Noma, also known as cancrum oris, is a rapidly progressive gangrenous infection that affects the oral and facial tissues of malnourished children in impoverished regions, particularly in sub-Saharan Africa. The disease typically begins as acute necrotising gingivitis and rapidly progresses to extensive tissue destruction, facial disfigurement, and high mortality if left untreated. This narrative review explores the clinical progression of Noma, its World Health Orgnisation (WHO) classification and simplified staging systems, the pathogenesis involving malnutrition, immunosuppression, and microbial dysbiosis, as well as the polymicrobial nature of the disease. Diagnosis of Noma is primarily clinical, although emerging microbiome-based diagnostic techniques show promise for early detection. Management requires a comprehensive approach that combines early antibiotic therapy, nutritional rehabilitation, wound care, and delayed reconstructive surgery. Preventive strategies include adequate vaccination (particularly against measles), community-based oral health education, and improvements in Water, Sanitation, and Hygiene (WASH) initiatives. Strengthening local healthcare infrastructure and establishing sustainable surgical programmes are essential for long-term control and rehabilitation of Noma. Addressing the socio-economic determinants of Noma through holistic public health efforts remains crucial for reducing its burden and achieving global eradication.
BackgroundDelayed abdominal closure (DAC) after congenital diaphragmatic hernia (CDH) repair is often guided by subjective assessment. This is particularly critical in neonates receiving extracorporeal membrane oxygenation (ECMO), where inappropriate closure can precipitate abdominal compartment syndrome (ACS), yet objective guidance is lacking. Here, we describe a case where intraoperative bladder pressure (BP) monitoring provided an objective guide for DAC.Case introductionA term male neonate with severe left-sided CDH and pulmonary hypertension required veno-arterial ECMO. On ECMO day 4, he underwent repair of the diaphragmatic defect. Following visceral reduction, abdominal wall tension increased, and BP was measured at 20mmHg. Based on this objective evidence of intra-abdominal hypertension, DAC was performed with placement of a temporary silastic silo. Following decompression, the BP decreased to 8 mmHg. The patient was successfully weaned from ECMO on postoperative day 1. Definitive abdominal wall closure was performed on day 7. The infant recovered and was discharged on day 38 of life.ConclusionIntraoperative BP monitoring is a simple, reproducible, and objective tool that can effectively guide the decision for DAC in neonates undergoing ECMO-assisted CDH repair, potentially preventing ACS and improving outcomes.
Objectives: Cardiac surgery is associated with an increased dioxygen (O2) consumption (VO2) following cardiopulmonary bypass (CPB). But data on intraoperative VO2 variation during pulmonary endarterectomy (PEA) are scarce. We aimed to assess the variation of VO2 and O2 delivery (DO2) between the induction of general anesthesia and the weaning off CPB in patients undergoing PEA. Methods: A prospective single center observational study was conducted from May to November 2023 in patients that underwent PEA. Hemodynamic and biological data were collected from arterial and venous blood gas after the induction of general anesthesia and after CPB weaning. Results: Forty-nine patients were included in the final analysis. The mean age was 57 (±14.3) years, and 30 (61%) patients were male. There was no significant change in VO2 and DO2 (O2 delivery) after CPB weaning (VO2=104.5 (±45.9) vs 110.5 (±30.4) ml of O2/min/m2; p=0.33; DO2=426.1 (±166.3) vs 398.1 (±109.4) ml of O2/min/m2; p=0.18 respectively). There was a weak correlation between CPB duration and VO2 following CPB weaning (R=0.41; p=0.008). No correlation between the duration of aortic cross clamp time, the duration of circulatory arrest, and post CPB VO2 were found (R=0.22; p=0.14 and R=0.22; p=0.10, respectively). Conclusion: There was no significant increase in VO2 and DO2 after deep hypothermic circulatory arrest PEA surgery.
Robotic surgery represents a major breakthrough in medical interventions, which has revolutionized surgical procedures. However, the high cost and limited accessibility of robotic surgery systems pose significant challenges for training purposes. This study addresses these issues by developing a cost-effective robotic laparoscopy training system that closely replicates advanced robotic surgery setups to ensure broad access for both on-site and remote users. Key innovations include the design of a low-cost robotic end-effector that effectively mimics high-end laparoscopic instruments. Additionally, a digital twin platform was established, facilitating detailed simulation, testing, and real-time monitoring, which enhances both system development and deployment. Furthermore, teleoperation control was optimized, leading to improved trajectory tracking while maintaining remote center of motion (RCM) constraint, with a RMSE of 5 μm and reduced system latency to 0.01 seconds. As a result, the system provides smooth, continuous motion and incorporates essential safety features, making it a highly effective tool for laparoscopic training.
Bhuvan Sachdeva, Naren Akash, Tajamul Ashraf
et al.
Cataract surgery is the most common surgical procedure globally, with a disproportionately higher burden in developing countries. While automated surgical video analysis has been explored in general surgery, its application to ophthalmic procedures remains limited. Existing works primarily focus on Phaco cataract surgery, an expensive technique not accessible in regions where cataract treatment is most needed. In contrast, Manual Small-Incision Cataract Surgery (MSICS) is the preferred low-cost, faster alternative in high-volume settings and for challenging cases. However, no dataset exists for MSICS. To address this gap, we introduce Sankara-MSICS, the first comprehensive dataset containing 53 surgical videos annotated for 18 surgical phases and 3,527 frames with 13 surgical tools at the pixel level. We benchmark this dataset on state-of-the-art models and present ToolSeg, a novel framework that enhances tool segmentation by introducing a phase-conditional decoder and a simple yet effective semi-supervised setup leveraging pseudo-labels from foundation models. Our approach significantly improves segmentation performance, achieving a $23.77\%$ to $38.10\%$ increase in mean Dice scores, with a notable boost for tools that are less prevalent and small. Furthermore, we demonstrate that ToolSeg generalizes to other surgical settings, showcasing its effectiveness on the CaDIS dataset.
Syed Abdul Mateen, Niharika Malvia, Syed Abdul Khader
et al.
This paper presents an approach for surgical phase recognition using video data, aiming to provide a comprehensive understanding of surgical procedures for automated workflow analysis. The advent of robotic surgery, digitized operating rooms, and the generation of vast amounts of data have opened doors for the application of machine learning and computer vision in the analysis of surgical videos. Among these advancements, Surgical Phase Recognition(SPR) stands out as an emerging technology that has the potential to recognize and assess the ongoing surgical scenario, summarize the surgery, evaluate surgical skills, offer surgical decision support, and facilitate medical training. In this paper, we analyse and evaluate both frame-based and video clipping-based phase recognition on thoracic surgery dataset consisting of 11 classes of phases. Specifically, we utilize ImageNet ViT for image-based classification and VideoMAE as the baseline model for video-based classification. We show that Masked Video Distillation(MVD) exhibits superior performance, achieving a top-1 accuracy of 72.9%, compared to 52.31% achieved by ImageNet ViT. These findings underscore the efficacy of video-based classifiers over their image-based counterparts in surgical phase recognition tasks.
We present estimates for the number of ions needed to implement fault-tolerant lattice surgery between spatially separated trapped-ion surface codes. Additionally, we determine attainable lattice surgery rates given a number of dedicated ``communication ions" per logical qubit. Because our analysis depends heavily on the rate that syndrome extraction cycles take place, we survey the state-of the art and propose three possible cycle times between $10$ and $1000 μs$ that we could reasonably see realised provided certain technological milestones are met. Consequently, our numerical results indicate that hundreds of resource ions will be needed for lattice surgery in the slowest case, while close to a hundred thousand will be needed in the fastest case. The main factor contributing to these prohibitive estimates is the limited rate that ions can be coupled across traps. Our results indicate an urgent need for optical coupling to improve by one or more orders of magnitude for trapped-ion quantum computers to scale.
Periacetabular osteotomy (PAO) is an effective approach for the surgical treatment of developmental dysplasia of the hip (DDH). However, due to the complex anatomical structure around the hip joint and the limited field of view (FoV) during the surgery, it is challenging for surgeons to perform a PAO surgery. To solve this challenge, we propose a robot-assisted, augmented reality (AR)-guided surgical navigation system for PAO. The system mainly consists of a robot arm, an optical tracker, and a Microsoft HoloLens 2 headset, which is a state-of-the-art (SOTA) optical see-through (OST) head-mounted display (HMD). For AR guidance, we propose an optical marker-based AR registration method to estimate a transformation from the optical tracker coordinate system (COS) to the virtual space COS such that the virtual models can be superimposed on the corresponding physical counterparts. Furthermore, to guide the osteotomy, the developed system automatically aligns a bone saw with osteotomy planes planned in preoperative images. Then, it provides surgeons with not only virtual constraints to restrict movement of the bone saw but also AR guidance for visual feedback without sight diversion, leading to higher surgical accuracy and improved surgical safety. Comprehensive experiments were conducted to evaluate both the AR registration accuracy and osteotomy accuracy of the developed navigation system. The proposed AR registration method achieved an average mean absolute distance error (mADE) of 1.96 ± 0.43 mm. The robotic system achieved an average center translation error of 0.96 ± 0.23 mm, an average maximum distance of 1.31 ± 0.20 mm, and an average angular deviation of 3.77 ± 0.85°. Experimental results demonstrated both the AR registration accuracy and the osteotomy accuracy of the developed system.
Donna J. Oeffinger, PhD, Henry Iwinski, MD, Vishwas Talwalkar, MD
et al.
Background: Despite widespread usage of the SRS-22r questionnaire (Scoliosis Research Society Questionnaire-22r), the English version has only sparingly been subjected to analysis using modern psychometric techniques for patients with adolescent idiopathic scoliosis (AIS). The study purpose was to improve interpretation and clinical utility of the SRS-22r for adolescents with AIS by generating additional robust evidence, using modern statistical techniques. Questions about (1) Structure and (2) Item and Scale Functioning are addressed and interpreted for clinicians and researchers. Methods: This retrospective case review analyzed SRS-22r data collected from 1823 patients (mean age 14.9±2.2years) with a primary diagnosis of AIS who clinically completed an SRS-22r questionnaire.Individual SRS-22r questions and domain scores were retrieved through data queries. Patient information collected through chart review included diagnosis, age at assessment, sex, race and radiographic parameters. From 6044 SRS-22r assessments, 1 assessment per patient was randomly selected. Exploratory structural equation modeling (ESEM) and item response theory (IRT) techniques were used for data modeling, item calibration, and reliability assessment. Results: ESEM demonstrated acceptable fit to the data: χ2 (130)=343.73, p<.001; RMSEA=0.035; CFI=0.98; TLI=0.96; SRMR=0.02. Several items failed to adequately load onto their assigned factor. Item fit was adequate for all items except SRSq10 (Self-Image), SRSq16 (Mental Health), and SRSq20 (Mental Health). IRT models found item discriminations are within normal levels for items in psychological measures, except items SRSq1 (pain), SRSq2 (pain), and SRSq16 (mental health). Estimated reliability of the Function domain (ρ=0.69) was low, however, Pain, Self-Image and Mental Health domains exhibited high (ρ>0.80) reliability. Conclusions: Modern psychometric assessment of the SRS-22r, in adolescent patients with AIS, are presented and interpreted to assist clinicians and researchers in understanding its strengths and limitations. Overall, the SRS-22r demonstrated good psychometric properties in all domains except function. Cautious interpretation of the total score is suggested, as it does not reflect a single HRQoL construct.
Orthopedic surgery, Neurology. Diseases of the nervous system
Lena Katharina Müller-Heupt, Anja Eckelt, John Eckelt
et al.
Periodontitis is a common global disease caused by bacterial dysbiosis leading to tissue destruction, and it is strongly associated with anaerobic bacterial colonization. Therapeutic strategies such as oxygen therapy have been developed to positively influence the dysbiotic microbiota, and the use of oxygen-releasing substances may offer an added benefit of avoiding systemic effects commonly associated with antibiotics taken orally or hyperbaric oxygen therapy. Therefore, the oxygen release of calcium peroxide (CaO<sub>2</sub>) was measured using a dissolved oxygen meter, and CaO<sub>2</sub> solutions were prepared by dissolving autoclaved CaO<sub>2</sub> in sterile filtered and deionized water. The effects of CaO<sub>2</sub> on planktonic bacterial growth and metabolic activity, as well as on biofilms of <i>Streptococcus oralis</i> and <i>Porphyromonas gingivalis</i>, were investigated through experiments conducted under anaerobic conditions. The objective of this study was to investigate the potential of CaO<sub>2</sub> as an antimicrobial agent for the treatment of periodontitis. Results showed that CaO<sub>2</sub> selectively inhibited the growth and viability of <i>P. gingivalis</i> (<i>p</i> < 0.001) but had little effect on <i>S. oralis</i> (<i>p</i> < 0.01), indicating that CaO<sub>2</sub> has the potential to selectively affect both planktonic bacteria and mono-species biofilms of <i>P. gingivalis</i>. The results of this study suggest that CaO<sub>2</sub> could be a promising antimicrobial agent with selective activity for the treatment of periodontitis.
The epidermal growth factor receptor (EGFR) plays crucial roles in several important biological functions such as embryogenesis, epithelial tissue development, and cellular regeneration. However, in multiple solid tumor types overexpression and/or activating mutations of the <i>EGFR</i> gene frequently occur, thus hijacking the EGFR signaling pathway to promote tumorigenesis. Non-small cell lung cancer (NSCLC) tumors in particular often contain prevalent and shared EGFR mutations that provide an ideal source for public neoantigens (NeoAg). Studies in both humans and animal models have confirmed the immunogenicity of some of these NeoAg peptides, suggesting that they may constitute viable targets for cancer immunotherapies. Peptide vaccines targeting mutated EGFR have been tested in multiple clinical trials, demonstrating an excellent safety profile and encouraging clinical efficacy. For example, the CDX-110 (rindopepimut) NeoAg peptide vaccine derived from the EGFRvIII deletion mutant in combination with temozolomide and radiotherapy has shown efficacy in treating EGFRvIII-harboring glioblastoma multiforme (GBM) patients undergone surgery in multiple Phase I and II clinical trials. Furthermore, pilot clinical trials that have administered personalized NeoAg peptides for treating advanced-stage NSCLC patients have shown this approach to be a feasible and safe method to increase antitumor immune responses. Amongst the vaccine peptides administered, EGFR mutation-targeting NeoAgs induced the strongest T cell-mediated immune responses in patients and were also associated with objective clinical responses, implying a promising future for NeoAg peptide vaccines for treating NSCLC patients with selected EGFR mutations. The efficacy of NeoAg-targeting peptide vaccines may be further improved by combining with other modalities such as tyrosine kinase or immune checkpoint inhibitor (ICI) therapy, which are currently being tested in animal models and clinical trials. Herein, we review the most current basic and clinical research progress on EGFR-targeted peptide vaccination for the treatment of NSCLC and other solid tumor types.
Corinne E. Praska, Riccardo Tamburrini, Juan Sebastian Danobeitia
et al.
Organ transplantation is characterized by a sequence of steps that involve operative trauma, organ preservation, and ischemia-reperfusion injury in the transplant recipient. During this process, the release of damage-associated molecular patterns (DAMPs) promotes the activation of innate immune cells via engagement of the toll-like receptor (TLR) system, the complement system, and coagulation cascade. Different classes of effector responses are then carried out by specialized populations of macrophages, dendritic cells, and T and B lymphocytes; these play a central role in the orchestration and regulation of the inflammatory response and modulation of the ensuing adaptive immune response to transplant allografts. Organ function and rejection of human allografts have traditionally been studied through the lens of adaptive immunity; however, an increasing body of work has provided a more comprehensive picture of the pivotal role of innate regulation of adaptive immune responses in transplant and the potential therapeutic implications. Herein we review literature that examines the repercussions of inflammatory injury to transplantable organs. We highlight novel concepts in the pathophysiology and mechanisms involved in innate control of adaptive immunity and rejection. Furthermore, we discuss existing evidence on novel therapies aimed at innate immunomodulation and how this could be harnessed in the transplant setting.
Bhavya Krishna, Kavita Rani Sharma, Ranju Gandhi
et al.
Pheochromocytoma is a challenging case for any anesthesiologist and a team approach is required throughout the perioperative period to prevent anticipated difficulties and best manage any unforeseen complications that develop. We discuss successful management of certain unique challenges, like multifocal arrhythmias and surgical rebleed during transport, during pheochromocytoma surgery in an adult, in addition to the usual perioperative problems.
Anesthesiology, Medical emergencies. Critical care. Intensive care. First aid
Abstract Introduction Chronic postoperative pain poses challenges, emphasizing the importance of accurately predicting pain in advance. Generally, pain perception is associated with the temporal dynamics of the brain, which can be represented by microstates. Specifically, microstates are transient and patterned brain topographies formed by temporally overlapping and spatially synchronized oscillatory activities. Consequently, by characterizing brain activity, microstates offer valuable insights into pain perception. Methods In this prospective study, 66 female patients undergoing breast cancer surgery were included. Their preoperative resting‐state electroencephalography (EEG) was recorded. Preoperative resting‐state EEG was recorded and four specific brain microstates (labeled as A, B, C, and D) were extracted. Temporal characteristics were then analyzed from these microstates. Patients were classified into two groups based on their Numerical Rating Scale (NRS) scores at three months postoperatively. Those with NRS scores ranging from 4 to 10 were classified as the high pain group, while patients with NRS ranging from 0 to 3 were classified as the lowpain group. Statistical analyses were performed to compare the microstate characteristics between these two groups. Results Twenty‐one patients (32%) were classified as the high pain group and forty‐five (68%) as the low‐pain group. The occurrence and coverage of microstate C were significantly higher in the high pain group. Additionally, there were significant differences in the microstates transitions between the two groups. Furthermore, the study revealed a positive correlation between the coverage of microstate C and the NRS. Conclusions Preoperative resting‐state microstate features have shown correlations with postoperative pain. This study presents a novel and advanced perspective on the potential of microstates as a marker for postoperative pain.
Suraj Chakravarthi Raja, Won Suk You, Kian Jalaleddini
et al.
Tendon transfer surgery is often used to restore hand grasp function following high median-ulnar nerve palsy. This surgery typically reroutes and sutures the tendon of the extensor carpi radialis longus (ECRL) muscle to all four flexor digitorum profundus (FDP) tendons of the hand, coupling them together. This makes it difficult to grasp irregularly shaped objects. We propose inserting a novel implantable passive device between the FDP tendons to surgically construct a differential mechanism, enabling the fingers to individually adapt to the irregular contours during grasping. These passive implants with no moving parts are fabricated from biocompatible materials. We tested the implants’ ability to create differential flexion between the index and middle fingers when actuated by a single muscle in two human cadaver hands using a computerized closed-loop control paradigm. In these cadaveric models, the implants enabled significantly more differential flexion between the index and middle fingers for a wide range of donor tendon tensions. The implants also redistributed fingertip forces between fingers. When grasping uneven objects, the difference in contact forces between fingers reduced by nearly 23% compared to the current suture-based surgery. These results suggest that self-adaptive grasp is possible in tendon transfers that drive multiple distal flexor tendons.
Reconstruction of the soft tissues in robotic surgery from endoscopic stereo videos is important for many applications such as intra-operative navigation and image-guided robotic surgery automation. Previous works on this task mainly rely on SLAM-based approaches, which struggle to handle complex surgical scenes. Inspired by recent progress in neural rendering, we present a novel framework for deformable tissue reconstruction from binocular captures in robotic surgery under the single-viewpoint setting. Our framework adopts dynamic neural radiance fields to represent deformable surgical scenes in MLPs and optimize shapes and deformations in a learning-based manner. In addition to non-rigid deformations, tool occlusion and poor 3D clues from a single viewpoint are also particular challenges in soft tissue reconstruction. To overcome these difficulties, we present a series of strategies of tool mask-guided ray casting, stereo depth-cueing ray marching and stereo depth-supervised optimization. With experiments on DaVinci robotic surgery videos, our method significantly outperforms the current state-of-the-art reconstruction method for handling various complex non-rigid deformations. To our best knowledge, this is the first work leveraging neural rendering for surgical scene 3D reconstruction with remarkable potential demonstrated. Code is available at: https://github.com/med-air/EndoNeRF.
Robot-assisted surgery has become progressively more and more popular due to its clinical advantages. In the meanwhile, the artificial intelligence and augmented reality in robotic surgery are developing rapidly and receive lots of attention. However, current methods have not discussed the coherent integration of AI and AR in robotic surgery. In this paper, we develop a novel system by seamlessly merging artificial intelligence module and augmented reality visualization to automatically generate the surgical guidance for robotic surgery education. Specifically, we first leverage reinforcement leaning to learn from expert demonstration and then generate 3D guidance trajectory, providing prior context information of the surgical procedure. Along with other information such as text hint, the 3D trajectory is then overlaid in the stereo view of dVRK, where the user can perceive the 3D guidance and learn the procedure. The proposed system is evaluated through a preliminary experiment on surgical education task peg-transfer, which proves its feasibility and potential as the next generation of robot-assisted surgery education solution.