Hasil untuk "Surgery"

Heidi Nelson, Daniel J. Sargent, H. S. Wieand et al.

V. Fazio, Y. Ziv, J. Church et al.

Manasa H. Kalluri, BS, Armin Edalatpour, MD, Allison J. Seitz, MD et al.

Summary:. Raynaud phenomenon (RP) is a vasospastic condition of the digital arteries that can cause pain, skin color changes, and functional limitations. Although botulinum toxin is not currently Food and Drug Administration–approved for the treatment of RP, it has been used in refractory RP and has generally been found to be well tolerated. At our institution, incobotulinumtoxinA (Xeomin) and abobotulinumtoxinA (Dysport) are commonly used. Here, we report our experience with the use of incobotulinumtoxinA (Xeomin) in the hand. We present 2 cases of patients with RP in bilateral hands who presented for Botox injections after failure of conservative and medical therapy. In both cases, incobotulinumtoxinA (Xeomin) was used. A week later, both patients experienced various distributions of severe muscle weakness, including intrinsic, thenar, and hypothenar muscle weakness, which did not improve during the subsequent 4 weeks. Although safe, further studies are needed to assess the diffusion of various botulinum toxin A formulations, especially in the hands, as prolonged intrinsic, thenar, and hypothenar muscle weakness can be detrimental to patients.

Yash Kumar Atri, Thomas H Shin, Thomas Hartvigsen

While bariatric and metabolic surgery (MBS) is considered the gold standard treatment for severe and morbid obesity, its therapeutic efficacy hinges upon active and longitudinal engagement with multidisciplinary providers, including surgeons, dietitians/nutritionists, psychologists, and endocrinologists. This engagement spans the entire patient journey, from preoperative preparation to long-term postoperative management. However, this process is often hindered by numerous healthcare disparities, such as logistical and access barriers, which impair easy patient access to timely, evidence-based, clinician-endorsed information. To address these gaps, we introduce bRAGgen, a novel adaptive retrieval-augmented generation (RAG)-based model that autonomously integrates real-time medical evidence when response confidence dips below dynamic thresholds. This self-updating architecture ensures that responses remain current and accurate, reducing the risk of misinformation. Additionally, we present bRAGq, a curated dataset of 1,302 bariatric surgery--related questions, validated by an expert bariatric surgeon. bRAGq constitutes the first large-scale, domain-specific benchmark for comprehensive MBS care. In a two-phase evaluation, bRAGgen is benchmarked against state-of-the-art models using both large language model (LLM)--based metrics and expert surgeon review. Across all evaluation dimensions, bRAGgen demonstrates substantially superior performance in generating clinically accurate and relevant responses.

Changhao Zhang, Matthew J. Clarkson, Mobarak I. Hoque

3D reconstruction of endoscopic surgery scenes plays a vital role in enhancing scene perception, enabling AR visualization, and supporting context-aware decision-making in image-guided surgery. A critical yet challenging step in this process is the accurate estimation of the endoscope's intrinsic parameters. In real surgical settings, intrinsic calibration is hindered by sterility constraints and the use of specialized endoscopes with continuous zoom and telescope rotation. Most existing methods for endoscopic 3D reconstruction do not estimate intrinsic parameters, limiting their effectiveness for accurate and reliable reconstruction. In this paper, we integrate intrinsic parameter estimation into a self-supervised monocular depth estimation framework by adapting the Depth Anything V2 (DA2) model for joint depth, pose, and intrinsics prediction. We introduce an attention-based pose network and a Weight-Decomposed Low-Rank Adaptation (DoRA) strategy for efficient fine-tuning of DA2. Our method is validated on the SCARED and C3VD public datasets, demonstrating superior performance compared to recent state-of-the-art approaches in self-supervised monocular depth estimation and 3D reconstruction. Code and model weights can be found in project repository: https://github.com/MOYF-beta/EndoSfM3D.

Yang Meng, Zewen Pan, Yandi Lu et al.

Cataract surgery remains one of the most widely performed and effective procedures for vision restoration. Effective surgical planning requires integrating diverse clinical examinations for patient assessment, intraocular lens (IOL) selection, and risk evaluation. Large language models (LLMs) have shown promise in supporting clinical decision-making. However, existing LLMs often lack the domain-specific expertise to interpret heterogeneous ophthalmic data and provide actionable surgical plans. To enhance the model's ability to interpret heterogeneous ophthalmic reports, we propose a knowledge-driven Multi-Agent System (MAS), where each agent simulates the reasoning process of specialist ophthalmologists, converting raw clinical inputs into structured, actionable summaries in both training and deployment stages. Building on MAS, we introduce CataractSurg-80K, the first large-scale benchmark for cataract surgery planning that incorporates structured clinical reasoning. Each case is annotated with diagnostic questions, expert reasoning chains, and structured surgical recommendations. We further introduce Qwen-CSP, a domain-specialized model built on Qwen-4B, fine-tuned through a multi-stage process tailored for surgical planning. Comprehensive experiments show that Qwen-CSP outperforms strong general-purpose LLMs across multiple metrics. Our work delivers a high-quality dataset, a rigorous benchmark, and a domain-adapted LLM to facilitate future research in medical AI reasoning and decision support.

Zhenkun Li, Fan Ye

Suppose $K \subset S^3$ is a knot and suppose $p$ and $q$ are co-prime integers with $q\ge 1$. For any field $\mathbb{K}$, we establish a dimension formula for the framed instanton homology of knot surgeries: $$ \dim I^\sharp(S^3_{p/q}(K); \mathbb{K}) = q \cdot r_{\mathbb{K}}(K) + |p - q \cdot ν^\sharp_{\mathbb{K}}(K)| $$ for certain integers $r_{\mathbb{K}}(K)$ and $ν^\sharp_{\mathbb{K}}(K)$, except possibly when $p/q = ν^\sharp_{\mathbb{K}}(K)$ and $ν^\sharp_{\mathbb{K}}(K)$ is even. This formula generalizes the result of Baldwin--Sivek from the case $\mathbb{K} = \mathbb{C}$ to arbitrary fields. Based on the result for $\mathbb{K} = \mathbb{Z}/2$, we obtain that $S^3_{p/q}(K)$ is not $SU(2)$-abelian for any knot $K$ other than the unknot and the right-handed trefoil whenever $p/q \in [0,6)$ and $p \in \{ a^e, 2a^e \}$ for some prime number $a$ and natural number $e$, thereby extending existing results for $p/q \in [0,5]$ and $p = a^e$. A byproduct of the techniques developed in this paper is that we generalize the distance-two surgery exact triangle by Culler--Daemi--Xie and Daemi--Miller-Eismeier--Lidman from $\mathbb{Z}/2$ coefficients to any coefficient ring.

Irina Bianca Serban, Dimitra Dritsa, David ten Cate et al.

Multimodal prehabilitation for colorectal cancer (CRC) surgery aims to optimize patient fitness and reduce postoperative complications. While telemonitoring's clinical value in supporting decision-making is recognized, patient perspectives on its use in prehabilitation remain underexplored, particularly compared to its related clinical context, rehabilitation. To address this gap, we conducted interviews with five patients who completed a four-week CRC prehabilitation program incorporating continuous telemonitoring. Our findings reveal patients' willingness to engage with telemonitoring, shaped by their motivations, perceived benefits, and concerns. We outline design considerations for patient-centered systems and offer a foundation for further research on telemonitoring in CRC prehabilitation.

HAN Wenjuan, WANG Lei, WANG Lumeng et al.

ObjectiveTo investigate the status quo of corneal injury in patients undergoing non-head/facial general anesthesia surgery and to analyze its influencing factors.MethodsA total of 413 patients undergoing non-head/facial general anesthesia surgery at a tertiary grade A hospital in Chongqing city were selected as the study subjects by stratified sampling method from March to July 2024.Data were collected using a general information questionnaire of patients and a surgical⁃related factors questionnaire for corneal injury in non⁃head/facial general anesthesia patients.The corneal injury status of these patients was assessed.ResultsAmong the 413 patients,90 cases developed corneal injuries,resulting in an incidence rate of 21.8%.The result of multivariate analysis showed that preoperative eye care measures were protective factors for corneal injury in these patients(<italic>P</italic>&lt;0.05).However,incomplete eyelid closure (visible conjunctiva and cornea) before or after surgery,preoperative or intraoperative use of atropine,and taller body height were risk factors for corneal injury(<italic>P</italic>&lt;0.05).ConclusionsThe incidence of corneal injury in patients undergoing non⁃head/facial general anesthesia surgery was relatively high.Preoperative eye care measures,degree of eyelid closure before or after surgery,preoperative or intraoperative use of atropine,and body height were influencing factors of corneal injury.Medical staff should closely monitor patients' corneal conditions, implement perioperative eye care measures,prevent corneal injuries,and improve both nursing quality and medical safety.

Б. Хамдамов, А. Ешчанов, С. Давлатов et al.

Acute adhesive small bowel obstruction (AASBO) ranks among the most common indications for emergency abdominal surgery. However, conventional approaches to severity assessment and treatment selection do not incorporate the significant immunological disturbances characteristic of this condition. Objective. To enhance the diagnosis and management of AASBO through the implementation of a clinical-immunological risk stratification scale and to evaluate the impact of immunotherapy on clinical and immune outcomes. Materials and Methods. A total of 115 patients with AASBO were enrolled and allocated to a control group (n=56; standard care) or a study group (n=59; standard care plus immunotherapy). Comprehensive clinical, laboratory, radiological, and immunological parameters were analyzed. A prognostic scale incorporating 25 variables was developed. Immune response dynamics and complication rates were rigorously assessed. All procedures were conducted in accordance with the World Medical Association's Declaration of Helsinki (2000 amendments). Statistical analyses were performed using SPSS 22.0 and MedCalc software. Normality was assessed with Shapiro-Wilk test. Between-group comparisons utilized Mann-Whitney U test, Student's t-test, Pearson's chi-square test, and Spearman's correlation analysis. Predictive performance was evaluated through ROC analysis calculating the area under the curve (AUC). Statistical significance was defined as p < 0.05. Funding: This work was carried out within the framework of the research plan of the Bukhara State Medical Institute (05.2022 DSc.135) entitled “Development of new approaches to early diagnosis, treatment, and prevention of pathological conditions affecting the health of the population of the Bukhara region after COVID-19 (2022–2026)”. Results. Severe disease progression was significantly associated with CD4⁺ counts < 600 cells/µL, HLA-DR⁺ expression < 30%, IL-6 levels > 30 pg/mL, and TNF-α levels > 25 pg/mL. The study group demonstrated a 3.3-fold reduction in mortality, a 28.1% shorter hospital stay, and a 2.4-fold decrease in Clavien-Dindo grade III-V complications. The integrated prognostic scale exhibited high predictive accuracy (AUC = 0.917). Conclusion. The incorporation of clinical-immunological stratification and immunotherapy into the management algorithm for AASBO significantly improves treatment outcomes, reduces complication rates, and decreases mortality.

Soumyadeep Chandra, Sayeed Shafayet Chowdhury, Courtney Yong et al.

Surgical action localization is a challenging computer vision problem. While it has promising applications including automated training of surgery procedures, surgical workflow optimization, etc., appropriate model design is pivotal to accomplishing this task. Moreover, the lack of suitable medical datasets adds an additional layer of complexity. To that effect, we introduce a new complex dataset of nephrectomy surgeries called UroSlice. To perform the action localization from these videos, we propose a novel model termed as `ViTALS' (Vision Transformer for Action Localization in Surgical Nephrectomy). Our model incorporates hierarchical dilated temporal convolution layers and inter-layer residual connections to capture the temporal correlations at finer as well as coarser granularities. The proposed approach achieves state-of-the-art performance on Cholec80 and UroSlice datasets (89.8% and 66.1% accuracy, respectively), validating its effectiveness.

Hisashi Ishida, Manish Sahu, Adnan Munawar et al.

Skull base surgery is a demanding field in which surgeons operate in and around the skull while avoiding critical anatomical structures including nerves and vasculature. While image-guided surgical navigation is the prevailing standard, limitation still exists requiring personalized planning and recognizing the irreplaceable role of a skilled surgeon. This paper presents a collaboratively controlled robotic system tailored for assisted drilling in skull base surgery. Our central hypothesis posits that this collaborative system, enriched with haptic assistive modes to enforce virtual fixtures, holds the potential to significantly enhance surgical safety, streamline efficiency, and alleviate the physical demands on the surgeon. The paper describes the intricate system development work required to enable these virtual fixtures through haptic assistive modes. To validate our system's performance and effectiveness, we conducted initial feasibility experiments involving a medical student and two experienced surgeons. The experiment focused on drilling around critical structures following cortical mastoidectomy, utilizing dental stone phantom and cadaveric models. Our experimental results demonstrate that our proposed haptic feedback mechanism enhances the safety of drilling around critical structures compared to systems lacking haptic assistance. With the aid of our system, surgeons were able to safely skeletonize the critical structures without breaching any critical structure even under obstructed view of the surgical site.

Xiaoqian Huang, Ruiqi Liu, Shiwei Yang et al.

Background Single-cell annotation plays a crucial role in the analysis of single-cell genomics data. Despite the existence of numerous single-cell annotation algorithms, a comprehensive tool for integrating and comparing these algorithms is also lacking. Methods This study meticulously investigated a plethora of widely adopted single-cell annotation algorithms. Ten single-cell annotation algorithms were selected based on the classification of either reference dataset-dependent or marker gene-dependent approaches. These algorithms included SingleR, Seurat, sciBet, scmap, CHETAH, scSorter, sc.type, cellID, scCATCH, and SCINA. Building upon these algorithms, we developed an R package named scAnnoX for the integration and comparative analysis of single-cell annotation algorithms. Results The development of the scAnnoX software package provides a cohesive framework for annotating cells in scRNA-seq data, enabling researchers to more efficiently perform comparative analyses among the cell type annotations contained in scRNA-seq datasets. The integrated environment of scAnnoX streamlines the testing, evaluation, and comparison processes among various algorithms. Among the ten annotation tools evaluated, SingleR, Seurat, sciBet, and scSorter emerged as top-performing algorithms in terms of prediction accuracy, with SingleR and sciBet demonstrating particularly superior performance, offering guidance for users. Interested parties can access the scAnnoX package at https://github.com/XQ-hub/scAnnoX.

Won Beom Jung

Rectal cancer is one of the most common carcinomas and a leading cause of cancer-related mortality. Although significant advancements have been made in the treatment of rectal cancer, the deterioration of quality of life (QoL) remains a challenging issue. Various tools have been developed to assess QoL, including the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, the QLQ-C30 and QLQ-CR29 by the European Organization for Research and Treatment of Cancer (EORTC), and the 36-Item Short Form Health Survey (SF-36). Factors such as the lower location of the tumor, radiation therapy, chemoradiotherapy, and chemotherapy are associated with a decline in QoL. Furthermore, anastomotic leakage following rectal cancer resection is an important risk factor affecting QoL. With the development of novel treatment approaches, including neoadjuvant therapies such as chemoradiotherapy and total neoadjuvant therapy, the rate of clinical complete remission has increased, leading to the emergence of organ-preserving strategies. Both local excision and the “watch-and-wait” approach following neoadjuvant therapy improved functional outcomes and QoL. Efforts to improve QoL after rectal cancer surgery are ongoing in surgical techniques for rectal cancer. Since QoL is determined by a complex interplay of factors, including the patient's physical condition, surgical techniques, and psychological and social elements, a comprehensive approach is necessary to understand and enhance it. This review aims to describe the methods for measuring QoL in rectal cancer patients after surgery, the key risk factors involved, and various strategies and efforts to improve QoL outcomes.

Alessia Di Girolamo, Marta Ascione, Francesca Miceli et al.

Background: Accessory renal arteries (ARAs) frequently coexist with abdominal aortic aneurysms (AAA) and can influence treatment. This study aimed to retrospectively analyze the ARA’s exclusion effect on patients undergoing standard endovascular aneurysm repair for AAA. Methods: The study focused on medium- and long-term outcomes, including type II endoleak, aneurysmal sac changes, mortality, reoperation rates, renal function, and infarction post-operatively. Results: 76 patients treated with EVAR for AAA were included. One hundred and two ARAs were identified: 69 originated from the neck, 30 from the sac, and 3 from the iliac arteries. The ARA treatment was embolization in 15 patients and coverage in 72. Technical success was 100%. One-month post-operative computed tomography angiography (CTA) revealed that 76 ARAs (74.51%) were excluded. Thirty-day complications included renal deterioration in 7 patients (9.21%) and a blood pressure increase in 15 (19.73%). During follow-up, 16 patients (21.05%) died, with three aneurysm-related deaths (3.94%). ARA-related type II endoleak (T2EL) was significantly associated with the ARA’s origin in the aneurysmatic sac. Despite reinterventions were not significantly linked to any factor, post-operative renal infarction was correlated with an ARA diameter greater than 3 mm and ARA embolization. Conclusion: ARAs can influence EVAR outcomes, with anatomical and procedural factors associated with T2EL and renal infarction. Further studies are needed to optimize the management of ARAs during EVAR.

Anina F. van de Koolwijk, Thijs S.R. Delnoij, Martje M. Suverein et al.

Background: Prospective, trial-based data comparing health-related quality of life (HRQoL) in patients surviving out-of-hospital cardiac arrest (OHCA) through extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) are scarce. We aimed to determine HRQoL during 1-year after refractory OHCA in patients treated with ECPR and CCPR. Methods: We present a secondary analysis of the multicenter INCEPTION-trial, which studied the effectiveness of ECPR versus CCPR in patients with refractory OHCA. HRQoL was prospectively assessed using the EQ-5D-5L questionnaire. Poor HRQoL was pragmatically defined as an EQ-5D-5L health utility index (HUI) > 1 SD below the age-adjusted norm. We used mixed linear models to assess the difference in HRQoL over time and univariable analyses to assess factors potentially associated with poor HRQoL. Results: A total of 134 patients were enrolled, and hospital survival was 20% (27 patients). EQ-5D-5L data were available for 25 patients (5 ECPR and 20 CCPR). One year after OHCA, the estimated mean HUI was 0.73 (0.05) in all patients, 0.84 (0.12) in ECPR survivors, and 0.71 (0.05) in CCPR survivors (p-value 0.31). Eight (32%) survivors had a poor HRQoL. HRQoL was good in 17 (68%) patients, with 100% in ECPR survivors versus 60% in CCPR survivors (p-value 0.14). Conclusion: One year after refractory OHCA, 68% of the survivors had a good HRQoL. We found no statistically significant difference in HRQoL one year after OHCA in patients treated with ECPR compared to CCPR. However, numerical differences may be clinically relevant in favor of ECPR.

Thor S. Stead, ScB, Nikhil Sobti, MD, Amy C. Kite, MD

Zaisheng Zhu, Yiyi Zhu, Hongqi Shi et al.

ObjectiveThis study aims to investigate and analyze the feasibility, oncological outcomes, functional efficacy, and complications with the prostatic capsule sparing (PCS) as well as the nerve sparing (NS) in radical cystectomy for bladder cancer.Patients and methodsBetween January 2007 and December 2021, 67 total cystectomies with PCS and 54 with NS were performed at our institution. The inclusion criteria for PCS were as follows: proactive, fully informed patient consent; negative transurethral resection of the bladder neck; normal prostate-specific antigen (PSA) level &lt; 4 ng/dL; and normal transrectal ultrasonography with biopsy of any suspicious nodes. Patients received complete oncological and functional follow-ups. The Kaplan-Meier method was utilized to characterize survival outcomes after surgery.ResultsThe median follow-up times for PCS and NS were 144 and 122 months, respectively. Cumulative survival estimated the 5- and 10-years cancer-specific survival were 93.0% and 88.7% for the PCS group and 79.7% and 79.6% for the NS group, respectively (p = 0.123). In terms of function, the daytime urinary control at 3, 6, and 12 months postoperatively was 80.60%, 97.01%, and 100% in the PCS group, and 53.70%, 85.19%, and 94.44% in the NS group, respectively (p = 0.002, 0.023, and 0.100); and nocturnal urinary control was 62.69%, 94.03%, and 98.51% in the PCS group, and 40.74%, 72.22%, and 87.04% in the NS group, respectively (p = 0.016, 0.001, and 0.022). The erectile function recovery revealed that 62.69% and 40.74% of patients returned to preoperative levels (International Index of Erectile Function (IIEF)-5 score ≥ 15) in the PCS and NS groups, respectively (p = 0.016). Considering complications within 30 days after surgery, 4.48% and 7.69% patients had Clavien ≥ III complications in the PCS and NS groups, respectively (p = 0.700).ConclusionThe PCS provides better restored urinary control and sexual function than the NS technique and does not affect oncological outcomes. However, PCS is prone to bladder-neck obstruction complications and requires closer long-term follow-up.

Zahra Jourahmad, Jafar Mehvari Habibabadi, Houshang Moein et al.

In this study, we developed and tested machine learning models to predict epilepsy surgical outcome using noninvasive clinical and demographic data from patients. Methods: Seven dif-ferent categorization algorithms were used to analyze the data. The techniques are also evaluated using the Leave-One-Out method. For precise evaluation of the results, the parameters accuracy, precision, recall and, F1-score are calculated. Results: Our findings revealed that a machine learning-based presurgical model of patients' clinical features may accurately predict the outcome of epilepsy surgery in patients with drug-resistant lesional epilepsy. The support vector machine (SVM) with the linear kernel yielded 76.1% in terms of accuracy could predict results in 96.7% of temporal lobe epilepsy (TLE) patients and 79.5% of extratemporal lobe epilepsy (ETLE) cases using ten clinical features. Significance: To predict the outcome of epilepsy surgery, this study recommends the use of a machine learning strategy based on supervised classification and se-lection of feature subsets data mining. Progress in the development of machine learning-based prediction models offers optimism for personalised medicine access.

Yingchao Li, Yuqing Wu, Suolin Li et al.

Intestinal microecology is established from birth and is constantly changing until homeostasis is reached. Intestinal microecology is involved in the immune inflammatory response of the intestine and regulates the intestinal barrier function. The imbalance of intestinal microecology is closely related to the occurrence and development of digestive system diseases. In some gastrointestinal diseases related to pediatric surgery, intestinal microecology and its metabolites undergo a series of changes, which can provide a certain basis for the diagnosis of diseases. The continuous development of microecological agents and fecal microbiota transplantation technology has provided a new means for its clinical treatment. We review the relationship between pathogenesis, diagnosis and treatment of pediatric surgery-related gastrointestinal diseases and intestinal microecology, in order to provide new ideas and methods for clinical diagnosis, treatment and research.