Non-invasive Procedure Research Articles

Non-Facial Skin Rejuvenation of the Neck, Chest, and Hands. Part One: Using Injections.

The demand for aesthetic procedures aimed at restoring and preserving a youthful appearance is growing. While numerous non-surgical facial rejuvenation techniques are available, there is a need for a comprehensive review of clinic-based procedures targeting non-facial body parts. This review aims to describe and evaluate clinic-based techniques for rejuvenating the neck, chest, and hands, focusing on various types of fillers and other non-invasive procedures. In this first part of this review, we conducted an extensive literature review on PubMed, reporting the effectiveness of different fillers, detailing their preparation, required volume per area, injection methods, durability, and any associated side effects. We also discuss the use of mesotherapy, microneedling, chemical peeling, and Profhilo in these specific body areas. The review synthesizes the latest data on the effectiveness and safety of these procedures, highlighting the advancements in filler technology and the growing popularity of non-invasive techniques for body rejuvenation. This article serves as a valuable resource for practitioners and patients interested in non-surgical body rejuvenation, providing insights into the best practices.

Microfocused Ultrasound With Visualization (MFU-V) Effectiveness and Safety: A Systematic Review and Meta-Analysis.

Microfocused ultrasound with visualization (MFU-V) is an advanced, non-invasive cosmetic procedure widely used in skin lifting and tightening. We performed a systematic review and meta-analysis to evaluate the aesthetic effectiveness, patients' satisfaction, skin quality, and safety profile of MFU-V treatment. A comprehensive search of 5 bibliographic databases up to 2023 was conducted. Pooled effect estimates using random effects models and corresponding 95% confidence intervals (95% CI) were calculated. Out of 4,019 references, 42 studies were included. Meta-analysis showed 89% of patients (95% CI: 81- 94%; I2: 63%, n=411) demonstrated some degree of global aesthetic improvement, as assessed by investigators. Similarly, 84% of patients (95% CI: 73- 91%; I2: 64%, n=312) reported improvement following treatment. Satisfaction of any level was reported by 84% of patients (95% CI: 61- 94%; I²: 52%, n=326), and 62% (95% CI: 37- 82%; I²: 3%, n=172) when 'neutral' as a response was provided for the patients. Skin quality (e.g., wrinkles, texture) also improved. Patients reported a pooled mean pain score of 4.85 (95% CI: 4.35, 5.35; I2: 97%, n=785), indicating moderate pain. Common adverse events included erythema, edema, swelling, bruising, and tenderness, all of which were generally mild to moderate in severity. Overall, our analysis demonstrated a notable increase in global aesthetic improvement and patients' satisfaction following MFU-V treatment, accompanied by moderate pain and a generally favorable safety profile. However, the potential misclassification of neutral responses as positive could result in an overestimation of the treatment's efficacy. These findings highlight the need for well-designed trials to further explore MFU-V's clinical applications.

Endometriosis: Future Biological Perspectives for Diagnosis and Treatment

Endometriosis is an oestrogen-dependent inflammatory disease affecting menstruating women, with varying levels of severity. Oestrogen dysregulation is responsible for chronic inflammation, angiogenesis, endometrial lesion development, progression, and infertility during menarche in afflicted women. The inflammatory mediators associated with this chronic painful disease have been established, with research also indicating the relationship between dysbiosis and disease manifestation. Endometriosis is also present with several painful comorbidities, including endometrial cancer, cardiovascular disease, and autoimmunity. The lack of specific and sensitive non-invasive diagnostic procedures, coupled with poor response to current therapeutic approaches, means that treatment needs remain unmet. Surgical procedures are performed to remove endometriosis ectopic lesions, for which the recurrence rate of disease is up to 50%, with certain patients exhibiting no alleviation of symptoms. This review aims to outline the aetiology of endometriosis, detailing novel diagnostic approaches and potential therapeutic approaches, namely advanced therapeutic medical products (ATMPs), including stem cell therapy and clustered regularly interspaced short palindromic repeats (CRISPR) gene editing. This timely review also provides novel insights into the important recent modalities which may be applied for the diagnosis and therapeutic response of endometriosis, including biomarkers, microfluidic platforms, and organoid systems. Undoubtedly, reliable, reproducible, sensitive, and specific models of endometriosis in humans are urgently needed to investigate and detail the aetiology of this debilitating disease.

Sensors: future tools for detecting young patient's stress during a dental invasive versus a non-invasive dental treatment-a pilot study.

A reliable tool to visualise children's early stress signs to prevent dental fear development is needed. The aim was to evaluate the commercially available, CE marked, Shimmer3 GSR + unit's ability to indicate for stress as a reaction of fear or pain for a non-invasive dental treatment (NI) and an invasive dental treatment (I). Patients 14-16years old were invited to undergo an oral check-up (NI) or an orthodontic premolar extraction (I), respectively. Digital data, measured via electrodes and optical pulse probe, placed on the wrist and fingers, monitored by the Shimmer3 GSR + unit, was transferred via Bluetooth to the HP-laptop. The observed digital parameters were: heart rate based on photoplethysmography (PPG), galvanic skin response (GSR), and 3-axis gyroscope and accelerometer signals for hand movements. Protocols for patient self-report scales were used: coloured analogue scale for pain intensity, facial analogue scale for the mood, and a dental fear scale. Descriptive statistics was performed. The NI-group: 20 patients, (14.6 ± 0.5years), underwent 20 oral check-ups. The I-group: 14 patients, (15.3 ± 0.5years), underwent 28 premolar extractions. All patients tolerated the Shimmer3 GSR + unit well. The GSR signal increased significantly, at start and during the oral injection, in the I-group. The GSR amplitudes persisted throughout and post the dental injection. No general uniform pattern or high GSR amplitudes were produced regarding NI-group. Considering the limitations of this study, the following conclusions can be made: the invasive treatment resulted in a specific unison GSR pattern, while the non-invasive procedure showed individually scattered GSR reactions. The commercially available CE-marked Shimmer3 GSR + device indicated the patient's stress response triggered by the invasive anaesthetic procedure.

Antepartum Cardiotocography and Feto-maternal Outcome Among Admitted Patients in Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh

Background: Admission Cardiotocography (CTG) a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward. This study is performed to assess the association of admission CTG findings with feto-maternal outcome at a tertiary health facility in Bangladesh. Materials and methods: A prospective, observational study of 50 pregnant women who were admitted into the labor ward with singleton live pregnancies in Bangabandhu Sheikh Mujib Medical University. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at p< 0.05. Results: The admission CTG findings were normal in 72% and abnormal in 28% of the women. The occurrence of low birth weight, asphyxiated neonates and Special Care Neonatal Unit (SCANU) admission was significantly more frequent among those with abnormal admission CTG results compared with normal results (p<0.001 for each). The incidence of cesarean delivery was more common when the CTG findings were abnormal, whereas all women with normal CTG result had a vaginal delivery (p<0.001). Conclusion: Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score and SCANU admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological. IAHS Medical Journal Vol 7(1), June 2024; 50-53

Abstract 4143239: Extracorporeal Shockwave Therapy Improves Physical Outcomes and Quality of Life In Patients With Symptomatic Peripheral Arterial Disease: Results from a Meta-analysis of Randomized Controlled Trials

Introduction: Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that may be useful to treat symptomatic peripheral arterial disease (PAD). Trials comparing ESWT with control groups have shown promising results. Methods: PubMed, Cochrane, EMBASE, and Google Scholar were searched for randomized controlled trials reporting the efficacy of extracorporeal shockwave therapy versus control in patients with symptomatic PAD. Data from eligible studies was analyzed using the Review Manager 5.4 software. Mean difference (MD) and 95% Confidence intervals (CI) were calculated for continuous outcomes. Inverse variance method and a random effects model were used for pooled estimates. A p-value < 0.05 (Z-test) was considered significant. Results: 5 randomized controlled trials with 264 patients were included in our analysis. A significant increase in the mean walking distance (MD: 54.13, 95% CI 9.34 to 98.92, p=0.02), pain-free walking distance (MD: 54.13, 95% CI 14.19, 57.88, p= 0.001), SF-36 physical component summary (MD: 11.97, 95% CI 0.26 to 23.69, p=0.05), EQ-5D-3L index score (MD; 0.08, 95% CI: 0.00 to 0.15, p=0.05) and VascuQoL index ((MD: 0.48, 95% CI 0.03 to 0.92, p= 0.04) was seen with ESWT. A slightly higher ankle brachial pressure index was seen in the control group (MD: -0.01, 95% CI: -0.02 to -0.00, p=0.04). There was no difference in SF-36 physical functioning domain score (MD: 18.58, 95% CI: -0.29 to 37.45, p=0.05) and SF-36 bodily pain score (MD: 9.17, 95% CI: -2.885 to 21.19, p=0.13). Conclusions: There was significant improvement in walking distances, exertional symptoms, and quality of life with ESWT. However, ESWT did not translate to an increase in post-treatment ankle-brachial index which was slightly higher in the control group. There is a need for larger randomized controlled trials to substantiate the efficacy of ESWT in treating symptomatic PAD.

Prediction model of male reproductive function damage caused by CHOP chemotherapy regimen for non-Hodgkin's lymphoma.

The CHOP combined chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) is commonly used to treat non-Hodgkin Lymphoma (NHL). While these drugs are effective for cancer treatment, they may have side effects on the reproductive system that are poorly studied. This study used a mouse model to investigate the mechanisms of reproductive function impairment induced by the CHOP regimen and developed a predictive model for assessing reproductive damage with a non-invasive procedure. From 2022 to 2023, we statistically analyzed the changes of reproductive function of NHL patients before and after receiving CHOP regimen in the First Affiliated Hospital of Xiamen University. The NHL mouse model was established and divided into CHOP treatment group and control group. The weight of testis and epididymis, sperm quality and motility were compared between the two groups. Histopathological examination of testicular tissue was performed to determine pathological changes. ELISA was used to measure the expression of cytokines and cytokine pathways in serum, protein expression was analyzed by immunohistochemistry, and protein and mRNA levels of cytokines and pathways were evaluated by Western blotting and qPCR. Using stepwise regression method to select important factors, a prediction model of reproductive system damage was constructed. Fifty-two NHL patients included in the questionnaire showed significant reproductive system damage after CHOP regimen treatment. The weight of testis and epididymis, as well as the number and vitality of sperm in the mouse model treatment group were significantly lower than those in the control group. Serum LH, FSH, estradiol and progesterone levels decreased significantly, while inhibin B levels increased significantly. There was no significant change in testosterone or prolactin levels. Inflammatory markers such as CSF-1, IL-1, IL-6, TGF-β1 and GDNF increased significantly, while the level of SOD1 decreased significantly. Immunohistochemical staining analysis showed that CAMP, Caspase3, CSF-1, GDNF, IL-1, IL-6, PRKACB, TGF-β1 and TXNDC5 were all expressed in spermatocytes, and the expression of therapeutic histones was significantly higher than that of the control group. Western blot analysis further detected the protein expression, and QPCR detected the mRNA content. The results showed that the expression of histone and mRNA in the treatment group was significantly higher than that in the control group. Stepwise regression method determined that estradiol (E2) was the most important variable in the prediction model, and the AUC for predicting reproductive damage was 1. The CHOP regimen induces male reproductive toxicity, potentially mediated through alterations in hormone levels and increased expression of inflammatory cytokines and oxidative stress. Using E2 as the sole predictor in the model accurately predicts the extent of reproductive damage, offering a non-invasive method for detecting reproductive system damage.

Using Extracorporeal Shockwave Therapy in Patients with Orthopedic Conditions

Background: Among other non-invasive procedures, Extracorporeal Shockwave Treatment (ESWT) has been used to resolve many musculoskeletal ailments. The authors completed a systematic review to study articles that reported the effectiveness of focused shockwave therapy in patients with orthopedic conditions. Methods: A comprehensive search was conducted across reputable databases including Pub Med, The Cochrane Library, Science Direct, PEDro, Clinicaltrials.gov, and Google Scholar, ensuring a thorough review of the literature until October 10, 2022. Original articles of any design reporting on the use of ESWT in orthopedic patients were meticulously selected. Information related to study design, sample size, participants, intervention, and key findings of the study were extracted. The PEDro classification scale, a recognized tool, was used to evaluate the quality of the studies, further enhancing the credibility of findings. Results: Nineteen research articles (including 1157 participants) were retrieved and included for qualitative analysis. The sample size ranged from twenty-one to one hundred fifteen subjects, and the articles were published between 2001 and 2022. Out of 19 studies published, five were conducted in China, three in Germany, two in Iran and Turkey, and one in the United States, Canada, Italy, Denmark, Spain, Taiwan, and Saudi Arabia. The risk of bias was either moderate or low among the included studies. In patients with various orthopedic conditions, considerable moderate evidence of ESWT’s effectiveness and success in lowering pain levels, increasing treatment success rates, promoting patient-reported functional recovery, and raising performance-based functional outcomes was seen in the results. Conclusion: The systematic literature review provided compelling evidence of the successful application of ESWT in treating a wide range of musculoskeletal problems. These positive outcomes were achieved without severe complications and morbidities, offering a promising outlook for the future of orthopedic treatment.

Direct conversion of urine-derived cells into functional motor neuron-like cells by defined transcription factors

Direct cell-type conversion of somatic cells into cell types of interest has garnered great attention because it circumvents rejuvenation and preserves the hallmarks of cellular aging (unlike induced pluripotent stem cells [iPSCs]) and is more suitable for modeling diseases with strong age-related and epigenetic contributions. Fibroblasts are commonly used for direct conversion; however, obtaining these cells requires highly invasive skin biopsies. Urine-derived cells (UDCs) are an alternative cell source and can be obtained via noninvasive procedures. Herein, induced motor neuron-like cells (iMNs) were generated from UDCs by transducing transcription factors involved in motor neuron (MN) differentiation. iMNs exhibited neuronal morphology, upregulation of pan-neuron and MN markers, and MN functionality, including spontaneous calcium oscillation and bungarotoxin-positive neuromuscular junction formation, when co-cultured with myotubes. Altogether, the findings of this study indicated that UDCs can be converted to functional MNs. This technology may allow us to understand disease pathogenesis and progression and discover biomarkers and drugs for MN-related diseases at the population level.

MANTRACHIKITSA: FACTS AS MENTIONED IN THE AYURVEDIC CLASSICS

Mantra, indicates chanting of some prescribed verses for designated purposes, is a controversial but interesting and important topic. Scientific validation of mantra is difficult to establish due to the factors like – difficulty in (1) understanding the meaning of the verses, (2) understanding the mode of action, (3) understanding the effect scientifically etc. But traditional experience and classical references strongly support the use and efficacy of Mantra in different references. A number of researches are also already conducted in different levels with the aim to understand it scientifically. In the Ayurvedic classics a number of indications and benefits of Mantra are mentioned in different references like Vishachikitsa (in snakebite mentioned with top priority), Grahachikitsa (conditions that occur due to effect of some unseen, unundentifiable aetiologies etc.). The Ayurvedic scholars have discussed in detail about mantra with special reference to method of learning, practising etc. As a widely discussed noninvasive treatment procedure that is getting topmost priority in a condition like snakebite (a very dangerous and usually fatal poisoning) a discussion on Mantra basing upon the Ayurvedic classics is considered to be informative and thought provoking for the scientific forum.

Actual clinical practice pattern in SWL after COVID-19 era: a critical evaluation from different aspects.

To outline the current status of Shock Wave Lithotripsy (SWL) in stone treatment and the changes in the mode of application after the COVID-19 pandemic along with critical factors affecting the clinical practice of this particular procedure. This study targeted national and international urology experts who could share and contribute their experiences and perspectives on SWL practices after COVID-19 era. Approximately 650 urology specialists were invited to participate in the survey based study via Google Forms. Participation was voluntary and 398 of the invited participants completed the survey, yielding an acceptable response rate of approximately 61.23%. This survey highlights significant findings that shed light on the changes in clinical SWL applications. Nearly half of SWL procedures are performed by technicians or nurses instead of experienced urologists, potentially affecting the proper application and outcomes of the procedure. SWL seemed to be applied on a guideline (GL) indications based manner by the majority of the participants. Fluoroscopy remains still as the most commonly used method for radiological assessment, underscoring the necessity to teach sonography applications to younger urologists. Key reasons for the limited clinical application of SWL include the absence of lithotripters in the departments, high lithotriptor costs and significantly lower reimbursement rates compared to PNL and fURS modalities. Finally, an increase in SWL utilization rates has been observed post-COVID-19, highlighting its certain advantages realized during this period. These findings provide important insights into the role of SWL in stone treatment and the main factors influencing its clinical application practices. Although the popularity of SWL in the management of urinary stones is being stated to decline particularly in the last two decades, data obtained in this survey emphasized well that it is still a viable option especially for stones smaller than 15mm. Our findings highlight the enduring relevance of SWL in contemporary stone therapy protocols in the context of COVID-19, where outpatient, non-invasive procedures are preferred. In addition to the consideration of certain factors affecting the rate of its application in clinical practice, to achieve high success rates with minimal complications in SWL, strategic patient selection and adherence to procedure guidelines seem to be crucial.

Evaluating the Role of Hyperbaric Oxygenation Therapy in Improving Diabetic Foot Ulcer Healing: A Systematic Review

Background: Diabetic foot ulcer (DFU) is a frequent complication of poorly controlled diabetes mellitus and can lead to amputation, significantly impacting quality of life. Although DFU is common, its treatment remains complex and could benefit from improvement. Hyperbaric oxygenation therapy (HBOT) is a noninvasive procedure that has recently shown potential as an alternative treatment for DFU. Given the increasing interest in HBOT, with many centers actively researching and developing advancements in this area, this review aims to not only gather and analyze relevant studies but also assess the feasibility of integrating HBOT into clinical practice as a viable, noninvasive alternative for DFU treatment.Methods: This review was conducted following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guideline on studies published on HBOT for DFU. Each included study was critically appraised using the 2020 JBI Checklist for Randomized Controlled Trials.Results: From three databases, eight out of 1,665 records were included for this review. Critical appraisal revealed that of the eight studies, only three fulfilled all criteria outlined in the checklist, as three studies did not indicate blinding, and two studies were open-label. The utilization of HBOT in the treatment of DFU resulted in various changes both in the wound healing process and risk of complications.Conclusion: Based on the majority of the included studies, HBOT revealed a positive impact in aiding the healing of DFUs and in mitigating various risk of complications.

Grad-CAM Enabled Breast Cancer Classification with a 3D Inception-ResNet V2: Empowering Radiologists with Explainable Insights.

Breast cancer (BCa) poses a severe threat to women's health worldwide as it is the most frequently diagnosed type of cancer and the primary cause of death for female patients. The biopsy procedure remains the gold standard for accurate and effective diagnosis of BCa. However, its adverse effects, such as invasiveness, bleeding, infection, and reporting time, keep this procedure as a last resort for diagnosis. A mammogram is considered the routine noninvasive imaging-based procedure for diagnosing BCa, mitigating the need for biopsies; however, it might be prone to subjectivity depending on the radiologist's experience. Therefore, we propose a novel, mammogram image-based BCa explainable AI (BCaXAI) model with a deep learning-based framework for precise, noninvasive, objective, and timely manner diagnosis of BCa. The proposed BCaXAI leverages the Inception-ResNet V2 architecture, where the integration of explainable AI components, such as Grad-CAM, provides radiologists with valuable visual insights into the model's decision-making process, fostering trust and confidence in the AI-based system. Based on using the DDSM and CBIS-DDSM mammogram datasets, BCaXAI achieved exceptional performance, surpassing traditional models such as ResNet50 and VGG16. The model demonstrated superior accuracy (98.53%), recall (98.53%), precision (98.40%), F1-score (98.43%), and AUROC (0.9933), highlighting its effectiveness in distinguishing between benign and malignant cases. These promising results could alleviate the diagnostic subjectivity that might arise as a result of the experience-variability between different radiologists, as well as minimize the need for repetitive biopsy procedures.

Defining the molecular response to ischemia-reperfusion injury and remote ischemic preconditioning in human kidney transplantation

Background Ischemia-reperfusion injury (IRI) inevitably occurs during kidney transplantation and extended ischemia is associated with delayed graft function and poor outcomes. Remote ischemic preconditioning (RIPC) is a simple, noninvasive procedure aimed at reducing IRI and improving graft function. Experimental studies have implicated the kynurenine pathway as a protective mechanism behind RIPC. Methods First, paired biopsies from 11 living kidney donors were analyzed to characterize the acute transcriptomic response to IRI. Second, 16 living kidney donors were subjected to either RIPC (n = 9) or no pretreatment (n = 7) to evaluate the impact of RIPC on the transcriptomic response to IRI. Finally, the effect of RIPC on plasma metabolites was analyzed in 49 healthy subjects. Results There was a robust immediate response to IRI in the renal transcriptomes of living-donor kidney transplantation, including activation of the mitogen-activated protein kinase (MAPK) and epidermal growth factor receptor (EGFR) pathways. Preconditioning with RIPC did not significantly alter the transcriptomic response to IRI or the concentration of plasma metabolites. Conclusions The present data validate living-donor kidney transplantation as a suitable model for mechanistic studies of IRI in human kidneys. The failure of RIPC to alter transcriptomic responses or metabolites in the kynurenine pathway raises the question of the robustness of the standard procedure used to induce RIPC, and might explain the mixed results in clinical trials evaluating RIPC as a method to attenuate IRI.

Music Therapy for Pain and Anxiety Reduction in Pediatric Patients Undergoing Procedures: A Systematic Review and Meta-Analysis Protocol

Introduction: Many children undergo invasive and noninvasive procedures in the pediatric medical setting, which can be associated with pain and anxiety. Both pharmacological and nonpharmacological interventions are currently being used to minimize pain and anxiety in pediatric patients in the medical setting. Music therapy is an evidence-based, cost-effective, and nonpharmacological service administered by a board-certified music therapist which may reduce pediatric pain and anxiety during procedures. We will undertake a systematic review and meta-analysis that will comprehensively analyze the quantitative publications that detail the effects of music therapy on pediatric pain and anxiety for patients undergoing invasive or noninvasive medical procedures. Method: This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement and is registered in the International Prospective Register of Systematic Reviews (Prospero; CRD42023474635 ). A three-step, iterative search strategy will include (1) an initial scoping search, (2) development and execution of a comprehensive search strategy, and (3) a search for additional publications. Procedures for disagreements among reviewers and the article screening process are outlined. Statistical analyses including analysis of outcomes and sensitivity analysis has been determined. A plan for critical appraisal of sources using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) and quality of evidence using the Outcome Reporting Bias in Trials (ORBIT) of evidence is also present in this protocol. Conclusion: This protocol is presented with the intention to execute and publish results of this systematic review and meta-analysis to help inform clinical practice and future research.

Combined analysis of a serum mRNA/miRNA marker signature and CA 19-9 for timely and accurate diagnosis of recurrence after resection of pancreatic ductal adenocarcinoma: A prospective multicenter cohort study.

Timely and accurate detection of tumor recurrence in pancreatic ductal adenocarcinoma (PDAC) patients is an urgent and unmet medical need. This study aimed to develop a noninvasive molecular diagnostic procedure for the detection of recurrence after PDAC resection based on quantification of circulating mRNA and miRNA biomarkers in serum samples. In a multicentric study, serum samples from a total of 146 patients were prospectively collected after resection. Samples were classified into a "No Evidence of Disease" and a "Recurrence" group based on clinical follow-up data. A multianalyte biomarker panel was composed of mRNAs and miRNA markers and simultaneously analyzed in serum samples using custom microfluidic qPCR arrays (TaqMan array cards). A diagnostic algorithm was developed combining a 7-gene marker signature with CA19-9 data. The best-performing marker combination achieved 90% diagnostic accuracy in predicting the presence of tumor recurrence (98% sensitivity; 84% specificity), clearly outperforming the singular CA 19-9 analysis. Moreover, time series data obtained by analyzing successively collected samples from 5 patients during extended follow-up suggested that molecular diagnosis has the potential to detect recurrence earlier than routine clinical procedures. TaqMan array card measurements were found to be biologically valid and technically reproducible. The BioPac multianalyte marker panel is capable of sensitive and accurate detection of recurrence in patients resected for PDAC using a simple blood test. This could allow a closer follow-up using shorter time intervals than currently used for imaging, thus potentially prompting an earlier work-up with additional modalities to allow for earlier therapeutic intervention. This study provides a promising approach for improved postoperative monitoring of resected PDAC patients, which is an urgent and unmet clinical need.

Combined Efficacy of Q-Switched 785 nm Laser and Tranexamic Acid Cream in the Treatment of Melasma: A Prospective Clinical Study

Background and Objectives: Melasma, a hypermelanotic dermatologic condition that mainly affects women, poses challenges due to its complex etiology involving environmental and genetic factors. Its pathophysiology, marked by intricate histological changes, is not fully understood. This study explored the efficacy and safety of a new 785 nm picosecond laser in treating facial melasma. Materials and Methods: An 11-participant cohort, comprising women with Fitzpatrick phototypes II-III, underwent a treatment protocol with a new 785 nm picosecond laser. The clinical evaluation used the Global Aesthetic International Score (GAIS) and the Five-Point Likert Scale Questionnaire. The aim of the study was to understand the capacity of the 785 nm wavelength laser to interact with both the pigmentary and vascular components of melasma. Results: The GAIS outcomes revealed excellent (18.2%), good (54.5%), poor (18.2%), and no results (9.1%). The Likert Scale responses varied from very satisfied (18.2%) to slightly satisfied (9.1%). Clinical images at three months demonstrated resolution of melasma with no adverse events. Conclusions: This non-invasive procedure showed positive outcomes and high patient tolerance, emphasizing its potential in melasma management. However, in order to fully understand the interactions of pigmentary and vascular components with the 785 nm wavelength laser, further research is required. The small cohort represents a limitation for this study, therefore studies that include a larger number of patients are needed to assess the effectiveness of this laser treatment for facial melasma.

Comparison of measurement of integrated relaxation pressure by esophageal manometry with analysis of swallowing sounds with artificial intelligence in patients with achalasia.

Esophageal motility disorders are mainly evaluated with high-resolution manometry (HRM) which is a time-consuming and uncomfortable procedure with potential adverse events. Acoustic characterization of the swallowing has the potential to be an alternative noninvasive procedure. We compared the findings on HRM and swallowing sounds in 43 patients who were referred for evaluation of dysphagia. The sound analysis was done with empirical mode decomposition method and with artificial intelligence (AI) and the estimated integrated relaxation pressure (IRP) from a two-layer neural network method was compared to measured IRP on HRM. The model then was tested in five patients. IRP was estimated with high accuracy using the model developed with two-layer neural network method. The analysis of acoustic properties of swallowing has the potential to be used for evaluation of esophageal motility disorders, this needs to be further evaluated in larger studies.

Advanced Techniques In Oral Oncology: AComprehensiveReview

The most common type of oral cancer, oral squamous cell carcinoma (OSCC), is still amajor global health concern. Due to delayed diagnoses, which are frequently caused by low public awareness and fewscreeningalternatives, the five-year survival rate is still low. Modernmethods in oral oncology have arisen to enhance patient outcomes and early identification, including as molecular and imaging diagnostics. This review showcases several cutting-edge diagnostic techniques, including flow cytometry, next-generation sequencing(NGS), chemiluminescence, toluidine blue, immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), polymerase chain reaction (PCR), and nano-diagnostics. By providing insights into tumor behaviourand enabling customized treatment approaches, these techniques advance our knowledge of the genetic and proteomic landscape of oral cancer. Combining these cutting-edge approaches with conventional diagnosticsmight greatly improve the accuracy of OSCC detection and risk assessment, despite drawbacks like false positives and expensive procedures. Improving patient care greatly depends on the creation of quick, noninvasive procedures and the investigation of genetic biomarkers. The present review highlightsthe need for continued research and training in oral oncology to maximize early diagnosis and intervention strategies

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.