Hasil untuk "Surgery"

Guankun Wang, Long Bai, Junyi Wang et al.

Recently, Multimodal Large Language Models (MLLMs) have demonstrated their immense potential in computer-aided diagnosis and decision-making. In the context of robotic-assisted surgery, MLLMs can serve as effective tools for surgical training and guidance. However, there is still a lack of MLLMs specialized for surgical scene understanding in clinical applications. In this work, we introduce EndoChat to address various dialogue paradigms and subtasks in surgical scene understanding that surgeons encounter. To train our EndoChat, we construct the Surg-396K dataset through a novel pipeline that systematically extracts surgical information and generates structured annotations based on collected large-scale endoscopic surgery datasets. Furthermore, we introduce a multi-scale visual token interaction mechanism and a visual contrast-based reasoning mechanism to enhance the model's representation learning and reasoning capabilities. Our model achieves state-of-the-art performance across five dialogue paradigms and eight surgical scene understanding tasks. Additionally, we conduct evaluations with professional surgeons, most of whom provide positive feedback on collaborating with EndoChat. Overall, these results demonstrate that our EndoChat has great potential to significantly advance training and automation in robotic-assisted surgery.

Praveen Balakrishnan, Emy S. Surendran, Lisha S. Raj

Intervertebral disc prolapse (IVDP) or disc herniation is a moderately common disorder in males during their third to fifth decade of life. Conservative treatments are limited and surgery is an effective treatment option, but without much benefits in the long-term follow-up. Many claims of effects of Ayurveda interventions for IVDP are made, but evidence of effects of Ayurveda interventions in acute cases is meagre. This case report highlights the effects of Ayurveda management (following a multimodal approach with lepa, upanaha, pinda sweda, and vasti) within a short period of time of 26 days, in an acute case of IVDP. The Oswestry Disability Index reduced from 45 to zero and Functional Rating Index from 40 to 2. There was a linear reduction in pain and numbness in weekly follow up using the visual analogue scale. This case report highlights the role of Ayurveda treatments in the management of acute cases of intervertebral disc prolapse to achieve result within a short span of time.

Hussain Z, Abdulrahim Abdul Moti L, Jagal J et al.

Zahid Hussain,1,2 Lama Abdulrahim Abdul Moti,1 Jayalakshmi Jagal,2 Hnin Ei Thu,3 Shahzeb Khan,4 Mohsin Kazi5 1Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah, 27272, United Arab Emirates; 2Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates; 3Department of Pharmacology, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia; 4Center for Pharmaceutical Engineering Science, Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, West Yorkshire Bradford, BD7 1DP, UK; 5Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi ArabiaCorrespondence: Zahid Hussain, Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah, 27272, United Arab Emirates, Email zhussain@sharjah.ac.aeIntroduction: Owing to its high prevalence, colossal potential of chemoresistance, metastasis, and relapse, breast cancer (BC) is the second leading cause of cancer-related fatalities in women. Several treatments (eg, chemotherapy, surgery, radiations, hormonal therapy, etc.) are conventionally prescribed for the treatment of BC; however, these are associated with serious systemic aftermaths. In this research, we aimed to design a multiprong targeting strategy for concurrent action against different phenotypes of BC (MCF-7 and SK-BR-3) and tumor-associated macrophages (TAMs) for relapse-free treatment of BC.Methods: Paclitaxel (PTX) and tamoxifen (TMX) co-loaded chitosan (CS) nanoparticles (NPs) were prepared using the ionic-gelation method and optimized using the Design Expert® software by controlling different material attributes. For selective targeting through CD44-receptors that are heavily expressed on the BC cells and TAMs, the fabricated NPs (PTX-TMX-CS-NPs) were functionalized with hyaluronic acid (HA) as a targeting ligand.Results: The optimized HA-PTX-TMX-CS-NPs exhibited desired physicochemical properties (PS ~230 nm, PDI 0.30, zeta potential ~21.5 mV), smooth spherical morphology, high encapsulation efficiency (PTX ~72% and TMX ~97%), good colloidal stability, and biphasic release kinetics. Moreover, the lowest cell viability depicted in MCF-7 (~25%), SK-BR-3 (~20%), and RAW 264.7 cells (~20%), induction of apoptosis, cell cycle arrest, enhanced cell internalization, and alleviation of MCF-7 and SK-BR-3 migration proved the superior anticancer potential of HA-PTX-TMX-CS-NPs compared to unfunctionalized NPs and other control medicines.Conclusion: HA-functionalization of NPs is a promising multiprong strategy for CD44-receptors-mediated targeting of BC cells and TAMs to mitigate the progression, metastasis, and relapse in the BC. Keywords: paclitaxel, tamoxifen, hyaluronic acid, polymeric nanoparticles, CD44-receptors, breast cancer, cell uptake, anticancer efficacy

Yue Zhang, Dan Li, Xiaofei Bi et al.

ObjectiveTo investigate the prevalence and impact of anxiety and sleep disturbances during the intensive care unit (ICU) stay following cardiothoracic surgery in male patients, and to evaluate the efficacy and feasibility of a structured psychological intervention combining Cognitive Behavioral Therapy for Insomnia (CBT-I) principles with environmental optimization.MethodsThis study was designed as a multicenter, prospective, randomized controlled trial (RCT) conducted from January to April 2025 across three tertiary hospitals. A total of 120 adult male patients who underwent radical surgery for cardiac or lung cancer and were subsequently admitted to the ICU were enrolled. Baseline assessments were performed within 48 h after surgery. Participants were randomly allocated in a 1:1 ratio to either the intervention group (n = 60) or the standard care group (n = 60) using a computer-generated randomization sequence with concealed allocation. While the standard care group received routine perioperative management, the intervention group additionally received a structured psychological intervention that incorporated components of Cognitive Behavioral Therapy for Insomnia (CBT-I)—including sleep education, relaxation training, and behavioral strategies—along with daily psychological support and environmental optimization measures such as noise reduction, lighting adjustment, and use of sleep-promoting devices.Primary outcomes included Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain, ICU length of stay, incidence of postoperative complications, and the 30-day postoperative quality of life as measured by the SF-36. Multivariate logistic regression was used to assess the predictive value of anxiety and sleep disturbances on postoperative outcomes.ResultsOn postoperative day 3, the intervention group showed significantly lower GAD-7 scores (6.3 ± 1.6 vs. 8.4 ± 2.3, p = 0.016) and PSQI scores (7.5 ± 1.6 vs. 10.2 ± 2.3, p < 0.01) compared to the standard care group. Pain scores were also significantly reduced (2.7 ± 1.2 vs. 3.6 ± 1.3, p = 0.018). The intervention group had a shorter ICU stay (2.5 ± 0.6 days vs. 3.7 ± 1.2 days, p < 0.01), a lower rate of postoperative complications (17% vs. 36%, p = 0.033), and significantly better SF-36 scores at 30 days post-surgery (p < 0.05). Multivariate logistic regression identified both anxiety and sleep disturbance as independent predictors of postoperative complications (GAD-7: OR = 1.25, 95% CI: 1.03–1.42; PSQI: OR = 1.33, 95% CI: 1.14–1.51).ConclusionAnxiety and sleep disturbances are common during the postoperative ICU phase in male patients undergoing cardiothoracic surgery and are significantly associated with pain, complications, and recovery outcomes. Early implementation of a CBT-I–based psychological intervention in the ICU can effectively improve psychological status, shorten ICU stays, and reduce postoperative complications. The intervention is safe and shows high clinical utility, warranting consideration for integration into standardized postoperative care pathways, particularly in high-risk male populations.Clinical trial registrationThe study was retrospectively registered on the Chinese Clinical Trial Registry (ChiCTR) under the identifier ChiCTR240000123.

Prashasti Agrawal, MD, Michael Offin, MD, Victoria Lai, MD et al.

Introduction: WT1 often presents on the surface of diffuse pleural mesotheliomas (DPMs) and is an ideal therapeutic target. Galinpepimut-S (GPS), a tetravalent, non–human leukocyte antigen–restricted, heteroclitic WT1–specific peptide vaccine was safe and effective in early phase clinical trials and upregulates T-cell suppressive programmed death-ligand 1 in the tumor microenvironment of other malignancies. A randomized phase 2 study of adjuvant GPS in patients with DPM trended toward improved median overall survival. Methods: To further enhance immunogenicity, we combined GPS with nivolumab, an anti-PD1 monoclonal antibody, in an open-label, single-center phase 1 study, examining tolerability and immunogenicity in patients with previously treated DPM. We enrolled patients with progressive or recurrent DPM treated with at least one course of pemetrexed-based chemotherapy. Patients received two doses of GPS followed by six doses of GPS with intravenous nivolumab every 2 weeks, and up to six additional cycles until disease progression or unacceptable toxicity. Results: Ten patients were treated; 70% experienced mostly mild treatment-related adverse events; two experienced a grade 3 or higher adverse event. Three of the 10 patients (30%) reported vaccine-specific T-cell responses. There were no partial responses; three patients had prolonged stable disease with up to 17% decrease in tumor volume. Median progression-free survival was 3.9 months and the median overall survival was 7.4 months. Conclusions: Coadministration of GPS and nivolumab reported a tolerable toxicity profile and induced immune responses in a subset of patients, but initial response and survival benefit were limited possibly owing to the small sample size.

Charles C. White, IV, M.D., Brandon A. Cincere, M.D.

Many techniques and combinations of procedures exist for reconstruction of an injured acromioclavicular (AC) joint. Recently, there has been a focus on controlling anterior and posterior translation of the AC joint after the reduction of superior translation and coracoclavicular (CC) ligament stabilization. Diagnosis and treatment of anterior and posterior instability of the AC joint is critical, yet when AC/CC ligament reconstruction fails, this is often the result of recurrent superior migration of the clavicle relative to the acromion. We present a technique using knotless, all-suture anchor technology intended for higher-grade, operative AC joint injuries in “high-risk” patients, i.e., those returning to a collision sport such as football, rugby, hockey, or wrestling. Consideration also could be given to those performing a high-demand occupation, such as overhead work or manual labor. In addition, this technique could be employed in patients at risk for delayed or nonhealing, such as those with diabetes or who are smokers, those at risk of noncompliance, and revision cases. The all-suture anchor, knotless “suture staple” technique can be implemented easily to provide backup fixation of the AC joint directly as an augmentation to CC reconstruction, preferably arthroscopic-assisted reduction, and fixation with a cortical button and, when indicated, concomitant allograft reconstruction.

David Futer, Jessica S. Purcell, Saul Schleimer

This paper employs knot invariants and results from hyperbolic geometry to develop a practical procedure for checking the cosmetic surgery conjecture on any given one-cusped manifold. This procedure has been used to establish the following computational results. First, we verify that all knots up to 19 crossings, and all one-cusped 3-manifolds in the SnapPy census, do not admit any purely cosmetic surgeries. Second, we check that a hyperbolic knot with at most 15 crossings only admits chirally cosmetic surgeries when the knot itself is amphicheiral. Third, we enumerate all knots up to 13 crossings that share a common Dehn fillings with the figure-8 knot. The code that verifies these results is publicly available on GitHub.

Oluwatosin Alabi, Ko Ko Zayar Toe, Zijian Zhou et al.

In laparoscopic and robotic surgery, precise tool instance segmentation is an essential technology for advanced computer-assisted interventions. Although publicly available procedures of routine surgeries exist, they often lack comprehensive annotations for tool instance segmentation. Additionally, the majority of standard datasets for tool segmentation are derived from porcine(pig) surgeries. To address this gap, we introduce CholecInstanceSeg, the largest open-access tool instance segmentation dataset to date. Derived from the existing CholecT50 and Cholec80 datasets, CholecInstanceSeg provides novel annotations for laparoscopic cholecystectomy procedures in patients. Our dataset comprises 41.9k annotated frames extracted from 85 clinical procedures and 64.4k tool instances, each labelled with semantic masks and instance IDs. To ensure the reliability of our annotations, we perform extensive quality control, conduct label agreement statistics, and benchmark the segmentation results with various instance segmentation baselines. CholecInstanceSeg aims to advance the field by offering a comprehensive and high-quality open-access dataset for the development and evaluation of tool instance segmentation algorithms.

Elisha Falbel, Martin Mion-Mouton

In this paper, we introduce a notion of geometric surgery for flag structures, which are geometric structures locally modelled on the three-dimensional flag space under the action of ${\mathrm{PGL}}_3(\mathbb{R})$. Using such surgeries we provide examples of flag structures, of both uniformizable and non-uniformizable type.

Kanehiro Hiyama, MD, PhD, Takuya Takakuwa, MD, Reiko Yamaguchi, MD et al.

Shi Cheng

We try to give a geometric construction for 3d $\mathcal{N}=2$ gauge theories using three-manifolds and Dehn surgeries. We follow the story that wrapping M5-branes on plumbing three-manifolds leads to 3d theories with mixed Chern-Simons levels. This construction can be decorated by adding non-compact Lagrangian submanifolds in the cotangent bundles of three-manifolds. The M5-branes wrapping on these submanifolds through M-theory/IIB string duality lead to flavor D5-branes that engineer chiral multiplets. In this note, we only consider unknotted matter circles, which are intersections between these non-compact M5-branes and plumbing manifolds. Then various dualities of 3d theories can be interpreted as Kirby moves and equivalent surgeries. We also find the dictionary between geometric structures of three-manifolds and physical aspects of gauge theories.

Daegwang Yoo, Minsun Kang, Jaehun Jung

Background Postpancreatectomy diabetes can be caused by resection of functioning pancreatic tissue and is associated with postoperative pancreatic islet cell mass loss and subsequent endocrine dysfunction. Diabetes is a well‐known risk factor for ischemic heart disease. However, no previous studies have investigated ischemic heart disease in patients with postpancreatectomy diabetes and pancreatic cancer. Methods and Results Rates of patients with diabetes diagnosed with pancreatic cancer who underwent pancreatectomy between 2002 and 2019 in South Korea were obtained from the Korean National Health Insurance Service database. Patient‐level propensity score matching was conducted to reduce the possibility of selection bias, and multivariate Cox proportional hazards models were used to determine the association between postpancreatectomy diabetes and ischemic heart disease. In total, 30 242 patients were initially enrolled in the study. After applying exclusion criteria and propensity score matching, 2952 patients were included in the comparative analysis between the postpancreatectomy group with diabetes and the group without diabetes. Patients in the postpancreatectomy group with diabetes had significantly higher rates of ischemic heart disease than those in the group without diabetes. In total, 3432 patients were included in the comparison between the postpancreatectomy and prepancreatectomy groups with diabetes. There was no significant difference in the risk of ischemic heart disease between the postpancreatectomy and prepancreatectomy groups with diabetes. Conclusions Patients who developed diabetes after pancreatectomy had a higher risk of ischemic heart disease than patients who did not develop diabetes after pancreatectomy, and the rate of ischemic heart disease in these patients was similar to that in patients preoperatively diagnosed with diabetes.

Ruiqi Zhu, Dandan Zhang, Benny Lo

In recent decades, the tremendous benefits surgical robots have brought to surgeons and patients have been witnessed. With the dexterous operation and the great precision, surgical robots can offer patients less recovery time and less hospital stay. However, the controls for current surgical robots in practical usage are fully carried out by surgeons via teleoperation. During the surgery process, there exists a lot of repetitive but simple manipulation, which can cause unnecessary fatigue to the surgeons. In this paper, we proposed a deep reinforcement learning-based semi-autonomous control framework for robotic surgery. The user study showed that the framework can reduce the completion time by 19.1% and the travel length by 58.7%.