Pub Date : 2024-09-16eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1413637
Vanessa C C Luz, Sónia Gonçalves Pereira
Celiac disease is an autoimmune enteropathy caused by the ingestion of minute amounts of gluten in a subset of genetically predisposed individuals. Its onset occurs at different ages and with variable symptoms. The gut microbiome may contribute to this variability. This review aims to provide an overview of the available research on celiac disease gut microbiome and identify the knowledge gap that could guide future studies. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR), four electronic databases were searched for literature from January 2000 to July 2023 addressing celiac disease gut microbiome characterization using next-generation sequencing (NGS) approaches. From the 489 publications retrieved, 48 publications were selected and analyzed, focusing on sample characterization (patients, controls, and tissues) and methodologies used for NGS microbiome analysis and characterization. The majority of the selected publications regarded children and adults, and four were randomized clinical trials. The number of participants per study greatly varied and was typically low. Feces were the most frequently tested sample matrix, and duodenal samples were analyzed in one-third of the studies. Incomplete and diverse information on the methodological approaches and gut microbiome results was broadly observed. While similar trends regarding the relative abundance of some phyla, such as Pseudomonadota (former Proteobacteria), were detected in some studies, others contradicted those results. The observed high variability of technical approaches and possibly low power and sample sizes may prevent reaching a consensus on celiac disease gut microbiome composition. Standardization of research protocols to allow reproducibility and comparability is required, as interdisciplinary collaborations to further data analysis, interpretation, and, more importantly, health outcome prediction or improvement.
{"title":"Celiac disease gut microbiome studies in the third millennium: reviewing the findings and gaps of available literature.","authors":"Vanessa C C Luz, Sónia Gonçalves Pereira","doi":"10.3389/fmedt.2024.1413637","DOIUrl":"10.3389/fmedt.2024.1413637","url":null,"abstract":"<p><p>Celiac disease is an autoimmune enteropathy caused by the ingestion of minute amounts of gluten in a subset of genetically predisposed individuals. Its onset occurs at different ages and with variable symptoms. The gut microbiome may contribute to this variability. This review aims to provide an overview of the available research on celiac disease gut microbiome and identify the knowledge gap that could guide future studies. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR), four electronic databases were searched for literature from January 2000 to July 2023 addressing celiac disease gut microbiome characterization using next-generation sequencing (NGS) approaches. From the 489 publications retrieved, 48 publications were selected and analyzed, focusing on sample characterization (patients, controls, and tissues) and methodologies used for NGS microbiome analysis and characterization. The majority of the selected publications regarded children and adults, and four were randomized clinical trials. The number of participants per study greatly varied and was typically low. Feces were the most frequently tested sample matrix, and duodenal samples were analyzed in one-third of the studies. Incomplete and diverse information on the methodological approaches and gut microbiome results was broadly observed. While similar trends regarding the relative abundance of some phyla, such as Pseudomonadota (former Proteobacteria), were detected in some studies, others contradicted those results. The observed high variability of technical approaches and possibly low power and sample sizes may prevent reaching a consensus on celiac disease gut microbiome composition. Standardization of research protocols to allow reproducibility and comparability is required, as interdisciplinary collaborations to further data analysis, interpretation, and, more importantly, health outcome prediction or improvement.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1400615
Andrew T McKenzie, Ariel Zeleznikow-Johnston, Jordan S Sparks, Oge Nnadi, John Smart, Keith Wiley, Michael A Cerullo, Aschwin de Wolf, Francesca Minerva, Ramón Risco, George M Church, João Pedro de Magalhães, Emil F Kendziorra
When faced with the prospect of death, some people would prefer a form of long-term preservation that may allow them to be restored to healthy life in the future, if technology ever develops to the point that this is feasible and humane. Some believe that we may have the capacity to perform this type of experimental preservation today-although it has never been proven-using contemporary methods to preserve the structure of the brain. The idea is that the morphomolecular organization of the brain encodes the information required for psychological properties such as personality and long-term memories. If these structures in the brain can be maintained intact over time, this could theoretically provide a bridge to access restorative technologies in the future. To consider this hypothesis, we first describe possible metrics that can be used to assess structural brain preservation quality. We next explore several possible methods to preserve structural information in the brain, including the traditional cryonics method of cryopreservation, as well as aldehyde-stabilized cryopreservation and fluid preservation. We focus in-depth on fluid preservation, which relies on aldehyde fixation to induce chemical gel formation in a wide set of biomolecules and appears to be a cost-effective method. We describe two theoretical recovery technologies, alongside several of the ethical and legal complexities of brain preservation, all of which will require a prudent approach. We believe contemporary structural brain preservation methods have a non-negligible chance of allowing successful restoration in the future and that this deserves serious research efforts by the scientific community.
{"title":"Structural brain preservation: a potential bridge to future medical technologies.","authors":"Andrew T McKenzie, Ariel Zeleznikow-Johnston, Jordan S Sparks, Oge Nnadi, John Smart, Keith Wiley, Michael A Cerullo, Aschwin de Wolf, Francesca Minerva, Ramón Risco, George M Church, João Pedro de Magalhães, Emil F Kendziorra","doi":"10.3389/fmedt.2024.1400615","DOIUrl":"10.3389/fmedt.2024.1400615","url":null,"abstract":"<p><p>When faced with the prospect of death, some people would prefer a form of long-term preservation that may allow them to be restored to healthy life in the future, if technology ever develops to the point that this is feasible and humane. Some believe that we may have the capacity to perform this type of experimental preservation today-although it has never been proven-using contemporary methods to preserve the structure of the brain. The idea is that the morphomolecular organization of the brain encodes the information required for psychological properties such as personality and long-term memories. If these structures in the brain can be maintained intact over time, this could theoretically provide a bridge to access restorative technologies in the future. To consider this hypothesis, we first describe possible metrics that can be used to assess structural brain preservation quality. We next explore several possible methods to preserve structural information in the brain, including the traditional cryonics method of cryopreservation, as well as aldehyde-stabilized cryopreservation and fluid preservation. We focus in-depth on fluid preservation, which relies on aldehyde fixation to induce chemical gel formation in a wide set of biomolecules and appears to be a cost-effective method. We describe two theoretical recovery technologies, alongside several of the ethical and legal complexities of brain preservation, all of which will require a prudent approach. We believe contemporary structural brain preservation methods have a non-negligible chance of allowing successful restoration in the future and that this deserves serious research efforts by the scientific community.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11416988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1436034
Ambuj Yadav, Himanshu Dandu, Gaurav Parchani, Kumar Chokalingam, Pooja Kadambi, Rajesh Mishra, Ahsina Jahan, Jean-Louis Teboul, Jos M Latour
Objective: To assess the efficacy of continuous contactless vital signs monitoring with an automated Early Warning System (EWS) in detecting clinical deterioration among patients in general wards.
Methods: A prospective observational cohort study was conducted in the medical unit of a tertiary care hospital in India, involving 706 patients over 84,448 monitoring hours. The study used a contactless ballistocardiography system (Dozee system) to continuously monitor heart rate, respiratory rate, and blood pressure. The study assessed total, mean, and median alerts at 24, 48, 72, 96, 120 h, and length of stay (LOS) before patient deterioration or discharge. It analyzed alert sensitivity and specificity, average time from initial alert to deterioration, and healthcare practitioners (HCP) activity. Study was registered with the Clinical Trials Registry-India CTRI/2022/10/046404.
Results: Out of 706 patients, 33 (5%) experienced clinical deterioration, while 673 (95%) did not. The deterioration group consistently had a higher number of alerts compared to those who were discharged normally, across all time-points. On average, the time between the initial alert and clinical deterioration was 16 h within the last 24 h preceding the event. The sensitivity of the Dozee-EWS varied between 67% and 94%. HCP spend 10% of their time on vital signs check and documentation.
Conclusions: This study suggests that utilizing contactless continuous vital signs monitoring with Dozee-EWS in general ward holds promise for enhancing the early detection of clinical deterioration. Further research is essential to evaluate the effectiveness across a wider range of clinical settings.
{"title":"Early detection of deteriorating patients in general wards through continuous contactless vital signs monitoring.","authors":"Ambuj Yadav, Himanshu Dandu, Gaurav Parchani, Kumar Chokalingam, Pooja Kadambi, Rajesh Mishra, Ahsina Jahan, Jean-Louis Teboul, Jos M Latour","doi":"10.3389/fmedt.2024.1436034","DOIUrl":"https://doi.org/10.3389/fmedt.2024.1436034","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficacy of continuous contactless vital signs monitoring with an automated Early Warning System (EWS) in detecting clinical deterioration among patients in general wards.</p><p><strong>Methods: </strong>A prospective observational cohort study was conducted in the medical unit of a tertiary care hospital in India, involving 706 patients over 84,448 monitoring hours. The study used a contactless ballistocardiography system (Dozee system) to continuously monitor heart rate, respiratory rate, and blood pressure. The study assessed total, mean, and median alerts at 24, 48, 72, 96, 120 h, and length of stay (LOS) before patient deterioration or discharge. It analyzed alert sensitivity and specificity, average time from initial alert to deterioration, and healthcare practitioners (HCP) activity. Study was registered with the Clinical Trials Registry-India CTRI/2022/10/046404.</p><p><strong>Results: </strong>Out of 706 patients, 33 (5%) experienced clinical deterioration, while 673 (95%) did not. The deterioration group consistently had a higher number of alerts compared to those who were discharged normally, across all time-points. On average, the time between the initial alert and clinical deterioration was 16 h within the last 24 h preceding the event. The sensitivity of the Dozee-EWS varied between 67% and 94%. HCP spend 10% of their time on vital signs check and documentation.</p><p><strong>Conclusions: </strong>This study suggests that utilizing contactless continuous vital signs monitoring with Dozee-EWS in general ward holds promise for enhancing the early detection of clinical deterioration. Further research is essential to evaluate the effectiveness across a wider range of clinical settings.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1360280
Lariza María de la Caridad Portuondo-Mallet, Niurka Mollineda-Diogo, Rubén Orozco-Morales, Juan Valentín Lorenzo-Ginori
Problem: Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania and has a high prevalence and impact on global health. Currently, the available drugs for its treatment have drawbacks, such as high toxicity, resistance of the parasite, and high cost. Therefore, the search for new, more effective, and safe drugs is a priority. The effectiveness of an anti-leishmanial drug is analyzed through in vitro studies in which a technician manually counts the intracellular form of the parasite (amastigote) within macrophages, which is slow, laborious, and prone to errors.
Objectives: To develop a computational system that facilitates the detection and counting of amastigotes in microscopy images obtained from in vitro studies using image processing techniques.
Methodology: Segmentation of objects in the microscope image that might be Leishmania amastigotes was performed using the multilevel Otsu method on the saturation component of the hue, saturation, and intensity color model. In addition, morphological operations and the watershed transform combined with the weighted external distance transform were used to separate clustered objects. Then positive (amastigote) objects were detected (and consequently counted) using a classifier algorithm, the selection of which as well as the definition of the features to be used were also part of this research. MATLAB was used for the development of the system.
Results and discussion: The results were evaluated in terms of sensitivity, precision, and the F-measure and suggested a favorable effectiveness of the proposed method.
Conclusions: This system can help researchers by allowing large volumes of images of amastigotes to be counted using an automatic image analysis technique.
问题:利什曼病是由利什曼属原生动物寄生虫引起的一种疾病,发病率很高,对全球健康影响很大。目前,现有的治疗药物存在毒性大、寄生虫抗药性强、成本高昂等缺点。因此,寻找更有效、更安全的新药是当务之急。抗利什曼病药物的有效性是通过体外研究来分析的,在体外研究中,技术人员手动计数巨噬细胞内寄生虫(变形虫)的细胞内形式,这种方法缓慢、费力且容易出错:目的:开发一个计算系统,利用图像处理技术,帮助在体外研究获得的显微镜图像中检测和计数变形虫:方法:使用色调、饱和度和强度色彩模型中饱和度分量的多级大津法,对显微镜图像中可能是利什曼原虫的物体进行分割。此外,还使用形态学运算和分水岭变换结合加权外距离变换来分离聚类对象。然后使用分类器算法检测(并因此计数)阳性(非原虫)对象,该算法的选择和所用特征的定义也是本研究的一部分。系统的开发使用了 MATLAB:从灵敏度、精确度和 F 测量方面对结果进行了评估,结果表明所提议的方法非常有效:该系统可以帮助研究人员利用自动图像分析技术对大量非主流图像进行计数。
{"title":"Detection and counting of <i>Leishmania</i> intracellular parasites in microscopy images.","authors":"Lariza María de la Caridad Portuondo-Mallet, Niurka Mollineda-Diogo, Rubén Orozco-Morales, Juan Valentín Lorenzo-Ginori","doi":"10.3389/fmedt.2024.1360280","DOIUrl":"10.3389/fmedt.2024.1360280","url":null,"abstract":"<p><strong>Problem: </strong>Leishmaniasis is a disease caused by protozoan parasites of the genus <i>Leishmania</i> and has a high prevalence and impact on global health. Currently, the available drugs for its treatment have drawbacks, such as high toxicity, resistance of the parasite, and high cost. Therefore, the search for new, more effective, and safe drugs is a priority. The effectiveness of an anti-leishmanial drug is analyzed through <i>in vitro</i> studies in which a technician manually counts the intracellular form of the parasite (amastigote) within macrophages, which is slow, laborious, and prone to errors.</p><p><strong>Objectives: </strong>To develop a computational system that facilitates the detection and counting of amastigotes in microscopy images obtained from <i>in vitro</i> studies using image processing techniques.</p><p><strong>Methodology: </strong>Segmentation of objects in the microscope image that might be <i>Leishmania</i> amastigotes was performed using the multilevel Otsu method on the saturation component of the <i>hue, saturation, and intensity</i> color model. In addition, morphological operations and the watershed transform combined with the weighted external distance transform were used to separate clustered objects. Then positive (amastigote) objects were detected (and consequently counted) using a classifier algorithm, the selection of which as well as the definition of the features to be used were also part of this research. MATLAB was used for the development of the system.</p><p><strong>Results and discussion: </strong>The results were evaluated in terms of sensitivity, precision, and the F-measure and suggested a favorable effectiveness of the proposed method.</p><p><strong>Conclusions: </strong>This system can help researchers by allowing large volumes of images of amastigotes to be counted using an automatic image analysis technique.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1371447
J S van Haren, F L M Delbressine, M Monincx, T Hoveling, N Meijer, C Bangaru, J Sterk, D A A van der Woude, S G Oei, M B van der Hout-van der Jagt
Introduction: Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure.
Methods: Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother's uterus to an extra-uterine life support system. To facilitate a user-centered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians.
Results & discussion: Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context.
{"title":"From intra- to extra-uterine: early phase design of a transfer to extra-uterine life support through medical simulation.","authors":"J S van Haren, F L M Delbressine, M Monincx, T Hoveling, N Meijer, C Bangaru, J Sterk, D A A van der Woude, S G Oei, M B van der Hout-van der Jagt","doi":"10.3389/fmedt.2024.1371447","DOIUrl":"10.3389/fmedt.2024.1371447","url":null,"abstract":"<p><strong>Introduction: </strong>Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure.</p><p><strong>Methods: </strong>Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother's uterus to an extra-uterine life support system. To facilitate a user-centered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians.</p><p><strong>Results & discussion: </strong>Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1461460
Makiko Mochizuki, Hideki Maeda
Background: Although a variety of drug delivery devices have been launched in recent years, few studies have comprehensively investigated the market trends of combination drugs and medical devices approved or certified in Japan and the regulatory challenges related to their approval. Among the drug delivery devices, autoinjectors are more convenient than traditional prefilled syringes and are designed with safety features to prevent needlestick accidents, allowing self-injection by patients. Therefore, autoinjectors have been incorporated into the treatment of various diseases and have shown significant growth among drug delivery devices.
Aim: This study aimed to investigate the market trends of combination drugs approved in Japan, especially those with autoinjector formulations, and to explore the challenges in the regulatory aspects of combination drugs.
Methods: Information on the number of marketed drugs and medical devices was obtained from the Pharmaceuticals and Medical Devices Agency (PMDA) database using specific definitions. We looked at the annual changes in the number of drug delivery devices approved and certified as combination drugs or medical devices and the number of canceled certifications. We also examined the classification and main certification criteria for Japanese medical device nomenclature.
Results: The study suggested that the number of combination drugs with autoinjector formulations is increasing, replacing previously approved or certified pen-type medication injectors. Moreover, 53% of all drug products were approved for autoinjector formulations after the initial authorization approval in Japan, and more than half of them obtained approval for additional formulations for autoinjectors within five years of the initial authorization approval, with the largest number of cases obtaining approval for additional formulations two years later.
Conclusion: The lack of clear regulatory requirements for autoinjectors may lead to confusion among applicants. Furthermore, there are challenges in filing regulatory applications, thus hindering the rapid launch of combination drug-utilizing devices with superior usability.
{"title":"Trends in the market for drug delivery devices categorized as combination drugs and medical devices and regulatory challenges for autoinjectors in Japan.","authors":"Makiko Mochizuki, Hideki Maeda","doi":"10.3389/fmedt.2024.1461460","DOIUrl":"10.3389/fmedt.2024.1461460","url":null,"abstract":"<p><strong>Background: </strong>Although a variety of drug delivery devices have been launched in recent years, few studies have comprehensively investigated the market trends of combination drugs and medical devices approved or certified in Japan and the regulatory challenges related to their approval. Among the drug delivery devices, autoinjectors are more convenient than traditional prefilled syringes and are designed with safety features to prevent needlestick accidents, allowing self-injection by patients. Therefore, autoinjectors have been incorporated into the treatment of various diseases and have shown significant growth among drug delivery devices.</p><p><strong>Aim: </strong>This study aimed to investigate the market trends of combination drugs approved in Japan, especially those with autoinjector formulations, and to explore the challenges in the regulatory aspects of combination drugs.</p><p><strong>Methods: </strong>Information on the number of marketed drugs and medical devices was obtained from the Pharmaceuticals and Medical Devices Agency (PMDA) database using specific definitions. We looked at the annual changes in the number of drug delivery devices approved and certified as combination drugs or medical devices and the number of canceled certifications. We also examined the classification and main certification criteria for Japanese medical device nomenclature.</p><p><strong>Results: </strong>The study suggested that the number of combination drugs with autoinjector formulations is increasing, replacing previously approved or certified pen-type medication injectors. Moreover, 53% of all drug products were approved for autoinjector formulations after the initial authorization approval in Japan, and more than half of them obtained approval for additional formulations for autoinjectors within five years of the initial authorization approval, with the largest number of cases obtaining approval for additional formulations two years later.</p><p><strong>Conclusion: </strong>The lack of clear regulatory requirements for autoinjectors may lead to confusion among applicants. Furthermore, there are challenges in filing regulatory applications, thus hindering the rapid launch of combination drug-utilizing devices with superior usability.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01eCollection Date: 2024-01-01DOI: 10.3389/fmedt.2024.1399729
Mariachiara Arminio, Dario Carbonaro, Umberto Morbiducci, Diego Gallo, Claudio Chiastra
Over the last years computer modelling and simulation has emerged as an effective tool to support the total product life cycle of cardiovascular devices, particularly in the device preclinical evaluation and post-market assessment. Computational modelling is particularly relevant for heart valve prostheses, which require an extensive assessment of their hydrodynamic performance and of risks of hemolysis and thromboembolic complications associated with mechanically-induced blood damage. These biomechanical aspects are typically evaluated through a fluid-structure interaction (FSI) approach, which enables valve fluid dynamics evaluation accounting for leaflets movement. In this context, the present narrative review focuses on the computational modelling of bileaflet mechanical aortic valves through FSI approach, aiming to foster and guide the use of simulations in device total product life cycle. The state of the art of FSI simulation of heart valve prostheses is reviewed to highlight the variety of modelling strategies adopted in the literature. Furthermore, the integration of FSI simulations in the total product life cycle of bileaflet aortic valves is discussed, with particular emphasis on the role of simulations in complementing and potentially replacing the experimental tests suggested by international standards. Simulations credibility assessment is also discussed in the light of recently published guidelines, thus paving the way for a broader inclusion of in silico evidence in regulatory submissions. The present narrative review highlights that FSI simulations can be successfully framed within the total product life cycle of bileaflet mechanical aortic valves, emphasizing that credible in silico models evaluating the performance of implantable devices can (at least) partially replace preclinical in vitro experimentation and support post-market biomechanical evaluation, leading to a reduction in both time and cost required for device development.
{"title":"Fluid-structure interaction simulation of mechanical aortic valves: a narrative review exploring its role in total product life cycle.","authors":"Mariachiara Arminio, Dario Carbonaro, Umberto Morbiducci, Diego Gallo, Claudio Chiastra","doi":"10.3389/fmedt.2024.1399729","DOIUrl":"10.3389/fmedt.2024.1399729","url":null,"abstract":"<p><p>Over the last years computer modelling and simulation has emerged as an effective tool to support the total product life cycle of cardiovascular devices, particularly in the device preclinical evaluation and post-market assessment. Computational modelling is particularly relevant for heart valve prostheses, which require an extensive assessment of their hydrodynamic performance and of risks of hemolysis and thromboembolic complications associated with mechanically-induced blood damage. These biomechanical aspects are typically evaluated through a fluid-structure interaction (FSI) approach, which enables valve fluid dynamics evaluation accounting for leaflets movement. In this context, the present narrative review focuses on the computational modelling of bileaflet mechanical aortic valves through FSI approach, aiming to foster and guide the use of simulations in device total product life cycle. The state of the art of FSI simulation of heart valve prostheses is reviewed to highlight the variety of modelling strategies adopted in the literature. Furthermore, the integration of FSI simulations in the total product life cycle of bileaflet aortic valves is discussed, with particular emphasis on the role of simulations in complementing and potentially replacing the experimental tests suggested by international standards. Simulations credibility assessment is also discussed in the light of recently published guidelines, thus paving the way for a broader inclusion of <i>in silico</i> evidence in regulatory submissions. The present narrative review highlights that FSI simulations can be successfully framed within the total product life cycle of bileaflet mechanical aortic valves, emphasizing that credible <i>in silico</i> models evaluating the performance of implantable devices can (at least) partially replace preclinical <i>in vitro</i> experimentation and support post-market biomechanical evaluation, leading to a reduction in both time and cost required for device development.</p>","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-15DOI: 10.3389/fmedt.2024.1297552
V. Frey, P. Langthaler, N. Renz, Georg Zimmermann, C. Höhn, K. Schwenker, Aljoscha Thomschewski, Alexander B. Kunz, Y. Höller, R. Nardone, Eugen Trinka
Patients with spinal cord injury (SCI) show abnormal cortical excitability that might be caused by deafferentation. We hypothesize a reduced short-interval intracortical inhibition preceding movement in patients with SCI compared with healthy participants. In addition, we expect that neuroplasticity induced by different types of sports can modulate intracortical inhibition during movement preparation in patients with SCI.We used a reaction test and paired-pulse transcranial magnetic stimulation to record cortical excitability, assessed by measuring amplitudes of motor-evoked potentials in preparation of movement. The participants were grouped as patients with SCI practicing wheelchair dancing (n = 7), other sports (n = 6), no sports (n = 9), and healthy controls (n = 24).There were neither significant differences between healthy participants and the patients nor between the different patient groups. A non-significant trend (p = .238), showed that patients engaged in sports have a stronger increase in cortical excitability compared with patients of the non-sportive group, while the patients in the other sports group expressed the highest increase in cortical excitability.The small sample sizes limit the statistical power of the study, but the trending effect warrants further investigation of different sports on the neuroplasticity in patients with SCI. It is not clear how neuroplastic changes impact the sensorimotor output of the affected extremities in a patient. This needs to be followed up in further studies with a greater sample size.
{"title":"Influence of sports on cortical excitability in patients with spinal cord injury: a TMS study","authors":"V. Frey, P. Langthaler, N. Renz, Georg Zimmermann, C. Höhn, K. Schwenker, Aljoscha Thomschewski, Alexander B. Kunz, Y. Höller, R. Nardone, Eugen Trinka","doi":"10.3389/fmedt.2024.1297552","DOIUrl":"https://doi.org/10.3389/fmedt.2024.1297552","url":null,"abstract":"Patients with spinal cord injury (SCI) show abnormal cortical excitability that might be caused by deafferentation. We hypothesize a reduced short-interval intracortical inhibition preceding movement in patients with SCI compared with healthy participants. In addition, we expect that neuroplasticity induced by different types of sports can modulate intracortical inhibition during movement preparation in patients with SCI.We used a reaction test and paired-pulse transcranial magnetic stimulation to record cortical excitability, assessed by measuring amplitudes of motor-evoked potentials in preparation of movement. The participants were grouped as patients with SCI practicing wheelchair dancing (n = 7), other sports (n = 6), no sports (n = 9), and healthy controls (n = 24).There were neither significant differences between healthy participants and the patients nor between the different patient groups. A non-significant trend (p = .238), showed that patients engaged in sports have a stronger increase in cortical excitability compared with patients of the non-sportive group, while the patients in the other sports group expressed the highest increase in cortical excitability.The small sample sizes limit the statistical power of the study, but the trending effect warrants further investigation of different sports on the neuroplasticity in patients with SCI. It is not clear how neuroplastic changes impact the sensorimotor output of the affected extremities in a patient. This needs to be followed up in further studies with a greater sample size.","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.3389/fmedt.2024.1388207
Rahul Vellaparambil, Woo-Suck Han, Pierluigi Di Giovanni, Stéphane Avril
Numerical simulations have demonstrated the superior bending flexibility of auxetic stents compared to conventional stent designs for endovascular procedures. However, conventional stent manufacturing techniques struggle to produce complex auxetic stent designs, fueling the adoption of additive manufacturing techniques.In this study, we employed DMLS additive manufacturing to create Titanium Ti64 alloy stent prototypes based on auxetic stent designs investigated in a previous study. These prototypes were then subjected to experimental three-point bending tests.The experimental results were replicated using a finite element model, which showed remarkable accuracy in predicting the bending flexibility of four auxetic stents and two conventional stents.Although this validation study demonstrates the promising potential of DMLS and other additive manufacturing methods for fabricating auxetic stents, further optimization of current stent design limitations and the incorporation of post-processing techniques are essential to enhance the reliability of these additive manufacturing processes.
{"title":"Experimental validation of auxetic stent designs: three-point bending of 3D printed Titanium prototypes","authors":"Rahul Vellaparambil, Woo-Suck Han, Pierluigi Di Giovanni, Stéphane Avril","doi":"10.3389/fmedt.2024.1388207","DOIUrl":"https://doi.org/10.3389/fmedt.2024.1388207","url":null,"abstract":"Numerical simulations have demonstrated the superior bending flexibility of auxetic stents compared to conventional stent designs for endovascular procedures. However, conventional stent manufacturing techniques struggle to produce complex auxetic stent designs, fueling the adoption of additive manufacturing techniques.In this study, we employed DMLS additive manufacturing to create Titanium Ti64 alloy stent prototypes based on auxetic stent designs investigated in a previous study. These prototypes were then subjected to experimental three-point bending tests.The experimental results were replicated using a finite element model, which showed remarkable accuracy in predicting the bending flexibility of four auxetic stents and two conventional stents.Although this validation study demonstrates the promising potential of DMLS and other additive manufacturing methods for fabricating auxetic stents, further optimization of current stent design limitations and the incorporation of post-processing techniques are essential to enhance the reliability of these additive manufacturing processes.","PeriodicalId":94015,"journal":{"name":"Frontiers in medical technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}