A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of singleuse disposable medical devices. This has resulted in increased health care expenditures and health care-generated waste and pollution, with associated public health damage. It has also caused the supply chain to be vulnerable to disruption and demand fluctuations. Transformation of the medical device industry to a more circular economy would advance the goal of providing increasingly complex care in a low-emissions future. Barriers to circularity include perceptions regarding infection prevention, behaviors of device consumers and manufacturers, and regulatory structures that encourage the proliferation of disposable medical devices. Complementary policy-and market-driven solutions are needed to encourage systemic transformation.
The information gathered from clinical history and EUS, complemented by fluid analysis after EUS-guided FNA, predicts neoplastic pancreatic cysts and assists in decision-making for medical or surgical approach.
Endoscopic ultrasonography (EUS) is considered the most sensitive imaging method for the diagnosis of chronic pancreatitis (CP). Several investigators have shown that EUS findings of CP correlate with the presence of CP on endoscopic retrograde pancreatography (ERP). In general, for diagnosing CP using EUS, the presence or absence of the following EUS criteria is determined: hyperechoic foci, hyperechoic strands, lobularity, shadowing calcifications, cysts, hyperechoic duct margins, visible side branches, main pancreatic duct dilatation, and main pancreatic duct irregularity. Using these criteria, we reviewed the number of EUS criteria required to diagnose early CP and whether each EUS criterion correlates with the severity of CP on ERP. CP is likely when more than three criteria (for "early CP") or more than five criteria (for "moderate CP") are present. Moreover, each EUS criterion has its own importance at each ERP classification level. However, the obtained images can be operator dependent, and interobserver variability may affect interpretation of CP by EUS. Therefore, we performed a quantitative computer analysis of parenchymal echogenicity and compared it with the EUS diagnosis of CP so that the diagnosis of CP on the basis of EUS criteria could be objectively supported by the quantitative analysis of EUS images. In conclusion, EUS can objectively distinguish between a normal pancreas and CP, and can be used to evaluate the severity of the CP. EUS is a useful modality for diagnosing CP and is relatively less invasive than other available modalities.
Functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) are noninvasive techniques recently used to investigate cortical motor physiology. However, these modalities measure different phenomena, and in studies of human motor control they have given inconsistent results. We have developed a reproducible technique which co-registers TMS and fMRI, using a frameless method. In four normal subjects, the TMS map and fMRI activation were present on the primary motor cortex contralateral to the target hand, with some extension into primary sensory cortex. fMRI activation alone was also present in the medial motor cortex bilaterally and in the sensorimotor cortex ipsilateral to the target hand. This technique allows a more comprehensive evaluation of the physiologic events involved in motor control.
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