Medical Procedures Research Articles

Development and Validation of Claims-based Algorithms for Identifying Hospitalized Patients With COVID-19 and Their Severity in 2020 and 2021.

This study aimed to develop and validate claims-based algorithms for identifying hospitalized patients with coronavirus disease 2019 (COVID-19) and disease severity. We used claims data including all patients at the National Center for Global and Medicine Hospital between January 1, 2020, and December 31, 2021. The claims-based algorithms for three statuses with COVID-19 (hospitalizations, moderate or higher status, and severe status) were developed using diagnosis codes (International Classification of Diseases, 10th revision code: U07.1, B34.2) and relevant medical procedure code. True cases were determined using the COVID-19 inpatient registry and electronic health records. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each algorithm at 6-month intervals. Of the 75,711 total patients, the number of true cases was 1,192 for hospitalizations, 622 for moderate or higher status, and 55 for severe status. The diagnosis code-only algorithm for hospitalization had sensitivities 90.4% to 94.9% and PPVs 9.3% to 19.4%. Among the algorithms consisting of both diagnosis codes and procedure codes, high sensitivity and PPV were observed during the following periods: 93.9% and 97.1% for hospitalization (January-June 2021), 90.4% and 87.5% for moderate or higher status (July-December 2021), and 92.3% and 85.7% for severe status (July-December 2020), respectively. Almost all algorithms had specificities and NPVs of approximately 99%. The diagnosis code-only algorithm for COVID-19 hospitalization showed low validity throughout the study period. The algorithms for hospitalizations, moderate or higher status, and severe status with COVID-19, consisting of both diagnosis codes and procedure codes, showed high validity in some periods.

Integrating Marma Sharira: Ayurveda’s Insights into Modern Traumatology

Marma Sharira, an integral concept in Ayurveda, represents vital points in the human body where the life force (Prana) is concentrated. Marma points are certain anatomical locations on the human body that are important for understanding trauma management and injury prevention in addition to preserving health. When these sites are traumatized there can be profound effects on the body and mind. Several clinical observations suggests that Marma therapy i.e. manipulation of Marma points not only accelerates the healing process but also enhances the body's innate capacity for recovery by harmonizing the flow of Prana (vital life force) facilitatingin pain management, stress reduction, musculoskeletal disorders, and enhancing overall vitality. By balancing the body's energy flow, it supports the immune system, accelerates healing processes, and improves quality of life. The paper also highlights the benefits of a multidisciplinary approach that combines traditional knowledge with modern medical procedures as reported in stroke management, and it explores how Marma Sharira's tenets might help with trauma treatment today.

The Relationship Between Family Support and Self-Efficacy in Preoperative Breast Cancer Patients: Implications for Healthcare Practices

Preoperative carcinoma mammae patients frequently experience diminished self-efficacy, which can impede their ability to cope with medical procedures and affect recovery outcomes. Family support is considered a crucial factor in enhancing self-efficacy, offering emotional, informational, and instrumental assistance that strengthens patients’ confidence. This study aims to explore the relationship between family support and self-efficacy in preoperative breast cancer patients at Abdul Moeloek Hospital, Lampung Province, in 2023. Utilizing a cross-sectional design, 78 respondents were selected through non-probability sampling. Family support was measured using a validated family support questionnaire, while self-efficacy was assessed through the Strategies Used by People to Promote Health (SUPPH) questionnaire. The results revealed that 85.9% of patients reported high levels of family support, and 88.5% exhibited strong self-efficacy. Statistical analysis, using the Chi-Square test, indicated a significant relationship between family support and self-efficacy (p = 0.003), reinforcing the theoretical framework of Bandura’s self-efficacy model, which posits that social support enhances individuals' confidence in overcoming challenges. The findings suggest that integrating structured family support programs into preoperative care can improve self-efficacy, ultimately leading to better patient outcomes. This research contributes to the understanding of psychosocial factors in cancer care, emphasizing the need for educational interventions targeting families to optimize patient recovery.

Enhanced X-ray shielding efficiency and visible light degradation performance of a multilayer composite protective material

To mitigate the adverse effects of high-energy radiation, such as X-rays, on patients during medical procedures, a multifunctional composite nanofibrous membrane has been engineered to shield against low-energy X-rays. This study involves integrating processed oil-tea camellia shells (OCS) powder into molten polylactic acid (PLA) for modification. Concurrently, metallic Bi is introduced to enhance Bi2WO6, which is subsequently combined with modified PLA and electrospun into nanofibrous membranes for photocatalytic antimicrobial and organic pollutant degradation. Additionally, sodium hyaluronate (NaHA) and a silver nanoparticle solution are electrospun with PLA to form a skin-friendly protective layer. Following this, a chitosan (CS) solution containing WO3 and B4C is used as a coating on the multilayered membranes. The membranes are then freeze-dried to create sandwich-structured multilayer composite protective material. This method addresses challenges associated with polylactic acid (PLA) in electrospinning and alleviates limitations such as low light absorption and slow charge transfer in Bi2WO6. Compared to similar materials, this composite material is lightweight, flexible for cutting, and exhibits strong X-ray shielding capabilities. The composite nanofibrous membrane demonstrates a shielding efficiency of 97.75 ± 2.05 % at low X-ray energy (46 kVp). Moreover, under visible light, the membrane generates reactive oxygen species, resulting in the efficient removal of 98.03 % of methylene blue (MB), 96.35 % of rhodamine B (Rh.B), and 91.51 % of methyl orange (MO) within 180 minutes. Furthermore, it displays bactericidal activity against E. coli and S. aureus under both dark and light conditions. In natural settings, the composite membrane undergoes gradual degradation in soil, completely decomposing within 28 days due to the influence of rainfall and microorganisms. Consequently, this composite membrane holds significant promise for specialized medical protective applications.

Venesection conducted by physicians, barber-surgeons, bell-ringers and indigenous healers in Finland over 500 years. A narrative literature review with a limited genealogical search

Venesection was was a common medical procedure from ancient times to the 19th century, frequently performed by physicians and barber-surgeons. In Finland, priests, church bell-ringers, and indigenous healers also performed venesection for a variety of diseases, although without a medical basis. Venesection and its complications may have caused a number of deaths. The treatment was discredited due to increased criticism, which was substantiated by statistical evidence. Today, medical venesection performed by physicians is only an exceptional treatment for a few number of disorders. The purpose of this article is to is to shed light on the long and fascinating history of venesection in Finland from 1488 to 1976, as well as its role in the evolution of medical procedures. This will be achieved through a review of the literature, the introduction of some neglected sources, a register-based search, and an investigation into who conducted the surgery and why venesection persisted for so long in Finland. The sources consist of church records and scholarly literature. The novel and main finding of this study was that there were a large number of professionals doing venesection when there were few physicians. This study discovered 2,341 bell-ringer-phlebotomists in Finland between 1755 and 1877 who constituted the bulk of people conducting venesection as compared to barber-surgeons and physicians. This former group was made up of predominantly Swedish-named guys who lived in western Finland. Another novel finding was that patient safety legislation effectively reduced the indigenous practice of venesection by quacks.

Economic burden of hospital admissions for adverse drug reactions in France: The IATROSTAT-ECO study.

Hospitalizations for adverse drug reactions (ADR-HA) have increased over the last decade, but the impact of ADR-HA has rarely been evaluated. The aim of this study was to estimate the economic burden of ADR-HA in France. A partial economic evaluation from the viewpoint of French public health insurance was performed, based on a previous pharmacovigilance study (IATROSTAT) performed in 2018 in public hospital medical units. The cost included direct medical costs, collected retrospectively, from the French hospital discharge database. The economic burden was estimated by calculating the total cost per ADR-HA patient (cost of hospital stays, additional daily cost of specific stays, such as in a resuscitation, intensive care or continuous surveillance unit, drug products and medical devices in addition to Healthcare Resource Group-based tariffs, and specific outpatient consultations and other clinical and technical medical procedures, over 3 months as from the first day of ADR-HA). The robustness of the results was assessed using a one-way deterministic sensitivity analysis of cost factors applying tariffs from 2023 instead of 2018. According to the 2018 tariffs (vs. 2023), the mean total cost per patient with ADR-HA was estimated at €5208 ± €3719 (vs. €5974 ± €4232) ranging from €514 to €23 355 (vs. €618 to €27 380). The total cost for 196 patients with ADR-HA admitted to a sample of French public hospitals was estimated at €1 020 549 (vs. €1 170 960). It could be estimated at €1.3 billion at the national level. In addition to the increase in the number of expensive drugs, the ageing population and polypharmacy, the economic impact of serious ADR-HA weighs heavily on healthcare spending.

A-154 Non-standard body fluid validation of d-dimer analysis of organox liver perfusate to support clinical evaluations of donor livers prior to transplantation

Abstract Background Non-standard body fluid analysis is considered a challenge to laboratories since very few have been approved by the FDA for routine testing. As medical procedures evolve, the laboratory must balance the requirement to uphold regulatory standards while also supporting procedures that improve patient care. The LUMC Liver Transplant Team recently implemented the use of the FDA-approved OrganOx Metra normothermic machine perfusion instrument for maintaining donor livers under physiologic conditions prior to transplantation. The team mitigates risk for biliary complications associated with fibrin microthrombi by perfusing a combination of alteplase rTPA with fresh frozen plasma and monitoring the prevalence of fibrin through the release of D-dimers over the course of ex situ normothermic preservation. Liver perfusate is not an FDA-approved specimen type for the analysis of D-dimer and requires laboratory verification as a compatible specimen for analysis. Methods The D-dimer HS 500 assay was performed on an ACL TOP 750 analyzer. Carry-over studies evaluated activated partial thromboplastin time (aPTT) of a normal control (citrated plasma) specimen initially, and repeatedly in-between sets of D-dimer measurements of heparinized perfusate specimen. Recovery studies were performed by mixing liver perfusate with citrated plasma spiked with D-dimer in known ratios, allowing for the calculation of an expected value of D-dimer. Results Carry-over studies measuring aPTTs of normal plasma specimens provided %CVs of 1 and 3%. Recovery of D-dimer in seven sets of independent add-mixture series (three mixed specimen per set) was on average 105% with a range from 95 to 113% recovery. Conclusions Concern for cross-contamination of perfusate specimen containing heparin anticoagulant on analyzers used to evaluate routine coagulation testing was mitigated by the results of the carry-over study, which provided %CV within the manufacturer limit for intraday precision. Recovery studies evaluating matrix effect for the analysis of D-dimer on liver perfusate generated under the LUMC liver transplant protocol indicated that the matrix of the perfusate did not impact D-dimer analysis, as compared to the FDA-approved specimen type.

Risk stratification for cardiovascular disease based on prior coronary artery disease, cerebrovascular disease and type 2 diabetes mellitus.

History of coronary artery disease (CAD), cerebrovascular disease (CeVD), type 2 diabetes and their combined effect on cardiovascular disease are essential for cardiovascular risk management. We investigated the association of prior CAD, prior CeVD, type 2 diabetes and their combination with the risk of cardiovascular disease. This is a historical cohort study including 342,033 participants (aged 18-72 years) followed up for ≥5 years between 2008 and 2016. Participants were classified into eight groups (with or without prior CAD, prior CeVD and type 2 diabetes). Type 2 Diabetes was defined by fasting plasma glucose and glycated hemoglobin levels, and antidiabetic drug prescription. Prior and subsequent CAD and CeVD were identified according to claims using International Classification of Diseases 10th Revision codes, medical procedures and questionnaires. Cox regression models were used to evaluate the risk of cardiovascular events. The median follow-up period was 6.4 years. The incidence of composite cardiovascular events of CAD and CeVD in the CAD-/CeVD-, CAD+/CeVD-, CAD-/CeVD+ and CAD+/CeVD+ groups were 1.92 and 6.94, 25.14 and 31.98 per 1,000 person-years in non-diabetes participants, and 8.66, 18.04, 39.98 and 60.72 in type 2 diabetes patients, respectively. Hazard ratios of cardiovascular events compared with CAD-/CeVD-/non-diabetes were 1.66 (95% confidence interval 1.55-1.78) in CAD-/CeVD-/type 2 diabetes and 1.84 (1.56-2.18) in CAD+/CeVD-/non-diabetes. CeVD+ was linked to a 4-7-fold increase in the risk of cardiovascular events regardless of CAD+ or type 2 diabetes. Type 2 diabetes increased the risk of cardiovascular disease as high as a history of CAD, whereas prior CeVD alone increased the risk of future CeVD without additional effects by type 2 diabetes.

Utilidad de la realidad virtual en la formación médica: manejo clínico de un paciente con monoartritis de rodilla

The use of technological environments with virtual reality (VR) techniques for the practice of arthrocentesis offers an effective and safe way to learn and improve the necessary skills to carry out a medical procedure and patient care. This article presents an interactive simulator using immersive VR, in which the participant experiences practicing clinical management and decision-making in the face of a person presenting with monoarthritis in a medical consultation. The objective with this development is for the user to acquire the competence to perform, correctly and safely, a knee arthrocentesis and to differentiate the types of synovial fluids that can be found in a joint. In turn, it provides clinical guidance and assists with the user's medical decision-making. There fore, the aim is to improve the quality of care and patient safety when practicing this technique previously through clinical simulation.

Iatrogenic tracheobronchial rupture in a fragile patient: A case report

An acute injury of the tracheobronchial system is a rare but potentially life-threatening condition that can be caused by medical procedures. Diagnosis requires a thorough evaluation of the patient’s medical history, physical examination, and imaging tests. Identification of a tracheal rupture in patients under sedation or general anesthesia may be difficult, and a strong clinical suspicion is essential. Treatment can be conservative or surgical, depending on the severity of the injury and the patients’ clinical status. The key prognostic determinant is a prompt identification and appropriate management.

Statistical Analyses Plan for “MAGnItude of cigarette substitutioN after Initiation oF e-cigarettes and its ImpaCt on biomArkers of exposure and potenTial harm in dual users”: MAGNIFICAT trial

BackgroundThe substitution of combustible cigarettes (CC) with non-combustible nicotine alternatives, such as e-cigarettes (EC), significantly lowers exposure to harmful chemicals. However, many individuals who use ECs continue smoking CCs, becoming dual users and remaining at increased risk of toxin exposure. This study will examine how the reduction in cigarettes smoked per day (CPD) after switching to ECs correlates with changes in biomarkers of exposure (BoE) and potential harm (BoPH) to evaluate the extent of harm in dual users. MethodsThe study is a prospective, non-randomised, observational, longitudinal cohort study in which 250 CC smokers will be invited to use EC as part of a smoking reduction/cessation strategy. Participants will be grouped in five dual use categories based on the change from baseline in CPD at 1, 3 and 6 months, based on self-reported use in the preceding 30 days. The primary outcome of interest is the mean absolute urinary 2-cyanoethyl mercapturic acid (2CyEMA), a well-validated BoE, also assessed at 1, 3 and 6 months. Other BoE will be assessed, together with exploration of the association between varying intensities of dual use and BoPH. The association between the dual use category and levels of BoE will be evaluated using analysis of variance (ANOVA), in order to understand which BoE are best suited to identifying different levels of dual use. Exploratory assessment of the value of BoPH will similarly be evaluated, to assess whether their predictive power extends from the binary smoker/non-smoker categorization to a more nuanced dual use categorization. The specific details of the own-brand CC will be available once smokers' enrollment in the study is complete. The EC used in the study will be the KIWI 2 Pen refillable pod system, with participants given the option to choose from three different flavored e-liquids: LEAF, MIDWAY, and GLACIAL, all containing 0.9% nicotine. For specialized equipment used for biomarker analysis please refer our previous publication: https://pubmed.ncbi.nlm.nih.gov/38584934/ ConclusionEC are increasingly adopted as a harm reduction strategy in CC smokers who wish to quit smoking, the outlined Statistical Analysis Plan (SAP) provides a robust approach to understand the impact of EC on CC use and to quantify the impact of dual use on clinical outcomes using BoPH. For statistical calculations we will use R software.The subject of this SAP manuscript – trial research – due to planned medical procedures, is a subject of verification by proper ERB (Ethics Review Board) in Poland and gained required approval prior to the start of the actions. The positive opinion was granted on 22nd February 2024, with the signature number 04/24.

Current sedation practices for non-invasive procedures in tertiary maternity and children's hospitals in China: a 5-year update.

Sedation techniques can ease anxiety during medical procedures for children. Our previous report on Chinese sedation practices for non-invasive procedures in 2018 is outdated due to the rapid development of sedation services. This study provides an updated report on sedation practices for non-invasive procedures in China. This is a cross-sectional study. Questionnaires were sent to tertiary maternity and children's hospitals nationwide through the WeChat Mini Program. The survey questioned the location and caseloads of hospitals providing sedation services, support facilities, contraindications, fasting practices, sedation regimens, monitoring practices, staff structure, certification requirements for sedation providers and quality control data. Procedural sedation for non-invasive procedures were provided in 88 of 114 hospitals. These hospitals are located across the country except Heilongjiang province and the Tibet Autonomous Region. Compared with previous reports, significant increases were found in the number of hospitals providing sedation services, dedicated sedation rooms and recovery rooms and full-time sedation providers. Most hospitals advocated the 2-4-6 rule for pre-sedation fasting. Dexmedetomidine was the most used first-choice sedative. Anaesthesiologists remain the primary sedation providers, but nurses are also important. The most mentioned qualification requirements for sedation providers were a professional title of attending doctor, ≥5 years of working experience in paediatric anaesthesia and paediatric advanced life support certification. Sedation service records were used in 83 hospitals, but only 42 and 39 recorded success rates and adverse events, respectively. Sedation services for non-invasive procedures are available in most areas of China. More hospitals now provide sedation services and full-time sedation providers. Supporting facilities and sedation regimens have improved. Non-anaesthesiologist sedation providers are important at current stage, developing training programmes for them may be necessary. Attention should be focused on quality control and improvement of sedation services.

Cardiac index as a surrogate marker for anxiety in pediatric patients undergoing ambulatory endoscopy: a prospective cohort study

Objective.Pediatric patients undergoing medical procedures often grapple with preoperative anxiety, which can impact postoperative outcomes. While healthcare providers subjectively assess anxiety, objective quantification tools remain limited. This study aimed to evaluate two objective measures-cardiac index (CI) and heart rate (HR) in comparison with validated subjective assessments, the modified Yale Preoperative Anxiety Scale (mYPAS) and the numeric rating scale (NRS).Approach.In this prospective, observational cohort study, children ages 5-17 undergoing ambulatory endoscopy under general anesthesia underwent simultaneous measurement of objective and subjective measures at various time points: baseline, intravenous placement, two-minutes post-IV placement, when departing the preoperative bay, and one-minute prior to anesthesia induction.Main Results.Of the 86 enrolled patients, 77 had analyzable CI data and were included in the analysis. The median age was 15 years (interquartile range 13, 16), 55% were female, and most were American Society of Anesthesiologists (ASA) Physical Status 2 (64%), and had previous endoscopies (53%). HR and CI correlated overall (r= 0.65, 95% CI: 0.62, 0.69;p< 0.001), as did NRS and mYPAS (r= 0.39, 95% CI: 0.34, 0.44;p< 0.001). The correlation between HR and CI was stronger with NRS (r= 0.24, 95% CI: 0.19, 0.29;p< 0.001; andr= 0.13, 95% CI: 0.07, 0.19;p< 0.001, respectively) than with mYPAS (r= 0.06, 95% CI: 0.00, 0.11;p= 0.046; andr= 0.08, 95% CI: 0.02, 0.14;p= 0.006, respectively). The correlation with mYPAS for both HR and CI varied significantly in both direction and magnitude across the different time points.Significance.A modest yet discernable correlation exists between objective measures (HR and CI) and established subjective anxiety assessments.

THE ROLE OF HEALTH TOURISM TRAVEL AGENCIES IN HEALTH TOURISM

In today's world, health tourism is rapidly gaining popularity. Patients travel internationally to access various healthcare services and treatments, such as medical procedures, cosmetic surgery, dental care, thermal tourism, and spa-wellness services. One of the critical factors contributing to a successful experience in the challenging and complex journey of health tourism is the role played by health tourism travel agencies. These agencies facilitate patients' access to international healthcare services, guide patients, organize their travel, and offer personalized solutions to meet their needs. In addition to coordinating logistics, travel agencies help ensure a seamless healthcare experience by addressing cultural and language barriers and improving communication between patients and healthcare providers. This study aims to define the roles and responsibilities of health tourism travel agencies, emphasizing their growing importance in the global healthcare landscape.

Study of the Accuracy and Reliability of Dosimetric Measurements for X-ray Beams with Radiation Qualities N-40, N-100, N-200

Radiation dosimetry is a critical aspect of medical, industrial, and scientific applications involving ionizing radiation. Accurate measurements of radiation doses ensure the safety and effectiveness of radiological practices, which is essential for protecting patients in medical procedures, maintaining safety in industrial applications, and ensuring accuracy in scientific research. Leading international organizations conduct research aimed at improving measurement accuracy and the dissemination of measurement units. One of the methods contributing to this effort is various international projects. The National Scientific Centre “Institute of Metrology” has participated in one such international project. This international project, involving several National Metrology Institutes (NMIs), aimed to improve the accuracy and consistency of radiation dosimetry across Europe. By standardizing measurement and calibration procedures, the project seeks to create a unified system for measuring radiation doses, thereby improving the reliability of ionizing radiation dosimetry. This project is particularly significant given the continuous increase in radiation-based technologies across various fields. For example, precise measurements of ionizing quantities are crucial in the medical field, especially for radiotherapy, to ensure that patients receive the necessary dose with minimal exposure to surrounding healthy tissues. Similarly, in industrial radiography, accurate dosimetry is essential for meeting safety standards and preventing excessive radiation exposure to workers. The international project, with the Physikalisch-Technische Bundesanstalt (PTB) and the Central Office of Measures (GUM) as leading organizations, aims to improve key factors in ionizing radiation dosimetry. These include developing reliable calibration protocols for various types of radiation, establishing traceability chains to ensure measurement accuracy, and sharing best dosimetry practices among project participants. Preliminary comparisons were performed between NMIs, with two control participants serving as references while other NMIs participated anonymously (knowing only their number and the numbers of the reference participants). Each participant had the opportunity to compare their obtained values with the reference values and make adjustments for future measurements. The collaborative nature of such cooperation also promotes knowledge and experience exchange, fostering innovation and improvement in dosimetry techniques. The NSC “Institute of Metrology”, a leading organization in the field of the ionizing radiation metrology, has actively participated in this project as a representative from Ukraine. The paper presents the results of international comparisons for X-ray beams with the radiation qualities N-40, N-100, N-200.

The Civil Law Aspects of Informed Consent to Medical Procedures

Introduction: Informed consent is a communication process between healthcare providers and patients regarding the medical procedures to be performed. Its aim is to provide sufficient information so that patients can make informed decisions, and it is regulated by various laws and regulations in Indonesia.Purpose of the Research: The purpose of this research is to analyze the legal position of informed consent from the perspective of Indonesian civil law and to examine the civil law implications that arise if there is a violation of the informed consent principle in medical procedures.Method of Research: This research uses normative legal methods with legislative and conceptual approaches, analyzing primary, secondary, and tertiary legal materials through literature study, and applying descriptive qualitative analysis.Results of Research: Research findings indicate that informed consent holds a strong legal position within the perspective of Indonesian civil law, being viewed as a manifestation of a therapeutic agreement that must meet the valid agreement requirements according to the Civil Code (KUHPerdata) and be supported by various regulations. Violations of the principles of informed consent can lead to significant civil legal implications, including claims for damages on the grounds of breach of contract or unlawful acts, cancellation of the therapeutic agreement, liability for breach of professional standards, and claims based on consumer protection law. These implications can involve healthcare professionals and healthcare institutions, with consequences that include payment of material and immaterial damages, the burden of proof in court, and impacts on reputation and medical practice.

Coronary Artery Disease, Family History, and Screening Perspectives: An Up-to-Date Review.

Family history for CAD (coronary artery disease) is an established cardiovascular (CV) risk factor and it is progressively acquiring importance in patients' CV risk stratification. Numerous studies have demonstrated that individuals with a first-degree relative affected by CAD have a significantly higher risk of developing the condition themselves; in particular, when CAD occurs at an early age in relatives. Indeed, recently published CCS (chronic coronary syndrome) ESC (European Society of Cardiology) guidelines include family history (FH) as a risk factor to consider when calculating pre-test risk for CAD. ESC guidelines on preventive cardiology (2021) only suggested CV risk assessment in the presence of a positive FH for CV disease, not considering it in the actual risk scores. Evidence suggests that positive anamnesis for relatives affected by CAD correlates with ACS (acute coronary syndrome) and CAD, with slight differences in relative risk as far as the degree of kinship is concerned. Genetic factors contribute to this correlation by influencing key processes that affect heart health, such as cholesterol metabolism, blood pressure regulation, and inflammatory responses. New technologies in the genetics field are increasing the availability of genome sequencing, and new polymorphism panels are being tested as predictive for CAD, objectifying familiarity. Advances in imaging techniques allow the assessment of coronary atherosclerosis and its composition, and these are acquiring strength in evidence and recommendations in ESC guidelines as a way to define coronary disease in low and low-to-intermediate risk patients and to guide medical therapy and interventional procedures. Use of these emerging tools to guide screening is likely to be extended, beyond high CV risk patients, to individuals with FH for early CAD and/or specific genetic profiles, as recent evidence in the literature is suggesting.

Enhancing Skin Disease Diagnosis Through Fine-Tune Convolutional Neural Network: A Comparative Study with Multi-class Approach

Due to their similar appearance, skin disorders frequently disguise their early warning signs from our skin, which is the defense system of the body. Preventing serious disorders requires their early detection. This work investigated the use of fine-tune transfer learning as a fast and accurate way to diagnose skin diseases. To classify different skin issues, we used pre-trained models, i.e., InceptionV3, DenseNet201, and Xception. This work examined 17,500 photos from three sources. It was found that fine-tune Xception performed exceptionally well, with an accuracy rate of 99.14%. It was closely followed by DenseNet201 and InceptionV3, each with different processing speeds, 98.74% and 98.46%, respectively. We used transfer learning with data sets validated by medical experts, outperforming earlier research in precision. This more accurate detection of skin diseases could greatly improve patient outcomes and expedite medical procedures. This approach is new in that it fine-tunes transfer learning by utilizing a vast number of data to increase accuracy compared to other researcher works.

Improving the steering performance of microrobots by using a magnetically actuated technique

Mobile microrobots show the significance of potential medical procedures and challenge areas within the human body. An applied electromagnetic field is used as a precise magnetic actuation system for controllable steering mobility, and positioning is used. In this work, an adaptable microrobot is developed with an effective technique to enhance steering. An electromagnetic system is employed to produce an external magnetic field that guides a microrobot to improve its steerability. In particular, a driving system of eight coils creates a magnetic field that actuates the microrobot and enables upward and downward motion. Accordingly, three types of microrobot designs are proposed. Consequently, an efficient variation of steering in terms of deformation angle is achieved. The corresponding performance is determined mathematically in terms of the main system parameters, such as external magnetic field and microrobot geometry. In addition, finite element model is used for comparison and validation. Simulation results show that for a relatively high value of magnet field, namely, 15 mT and 90°, the deformation angles were 36.98° for the first design, 39.11° for the second design, and 34.48° for the third design in upward deformation. By contrast, the downward deformation ranges were –40.42°, –39.46°, and –37.04° for the first, second, and third designs, respectively, at –90° The error between the upward and downward steering of the second design had the lowest value of 0.35° The second design of the microrobots has the least error between the upward and downward deformation ratio at 0.89 %. In comparison, the first design has a 9.3 % error, and the third design has a 7.42 % error, with a relatively high value of magnetic field density (15 mT). Simulations have shown that the proposed second design is suitable for navigating narrow artery branches with the least error ratio and more precise control. This work verifies that the model could accurately control the steering of microrobots.

A Comprehensive Theological and Scientific Study of Gestational Surrogacy

With advancements in science and in response to the desire of childless individuals, surrogacy has emerged as a contemporary method of treating infertility. Intriguingly, due to its novelty, this topic has sparked considerable legal and jurisprudential debate. In essence, this medical procedure involves fertilizing a woman's egg with a man's sperm outside the womb. Subsequently, due to the woman's inability to carry the pregnancy, the embryo is implanted into another woman's uterus. Surrogacy, in fact, is a means for infertile couples to have a child. Through assisted reproductive technologies, an embryo created via in vitro fertilization is transferred to a gestational carrier, who carries the pregnancy to term and then relinquishes the child to the intended parents. In Iran, assisted reproductive technologies are employed when couples, or either partner, experience infertility. In these procedures, the sperm and egg of the legal and marital couple are fertilized in a laboratory, and the resulting embryo is donated to another legal and marital couple. A crucial issue in this context is the determination of the child's parentage, especially maternal lineage. Due to the silence of the law, this matter must be resolved by examining the Constitution of the Islamic Republic of Iran and relevant jurisprudential opinions, as well as the perspectives of legal experts. In this regard, determining the maternal lineage, which involves the biological mother and the gestational carrier, presents a challenge and requires further exploration. The conclusion of this paper is that, based on Quranic verses, hadiths, the principle of freedom of will, the intentions of the parties involved, the best interests of the child, customary practices, and legal principles, the gestational carrier is considered the legal mother of the child.