Hasil untuk "Surgery"

W. Potts

M. Makuuchi, T. Kosuge, T. Takayama et al.

M. Mythen, A. Webb

A. Howell, G. Ribeiro, R. Swindell

Yingxue Guo, Yuan Wang, Fanghua Li et al.

Intraductal papillary mucinous neoplasm (IPMN) with invasive carcinoma is a rare type of pancreatic cancer that has a better prognosis than classic pancreatic infiltrating ductal carcinoma. Most distant metastases occur in the lymph nodes, lungs, liver, and bones at advanced stages. We report a rare case of an IPMN with invasive carcinoma that metastasized to the uterus, resulting in long-term survival after debulking surgery combined with hyperthermic intraperitoneal chemotherapy on a systemic treatment basis. This rare case highlights the need for oncologists and gynecologists to be vigilant regarding these uncommon metastatic diseases and exercise caution in diagnosis. Comprehensive treatments, including debulking surgery, may improve survival.

Dennis N. Schneider, Lars Wagner, Daniel Rueckert et al.

Accurate grasping point prediction is a key challenge for autonomous tissue manipulation in minimally invasive surgery, particularly in complex and variable procedures such as colorectal interventions. Due to their complexity and prolonged duration, colorectal procedures have been underrepresented in current research. At the same time, they pose a particularly interesting learning environment due to repetitive tissue manipulation, making them a promising entry point for autonomous, machine learning-driven support. Therefore, in this work, we introduce attachment anchors, a structured representation that encodes the local geometric and mechanical relationships between tissue and its anatomical attachments in colorectal surgery. This representation reduces uncertainty in grasping point prediction by normalizing surgical scenes into a consistent local reference frame. We demonstrate that attachment anchors can be predicted from laparoscopic images and incorporated into a grasping framework based on machine learning. Experiments on a dataset of 90 colorectal surgeries demonstrate that attachment anchors improve grasping point prediction compared to image-only baselines. There are particularly strong gains in out-of-distribution settings, including unseen procedures and operating surgeons. These results suggest that attachment anchors are an effective intermediate representation for learning-based tissue manipulation in colorectal surgery.

M. van der Burg, M. van Lent, M. Buyse et al.

Shiqi Liu, Haomin Wu, Pengjie Zhang et al.

Abstract Although various malignant tumors have been associated with the aberrant expression of Neural Epidermal Growth Factor-Like 2 (NELL2), its involvement in hepatocellular carcinoma (HCC) has not been previously documented. In this study, NELL2, recognized as a crucial tumor-suppressor gene, was found to be infrequently expressed in HCC. In vitro experiments demonstrated that the overexpression of NELL2 significantly inhibited the proliferation, migration, and invasion of liver cancer cells, whereas the suppression of NELL2 markedly enhanced these oncogenic properties. Further investigation revealed that NELL2 impedes epithelial-mesenchymal transition (EMT) via the Notch signaling pathway. Inhibition of the Notch pathway reversed the increased tumor proliferation, migration, and invasion observed following the downregulation of NELL2 expression. Notably, gene enrichment analysis and in vitro studies indicated that NELL2 effectively induced ferroptosis in HCC cells, as evidenced by increased levels of cellular malondialdehyde (MDA), iron, and Reactive Oxygen Species (ROS), alongside decreased glutathione (GSH) levels. The blockade of the Notch signaling pathway substantially diminished NELL2’s capacity to induce ferroptosis. In summary, our findings suggest that NELL2 modulates the Notch signaling pathway to inhibit EMT and promote ferroptosis. Consequently, NELL2 may serve as a novel therapeutic target, potentially functioning as a tumor suppressor gene in HCC.

M D Ray, Manish Kumar Gaur

Abstract Introduction The nodal positivity in advanced ovarian cancers is approximately 68–70% histopathologically. Even after neoadjuvant chemotherapy (NACT) chance of nodal positivity is around 50–80%. In the prevailing literature, the nodal burden is a neglected entity in both assessment and documentation and complete clearance during the CRS. We aim to highlight the importance of nodal dissection and propose a Nodal Cancer Index (NCI) like PCI for ovarian cancers based on our experience of 105 cases. Materials and methods We included 105 patients with advanced ovarian cancers who underwent CRS. Retroperitoneal lymph nodes and bilateral pelvic lymph node dissection were routinely done in all the cases. For Nodal Cancer Index calculation, the abdomen is divided into 13 zones, zones 1–6 for retroperitoneum, zones 1–6 for Pelvic nodes, and zone 0 for extra-abdominal nodes. Furthermore, a Nodal size score ranging from 1 to 3 has been proposed so that the Nodal Cancer Index ranges from 13 to 39. Results The median age of the patients was 51 years (range 19–71) and the most significant patients were in stage III (65.7%), and 34.3% had stage IV disease at presentation. The lymph nodes were found to be positive in 62 patients (59%), and the positivity rate was higher in patients who underwent upfront surgery 36 (58.1%) as compared to 26 (41.9%) in those who received NACT. The majority of the patients (56.6%) had positive lymph nodes in both the pelvic and retroperitoneal groups, whereas 19.3% had only pelvic nodes positive, and 24.2% had only retroperitoneal nodes positive. The probability of overall survival at 5 years in our patients was 48.9% (95% CI = 35.5–61). Conclusion The results of our analytic observation confirm that systemic lymphadenectomy of all 13 zones proposed by our study should be an integral part of optimal CRS in the advanced carcinoma ovary and this will help us manage these advanced cases in a better objective manner.

Colya N. Englisch, Karl T. Boden, Clemens N. Rudolph et al.

Purpose: Implantation cysts of the iris are rare benign lesions resulting from epithelial downgrowth after trauma or surgery. This report highlights the management of an exceptional case of implantation cysts manifestation five decades after penetrating childhood trauma. Observation: A 59-year-old male patient with a history of penetrating trauma of the cornea at the age of 4 years presented with cystic anterior chamber lesions exhibiting pigment deposition. The pupil was distorted and almost entirely covered. 50 MHz ultrasound biomicroscopy and anterior segment optical coherence tomography displayed no evidence of malignancy. The cystic lesions were excised in an endothelium-protective manner and histopathological analysis revealed dysplasia-free corneal squamous epithelium compatible with implantation cysts of the iris. Conclusion and importance: Implantation cysts of the iris are benign and rare. Anterior segment imaging is required to exclude malignancies. Most cases emerge after surgery or trauma within months to a few years after injury. However, occurrence can also be delayed by several decades. It is thus mandatory to demand a full and long–lasting ophthalmological anamnesis, to accurately distinguish, diagnose, and treat cystic lesions of the iris.

Xiaoxia Huang, Qiancheng Wang, Dan Han et al.

Abstract Background The mechanisms underlying cardiac remodeling in aortic valvular (AoV) disease remain poorly understood, partially due to the insufficiency of appropriate preclinical animal models. Here, we present a novel murine model of aortic regurgitation (AR) generated by trans‐apical wire destruction of the AoV. Methods Directed by echocardiography, apical puncture of the left ventricle (LV) was performed in adult male C57BL/6 mice, and a metal guidewire was used to induce AoV destruction. Echocardiography, invasive LV hemodynamic and histological examination were conducted to assess the degree of AR, LV function and remodeling. Results AR mice exhibited rapid aortic regurgitation velocity (424 ± 15.22 mm/s) immediately following successful surgery. Four weeks post‐surgery, echocardiography revealed a 54.6% increase in LV diastolic diameter and a 55.1% decrease in LV ejection fraction in AR mice compared to sham mice. Pressure‐volume catheterization indicated that AR mice had significantly larger LV end‐diastolic volumes (66.2 ± 1.5 μL vs. 41.8 ± 3.4 μL), reduced LV contractility (lower dP/dtmax and Ees), and diminished LV compliance (smaller dP/dtmin and longer Tau) compared to sham mice. Histological examination demonstrated that AR mice had significantly larger cardiomyocyte area and more myocardial fibrosis in LV tissue, as well as a 107% and a 122% increase of heart weight/tibial length and lung weight/tibial length, respectively, relative to sham mice. Conclusions The trans‐apex wire‐induced destruction of the AoV establishes a novel and efficient murine model to develop AR, characterized by significant eccentric LV hypertrophy, heart failure, and pulmonary congestion.

Margaret Wooddell PhD, MBA, Dong Dai PhD, Feng Lin PhD et al.

Category: Other Introduction/Purpose: Tenosynovial giant cell tumors (TGCT) are neoplastic, inflammatory lesions that arise within the synovium and can be locally aggressive. Patients with TGCT frequently experience pain and joint swelling, stiffness, reduced range of motion, and instability in affected joints. Surgical resection is standard treatment for TGCT; however, the diffuse subtype is associated with poor surgical outcomes and high rates of disease recurrence. Pexidartinib (Turalio ® ), a CSF-1R antagonist, is the first and only systemic therapy approved by the FDA for treatment of adult patients with symptomatic TGCT associated with severe morbidity or functional limitations and not amenable to improvement with surgery. The objective of this study was to assess symptom change over time among adult patients who were treated with pexidartinib for TGCT in a real-world setting. Methods: This was a longitudinal observational study of patients receiving pexidartinib for TGCT treatment in the real-world setting. The study collected Patient Reported Outcomes (PRO) from patient surveys prospectively and clinical data from medical charts retrospectively. The surveys were administered to adult patients enrolled in the post-market Turalio ® Risk Evaluation and Mitigation Strategy (REMS) program: the first wave was sent in 2021 (“Baseline”) and the final was sent in 2022 (“Follow-up”). Patients were required to be receiving pexidartinib before the Baseline Survey and to be on pexidartinib when they accessed the Follow-up Survey. The surveys consisted of validated instruments to measure PROs. The EQ-5D-5L was administered in the Follow-up Survey to understand patients’ general health state. The scores and paired changes from baseline were summarized by descriptive statistics and a random slope regression model was developed to adjust for the time since first pexidartinib dose. Results: Forty-five patients actively taking pexidartinib to treat TGCT were invited to participate in both waves of the survey; 31 (68.9%) participated in both surveys. Mean (SD) time between baseline and follow-up was 1.02 (0.17) years, mean (SD) age at follow-up was 41.9 (13.70) years, and 67.7% were female. The most common tumor sites were at the knee (67.7%), ankle (16.1%), foot (9.7%), and hip (9.7%) (non-mutually exclusive). Changes in PROs are shown in Table 1. During follow-up, at least 71% of respondents indicated slight or no problems in each of the five EQ-5D-5L domains. Since the start of the study, the majority (85.7%) of respondents experienced improved overall symptoms. Conclusion: In this study, most TGCT patients reported symptom improvement in physical function, stiffness and pain during pexidartinib treatment. After an additional year of follow-up, the PROs of physical function, worst stiffness, worst pain, and treatment satisfaction were sustained. The findings suggest longer-term benefits for patients continuing treatment with pexidartinib. Outcomes for patients who discontinued pexidartinib should be evaluated in future studies.

Kecheng Li, Kecheng Li, Xiaoli Zhou et al.

IntroductionBeta-amyloid accumulation in the brain appears to be a key initiating event in Alzheimer’s disease (AD), and factors associated with increased deposition of beta-amyloid are of great interest. Enhanced deposition of amyloid-β peptides is due to an imbalance between their production and elimination. Previous studies show that diminished levels of CSF amyloid beta 42 (Aβ42) is a biomarker in AD; however, the role of serum Aβ42 in AD is contradictory. BMI and obesity have been reported to be related to increased serum Aβ42 levels. Therefore, we aimed to investigate the relation between metabolic syndrome (MetS), its clinical measures (abdominal obesity, high glucose, high triglyceride, low high-density lipoprotein cholesterol level, and hypertension), and serum Aβ42 levels.MethodsA total of 1261 subjects, aged 18–89 years in Chengdu, China, were enrolled from January 2020 to January 2021 to explore the correlation of serum Aβ42 levels with body mass index (BMI), blood lipids, and blood pressure. Furthermore, as the risk of MetS is closely related to age, 1,212 participants (N = 49 with age ≥ 80 years old were excluded) were analyzed for the correlation of serum Aβ42 level and MetS clinical measures.ResultsThe results showed that log-transformed serum Aβ42 level was positively correlated with BMI (R = 0.29; p < 0.001), log-transformed triglyceride (R = 0.14; p < 0.001), and diastolic blood pressure (DBP) (R = 0.12; p < 0.001) and negatively correlated with high-density lipoprotein (HDL-c) (R = −0.18; p < 0.001). After adjusting for age, sex, and other covariates, elevated serum Aβ42 level was correlated with higher values of BMI (βmodel1 = 2.694, βmodel2 = 2.703) and DBP (βmodel1 = 0.541, βmodel2 = 0.546) but a lower level of HDL-c (βmodel2 = −1.741). Furthermore, serum Aβ42 level was positively correlated with MetS and its clinical measures, including BMI and DBP, and negatively correlated with HDL-c level in the Han Chinese population. However, the level of serum Aβ42 did not show a significant correlation with high glucose or high triglyceride.DiscussionThese observations indicate that MetS and its components are associated with higher levels of serum Aβ42 and hence limit the potential of serum Aβ42 as a suitable diagnostic biomarker for AD. As such, we recommend serum Aβ42 serve as a direct risk biomarker for MetS rather than for AD.

Xiaoyue Zhang, Yongkang Qiu, Jixin Zhang et al.

BackgroundLow-grade fibromyxoid sarcoma (LGFMS) is a rare type of soft tissue sarcoma that often involves the deep soft tissue of the extremities and trunk in young and middle-aged adults. It is uncommon in the elderly. Here we discuss a case of LGFMS in an elderly patient who had recurrence and metastasis within 2 years of resection of the primary tumor.Case reportA 71-year-old LGFMS patient was presented with a mass in the left forearm accompanied by pain and numbness from the left upper arm to fingers. The patient subsequently underwent 3 surgical resections, although she had 3 recurrences within 6 months after the initial diagnosis. Considering the malignant biological behavior of the tumor, an amputation at 5 cm above the elbow was eventually performed. However, recurrence in the extremity of the stump and chest wall metastasis were observed 2 years after amputation. Then resection of the metastases, radiotherapy and particle implantation therapy were performed. The patient is currently undergoing follow-up and has no evidence of recurrence.ConclusionIn our case, multiple early postoperative recurrences may be associated with a positive margin at initial operation. The patient underwent a total of 5 operations including local resection of the primary tumor, twice wide resections, amputation and metastatic surgery with 4 early postoperative recurrences and metastases within 4 years, suggesting that LGFMS may have highly invasive biological behavior. Our case demonstrated that early aggressive surgical treatment is recommended for LGFMS patients with a positive margin at initial operation and patients who had recurrence even after wide resection rather than local resection. Further research is needed to develop more effective treatment options for rapidly progress and highly aggressive LGFMS.

Jisun Lee, Seung-Kee Min

Adventitial cystic disease (ACD), a rare vascular disease characterized by mucus accumulation in the adventitia of blood vessels, typically affects the popliteal artery. We present the case of a 61-year-old female diagnosed with ACD in 2018 who was initially treated with endovascular stenting and percutaneous aspiration of the cyst. The patient, who had been asymptomatic for 5 years, developed a stent fracture and pseudoaneurysm requiring surgical intervention. Despite initial successful treatment, complications such as stent fracture and recurrence can occur; therefore, surgical treatment is recommended to optimize outcomes in patients with ACD. Endovascular treatment and cyst aspiration should only be considered in cases with high surgical risk. After treatment, long-term follow-up and individualized management strategies are important to monitor ACD recurrence.

Yavuz Kocabey, M.D., Ahmet Fırat, M.D., Ahmet Yıldırım, M.D. et al.

Optimal graft choice and fixation technique are still ongoing topics of debate for primary and revision anterior cruciate ligament reconstruction. Interference screws are frequently used as graft fixation devices but can sometimes lead to tunnel widening, cyst formation, chronic inflammation, screw breakage, and persistent pain. Tibial tunnel widening is of special concern because it is often associated with graft failure. This technical note introduces a graft technique with a periosteum–patellar tendon–bone autograft and a press-fit tibial fixation approach that could be a viable option for secure anterior cruciate ligament reconstruction while offering the possibility of a quicker postoperative recovery, less pain, and a quicker return to everyday activities.

Beibei Liu, Lisa Piccirillo

We provide new examples of 3-manifolds with weight one fundamental group and the same integral homology as the lens space $L(2k,1)$ which are not surgery on any knot in the three-sphere. Our argument uses Furuta's 10/8-theorem, and is simple and combinatorial to apply.

Adrito Das, Bilal Sidiqi, Laurent Mennillo et al.

Improved surgical skill is generally associated with improved patient outcomes, although assessment is subjective; labour-intensive; and requires domain specific expertise. Automated data driven metrics can alleviate these difficulties, as demonstrated by existing machine learning instrument tracking models in minimally invasive surgery. However, these models have been tested on limited datasets of laparoscopic surgery, with a focus on isolated tasks and robotic surgery. In this paper, a new public dataset is introduced, focusing on simulated surgery, using the nasal phase of endoscopic pituitary surgery as an exemplar. Simulated surgery allows for a realistic yet repeatable environment, meaning the insights gained from automated assessment can be used by novice surgeons to hone their skills on the simulator before moving to real surgery. PRINTNet (Pituitary Real-time INstrument Tracking Network) has been created as a baseline model for this automated assessment. Consisting of DeepLabV3 for classification and segmentation; StrongSORT for tracking; and the NVIDIA Holoscan SDK for real-time performance, PRINTNet achieved 71.9% Multiple Object Tracking Precision running at 22 Frames Per Second. Using this tracking output, a Multilayer Perceptron achieved 87% accuracy in predicting surgical skill level (novice or expert), with the "ratio of total procedure time to instrument visible time" correlated with higher surgical skill. This therefore demonstrates the feasibility of automated surgical skill assessment in simulated endoscopic pituitary surgery. The new publicly available dataset can be found here: https://doi.org/10.5522/04/26511049.