Health Technology Research Articles

A Systematic Literature Review of Modelling Approaches to Evaluate the Cost Effectiveness of PET/CT for Therapy Response Monitoring in Oncology.

This systematic literature review addresses model-based cost-effectiveness studies for therapy response monitoring with positron emission tomography (PET) generally combined with low-dose computed tomography (CT) for various cancer types. Given the known heterogeneity in therapy response events, studies should consider patient-level modelling rather than cohort-based modelling because of its flexibility in handling these events and the time to events. This review aims to identify the modelling methods used and includes a systematic assessment of the assumptions made in the current literature. This study was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Information sources included electronic bibliographic databases, reference lists of review articles and contact with experts in the fields of nuclear medicine, health technology assessment and health economics. Eligibility criteria included peer-reviewed scientific publications and published grey literature. Literature searches, screening and critical appraisal were conducted by two reviewers independently. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to assess the methodological quality. The Bias in Economic Evaluation (ECOBIAS) checklist was used to determine the risk of bias in the included publications. The search results included 2959 publications. The number of publications included for data extraction and synthesis was ten, representing eight unique studies. These studies addressed patients with lymphoma, advanced head and neck cancers, brain tumours, non-small cell lung cancer and cervical cancer. All studies addressed response to chemotherapy. No study evaluated response to immunotherapy. Most studies positioned PET/CT as an add-on modality and one study positioned PET/CT as a replacement for conventional imaging (X-ray and contrast-enhanced CT). Three studies reported decision-tree structures, four studies reported cohort-level state-transition models and one study reported a partitioned survival model. No patient-level models were reported. The simulation horizons adopted ranged from 1 year to lifetime. Most studies reported a probabilistic analysis, whereas two studies reported a deterministic analysis only. Two studies conducted a value of information analysis. Multiple studies did not adequately discuss model-specific aspects of bias. Most importantly and regularly observed were a high risk of structural assumptions bias, limited simulation horizon bias and wrong model bias. Model-based cost-effectiveness analysis for therapy response monitoring with PET/CT was based on cohorts of patients instead of individual patients in the current literature. Therefore, the heterogeneity in therapy response events was commonly not addressed appropriately. Further research should include more advanced and patient-level modelling approaches to accurately represent the complex context of clinical practice and, therefore, to be meaningful to support decision making. This review is registered in PROSPERO, the international prospective register of systematic reviews funded by the National Institute for Health Research, with CRD42023402581.

Ultraflexible Vertical Corbino Organic Electrochemical Transistors for Epidermal Signal Monitoring.

Skin-conformal organic electrochemical transistors (OECTs) have attracted significant attention for real-time physiological signal monitoring and are vital for health diagnostics and treatments. However, mechanical harmonization amid the inherent dynamic nature of the skin surface and the acquisition of intrinsic physiological signals are significant challenges that hinder the integration of the ultimate skin interface. Thus, this study proposes a novel 4-terminal (4-T) vertical Corbino OECT, exhibiting high transconductance (>400 mS) and offering remarkable resilience and operational stability at an extremely low voltage of 10mV (1.9% of minimal current change after 104 biasing cycles and endurance up to 103 cycles of repetitive deformation with a 5µm bending radius). Consequently, ultralow-power, motion-resistant epidermal electrocardiogram, electromyogram, and electrooculogram sensors are developed with an exceptional signal-to-noise ratio of 40.1dB. The results of this study present a significant stride in non-invasive, skin-interfaced health-monitoring technologies and herald a new era in integrative health technologies.

Synthesis and Characterization of Carbonaceous Materials for Medical Applications: A Comprehensive Review

Carbonaceous materials have gained significant attention in recent years for their various applications in the field of medicine and biotechnology. This comprehensive review explores the synthesis and characterization of carbon-based materials and their potentials in various medical applications. The paper delves into the methods of fabrication of carbon-based nanoparticles, such as carbon nanotubes, biochar, and graphene, while highlighting their unique properties. Characterization techniques, such as microscopy, spectroscopy, and surface analysis, are discussed to provide insights into the chemical and structural properties of these materials. Furthermore, the review examined their wide-ranging medical applications, encompassing tissue engineering, drug delivery, biosensing, and imaging, showcasing the versatility and promising contributions of carbonaceous materials in the healthcare industry. The review outlines the current challenges and prospects in the field, emphasizing the growing significance of carbon-based materials as valuable tools in advancing medical science and technology, as well as public health.

Verbal feedback for written assessment: evaluating a novel feedback communication strategy

Background/Aims Feedback plays a pivotal role in learning, but traditional written feedback often lack engagement and specificity, hindering learners' ability to effectively apply feedback. In midwifery education, the need for innovative feedback delivery mechanisms is pronounced. The aim of this study was to evaluate the integration of digital health technologies in feedback delivery in a midwifery programme. Methods A novel communication strategy was implemented in a midwifery programme in northwest England, where the benefits, challenges and future implications of leveraging digital health technologies for assessment feedback were assessed. Results Preferences were mixed, with 45.1% of learners favouring written feedback. Verbal feedback was perceived as more personal and motivating, and valued for its nuance, tone and ability to clarify complex points, although written feedback provided clearer, detailed information for future reference. Less experienced markers struggled with verbal feedback, while more experienced markers appreciated the quicker, more refreshing process. All markers found feedback templates helpful for ensuring equitable feedback. Conclusions This study scrutinised the significance of rethinking feedback delivery in midwifery education and indicates that digital health technologies present promising opportunities for reshaping the feedback landscape. Implications for practice Developing student confidence and competence in digital literacy remains a significant challenge. Higher education institutions can collaborate with healthcare providers to offer training in digital health technologies, helping midwives adapt to modern clinical environments.

Health Technology Assessment of Nailfold Capillaroscopy and Digital Retina Imaging in Diabetes Screening

AimThis study aims to identify the criteria for the evaluation of medical technologies in diabetes screening and then perform health technology assessment (HTA) for two technologies: digital retina imaging (DRI) and Nailfold Capillaroscopy (NFC). MethodsA multicriteria decision-making tool measuring attractiveness using a categorical-based evaluation technique (MACBETH) was used to calculate and compare alternatives. A focus group of ten decision-makers with more than ten years of experience in health technology was used for the decision-making. The Delphi Method was used to get a consensus about comparing criteria and alternatives to these criteria. The sampling method used in the study was the nonprobability purposive sampling method. ResultsThe study concluded that clinical efficacy (0.42) is the most important criterion for evaluating medical technologies, followed by cost-effectiveness (0.27). At the same time, ethical considerations were found to be less important (0.03). The sensitivity analysis concluded that the decision is sensitive to clinical efficacy and cost-effectiveness changes. The study found that none of the alternatives dominates others as an option for early detection of diabetes through vascular changes. LimitationsThis study primarily uses systemic literature review methods to identify criteria for evaluating alternatives. There may be additional criteria for evaluation. ConclusionThis study provides an approach for a multicriteria comparison of medical devices. The study findings are useful for public health professionals and health policymakers. Plain Language SummaryThis study assesses nailfold capillaroscopy (NFC) as a substitute for digital retina imaging (DRI) in diabetes screening using the MACBETH multicriteria decision-making tool. The research identifies five key evaluation criteria: clinical efficacy, cost-effectiveness, patient needs, user safety, and ethical considerations. A focus group of experienced health technology decision-makers was used to compare NFC and DRI. Results indicate that clinical efficacy and cost-effectiveness are the most critical factors, with NFC showing potential but not significantly outperforming DRI. Sensitivity analyses highlight the need for further research to validate NFC as an effective diabetes screening tool.

055. The Comparative Efficacy Surgical Techniques of Transanal Endoscopic Microsurgery Versus Radical Resection for Early-Stage Rectal Cancer: A Systematic Review And Meta-Analysis

Background: Colorectal cancer ranks third in incidence and second in mortality among all tumours. Radical surgery has been the conventional treatment for early-stage rectal cancer. Advancements in medical technology have established Transanal Endoscopic Microsurgery (TEM.) as a viable minimally invasive surgical treatment for early-stage cancer. Nonetheless, there is still ambiguity regarding the selection of surgical methods for individuals with early-stage rectal carcinoma. This meta-analysis aims to compare the outcomes of two surgical techniques. Methods: We searched PubMed, Web of Science, and the Cochrane Library to discover research and trials published from 2010 up to 2023. We utilised Revman 5.4.2 to do the meta-analysis. Results: Five studies were considered, comprising 358 patients, including transanal endoscopic microsurgery and radical resection for early-stage rectal cancer. Our findings indicate that TEM surgical approach was significant in reducing intraoperative bleeding MD -131.18 95% CI [-205.79;-56.56] p=0.0006, operative time MD -82.37 95% CI [-97.59;-67,16] p< 0.00001. However, our result shows that TEM surgical increased hospital stay MD -2.50 95% CI [-10.94;-5.95] p< 0.56. We also found TEM surgery was associated with lowering the incidence of post-operative bleeding RR 0.32 95% CI [0.11,0.97] p =0.04 and permanent stoma RR 0.25 95% CI [0.07,0.83] p =0.02. Conclusion: This study demonstrated that TEM surgery was associated with reducing the incidence of intra-operative bleeding, operative time, post-operative bleeding and permanent stoma. Additional investigations are required to validate these findings.

Blue lasers using low-toxicity colloidal quantum dots.

Blue lasers play a pivotal role in laser-based display, printing, manufacturing, data recording and medical technologies. Colloidal quantum dots (QDs) are solution-grown materials with strong, tunable emission covering the whole visible spectrum, but the development of QD lasers has largely relied on Cd-containing red-emitting QDs, with technologically viable blue QD lasers remaining out of reach. Here we report on the realization of tunable and robust lasing using low-toxicity blue-emitting ZnSe-ZnS core-shell QDs that are compact in size yet still feature suppressed Auger recombination and long optical gain lifetime approaching 1 ns. These characteristics allow us to handle the blue QDs like laser dyes for liquid-state amplified spontaneous emission and lasing. The blue QD laser is operated under quasi-continuous-wave excitation by solid-state nanosecond lasers. A Littrow-configuration cavity enables narrow linewidth (<0.2 nm), wavelength-tunable, coherent and stable laser outputs without circulating the solution. These results indicate the promise of ZnSe-ZnS QDs to fill the 'blue gap' of QD lasers and to replace less stable blue laser dyes for a multitude of applications.

Comparing scissors and scalpels to a novel surgical instrument: a biomechanical sectioning study

BackgroundThis study introduces a novel surgical instrument to reduce iatrogenic nerve injuries during procedures such as carpal tunnel and ulnar nerve decompression surgery. These injuries often result from direct damage to surrounding tissues by surgical instruments, whose designs have remained largely unchanged over the past decades. The novel device is a modified surgical forceps that has a deployable surgical scalpel that runs along a groove on the forceps. This design protects important anatomical structures while allowing fast dissection and cutting of fascial layers.MethodsThe process used to develop a novel instrument included computer-aided design (CAD) modeling, 3D printing for prototyping, and the fabrication of an aluminum prototype. Biomechanical testing was performed with the novel device, iris scissors, bandage scissors, and a scalpel on an MTS Static Materials Test System. The peak force to slide-cut, number of cut attempts, and percentage cut on first attempt were compared between the prototype and traditional surgical tools. The materials cut in testing were Ace™ bandage, stockinette, and gauze. Statistical analyses were performed using Welch’s t-tests and Fisher’s exact tests.ResultsCompared to conventional bandage and iris scissors, the novel surgical instrument required significantly less force to cut through an Ace™ bandage, stockinette, and gauze (p < 0.01). The number of cuts required to transect those same materials with the novel device was comparable to that of the scalpel and bandage scissors. Additionally, while there were no differences between the novel device and the other devices for an Ace™ bandage and stockinette, the novel device tended to cut a greater percentage of gauze in one pass than did the iris scissors.ConclusionThe novel surgical instrument designed in this study required less force compared to conventional scissors, demonstrated cutting efficiency similar to that of a scalpel blade, and had more safety features than either instrument. This study highlights the value of collaboration between biomedical engineering and orthopedic surgery departments on innovation in medical technology, through which new technologies with improved design and functionality demonstrate the potential to reduce iatrogenic injuries.

Evaluating progress towards implementation of the European HTA Regulation: Insights generated from the European Access Academy's multi-stakeholder survey

ObjectivesWe conducted a multi-stakeholder survey to assess stakeholders' perceptions of the progress made towards the implementation of the European Regulation on Health Technology Assessment (EU HTA R) and to identify and prioritize the remaining challenges for implementation. MethodsUsing two iterative Delphi cycles, an exploratory, semi-quantitative survey was developed to identify how stakeholders 1) experienced preparatory activities of the Regulation, and 2) prioritized remaining challenges for successful implementation. The survey was distributed among the network of the European Access Academy and via social media to ensure coverage of key stakeholders. Descriptive analyses were performed on quantitative response items, and relative importance was calculated for ranking items. Free-text responses supplemented participants' answers to quantitative questions. ResultsN = 61 responses were received from N = 15 countries including Global/ EU-wide institutions (Patients and Patients’ representatives: 7; Clinicians’ representatives: 5; Regulators: 3; Health Technology Developers (HTDs): 20; HTA bodies: 10; Payers: 7; Policy Makers: 2; Academic representatives: 7). The majority of respondents were aware of preparatory activities, with 74 % (N = 45) observing the drafting of Guidance Documents and 64 % (N = 39) noting the establishment of the Coordination Group. Respondents ranked the success of preparatory activities neutral with a slight tendency towards a positive ranking. Key challenges were Member States' readiness for Joint Clinical Assessments, HTA capacity/ capability constraints, and the applicability/ feasibility of the methodological framework. ConclusionsThis study identified the key remaining challenges for the successful establishment of the EU HTA process. Key findings emphasize the readiness of national systems and procedures as pivotal factors. Balancing operational efficiency with strategic objectives, including the development of a European Value Framework, is imperative for harnessing the full potential of the joint HTA process and enhancing patient access to innovative technologies on a pan-European scale. Public interest summaryIn January 2022, the European Union (EU) adopted the European Regulation on Health Technology Assessment (HTA). By harmonizing HTA practices and promoting collaboration across Member States, the joint procedure as set out in the regulation aims to improve efficient use of resources and ensure long-term sustainability of EU-wide HTA cooperation. Close to reaching the half-way mark of the preparation phase in mid-2023, we conducted a multi-stakeholder survey to assess perceptions of the progress made towards implementation of a joint procedure and to prioritize remaining challenges. The responses indicated a neutral to positive perception of the preparatory activities (i.e., establishing a coordination group and a stakeholder network, and creating guidance documents). Respondents prioritized challenges related to the readiness of Member States, limitations in HTA capacity and capability, and applicability of the assessment methods. Further research is needed to define targeted strategies for specific stakeholder groups to effectively address the identified challenges.

Effectiveness of Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM) -intervention on self-efficacy in weight management in pregnant women: a quasi-experimental trial

BackgroundHalf of women with overweight gain excessive weight during pregnancy. Perceived self-efficacy plays a significant role in adherence to healthy behaviours, especially in turning points of life, such as a pregnancy. ObjectivesTo assess the effectiveness of the Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM)-intervention in terms of improving self-efficacy in eating and physical activity and preventing excessive weight gain of pregnant women with overweight. The second aim was to evaluate the fidelity of the intervention implementation. MethodsPregnant women with overweight (N=54) attending maternity clinics in Southwest Finland between 2021 and 2023, were recruited using convenience sampling. The SLIM-intervention included: health technology, motivational interviewing, feedback, and goal setting. The intervention was implemented in prenatal visits in maternity clinics continuing to 12 weeks postpartum. The change in self-efficacy was measured with Weight Efficacy Life-Style Questionnaire (score 0–180) and Self-Efficacy for Physical Activity Scale (score 5–25) with repeated measures in three timepoints. Data on weight were collected from patient records. ResultsThe levels of self-efficacy were high throughout the study period and there were no significant changes in self-efficacy in eating (p=0.650) or physical activity (p=0.936). Most of the women (N=9/10), whose gestational weight gain was within recommendations or less, managed to lose weight during the postpartum period (p<0.001). ConclusionsAlthough the intervention was not effective in improving self-efficacy, the importance of recommended gestational weight gain on better postpartum weight management was highlighted. A long follow-up time was valuable for examination of changes over time and understanding trends, patterns, and outcomes of the study. RegistrationThe trial was registered at the Clinicaltrials.gov register platform (ID NCT04826861) on March 17th, 2021.

Remote Patient Monitoring Using Mobile Health Technology in Cancer Care and Research: Patients' Views and Preferences.

There is an increasing interest in studying the potential of mobile health (mHealth) technologies, such as smartphone apps and wearables, as monitoring tools for patients with cancer during or after their treatment. However, little research is dedicated to exploring the opinions and concerns of patients regarding the adoption of these technologies. This study aimed to gain insight into patients' perspectives and preferences for participating in mHealth-based monitoring in cancer care. A qualitative study comprising semistructured interviews was conducted in the Netherlands between April and June 2023. Participants were eligible if they were 18 years or older with a current or past diagnosis of cancer. The interview guide was developed on the basis of the technology acceptance model, with main themes being use, communication, trust, privacy, and expectations. Thirteen participants with urologic primary cancer were interviewed. Most patients had already some familiarity with the use of digital monitoring devices or wearables. Main barriers included persistent reminders of the illness, receiving notifications deemed unnecessary or unwanted, and the acknowledgment that mHealth technology does not serve as a substitute for human doctors. Conversely, patients recognized the potential for time-savings through the utilization of mHealth, viewed active monitoring as nonburdensome, considered mHealth a tool for reducing the communication threshold with their doctor, and expressed willingness to adopt such a platform if they perceived personal or societal relevance. This study has elucidated which factors are important for successful development of mHealth for patients with cancer. While both barriers and facilitators play a role, patients' attitudes were positive toward the implementation of remote digital monitoring, showing promising prospects for future research of mHealth in oncology.

Building robust, proportionate, and timely approaches to regulation and evaluation of digital mental health technologies.

Demand for mental health services exceeds available resources globally, and access to diagnosis and evidence-based treatment is affected by long delays. Digital mental health technologies present an opportunity to reimagine the delivery of mental health support by providing innovative, effective, and tailored approaches that meet people's individual preferences and goals. These technologies also present new challenges, however, and efforts must be made to ensure they are safe and effective. The UK Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence have launched a partnership, funded by Wellcome, that explores regulation and evaluation of digital mental health technologies. This Viewpoint describes a series of key challenges across the regulatory and health technology assessment pathways and aims to facilitate discussions to ensure that approaches to regulation and evaluation are informed by patients, the public, and professionals working within mental health. We invite partners from across the mental health community to engage with, collaborate with, and provide scrutiny of this project to ensure it delivers the best possible outcomes.

Using artificial intelligence to address mental health inequalities: co-creating machine learning algorithms with key stakeholders and citizen engagement

Purpose Artificial intelligence (AI) is poised to reshape mental health practices, policies and research in the coming decade. Simultaneously, mental health inequalities persist globally, imposing considerable costs on individuals, communities and economies. This study aims to investigate the impact of AI technologies on future citizenship for individuals with mental health challenges (MHCs). Design/methodology/approach This research used a community-based participatory approach, engaging peer researchers to explore the perspectives of adults with MHCs from a peer-led mental health organisation. This study evaluated potential threats and opportunities presented by AI technologies for future citizenship through a co-created film, depicting a news broadcast set in 2042. Data were gathered via semi-structured interviews and focus groups and were analysed using a reflexive thematic approach. Findings The analysis identified four key themes: Who holds the power? The divide, What it means to be human, and Having a voice. The findings indicate that adults with living experiences of MHCs are eager to influence the development of AI technologies that affect their lives. Participants emphasised the importance of activism and co-production while expressing concerns about further marginalisation. Originality/value This study provides new insights into the intersection of AI, technology and citizenship, highlighting the critical need for inclusive practices in technological advancement. By incorporating the perspectives of individuals with living experiences, this study advocates for participatory approaches in shaping AI technologies in mental health. This includes the co-creation of machine learning algorithms and fostering citizen engagement to ensure that advancements are equitable and empowering for people with MHCs.

A Framework for Multimodal Medical Image Interaction.

Medical doctors rely on images of the human anatomy, such as magnetic resonance imaging (MRI), to localize regions of interest in the patient during diagnosis and treatment. Despite advances in medical imaging technology, the information conveyance remains unimodal. This visual representation fails to capture the complexity of the real, multisensory interaction with human tissue. However, perceiving multimodal information about the patient's anatomy and disease in real-time is critical for the success of medical procedures and patient outcome. We introduce a Multimodal Medical Image Interaction (MMII) framework to allow medical experts a dynamic, audiovisual interaction with human tissue in three-dimensional space. In a virtual reality environment, the user receives physically informed audiovisual feedback to improve the spatial perception of anatomical structures. MMII uses a model-based sonification approach to generate sounds derived from the geometry and physical properties of tissue, thereby eliminating the need for hand-crafted sound design. Two user studies involving 34 general and nine clinical experts were conducted to evaluate the proposed interaction framework's learnability, usability, and accuracy. Our results showed excellent learnability of audiovisual correspondence as the rate of correct associations significantly improved (p < 0.001) over the course of the study. MMII resulted in superior brain tumor localization accuracy (p < 0.05) compared to conventional medical image interaction. Our findings substantiate the potential of this novel framework to enhance interaction with medical images, for example, during surgical procedures where immediate and precise feedback is needed.

AI based diagnostics product design for osteosarcoma cells microscopy imaging of bone cancer patients using CA-MobileNet V3

ObjectiveThe incidence of osteosarcoma (OS) is low, but primary malignant bone tumors rank third among the causes of death in cancer patients under the age of 20. Currently, analysis of cellular structure and tumor morphology through microscopic images remains one of the main diagnostic methods for osteosarcoma. However, this completely manual approach is tedious, time-consuming, and difficult to diagnose accurately due to the similarities in certain characteristics of malignant and benign tumors. MethodsLeveraging the potential of artificial intelligence (AI) in assessing and classifying images, this study explored a modified CA-MobileNet V3 model that was embedded into innovative microscope products to enhance the microscope’s feature extraction capabilities and help reduce misclassification during diagnosis. ResultsThe intelligent recognition model method introduced in this paper has significant advantages in retrieval and classification of osteosarcoma cells and other cell types. Compared with models such as ShuffleNet V2, EfficientNet V2, Mobilenet V3 (without transfer learning), TL-MobileNet V3 (with transfer learning), etc., the model size is only 5.33 MB, is a lightweight model, and the accuracy of the improved model reached 98.69 %. In addition, the artificial intelligence microscope (AIM) with integrated design based on this model can also help improve diagnostic efficiency. ConclusionThe innovative method of the CA-MobileNet V3 automatic classification model based on deep learning provides an efficient and reliable solution for the pathological diagnosis of osteosarcoma. This study contributes to medical image analysis and provides doctors with an accurate and valuable tool for microscopic diagnosis. It also promotes the advancement of artificial intelligence in medical imaging technology.

A novel adjunctive diagnostic method for bone cancer: Osteosarcoma cell segmentation based on Twin Swin Transformer with multi-scale feature fusion

BackgroundOsteosarcoma, the most common primary bone tumor originating from osteoblasts, poses a significant challenge in medical practice, particularly among adolescents. Conventional diagnostic methods heavily rely on manual analysis of magnetic resonance imaging (MRI) scans, which often fall short in providing accurate and timely diagnosis. This underscores the critical need for advancements in medical imaging technologies to improve the detection and characterization of osteosarcoma. MethodsIn this study, we sought to address the limitations of current diagnostic approaches by leveraging Hoechst-stained images of osteosarcoma cells obtained via fluorescence microscopy. Our primary objective was to enhance the segmentation of osteosarcoma cells, a crucial step in precise diagnosis and treatment planning. Recognizing the shortcomings of existing feature extraction networks in capturing detailed cellular structures, we propose a novel approach utilizing a twin swin transformer architecture for osteosarcoma cell segmentation, with a focus on multi-scale feature fusion. ResultsThe experimental findings demonstrate the effectiveness of the proposed Twin Swin Transformer with multi-scale feature fusion in significantly improving osteosarcoma cell segmentation. Compared to conventional techniques, our method achieves superior segmentation performance, highlighting its potential utility in clinical settings. ConclusionThe development of our Twin Swin Transformer with multi-scale feature fusion method represents a significant advancement in medical imaging technology, particularly in the field of osteosarcoma diagnosis. By harnessing advanced computational techniques and leveraging high-resolution imaging data, our approach offers enhanced accuracy and efficiency in osteosarcoma cell segmentation, ultimately facilitating better patient care and clinical decision-making.

CDC42 deficiency leads to endometrial stromal cell senescence in recurrent implantation failure.

Does the downregulation of cell division cycle 42 (CDC42) protein in endometrial stroma lead to endometrial senescence in patients with recurrent implantation failure (RIF), and what is the potential mechanism? CDC42 deficiency causes endometrial stromal senescence and decidualization defects, impairing uterine receptivity of RIF patients, via activation of Wnt signaling pathway. Uterine aging is unique due to the cyclic remodeling and decidualization of endometrial tissue. Several transcriptomic studies have reported increased senescence in the endometrium in young patients with RIF. Our previous transcriptomic sequencing study discovered that endometrium from women with RIF showed downregulation of CDC42, which is an essential molecule affected by various senescence-related diseases. The endometrial samples of a total of 71 fertile control patients and 37 RIF patients were collected to verify the association between CDC42 expression and endometrial senescence of RIF patients. Primary endometrial stromal cells (EnSCs) were isolated from endometrial biopsies taken from patients without any endometrial complications and planning to undergo IVF, then subjected to adenovirus-mediated CDC42 knockdown and decidualization induction to explore the detailed mechanism by which CDC42 governs stromal senescence and decidualization. Wnt inhibitor XAV-939 was used to correct the endometrial senescence and decidualization defect. Senescence was determined by cell cycle arrest markers (e.g. P16, P21, and P53), SASP molecules (e.g. IL6 and CXCL8), and SA-β-gal staining. Masson's staining and Sirius Red staining were used to detect the endometrial fibrosis. Decidualization was evaluated by the mRNA expression and protein secretion of PRL and IGFBP1, F-actin immunostaining, and the BeWo spheroids 'in vitro implantation' model. Methods used to assess cell function included adenovirus transduction, RNA-sequencing, bioinformatic analysis, western blotting, RT-qPCR, ELISA, and immunofluorescence. Here, we observed remarkably increased levels of stromal senescence and fibrosis, along with stromal CDC42 deficiency, in the endometrium of patients with RIF (P < 0.001). Knockdown of CDC42 effectively induced premature senescence in EnSCs, leading to aberrant accumulation of senescent EnSCs and collagen deposition during decidualization. CDC42 deficiency in EnSCs restrained the decidualization differentiation and receptivity to trophoblast cells. Transcriptomic analysis revealed Wnt signaling activation as a critical downstream alteration in CDC42-deficient EnSCs. Mechanistically, CDC42 interacted with AKT competitively to impede the binding of GSK3β to AKT. Knockdown of CDC42 increased AKT-mediated phosphorylation of GSK3β to inactivate the Axin-GSK3β destruction complex, leading to accumulation and nuclear translocation of β-catenin. Importantly, Wnt signaling inhibitors partially corrected the endometrial senescence caused by CDC42 deficiency, and improved both decidualization and trophoblast invasion. RNA-seq data sets generated in this study have been deposited at the NCBI database with BioProject accession number PRJNA1102745. The present study was based on in vitro cell cultures. Further studies involving CDC42-regulated endometrial senescence are needed in knockout mice model and human endometrial assembloids. In addition to uncovering endometrial senescence in RIF, our findings underscore the significance of CDC42 in modulating EnSC senescence to maintain the decidualization function, and suggest Wnt signaling inhibitors as potential therapeutic agents for alleviating endometrial senescence. This work was supported by the National Natural Science Foundation of China [82271698 (R.J.), 82030040 (H.S.), 82288102 (H.W.), and 82371680 (G.Y.)]; the Natural Science Foundation of Jiangsu Province [BK20231117 (R.J.)]; and the Medical Science and Technology Development Foundation of Nanjing Department of Health [YKK23097 (Y.Z.)]. The authors declare no potential conflicts of interest.

The Mobile lifestyle intervention for food and exercise (mLife) study: Protocol of a remote behavioral weight loss randomized clinical trial for type 2 diabetes prevention

BackgroundEmerging research has examined electronic and mobile health (e/mHealth) technologies for weight loss and manage of type 2 diabetes mellitus (T2DM), but few studies have focused specifically on ways to target social support behaviors that have proven to be effective. While gamifying an mHealth behavioral weight loss intervention holds promise to promote and sustain social support, there has been very little research in this area. The mobile Lifestyle Intervention for Food and Exercise study (mLife) was designed to test if receiving points for social support is an effective way to promote sustained weight loss. ObjectiveTo describe the design of the 12-month mLife study, a randomized clinical trial, which compares the differential long-term effect of a behavioral weight loss program with and without gamification among adults with overweight or obesity. MethodsParticipants (target N = 240) in two consecutive cohorts were randomized to either the mLife+points or mLife group. The weight loss intervention for both groups included diet and physical activity (PA) recommendations, education, daily diet logging, visualization of PA and body weight readings captured with a wearable tracker and e-scale, and facilitation of social interaction among participants. The mLife+points group earned points for social support activities. Remote follow-up assessments of weight, anthropometric measures, diet (24 h dietary recalls), PA, social support provision, receipt and enjoyment, factors driving self-monitoring adherence and study compliance/responsiveness occurred at 6 and 12-months post-baseline. ConclusionThe mLife study informs the expansion of gamification within mHealth programs to enhance social support provision and receipt during weight loss. Trial registrationThis study was registered on clintrials.gov on the 30th of October 2017, under the trial registration number: NCT05176847.

MOBILE HEALTH: ECG MONITORING FOR ATRIAL FIBRILLATION DETECTION

This systematic review examines the use of mobile health (mHealth) technologies, such as smartphone apps and wearable devices, for detecting atrial fibrillation (AF). The review includes studies assessing the quality and performance of mobile apps and smartwatch algorithms, as well as the clinical validity of ECG measurement and photoplethysmography technology. Findings suggest diverse results, with some studies indicating promising sensitivity and specificity for AF detection. However, there is a need for further research to develop reliable algorithms for diagnosing and managing cardiovascular conditions using mHealth technologies.

Nurse-Authored Patents and Their Influencing Factors Analysis Among Oncology Nurses Based on the Structural Equation Model.

This study analysed the status of nurse-authored patents and their influencing factors. In particular, this study examined the effects of nurses' innovative behaviour and creative self-efficacy on nurse-authored patent output via structural equation modelling (SEM). A descriptive cross-sectional study. Nurses were recruited from one tertiary cancer hospital in Beijing, China. Among them, 352 oncology nurses completed the online versions of the Nurse Innovative Behavior Scale and Creative Self-Efficacy Scale in 2023. We collected a total of 332 valid questionnaires. Fifty-seven (17.2%) nurses had 1-3 patents, and only 6 (1.8%) had more than three patents. The final model revealed a chain reaction between creative self-efficacy, innovation behaviour and nurse-authored patent output (χ2 = 11.962, df = 7, p = 0.102). Significant differences were observed in the number of nurse-authored patents and based on age, educational profile, professional title, length of service, position, participation in science and technology innovation training, and experience in project presentation (all p < 0.05). Nurses still play a minor role in the field of medical technology innovation. It is necessary to promote innovative behaviour among nurses and improve their creative self-efficacy in terms of innovation. Developing intervention strategies to encourage nurses to pursue clinical innovations is crucial for nursing managers and technological innovation promoters.