In our earlier work, we studied the link surgery modules of two component L-space links. Therein, we computed two of the four idempotents of such modules. In this article, we use Koszul duality to give an alternate account of this proof, and also to extend it to compute the entire link surgery modules of such links, modulo a technical result which will be proven in a subsequent paper.
Piotr Górka, Julia Frączek, Karolina Borówka
et al.
Background: Hamstring muscle injuries (HMI) remain the most prevalent non-contact injury in high-speed sports, particularly football and athletics. Despite sports medicine advancements, HMI is characterised by high recurrence rates (12–33%), causing significant time loss and performance decrements.
Aim: This paper provides a comprehensive literature review regarding the functional anatomy, risk factors, diagnostic classification, and evidence-based treatment strategies for HMI.
Material and methods: A narrative literature review was conducted using PubMed and MEDLINE. We focused on high-quality studies (systematic reviews, randomised controlled trials, clinical guidelines) published between 2010 and 2025, covering conservative and surgical management.
Results: The biceps femoris long head's bi-articular architecture and dual innervation predispose it to eccentric strain during sprinting. Diagnosis has evolved with the British Athletics Muscle Injury Classification (BAMIC), which identifies intratendinous involvement as predicting prolonged recovery. Conservative management remains the gold standard for mid-substance injuries; L-protocol (lengthening) and eccentric strengthening show superior outcomes over concentric training. Surgery is indicated for complete proximal avulsions or high-grade partial tears with retraction (>2 cm); acute repair yields better outcomes than chronic reconstruction.
Conclusions: Effective HMI management requires a multimodal approach. While conservative care resolves most injuries, precise MRI diagnosis is crucial to identify surgical candidates early. Return to play must be criteria-based, prioritising restored eccentric strength, fascicle length, and sprint mechanics over time-based protocols or imaging clearance.
Takuya Kitamura, Kentaro Endo, Nobutake Ozeki
et al.
Abstract Human synovial mesenchymal stem cells (MSCs) demonstrate high chondrogenic capacity for regenerative medicine. While ultrasound-guided collection procedures utilize local anesthetics for patient comfort, their effects on synovial MSCs remain unclear despite their known cytotoxicity to other MSC types. This study investigated whether clinically relevant concentrations of lidocaine and ropivacaine affect synovial MSC proliferation and differentiation. Human synovial tissue from eight donors undergoing knee surgery was minced and treated for 20 min with 0.5% lidocaine, 0.2% ropivacaine, or saline control. Following enzymatic digestion, cell viability and nucleated cell yield per synovial weight were assessed immediately and after a 14-day culture expansion. Trilineage differentiation capacity was evaluated through chondrogenic pellet culture, adipogenic Oil Red O staining, and calcification Alizarin Red staining. Cell viability, nucleated cell numbers per synovium weight, and cell yield after 14-day expansion showed no significant differences between treatments. Cartilage pellet weights, Oil Red O-positive adipogenic colonies, and calcification areas remained comparable across all groups. Lidocaine or ropivacaine can be safely used during ultrasound-guided synovial tissue collection without compromising therapeutic potential. These findings support the safe clinical implementation of ultrasound-guided synovial tissue harvesting using local anesthetics, reinforcing this process as a feasible and practical platform for synovial MSC-based regenerative therapies.
Background: Septic arthritis is an uncommon but severe condition that can lead to rapidly progressive articular destruction and septicemia. Although the knee is the most commonly affected joint in septic arthritis, bilateral involvement is an exceedingly rare condition often associated with immunocompromising conditions, medical comorbidities or other sources of infection. Case report: A 74-year-old male immunocompetent patient presented with two to three days of atraumatic bilateral knee pain and swelling with difficulty ambulating, with presenting vital signs concerning for sepsis. Physical exam was notable for large bilateral knee effusions, warmth and significantly limited range of motion. Bilateral knee arthrocentesis was performed with synovial fluid analysis consistent with bilateral septic arthritis. The patient was managed with intravenous antibiotics and operative arthrotomy and irrigation. Synovial fluid cultures from the emergency department and operating room, as well as 4/4 blood cultures all grew Group G streptococcus. No primary source of infection was identified. The patient completed a course of intravenous antibiotics tailored to culture susceptibility and had resolution of symptoms. Why should an emergency physician be aware of this?: Polyarticular septic arthritis carries high morbidity and mortality. Although uncommon, atypical presentations and absence of usual risk factors can lead to delays or missed diagnoses in the emergency department. It is essential to maintain a high index of suspicion in the patient presenting with undifferentiated multifocal joint pain or swelling, in the appropriate clinical context, to make an early diagnosis and initiate aggressive treatment to prevent complications.
Medical emergencies. Critical care. Intensive care. First aid
The science and clinical practice of medical physics has been integral to the advancement of radiology and radiation therapy for over a century. In parallel, advances in surgery - including intraoperative imaging, registration, and other technologies within the expertise of medical physicists - have advanced primarily in connection to other disciplines, such as biomedical engineering and computer science, and via somewhat distinct translational paths. This review article briefly traces the parallel and convergent evolution of such scientific, engineering, and clinical domains with an eye to a potentially broader, more impactful role of medical physics in research and clinical practice of surgery. A review of image-guided surgery technologies is offered, including intraoperative imaging, tracking / navigation, image registration, visualization, and surgical robotics across a spectrum of surgical applications. Trends and drivers for research and innovation are traced, including federal funding and academic-industry partnership, and some of the major challenges to achieving major clinical impact are described. Opportunities for medical physicists to expand expertise and contribute to the advancement of surgery in the decade ahead are outlined, including research and innovation, data science approaches, improving efficiency through operations research and optimization, improving patient safety, and bringing rigorous quality assurance to technologies and processes in the circle of care for surgery. Challenges abound but appear tractable, including domain knowledge, professional qualifications, and the need for investment and clinical partnership.
Thomas Borsani, Andrea Rosani, Giuseppe Nicosia
et al.
The multi-task learning ($MTL$) paradigm aims to simultaneously learn multiple tasks within a single model capturing higher-level, more general hidden patterns that are shared by the tasks. In deep learning, a significant challenge in the backpropagation training process is the design of advanced optimisers to improve the convergence speed and stability of the gradient descent learning rule. In particular, in multi-task deep learning ($MTDL$) the multitude of tasks may generate potentially conflicting gradients that would hinder the concurrent convergence of the diverse loss functions. This challenge arises when the gradients of the task objectives have either different magnitudes or opposite directions, causing one or a few to dominate or to interfere with each other, thus degrading the training process. Gradient surgery methods address the problem explicitly dealing with conflicting gradients by adjusting the overall gradient trajectory. This work introduces a novel gradient surgery method, the Similarity-Aware Momentum Gradient Surgery (SAM-GS), which provides an effective and scalable approach based on a gradient magnitude similarity measure to guide the optimisation process. The SAM-GS surgery adopts gradient equalisation and modulation of the first-order momentum. A series of experimental tests have shown the effectiveness of SAM-GS on synthetic problems and $MTL$ benchmarks. Gradient magnitude similarity plays a crucial role in regularising gradient aggregation in $MTDL$ for the optimisation of the learning process.
In our earlier work on $2$-torsion in instanton Floer homology, we considered only integral surgeries on a knot $K\subset S^3$ and showed that the absence of $2$-torsion forces $K$ to be fibered. The present paper extends the result to all rational surgeries. We prove that if the framed instanton homology $I^{\sharp}(S^3_r(K);\mathbb{Z})$ is $2$-torsion-free for some $r\in \mathbb{Q}_+$, then $K$ is an instanton L-space knot and $r>2g(K)-1$. Leveraging this $2$-torsion perspective, we also obtain new small-surgery obstructions: If either $S^{3}_{5}(K)$ or $S^{3}_{11/2}(K)$ is $SU(2)$-abelian, then $K$ must be the unknot or the right-handed trefoil. This result sharpens the small-$SU(2)$-abelian surgery theorems of Kronheimer--Mrowka, Baldwin--Sivek, and Baldwin--Li--Sivek--Ye.
IntroductionHead and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous malignancy with poor overall prognosis. Recent studies have suggested that propionate metabolism-related genes (PMRGs) may play key roles in tumor progression and immune regulation, yet their functions in HNSCC remain unclear.MethodsTranscriptomic data from 502 HNSCC tumor samples and 44 normal tissue samples were obtained from the UCSC Xena database as the training set. Two independent datasets (GSE41613 and GSE6631) from the GEO database were used for validation. Differentially expressed genes (DEGs), key module genes identified via weighted gene co-expression network analysis (WGCNA), and PMRGs were intersected to identify candidate genes. A prognostic model was constructed using Cox regression and LASSO analysis. Immune infiltration, somatic mutations, and drug sensitivity were compared between high- and low-risk groups. Gene expression was further validated by RT-qPCR using clinical samples.ResultsA total of 42 intersecting genes were identified, and four feature genes (PRKAA2, SLC7A5, GRIP2, CHGB) were selected to build the prognostic model. The model effectively stratified patients into high- and low-risk groups with significant survival differences in both the training and validation cohorts. The high-risk group exhibited marked differences in immune cell infiltration, immune checkpoint expression, and cancer immune cycle activity. Mutation burden and drug sensitivity also varied significantly between risk groups. A nomogram combining risk score and pathological N stage showed strong predictive performance.DiscussionThis study highlights the potential role of PMRGs in immune regulation and tumor progression in HNSCC. The proposed four-gene signature provides a novel tool for prognosis prediction and offers new insights for risk stratification and individualized therapy. Further multicenter validation and mechanistic studies are warranted.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Abstract Obesity is a significant risk factor for thoracic aortic dissection (TAD), as supported by UK Biobank data showing obese individuals have a higher risk of TAD. The study investigates leptin, a hormone elevated in obesity, and finds that hyperleptinemia is common in TAD patients, suggesting its role in disease pathogenesis. Using leptin‐knockout mice, it is demonstrated that exogenous leptin exacerbates TAD by promoting phenotypic transitions in vascular smooth muscle cells (VSMCs). These adverse effects are reversible with pharmacologic leptin blockade, indicating potential therapeutic benefits. Single‐cell RNA sequencing reveals a novel smooth muscle cells (SMC) cluster, Nrip2+, in the aorta, with a distinct contractile gene profile. Increased Nrip2+ VSMCs are linked to enhanced mitochondrial energy metabolism. Elevated Nrip2+ VSMCs inhibit the leptin‐induced transition from a contractile to a synthetic phenotype, reducing TAD incidence. The findings suggest that high blood leptin levels contribute to the increased TAD risk in obese individuals by suppressing Nrip2+ SMCs, leading to abnormal mitochondrial metabolism and VSMC phenotypic transitions. Thus, targeting leptin to boost Nrip2+ VSMC metabolic activity is a promising strategy for TAD prevention and treatment.
Takuya Mizumoto, Yoshihide Nanno, Jun Ishida
et al.
ABSTRACT Aim Regarding the resectability of pancreatic adenocarcinoma (PDAC), not only anatomical factors but also biological and conditional factors have come to be considered. This study examined the impact of the Global Leadership Initiative on Malnutrition (GLIM) criteria on prognosis after resection of anatomically resectable PDAC. Methods The medical records of consecutive patients who underwent resection for resectable PDAC between January 1, 2014, and December 31, 2022, were retrospectively reviewed. Patients were classified as normal, moderately, or severely malnourished according to the GLIM criteria. Results In total, 194 patients were included in the analysis. According to the GLIM criteria, 61 (31.4%), 49 (25.2%), and 84 (42.3%) patients were normal, moderately, and severely malnourished, respectively. Patients with malnutrition had shorter overall, recurrence‐free, and disease‐specific survival (OS, RFS, and DSS) than normal patients (OS, normal vs. moderate, p = 0.015; normal vs. severe, p < 0.001; RFS, normal vs. moderate p = 0.012, normal vs. severe, p < 0.001; DSS, normal vs. moderate, p = 0.023; normal vs. severe, p < 0.001). In multivariate analysis regarding OS using all factors, moderate or severe malnutrition according to the GLIM criteria (p = 0.007), performance status (p = 0.086), preoperative diabetes (p = 0.017), tumor diameter ≥ 3 cm (p = 0.002), lymph node metastasis (p < 0.001), and postoperative adjuvant therapy (p = 0.027) were independent prognostic factors. In multivariate analysis using preoperative factors, malnutrition according to the GLIM criteria remained a significant prognostic factor (p = 0.003). Conclusion The GLIM criteria are effective prognostic predictors in patients with resectable PDAC undergoing upfront surgery. Preoperative nutritional assessment using these criteria may contribute to determining treatment plans for resectable PDAC.
Surgery, Diseases of the digestive system. Gastroenterology
Yousef Yeganeh, Rachmadio Lazuardi, Amir Shamseddin
et al.
Surgical data science (SDS) is a field that analyzes patient data before, during, and after surgery to improve surgical outcomes and skills. However, surgical data is scarce, heterogeneous, and complex, which limits the applicability of existing machine learning methods. In this work, we introduce the novel task of future video generation in laparoscopic surgery. This task can augment and enrich the existing surgical data and enable various applications, such as simulation, analysis, and robot-aided surgery. Ultimately, it involves not only understanding the current state of the operation but also accurately predicting the dynamic and often unpredictable nature of surgical procedures. Our proposed method, VISAGE (VIdeo Synthesis using Action Graphs for Surgery), leverages the power of action scene graphs to capture the sequential nature of laparoscopic procedures and utilizes diffusion models to synthesize temporally coherent video sequences. VISAGE predicts the future frames given only a single initial frame, and the action graph triplets. By incorporating domain-specific knowledge through the action graph, VISAGE ensures the generated videos adhere to the expected visual and motion patterns observed in real laparoscopic procedures. The results of our experiments demonstrate high-fidelity video generation for laparoscopy procedures, which enables various applications in SDS.
Vincenzo Marcelli, Vincenzo Marcelli, Beatrice Giannoni
et al.
Downbeat nystagmus (DBN) is a neuro-otological finding frequently encountered by clinicians dealing with patients with vertigo. Since DBN is a finding that should be understood because of central vestibular dysfunction, it is necessary to know how to frame it promptly to suggest the correct diagnostic-therapeutic pathway to the patient. As knowledge of its pathophysiology has progressed, the importance of this clinical sign has been increasingly understood. At the same time, clinical diagnostic knowledge has increased, and it has been recognized that this sign may occur sporadically or in association with others within defined clinical syndromes. Thus, in many cases, different therapeutic solutions have become possible. In our work, we have attempted to systematize current knowledge about the origin of this finding, the clinical presentation and current treatment options, to provide an overview that can be used at different levels, from the general practitioner to the specialist neurologist or neurotologist.
Abstract Circular RNAs (circRNAs) have been shown to play important roles in tumour development and tumour immunology. However, genome‐wide characterisation of circRNAs and their roles in the immunology and immunotherapy of gallbladder carcinoma (GBC) has been lacking. We present a comprehensive characterisation of the circRNA landscape in GBC, revealing GBC‐specific circRNAs. Our analysis found that circRNAs are significantly enriched in cell proliferation and are involved in cancer‐related hallmarks. In particular, circAATF was upregulated in GBC, which was positively correlated with AATF mRNA expression, and promoted GBC cell growth. Through integrating computational and experimental approaches, we revealed that circAATF is positively associated with the CD4+ T cell abundance and PD‐L1 level, and enhances the clinical benefits of anti‐PD‐L1 immunotherapy for GBC. We further demonstrate that circAATF elevates the PD‐L1 level by activating phosphorylated AKT and acting as a sponge for miR‐142‐5p. CircAATF is positively associated with CD4+ T cells and PD‐L1 levels and shows potential to aid anti‐PD‐L1 immunotherapy for GBC. Our study provides insights into roles of circAATF in the tumour development and immunology of GBC and accelerates the development of therapeutic strategies for GBC immunotherapy. Highlights We present a comprehensive characterisation of circRNA landscape in gallbladder carcinoma (GBC). CircAATF is positively associated with CD4+ T cell abundance and PD‐L1 expression and is shown to promote PD‐L1 treatment in mouse model. CircAATF can elevate PD‐L1 level through phosphorylated AKT and linear AATF, which upregulates PD‐L1 by acting as a sponge of miR‐142‐5p.
Jay N. Paranjape, Shameema Sikder, Vishal M. Patel
et al.
Surgical tool presence detection is an important part of the intra-operative and post-operative analysis of a surgery. State-of-the-art models, which perform this task well on a particular dataset, however, perform poorly when tested on another dataset. This occurs due to a significant domain shift between the datasets resulting from the use of different tools, sensors, data resolution etc. In this paper, we highlight this domain shift in the commonly performed cataract surgery and propose a novel end-to-end Unsupervised Domain Adaptation (UDA) method called the Barlow Adaptor that addresses the problem of distribution shift without requiring any labels from another domain. In addition, we introduce a novel loss called the Barlow Feature Alignment Loss (BFAL) which aligns features across different domains while reducing redundancy and the need for higher batch sizes, thus improving cross-dataset performance. The use of BFAL is a novel approach to address the challenge of domain shift in cataract surgery data. Extensive experiments are conducted on two cataract surgery datasets and it is shown that the proposed method outperforms the state-of-the-art UDA methods by 6%. The code can be found at https://github.com/JayParanjape/Barlow-Adaptor
In this article, we apply slope detection techniques to study properties of toroidal $3$-manifolds obtained by performing Dehn surgeries on satellite knots in the context of the $L$-space conjecture. We show that if $K$ is an $L$-space knot or admits an irreducible rational surgery with non-left-orderable fundamental group, then the JSJ graph of its exterior is a rooted interval. Consequently, any rational surgery on a composite knot has a left-orderable fundamental group. This is the left-orderable counterpart of Krcatovich's result on the primeness of $L$-space knots, which we reprove using our methods. Analogous results on the existence of co-orientable taut foliations are proved when the knot has a fibred companion. Our results suggest a new approach to establishing the counterpart of Krcatovich's result for surgeries with co-orientable taut foliations, on which partial results have been achieved by Delman and Roberts. Finally, we prove results on left-orderable $p/q$-surgeries on knots with $p$ small.
Fayez H. Alruwaili, Michael P. Clancy, Marzieh S. Saeedi-Hosseiny
et al.
In the face of challenges encountered during femur fracture surgery, such as the high rates of malalignment and X-ray exposure to operating personnel, robot-assisted surgery has emerged as an alternative to conventional state-of-the-art surgical methods. This paper introduces the development of Robossis, a haptic system for robot-assisted femur fracture surgery. Robossis comprises a 7-DOF haptic controller and a 6-DOF surgical robot. A unilateral control architecture is developed to address the kinematic mismatch and the motion transfer between the haptic controller and the Robossis surgical robot. A real-time motion control pipeline is designed to address the motion transfer and evaluated through experimental testing. The analysis illustrates that the Robossis surgical robot can adhere to the desired trajectory from the haptic controller with an average translational error of 0.32 mm and a rotational error of 0.07 deg. Additionally, a haptic rendering pipeline is developed to resolve the kinematic mismatch by constraining the haptic controller (user hand) movement within the permissible joint limits of the Robossis surgical robot. Lastly, in a cadaveric lab test, the Robossis system assisted surgeons during a mock femur fracture surgery. The result shows that Robossis can provide an intuitive solution for surgeons to perform femur fracture surgery.
Hassan M. Ahmed, Nancy M. Salem, Walid I. Al-Atabany
A stable shape for corneas experiencing refractive surgery has to be sustained so as to elude post-refractive surgery de-compensation. This de-compensation leads to visual complications and unsatisfactory procedure recovery. Variation in corneal lamellae and collagen fibres is induced by recent LASER refractive surgical procedures utilizing LASER ablation and disruption techniques. Conserving a steady response of central apex flattening and peripheral steepening in an elastic cornea pre- and post- procedure is the ultimate purpose of successful refractive surgery. Early diagnosis of ectatic corneal disorders and better understanding of corneal pathogenesis is achieved by assessment of corneal biomechanical properties. The ultimate objective of this research is to estimate the biomechanical properties for both normal and pathogenic corneal tissue pre- and post-operative refractive surgery. This achieved using ultrasonic acoustic radiation force impulse as a non-invasive method accounting for its high localization. Induced displacement tracking methods will be utilized for assessment of soft tissue biomechanical properties related to the investigated soft tissue. Ultrasound probe simulations will be carried out to optimize the probe design. FEM simulations will take place to precisely estimate in-situ corneal tissue biomechanics. In this research, corneal biomechanical properties are studied and estimated using acoustic radiation force impulse. This is achieved either by estimating the focal peak axial deformation value or by estimating the shear wave speed for the resulting propagating deformation wave.
[Background] The popularity of robot-assisted colorectal surgery has risen over recent years; however, patient-related advantages over laparoscopic surgery remain uncertain. [Objective] The goal of this study was to compare short-term patient outcomes following robotic and laparoscopic partial or complete rectal resections. [Design] This was a retrospective cohort study. [Settings] The study was conducted at 5 large tertiary care Kaiser Permanente medical centers across Southern California. [Patients] There were 863 consecutive robotic and laparoscopic pelvic rectal surgeries, including low anterior resections, proctectomies with coloanal anastomosis, and abdominoperineal resections, performed between January 2010 and December 2019. [Main outcome measures] Short-term patient outcomes, including postoperative length of hospital stay, emergency department returns, and 30-day readmissions, and mortality. [Results] A total of 458 surgical procedures were performed via robotic versus 405 via laparoscopic approaches. The robotic group had a higher proportion of male patients (57.4% vs 50.4%; p=0.04) and a higher proportion of obese (27.1% vs 26.9%; p=0.02) and overweight patients (36.9% vs 35.1%; p=0.01). There was no difference in underlying comorbidities of diabetes or smoking, or in the rate of ileostomy creation. After adjusting for Charlson Comorbidity Index, no significant difference was found in emergency department returns between robotic and laparoscopic surgical patients (p=0.17). There were no significant outcome differences between the 2 groups with regards to length of stay during procedure, 30-day readmission, or death rates. [Limitations] This study was limited by the lack of randomization in its design, selection of patients for surgical approach, and training and familiarity with robotic rectal surgery. [Conclusions] This study shows length of stay during the procedure and postoperative 30-day readmission rates were generally similar between robotic and laparoscopic patients. Male patients and those with a higher BMI were more likely to have been operated via a robotic method.