Medical Procedures Research Articles

Review Mechanisms for Advanced Medical Therapies in Japan and Thailand: A Proposal for the Use of Expert Clinical Benefit Assessments at Designated Institutions

AbstractAdvanced new therapies, such as stem cell and gene therapies and xenotransplantation, represent challenges for regulatory and ethical review. Major drug agencies, such as in the U.S., India, and Europe, have asserted regulatory authority and require ethics review by local ethics review committees, using the same strict requirements as those for standard drug approvals. In spite of this, unapproved and undocumented stem cell clinics flourish in all of these places, suggesting that current approaches do not offer patients sufficient protection. Japan has attempted another approach, requiring approvals at local levels for all regenerative medical procedures, and a faster approval of promising new interventions. The Japanese approach has, however, also been criticized as not striking a proper balance between early access and a proper assessment of safety and effectiveness. For smaller and less-resourced countries, such as Thailand, one major challenge is limited expertise to conduct the evaluation of these advanced new therapies. This article provides an overview of the issues facing regulators and proposes that countries should restrict the early adoption of advanced new therapies to specialized clinics with appropriate scientific and ethical expertise for review. Review in these institutions should focus on expert clinical benefit assessments for individual patients being offered such interventions, independently of whether they are offered as research or therapy.

Cyborg Children: A Systematic Literature Review on the Experience of Children Using Extended Reality.

This literature review presents a comprehensive and systematic account of research on the experiences of children with extended reality (XR), including VR, AR, and other types of immersive technologies that enhance and augment children's activities. The search on Scopus and Web of Science produced 531 outputs. Content analysis with inter-rater reliability (Krippendorff's α) and Leximancer, a software for text mining, were used for analyzing the material. Four research strands were identified: (1) interventions, treatments, and medical procedures in clinical contexts; (2) teaching and learning enhanced by XR; (3) children's adoption and user experiences; (4) design and prototyping of XR hardware and software for children. The results showed the following findings: (a) studies on children's clinical interventions and treatments using HMD-supported immersive virtual reality comprise the most substantial strand of studies; (b) research in this area, and in teaching and learning studies, has grown dramatically since 2017, while the other areas have been stagnant over the years; (c) AR research is still limited and is mainly applied in educational contexts for design and prototyping; (d) few studies have considered children's perspectives on XR safety issues; (e) research on the use of XR for enhancing social and emotional skills development is underrepresented. Future research should focus on the potential of XR technologies for interventions to enhance children's psychosocial wellbeing and health more broadly. The further implications and study limitations for the fast-developing nature of this transdisciplinary research field are also discussed.

Ethics of abortion in transplantation.

The controversial medical procedure of abortion is the subject of this article. It argues that for transplant patients, including recipients, abortion is ethical. In June 2022, the United States Supreme Court overturned the long-standing decision of Roe v. Wade. This decision has led to a socio-legal environment where obtaining an abortion is impossible for some patients. However, the moral position relating to patients who have undergone transplants or are on a waiting list has been largely overlooked. End-stage renal, liver, and heart disease presents a hazardous situation for pregnancy, posing risks to both the fetus and the pregnant person. The abortion procedure is medically safer and allows a patient to proceed with a transplant. Limiting access to abortion or preventing it altogether will have a significant negative impact on transplant patients. The ethical analysis of abortion can be likened to compelling a relative or loved one of a transplant recipient to donate an organ to their family member or loved one. This article emphasizes the importance of maintaining the legal availability of abortion for transplant patients. Allowing abortions in transplant patients upholds ethical parity, as seen in the analogous situation of live organ donation.

Immersive Virtual Reality for Pain and Anxiety Management Associated with Medical Procedures in Children and Adolescents: A Systematic Review.

(1) Objectives: The purpose of this study was to investigate the studies that evaluate the effectiveness of immersive virtual reality (VR) as a distraction technique for pain and anxiety associated with medical procedures in children and adolescents. (2) The methods involved a systematic review of randomized controlled trials retrieved from databases in health sciences (Pubmed, CINHAL, Scopus, WOS, ProQuest, Cuiden Plus, InDICEs-CSIC). PRISMA guidelines were followed. (3) Results: Twelve trials were included. Four involved venipuncture, four involved surgical procedures, one involved vaccination, one involved burn care, one involved secondary wound closure, and the last one involved subcutaneous port access. (4) Discussion: Children who undergo medical procedures often experience pain and anxiety, which affects their physical condition and their relationships with caregivers and health professionals. Immersive VR is an effective alternative to medications to help in these cases. No author found statistically significant differences against the use of VR for distraction and palliation of pain and anxiety, which seems to be more effective at a younger age. It is important to personalize the immersive VR experience and equipment. (5) Conclusions: VR, when used with analgesics and anesthetics, appears effective in managing pain and distress caused by medical procedures.

The Use of Photodynamic Therapy in the Treatment of Endometrial Cancer-A Review of the Literature.

Endometrial cancer is the most common malignant tumor of the female reproductive system. It develops in the mucous membrane lining the inside of the uterine body-the endometrium, through the abnormal and continuous growth of cancer cells originating from the uterine mucosa. In recent years, there has been a significant increase in the number of cases in European countries. Photodynamic therapy (PDT) is an innovative and dynamically developing medical procedure, useful in the treatment of cancer and non-cancer tissue conditions. The PDT reaction involves the activation of a photosensitizing substance with visible light, which in turn leads to the formation of free oxygen radicals, which contribute to the destruction of the cell. PDT is minimally invasive, has few side effects, and preserves organ anatomy and function. Both diagnostics and photodynamic therapy as modern methods of treatment are becoming more and more popular in many research units around the world. They are most often practiced and tested in in vitro experimental conditions. In clinical practice, the use of PDT is rare. Comprehensive cooperation between scientists contributes to taking steps towards obtaining new, synthetic photosensitizers, directing their physicochemical properties, and showing the impact on a given organism. This review examines the evidence for the potential and usefulness of PDT in the treatment of endometrial cancer. This review highlights that PDT is gaining popularity and is becoming a promising field of medical research.

To assess the attitudes of Irish patients attending a pigmented lesion clinic and healthcare staff employed in an academic hospital to biobanking, a quantitative study

AbstractBackgroundA Biobank is a collection of biospecimens or biological samples and corresponding patient data points which are used for the purposes of medical research. Patient participation and support is imperative to biobank research.ObjectivesWe aim to quantitatively assess the attitudes of Irish patients attending a pigmented lesion clinic (PLC) in an Irish dermatology centre and staff working at an academic teaching hospital, to biobanking.MethodsA questionnaire was distributed to Healthcare staff working in an Academic Hospital and members of the Irish Association of Dermatology via their hospital email address. Patients who attended PLC January–April 2023, and patients previously diagnosed with melanoma January 2019–January 2021 were asked to complete the questionnaire. Respondents from a market research company, Bounce insights, was sent a modified questionnaire via a survey.ResultsIn total there were 426 respondents of ages; 16–<18 years = 31 (7%), 18–35 years = 105 (25%), 36–65 years = 191 (45%) and >65 years = 99 (23%). There were 166 (39%) males and 260 (61%) females. Of the 426 total respondents there were 180 (42%) previous healthcare workers. The number of total participants who were aware of biobanks was 130 (31%), no = 283 (66%), not sure = 13 (3%). Over 20% (84) of participants had donated a biospecimen previously. Healthcare workers reported a positive response in 84% (102) but only 46% (72) of the Bounce marketing respondents felt similarly (p = <0.001). Over 60% of healthcare staff, 16% of all patients and 21% of the Bounce marketing group were aware of Biobanks. In total 83% (352) of all respondents were willing to donate a biospecimen following a medical procedure but 78% (331) were willing to donate an additional blood sample and that number fell to 57% (242) when asked if they would donate an additional tissue sample purely for the purposes of research. The number who would encourage a family member to donate a biospecimen was; yes = 241 (56.5%), no = 41 (9.6%) and not sure = 144 (34%). Interestingly age was related to individuals' initial impression of biobanks (X2 (6, N = 426) = 32, p = <0.001), to a willingness to donate a biospecimen (p = <0.039) and to a desire to be informed if their specimen was disposed of (p = <0.001).ConclusionsIn Ireland, the majority of patients, healthcare workers and other members of the public are willing to donate biospecimens for the purposes of research.

The Role of Epigenetic Mechanisms in the Pathogenesis of Hepatitis C Infection.

Hepatitis C virus (HCV) is a hepatotropic virus that can be transmitted through unsafe medical procedures, such as injections, transfusions, and dental treatment. The infection may be self-limiting or manifest as a chronic form that induces liver fibrosis, cirrhosis, or progression into hepatocellular carcinoma (HCC). Epigenetic mechanisms are major regulators of gene expression. These mechanisms involve DNA methylation, histone modifications, and the activity of non-coding RNAs, which can enhance or suppress gene expression. Abnormal activity or the dysregulated expression of epigenetic molecules plays an important role in the pathogenesis of various pathological disorders, including inflammatory diseases and malignancies. In this review, we summarise the current evidence on epigenetic mechanisms involved in HCV infection and progression to HCC.

Automatic Surgery in Transcatheter Aortic Valve Replacement Using Augmented Reality.

Augmented Reality (AR) is in high demand in medical applications. The aim of the paper is to provide automatic surgery using AR for the Transcatheter Aortic Valve Replacement (TAVR). TAVR is the alternate medical procedure for open-heart surgery. TAVR replaces the injured valve with the new one using a catheter. In the existing model, remote guidance is given, while the surgery is not automated based on AR. In this article, we deployed a spatially aligned camera that is connected to a motor for the automation of image capture in the surgical environment. The camera tracks the 2D high-resolution image of the patient's heart along with the catheter testbed. These captured images are uploaded using the mobile app to a remote surgeon who is a cardiology expert. This image is utilized for the 3D reconstruction from 2D image tracking. This is viewed in a HoloLens like an emulator in a laptop. The surgeon can remotely inspect the 3D reconstructed images with additional transformation features such as rotation and scaling. These transformation features are enabled through hand gestures. The surgeon's guidance is transmitted to the surgical environment to automate the process in real-time scenarios. The catheter testbed in the surgical field is controlled by the hand gesture guidance of the remote surgeon. The developed prototype model demonstrates the effectiveness of remote surgical guidance through AR.

Obstetric violence and consent during pregnancy and childbirth: the Eighth Amendment and its impact on the Irish maternity system

ABSTRACT In the run up to the referendum on abortion in Ireland in 2018, women shared experiences of being denied abortion care through social media. The ‘In Her Shoes’ dataset is a collection of archived Facebook posts in which women shared their experiences of obstetric coercion, lack of information and lack of consent to medical procedures during pregnancy and childbirth. Using women’s testimonies from the In Her Shoes database (https://repository.dri.ie/catalog/wm11nd02p), this research will critically analyse these stories. The paper will analyse women’s experiences in maternity care pre-2018 before the constitutional change. The article includes experiences of being denied treatment because of their pregnancy, being forced to continue the pregnancy when there was a risk to the woman’s health, as well as a lack of information and lack of consent to medical procedures. The article puts women’s experiences at the forefront of the research and analyses their experiences within a medical narrative framework. It argues that the Eighth Amendment, not just denied abortion care, but contributed towards a medical culture in which the patient’s experience was not central to that care. Since the removal of the Eighth Amendment, we should move towards a patient-centered care approach to maternity care in Ireland.

Virtual Reality: A Game Changer for Children’s Medical Procedures

Virtual Reality: A Game Changer for Children’s Medical Procedures

Testicular torsion and ultrasound-assisted manual detorsion.

Testicular torsion is a medical emergency that requires an immediate and multidisciplinary approach from emergency, surgical, and radiological services. In this article, we discuss the current knowledge and growing value of ultrasound (US) for intravaginal testicular torsion diagnosis and our experience with manual testicular detorsion with US assistance. Testicular torsion requires prompt and accurate diagnosis and quick therapeutic action. Technological advances in US equipment and knowledge of this pathology place the radiologist in an excellent position for its diagnosis and management. During the same medical procedure, the radiologist can both confirm the intravaginal testicular torsion and attempt manual testicular detorsion. US-assisted manual testicular detorsion is a non-invasive, simple, quick, safe, and effective manoeuvre that can rapidly restore testicular blood flow, maximising testicular salvage, relieving the patient's symptoms, and facilitating surgery.

Long noncoding RNA MALAT1 mediates fibrous topography-driven pathologic calcification through trans-differentiation of myoblasts

Prosthesis-induced pathological calcification is a significant challenge in biomaterial applications and is often associated with various reconstructive medical procedures. It is uncertain whether the fibrous extracellular matrix (ECM) adjacent to biomaterials directly triggers osteogenic trans-differentiation in nearby cells. To investigate this possibility, we engineered a heterogeneous polystyrene fibrous matrix (PSF) designed to mimic the ECM. Our findings revealed that the myoblasts grown on this PSF acquired osteogenic properties, resulting in mineralization both in vitro and in vivo. Transcriptomic analyses indicated a notable upregulation in the expression of the long noncoding RNA metastsis-associated lung adenocarcinoma transcript 1 (Malat1) in the C2C12 myoblasts cultured on PSF. Intriguingly, silencing Malat1 curtailed the PSF-induced mineralization and downregulated the expression of bone morphogenetic proteins (Bmps) and osteogenic markers. Further, we found that PSF prompted the activation of Yap1 signaling and epigenetic modifications in the Malat1 promoter, crucial for the expression of Malat1. These results indicate that the fibrous matrix adjacent to biomaterials can instigate Malat1 upregulation, subsequently driving osteogenic trans-differentiation in myoblasts and ectopic calcification through its transcriptional regulation of osteogenic genes, including Bmps. Our findings point to a novel therapeutic avenue for mitigating prosthesis-induced pathological calcification, heralding new possibilities in the field of biomaterial-based therapies.

Navigation benchmarking for autonomous mobile robots in hospital environment

The widespread adoption of robotic technologies in healthcare has opened up new perspectives for enhancing accuracy, effectiveness and quality of medical procedures and patients’ care. Special attention has been given to the reliability of robots when operating in environments shared with humans and to the users’ safety, especially in case of mobile platforms able to navigate autonomously. From the analysis of the literature, it emerges that navigation tests carried out in a hospital environment are preliminary and not standardized. This paper aims to overcome the limitations in the assessment of autonomous mobile robots navigating in hospital environments by proposing: (i) a structured benchmarking protocol composed of a set of standardized tests, taking into account conditions with increasing complexity, (ii) a set of quantitative performance metrics. The proposed approach has been used in a realistic setting to assess the performance of two robotic platforms, namely HOSBOT and TIAGo, with different technical features and developed for different applications in a clinical scenario.

KIF11 promotes vascular smooth muscle cell proliferation by regulating cell cycle progression and accelerates neointimal formation after arterial injury in mice.

Background and aims: One of the primary causes of lumen narrowing is vascular injury induced during medical procedures. Vascular injury disrupts the integrity of the endothelium, triggering platelet deposition, leukocyte recruitment, and the release of inflammatory factors. This, in turn, induces the proliferation of vascular smooth muscle cells (VSMCs), leading to neointima formation. However, the molecular mechanism underlying VSMC proliferation following injury remains unknown. KIF11 is critical in regulating the cell cycle by forming bipolar spindles during mitotic metaphase. This process may contribute to VSMCs proliferation and neointima formation following vascular injury. Yet, the function of KIF11 in VSMCs has not been elucidated. This study aims to investigate the role and mechanisms of KIF11 in regulating VSMCs cycle progression and proliferation. Methods: After conducting biological analysis of the transcriptome sequencing data from the mouse carotid artery injury model and the cell transcriptome data of PDGF-BB-induced VSMCs, we identified a potential target gene, KIF11, which may play a crucial role in vascular injury. Then we established a vascular injury model to investigate how changes in KIF11 expression and activity influence in vivo VSMCs proliferation and neointimal formation. In addition, we employed siRNA and specific inhibitors to suppress KIF11 expression and activity in VSMCs cultured in vitro to study the mechanisms underlying VSMCs cycle progression and proliferation. Results: The results of immunohistochemistry and immunofluorescence indicate a significant upregulation of KIF11 expression in the injured vascular. The intraperitoneal injection of the KIF11 specific inhibitor, K858, partially inhibits intimal hyperplasia in the vascular injury model. In vitro experiments further demonstrate that PDGF-BB upregulates KIF11 expression through the PI3K/AKT pathway, and enhances KIF11 activity. Inhibition of both KIF11 expression and activity partially reverses the pro-cycle progression and pro-proliferation effects of PDGF-BB on VSMCs. Additionally, KIF11 overexpression partially counteracts the proliferation arrest and cell cycle arrest induced by inhibiting the PI3K/AKT pathway in VSMCs. Conclusion: Our study highlights the crucial role of KIF11 in regulating the cycle progression and proliferation of VSMCs after vascular injury. A comprehensive understanding of these mechanisms could pave the way for potential therapeutic interventions in treating vascular stenosis.

Safety of procedural sedation in emergency department settings among the adult population: a systematic review and meta-analysis of randomized controlled trials.

Procedural sedation and analgesia (PSA) are a common practice in emergency departments (EDs), aiming to alleviate pain, anxiety, and discomfort during various medical procedures. We have undertaken a systematic review and meta-analysis with the aim of assessing the incidence of adverse events associated with PSA, including those related to individual drugs and various drug combinations. The study adhered to PRISMA guidelines for a systematic review and meta-analysis of adverse events in ED sedation. A comprehensive search strategy was employed across ten databases, supplemented by searches on clinicaltrials.gov and manual reviews of reference lists. Data extraction focused on medication administration and adverse events. The study considered four types of adverse events: cardiac, respiratory, gastrointestinal, and neurological. Only randomized controlled trials (RCTs) focusing on PSA administered to adult patients within the ED setting were included. The statistical analysis employed OpenMeta Analyst to conduct a one-arm meta-analysis, with findings presented alongside their corresponding 95% Confidence Intervals. Forest plots were constructed to combine and evaluate results, and sensitivity analyses were performed to identify sources of heterogeneity. From a literature search of 4246 records, 32 RCTs were deemed suitable for this meta-analysis. The analysis included 6377 procedural sedations. The most common adverse event was hypoxia, with an incidence rate of 78.5 per 1000 sedations (95% CI = 77.5-133.5). This was followed by apnea and hypotension, with incidence rates of 31 (95% CI = 19.5-41.8) and 28.1 (95% CI = 17.4-38.9) per 1,000 sedations, respectively. Agitation and vomiting each occurred in 15.6 per 1,000 sedations (95% CI = 8.7-22.6). Severe adverse events were rare, with bradycardia observed in 16.7 per 1,000 sedations, laryngospasm in 2.9 per 1,000 sedations (95% CI = - 0.1 to 6), intubation in 10.8 per 1,000 sedations (95% CI = 4-17), and aspiration in 2.7 per 1,000 sedations (95% CI = - 0.3 to 5.7). Ketamine is found to be the safest option in terms of respiratory adverse events, with the lowest rates of apnea and hypoxia, making it the least respiratory depressant among the evaluated drugs. Etomidate has the least occurrence of hypotension when used alone. Propofol has the highest incidence of hypotension when used alone and ranks second in hypoxia-related adverse events after midazolam. Using combinations of sedating agents, such as propofol and ketamine, has been found to offer several advantages over single drugs, especially in reducing adverse events like vomiting, intubation difficulty, hypotension, bradycardia, and laryngospasm. The combination significantly reduces the incidence of hypotension compared to using propofol or ketamine individually. Despite the regular use of procedural sedation, it can sometimes lead to serious adverse events. Respiratory issues like apnea and hypoxia, while not common, do occur more often than cardiovascular problems such as hypotension. However, the least frequent respiratory complications, which can also pose a threat to life, include laryngospasm, aspiration, and intubation. These incidents are extremely rare.

Using Gagne's instructional design to teach communication skills in phlebotomy education through role-play.

Background: Phlebotomy is a medical procedure that is performed frequently in the blood collection activities of medical institutions. The procedure involves close interaction with different types of patients-some of whom are cooperative and others, who, for many reasons, are not (for example, patients who have a fear of needles). Blood extraction is an essential skill in several medical specialties, such as in laboratory sciences. Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy. In this paper, I propose a lesson plan for teaching communication skills to medical laboratory sciences and nursing students based on Gagne's instructional design. Methods: The training session included two main parts: training session using Gange's instructional design and at the end of the session, the participants were surveyed for the effectiveness of the training session. Results: 17 participants were included in the study. Overall, the majority of the participants were highly satisfied with the effectiveness of the training session in teaching communication skills with all seven survey questions receiving a mean score of 4.58 on a Likert scale of 1-5. Conclusion: We demonstrated the effectiveness of Gange's instructional beyond theoretical lesson planning to teach communication skills through role-play in phlebotomy education.

Airway and Airway Obstruction Site Segmentation Study Using U-Net with Drug-Induced Sleep Endoscopy Images.

Obstructive sleep apnea is characterized by a decrease or cessation of breathing due to repetitive closure of the upper airway during sleep, leading to a decrease in blood oxygen saturation. In this study, employing a U-Net model, we utilized drug-induced sleep endoscopy images to segment the major causes of airway obstruction, including the epiglottis, oropharynx lateral walls, and tongue base. The evaluation metrics included sensitivity, specificity, accuracy, and Dice score, with airway sensitivity at 0.93 (± 0.06), specificity at 0.96 (± 0.01), accuracy at 0.95 (± 0.01), and Dice score at 0.84 (± 0.03), indicating overall high performance. The results indicate the potential for artificial intelligence (AI)-driven automatic interpretation of sleep disorder diagnosis, with implications for standardizing medical procedures and improving healthcare services. The study suggests that advancements in AI technology hold promise for enhancing diagnostic accuracy and treatment efficacy in sleep and respiratory disorders, fostering competitiveness in the medical AI market.

Evaluation of Patients Receiving Home Care Services and Services Provided

Aim: It is important to know patient characteristics and medical needs in the planning and operation of home care services (HCS). In this study, the descriptive characteristics of patients who received HCS and the medical services provided were evaluated. Materials and Methods: Patients receiving HCS for at least one-year were included this cross-sectional study. Patient records were examined and in addition to descriptive features, the number of visits made by the HCS unit in the last year for each patient, the reasons for these visits and the procedures performed was recorded. Results: While 60.4% of the patients were female, 83.6% were ≥65 years. It was determined that 72.6% of the patients were bedridden, 30.5% used a urinary catheter and 32.9% had pressure ulcer. A total of 2774 (median=16) home visits were made, and the most common medical procedures were blood test and wound dressing. Functional bed use and pressure ulcer for wound dressing, rural location and diabetes for blood test and rural location, urinary catheter use and history of pulmonary embolism for urinalysis were determined as risk factors. Conclusion: The characteristics of the patients receiving HCS, and the services provided were determined and it was seen that they were related to each other.

Medical tourism: Medical dream or nightmare?

Medical tourism is an act of a foreign national traveling across international borders to undergo a particular medical procedure. India, Malaysia, Turkey, Singapore, and Thailand have established themselves as prominent destinations in the medical tourism industry, while Canada and the United Kingdom are commonly sought-after source countries for medical travelers. The medical tourism sector offers a range of benefits and drawbacks for citizens of both the source country and the destination country. Traveling long distances for medical treatment presents inherent risks such as complications during travel and exposure to unfamiliar environments. For instance, patients may face an increased risk of developing deep vein thrombosis (DVTs) due to prolonged periods of immobility during flights or other modes of transportation. The most popular desired procedures for medical tourists include elective cosmetic surgery, dental procedures, organ transplants, cardiac surgery, and orthopaedic surgery.Medical tourism is double-edged in nature and can be both beneficial to the health system and the recipient thereof. It is however clear that various international legal and regulatory frameworks are necessitated to both protect the interests of the medical tourist and the treating medical body. There is no question that medical tourism will continue to rise in popularity, it is however prudent that potential medical tourists do their due diligence into the potential destination for their treatment of choice to better nullify the likelihood of a medical misadventure occurring.

Correlations of Imaging and Therapy in Breast Cancer Based on Molecular Patterns: An Important Issue in the Diagnosis of Breast Cancer.

Breast cancer is a global health issue affecting countries worldwide, imposing a significant economic burden due to expensive treatments and medical procedures, given the increasing incidence. In this review, our focus is on exploring the distinct imaging features of known molecular subtypes of breast cancer, underlining correlations observed in clinical practice and reported in recent studies. The imaging investigations used for assessment include screening modalities such as mammography and ultrasonography, as well as more complex investigations like MRI, which offers high sensitivity for loco-regional evaluation, and PET, which determines tumor metabolic activity using radioactive tracers. The purpose of this review is to provide a better understanding as well as a revision of the imaging differences exhibited by the molecular subtypes and histopathological types of breast cancer.