Hasil untuk "Surgery"

Seifeddine Sellemi, Abdelbadia Chaker, Tanguy Vendeuvre et al.

Robotic-assisted surgery has emerged as a promising approach to improve surgical ergonomics, precision, and workflow efficiency, particularly in complex procedures such as cervical spine surgery. In this study, we evaluate the performance of a collaborative robotic system designed to assist surgeons in drilling tasks by assessing its accuracy in executing predefined trajectories. A total of 14 drillings were performed by eight experienced cervical surgeons, utilizing a robotic-assisted setup aimed at ensuring stability and alignment. The primary objective of this study is to quantify the deviations in the position and orientation of the drilling tool relative to the planned trajectory, providing insights into the system's reliability and potential impact on clinical outcomes. While the primary function of robotic assistance in surgery is to enhance surgeon comfort and procedural guidance rather than solely optimizing precision, understanding the system's accuracy remains crucial for its effective integration into surgical practices part of this primary experimental feedback, the study offers an in-depth analysis of the co-manipulated robotic system's performance, focusing on the experimental setup and error evaluation methods. The findings of this study will contribute to the ongoing development of robotic-assisted cervical surgery, highlighting both its advantages and areas for improvement in achieving safer and more efficient surgical workflows

N.K. Gupta, Ayesha Ahmad, Uma Gupta

Education is derived 'Educatum' a Latin word, combination of 'e' and 'duco'. 'e' means 'out of' or 'from inside' and 'duco' means 'to lead out' - means to lead out of what is there inside the mind and soul of learner. Medical education has undergone significant changes in the last few decades due to the technological explosion, and medical students need to be exposed in appropriate and calculated manner at that stage of education

Soheil Azarpendar

Liu and Piccirillo developed a combinatorial argument that employs the 10/8-theorem to demonstrate that certain manifolds cannot be obtained via Dehn surgery on a knot. We extend their approach by creating additional examples using chainmail links.

Rakesh Bhandary

Olle Ljungqvist

Gaia Colalillo, Simona Ippoliti, Anastasios D. Asimakopoulos

Background and Objective: Benign prostatic hyperplasia (BPH) and urethral stricture (US) are common causes of lower urinary tract symptoms in ageing men, often requiring repeated interventions. Conventional treatments of US, such as urethrotomy and mechanical dilation, have high recurrence rates. The Optilume drug-coated balloon catheter system, which combines mechanical dilation with paclitaxel delivery, has emerged as a minimally invasive alternative. This systematic review assesses its efficacy and safety in the management of BPH and US. Methods: A systematic search of PubMed was conducted for studies published between August 2020 and October 2023. Eligible studies included randomised controlled trials (RCTs), cohort studies, and case reports evaluating Optilume’s therapeutic effects. Key outcomes analysed included symptom relief, urinary flow improvement, recurrence rates, and adverse events. Results: Seven studies met the inclusion criteria, including five on US and two on BPH. The ROBUST trial series demonstrated sustained improvements in urinary flow rates and symptom scores in US patients over follow-up periods of up to four years. The EVEREST-1 and PINNACLE trials reported significant symptom relief and preserved sexual function in BPH patients, with a favourable safety profile and minimal complications. Conclusions: Optilume appears to be a promising alternative to conventional endoscopic treatments for US and BPH, offering durable symptom relief with a low complication rate. Further long-term studies are required to confirm its efficacy and cost-effectiveness in routine clinical practice.

Xue Luo, Xingxing Bie, Na Luo et al.

Primary hepatic neuroendocrine neoplasms (PHNENs) are a rare type of neuroendocrine tumors originating in the liver. These tumors are characterized by non-specific clinical symptoms and atypical imaging features, making differentiation from other primary hepatic masses, such as hepatocellular carcinoma (HCC) and parasitic lesions, challenging. The diagnosis of PHNENs is based on characteristic histological features associated with this condition and results from immunohistochemistry assays. Here, we report on a case of a 22-year-old female presenting with a large hepatic neoplastic lesion. Computed tomography (CT) imaging results revealed a highly vascularized mass with clear boundaries located in the right lobe of the liver, suggesting a diagnosis of HCC. The patient underwent a fine-needle aspiration biopsy and subsequent complete surgical resection of the tumor. Results from both the fine-needle aspiration and histology of the surgically resected specimen showed that the tumor cells were arranged in a solid structure with a trabecular pattern. The tumor cells exhibited positive expressions for the epithelial cell markers AE1/AE3, along with the neuroendocrine markers, synaptophysin (Syn), chromogranin (CgA), and CD56 as based on results from immunohistochemical staining. The Ki-67 proliferation index was > 20%, and the mitotic count was > 20 per 2 square millimeters, leading to a final diagnosis of a hepatic neuroendocrine neoplasms, Grade 3 (G3). PHNENs are extremely rare, and, to our knowledge, there have been no reports in the literature of adolescents or young adults diagnosed with the G3-type.

Gongan Jiang, Weijun Wang, Yuhao Yang et al.

Abstract Objective Information on pathogens and sensitive antibiotics is crucial for treating periprosthetic joint infection (PJI), one of the most severe complications of joint arthroplasty. Lacking this information is not uncommon, and empirical antibiotic treatment should be adopted as a compromise. This study aimed to develop regional-specific antimicrobial regimens and provide a reference for empirical antibiotic treatment for PJI by retrospectively analyzing the pathogen profiles of PJI patients treated in our center and their antibiotic sensitivities. Methods PJI patients treated at our center from January 2018 to December 2024 were retrospectively recruited. Joint aspiration was performed preoperatively to collect synovial fluid for culture and differential cell counting, and synovial tissue samples were obtained intraoperatively from at least three different sites for culture. Patients were diagnosed according to the guidelines of the 2018 International Consensus Meeting and the European Bone and Joint Infection Society. The culture-positive rate, distribution of gram-positive pathogens, methicillin resistance, mixed infections, and multidrug resistance were analyzed. The effective coverage rates of antibiotics were determined, and appropriate empirical antibiotic regimens were proposed. Results A total of 255 PJI patients, comprising 104 males and 151 females, were included; 141 patients had hip PJI, and 114 had knee PJI. Among them, 224 patients (87.8%) had positive culture results. We isolated 335 pathogens, including 218 coagulase-negative staphylococcal infections (65.1%). Staphylococcus epidermidis was the most prevalent pathogen, with 86 isolates (25.7%), followed by Staphylococcus aureus, with 45 isolates (13.4%), and Streptococci, with 20 isolates (6.0%). In hip PJI, the most common pathogens were Staphylococcus epidermidis (50 isolates, 26.6%) and Staphylococcus aureus (30 isolates, 16.0%), and in knee PJI, Staphylococcus epidermidis was predominant (36 isolates, 24.5%). In terms of drug resistance, 48.1% of the staphylococcal strains were methicillin resistant, and 57.6% of the pathogens were multidrug resistant. Staphylococci showed 100% sensitivity to vancomycin and linezolid but were highly resistant to β-lactams and quinolones. In patients with acute postoperative PJI, the combination of vancomycin combined with ceftazidime was 98.4% effective. In patients with chronic PJI, vancomycin combined with imipenem and meropenem achieved effective coverage rates of 94.4% and 95.5%, respectively. The combination of linezolid with meropenem also achieved a 95.5% effective coverage rate. Conclusion Gram-positive bacteria were the predominant pathogens associated with PJI, with high rates of methicillin resistance and multidrug resistance. The combination of vancomycin and meropenem is an empirical antibiotic regimen for culture-negative chronic PJI patients in this region, with the combination of linezolid and meropenem as an alternative. For patients with culture-negative acute postoperative PJI, vancomycin combined with ceftazidime is suggested as the preferred empirical therapy.

Çağla Karavaizoğlu, Kazım Okan Dolu, Ayşe Süleyman et al.

Skin prick tests (SPT) are widely used in the diagnosis of allergic diseases because of their reliability, simplicity, cost-effectiveness, and rapid results. Herein, we report a 4-year-old boy who developed anaphylaxis with aeroallergen SPT in an asthmatic child. SPTs were positive for both house dust and Plantago allergens.Although the frequency of systemic reactions to SPTs is low, these tests should only be performed in medical facilities with appropriate equipment and well-trained medical personnel for anaphylaxis.

Lorio MP, Tate JL, Myers TJ et al.

Morgan P Lorio,1 Jordan Lee Tate,2 Thomas J Myers,3 Jon E Block,4 Douglas P Beall5 1Advanced Orthopedics, Altamonte Springs, FL, USA; 2Southern Pain and Spine Associates, Jasper, GA, USA; 3Paradigm Health System, Slidell, LA, USA; 4Private Practice, San Francisco, CA, USA; 5Comprehensive Specialty Care, Edmond, OK, USACorrespondence: Jon E Block, Private Practice, 2210 Jackson Street, Ste. 401, San Francisco, CA, 94115, USA, Tel +1(415) 775-7947, Email jb@drjonblock.comAbstract: Specific clinical diagnostic criteria have established a consensus for defining patients with lumbar discogenic pain. However, if conservative medical management fails, these patients have few treatment options short of surgery involving discectomy often coupled with fusion or arthroplasty. There is a rapidly-emerging research effort to fill this treatment gap with intradiscal therapies that can be delivered minimally-invasively via fluoroscopically guided injection without altering the normal anatomy of the affected vertebral motion segment. Viable candidate products to date have included mesenchymal stromal cells, platelet-rich plasma, nucleus pulposus structural allograft, and other cell-based compositions. The objective of these products is to repair, supplement, and restore the damaged intervertebral disc as well as retard further degeneration. In doing so, the intervention is meant to eliminate the source of discogenic pain and avoid surgery. Methodologically rigorous studies are rare, however, and based on the best clinical evidence, the safety as well as the magnitude and duration of clinical efficacy remain difficult to estimate. Further, we summarize the US Food and Drug Administration’s (FDA) guidance regarding the interpretation of the minimal manipulation and homologous use criteria, which is central to designating these products as a tissue or as a drug/device/biologic. We also provide perspectives on the core evidence and knowledge gaps associated with intradiscal therapies, propose imperatives for evaluating effectiveness of these treatments and highlight several new technologies on the horizon.Keywords: degenerative, disc, intradiscal, autologous, allogeneic, injection, regenerative, discogenic, pain

Elisa Cassart, Joan Miquel, Fernando Santana et al.

Veysi Adin, Chunwoo Kim

As the more sensors and actuators are used in the robotic systems to provide more features, complexity of the system is increasing. When it comes to medical robotics, it becomes harder to ensure safety and determinism in the system. To deal with increasing complexity and ensure precise periodicity and execution timing for a medical robot, in this paper we report development of EtherCAT master as a part of software framework for spine surgery robot. We implemented multi-axis controller using open-source EtherCAT master running in real-time preemptive Linux. We evaluated the real-time performance of the system in terms of periodicity, jitter and execution time in our first prototype of spine surgery robot.

Yu Jiang Master of Engineering, Kang Wang Master of Medicine, Yu-Ran Wang Master of Engineering et al.

Microvascular invasion of hepatocellular carcinoma is an important factor affecting tumor recurrence after liver resection and liver transplantation. There are many ways to classify microvascular invasion, however, an international consensus is urgently needed. Recently, artificial intelligence has emerged as an important tool for improving the clinical management of hepatocellular carcinoma. Many studies about microvascular invasion currently focus on preoperative and prognosis prediction of microvascular invasion using artificial intelligence. In this paper, we review the definition and staging of microvascular invasion, especially the diagnosis of it by using artificial intelligence. In preoperative prediction, deep learning based on multimodal data modeling of radiomics-screened features, clinical features, and medical images is currently the most effective means. In prognostic prediction, pathology is the gold standard, and the techniques used should more effectively utilize the global features of the pathology images.

Pastor Escárcega-Fujigaki, Guillermo Hernandez-Peredo-Rezk, Hayde Velez-Blanco et al.

Introduction: Choledochal cyst is a congenital anomaly of the bile duct without associated pathology as compared to esophageal atresia, whose pathology is usually part of the VACTERL association list (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities). In addition to these core component features, patients may also have other congenital anomalies. Case presentation: A single case of the association of type 1 choledochal cyst (Todani), type III esophageal atresia (Ladd-Gross), evanescent testicle, and clinodactyly of both little fingers, is reported for the first time. A cytogenetic study reports an apparently normal male with a 46 XY karyotype, GTG bands, 400–550 band resolution, and extended exome sequencing without alterations. Esophageal plasty, hepatic-duodenal bypass in early childhood, and resection of the evanescent testicle with fixation of the contralateral testicle were performed at one year of age. We observed a satisfactory evolution after four years and four months of follow-up. Conclusion: In this report, we present this novel case of the association of type 1 choledochal cyst (Todani), type III esophageal atresia (Ladd-Gross), evanescent testicle, and clinodactyly of both little fingers, which has not been previously reported in the literature.

Masao Yoshida, Emine Cesmecioglu, Canan Firat et al.

Whole-block imaging (WBI) using micro-computed tomography (micro-CT) allows the nondestructive reconstruction of a three-dimensional view of tissues, implying that WBI may be used for accurate pathological evaluation of patients with rectal cancer. HOWEVER, the clinical impact of this approach is unclear. We aimed to clarify the efficacy of WBI in the whole-mount specimens of locally advanced rectal cancer. A total of 237 whole-mount formalin-fixed paraffin-embedded blocks from 13 patients with rectal cancer who underwent surgical treatment were enrolled and scanned with micro-CT to generate three-dimensional images. WBI was evaluated following the conventional pathological review of the corresponding whole-slide imaging (WSI). WBI identified all tumor sites detected using WSI. Furthermore, WBI revealed one additional tumor site, which was not detected using WSI. Tumor resection margin was significantly closer to the soft-tissue edge when measured using WBI (7.7 mm vs. 6.6 mm, <i>p</i> < 0.01). Seventy-six percent of tumor deposits on WSI were changed according to the evidence of tumor interaction with the surrounding tissues confirmed using WBI. Furthermore, WBI revealed 25 additional lymph nodes, six of which were metastatic. The combination of conventional hematoxylin and eosin-stained imaging and WBI may contribute to an accurate pathological assessment.

Yinling Mao, Jiachen Lv, Li Jiang et al.

Abstract Background Long non-coding RNAs (lncRNAs), acting as competing endogenous RNA (ceRNA) have been reported to regulate the expression of targeted genes by sponging miRNA in colon adenocarcinoma (COAD). Methods However, their potential implications for recurrence free survival prognosis and functional roles remains largely unclear in COAD. In this study, we downloaded the TCGA dataset (training dataset) and GSE39582 (validation dataset) of COAD patients with prognostic information. Results A total of 411 differentially expressed genes (DElncRNAs: 12 downregulated and 43 upregulated), 18 DE miRNAs (9 downregulated and 9 upregulated) and 338 DEmRNAs (113 downregulated and 225 upregulated) were identified in recurrence samples compared with non-recurrence samples with the thresholds of FDR < 0.05 and |log2FC|> 0.263. Based on six signature lncRNAs (LINC00899, LINC01503, PRKAG2-AS1, RAD21-AS1, SRRM2-AS1 and USP30-AS1), the risk score (RS) system was constructed. Two prognostic clinical features, including pathologic stage and RS model status were screened for building the nomogram survival model. Moreover, a recurrent-specific ceRNA network was successfully constructed with 2 signature lncRNAs, 4 miRNAs and 113 mRNAs. Furthermore, we further manifested that SRRM2-AS1 predicted a poor prognosis in COAD patients. Furthermore, knockdown of SRRM2-AS1 significantly suppressed cell proliferation, migration, invasion and EMT markers in HT-29 and SW1116 cells. Conclusion These identified novel lncRNA signature and ceRNA network associated with recurrence prognosis might provide promising therapeutic targets for COAD patients.

Andrea Roberti, Nicola Piccinelli, Daniele Meli et al.

Autonomy is the frontier of research in robotic surgery and its aim is to improve the quality of surgical procedures in the next future. One fundamental requirement for autonomy is advanced perception capability through vision sensors. In this paper, we propose a novel calibration technique for a surgical scenario with da Vinci robot. Calibration of the camera and the robot is necessary for precise positioning of the tools in order to emulate the high performance surgeons. Our calibration technique is tailored for RGB-D camera. Different tests performed on relevant use cases for surgery prove that we significantly improve precision and accuracy with respect to the state of the art solutions for similar devices on a surgical-size setup. Moreover, our calibration method can be easily extended to standard surgical endoscope to prompt its use in real surgical scenario.

Xin Yin, Jinghua Xia, Ying Sun et al.

Abstract Background CHCHD2 was identified a novel cell migration-promoting gene, which could promote cell migration and altered cell adhesion when ectopically overexpressed in NIH3T3 fibroblasts, and it was identified as a protein necessary for OxPhos function as well. However, the clinic relevance of CHCHD2 expression in NSCLC remains unclear. Here we assumed that CHCHD2 expression would accompanies the expression of HIF-1α to response hypoxia in the occurrence of NSCLC. Methods In order to verify this hypothesis, correlations among the expression levels of CHCHD2 and HIF-1α were detected and analyzed in 209 pair cases of NSCLC. The expression and location of these molecules were assessed using Immunohistochemistry, immunohistofluorescence, qRT-PCR and western blotting. The differences and correlations of the expression of these two molecules with clinical pathological characteristics in NSCLC were statistically analyzed using Wilcoxon (W) text, Mann-Whitney U, Kruskal-Wallis H and cross-table tests. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of the expression of CHCHD2 and HIF-1α on the patients’ survival. Results Data showed that CHCHD2 and HIF-1α expression were higher in NSCLC than in normal tissues (all P = 0.000). CHCHD2 expression was significantly related with smoking, tumor size, differentiation degree, TNM Stage, lymph metastasis (all P<0.05). The HIF-1α expression was significantly associated with smoking, tumor category, differentiation degree, TNM Stage, Lymph metastasis (all P<0.05). There was a marked correlation of CHCHD2 and HIF-1α expression with histological type, differentiation and lymph metastasis of NSCLC (all P<0.05, rs >0.3). Immunohistofluorescence showed that there were co-localization phenomenon in cytoplasm and nucleus between CHCHD2 and HIF-1α expression. NSCLC patients with higher CHCHD2 and HIF-1α expression had a significantly worse prognosis than those with lower CHCHD2 and HIF-1α expression (all P = 0.0001; log-rank test). The multivariate analysis indicated that CHCHD2 expression was an independent prognostic factor in NSCLC (hazard ratio [HR], 0.492, P = 0.001). Conclusion Our results indicate that over-expression of CHCHD2 would promote the expression of HIF-1α to adapt the hypoxia microenviroment in NSCLC and CHCHD2 could serves as a prognostic biomarker in NSCLC.

Julien Chouteau, Jean-Charles Rollier, Michel P. Bonnin et al.

Abstract Purpose Dual-mobility (DM) cups are increasingly used in total hip arthroplasty (THA) but there lacks literature on their long-term results. We aimed to investigate outcomes of a fourth-generation cementless DM acetabular cup at 7–11 years. Methods We retrospectively evaluated 240 consecutive hips that received cementless THA using the same dual mobility cup (Novae Sunfit TH) and femoral stem (Corail). Patients were recalled at ≥7 years to collect Oxford hip scores (OHS), Harris hip scores (HHS), and inspect for radiolucent lines and granulomas. Multi-variable analyses were performed to determine whether HHS or OHS were associated with pre- or intra-operative variables. Results At 8.4 ± 0.8 years (range, 7–11), 6 hips were revised (2.5%), 54 deceased (22.5%), and 14 could not be reached (5.8%). Four revisions (2 cup+stem, 2 liners only) were due to sepsis (1.7%), one (cup and stem) for trauma (0.4%), and one (stem) due to aseptic loosening (0.4%). For the remaining 166 hips, HHS was 83.6 ± 13.2 and OHS was 20.3 ± 6.7. Multi-variable analysis confirmed that HHS (β = − 0.38; p = 0.039) and OHS (β = 0.36; p < 0.001) worsened with age, and that OHS was worse for Charnley C patients (β = 3.17; p = 0.009). Neither granulomas nor radiolucenies were observed around any cups, but radiolucenies were seen around 25 stems (20.3%). Conclusions This fourth-generation DM cup demonstrated satisfactory outcomes at 7–11 years, with no instabilities or cup revisions due to aseptic loosening. Better OHS was observed for younger patients and those presenting higher Charnley grade. Level of evidence Level IV, retrospective case study.