pivotal materials in modern healthcare systems, and find extensively application in surgical gowns, masks, nursing pads, and surgical instrument packaging. As healthcare requirements evolve and medical technology advances, the demand for functional nonwoven medical devices is continuously increasing. In addition, numerous environmental challenges and the need to transition to a sustainable society have increased the popularity of studies on environmentally friendly multifunctional nonwoven materials prepared from biomass fibers. Therefore, in this study, ecofriendly bamboo fibers were used to fabricate multifunctional medical nonwoven materials with superhydrophobic, antibacterial, flame-retardant, and biocompatible properties. Specifically, ZIF-67 was grown in situ on natural bamboo cellulose fibers (BCFs) extracted from natural bamboo and coated with polydimethylsiloxane to construct an environmentally friendly and versatile nonwoven fabric. The treated nonwoven fabric exhibited superhydrophobicity with contact angle of 163° and possess excellent self-cleaning properties. The antibacterial activity of the samples was investigated by the plate-counting method; the results showed that the untreated BCFs did not exhibit antibacterial activity, whereas the treated bamboo nonwoven fabrics demonstrated significant antibacterial activity (p < 0.001), with an antibacterial rate of >99 % against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, and Candida albicans. In addition, when the samples were exposed to different temperatures (−4 and 50 °C) and humidities (0 % and 95 %), they demonstrated an antibacterial activity of >99 % against E. coli (F5,10 = 0.602; p = 0.670) and S. aureus (F4,10 = 0.289; p = 0.879). The heat release rate and smoke production rate of the nonwoven fabric decreased by 54.64 % and 93.18 %, respectively, compared to those of the BCFs, indicating excellent flame retardancy. The nonwoven fabric also exhibited satisfactory biocompatibility and breathability, ensuring user comfortability. This research not only has significant implications for producing low-cost, environmentally friendly, sustainable, and multifunctional medical products and openi up new pathways for the diversified utilization of bamboo, thereby expanding its applicability.

Essential Package of Palliative Care for Iranian Children with Cancer

Background: Despite medical advancements and treatment development, children with cancer experience a wide range of symptoms related to the disease and treatment side effects. Providing palliative care is essential to improve the quality of life for both the child and the family. Given limited available resources, cost-effective service packages can address this need. Objectives: This study aimed to develop an essential palliative care package for children with cancer in Iran. Methods: The study was under Health System Research and employed an exploratory mixed method design in three phases. The initial stage involved two sub-studies including a review of literature and a qualitative study. In the subsequent phases, the package draft was compiled and validated using the Delphi technique with input from 12 experts. Results: The essential palliative care package for children with cancer comprised two main components: INPUT, including dimensions related to medicine, human resources, equipment, and service delivery setting. INTERVENTION, encompasses physical, psychological, social, spiritual symptom management, and growth and development. Conclusions: Customized for Iran's social and cultural context, this essential service package provides safe, efficient, convenient, and affordable care. Physicians and nurses with primary training can integrate it into primary care including home care, emphasizing the importance of palliative care.

Assessment of patients' baseline cystic fibrosis knowledge levels following translation and adaptation of the CF R.I.S.E translation program into Turkish.

Cystic fibrosis (CF) patients have a limited life expectancy, but significant medical advances now highlight the need for successful transition programs from pediatric to adult care. The goal of this project was to introduce the transition program CF R.I.S.E (Responsibility. Independence. Self-care. Education.) to a CF center with limited resources at Marmara University (MU). The program was adapted and translated into Turkish with the CF Foundation's permission. A team of experts collaborated to develop educational materials for patients and families. After translation and implementation of the CF S.O.B.E program, 11 Knowledge Assessment Questionnaire (KQA) tests were administered online to the patients aged between 16 and 25 years to assess the lack of patient knowledge. The CF R.I.S.E program was successfully implemented within 6 months. A pilot study showed positive feedback from randomly selected patients, indicating the program's effectiveness and understandability. The mean age of the patients was 19.4 ± 2.9 years, and 42 (52%) were female. The mean forced expiratory volume (FEV1pp) was 76.3 ± 23.2. Fourteen (17.3%) and 4 (4.9%) of the patients colonized with Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA), respectively. Fifteen (18.5%) were on modulator therapy. Eleven Knowledge Assessment Questionnaires (KAQ) surveys were administered to 81 patients. The percentage of correct responses to the KAQs ranged from 47.9% to 68.3%. MU CF Center in Turkey implemented the CF S.O.B.E (Responsibility, Self-care, Independence, and Education in Turkish) program. The center aims to make the program a regular practice and expand collaboration with adult clinics. Future studies will assess its long-term impact and applicability in different health settings. The final goal is to disseminate the program's resources and promote structured transition practices across the country.

The History of the Cesarean Section

This paper outlines the evolution of the Cesarean section (C-section) from its origin in the 1500s to the present day. It explores how this procedure has significantly changed over time, starting as a rare operation only given to dying mothers as a means to help save their unborn child to becoming a typical part of childbirth today. This review covers the historical developments, including early surgeries, the influences of religion in surgical practices, and medical advances such as anesthetics and better surgical techniques and tools.

Federated unsupervised random forest for privacy-preserving patient stratification.

In the realm of precision medicine, effective patient stratification and disease subtyping demand innovative methodologies tailored for multi-omics data. Clustering techniques applied to multi-omics data have become instrumental in identifying distinct subgroups of patients, enabling a finer-grained understanding of disease variability. Meanwhile, clinical datasets are often small and must be aggregated from multiple hospitals. Online data sharing, however, is seen as a significant challenge due to privacy concerns, potentially impeding big data's role in medical advancements using machine learning. This work establishes a powerful framework for advancing precision medicine through unsupervised random forest-based clustering in combination with federated computing. We introduce a novel multi-omics clustering approach utilizing unsupervised random forests. The unsupervised nature of the random forest enables the determination of cluster-specific feature importance, unraveling key molecular contributors to distinct patient groups. Our methodology is designed for federated execution, a crucial aspect in the medical domain where privacy concerns are paramount. We have validated our approach on machine learning benchmark datasets as well as on cancer data from The Cancer Genome Atlas. Our method is competitive with the state-of-the-art in terms of disease subtyping, but at the same time substantially improves the cluster interpretability. Experiments indicate that local clustering performance can be improved through federated computing. The proposed methods are available as an R-package (https://github.com/pievos101/uRF).

Characteristics and Impact of Randomized Trials on Drugs or Devices in Cardiovascular Medicine.

Clinical trials, essential for medical advancement, vary significantly in methodology and regulatory pathways depending on the type of therapeutic intervention (i.e., drugs or devices). This study aimed to determine whether the drug or device intervention types influence the impact of randomized trials in cardiovascular medicine. We analyzed late-breaking randomized controlled trials presented at major cardiology conferences from 2015 to 2021. The primary endpoint was the total number of citations obtained. Secondary endpoints included the number of citations at 1 and 2 years, number of total and 1-year mentions, and several metrics of study conduct and publication. Statistical analysis included tests for comparisons of continuous or categorical variables, based on their distribution, as appropriate. To adjust the results for potential confounders, univariable and multivariable regression models were utilized. Additionally, sensitivity analyses were conducted to explore both the effect of neutral or positive study outcomes on the comparative impact of drug versus device trials and the impact of the coronavirus disease 2019 (COVID-19) pandemic on the primary endpoint. Of 382 eligible randomized trials, 227 (59.4%) were trials of drugs and 155 (40.6%) were trials of devices. Drug trials had a higher median number of total citations compared to device studies (93 [interquartile range {IQR} 48-137] vs. 82 [IQR 39-192]; p = 0.025). This difference was consistent at 1 and 2 years and was also observed in the number of total mentions and mentions at 1 year. All the metrics of study conduct and publication were similar, except for drug studies being more often stopped prematurely (8.8 vs. 1.9%; p = 0.006). After adjusting for multiple potential confounders, the difference in citations and mentions was no longer statistically significant. However, drug trials remained more likely to be stopped prematurely (adjusted odds ratio = 1.15; 95% confidence interval 1.03-1.28; p = 0.009). Positive study outcomes significantly influenced the number of citations and the likelihood of a trial being stopped prematurely. Drug trials are often stopped early and receive more citations and mentions than device trials. However, these differences are mainly due to factors other than the treatment itself. Studies published simultaneously tend to get more attention, and drug trials with positive results are cited more often than those with neutral results.

Psychiatric disorders from EEG signals through deep learning models

Psychiatric disorders present diagnostic challenges due to individuals concealing their genuine emotions, and traditional methods relying on neurophysiological signals have limitations. Our study proposes an improved EEG-based diagnostic model employing Deep Learning (DL) techniques to address this. By experimenting with DL models on EEG data, we aimed to enhance psychiatric disorder diagnosis, offering promising implications for medical advancements. We utilized a dataset of 945 individuals, including 850 patients and 95 healthy subjects, focusing on six main and nine specific disorders. Quantitative EEG data were analyzed during resting states, featuring power spectral density (PSD) and functional connectivity (FC) across various frequency bands. Employing artificial neural networks (ANN), K nearest neighbors (KNN), Long short-term memory (LSTM), bidirectional Long short-term memory (Bi LSTM), and a hybrid CNN-LSTM model, we performed binary classification. Remarkably, all proposed models outperformed previous approaches, with the ANN achieving 96.83 % accuracy for obsessive-compulsive disorder using entire band features. CNN-LSTM attained the same accuracy for adjustment disorder, while KNN and LSTM achieved 98.94 % accuracy for acute stress disorder using specific feature sets. Notably, KNN and Bi-LSTM models reached 97.88 % accuracy for predicting obsessive-compulsive disorder. These findings underscore the potential of EEG as a cost-effective and accessible diagnostic tool for psychiatric disorders, complementing traditional methods like MRI. Our study's advanced DL models show promise in enhancing psychiatric disorder detection and monitoring, with significant implications for clinical application, inspiring hope for improved patient care and outcomes. The potential of EEG as a diagnostic tool for psychiatric disorders is substantial, as it can lead to improved patient care and outcomes in the field of psychiatry.

Post-operative Crohn's Disease Recurrence and Infectious Complications: A Transcriptomic Analysis.

Crohn's disease (CD) is a chronic inflammatory condition affecting the gastrointestinal tract, characterized by complications such as strictures, fistulas, and neoplasia. Despite medical advancements, a significant number of patients with Crohn's disease require surgery, and many experience post-operative complications and recurrence. Previous studies have analyzed gene expression to study recurrence and post-operative complications independently. This study aims to identify overlapping differentially expressed genes and pathways for recurrence and post-operative complications. A dataset including 45 patients with Crohn's disease, including gene expression from ileum and colon tissue, endoscopic recurrence, and intra-abdominal septic complications was analyzed. Gene set enrichment analysis was used to identify gene pathways associated with the outcomes. Finally, a multi-variable logistic regression model was created to assess whether gene pathways were independently associated with both outcomes. In ileum tissue, several inflammatory pathways, including interferon alpha and gamma response were upregulated in patients with endoscopic recurrence and intra-abdominal septic complications. In addition, there was upregulation of the epithelial mesenchymal transition pathway. In colon tissue, metabolic processes, such as myogenesis and oxidative phosphorylation were downregulated in both outcomes. In a multivariate model, downregulation of myogenesis in colon tissue was significantly associated with both endoscopic recurrence and intra-abdominal septic complications. These findings shed light on the underlying biology of these outcomes and suggest potential biomarkers or therapeutic targets to reduce their occurrence. Further validation and multi-institutional studies are warranted to confirm these results and improve post-operative outcomes for patients with Crohn's disease.

Per- and polyfluoroalkyl substances (PFAS) and hypertensive disorders of Pregnancy- integration of epidemiological and mechanistic evidence

BackgroundHypertensive disorders of pregnancy (HDP) remain a significant global health burden despite medical advancements. HDP prevalence appears to be rising, leading to increased maternal and fetal complications, mortality, and substantial healthcare costs. The etiology of HDP are complex and multifaceted, influenced by factors like nutrition, obesity, stress, metabolic disorders, and genetics. Emerging evidence suggests environmental pollutants, particularly Per- and polyfluoroalkyl substances (PFAS), may contribute to HDP development. ObjectiveThis review integrates epidemiological and mechanistic data to explore the intricate relationship between PFAS exposure and HDP. Epidemiological evidenceStudies show varying degrees of association between PFAS exposure and HDP, with some demonstrating positive correlations, particularly with preeclampsia. Meta-analyses suggest potential fetal sex-specific differences in these associations. Mechanistic insightsMechanistically, PFAS exposure appears to disrupt vascular hemodynamics, placental development, and critical processes like angiogenesis and sex steroid regulation. Experimental studies reveal alterations in the renin-angiotensin system, trophoblast invasion, oxidative stress, inflammation, and hormonal dysregulation – all of which contribute to HDP pathogenesis. Elucidating these mechanisms is crucial for developing preventive strategies. Therapeutic potentialTargeted interventions such as AT2R agonists, caspase inhibitors, and modulation of specific microRNAs show promise in mitigating adverse outcomes associated with PFAS exposure during pregnancy. Knowledge gaps and future directionsFurther research is needed to comprehensively understand the full spectrum of PFAS-induced placental alterations and their long-term implications for maternal and fetal health. This knowledge will be instrumental in developing effective preventive and therapeutic strategies for HDP in a changing environmental landscape.

Bioethics in Sport

Whether recreational or professional, sport is an integral part of human life, so its daily impact on society is undeniable. It is, therefore, important to recognise the role of moral values and ethics in sport, which can help to ensure fairness and preserve the integrity of professional sports. In recent years, there has been a growing awareness of the importance of implementing these values in professional sport, as it is crucial to enable physical performance without compromising the very essence of sport. However, using prohibited substances and methods in professional sports today has become an increasingly worrying ethical issue, particularly in sports medicine. The primary aim of sports science, especially sports physiology, is to help athletes improve their performance and prevent and overcome injuries, while the primary goal of sports management and some athletes is often to win, which can lead to unethical means to achieve this goal. This behaviour raises many ethical doubts and highlights the need for a framework to address these contemporary challenges increasingly facing professional sport today. Bioethics can effectively address these challenges by examining medical and scientific advances’ ethical, social, moral, and legal implications. By considering the values, principles, and norms underlying medical and scientific practices, bioethics in the context of sport can provide guidance and recommendations for bioethical decision-making concerning (bio)ethical doubts or controversies that may arise, such as the use of performance-enhancing drugs, non-therapeutic use of gene therapy and ethical considerations related to using new technologies. This paper, therefore, aims to emphasise the importance of bioethics as a bridging science in sport in the context of the (bio)ethical challenges that increasingly characterise the professional practice of sport today.

Regenerative Retinal Laser and Light Therapies (RELITE): Proposal of a New Nomenclature, Categorization, and Trial Reporting Standard.

Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements. A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns. The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose "regenerative retinal laser and light therapies (RELITE)" as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT). Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability: Pattern-Dosimetry-Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength-Subcategory-Category. Regenerative retinal laser and light therapies are widely used for different diseases and may become valuable in the future. A precise nomenclature system and strict reporting standards are needed to allow for a better understanding, reproduceable and comparable clinical trials, and overall acceptance. We defined categories for a systematic therapeutic goal-based nomenclature to facilitate future research in this field.

Aging In The Face of Diabetes: Severe Hypoglycemia in Older Adults

Global rates of type 1 and type 2 diabetes (T1D, T2D) continue to climb, despite medical advancements. Older adults constitute one of the fastest growing segments of the diabetes population, backed by the world’s unprecedented aging population, decreased diabetes mortality rates, and the obesity epidemic. In Canada, individuals aged ≥65 years account for more than a quarter of all prevalent diabetes cases, far exceeding the other age groups. Older adults with diabetes face the highest risks of microvascular and macrovascular complications, which, compared to younger age cohorts, can contribute to significant functional loss, frailty, and premature mortality. A considerable amount of research links intensive glucose-lowering with insulin or secretagogues to reduced cardiovascular disease. However, the consequent risk of severe hypoglycemia and related sequelae can be particularly catastrophic for older adults, exacerbated by coexisting health conditions and age-related social needs. Approximately 40% of Canadians with T2D aged ≥65 years currently use secretagogues, while 27% use insulin—alongside all those with T1D. Longitudinal evidence suggests that since the year 2000, hospital admission rates for hypoglycemia have consistently surpassed those for hyperglycemia, especially among individuals aged 75 years and above. Economic modelling estimates that the Canadian healthcare system spends $125,932 CAD per year on iatrogenic hypoglycemia, with the bulk of these costs likely allocated to people ≥65 years. Diabetes in older adults is a pressing public health issue in Canada, marked by clinical diversity and widespread use of medications that are prone to cause hypoglycemia. This review outlines recent epidemiologic findings on severe hypoglycemia among community-dwelling older adults with T1D or T2D treated with insulin or secretagogues. Understanding the complex factors contributing to severe hypoglycemia in this population is crucial for developing tailored prevention strategies that are both effective and safe.