Exploring Innovations in Medical Interventions

Therapeutic Ultrasound: 2024 Update Overview

Therapeutic ultrasound has evolved considerably over the past decade and now represents a versatile tool in clinical interventions. Recent updates reflect significant advances in technology and safety considerations in the treatment of various conditions using ultrasound energy (1).

Ultrasound, traditionally known for its diagnostic capabilities, is now harnessed to induce both thermal and mechanical bioeffects. These bioeffects depend on parameters such as frequency, intensity, pulse duration, and in situ tissue characteristics. For example, focused ultrasound therapy can cause controlled heating that leads to thermal ablation in target tissues, such as thyroid nodules, uterine fibroids, and liver tumors. The process involves elevating tissue temperatures to levels sufficient to cause cell death in a matter of seconds to minutes. In contrast, low‐intensity pulsed ultrasound (LIPUS) works primarily via non‐thermal mechanisms to enhance bone fracture healing and to gently modulate neural circuits for potential neuromodulation applications.

Furthermore, advances in ultrasound monitoring techniques have enhanced treatment precision. Image‐guided therapy now incorporates modalities—such as magnetic resonance imaging (MRI) thermometry and ultrasound-based passive cavitation imaging—to provide real-time feedback on tissue changes during therapy. Such improvements enable clinicians to measure temperature distributions accurately and to observe cavitation activity, ensuring that intervention parameters remain within safe limits while achieving the desired therapeutic effect.

Innovative approaches—including histotripsy (mechanical tissue fractionation via inertial cavitation), catheter-based ultrasound for stone fragmentation, and ultrasound-assisted drug delivery—underscore the broad clinical impact of this technology. Table 2 below provides a brief overview of several therapeutic ultrasound device types and their typical parameters.

Table 2: Overview of Selected Therapeutic Ultrasound Device Types

Note: The above values and applications represent typical ranges and common clinical uses for these devices (1).

The current update emphasizes the importance of precise parameter selection to ensure optimal therapeutic outcomes while minimizing the risk of unintended tissue damage. As promising clinical applications continue to be tested in large-scale clinical trials and integrated into routine practice, therapeutic ultrasound is poised to become an increasingly vital tool across multiple disciplines in medicine.

Electronic Cigarettes for Smoking Cessation – A Living Systematic Review

Smoking remains a leading cause of preventable morbidity and mortality worldwide. For decades, clinicians have sought effective tools to help people quit smoking, and electronic cigarettes (ECs) have emerged as a contentious yet potentially powerful aid in smoking cessation. A recent living systematic review has synthesized evidence regarding the safety, tolerability, and effectiveness of nicotine-containing ECs compared with other smoking cessation treatments, including nicotine replacement therapy (NRT), non-nicotine ECs, and behavioral or no support (2).

The review incorporated data from 90 studies with a total of over 29,000 participants. A key finding was that nicotine ECs increased long-term abstinence from smoking considerably when compared with traditional NRT. In the pooled analysis, people who used nicotine ECs were about 59% more likely to achieve smoking cessation at six months or longer compared to those using NRT (risk ratio [RR] 1.59; 95% confidence interval [CI]: 1.30 to 1.93; 7 studies, 2,544 participants). Furthermore, while adverse events (AEs) related to EC use were generally similar to those observed with other cessation aids, serious adverse events (SAEs) were rare (2).

Below is a summary table that highlights the key outcome measures from the systematic review comparing nicotine ECs with NRT.

Table 1: Key Outcome Measures – Nicotine ECs vs. NRT

These results suggest that nicotine ECs may offer a significant advantage over conventional NRT in facilitating smoking cessation. However, the review also noted that longer-term data and more precision on safety outcomes are needed to fully understand the benefits and potential harms of EC use. This living systematic review approach ensures that as new evidence emerges, recommendations can be updated promptly to help guide policymakers, healthcare providers, and individual patients in making informed decisions.

Lived Experiences of Lung Transplantation in Cystic Fibrosis

For individuals with cystic fibrosis (CF), progressive respiratory decline can eventually lead to the need for lung transplantation—a procedure that, while life-saving, is accompanied by substantial physical and psychological challenges. A recent qualitative study explored the lived experiences of 23 lung-transplanted individuals with CF, providing in-depth insights into both the pre-transplant waiting period and the post-transplant recovery phase (3).

Participants described the pre-transplant phase as a period marked by physical deterioration, isolation, and dependency on family support. Many patients felt unprepared for the rapid decline in lung function, with everyday activities becoming overwhelming tasks. The study revealed that the waiting period brought not only physical challenges such as extreme fatigue and reduced mobility, but also emotional burdens, including anxiety, guilt, and a sense of loss concerning their previous identity.

Post-transplant, patients experienced a mixture of relief and new challenges. Although the sense of being “reborn with new lungs” instilled hope and improved the capacity for normal activities, the immediate postoperative period was frequently associated with intense pain and a difficult adjustment to a new identity. The necessity of lifelong immunosuppressive medications, along with their associated side effects, further complicated recovery. Many participants stressed the importance of transparent communication with healthcare professionals and expressed a desire for earlier psychological and palliative support to ease the transition.

The insights from this study underscore the importance of holistic, patient-centered care that addresses both the physical and emotional needs of lung transplant recipients. These findings may help transplant teams develop more comprehensive preoperative preparation programs and long-term support strategies designed to improve quality of life after transplantation (3).

Psychotropic Drugs in Dermatology: Anti-depressants and Contraindications

In the realm of dermatology, psychotropic drugs—particularly anti-depressants such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs)—play a dual role in addressing both mood disorders and dermatologic conditions like chronic urticaria, pruritus, and compulsive skin picking (5). Doxepin, for instance, exhibits not only anti-depressant effects but also potent anti-histaminic and antipruritic properties. It is used to manage conditions such as atopic eczema and lichen simplex chronicus, with a typical starting dose of 25 mg/day and gradual titration up to a maximum of 300 mg/day (5).

Contraindications for TCAs are critical to consider. Absolute contraindications include recent myocardial infarction and active suicidal ideation due to the risk of fatal overdose. Relative contraindications encompass hypersensitivity to TCAs, severe liver disease, very young age, breastfeeding, and recent use of monoamine oxidase inhibitors (MAOIs). Such detailed guidance ensures that clinicians prescribe these medications safely and effectively, tailoring treatment to each patient’s specific clinical profile (5).

The emphasis on understanding contraindications and the dual benefits of psychotropic drugs in dermatology highlights the necessity of integrating pharmacologic therapy with careful clinical assessment in specialty areas where psychological factors may exacerbate physical symptoms.

Case Insights in Pulmonary Diagnostics

Accurate diagnosis in pulmonary medicine relies heavily on comprehensive patient history and detailed imaging assessments. Two recent case reports illustrate the critical need for thorough clinical evaluation. In one case, a 24-year-old male presenting with a persistent cough, later found to have a lung mass on chest X-ray and a cavitary lesion on CT scan, underscored the importance of obtaining a complete drinking and substance-use history. The delay in linking recurrent binge drinking with aspiration pneumonia ultimately delayed appropriate treatment (9).

In another case, a 63-year-old female displayed nonspecific symptoms including left upper quadrant abdominal pain and cough. Extensive workup including CT scans revealed subtle calcifications and minimal pleural effusions. Eventually, cultures returned positive for Mycobacterium scrofulaceum, a rare pathogen that can be misinterpreted as contamination. These cases highlight that limited history or subtle imaging findings can lead to misdiagnosis, emphasizing the need for multidisciplinary approaches and detailed patient interviews to avoid unnecessary invasive procedures (9, 10).

These clinical insights serve as reminders that in pulmonary diagnostics, careful attention to patient history—often encapsulated in the old adage “listen to your patient”—can be the key to appropriate and timely management.

Data Tables Summary

Table 1: Key Outcome Measures – Nicotine ECs vs. NRT

(Adapted from the systematic review findings in reference 2)

Table 2: Overview of Selected Therapeutic Ultrasound Device Types

(Adapted from the overview in reference 1)

Frequently Asked Questions (FAQ)

What is therapeutic ultrasound and how does it work?
Therapeutic ultrasound uses high-frequency sound waves to induce thermal and mechanical bioeffects in tissues, facilitating treatments such as tissue ablation, bone healing, and neuromodulation. Parameters like intensity, frequency, and pulse duration are carefully controlled to achieve the desired effect without damaging surrounding tissues (1).

How effective are electronic cigarettes compared to traditional nicotine replacement therapies?
According to a recent systematic review, nicotine-containing electronic cigarettes show a significant increase in long-term smoking cessation compared to conventional nicotine replacement therapies. The pooled data indicates a risk ratio of 1.59, suggesting that users of nicotine ECs are approximately 59% more likely to quit smoking at six to twelve months than those who use NRT (2).

What are some of the challenges faced by lung transplant recipients with cystic fibrosis?
Individuals with CF who undergo lung transplantation often face a challenging period before and after the surgery. Prior to transplantation, patients may experience severe physical decline, isolation, and emotional stress. Post-transplant, although many feel a sense of renewal, they must adjust to significant pain, lifelong immunosuppressive medication, and a redefined personal identity. These insights stress the need for comprehensive, multidisciplinary support during the transplant process (3).

What precautions should clinicians take when prescribing psychotropic drugs for dermatological conditions?
Clinicians must be aware of both the dual therapeutic benefits and the contraindications associated with psychotropic drugs such as TCAs and SSRIs. For example, with TCAs, contraindications include recent myocardial infarction and active suicidal ideation, while relative contraindications involve hypersensitivity, liver disease, or concurrent use of monoamine oxidase inhibitors. Such considerations ensure safe and effective patient-specific treatment (5).

Why is a thorough patient history critical in pulmonary diagnostics?
Comprehensive patient history is vital because subtle clinical details—such as undisclosed substance use—can dramatically alter diagnostic and treatment pathways. Case reports have shown that incomplete histories can lead to misdiagnosis or delayed treatment, potentially resulting in unnecessary invasive procedures (9, 10).

References

1. Bader, K. B., Padilla, F., Haworth, K. J., Ellens, N., Dalecki, D., Miller, D. L., … & Vaezy, S. (2024). Overview of therapeutic ultrasound applications and safety considerations: 2024 update. Journal of Ultrasound in Medicine

2. Lindson, N., Butler, A. R., McRobbie, C., Hajek, P., Bullen, C., Hajek, P., … & Turner, T. (2025). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, CD010216.pub9

3. Skogeland, U., de Monestrol, I., Pincikova, T., Godskesen, T., (et al.). (2025). Lived experiences for individuals with cystic fibrosis who have undergone lung transplantation: A qualitative study. BMC Nursing, 27, 2774. https://doi.org/10.1186/s12912-025-02774-x

4. [Psychotropic Drugs in Dermatology Part 1: Anti-depressants and Mood Stabilisers]. (n.d.). PubMed. https://pubmed.ncbi.nlm.nih.gov/11784973/

5. When the Missing Link Was a Drink: Missed Diagnosis of a Lung Mass Due to Limited History. (n.d.). Cureus. https://doi.org/10.7759/cureus.76956

6. Would You Rather Treat? A Rare Case of Mycobacterium Scrofulaceum. (n.d.). European Journal of Case Reports in Internal Medicine. https://doi.org/10.12890/2025_004963

This article was developed to provide an in-depth exploration of several innovative medical interventions that are reshaping patient care. The information presented is based on the latest scientific research and systematic reviews to ensure accuracy and relevance for healthcare professionals and interested readers alike.