Hasil untuk "Medicine (General)"

M. Vernooij, M. Ikram, H. Tanghe et al.

N. Collop, W. Anderson, B. Boehlecke et al.

R. Miller, H. E. Pople, J. Myers

D. Studdert, M. Mello, W. Sage et al.

M. Maitz

Abstract Multiple biological, synthetic and hybrid polymers are used for multiple medical applications. A wide range of different polymers is available, and they have further the advantage to be tunable in physical, chemical and biological properties in a wide range to match the requirements of specific applications. This review gives a brief overview about the introduction and developments of polymers in medicine in general, addressing first stable polymers, then polymers with degradability as a first biological function, followed by various other functional and responsive polymers. It is shown up that biomedical polymers comprise not only bulk materials, but also coatings and pharmaceutical nano-carriers for drugs. There is subsequently an overview of the most frequently used polymer classes. The main body of the review then is structured according to the medical applications, where key requirements of the applications and the currently used polymer solutions are indicated.

W. Coleman

T. Brenn

Joana Marques‐Antunes, Egon Rodrigues, Marta Guimarães et al.

PurposeRepairing complex abdominal wall hernias is challenging, often requiring component separation techniques (CST) for tension-free closure. Adjuvant therapies, such as botulinum toxin type A (BTA), preoperative progressive pneumoperitoneum (PPP), and intraoperative fascial traction (IFT), may reduce the need for CST by improving abdominal wall compliance and reduce the complexity of the hernia. There is limited knowledge about the effects of their combined use. Our aim is to evaluate the rate of CST in abdominal wall reconstruction for complex midline hernias after adjuvant therapies.MethodsA cross-sectional study was conducted on patients who underwent surgery for correction of midline complex abdominal hernias between June 2020 and June 2024. Patients submitted to BTA, PPP, or/and IFT were included. Exclusion criteria were non-midline hernias, non eletive surgeries and less than 3 months of follow-up.ResultsAmong the 44 patients studied, 61.4% underwent abdominal wall reconstruction without requiring CST. Traditional predictors like component separation index and rectus/defect ratio were not associated with a higher rate of CST after adjuvant therapies. 45.5% of patients underwent a combination of adjuvant techniques (BTA + PPP or BTA + IFT). The early and late complication rates were 20.5% and 9.1%. A recurrence rate of 4.5% was reported after a median follow-up of 13 months.ConclusionThis study suggests that adjuvant therapies may influence the surgical approach to abdominal wall reconstruction. The synchronous application of adjuvant therapies, both preoperatively and intraoperatively, could enhance their effect and contribute to the use of less disruptive techniques.

Choon Chiat Oh, Boon Yee Lim, Elizabeth Chun Yong Lee et al.

ABSTRACT Background Cutaneous squamous cell carcinoma (cSCC) remains poorly understood at the molecular level, both in the immunocompetent and immunosuppressed population with skin of colour. Data on the diversity of viruses found in cSCC is also lacking. Objectives We aimed to characterise the immunological and molecular profiles of cSCC in organ transplant recipients (OTR) and non‐transplant recipients in an Asian cohort (n = 53) and explore the diversity of viruses detected. Methods Gene expression analysis was performed on snap‐frozen cSCC tissues using the NanoString PanCancer IO360 panel. Viral detection was performed using the Twist Comprehensive Viral Research Panel. Results cSCC presented dysregulation of immune response pathways and tumour microenvironment remodelling compared to adjacent normal skin tissue. Cell‐type profiling based on gene expression profiles showed higher levels of exhausted CD8 cells, neutrophils, and cytotoxic cells in tumour cells. Furthermore, three distinct clusters of cSCC gene signatures could be observed, where Cluster 3 with the highest Tumour inflammation signature (TIS) scores displayed distinct upregulation of most pathways suggesting a more inflamed or “hot” tumour phenotype. cSCC of OTR exhibited greater expression of tumour markers (AQP9, SERPINA1) and reduced expression of T‐cell cytokines (CXCL10, CXCL11). Viruses were particularly enriched in tumour tissue, as compared with normal skin. In addition, there was an enrichment of detectable viruses in transplant‐associated cSCC, with several tumours harbouring multiple viruses (HPV, EBV, MCV, and TTV). Conclusions cSCC is marked by a pro‐tumorigenic immune environment with altered immune cell populations. These findings support the potential for stratified, immune‐tailored treatment approaches for cSCC, especially in OTR who have a higher disease burden. Future studies on the possible oncogenic role of the detected viruses can be undertaken.

Ryan T. Li, Scott R. Kling, Michael J Salata et al.

Context: Wearable performance devices and sensors are becoming more readily available to the general population and athletic teams. Advances in technology have allowed individual endurance athletes, sports teams, and physicians to monitor functional movements, workloads, and biometric markers to maximize performance and minimize injury. Movement sensors include pedometers, accelerometers/gyroscopes, and global positioning satellite (GPS) devices. Physiologic sensors include heart rate monitors, sleep monitors, temperature sensors, and integrated sensors. The purpose of this review is to familiarize health care professionals and team physicians with the various available types of wearable sensors, discuss their current utilization, and present future applications in sports medicine. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database. Included studies searched development, outcomes, and validation of wearable performance devices such as GPS, accelerometers, and physiologic monitors in sports. Study Design: Clinical review. Level of Evidence: Level 4. Results: Wearable sensors provide a method of monitoring real-time physiologic and movement parameters during training and competitive sports. These parameters can be used to detect position-specific patterns in movement, design more efficient sports-specific training programs for performance optimization, and screen for potential causes of injury. More recent advances in movement sensors have improved accuracy in detecting high-acceleration movements during competitive sports. Conclusion: Wearable devices are valuable instruments for the improvement of sports performance. Evidence for use of these devices in professional sports is still limited. Future developments are needed to establish training protocols using data from wearable devices.

Felix E Y Aggor, Martinna Bertolini, Bianca M Coleman et al.

Oropharyngeal candidiasis (OPC) is the most common human fungal infection, arising typically from T cell immune impairments. IL-17 and IL-22 contribute individually to OPC responses, but here we demonstrate that the combined actions of both cytokines are essential for resistance to OPC. Mice lacking IL-17RA and IL-22RA1 exhibited high fungal loads in esophagus- and intestinal tract, severe weight loss, and symptoms of colitis. Ultimately, mice succumbed to infection. Dual loss of IL-17RA and IL-22RA impaired expression of small proline rich proteins (SPRRs), a class of antimicrobial effectors not previously linked to fungal immunity. Sprr2a1 exhibited direct candidacidal activity in vitro, and Sprr1-3a-/- mice were susceptible to OPC. Thus, cooperative actions of Type 17 cytokines mediate oral mucosal anti-Candida defenses and reveal a role for SPRRs.

Ashagrie Sharew Iyassu, Haile Mekonnen Fenta, Zelalem G. Dessie et al.

Abstract Background In causal analyses, some third factor may distort the relationship between the exposure and the outcome variables under study, which gives spurious results. In this case, treatment groups and control groups that receive and do not receive the exposure are different from one another in some other essential variables, called confounders. Method Place of birth was used as exposure variable and age-specific childhood vaccination status was used as outcome variables. Three approaches of confounder selection techniques such as all pre-treatment covariates, outcome cause covariates, and common cause covariates were proposed. Multiple logistic regression was used to estimate the propensity score for inverse probability treatment weighting (IPTW) confounder adjustment techniques. The proportional odds model was used to estimate the causal effect of place of birth on age-specific childhood vaccination. To validate the result obtained from observed data, we used a plasmode simulation of resampling 1000 samples from actual data 500 times. Result Outcome cause and common cause confounder identification techniques gave comparable results in terms of treatment effect in the plasmode data. However, outcome causes that contain common causes and predictors of the outcome confounder identification gave relatively better treatment effect results. The treatment effect result in the IPTW confounder adjustment method was better than that of the regression adjustment method. The effect of place of birth on log odds of cumulative probability of age-specific childhood vaccination was 0.36 with odds ratio of 1.43 for higher level vaccination status. Conclusion It is essential to use plasmode simulation data to validate the reproducibility of the proposed methods on the observed data. It is important to use outcome-cause covariates to adjust their confounding effect on the outcome. Using inverse probability treatment weighting gives unbiased treatment effect results as compared to the regression method of confounder adjustment. Institutional delivery increases the likelihood of childhood vaccination at the recommended schedule.

Marcus William Kruger, Jana du Plessis, Pravani Moodley

Introduction: Unstable pelvic fractures cause significant bleeding, morbidity, and mortality. Commercially available Pelvic Circumferential Compression Devices (PCCDs) are used in the initial resuscitation and management of these cases. In the trauma-burdened, resource limited setting of Southern Africa, the available alternative is a pelvic sheet binder (PSB). For optimal results placement should be at the greater trochanters (GTs). Prior studies have shown that practitioners are inaccurate in their placement. This study aimed to describe placement of PSBs by doctors and factors influencing placement. Methods: This was a multicentre, prospective, observational, simulation-based study. Doctors working in Emergency Departments (EDs) and Trauma Emergency Units (TEUs) in Johannesburg were asked to place a PSB on two healthy male models of differing body mass index (BMI), as simulated patients (SPs). Outcomes were based on PSB position relative to the GTs, marked using an ultraviolet pen, and photographed under ultraviolet light. Data on techniques of placement, as well as practitioner factors, were also collected to investigate their influence on accuracy. Results: In this study 147/176 (83.5 %) of the PSBs placed were correct (trochanteric). Of those placed on the normal BMI SP 71/88 (81 %) were correct and 76/88 (86 %) of those on the increased BMI SP. BMI did not appear to influence accuracy of placement. Practitioner factors that had statistically significant association with accurate placement included the following: Working in the TEU, work experience of ≥6 years, a diploma in primary emergency care (DipPEC, College of emergency medicine, South Africa), all methods of placing the PSB and inspecting to find the GTs. Conclusion: The overall accuracy of PSBs placement was high (83.5 %). Additional postgraduate training (DipPEC) and work experience improved placement accuracy. This study highlighted the importance of additional trauma training and areas of possible future research, such as optimal binder width and method of securing PSBs.

Aaron Stupple, David Singerman, L. Celi

INTRODUCTION If anyone doubts the explosive growth of interest in digital medicine, consider a recent conference and workshop in Beijing, jointly organized by the People’s Liberation Army General Hospital and MIT Critical Data to showcase the opportunities and challenges of applying machine learning to the kind of data routinely collected during the provision of care. In person, 500 attendees heard a keynote and panels and participated in a health data hackathon. Online, however, the event was streamed to more than one million unique viewers. As databases of medical information are growing, the cost of analyzing data is falling, and computer scientists, engineers, and investment are flooding into the field, digital medicine is subject to increasingly hyperbolic claims. Every week brings news of advances: superior algorithms that can predict clinical events and disease trajectory, classify images better than humans, translate clinical texts, and generate sensational discoveries around new risk factors and treatment effects. Yet the excitement about digital medicine—along with the technologies like the ones that enable a million people to watch a major event—poses risks for its robustness. How many of those new findings, in other words, are likely to be reproducible? Digital medicine must take steps to avoid a reproducibility “crisis” of the kind that has engulfed other areas of biomedicine and human science in the last decade and shaken public confidence in the validity of scientific work. The goal of this paper is to use a historical perspective on reproducibility and its current crisis to suggest how digital medicine can avoid a reproducibility crisis of its own.

M. D. Mauricio, S. Guerra-Ojeda, P. Marchio et al.

Nanotechnology has had a significant impact on medicine in recent years, its application being referred to as nanomedicine. Nanoparticles have certain properties with biomedical applications; however, in some situations, they have demonstrated cell toxicity, which has caused concern surrounding their clinical use. In this review, we focus on two aspects: first, we summarize the types of nanoparticles according to their chemical composition and the general characteristics of their use in medicine, and second, we review the applications of nanoparticles in vascular alteration, especially in endothelial dysfunction related to oxidative stress. This condition can lead to a reduction in nitric oxide (NO) bioavailability, consequently affecting vascular tone regulation and endothelial dysfunction, which is the first phase in the development of cardiovascular diseases. Therefore, nanoparticles with antioxidant properties may improve vascular dysfunction associated with hypertension, diabetes mellitus, or atherosclerosis.

Angel Chao, Ren-Chin Wu, Chiao-Yun Lin et al.

Small cell neuroendocrine carcinoma of the cervix (SCNECC) is an uncommon but aggressive uterine malignancy, the cause of which is generally associated with human papillomavirus (HPV) infection. A lack of clinical trials and evidence-based treatment guidelines poses therapeutic challenges to this rare tumor. At present, published data remain limited to case series and case reports. While clinical management has traditionally followed those of small cell neuroendocrine (SCNE) lung cancer relying on surgery, chemoradiation, and systemic chemotherapy, the prognosis remains dismal. Immune checkpoint inhibitors (ICIs), such as monoclonal antibodies that target programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1), atezolizumab and durvalumab have proven effective in extensive-stage SCNE lung cancer. Moreover, pembrolizumab has also proven beneficial effects when added onto chemotherapy in metastatic and recurrent HPV-associated non-SCNE cervical cancer. It holds promise to use ICIs in combination with chemoradiation to improve the clinical outcomes of patients with SCNECC. Future advances in our understanding of SCNECC biology – associated with the study of its genomic and molecular aberrations as well as knowledge from SCNE of lung and other extrapulmonary sites– would be helpful in discovering new molecular targets for drug development. Collaborative efforts and establishment of a SCNECC-specific biobank will be essential to achieve this goal.

Koma Akim

The objective of the study is to demonstrate the significance of damage control surgery in saving lives and possibly preventing permanent disability in a resource poor environment. This is because in resource limited settings, advanced treatment modalities such as external fixation and angiography with embolization are not available. Moreover, besides being expensive, these treatment methods for pelvic fractures require training and skills to perform. The retroperitoneal pelvic packing is easy to learn and, thus can be used in an emergency to save lives and prevent long-term problems in patients who have sustained life threatening pelvic injuries and severe haemorrhage. Therefore, specialist surgeons, especially those working in low- and middle-income countries, should be encouraged to learn and consider retroperitoneal pelvic packing as a stabilization and definitive treatment in some cases of pelvic fractures.

Heather Symecko, Robert Schnoll, Rinad S. Beidas et al.

Abstract Background Germline genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) for individuals including, but not limited to, those with a personal history of ovarian cancer, young-onset (< 50 years) breast cancer, and a family history of ovarian cancer or male breast cancer. Genetic testing is underused overall, and rates are consistently lower among Black and Hispanic populations. Behavioral economics-informed implementation strategies, or nudges, directed towards patients and clinicians may increase the use of this evidence-based clinical practice. Methods Patients meeting eligibility for germline genetic testing for breast and ovarian cancer will be identified using electronic phenotyping algorithms. A pragmatic cohort study will test three sequential strategies to promote genetic testing, two directed at patients and one directed at clinicians, deployed in the electronic health record (EHR) for patients in OB-GYN clinics across a diverse academic medical center. We will use rapid cycle approaches informed by relevant clinician and patient experiences, health equity, and behavioral economics to optimize and de-risk our strategies and methods before trial initiation. Step 1 will send patients messages through the health system patient portal. For non-responders, step 2 will reach out to patients via text message. For non-responders, Step 3 will contact patients’ clinicians using a novel “pend and send” tool in the EHR. The primary implementation outcome is engagement with germline genetic testing for breast and ovarian cancer predisposition, defined as a scheduled genetic counseling appointment. Patient data collected through the EHR (e.g., race/ethnicity, geocoded address) will be examined as moderators of the impact of the strategies. Discussion This study will be one of the first to sequentially examine the effects of patient- and clinician-directed strategies informed by behavioral economics on engagement with breast and ovarian cancer genetic testing. The pragmatic and sequential design will facilitate a large and diverse patient sample, allow for the assessment of incremental gains from different implementation strategies, and permit the assessment of moderators of strategy effectiveness. The findings may help determine the impact of low-cost, highly transportable implementation strategies that can be integrated into healthcare systems to improve the use of genomic medicine. Trial registration ClinicalTrials.gov. NCT05721326. Registered February 10, 2023. https://www.clinicaltrials.gov/study/NCT05721326

M. Bashaar, V. Thawani, M. Hassali et al.

BackgroundMost of the medicine users remain unaware about the disposal of unused or expired medicines. The aim of this study was to know the disposal practices of unused and expired medicines among the general public in Kabul.MethodsThis was a descriptive, cross-sectional survey, conducted through face-to-face interviews using prevalidated structured questionnaire. Returned questionnaires were double-checked for accuracy. Statistical Package for Social Science (SPSS) version 23 was used for statistical analysis.ResultsTotal of 301 valid questionnaires were returned with a response rate of 100% in which 73.4% men and 26.6% women participated. More than half of the respondents were university graduates. Interestingly, 83.4% of the interviewees purchased medicines on the prescription of which 47.2% were university graduates, while 14.6% purchased medicine over the counter. Among the respondents, 46.5/100 purchased antibiotics and the remaining purchased NSAIDs, anti-hypertensive and anti-diabetic medicines. Significantly, 97/100 checked the expiry date of medicine before buying. Majority (95.3%) of the respondents’ stored medicines at home. 77.7% of the respondents discarded the expired medicines in household trash. Majority of respondents held government responsible for creation of awareness for proper medicine disposal. Almost entire sample (98%) felt that improper disposal of unused and expired medicines can affect the environment and health.ConclusionGaps exist in practices, therefore robust, safe and cost-effective pharmaceutical waste management program supported with media campaign is needed. Healthcare practitioners and community pharmacists should offer training to educate customers on standard medicine disposal practices.

Zonyin Shae, J. Tsai