Runtime optimization of the quantum computing within a given computational resource is important to achieve practical quantum advantage. In this paper, we propose a runtime reduction protocol for the lattice surgery, which utilizes the soft information corresponding to the logical measurement error. Our proposal is a simple two-step protocol: operating the lattice surgery with the small number of syndrome measurement cycles, and reexecuting it with full syndrome measurement cycles in cases where the time-like soft information catches logical error symptoms. We firstly discuss basic features of the time-like complementary gap as the concrete example of the time-like soft information based on numerical results. Then, we show that our protocol surpasses the existing runtime reduction protocol called temporally encoded lattice surgery (TELS) for the most cases. In addition, we confirm that the combination of our protocol and the TELS protocol can reduce the runtime further, over 50% in comparison to the naive serial execution of the lattice surgery. The proposed protocol in this paper can be applied to any quantum computing architecture based on the lattice surgery, and we expect that this will be one of the fundamental building blocks of runtime optimization to achieve practical scale quantum computing.
Laura S. Herzog, Lucas Berent, Aleksander Kubica
et al.
Large-scale fault-tolerant quantum computation requires compiling logical circuits into physical operations tailored to a given architecture. Prior work addressing this challenge has mostly focused on the surface code and lattice surgery schemes. In this work, we broaden the scope by considering lattice surgery compilation for topological codes beyond the surface code. We begin by defining a code substrate - a blueprint for implementing topological codes and lattice surgery. We then abstract from the microscopic details and rephrase the compilation task as a mapping and routing problem on a macroscopic routing graph, potentially subject to substrate-specific constraints. We explore specific substrates and codes, including the color code and the folded surface code, providing detailed microscopic constructions. For the color code, we present numerical simulations analyzing how design choices at the microscopic and macroscopic levels affect the depth of compiled logical $\mathrm{CNOT}+\mathrm{T}$ circuits. An open-source code is available on GitHub https://github.com/cda-tum/mqt-qecc.
Bhuvan Sachdeva, Sneha Kumari, Rudransh Agarwal
et al.
Cataract surgery is one of the most commonly performed surgeries worldwide, yet intraoperative complications such as iris prolapse, posterior capsule rupture (PCR), and vitreous loss remain major causes of adverse outcomes. Automated detection of such events could enable early warning systems and objective training feedback. In this work, we propose CataractCompDetect, a complication detection framework that combines phase-aware localization, SAM 2-based tracking, complication-specific risk scoring, and vision-language reasoning for final classification. To validate CataractCompDetect, we curate CataComp, the first cataract surgery video dataset annotated for intraoperative complications, comprising 53 surgeries, including 23 with clinical complications. On CataComp, CataractCompDetect achieves an average F1 score of 70.63%, with per-complication performance of 81.8% (Iris Prolapse), 60.87% (PCR), and 69.23% (Vitreous Loss). These results highlight the value of combining structured surgical priors with vision-language reasoning for recognizing rare but high-impact intraoperative events. Our dataset and code will be publicly released upon acceptance.
Sujoy Bhattacharjee, Arghya Kundu Choudhury, Abhirup Bose
et al.
Aim: Total Knee Arthroplasty (TKA) is a frequent surgical option for managing pain and improving movement in patients diagnosed with rheumatoid arthritis (RA). Nevertheless, the use of Posterior Cruciate Ligament-retaining (PCL-retaining) implants are reported less frequently. This research focuses on evaluating the clinical outcomes of PCL-retaining total knee arthroplasty and determining its therapeutic effectiveness in the management of RA. Methodology: The current retrospective study consists of total 262 primary posterior cruciate ligament-retaining total knee arthroplasties (TKAs) performed on patients diagnosed with RA between the month January 2019 and June 2022. Preoperative and postoperative evaluations were conducted to assess pain and joint functionality. Outcome measurements were recorded over a follow-up period of two years post-surgery. Results: After surgery, the patient reported clinical outcomes improved significantly among the patients which indicates improvement in functionality (p < 0.001) and painless range of motion. Overall, the data suggests significant improvements in pain and knee function following the primary TKA among patients with systemic RA affecting their knees. There were no revision surgeries or further surgical intervention for residual synovitis except medical management among our cohort of patients. Conclusion: Notwithstanding the requirement for prolonged follow-up, the findings from this short-term study indicate that PCL-retaining TKA demonstrated no early complications, no increase in revision rates, and considerable improvements in patient-reported clinical outcomes.
Adrito Das, Danyal Z. Khan, Dimitrios Psychogyios
et al.
The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.
Fault-tolerant quantum computation using lattice surgery can be abstracted as operations on graphs, wherein each logical qubit corresponds to a vertex of the graph, and multi-qubit measurements are accomplished by connecting the vertices with paths between them. Operations attempting to connect vertices without a valid path will result in abnormal termination. As the permissible paths may evolve during execution, it is necessary to statically verify that the execution of a quantum program can be completed. This paper introduces a type-based method to statically verify that well-typed programs can be executed without encountering halts induced by surgery operations. Alongside, we present $\mathcal{Q}_{LS}$, a first-order quantum programming language to formalize the execution model of surgery operations. Furthermore, we provide a type checking algorithm by reducing the type checking problem to the offline dynamic connectivity problem.
Noa Martonovich, Sharon Reisfeld, Yaniv Yonai
et al.
Pyomyositis, accompanied by aseptic arthritis, has been previously documented in several publications. However, none of the authors in the mentioned case reports offered a pathophysiological explanation for this unusual phenomenon or proposed a treatment protocol. We present a case of a healthy, 70-year-old male who was presented to the emergency department 4 days after tripping over a pile of wooden planks and getting stabbed by a nail to his thigh. The right thigh was swollen. Unproportional pain was produced by a light touch to the thigh. A laboratory test and a CT scan were obtained. The working diagnosis was pyomyositis of the thigh and septic arthritis of the ipsilateral knee. The patient underwent urgent debridement and irrigation of his right thigh. An arthroscopic knee lavage was performed as well. Intraoperative cultures from the thigh revealed the growth of Streptococcus pyogenes and Staphylococcus aureus. Cultures from synovial fluid were sterile; thus, septic arthritis was very unlikely. The source of the knee effusion might have been an aseptic inflammatory response due to the proximity of the thigh infection. Anatomically, the quadriceps muscle inserts on the patella, and its tendon fuses with the knee capsule, creating a direct fascial track from the thigh to the knee. The inflammatory response surrounding the infection may have followed this track, creating a domino effect, affecting adjacent capillaries within the joint capsule, and causing plasma leakage into the synovial space, leading to joint effusion. Our suggested treatment is addressing the primary infection with antibiotics and considering adding anti-inflammatory therapy, given our suspicion that this process has an inflammatory component.
Oded Hershkovich, Inga Tetroashvili, Adam Lee Goldstein
et al.
<i>Background and Objectives:</i> The incidence of proximal femoral fractures (PFFs) is rising, causing significant morbidity and mortality. Regional anesthesia (RA)’s benefits include the avoidance of intubation and mechanical ventilation, decreased blood loss, and improved analgesia. General anesthesia (GA) offers improved hemodynamic stability. This study examines the in-hospital post-surgical morbidity and mortality seen in PFFs in a cohort of the elderly undergoing GA or RA. <i>Materials and Methods:</i> This is a retrospective cohort study of 319 PFF patients older than 65 years over a single year. <i>Results:</i> In total, 73.7% of patients underwent GA. The patient characteristics were identical between groups, except for smoking. Hypertension was the most frequent comorbidity, followed by hyperlipidemia, NIDDM, and IHD. The overall patient complication rate was 11.4%. Pneumonia was the most common complication (5.1% in GA, 8.4% in RA). A total of 0.9% of patients required ICU admission. Overall, the in-hospital mortality rate was 2.3%, with no statistically significant difference between GA and RA. The GA and RA cohorts were similar in terms of their patient demographics, medical history, and preoperative parameters. In total, 73% of surgeries were under GA. No statistically significant differences were found in total anesthesia time or complication rates. <i>Conclusions:</i> We did not find a difference between general and spinal anesthesia regarding complication rates, anesthesia time, or morbidity. General anesthesia remains best suited for patients receiving anticoagulation treatment and undergoing semi-urgent surgery, but, other than that, the mode of anesthesia administered remains up to the anesthesiologist’s preference.
Purpose: Although magnesium sulfate (MgSO4) is widely used as an analgesic adjuvant to peripheral analgesic cocktails, its efficacy in total knee arthroplasty (TKA) is still controversial. Therefore, we systematically reviewed and meta-analyzed the literature to assess the analgesic efficacy of MgSO4 as an adjuvant to the analgesic cocktail in TKA.
Methods: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched. The meta-analysis was performed according to the PRISMA guidelines. Data were qualitatively synthesized or meta-analyzed using a random-effects model.
Results: Five randomized controlled trials involving 432 patients were included. Meta-analyses detected significant differences between the MgSO4 and control groups in the visual analog scale (VAS) pain scores (rest) at 6, 12, and 24 h postoperatively; VAS pain scores (motion) at 12, 24, and 48 h postoperatively; morphine consumption within 24 h, 24–48 h, and during the total hospitalization period; time to first rescue analgesia after TKA; and length of hospital stay. Regarding the functional recovery, the meta-analysis demonstrated significant differences between groups in terms of knee range of motion on postoperative day 1; daily mobilization distance on postoperative day 1; and daily mobilization distance. There was no significant intergroup difference in surgical complications.
Conclusion: The findings suggest that MgSO4 is a promising adjunct to the analgesic cocktail, achieving significant improvements in pain scores and total opioid consumption during the early postoperative period after TKA.
Jafet Massri-Pugin MD, Gabriel Matamoros MD, Sergio Morales MD, MSc
et al.
Category: Ankle; Trauma Introduction/Purpose: Tillaux-Chaput fractures (TCF) occur in the anterolateral rim of the distal tibia. When the TCF is not treated correctly, there is a risk of chronic pain, instability, and post-traumatic osteoarthritis. Although the role of computed tomography (CT) scan has been investigated in the operative planning of ankle fractures, its role in the operative planning of TCF is unknown. This study aimed to evaluate the role of the CT scan in the preoperative planning for TCF in adults. Methods: A retrospective review of ankle fractures evaluated in the emergency and outpatient department between 2013-2023 was performed in a university hospital. Inclusion criteria were patients aged≥ 18 years, radiograph and CT-scan evaluation, and the presence of TCF confirmed by CT-scan. Exclusion criteria were distal tibial/pilon fractures, or prior ankle surgery. Three foot and ankle surgeons assessed the deidentified-randomized radiographs. They classified the TCF according to Rammelt classification(type1:extraarticular avulsion, type2:fracture with compromise of the incisura, type3: fracture with impaction of the anterolateral plafond), formulated a treatment (conservative/surgery), and if treated surgically, defined the patient positioning, type of fixation and surgical approach for the TCF. The same questions were answered after evaluating the CT-scans. Changes in surgical strategy after CT-scan evaluation were recorded. Forward stepwise regression was performed to determine which variables are associated with the change in operative planning. Interobserver agreement was calculated (Fleiss's Kappa coefficient).P-value < 0.05 was considered significant. Results: 1134 ankle fractures were evaluated. 481 fractures met the inclusion criteria, of which 83(17.3%) had a TCF. After CT-scan evaluation, the classification and conservative/surgical plan changed by 69.1% and 12.5%, respectively. When surgery was selected, the patient positioning, surgical fixation, and approach for the TCF changed by 32.1%,43.8%, and 35.3%, respectively.Regression analysis showed that the detection of TCF under CT-scan changes the conservative/surgical plan(OR 6.7, 1.7-25.9), and the type of fixation for TCF(OR 0.15, 0.1-0.4).Moreover, the change in the classification is a predictor of change in the surgical fixation(OR 8.1 3.0-21.7) and approach(OR 4.1, 1.7-9.9). Posterior malleolar fracture was the only predictor associated with the change in the patient positioning(OR 7.1, 2.1-23.9).The agreement between radiographs and CT-scans was moderate or less for the surgical strategy. Conclusion: The CT scan changes the type of surgical fixation and approach for TCF by 43.8% and 35.3%, respectively. Moreover, the detection of TCF or change in the classification are independent predictors of change in surgical strategy. To our knowledge, this is the largest series of patients demonstrating the importance of the CT scan in the operative planning of TCF during adulthood.
Alexey A. Makovskiy, Lev S. Shnayder, Ekaterina S. Popravka
Introduction Strategical approaches to managing patients with a greater tuberosity fracture of the humerus
are controversial and there are discussions about surgical treatment options. Nondisplaced fractures require
no surgical management. Shoulder replacement can be indicated for the surgical treatment of proximal
humeral fractures with limited function of the upper limb and difficulties in refixation of the rotator cuff
tendons due to the peculiar anatomical location of the tendon fixation. Solution to this problem can improve
the quality of life of patients with greater tuberosity fracture of the humerus.
The objective was to evaluate the treatment outcome of a patient with a greater tuberosity fracture
of the humerus repaired with open refixation of the rotator cuff tendons and medialization of the border
of the articular surface of the humerus.
Material and methods A 46-year-old patient presented with limited movements and severe pain in the left
shoulder after humerus dislocation and a greater tuberosity fracture.
Results The condition was repaired with an open repair of the rotator cuff tendons and medialization
of the border of the articular surface of the humerus. The patient reported neither pain nor limited movements
in the left shoulder at the one-year follow-up.
Discussion Treatment options for patients with a greater tuberosity injury remains controversial.
The effectiveness and results of organ-saving surgery have not been explored and require scientific evaluation
using a larger cohort of patients.
Conclusion Excellent functional results were achieved in a patient with injury to the greater tuberosity using
surgical refixation of the rotator cuff tendons and medialization of the cartilaginous surface.
Automated Program Repair (APR) aspires to automatically generate patches for an input buggy program. Traditional APR tools typically focus on specific bug types and fixes through the use of templates, heuristics, and formal specifications. However, these techniques are limited in terms of the bug types and patch variety they can produce. As such, researchers have designed various learning-based APR tools with recent work focused on directly using Large Language Models (LLMs) for APR. While LLM-based APR tools are able to achieve state-of-the-art performance on many repair datasets, the LLMs used for direct repair are not fully aware of the project-specific information such as unique variable or method names. The plastic surgery hypothesis is a well-known insight for APR, which states that the code ingredients to fix the bug usually already exist within the same project. Traditional APR tools have largely leveraged the plastic surgery hypothesis by designing manual or heuristic-based approaches to exploit such existing code ingredients. However, as recent APR research starts focusing on LLM-based approaches, the plastic surgery hypothesis has been largely ignored. In this paper, we ask the following question: How useful is the plastic surgery hypothesis in the era of LLMs? Interestingly, LLM-based APR presents a unique opportunity to fully automate the plastic surgery hypothesis via fine-tuning and prompting. To this end, we propose FitRepair, which combines the direct usage of LLMs with two domain-specific fine-tuning strategies and one prompting strategy for more powerful APR. Our experiments on the widely studied Defects4j 1.2 and 2.0 datasets show that FitRepair fixes 89 and 44 bugs (substantially outperforming the best-performing baseline by 15 and 8), respectively, demonstrating a promising future of the plastic surgery hypothesis in the era of LLMs.
We define code maps between Calderbank-Shor-Steane (CSS) codes using maps between chain complexes, and describe code surgery between such codes using a specific colimit in the category of chain complexes. As well as describing a surgery operation, this gives a general recipe for new codes. As an application we describe how to `merge' and `split' along a shared $\overline{X}$ or $\overline{Z}$ operator between arbitrary CSS codes in a fault-tolerant manner, so long as certain technical conditions concerning gauge fixing and code distance are satisfied. We prove that such merges and splits on LDPC codes yield codes which are themselves LDPC.
Yousef Fallah, Mohsen Rezaei, Ramin Shayan-Moghadam
et al.
Background: Complex regional pain syndrome (CRPS) is an important common complication after surgical treatment for distal radius fracture. Recognition of the related factors is important to reduce the burden of the problem. Herein, the contributing factors for CRPS after distal radius fracture surgery are studied.
Methods: In this cross-sectional comparative study, 250 patients admitted to the orthopedics ward in Sina Hospital in Tehran, Iran, from 2017 to 2020, were enrolled. The contributing factors for CRPS after distal radius fracture surgery were determined in them. Results: The CRPS was seen in 17 cases (6.8%). 9 percent of male and 1.9 percent of female patients were diagnosed with CRPS. This showed a significant difference in the Fisher test (P = 0.028). The mean pain severity by Visual Analogue Scale (VAS) was higher in CRPS cases, that showed a significant difference by the Mann-Whitney test (P = 0.001).
Conclusion: According to the obtained results, it may be concluded that CRPS was seen in seven percent of patients under surgery for distal radius fracture and was related to the male gender and higher pain severity.
We prove an integral surgery formula for framed instanton homology $I^\sharp(Y_m(K))$ for any knot $K$ in a $3$-manifold $Y$ with $[K]=0\in H_1(Y;\mathbb{Q})$ and $m\neq 0$. Though the statement is similar to Ozsváth-Szabó's integral surgery formula for Heegaard Floer homology, the proof is new and based on sutured instanton homology $SHI$ and the octahedral lemma in the derived category. As a corollary, we obtain an exact triangle between $I^\sharp(Y_m(K))$, $I^\sharp(Y_{m+k}(K))$ and $k$ copies of $I^\sharp(Y)$ for any $m\neq 0$ and large $k$. In the proof of the formula, we discover many new exact triangles for sutured instanton homology and relate some surgery cobordism map to the sum of bypass maps, which are of independent interest. In a companion paper, we derive many applications and computations based on the integral surgery formula.
Christopher P. Miller MD, Jorge I. Acevedo MD, James R. McWilliam MD
et al.
Category: Ankle; Arthroscopy Introduction/Purpose: Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with non- surgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery (MIS) and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection Methods: The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using MIS techniques while also incorporating a percutaneous double row suture anchor repair. The technique utilizes four portals to access two endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double row suture anchor repair. Results: With over 75 surgeries performed, there have been zero wound complications and patients have been able to return to full weight bearing within 10 days after surgery. Follow up outcome data is currently being collected and will be reported as a case series once sufficient patients have completed their follow up. Conclusion: This study presents double-row repair following an endoscopic assisted MIS calcaneoplasty and Achilles debridement. The technique combines the benefits of the double row suture bridge repair with a minimal incision technique to debride the insertional tendinosis. In order to adequately debride the tendon and the posterior calcaneal tuberosity, the tendon foot print is elevated as the burr removes the bone at the insertion. The anterior portion of the tendon, which may be a pain generator as well, isdebrided endoscopically with the shaver. Finally, a double row suture bridge repair is performed in order to allow early weight bearing and rehabilitation.
Motasem Salameh MD, Ahmed K. Attia MD, Raymond Y. Hsu MD
et al.
Category: Basic Sciences/Biologics; Other Introduction/Purpose: Tranexamic acid (TXA) use is increasing in Orthopedic practice specially among arthroplasty surgeons. It was proven to decrease the estimated blood loss and need for blood transfusion in hip, knee and shoulder arthroplasty as well as pelvis and acetabulum surgery. There was no reported increase risk of thromboembolic events with the use of TXA in orthopedic practice. This systematic review and meta analysis aimed on reporting on the available evidence on the use of TXA in foot and ankle surgery. Methods: The current meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic-based search on MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases to November 2021. Clinical studies on tranexamic acid use in foot and ankle surgeries reporting at least one of the desired outcomes; estimated blood loss (EBL), Hemoglobin difference between pre- and post-op, or complications were included. To assess risk of bias, the Joanna Briggs institute critical appraisal tool was used for case series and the Newcastle Ottawa scale for comparetive studies. The level of evidence was assigned according to the Cochrane Book Review Group. Results: A total of 718 foot and ankle procedures were included. Out of those, 491 (68.38%) procedures received tranexamic acid while 221 (31.64%) served as controls and did not receive tranexamic acid. In the TXA group, 34 (6.92%) procedures received local TXA injection in one study, while the remaining majority of 457 (93.08%) procedures received intravenous (IV) TXA. Among the control group, saline was used a placebo in 113 (51.13%) controls in 3 studies, while no placebo was used in the remaining 108 (48.87%) controls. The pooled mean EBL for the TXA group was 57.75 mL [95% CI: 44.80 to 70.70, I2 = 98.31%] while the pooled mean EBL for the control group was 299.26 mL [95% CI: 212.43 to 386.09, I2= 98.96%] with statistical significance Figure 1. No significant difference was found between the two groups in terms of change of hemoglobin and risk of thromboembolic events and other complications. Figure 2,3 Conclusion: This systematic review and metaanalysis showed that the use of TXA in foot and ankle surgery was safe with no increased risk in thromboembolic events. The lower risk of bleeding using TXA despite being stastically significant, did not reach clinical significance and did not affect the post operative hemoglobin level. TXA can be considered in foot and ankle surgery in special cases with higher risk of bleeding or in cases where the use of tourniquet is contraindicated.