Hasil untuk "Surgery"

N. Surgery

Å. Fretland, V. Dagenborg, G. Bjørnelv et al.

Zoé Stehlin, Felix Karl-Ludwig Klingebiel, Hans-Christoph Pape et al.

<b>Background</b>: Although the difficulty level of figure skating programs has increased in the last two decades, particularly at the junior level, trends in performance have not been reported. This retrospective observational study investigated performance development trends among the top five junior figure skaters competing at international levels in both the ladies’ and men’s singles disciplines from 2005 to 2020. Data from 160 junior single ladies and 160 junior single men were analyzed. The focus was on the progression of technical elements—particularly jumps—and their potential correlation with injury risk. It was hypothesized that younger athletes are increasingly performing jumps with more revolutions, thereby enhancing overall competition standards. <b>Materials and Methods</b>: Using data from the Junior World Championships and Junior Grand Prix Finals, linear regression analysis and one-way ANOVA were conducted to track the frequency of double, triple, and quadruple jumps, as well as trends in age development among athletes in the singles categories from 2005 to 2020. <b>Results</b>: The results indicate a significant increase in the execution of higher-revolution jumps among junior athletes. Between 2005 and 2012, the frequency of double jumps declined across all events, with the most pronounced reductions observed in the Ladies’ Junior World Championships (Δ = 0.216, <i>p</i> = 0.004, d = 1.64) and the Men’s Junior World Championships (Δ = 0.500, <i>p</i> = 0.001, d = 1.82). From 2005 to 2011, the frequencies of triple and quadruple jumps increased, while double jumps remained stable or showed only slight increases. Triple jumps showed slight downward trends (e.g., R² = 0.0202 at the Men’s Junior World Championships). Although still rare, the frequency of quadruple jumps has shown a consistent upward trend across multiple competitions. Between 2000 and 2009, all four events exhibited declining age trends, with decreases ranging from −0.029 to −0.078 years of age per year. In the subsequent decade (2010–2020), when averaged across all events, the observed difference slope (Δ = 0.014) indicated a continued decline in athlete age. <b>Conclusions</b>: In summary, increases in more difficult jumps were found, with simultaneous decreases in less difficult jumps. As jump complexity rises, a parallel increase in sport-specific injury incidence can be anticipated, highlighting the need for proactive strategies for injury prevention and athlete well-being.

Shisen Li, Mianjiao Xie, Yongtao Du et al.

Abstract Chemo-resistance is one of the main obstacles in the treatment of colorectal cancer. Many studies have been performed to identify the mechanisms associated with chemo-resistance in colorectal cancer cells, and it has been found that increasing the activity of ABC family transporters, enhancing DNA repair, weakening apoptosis, strengthening stemness, and EMT are among the most important of these mechanisms. Inflammation and cytokines have been linked to colorectal cancer, and there is even a type of colorectal cancer that is caused by chronic inflammation in patients with inflammatory bowel disease. However, the association between cytokines and chemo-resistance in colorectal cancer cells is not yet clear. Various studies have shown that chemotherapy drugs, by affecting the tumor microenvironment, can enhance the recruitment of some immune cells and the production of some cytokines. These cytokines have a variety of effects on various chemo-resistance mechanisms in colorectal cancer cells. Some of them can strengthen chemo-resistance and others weaken chemo-resistance. IL-6, TNFα, IFN, IL1, IL8, IL-17, IL-10, and IL-22 are among the most important cytokines whose effects on chemo-resistance mechanisms in colorectal cancer cells are known. In this article, we will have a comprehensive overview of the effects of these cytokines on chemo-resistance mechanisms in colorectal cancer cells.

Chun Zhuang, Han‐Kwang Yang

ABSTRACT Background and Objective Fluorescence imaging has emerged as a valuable adjunct in gastric surgery, enhancing resection precision and oncologic outcomes. However, the use of indocyanine green (ICG) remains controversial due to uncertainties in efficacy and administration. A lack of standardized protocols persists. This review summarizes current applications of fluorescence in gastric cancer surgery, outlining existing challenges and future research needs. Methods A systematic PubMed search (2004–2024) was conducted using keywords such as “indocyanine green,” “carbon particle,” “blue dye,” “gastric cancer,” and “gastroesophageal junction cancer” to identify and review key uses of fluorescence agents in gastrointestinal malignancies. Key Findings Fluorescence‐guided imaging aids intraoperative tumor localization, shortens operative time, and enhances lymph node (LN) yield, improving staging accuracy. Its role in sentinel lymph node (SLN) detection is still under debate due to false negatives. ICG fluorescence angiography (ICG‐FA) may lower anastomotic leak rates, though strong supporting evidence is limited. No consensus exists regarding ICG dosage, timing, or delivery method. Conclusions Current evidence supports the safety and efficacy of fluorescence imaging in gastrointestinal surgery, with promising outcomes in precision and staging. However, uniform protocols for fluorescence use are urgently needed. Future studies should aim to standardize administration and optimize clinical implementation to fully realize its benefits.

Ju-tao Yu, Xiao-wei Hu, Jia-nan Wang et al.

Abstract Renal tubulointerstitial abnormalities predict diabetic kidney disease (DKD) progression, and targeting them may prevent DKD. Insulin-like growth factor binding-protein 7 (IGFBP7) is expressed in renal tubular cells and is elevated in both blood and urine during the early stages of human diabetes, serving as a predictor of the rate of disease progression. We showed that tubule- and glomerular-specific IGFBP7 promotes DKD, with tubular-derived IGFBP7 disrupting the renal microenvironment. IGFBP7 impairs mitochondrial bioenergetics in tubular cells, causing lipid accumulation, cell cycle arrest, interstitial inflammation, fibrosis, and glomerulosclerosis. These findings were substantiated by transgenic overexpression and the specific deletion of IGFBP7 in type 1/2 DKD mice. Mechanistically, IGFBP7 interacts with STAT3, promoting its acetylation/dimerization and downregulating mitochondrial bioenergetics. Our study identified levomefolic acid as a novel inhibitor of IGFBP7 and demonstrated its efficacy in mitigating the progression of DKD. Here we showed IGFBP7 is a promising therapeutic target for DKD.

Yunke Ao, Manish Prajapat, Yarden As et al.

Safety-critical control using high-dimensional sensory feedback from optical data (e.g., images, point clouds) poses significant challenges in domains like autonomous driving and robotic surgery. Control can rely on low-dimensional states estimated from high-dimensional data. However, the estimation errors often follow complex, unknown distributions that standard probabilistic models fail to capture, making formal safety guarantees challenging. In this work, we introduce a novel characterization of these general estimation errors using sub-Gaussian noise with bounded mean. We develop a new technique for uncertainty propagation of proposed noise characterization in linear systems, which combines robust set-based methods with the propagation of sub-Gaussian variance proxies. We further develop a Model Predictive Control (MPC) framework that provides closed-loop safety guarantees for linear systems under the proposed noise assumption. We apply this MPC approach in an ultrasound-image-guided robotic spinal surgery pipeline, which contains deep-learning-based semantic segmentation, image-based registration, high-level optimization-based planning, and low-level robotic control. To validate the pipeline, we developed a realistic simulation environment integrating real human anatomy, robot dynamics, efficient ultrasound simulation, as well as in-vivo data of breathing motion and drilling force. Evaluation results in simulation demonstrate the potential of our approach for solving complex image-guided robotic surgery task while ensuring safety.

Negin Ghamsarian, Raphael Sznitman, Klaus Schoeffmann et al.

To meet the growing demand for systematic surgical training, wet-lab environments have become indispensable platforms for hands-on practice in ophthalmology. Yet, traditional wet-lab training depends heavily on manual performance evaluations, which are labor-intensive, time-consuming, and often subject to variability. Recent advances in computer vision offer promising avenues for automated skill assessment, enhancing both the efficiency and objectivity of surgical education. Despite notable progress in ophthalmic surgical datasets, existing resources predominantly focus on real surgeries or isolated tasks, falling short of supporting comprehensive skill evaluation in controlled wet-lab settings. To address these limitations, we introduce WetCat, the first dataset of wet-lab cataract surgery videos specifically curated for automated skill assessment. WetCat comprises high-resolution recordings of surgeries performed by trainees on artificial eyes, featuring comprehensive phase annotations and semantic segmentations of key anatomical structures. These annotations are meticulously designed to facilitate skill assessment during the critical capsulorhexis and phacoemulsification phases, adhering to standardized surgical skill assessment frameworks. By focusing on these essential phases, WetCat enables the development of interpretable, AI-driven evaluation tools aligned with established clinical metrics. This dataset lays a strong foundation for advancing objective, scalable surgical education and sets a new benchmark for automated workflow analysis and skill assessment in ophthalmology training. The dataset and annotations are publicly available in Synapse.

Yifei Wang, Yingfei Gu

We propose a novel, distillation-free scheme for the fault-tolerant implementation of non-Clifford gates at the logical level, thereby completing the universal gate set. Our approach exploits generalized lattice surgery to integrate two quantum error-correcting (QEC) codes. Specifically, non-Clifford gates are executed transversally on one QEC code and then teleported to the main circuit via a logical-level joint measurement that connects two distinct QEC codes. In contrast to conventional magic state distillation (MSD) combined with gate teleportation, our method obviates the need for concatenating separate codes for distillation and logical qubits, thus reducing the total overhead from multiplicative to additive scaling. We illustrate our approach by explicitly demonstrating its implementation for a 3D color code interfaced with a surface code of the same code distance, and comment on its potential advantage over the conventional MSD-teleportation scheme.

Felix Holm, Gözde Ünver, Ghazal Ghazaei et al.

Understanding the intricate workflows of cataract surgery requires modeling complex interactions between surgical tools, anatomical structures, and procedural techniques. Existing datasets primarily address isolated aspects of surgical analysis, such as tool detection or phase segmentation, but lack comprehensive representations that capture the semantic relationships between entities over time. This paper introduces the Cataract Surgery Scene Graph (CAT-SG) dataset, the first to provide structured annotations of tool-tissue interactions, procedural variations, and temporal dependencies. By incorporating detailed semantic relations, CAT-SG offers a holistic view of surgical workflows, enabling more accurate recognition of surgical phases and techniques. Additionally, we present a novel scene graph generation model, CatSGG, which outperforms current methods in generating structured surgical representations. The CAT-SG dataset is designed to enhance AI-driven surgical training, real-time decision support, and workflow analysis, paving the way for more intelligent, context-aware systems in clinical practice.

Kexuan Li, Xi Zhou, Shuzhong Liu et al.

Jie Liu, Danping Zeng, Zhihui Jiang et al.

Abstract Backgroud Intussusception is a common acute abdominal disease in children, often leading to acute ileus in infants and young children. Objective This study aimed to develop and validate a nomogram for predicting recurrent intussusception in children within 48 h after pneumatic reduction of primary intussusception. Methods Clinical data of children with acute intussusception admitted to multiple hospitals from March 2019 to March 2021 were retrospectively analyzed. The children were divided into a successful reductioncontrol group (control group) and a recurrent intussusception group (RI group) according to the results of pneumatic reduction. Results A total of 2406 cases were included in this study, including 2198 control group and 208 RI group. In the total sample, 1684 cases were trained and 722 cases were verified. A logistic regression analysis was conducted to establish a predictive model based on age, abdominal pain time, white blood cells count, and hypersensitive C-reactive protein levels as independent predictors of intussusception recurrence. The nomogram successfully predicted recurrent intussusception after pneumatic reduction. Conclusion In this study, a nomogram was developed based on clinical risk factors to predict recurrent intussusception following pneumatic reduction in children. Age, abdominal pain time, white blood cell counts, and hypersensitive C-reactive protein levels were identified as predictors and incorporated into the nomogram. Internal validation demonstrated that this nomogram can offer a clear and convenient tool for identifying risk factors for recurrence of intussusception in children undergoing pneumatic reduction.

Maria Paola Belfiore, Valerio Nardone, Ida D’Onofrio et al.

Squamous cell carcinoma of the head and neck (SCCHN) is among the ten most common cancers worldwide, with advanced SCCHN presenting with a 5-year survival of 34% in the case of nodal involvement and 8% in the case of metastatic disease. Disease-free survival at 2 years is 67% for stage II and 33% for stage III tumors, whereas 12–30% of patients undergo distant failures after curative treatment. Previous treatments often hinder the success of salvage surgery and/or reirradiation, while the standard of care for the majority of metastatic SCCHN remains palliative chemo- and immuno-therapy, with few patients eligible for locoregional treatments. The aim of this paper is to review the characteristics of recurrent SCCHN, based on different recurrence sites, and metastatic disease; we will also explore the possibilities not only of salvage surgery and reirradiation but also systemic therapy choices and locoregional treatment for metastatic SCCHN.

Dan Chen

Andrew W. Cross, Zhiyang He, Patrick J. Rall et al.

In this paper, we introduce the gauge-fixed QLDPC surgery scheme, an improved logical measurement scheme based on the construction of Cohen et al. (Sci. Adv. 8, eabn1717). Our scheme leverages expansion properties of the Tanner graph to substantially reduce the space overhead of QLDPC surgery. In certain cases, we only require $Θ(w)$ ancilla qubits to fault-tolerantly measure a weight $w$ logical operator. We provide rigorous analysis for the code distance and fault distance of our schemes, and present a modular decoding algorithm that achieves maximal fault-distance. We further introduce a bridge system to facilitate fault-tolerant joint measurements of logical operators. Augmented by this bridge construction, our scheme can be used to connect different families of QLDPC codes into one universal architecture. Applying our toolbox, we show how to perform all logical Clifford gates on the [[144,12,12]] bivariate bicycle code. Our scheme adds 103 ancilla qubits into the connectivity graph, and one of the twelve logical qubits is used as an ancilla for gate synthesis. Logical measurements are combined with the automorphism gates studied by Bravyi et al. (Nature 627, 778-782) to implement 288 Pauli product measurements. We demonstrate the practicality of our scheme through circuit-level noise simulations, leveraging our proposed modular decoder that combines BPOSD with matching.

Vito Mondì, Chryssoula Tzialla, Salvatore Aversa et al.

Abstract Background Ophthalmia neonatorum is an acute conjunctivitis that occurs in newborns within the first month of life. The most serious infections are due to Chlamydia trachomatis and Neisseria gonorrhoeae, that may cause permanent damages. The use of ophthalmic prophylaxis varies widely around the world, according to the different health and socio-economic contexts. To date in Italy there is no a clear legislation regarding ophthalmia neonatorum prophylaxis at birth. Methods We invited all birth centers in Italy to carry out a retrospective survey relating the last three years. We collected data regarding demographics of neonates, drugs used for ophthalmic prophylaxis and results of the screening of pregnant women for Chlamydia trachomatis and Neisseria gonorrhoeae vaginal infections. Results Among 419 birth centers, 302 (72,1%) responded to the survey. Overall 1041384 neonates, 82,3% of those born in the three years considered, received ophthalmic prophylaxis. Only 4,585 (0,4%) of them received one of the drugs recommended by the WHO. The Centers that participated to the survey reported 12 episodes of Chlamydial conjunctivitis and no Gonococcal infection in the three years. Only 38% of the Centers performed vaginal swabs to pregnant women: 2,6% screened only for Neisseria, 9,6% only for Chlamydia and 25,8% for both germs. Conclusions The data obtained from the survey showed a low incidence of neonatal conjunctivitis due to either Neisseria gonorrhoeae or Chlamydia trachomatis in Italy. Due to the lack of legislation regulating the prophylaxis of ophthalmia neonatorum in newborns, the Italian Society of Neonatology, the Italian Society of Obstetrics and Gynecology and the Italian Society of Perinatal Medicine have recently issued new recommendations on this topic.

DENG Yuxiao, ZHAO Xianyuan, GAO Yuan

With the improvements in surgical technique, the indications for liver transplantation(LT) are being expanded to more complex and severe patients, who not only have liver function in the terminal stage, but also extrahepatic organs involve of varying degrees dysfunction. It was demonstrated that the strategy of extrahepatic organs management in early period after LT was associated with improving recovery. This paper summarized the strategy of extrahepatic organs management in early period after adult LT. Continuing to monitor system hemodynamics is helpful for stable graft perfusion. It is necessary to manage derangements of preload, myocardial contractility, and afterload. Early postoperative extubation is recommended by current guidelines. Routine screening pulmonary complications may help weaning from the ventilator. The diagnosis of acute kidney injury(AKI) after LT has been reported to using Kidney Disease: Improving Global Outcomes(KDIGO) criteria, a delayed calcineurin inhibitor initiation strategy may be beneficial for renal protection. Currently, there is no consensus on timing of renal replacement therapy initiation in patients with AKI. Patients with cirrhosis and a history of hepatic encephalopathy(HE) displays impaired neurological recovery, the diagnosis of HE is crucial and challenging.

William J. Bruce, MD, Danielle R. Olla, MD, James W. Feimster, MD et al.

Summary:. The greater omentum is a reliable choice for salvage soft-tissue reconstruction. Benefits include consistent anatomy, long pedicle length, and a high concentration of lymphatic tissue that is resistant to infection. We report the case of a 46-year-old man with a complex traumatic sacral wound resulting in severe limitation of reconstructive options. A pedicled greater omentum flap was transposed through the retroperitoneum via the lumbosacral triangle, resulting in durable soft-tissue coverage.

Shaojie Chen, Yongping Lin, Yue Zhu et al.

PRKAG2 cardiomyopathy is a rare progressive disease characterized by increased ventricular wall thickness and preexcitation. Dysfunction of the protein 5′-AMP-activated protein kinase (AMPK) plays a decisive role in the progression of ventricular lesions. Although patients with the PRKAG2-R302Q mutation have a high incidence of atrial fibrillation (AF), the molecular mechanism contributing to the disease remains unclear. We carried out whole-genome sequencing with linkage analysis in three affected members of a family. Atrial samples were obtained from the proband via surgical intervention. Control atrium biopsies were obtained from patients with persistent AF. Pathological changes were analyzed using the hematoxylin and eosin (H&amp;E), Masson, and periodic acid–Schiff (PAS) staining. The AMPK signaling pathway was investigated by western blot. A murine atrial cardiomyocyte cell line (HL-1) and human induced pluripotent stem derived atrial cardiomyocytes (hiPSC-ACMs) were transfected with an adenovirus carrying the same mutation. We used enzyme linked immunosorbent assay (ELISA) to determine the AMPK activity in HL-1 cells and hiPSC-ACMs overexpressing PRKAG2-R302Q. Pathological results showed a large quantity of glycogen accumulation and vacuolization in cardiomyocytes from the proband atrial tissue. Western blot analysis revealed that the AMPK activity was significantly downregulated compared with that of the controls. Furthermore, remarkable glycogen deposition and impairment of AMPK activity were reproduced in HL-1 cells overexpressing PRKAG2-R302Q. Taken together, PRKAG2-R302Q mutation directly impair atrial cardiomyocytes. PRKAG2-R302Q mutation lead to glycogen deposition and promote the growth of atrial lesions by disrupting the AMPK pathway.

Weibo Ning, Jiaqi Zhu, Hongjiang Chen et al.

This paper presents the development and experimental evaluation of a surgical robotic system for total hip arthroplasty (THA). Although existing robotic systems used in joint replacement surgery have achieved some progresses, the robot arm must be situated accurately at the target position during operation, which depends significantly on the experience of the surgeon. In addition, handheld acetabulum reamers typically exhibit uneven strength and grinding file. Moreover, the lack of techniques to real-time measure femoral neck length may lead to poor outcomes. To tackle these challenges, we propose a real-time traceable optical positioning strategy to reduce unnecessary manual adjustments to the robotic arm during surgery, an end-effector system to stabilise grinding, and an optical probe to provide real-time measurement of the femoral neck length and other parameters used to choose the proper prosthesis. The lengths of the lower limbs are measured as the prosthesis is installed. The experimental evaluation results show that, based on its accuracy, execution ability, and robustness, the proposed surgical robotic system is feasible for THA.