Discrimination of vocal folds lesions by multiclass classification using autofluorescence spectroscopy: An ex vivo study.

BACKGROUND: Autofluorescence spectroscopy is effective for noninvasive detection but underutilized in tissue with various pathology analyses. This study evaluates whether AFS can be used to discriminate between different types of laryngeal lesions in view of assisting in vocal fold surgery and preoperative investigations. METHODS: A total of 1308 spectra were recorded from 29 vocal fold samples obtained from 23 patients. Multiclass analysis was performed on the spectral data, categorizing lesions into normal, benign, dysplastic, or carcinoma. RESULTS: Through an appropriate selection of spectral components and a cascading classification approach based on artificial neural networks, a classification rate of 97% was achieved for each lesion class, compared to 52% using autofluorescence intensity. CONCLUSIONS: The ex vivo study demonstrates the effectiveness of AFS combined with multivariate analysis for accurate classification of vocal fold lesions. Comprehensive analysis of spectral data significantly improves classification accuracy, such as distinguishing malignant from precancerous or benign lesions.

Is research on 'smart living environments' based on unobtrusive technologies for older adults going in circles? Evidence from an umbrella review.

CONTEXT AND AIMS: To enable ageing in place, innovative and integrative technologies such as smart living environments may be part of the solution. Despite extensive published literature reviews on this topic, the effectiveness of smart living environments in supporting ageing in place, and in particular involving unobtrusive technologies, remains unclear. The main objective of our umbrella review was to synthesize evidence on this topic. METHODS: According to the PRIOR process, we included reviews from multiple databases that focused on unobtrusive technologies used to analyze and share information about older adults' behaviors and assessed the effectiveness of unobtrusive technologies to support ageing in place. Selection, extraction and quality appraisal were done independently by two reviewers. RESULTS: By synthesizing 17 published reviews that covered 191 distinct primary studies, we found that smart living environments based on unobtrusive technologies had low to moderate effectiveness to support older adults to age in place. Effectiveness appears to be strongest in the recognition of activities of daily living. The results must, however, be interpreted in light of the low overall level of evidence, i.e., low methodological value of the primary studies and poor methodological quality of the literature reviews. Most reviews concluded that unobtrusive technologies are not mature enough for widespread adoption. CONCLUSION: There is a necessity to support primary studies that can move beyond the proof-of-concept or pilot stages and expand scientific knowledge significantly on the topic. There is also an urgent need to publish high quality literature reviews to better support policy makers and funding agencies in the field of smart living environments.

Effectiveness of smart living environments to support older adults to age in place in their community: an umbrella review protocol.

INTRODUCTION: Frailty is a vulnerable condition exposing older adults to incidental adverse health events that negatively impact their quality of life and increase health and social costs. Digital solutions may play a key role in addressing this global problem and in particular, smart living environments. Smart living environments involve a notion of measurement or collection of data via several sensors, capturing the person's behaviours in the home or the person's health status over a long period of time. It thus has great potential for home support for older adults. The objective of this umbrella review will be: (1) to document the effectiveness of smart living environments to support ageing in place for frail older adults and (2) among the reviews assessing the effectiveness of smart living environment, to gather evidence on what factors and strategies were identified as influencing the implementation process. METHODS AND ANALYSIS: We will include systematic and scoping reviews of both quantitative and qualitative primary studies with or without meta-analysis focusing on assessing the effectiveness of interventions through smart living environments to support older adults in the community to age in place. The literature search will be done through the following biomedical, technological and sociological citation databases: MEDLINE, Embase, CINAHL, Web of Science and PsycINFO, and quality assessment of the reviews will be done thought AMSTAR2 checklist. The analysis of the results will be presented in narrative form. ETHICS AND DISSEMINATION: Our review will rely exclusively on published data from secondary sources and will thus not involve any interactions with human subjects. The results will be presented at international conferences and publications. PROSPERO REGISTRATION NUMBER: CRD42021249849.

Halofuginone regulates keloid fibroblast fibrotic response to TGF-ß induction.

Keloids are characterized by increased deposition of fibrous tissue in the skin and subcutaneous tissue following an abnormal wound healing process. Although keloid etiology is yet to be fully understood, fibroblasts are known to be key players in its development. Here we analyze the antifibrotic mechanisms of Halofuginone (HF), a drug reportedly able to inhibit the TGF-ß1-Smad3 pathway and to attenuate collagen synthesis, in an in-vitro keloid model using patient-derived Keloid Fibroblasts (KFs) isolated from fibrotic tissue collected during the "Scar Wars" clinical study (NCT NCT03312166). TGF-ß1 was used as a pro-fibrotic agent to stimulate fibroblasts response under HF treatment. The fibrotic related properties of KFs, including survival, migration, proliferation, myofibroblasts conversion, ECM synthesis and remodeling, were investigated in 2D and 3D cultures. HF at 50 nM concentration impaired KFs proliferation, and decreased TGF-ß1-induced expression of α-SMA and type I procollagen production. HF treatment also reduced KFs migration, prevented matrix contraction and increased the metallo-proteases/inhibitors (MMP/TIMP) ratio. Overall, HF elicits an anti-fibrotic contrasting the TGF-ß1 stimulation of KFs, thus supporting its therapeutic use for keloid prevention and management.

Comparison of Noninvasive Imagery Methods to Observe Healthy and Degenerated Olfactory Epithelium in Mice for the Early Diagnosis of Neurodegenerative Diseases.

Olfactory dysfunction could be an early and reliable indicator for the diagnosis of neurodegenerative disorders such as Alzheimer and Parkinson's diseases. In this paper, we compare the potential of different noninvasive medical imaging modalities (optical coherence tomography, confocal microscopy, and fluorescence endomicroscopy) to distinguish how the olfactory epithelium, both at the cellular and the structural levels, is altered. Investigations were carried out on three experimental groups: two pathological groups (mice models with deliberately altered olfactory epithelium and Alzheimer's disease transgenic mice models) were compared with healthy mice models. As histological staining, the three tested noninvasive imaging tools demonstrated the general tubular organization of the olfactory epithelium on healthy mice. Contrary to OCT, confocal microscopy, and endomicroscopy allowed visualizing the inner structure of olfactory epithelium as well as its morphological or functional changes on pathological models, alterations classically observed with histological assessment. The results could lead to relevant development of imaging tools for noninvasive and early diagnosis of neurodegenerative diseases through the in situ characterization of the olfactory epithelium.

Miniaturized fiber dosimeter of medical ionizing radiations on a narrow optical fiber.

Fiber dosimeters have recently drawn much interest for measuring in vivo and in real time the dose of medical radiations. This paper presents the first miniaturized fiber dosimeter integrated at the end of a narrow 125 µm outer diameter optical fiber. Miniaturization is rendered possible by exploiting the concept of a leaky wave optical antenna for interfacing the scintillators and the fiber and by taking advantage of the low propagation loss of narrow silica fibers and high detection yield of single-pixel photon counters. Upon irradiation at 6 MV in air, our fiber probe leads to a linear detection response with a signal-to-noise ratio as high as 195. Although implemented with inorganic scintillators and fiber, our miniaturized fiber probe induces minimum screening effects on ionizing radiations over a negligible area (0.153 mm2). Our nano-optically driven approach may thus result in ultra-compact fiber dosimeters of negligible footprint in the radiotherapeutic processes, even with non-water equivalent fibers and scintillators. This opens new opportunities for a large panel of therapies relying on ionizing radiations (photons or charged particles).

Multimodal investigation of a keloid scar by combining mechanical tests in vivo with diverse imaging techniques.

Keloids are pathologic scars, defined as fibroproliferative diseases resulting from abnormal wound responses, which grow beyond the original wound margins. They develop on specific pro-keloid anatomic sites frequently characterized by high stress states. The initiation and growth mechanisms of keloid are not well-understood. This study relates multimodal investigation of a keloid by using mechanical tests in vivo and imaging techniques. A single case composed of a keloid, the healthy skin surrounding the keloid, and the contralateral healthy skin on the upper arms of a woman has been investigated in extension and suction by using non-invasive devices dedicated to in vivo skin measurement. The thickness and microstructure of these soft tissues have been observed by echography, tomography and confocal microscopy. Displacement fields have been obtained by using digital image correlation. Unlike healthy skin, keloid is not a well-defined multilayer structure: the frontier between epidermis and dermis disappears. The mechanical behavior of keloid is highly different from healthy skin one. The R-parameters have been deduced from suction curves. Physical parameters as tissue extensibility, initial and final tangent moduli have been identified from the stress-strain curves. The extensibility (respectively, initial rigidity) of keloid is highly lower (respectively, higher) than that of healthy skin. To compare the final rigidity of keloid versus healthy skin, further tests have to be performed with higher strain values.

3D multi-tissue printing for kidney transplantation.

The kidneys are among the most commonly transplanted organs in the world. Transplant patients, as a consequence of their kidney disease and other risk factors which make it difficult for the surgeon to perform vascular anastomosis during kidney transplantation, often have numerous arterial calcifications. The preoperative assessment for transplantation includes an abdominal and pelvic CT scan without contrast that allows for the mapping of atheromatous calcification. However, non-contrast enhanced CT is not optimal and the surgeon is obliged to palpate the arteries during the operation to choose the anatomical site of the vascular anastomosis. This technical note reports the development of a new technique of preoperative reproduction of atherosclerotic arteries, owing to advancements in 3D multi-tissue printing technology. We used scans of four patients with varying degrees of calcified atheroma to model and print their arteries for their pre-surgical planning.

In Vivo Inspection of the Olfactory Epithelium: Feasibility of Robotized Optical Biopsy.

Inspecting the olfactory cleft can be of high interest, as it is an open access to neurons, and thus an opportunity to collect in situ related data in a non-invasive way. Also, recent studies show a strong link between olfactory deficiency and neurodegenerative diseases such as Alzheimer and Parkinson diseases. However, no inspection of this area is possible today, as it is very difficult to access. Only robot-assisted interventions seem viable to provide the required dexterity. The feasibility of this approach is demonstrated in this article, which shows that the path complexity to the olfactory cleft can be managed with a concentric tube robot (CTR), a particular type of continuum robot. First, new anatomical data are elaborated, in particular for the olfactory cleft, that remains hardly characterized. 3D reconstructions are conducted on the database of 20 subjects, using CT scan images. Measurements are performed to describe the anatomy, including metrics with inter-subject variability. Then, the existence of collision-free passageways for CTR is shown using the 3D reconstructions. Among the 20 subjects, 19 can be inspected using only 3 different robot geometries. This constitutes an essential step towards a robotic device to inspect subjects for clinical purposes.

Mécano-Stimulation™ of the skin improves sagging score and induces beneficial functional modification of the fibroblasts: clinical, biological, and histological evaluations.

BACKGROUND: Loss of mechanical tension appears to be the major factor underlying decreased collagen synthesis in aged skin. Numerous in vitro studies have shown the impact of mechanical forces on fibroblasts through mechanotransduction, which consists of the conversion of mechanical signals to biochemical responses. Such responses are characterized by the modulation of gene expression coding not only for extracellular matrix components (collagens, elastin, etc.) but also for degradation enzymes (matrix metalloproteinases [MMPs]) and their inhibitors (tissue inhibitors of metalloproteinases [TIMPs]). A new device providing a mechanical stimulation of the cutaneous and subcutaneous tissue has been used in a simple, blinded, controlled, and randomized study. MATERIALS AND METHODS: Thirty subjects (aged between 35 years and 50 years), with clinical signs of skin sagging, were randomly assigned to have a treatment on hemiface. After a total of 24 sessions with Mécano-Stimulation™, biopsies were performed on the treated side and control area for in vitro analysis (dosage of hyaluronic acid, elastin, type I collagen, MMP9; equivalent dermis retraction; GlaSbox(®); n=10) and electron microscopy (n=10). Furthermore, before and after the treatment, clinical evaluations and self-assessment questionnaire were done. RESULTS: In vitro analysis showed increases in hyaluronic acid, elastin, type I collagen, and MMP9 content along with an improvement of the migratory capacity of the fibroblasts on the treated side. Electron microscopy evaluations showed a clear dermal remodeling in relation with the activation of fibroblast activity. A significant improvement of different clinical signs associated with skin aging and the satisfaction of the subjects were observed, correlated with an improvement of the sagging cheek. CONCLUSION: Mécano-Stimulation is a noninvasive and safe technique delivered by flaps microbeats at various frequencies, which can significantly improve the skin trophicity. Results observed with objective measurements, ie, in vitro assessments and electron microscopy, confirm the firming and restructuring effect clinically observed.

Increased levels of circulating microparticles are associated with increased procoagulant activity in patients with cutaneous malignant melanoma.

Microparticles (MPs) are known to be increased in various malignancies and are involved in tumor invasion, angiogenesis, coagulation, and metastasis. We investigated the plasma levels of annexin-V MPs (AV(+)MPs), platelet-derived MPs (PMPs), and endothelial-derived MPs (EMPs) in patients with melanoma (n=129) and in healthy controls (n=49). A functional coagulation test STA Procoag-PPL measuring the clotting time was performed on samples containing MPs to evaluate their procoagulant potential. The plasma levels of PMPs, EMPs, and AV(+)MPs were significantly higher, and the clotting time-PPL was significantly lower in melanoma patients than in healthy controls. The plasma levels of PMPs, EMPs, and AV(+)MPs were higher in stage IV than in the other stages of melanoma, but with no significant difference. In addition, we observed an inverse correlation between PMPs, AV(+)MPs, and clotting times. Our data suggest that MPs are involved in the progression of melanoma and may be associated to melanoma-associated thrombogenesis.

Efficacy of micronutrient supplementation on skin aging and seasonal variation: a randomized, placebo-controlled, double-blind study.

BACKGROUND: Several studies have confirmed dramatic changes in skin surface parameters during the winter months. Although there are many studies supporting the positive effects of topical treatment, there are no published studies demonstrating the effects of oral supplementation in the prevention of negative skin changes during winter. The purpose of this study was to evaluate the efficacy of an oral micronutrient supplement in preventing the negative effects of winter weather on skin quality using noninvasive biometrologic instruments. METHODS: This study included 80 healthy female volunteers aged 35-55 years with phototype II-IV skin. Randomization was balanced. Two tablets of a micronutrient supplement (Perfectil® Platinum) or placebo were administered once daily for 4 months. The volunteers were examined at baseline, after 4 months, and 6 weeks after termination of treatment (month 5.5). The evaluation included skin microrelief by Visioscan® as the main outcome, and the secondary outcomes were results on standard macrophotography, skin tension by Reviscometer®, skin high-frequency ultrasound, and self-assessment. RESULTS: For all pseudoroughness and microrelief indicators, there was a significant increase from baseline to month 4 in the placebo group (P<0.05) but no change in the active group. Descriptive statistics for the mean minimum, mean maximum, and minimum to maximum ratio on the nonexposed study zone showed a significant and dramatic difference between baseline and month 4 and between baseline and month 5.5 (P<0.05) in the active group, indicating decreasing anisotropy of the skin. High-frequency ultrasound on the exposed study zone revealed that skin thickness was significantly decreased in the placebo group during winter but was stable in the treated group (P<0.01). The photography scaling and self-assessment questionnaire revealed no significant changes in either group. CONCLUSION: These results indicate that the skin is prone to seasonal changes during winter, particularly in exposed areas. The data also indicate that oral supplementation can be a safe treatment, with no serious side effects, and may prevent or even eliminate the negative effects of winter on the skin.

Assessment of the efficacy and safety of a new treatment for head lice.

Infestation with head lice is a widespread, persistent, and recurring issue leading to serious health problems if untreated. We are facing resistance phenomena to usual pediculicides and questions about their direct or cumulative toxicity. The aim of this trial was to assess the efficacy of a new product, free of chemical insecticides but with a physical effect. This product contains components whose antilice efficacy has already been demonstrated, as well as Andiroba oil which asphyxiates the lice and Quassia vinegar which dissolves the chitin of the nits (they are then inactivated). 30 patients with head lice infestation, aged 3-39 years, applied the treatment one to three times, 5 days apart. Cure was defined as the absence of live lice after 5, 10, or 14 days, and symptoms are usually associated with infestation. Easiness and safety of the treatment were assessed by the patients and/or their parents. Overall cure rates were 20% on D5 after one treatment, 37% on D10 after two treatments, and 90% on D14 after three treatments. Symptoms such as itch, scalp dryness, redness, and flakiness rapidly diminished. This treatment seems to be a beneficial addition or a valuable alternative to existing treatments, considering the total absence of chemical insecticides, the absence of drug-resistance induction in head lice, the absence of major toxicological risks compared with usual pediculicides, and the favourable patient use instructions.