サンプル依頼リスト カート
  • English
  • Korean
  • Traditional Chinese
  • Simplified Chinese
デフォルト表紙
市場調査レポート
商品コード
1452967

自己拡張型ステントの世界市場：2024-2031年

Global Self-Expanding Stents Market 2024-2031
出版日: | 発行: Orion Market Research | ページ情報: 英文 115 Pages | 納期: 2～3営業日

● お客様のご希望に応じて、既存データの加工や未掲載情報（例：国別セグメント）の追加などの対応が可能です。　 詳細はお問い合わせください。

価格
価格表記: USDを日本円(税抜)に換算
本日の銀行送金レート: 1USD=156.70円
自己拡張型ステントの世界市場：2024-2031年
出版日: 2024年02月09日
発行: Orion Market Research
ページ情報: 英文 115 Pages
納期: 2～3営業日
  • 全表示
  • 概要
  • 図表
  • 目次
概要

世界の自己拡張型ステントの市場規模、シェア、動向分析レポート：製品タイプ別（オープンセル、クローズドセル）、用途別（末梢動脈疾患、血管狭窄、消化管、呼吸器管、心臓血管系）、エンドユーザー別（病院、専門クリニック、外来手術センター）予測期間（2024-2031年）

自己拡張型ステントの世界市場は、予測期間中（2024-2031年）に4.5％の緩やかなCAGRで成長すると予測されます。自己拡張型ステントの継続的な進歩、これらのステントの新規用途を見出すための継続的な研究開発活動、対象疾患の有病率の増加が、世界市場の成長を促進する主な要因のいくつかです。

市場力学

対象疾患の有病率の増加

心臓疾患、血管狭窄、消化器疾患の有病率の増加は、自己拡張型ステント市場を牽引すると予想されます。WHOによると、世界全体では、心血管疾患（CVD）が原因で毎年推定1,790万人が死亡しています。その有病率の増加に伴い、自己拡張型ステントを含む効果的な治療オプションに対する需要は増加する傾向にあり、それが世界市場の成長に寄与しています。自己拡張型ステントは、狭窄または閉塞した動脈の治療において、構造的な支持を提供し、血流の改善を促進することで重要な役割を果たします。

FDA承認の増加

米国FDA承認の増加は、同市場における製品流出数の増加により、同市場の成長を促進すると予想されます。例えば、2022年7月、BiotronikはPulsar-18 T3末梢自己拡張型ステントシステムのFDA承認を取得しました。これは、血管内治療のためのより良い移植プロセスを提供するために特別に設計されています。2020年10月、Medtronic Plcは静脈流出閉塞を治療するAbre静脈自己拡張型ステントシステムのFDA承認を取得しました。このデバイスは、症候性腸大腿静脈流出閉塞症の患者における腸大腿静脈への使用を適応としています。

市場セグメンテーション

自己拡張型ステントの世界市場を詳細に分析すると、製品タイプ別、用途別、エンドユーザー別に以下のようなセグメントがあります：

  • 製品タイプに基づき、市場はオープンセルとクローズドセルに細分化されます。
  • 用途別では、市場は末梢動脈疾患、血管狭窄、消化管、呼吸器系、循環器系に細分化されます。
  • エンドユーザーに基づくと、市場は病院、専門クリニック、外来手術センターに細分化されます。

病院が世界市場で大きなシェアを占める

エンドユーザー別に見ると、自己拡張型ステントの世界市場は病院、専門クリニック、外来手術センターに細分化されます。病院では、高度な医療設備が整っているため、外科手術や非外科手術が数多く行われています。病院では患者数が多いため、ステントに対する需要が高いことが市場成長の主な要因となっています。自己拡張型ステントの処置を提供する先進的な病院が世界的に増加していることも、この地域の市場成長に大きく寄与しています。

地域別の展望

自己拡張型ステントの世界市場は、北米（米国、カナダ）、欧州（英国、イタリア、スペイン、ドイツ、フランス、その他欧州地域）、アジア太平洋（インド、中国、日本、韓国、その他アジア地域）、世界のその他の地域（中東・アフリカ、中南米）を含む地域別にさらに細分化されています。

北米が主要市場シェアを占める

すべての地域の中で、北米が大きなシェアを占めているのは、自己拡張型ステントの新たな応用分野を見出すことに焦点を当てた臨床研究が、この地域で活発化しているためです。例えば、ある研究機関は、社会経済的に中低レベルの環境において、すでに高額な機械的血栓除去術のレスキューステントとして、頭蓋内循環における冠動脈ステントの応用を見出そうとしています。北米市場では米国が大きなシェアを占めています。米国には、Abbott Laboratories、Pfizer、Johnson &Johnson、Novartisなどの自己拡張型ステントの主要メーカーがあります。

同国では、自己拡張型ステントの商業的発売が何度か行われています。これらのステントを使用して治療できる対象疾患に罹患しやすい高齢者人口が多いことが、市場の成長をさらに後押ししています。米国消化器病学会によると、成人人口の推定10パーセントから15パーセントが過敏性腸症候群（IBS）の症状に苦しんでいますが、この病気と診断されているのは成人のわずか5パーセントから7パーセントです。このため、IBS治療に対する大きな需要が生まれ、市場の成長に寄与しています。

目次

第1章 レポート概要

  • 業界の現状分析と成長ポテンシャルの展望
  • 調査方法とツール
  • 市場内訳
    • セグメント別
    • 地域別

第2章 市場概要と洞察

  • 調査範囲
  • アナリストの洞察と現在の市場動向
    • 主な調査結果
    • 推奨事項
    • 結論

第3章 競合情勢

  • 主要企業分析
  • Abbott Laboratories
    • 概要
    • 財務分析
    • SWOT分析
    • 最近の動向
  • Becton Dickinson, and Co.
    • 会社概要
    • 財務分析
    • SWOT分析
    • 最近の動向
  • Biotronic Inc.
    • 概要
    • 財務分析
    • SWOT分析
    • 最近の動向
  • Boston Scientific Corp.
    • 概要
    • 財務分析
    • SWOT分析
    • 最近の動向
  • 主要戦略分析

第4章 市場セグメンテーション

  • 自己拡張型ステントの世界市場：製品タイプ別
    • オープンセル
    • クローズドセル
  • 自己拡張型ステントの世界市場：用途別
    • 末梢動脈疾患
    • 血管狭窄
    • 消化管
    • 呼吸器系
    • 心臓血管系
  • 自己拡張型ステントの世界市場：エンドユーザー別
    • 病院
    • 外来手術センター
    • 専門クリニック

第5章 地域別分析

  • 北米
    • 米国
    • カナダ
  • 欧州
    • 英国
    • ドイツ
    • イタリア
    • スペイン
    • フランス
    • その他欧州
  • アジア太平洋
    • 中国
    • インド
    • 日本
    • 韓国
    • その他アジア太平洋
  • 世界のその他の地域

第6章 企業プロファイル

  • Braun Melsungen AG
  • Cardinal Health, Inc.
  • Cook Medical, Inc.
  • Cordis Corp.
  • Edward Lifesciences Corp.
  • Medtronic plc
  • Merit Medical Systems, Inc.
  • Olympus Corp.
  • Terumo Corp.
  • Veryan Medical
図表

LIST OF TABLES

  • 1.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY PRODUCT TYPE, 2023-2031 ($ MILLION)
  • 2.GLOBAL OPEN-CELL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 3.GLOBAL CLOSED-CELL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 4.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY APPLICATION, 2023-2031 ($ MILLION)
  • 5.GLOBAL SELF-EXPANDING STENTS FOR PERIPHERAL ARTERY DISEASE TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 6.GLOBAL SELF-EXPANDING STENTS FOR VASCULAR STENOSIS TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 7.GLOBAL SELF-EXPANDING STENTS GASTROINTESTINAL TRACT TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 8.GLOBAL SELF-EXPANDING STENTS CARDIOVASCULAR DISEASE TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 9.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY END-USER, 2023-2031 ($ MILLION)
  • 10.GLOBAL SELF-EXPANDING STENTS IN HOSPITALS MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 11.GLOBAL SELF-EXPANDING STENTS IN AMBULATORY SURGICAL CENTERS MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 12.GLOBAL SELF-EXPANDING STENTS IN SPECIALIZED CLINICS MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 13.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY REGION, 2023-2031 ($ MILLION)
  • 14.NORTH AMERICAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2023-2031 ($ MILLION)
  • 15.NORTH AMERICAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY PRODUCT TYPE, 2023-2031 ($ MILLION)
  • 16.NORTH AMERICAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY APPLICATION, 2023-2031 ($ MILLION)
  • 17.NORTH AMERICAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY END-USER, 2023-2031 ($ MILLION)
  • 18.EUROPEAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2023-2031 ($ MILLION)
  • 19. EUROPEAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY PRODUCT TYPE, 2023-2031 ($ MILLION)
  • 20.EUROPEAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY APPLICATION, 2023-2031 ($ MILLION)
  • 21.EUROPEAN SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY END-USER, 2023-2031 ($ MILLION)
  • 22.ASIA-PACIFIC SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2023-2031 ($ MILLION)
  • 23.ASIA-PACIFIC SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY PRODUCT TYPE, 2023-2031 ($ MILLION)
  • 24.ASIA-PACIFIC SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY APPLICATION, 2023-2031 ($ MILLION)
  • 25.ASIA-PACIFIC SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY END-USER, 2023-2031 ($ MILLION)
  • 26.REST OF THE WORLD SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2023-2031 ($ MILLION)
  • 27.REST OF THE WORLD SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY PRODUCT TYPE, 2023-2031 ($ MILLION)
  • 28.REST OF THE WORLD SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY APPLICATION, 2023-2031 ($ MILLION)
  • 29.REST OF THE WORLD SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY END-USER, 2023-2031 ($ MILLION)

LIST OF FIGURES

  • 1.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY PRODUCT TYPE, 2023 VS 2031 (%)
  • 2.GLOBAL OPEN-CELL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 3.GLOBAL CLOSED-CELL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 4.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY APPLICATION, 2023 VS 2031 (%)
  • 5.GLOBAL SELF-EXPANDING STENTS FOR PERIPHERAL ARTERY DISEASE TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 6.GLOBAL SELF-EXPANDING STENTS FOR VASCULAR STENOSIS TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 7.GLOBAL SELF-EXPANDING STENTS FOR GASTROINTESTINAL DISEASE TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 8.GLOBAL SELF-EXPANDING STENTS FOR CARDIOVASCULAR DISEASE TREATMENT MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 9.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY END-USER, 2023 VS 2031 (%)
  • 10.GLOBAL SELF-EXPANDING STENTS IN HOSPITALS MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 11.GLOBAL SELF-EXPANDING STENTS IN AMBULATORY SURGICAL CENTERS MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 12.GLOBAL SELF-EXPANDING STENTS IN SPECIALIZED CLINICS MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 13.GLOBAL SELF-EXPANDING STENTS MARKET RESEARCH AND ANALYSIS BY REGION, 2023 VS 2031 (%)
  • 14.US SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 15.CANADA SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 16.UK SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 17.FRANCE SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 18.GERMANY SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 19.ITALY SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 20.SPAIN SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 21.REST OF EUROPE SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 22.INDIA SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 23.CHINA SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 24.JAPAN SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 25.SOUTH KOREA SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 26.REST OF ASIA-PACIFIC SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 27.REST OF THE WORLD SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 28.LATIN AMERICA SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
  • 29.THE MIDDLE EAST & AFRICA SELF-EXPANDING STENTS MARKET SIZE, 2023-2031 ($ MILLION)
目次
Product Code: OMR2028182

Global Self-Expanding Stent Market Size, Share & Trends Analysis Report by Product Type (Open-Cell and Closed-Cell), by Application (Peripheral Artery Disease, Vascular Stenosis, Gastrointestinal Tract, Respiratory Tract, and Cardiovascular System), and by End-User (Hospitals, Specialized Clinics, and Ambulatory Surgical Centers) Forecast Period (2024-2031)

Global self-expanding stent market is anticipated to grow at a moderate CAGR of 4.5% during the forecast period (2024-2031). The ongoing advancements in self-expanding stents, continuous R&D activities to find novel applications for these stents along the increasing prevalence of targeted diseases are some of the key factors driving the growth of the global market.

Market Dynamics

Growing Prevalence of Targeted Disorders

The growing prevalence of cardiac disorders, vascular stenosis, and gastrointestinal disorders is anticipated to drive the self-expanding stents market. According to the WHO, globally, an estimated 17.9 million mortalities occur every year due to cardiovascular diseases (CVDs). With its increasing prevalence, the demand for effective treatment options, including self-expanding stents tends to increase; which in turn contributes to the global market growth. Self-expanding stents play a crucial role in the treatment of narrowed or blocked arteries by providing structural support and facilitating improved blood flow.

Increasing FDA Approvals

The increasing US FDA approvals are anticipated to drive the market growth owing to the increasing number of product outflow in the market. For instance, In July 2022, Biotronik received FDA approval for the Pulsar-18 T3 peripheral self-expanding stent system. It is specifically designed to offer a better implantation process for endovascular treatments. In October 2020, Medtronic Plc received FDA approval for an Abre venous self-expanding stent system that treats venous outflow obstruction. This device is indicated for use in the iliofemoral veins in patients with symptomatic iliofemoral venous outflow obstruction.

Market Segmentation

Our in-depth analysis of the global self-expanding stent market includes the following segments by product type, application, and end-user:

  • Based on product type, the market is sub-segmented into open-cell and closed-cell.
  • Based on application, the market is sub-segmented into peripheral artery disease, vascular stenosis, gastrointestinal tract, respiratory tract, and cardiovascular system.
  • Based on end-users, the market is sub-segmented into hospitals, specialized clinics, and ambulatory surgical centers.

Hospitals Held a Major Share in the Global Market

Based on the end-user, the global self-expanding stent market is sub-segmented into hospitals, specialized clinics, and ambulatory surgical centers. A large number of surgical and non-surgical procedures occur in hospitals due to the high availability of advanced medical equipment. The high demand for these stents in hospital settings due to the large patient population in these settings is a key contributor to the market growth. The increasing number of advanced hospitals globally that offer self-expanding stent procedures is a key contributor to the regional market growth.

Regional Outlook

The global self-expanding stent market is further segmented based on geography including North America (the US, and Canada), Europe (UK, Italy, Spain, Germany, France, and the Rest of Europe), Asia-Pacific (India, China, Japan, South Korea, and Rest of Asia), and the Rest of the World (the Middle East & Africa, and Latin America).

North America Holds Major Market Share

Among all the regions, North America holds a significant share owing to the growing regional focus on clinical research focused on finding new application areas for self-expanding stents. For instance, a research organization is working on finding the application of coronary stents in the intracranial circulation as rescue stenting for an already expensive mechanical thrombectomy procedure in a mid-low socioeconomic setting. The US held a major share of the North American market. The US is home to key manufacturers of self-expanding stents such as Abbott Laboratories, Pfizer, Johnson & Johnson, and Novartis among others.

The country noticed several commercial launches of self-expanding stents. The large presence of the geriatric population which is highly susceptible to targeted diseases that can be treated using these stents is further aiding the market growth. According to the American College of Gastroenterology, an estimated 10-15 percent of the adult population suffers from Irritable Bowel Syndrome (IBS) symptoms, yet only 5 to 7 percent of adults have been diagnosed with the disease. This creates huge demand for its treatment thereby contributing to the market growth.

Market Players Outlook

The major companies serving the global self-expanding stent market include Abbott Laboratories, Beckton, Dickinson & Co., Biotronik, Medtronic plc, Cook Medical, Inc., and Boston Scientific Corp. among others. The market players are increasingly focusing on business expansion and product development by applying strategies such as collaborations, mergers, and acquisitions to stay competitive in the market. For instance, in February 2022, Micro-Tech Endoscopy introduced the first self-expanding tracheobronchial nitinol y-stent. The Y-shaped tracheal Stent System is designed to be a flexible, compliant device to aid in the treatment of malignant neoplasms at the tracheobronchial carina.

The Report Covers:

  • Market value data analysis of 2023 and forecast to 2031.
  • Annualized market revenues ($ million) for each market segment.
  • Country-wise analysis of major geographical regions.
  • Key companies operating in the global self-expanding stent market. Based on the availability of data, information related to new product launches, and relevant news is also available in the report.
  • Analysis of business strategies by identifying the key market segments positioned for strong growth in the future.
  • Analysis of market-entry and market expansion strategies.
  • Competitive strategies by identifying 'who-stands-where' in the market.

Table of Contents

1.Report Summary

  • Current Industry Analysis and Growth Potential Outlook
  • 1.1.Research Methods and Tools
  • 1.2.Market Breakdown
    • 1.2.1.By Segments
    • 1.2.2.By Region

2.Market Overview and Insights

  • 2.1.Scope of the Report
  • 2.2.Analyst Insight & Current Market Trends
    • 2.2.1.Key Findings
    • 2.2.2.Recommendations
    • 2.2.3.Conclusion

3.Competitive Landscape

  • 3.1.Key Company Analysis
  • 3.2.Abbott Laboratories
    • 3.2.1.Overview
    • 3.2.2.Financial Analysis
    • 3.2.3.SWOT Analysis
    • 3.2.4.Recent Developments
  • 3.3.Becton Dickinson, and Co.
    • 3.3.1.Overview
    • 3.3.2.Financial Analysis
    • 3.3.3.SWOT Analysis
    • 3.3.4.Recent Developments
  • 3.4.Biotronic Inc.
    • 3.4.1.Overview
    • 3.4.2.Financial Analysis
    • 3.4.3.SWOT Analysis
    • 3.4.4.Recent Developments
  • 3.5.Boston Scientific Corp.
    • 3.5.1.Overview
    • 3.5.2.Financial Analysis
    • 3.5.3.SWOT Analysis
    • 3.5.4.Recent Developments
  • 3.6.Key Strategy Analysis

4.Market Segmentation

  • 4.1.Global Self-Expanding Stents Market by Product Type
    • 4.1.1.Open-Cell
    • 4.1.2.Closed-Cell
  • 4.2.Global Self-Expanding Stents Market by Application
    • 4.2.1.Peripheral Artery Disease
    • 4.2.2.Vascular Stenosis
    • 4.2.3.Gastrointestinal Tract
    • 4.2.4.Respiratory Tract
    • 4.2.5.Cardiovascular System
  • 4.3.Global Self-Expanding Stents Market by End-User
    • 4.3.1.Hospitals
    • 4.3.2.Ambulatory Surgical Centers
    • 4.3.3.Specialized Clinics

5.Regional Analysis

  • 5.1.North America
    • 5.1.1.United States
    • 5.1.2.Canada
  • 5.2.Europe
    • 5.2.1.UK
    • 5.2.2.Germany
    • 5.2.3.Italy
    • 5.2.4.Spain
    • 5.2.5.France
    • 5.2.6.Rest of Europe
  • 5.3.Asia-Pacific
    • 5.3.1.China
    • 5.3.2.India
    • 5.3.3.Japan
    • 5.3.4.South Korea
    • 5.3.5.Rest of Asia-Pacific
  • 5.4.Rest of the World

6.Company Profiles

  • 6.1.Braun Melsungen AG
  • 6.2.Cardinal Health, Inc.
  • 6.3.Cook Medical, Inc.
  • 6.4.Cordis Corp.
  • 6.5.Edward Lifesciences Corp.
  • 6.6.Medtronic plc
  • 6.7.Merit Medical Systems, Inc.
  • 6.8.Olympus Corp.
  • 6.9.Terumo Corp.
  • 6.10.Veryan Medical