Medical hypotheses最新文献

Robotic-assisted mitral valve surgery is gaining renewed popularity in the global surgical community. Appropriate patient-specific planning is pivotal for the safety and effectiveness of this procedure. One main step in this perspective is represented by the choice of placement of four ports in the right chest, for the introduction of robotic arms. Individual anatomical features (e.g., chest morphology and position of the mitral valve inside the chest) may determine inadequate surgical exposure, conversion to open procedure, or refusal for the technique. Currently, and contrary to robotic-assisted procedures in other surgical specialties, there is no dedicated approach or tool for patient-specific planning aimed at formally addressing these issues preoperatively. Herein, we present a dedicated, comprehensive method entailing: a homemade algorithm for rib segmentation (deep learning approach) and identification of intercostal spaces / candidate port entry sites; semiautomatic definition of a target working volume (mitral valve); definition of dedicated Performance Measure J* based on each potential triad of thoracic ports entry sites. We propose the dedicated J* parameter to better indicate the optimal patient-specific entry port solution than other parameters (h_e, ic, CCI and E). Prospective clinical studies should be based on the J* parameter. We hypothesize that this approach, dedicated to the requirements of robotic-assisted mitral valve surgery, may enhance the safety and the diffusion of this surgical strategy.

This article explores the potential of transauricular Vagus nerve stimulation (taVNS) in treating Functional Seizures (FS), a condition that significantly burdens healthcare systems. Traditional seizure treatments are ineffective for FS due to its unique pathophysiology, highlighting the urgent need for alternative therapeutic strategies. While invasive VNS has shown promise in improving autonomic balance, its invasive nature poses limitations in FS treatment. taVNS, a non-invasive alternative, enhances parasympathetic tone and reduces sympathetic activity. Additionally, it is hypothesized to modulate interoceptive processing by influencing Heart Rate Evoked Potential and normalizing interoceptive signals. This hypothesis article examines taVNS from a closed-loop perspective, focusing on the controllability and observability of its effects using wearable physiological sensors. It postulates regulating desired therapeutic states through physiological sensor feedback, suggesting the potential for customized, adaptive stimulation in FS treatment. However, rigorous testing of its controller and observer functions will be necessary for optimal clinical translation of adaptive taVNS.

Perinatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of neonatal encephalopathy, accounting for over half of all cases and the consequences of HIE can be devastating, making it one of the most severe perinatal complications. Therapeutic hypothermia has been shown to offer neuroprotection by reducing metabolic demand and slowing the cascade of injury processes. However, despite its benefits, therapeutic hypothermia has only modestly improved neurodevelopmental outcomes, indicating a major need for additional therapeutic approaches. Low-intensity transcranial ultrasound stimulation (TUS) is an emerging non-invasive brain stimulation technique for focally modulating specific brain regions that has recently drawn attention for its potential to modulate brain activity and promote neuroplasticity. The capacity of TUS to induce neuroplasticity through specific sonication parameters has been demonstrated in adult patients. Leveraging TUS to enhance functional connectivity and inhibit GABAergic systems within the injured thalami holds promise for inducing neuroplasticity in neonates with HIE. We hypothesize that enhancing thalamocortical functional connectivity and reducing local GABA levels through the use of TUS could potentially improve neurodevelopmental outcomes in neonates with HIE who have sustained thalamic injury and aim to test this hypothesis. Testing of the hypothesis will be conducted with a comprehensive assessment of safety and feasibility in neonates through a Phase I study, followed by further clinical studies to evaluate efficacy.

As a result of the ability of hydrogen rich water to delay muscle fatigue, and considering that tired striated muscles do not sufficiently protect the bone from mechanical stress, the hypothetical mechanism according to which the consumption of the respective drink by athletes could reduce the incidence of stress fractures is discussed. The application of patches with transdermal release of molecular hydrogen in the areas where stress fractures occur frequently could strengthen this preventive action, due to the local anti-inflammatory and regenerative action established experimentally on the senescent bone, to which could be added the stimulation of osteogenesis, the inhibition of bone resorption and the prevention of fractures due to the antioxidant action. The hypothesis can be tested experimentally using the rabbit tibia as a model, or statistical studies can be done on the incidence of stress fractures in athletes who consume hydrogen rich water. Even baths in water saturated with molecular hydrogen can prevent stress fractures, because they reduce the perception of muscle fever, and the plasters could also prevent the complications of this type of fractures.

The Möbius strip, a non-orientable surface characterized by a singular side and edge, can serve as an apt metaphor for comprehending the intricacies of cancer progression and treatment. This paper delves into the intersection between the topological properties of the Möbius strip and the dynamic, multifaceted nature of cancer. Moreover, similar to understand the miracle of Möbius strip in physical world, acknowledging tumors’ rationality within the body necessitates an inclusive and educational approach towards comprehending them rather than attempting to sever or dissect this complex structure. In essence, Möbius strips and tumors act as conduits connecting physical and biological realms; thus, unraveling these intricate structures may hold paramount importance in unlocking enigmas surrounding tumors.

Hepatitis B virus (HBV) outbreaks are typically associated with injection drug use and high-risk sexual behavior; however, some cannot be easily explained in these terms. The messy blood-feeding methods of simuliids, provoked Chanteau et al. to investigate the simuliid-facilitated Hepatitis-B transmission (SFHBVT) hypothesis in French Polynesia in the early 1990s. Souto et al. later proposed the hypothesis could explain a HBV outbreak in the Brazilian Amazon which they suggested was driven by the biting of the M. ozzardi vector Simulium oyapockense. A recent Amazon region blood bank survey has provided important further support for the SFHBVT hypothesis playing a role in Amazon region transmission, but the results of this study have hitherto not been discussed in a SFHBVT context. Mansonella ozzardi positive donations were significantly more likely to test positive in anti-HBc and anti-HBc plus HBsAg tests than were M. ozzardi negative donations, suggesting both exposure to the HBV and HBV infections are significantly more common in individuals infected with M. ozzardi. It is argued here that these Amazon region blood bank observations substantially increase the viability of the SFHBVT hypothesis and thus that the hypothesis should be considered more carefully when HBV disease control measures are formulated for the Brazilian Amazon region and indeed beyond.

Wound healing is a dynamic process that encompasses cellular, immunological, physiological and biochemical events, involving the recovery of tissue anatomy and restoration of homeostasis. Although we see advances in treatments that aim to help this process, there is still a constant need for more effective and accessible treatments. In this context, studies carried out with the alkaloid epiisopiloturine (EPI) have proven its anti-inflammatory potential, or which presents itself as a promising alternative. It is hypothesized that EPI has important anti-inflammatory properties, which can be effective in wound healing, bringing inflammatory hallmarks, such as the selective inhibitory activity of COX-2 and the production of pro-inflammatory cytokines. Furthermore, EPI reduces levels of oxidative stress in the tissue, presenting antioxidant characteristics, which can help protect against damage caused to the wound. EPI is believed to have promising treatment against inflammation and accelerating wound healing.