Use of artificial intelligence to address health disparities in low- and middle-income countries: a thematic analysis of ethical issues.

OBJECTIVES: Artificial intelligence (AI) is reshaping health and medicine, especially through its potential to address health disparities in low- and middle-income countries (LMICs). However, there are several issues associated with the use of AI that may reduce its impact and potentially exacerbate global health disparities. This study presents the key issues in AI deployment faced by LMICs. STUDY DESIGN: Thematic analysis. METHODS: PubMed, Scopus, Embase and the Web of Science databases were searched, from the date of their inception until September 2023, using the terms "artificial intelligence", "LMICs", "ethic∗" and "global health". Additional searches were conducted by snowballing references before and after the primary search. The final studies were chosen based on their relevance to the topic of this article. RESULTS: After reviewing 378 articles, 14 studies were included in the final analysis. A concept named the 'AI Deployment Paradox' was introduced to focus on the challenges of using AI to address health disparities in LMICs, and the following three categories were identified: (1) data poverty and contextual shifts; (2) cost-effectiveness and health equity; and (3) new technological colonisation and potential exploitation. CONCLUSIONS: The relationship between global health, AI and ethical considerations is an area that requires systematic investigation. Relying on health data inherent with structural biases and deploying AI without systematic ethical considerations may exacerbate global health inequalities. Addressing these challenges requires nuanced socio-political comprehension, localised stakeholder engagement, and well-considered ethical and regulatory frameworks.

Challenges and Suggestions of Ethical Review on Clinical Research Involving Brain-Computer Interfaces.

Brain-computer interface (BCI) technology is rapidly advancing in medical research and application. As an emerging biomedical engineering technology, it has garnered significant attention in the clinical research of brain disease diagnosis and treatment, neurological rehabilitation, and mental health. However, BCI also raises several challenges and ethical concerns in clinical research. In this article, the authors investigate and discuss three aspects of BCI in medicine and healthcare: the state of ethical governance, multidimensional ethical challenges pertaining to BCI in clinical research, and suggestive concerns for ethical review. Despite the great potentials of frontier BCI research and development in the field of medical care, the ethical challenges induced by itself, clinical research and complexity of brain function has put forward new special fields for ethics on BCI. To ensure "responsible innovation" BCI research in healthcare and medicine, the creation of an ethical global governance framework and system, along with special guidelines for cutting-edge BCI research in medicine are suggested.

BREAST-Q-Based Survey of the Satisfaction and Health Status of Patients with Breast Reconstruction.

AIMS: To explore the patients' satisfaction and health-related quality of life (HRQOL) of patients who received reconstruction after breast cancer surgery using the BREAST-Q questionnaire and further investigate the influencing risk factors. METHODS: This cross-sectional study enrolled patients who underwent first-ever breast reconstruction after unilateral or bilateral mastectomy at the Breast Surgery Department of First Affiliated Hospital of Zhengzhou University or People's Hospital of Zhengzhou between January 2016 and December 2021. Multivariable linear regression analysis was used to analyze the risk factors. RESULTS: A total of 202 participants were included. Age of >45 years (vs.≤35 years, ß = - 3.74, P < 0.001) was an independent risk factor influencing the satisfaction degree score. Age between 36 and 45 years (vs. ≤35 years, ß = - 0.26, P < 0.001), age of >45 years (vs. ≤35 years, ß = - 0.45, P < 0.001), nipple-preserving mastectomy (NSM)/ skin-preserving mastectomy (SSM) + sentinel lymph node dissection + prosthesis implantation + contralateral breast augmentation (vs. NSM/SSM + sentinel lymph node dissection + prosthesis implantation, ß = - 0.16, P=0.012), and the use of small intestinal submucosa (SIS) matrix (ß = 0.13, P = 0.044) were independent risk factors influencing the HRQOL scores. CONCLUSION: Age, the surgical procedure, and the use of matrix were associated with the satisfaction degree and HRQOL after breast reconstruction in patients receiving mastectomy. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Regulation concerns of supply and demand sides for aesthetic medicine from Chinese perspective.

Aesthetic medicine has become a booming industry in the world. However, there are widespread social and health risks posed by aesthetic medicine, including illegal practice, and misleading information from aesthetic medicine institutes. Social media and advertisement play important roles in leading to appearance anxiety among young people nowadays. Regarding the chaotic situation in the aesthetic medical field, there is a fact that the practice of aesthetic medicine has been marginally regulated, even in some developed countries. China has the largest population in the world as well as the large number of aesthetic medical customers. Regarding the protection of people from harm, there is a great challenge for the Chinese government. So, China has enacted the toughest governance these years both on the supply and demand side. Some of the strategies may be useful for health authorities in certain countries.

Identification of the circ_PRKDC/miR-20a-3p/RASA1 axis in regulating HaCaT keratinocyte migration.

Migration of keratinocytes plays a crucial role in the re-epithelialization phase during wound healing. Circular RNA (circRNA) protein kinase, DNA-activated, catalytic subunit (circ_PRKDC, hsa_circ_0084443) has been identified as a regulator of keratinocyte migration. However, the molecular basis governing it remains unclear. The levels of circ_PRKDC, microRNA (miR)-20a-3p, and RAS p21 protein activator 1 (RASA1) were assessed by quantitative real-time PCR (qRT-PCR) or western blot. Subcellular localization, Actinomycin D, and Ribonuclease (RNase) R assays were performed to characterise circ_PRKDC. Cell migration was gauged by transwell and wound-healing assays. A direct relationship between miR-20a-3p and circ_PRKDC or RASA1 was verified by dual-luciferase reporter and RNA pull-down assays. Circ_PRKDC expression was reduced in wound skin during wound healing. Circ_PRKDC modulated migration of HaCaT keratinocytes. Mechanistically, circ_PRKDC directly targeted miR-20a-3p. The regulation of circ_PRKDC on HaCaT keratinocyte migration was mediated by miR-20a-3p. RASA1 was identified as a direct and functional target of miR-20a-3p, and miR-20a-3p-mediated inhibition of RASA1 impacted HaCaT keratinocyte migration. Circ_PRKDC acted as a post-transcriptional modulator of RASA1 expression through miR-20a-3p. Moreover, circ_PRKDC modulated migration of HaCaT keratinocytes by RASA1. Our findings demonstrated a novel molecular basis, the miR-20a-3p/RASA1 axis, for the regulation of circ_PRKDC on HaCaT keratinocyte migration.

No ethical divide between China and the West in human embryo research.

This is a discussion of the reaction to the recent research article publication in the journal Protein & Cell by a group of scientists at Sun Yat-sen University using the CRISPR/Cas9 technique on editing non-viable human zygotes. Many commentators condemned the Chinese scientists for overstepping ethical boundaries long accepted in Western countries and accused China of having lax regulations on genomic research in general. We argue that not only did this research follow strict ethical standards and fully comply with current regulations, but China also has a well-developed regulatory framework governing such research comparable to many developed countries. We see the reactions among Western commentators as a misunderstanding of the current situation and an expression of a lack of willingness to acknowledge China as an equal partner in the international debate about proper limits to the development of new biotechnologies.

Eugenics and Mandatory Informed Prenatal Genetic Testing: A Unique Perspective from China.

The application of genetic technologies in China, especially in the area of prenatal genetic testing, is rapidly increasing in China. In the wealthy regions of China, prenatal genetic testing is already very widely adopted. We argue that the government should actively promote prenatal genetic testing to the poor areas of the country. In fact, the government should prioritize resources first to make prenatal genetic testing a standard routine care with an opt-out model in these area. Healthcare professions would be required to inform pregnant women about the availability of genetic testing and provide free testing on a routine basis unless the parents choose not to do so. We argue that this proposal will allow parents to make a more informed decision about their reproductive choices. Secondarily, this proposal will attract more healthcare professionals and other healthcare resources to improve the healthcare infrastructures in the less-developed regions of the country. This will help to reduce the inequity of accessing healthcare services between in different regions of China. We further argue that this policy proposal is not practicing eugenics.

Following the giant's paces-governance issues and bioethical reflections in China.

BACKGROUND: China has become a global player in the field of biosamples research and analysis of genetic data. The Beijing Genomics Institute is a genetics factory where enormous amounts of biosamples/data from all over the world are being analyzed. Most of the global bioethics discussions focused on research conducted by scientists from industrialized countries with subjects from poorer countries. Today, however, samples from industrialized nations are being analyzed in China on an unprecedented scale. This means that one should not just focus on bioethics developments in western countries, but also should pay attention to the situation in China. Under this era of rapid advancement in genomics, reassessing the conventionally accepted bioethical principles is strongly needed. DISCUSSION: In this paper, we will analyze the case of BGI in the context of the Chinese regulatory system in order to identify methods to regulate genetic research more effectively and to strengthen BGI's role in international collaborative research projects. Three main issues concerning sample collection and samples/data management are addressed. Firstly, an ambiguous definition of research, which does not specifically include biosamples/data, when applied to genetic research, may cause confusion and leave loopholes in governance. Secondly, the current regulations do not provide sufficient guidelines on the details of what information to present to prospective subjects, and how to combine informed consent with strategies of re-consent, withdrawal and feedback from research. Finally, the existing regulations do not adequately address issues of genetic privacy and data protection. SUMMARY: Bioethical issues related to genetic research in China may be partially due to the nature of genetic research and partially stems from the strategy of simply adopting general international guidelines into the Chinese context without detailed considerations of the local needs. However, there are no perfect readymade ethical solutions for everyone; every country faces different open questions and challenges behind what appears to be unified guidelines. Given the importance of China in international genetic research, other countries ought to be concerned about the bioethical developments in China. China should also have a substantive discussion with the international community on bioethics issues.

Awareness, Attitude, and Fertility Desire in Elective Oocyte Cryopreservation of Adults in Four Areas of China.

Purpose: Controversy exists on whether or not elective oocyte cryopreservation (eOC) can be conducted in public hospitals in China. Policymakers should take into account the benefits and risks in the Chinese population. This study explored basic data concerning the awareness, attitudes of eOC, and fertility desire of eOC in China to offer evidence for policy making. Methods: A total of 442 people in four areas of China responded to a survey. The questionnaire was divided into three parts: awareness, attitude, and fertility desire of eOC. Descriptive analysis and multivariable regression analysis were used in the study. Results: Generally, the respondents had a positive or neutral attitude towards eOC. However, about 90% of respondents did not know the cost of eOC. In general, a more positive attitude was found towards eOC among participants who had heard of the procedure compared with those who had not. Most women did not desire to reproduce by eOC. After adjusting for access to information, we found that female, older age groups, and singles were more likely to have increased awareness than their counterparts. The awareness of participants who accessed information from any source had a higher relative probability of having good awareness levels compared to participants who had not accessed the information. Undergraduates exhibited significantly higher levels of cognitive understanding, as indicated by their increased familiarity and comprehension, compared to high school students (relative risk ratio = 1.44, confidence interval = 0.48,4.29). Conclusion: Continued discussion is needed regarding the ethical, legal, and social aspects of performing eOC in public hospitals. Furthermore, policies are needed to regulate eOC to protect the reproductive freedom of healthy women.

Reconstruction of singular eyelid defects in aging individuals based on facial aesthetic subunits.

BACKGROUND: In consideration of the distinctive structural characteristics of the eyelid, the optimally matching donor site to the original recipient site skin should be selected when a full-thickness skin graft is anticipated in a small-sized or medium-sized eyelid defect in middle-aged or elderly patients. METHODS: Eight patients ranging in age from 47 to 71 years suffered singular eyelid defects of different causes. Based on the location, shape, and degree of the defects, we removed the redundant skin as a skin graft from the same side in the contralateral eyelid in a routine blepharoplasty procedure and transferred the graft to repair the defect. RESULTS: The skin grafts survived in all cases, and the incisions healed primarily. The eyelid laxity improved, and no complications occurred. All cases were followed up for 3 months to 2 years, the quality of skin grafts was similar to that of the surrounding skin, and the activity was ideal. CONCLUSIONS: When an eyelid defect is not amenable to direct closure and skin grafting is selected, the proper donor site is vital to the final outcome. The same facial aesthetic subunits, such as sufficient laxity in the contralateral eyelid skin in middle-aged and elderly patients, can provide the best match with the recipient skin and represent the best donor site for defect reconstruction.

Ethical and policy considerations for organ trafficking and transplant tourism: Based on the UK's first international case of human trafficking for the purpose of organ removal.

This study examines the UK's May 2023 judgment in an international organ trafficking and organ tourism case. Human trafficking for organ removal is one of the least understood but growing forms of trafficking worldwide. Countries in the Middle East, Asia, and the Americas are often widely criticized by the international transplant community as sites for organ trafficking. However, we believe that when discussing this issue, it is not just these areas that need to be addressed. What is particularly special is that this case not only involves transnational human trafficking, organ trafficking, and illegal organ transplantation interest chains but also involves the participation of national political officials and complex social and humanistic factors. This article focuses on the current ethical and policy issues involved in organ transplant tourism and organ trafficking and analyzes the implications of this case for our country's donation and transplantation work.

Circ_0008450 regulates keloid-derived fibroblast proliferation, migration, invasion and apoptosis with increased IGFBP5 through sponging miR-1224-5p.

BACKGROUND: Keloids (KD) are benign fibroproliferative tumors and circular RNAs (circRNAs) may participate in KD progression. At present, whether circ_0008450 regulates keloid-derived fibroblast phenotypes remains unclear. This study aimed to explore the functions of circ_0008450 in keloid (KD)-derived fibroblast phenotypes and the underlying mechanism. METHODS: Quantitative real-time polymerase chain reaction (qRT-PCR) or western blot assay was performed to determine the expression of circ_0008450, miR-1224-5p, insulin like growth factor binding protein 5 (IGFBP5) and extracellular matrix (ECM)-related markers. 5-Ethynyl-2'-deoxyuridine (EdU) assay was conducted to assess cell proliferation ability. Flow cytometry analysis was used to analyze cell cycle and cell apoptosis. Scratch assay and transwell assay were utilized to examine cell migration and invasion. Mechanism assays were executed to verify the relations of circ_0008450, miR-1224-5p and IGFBP5. RESULTS: Circ_0008450 was highly expressed in KD tissues and KD-derived fibroblasts. Circ_0008450 silencing inhibited KD-derived fibroblast proliferation, cell cycle, and motility and promoted apoptosis. The effect of circ_0008450 knockdown on KD-derived fibroblast processes was ameliorated by miR-1224-5p downregulation. IGFBP5 was a target gene of miR-1224-5p. IGFBP5 upregulation abated miR-1224-5p-mediated effects on KD-derived fibroblast processes. CONCLUSION: Circ_0008450 promoted KD-derived fibroblast proliferation, migration, and invasion and repressed apoptosis via sponging miR-1224-5p and elevating IGFBP5.

Medicine: business or profession?

As professionals, doctors have a contractual relationship with society that trains them and confers on them exclusive power to practice medical care. In the contract, power and responsibility should be balanced. When the power is conferred by society to a profession, the profession should take responsibility for society, including the provision of high quality services, and maintain high standard principled conduct and integrity.

Xenotransplantation-reflections on the bioethics.

Background: Similar to most countries in the world, China has a severe shortage of human organs, and this is one of the main issues restricting the application of organ transplantation technology. In 2019 alone, only 19,454 (23.90%) of the 81,410 people waiting were able to receive organ transplants. There is an increasing focus from both the medical profession and society on how to fill the gap between supply and demand. Methods: Xenotransplantation using animal organs is being considered as one option to make up for the shortage of human organs for transplantation. For some years now, the international medical community has been examining the possibility of using animal organs for human transplant. However, the research has faced two important types of challenges: scientific and ethical issues. Results: In January 2021, the first clinical trial of transgenic pig heart transplantation into a human recipient was completed by the Medical Center of the University of Maryland in the United States. This has stimulated enthusiasm and interest in xenotransplantation. Conclusions: The trend towards xenotransplantation has highlighted global problems such as the severe shortage of organ transplant donors and the high cost of organ transplantation. China needs to consider how to cope with the scientific, public health, and social ethics challenges of xenotransplantation clinical trials.

Circ_0057452 sponges miR-7-5p to promote keloid progression through upregulating GAB1.

Increasing evidence has shown that circular RNAs (circRNAs) play critical roles in various diseases, including keloid. The purpose of this study was to investigate the role of circ_0057452 and related action mechanisms during the development of keloid. The expression levels of circ_0057452, microRNA-7-5p (miR-7-5p) and GRB2 associated binding protein 1 (GAB1) mRNA were determined by quantitative real-time PCR (qRT-PCR). Cell proliferation was evaluated using methylthiazolyldiphenyl-tetrazolium bromide (MTT) and 5-Ethynyl-2'-deoxyuridine (Edu) assays. Flow cytometry analysis was utilized to determine cell cycle distribution and cell apoptosis. Western blot assay was used to measure apoptosis-related, collagen synthesis-related, and GAB1 protein levels. Cell migration and invasion were detected by wound healing assay and transwell assay. The interaction between miR-7-5p and circ_0057452 or GAB1 was confirmed by dual-luciferase reporter, RNA pull-down, and RNA Immunoprecipitation (RIP) assays. Circ_0057452 and GAB1 were upregulated in keloid tissues and keloid fibroblasts (KFs), while miR-7-5p was downregulated. Circ_0057452 knockdown or miR-7-5p overexpression inhibited the proliferation, migration, invasion, and collagen synthesis and induced cell cycle arrest and apoptosis of KFs. MiR-7-5p was targeted by circ_0057452, and its inhibition overturned the effects of circ_0057452 knockdown. In addition, GAB1 was a target of miR-7-5p, and GAB1 upregulation abolished the role of miR-7-5p overexpression and circ_0057452 knockdown in KFs. Circ_0057452 regulated the expression of GAB1 by adsorbing miR-7-5p in KFs. Circ_0057452 knockdown suppressed keloid development by regulating miR-7-5p/GAB1 axis, which might provide a promising therapeutic target for keloid.

Should more attention be paid to polio sequela cases in China?

Since "Global Polio Eradication Initiative" was launched by World Health Assembly in 1988, the incidence rate of polio has been reduced by more than 99%, and the whole world has entered a post polio era nowadays. China has been a polio free status recognized by World Health Organization for 22 years and most people believe that no more public health concerns need to be given. How is the population of polio survivors in China? What strategies of health economics and actions of public health for those with polio are ethically appropriate? This article, first of all, deeply summarizes and analyzes the history, current situation and unmet needs of population with polio sequelae and post-polio syndrome in China, and then, puts forward important issues faced by polio survivors who natural infected and who due to vaccine associated paralytic polio and vaccine derived poliovirus. The management of polio survivor is not only a medical and rehabilitation problem involving accessibility, accommodations, but also a public health issue, and most importantly, an ethical concern. Furthermore, from the perspective of ethics such as Justice and Cooperation, the author demonstrates the rationality and necessity of continuing to pay more attention to polio sequela cases at this stage in China. Finally, many valuable suggestions and practical recommendations are given.

Social acceptance for commercialization of genetically modified food animals.

Genetically modified food animals (GMFAs) are needed to address early the cumulative effects of livestock production on the environment, and to accommodate future food demands. In 2020 China and the USA, the world's two largest economies, embarked on regulatory reforms to boost the commercialization of such animals. However, gaining social acceptance of GMFAs for commercialization remains a global challenge. We propose a framework that focuses on social license for commercialization of GMFAs by defining four classes of improvement using precision genetics: (1) animals equivalent to natural variation to obtain the improved effect of cross-breeding (ENV); (2) animals with an inactivated gene that could occur via natural mutation (ENC-); (3) animals harboring a natural genetic sequence isolated from another species (ENC+); and (4) animals with synthetic sequences encoding novel genes (BNE). Our approach can guide regulators and the public to support orderly commercialization of GMFAs.