Dual-targeting CD44 and mucin by hyaluronic acid and 5TR1 aptamer for epirubicin delivery into cancer cells: Synthesis, characterization, in vitro and in vivo evaluation.

One of the revolutionized cancer treatment is active targeting nanomedicines. This study aims to create a dual-targeted drug delivery system for Epirubicin (EPI) to cancer cells. Hyaluronic acid (HA) is the first targeting ligand, and 5TR1 aptamer (5TR1) is the second targeting ligand to guide the dual-targeted drug delivery system to the cancer cells. HA is bound to highly expressed receptors like CD44 on cancer cells. 5TR1, DNA aptamer, is capable of recognizing MUC1 glycoprotein, which is overexpressed in cancer cells. The process involved binding EPI and 5TR1 to HA using adipic acid dihydrazide (AA) as a linker. The bond between the components was confirmed using 1H NMR. The binding of 5TR1 to HA-AA-EPI was confirmed using gel electrophoresis. The particle size (132.6 ± 9 nm) and Zeta Potential (-29 ± 4.4 mV) were measured for the final nanoformulation (HA-AA-EPI-5TR1). The release of EPI from the HA-AA-EPI-5TR1 nanoformulation was also studied at different pH levels. In the acidic pH (5.4 and 6.5) release pattern of EPI from the HA-AA-EPI-5TR1 nanoformulation was higher than physiological pH (7.4). The cytotoxicity and cellular uptake of the synthetic nanoformula were evaluated using MTT and flow cytometry analysis. Flow cytometry and cellular cytotoxicity studies were exhibited in a negative MUC1-cell line (CHO) and two positive MUC1+cell lines (MCF-7 and C26). Results confirmed that there is a notable contrast between the dual-targeted (HA-AA-EPI-5TR1) and single-targeted (HA-AA-EPI) nanoformulation in MCF-7 and C26 cell lines (MUC1+). In vivo studies showed that HA-AA-EPI-5TR1 nanoformulation has improved efficiency with limited side effect in C26 tumor-bearing mice. Also, Fluorescence imaging and pathological evaluation showed reduced side effects in the heart tissue of mice receiving HA-AA-EPI-5TR1 than free EPI. So, this targeted approach effectively delivers EPI to cancer cells with reduced side effects.

The 4P telehealth business framework for Iran.

BACKGROUND: Telehealth services can utilize various information technologies and improve quality and efficiency of healthcare delivery by facilitating education, treatment, follow-up, and decision-making. However, these services are not always commercialized, and in case of commercialization, there is no guarantee for their long-term sustainability in market. Therefore, business models and frameworks are used as part of commercialization processes to identify a set of factors affecting the sustainability, effectiveness, and key business activities. The current study aimed to develop a telehealth business framework for Iran. METHODS: This research was conducted in 2021, and a mixed-methods approach was used for data collection. Initially, a telehealth business framework was developed based on the findings derived from a systematic review and a qualitative research. The proposed framework was then reviewed by an expert panel (n = 9) in which the participants had at least three years of work experience in telehealth. Finally, the framework was validated using the Delphi method (three rounds). RESULTS: The expert panel believed that some components such as partners' expertise, required capital and financial resources, research and analysis, marketing and branding, tax, product registration, and marketing at scientific congresses and science and technology exhibitions needed to be added to the framework. In the Delphi study, 68 out of 74 components proposed in the initial framework were approved across four major dimensions; namely, prerequisites, production, payments and costs, and post-production services. CONCLUSIONS: It seems that the developed framework can facilitate commercializing telehealth technologies and developing business plans. In addition, telehealth start-ups can use this framework and its various components in a competitive market to be more successful in their businesses. However, it is still critical to evaluate the effectiveness of the framework in practice and in relation to the commercialization of telehealth technologies.

Telehealth Business Models and Their Components: Systematic Review.

BACKGROUND: Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services. OBJECTIVE: The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry. METHODS: This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively. RESULTS: Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components. CONCLUSIONS: Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization.

Key components and critical factors for developing a telehealth business framework: a qualitative study.

BACKGROUND: Telehealth technology and related products can help to solve the problems associated with providing health care services and equal distribution of resources. However, in order to run a telehealth business successfully, key components and critical factors need to be taken into account. A telehealth business framework can provide a rich understanding of these components and factors. Therefore, the present study aimed to identify the key components and critical factors for developing a telehealth business framework from the experts' perspectives. METHODS: The present qualitative study was conducted in 2020. The participants were 22 experts in the fields of medical informatics, health information management, telemedicine, telehealth, health entrepreneurship, health insurance, and digital health start-ups. In depth semi-structured interviews were conducted to collect data, and the data were analyzed using framework analysis. RESULTS: Four main themes derived from data analysis. The themes included key components for developing a telehealth business framework, success factors, challenges, and barriers of a telehealth business. Overall, the results indicated that the key components in a telehealth business framework included created value, key resources, key activities, key partners, licenses and permissions, product pricing, revenue, marketing, supporting services, and getting feedback from customers. Although receiving support from different individuals and organizations as well as economic benefits of telehealth services may consider as success factors, there are a number of challenges and barriers which should be taken into account. Otherwise, these factors may hinder the success of a telehealth business. CONCLUSIONS: The development of a telehealth business framework might be an important step towards developing a more complete business plan, facilitating the commercialization of telehealth products, and providing a solution for product sustainability in a competitive market. In the current study, the key components and critical factors for developing a telehealth business framework were identified; however, further research is needed to explore how these components and factors can be helpful in developing business plans and running a successful telehealth business.

Ethnobotany, Phytochemistry and Pharmacological Features of Centella asiatica: A Comprehensive Review.

Centella asiatica (CA) or Gotu cola is an herbal plant from the Apiaceae family with a long history of usage in different traditional medicines. It has long been used for the treatment of various ailments such as central nervous system (CNS), skin and gastrointestinal disorders especially in the Southeast Asia. This chapter focused on the phytochemical constituent and pharmacological activities of CA based on preclinical and clinical studies. Additionally, botanical description and distribution, traditional uses, interactions, and safety issues are reviewed. Electronic databases of Google Scholar, Scopus, PubMed, and Web of Science were searched to obtain relevant studies on the pharmacological activities of CA. Approximately, 124 chemical compounds including triterpenoids, polyphenolic compounds, and essential oils have been isolated and identified from CA. Ethnomedicinal applications of CA mostly include treatment of gastrointestinal diseases, wounds, nervous system disorders, circulatory diseases, skin problems, respiratory ailments, diabetes and sleep disorders in various ethnobotanical practices. Pharmacological studies revealed a wide range of beneficial effects of CA on CNS, cardiovascular, lung, liver, kidney, gastrointestinal, skin, and endocrine system. Among them, neuroprotective activity, wound healing and treatment of venous insufficiency, as well as antidiabetic activity seem to be more frequently reported. At the moment, considering various health benefits of CA, it is marketed as an oral supplement as well as a topical ingredient in some cosmetic products. Additional preclinical studies and particularly randomized controlled trials are needed to clarify the therapeutic roles of CA.

The necessity to develop a national classification system for Iranian traditional medicine.

BACKGROUND: Classification of disease and interventions in traditional medicine (TM) is necessary for standardised coding of information. Currently, in Iran, there is no standard electronic classification system for disease and interventions in TM. OBJECTIVE: The current study aimed to develop a national framework for the classification of disease and intervention in Persian medicine based on expert opinion. METHOD: A descriptive cross-sectional study was carried out in 2018. The existing systems for the classification of disease and interventions in TM were reviewed in detail, and some of the structural and content characteristics were extracted for the development of the classification of Iranian traditional medicine. Based on these features, a self-administered questionnaire was developed. Study participants (25) were experts in the field of Persian medicine and health information management in Tehran medical universities. RESULTS: Main axes for the classification of disease and interventions were determined. The most important applications of the classification system were related to clinical coding, policymaking, reporting of mortality and morbidity data, cost analysis and determining the quality indicators. Half of the participants (50%) stated that the classification system should be designed by maintaining the main axis of the World Health Organization classification system and changing the subgroups if necessary. A computer-assisted coding system for TM was proposed for the current study. CONCLUSION: Development of this classification system will provide nationally comparable data that can be widely used by governments, national organisations and academic researchers.

Need assessment of staffs' welfare services at tehran university of medical sciences: a cross-sectional study.

BACKGROUND: Reviewing the human resources management literature shows an absence of attention given to the employee's benefits. Taking a look at functions of the Tehran University of Medical Sciences' wellbeing services system, it uncovers a gap between employees' real needs and what is delivered to meet their needs. So it requires an improved comprehensive system for delivering wellbeing services (financial, insurance, health care services, educational and training services, etc). Wellbeing need assessment can helps planners to identify vital needs of employee and response to them effectively. Moreover it can be used to evaluate the effectiveness of the current services which are delivered. Thus, the aim of this study is to assess wellbeing services of staffs working in TUMS to (1) evaluate the satisfactory rate of services which are delivered, and (2) exploring those wellbeing needs which were not fulfilled by the organization. MATERIAL AND METHODS: Being a cross-sectional and analytic-descriptive survey including 98 responding participants, it is conducted by a questionnaire collecting employees' demographic information, their satisfactory rate of the implemented services, and determines unfulfilled wellbeing needs which were not already covered. RESULT: Results indicated that services related to financial, educational, non-financial, insurance, occupational health and tourism/recreational services were the most satisfactory services successively. 'Staff's unwillingness to receive services' and 'poor announcement' (unawareness on the wellbeing services),' were found to be the most frequent reasons for not receiving the existing wellbeing services. CONCLUSION: To increase the satisfaction rate and responsiveness to the real needs of the staff, the current delivery system of wellbeing services in the TUMS should be redesigned by defining new wellbeing packages.