Search Results (355)

Background: Recent advancements in enabling technologies, including artificial intelligence and telemedicine, alongside robust clinical study outcomes, have led to significant progress in upper limb and hand exoskeletons utilised for post-stroke rehabilitation. Objectives: This review aims to synthesize the recent scientific literature (2010–2025) on post-stroke upper-limb and hand exoskeletons, with particular attention to the sensing architectures—sensing modalities, signal processing, sensor fusion, and sensor-driven control—that integrate technical and biomedical domains to examine device architecture, clinical context, and outcome selection. Methods: A search of PubMed and Scopus was conducted on 10 November 2025, cross-checked against IEEE Xplore, Web of Science, Embase, and ACM Digital Library. We included studies evaluating wearable exoskeletons or robotic orthoses for the upper limb/hand in post-stroke rehabilitation. Two independent reviewers screened records and extracted data, with disagreements resolved by consensus. Data were synthesised using a predefined label-based taxonomy. The review protocol was not registered. Results: From 1889 identified records, 219 studies met the inclusion criteria. The synthesis reveals a transition from rigid, laboratory-centered systems to lighter, soft, and home-oriented solutions. Available evidence suggests potential impairment-level benefits, particularly for proximal motor control, but certainty remains limited due to heterogeneity, small samples, blinding limitations, inconsistent dosing, and limited long-term follow-up; gains in hand/finger dexterity appear even more variable. Discussion: While exoskeleton-assisted therapy appears associated with impairment-level gains, transfer to activities of daily living (ADLs) and real-world function remains inconsistently documented and insufficiently powered to support firm conclusions. Full article

Anastomotic leakage (AL) and pelvic sepsis remain important causes of morbidity after restorative rectal cancer surgery, affecting mortality, stoma-free survival, bowel function, and oncologic treatment. Reported rates after low anterior resection are approximately 5–20%. We conducted a structured narrative review of PubMed/MEDLINE and the Cochrane Library through 20 July 2026, focusing on prevention, recognition, source control, and long-term recovery after low pelvic reconstruction. Most biological requirements for healing and principles of source control are approach-agnostic, whereas open, laparoscopic, and robotic surgeries create different technical conditions for pelvic exposure, stapler trajectory, articulation, tactile feedback, conversion, and fluorescence imaging. This review therefore integrates approach-specific technical constraints with post-discharge recognition, anatomy-based source control, and patient-centered long-term outcomes rather than treating these domains separately. Among preventive measures, combined mechanical bowel preparation and oral antibiotics has the strongest support in elective, non-obstructed patients; indocyanine green fluorescence is a useful adjunct when perfusion is uncertain but does not replace assessment of tension or mechanical integrity. C-reactive protein is mainly useful for ruling out major complications, whereas contrast-enhanced computed tomography remains first-line imaging and pelvic magnetic resonance imaging is best reserved for selected small defects, chronic sinuses, or complex pelvic sepsis. Management should be driven first by physiology and then by leak timing and location, defect size, conduit viability, diversion status, and cavity drainability. Durable success includes sepsis control, anatomical healing, stoma reversal when feasible, and acceptable long-term function. Full article

Lung cancer remains the leading cause of cancer-related mortality worldwide, and durable benefit from immune checkpoint inhibitors is limited by immune exclusion, microenvironmental immunosuppression, and toxicity. This narrative translational review evaluates whether endobronchial intratumoral delivery of immuno- and gene-based therapies can transform bronchoscopic access into a therapeutic platform linking local tumour intervention with systemic antitumour immunity. We synthesise evidence on endobronchial ultrasound, electromagnetic navigation bronchoscopy, and robotic-assisted bronchoscopy, together with local checkpoint blockade, cytokine and mRNA-lipid nanoparticle constructs, oncolytic virotherapy, dendritic-cell approaches, viral and non-viral gene transfer, and enzyme- or metabolite-based strategies. Current clinical evidence remains preliminary, consisting mainly of Phase I trials, small prospective cohorts, and case-based signals, with feasibility and safety observations but no completed randomised trial demonstrating efficacy against standard-of-care systemic therapy. The most plausible candidates are patients with advanced or recurrent NSCLC, bronchoscopically accessible lesions, inadequate response to systemic immunotherapy, and immune-excluded or locally immunosuppressed tumours. Biomarkers such as PD-L1, tumour mutational burden, CD8+ infiltration, tertiary lymphoid structures, radiomics, and circulating tumour DNA require validation. This review integrates delivery technology, immune mechanisms, statistical evidence appraisal, biomarker limitations, AI-guided planning, and global feasibility. Full article

This report presents a within-patient comparison of ¹⁸F-rhPSMA-7.3 and ¹⁸F-PSMA-1007 PET/CT in a 71-year-old man with Gleason score 4 + 3 = 7, pT3bN1 metastatic castration-resistant prostate cancer after robot-assisted radical prostatectomy, multiple androgen-deprivation and androgen receptor-directed treatments, and radiotherapy for para-aortic nodal metastases. The scans showed concordant PSMA-avid cervical-to-mediastinal lymphadenopathy and an ill-defined right lower-lobe pulmonary lesion with a recorded SUVmax > 15, despite distinct physiologic biodistributions. Infection or inflammation remained a relevant differential diagnosis, and the patient declined biopsy. Antibiotics did not improve the CT findings. After enrollment in a clinical trial of systemic therapy, the last available pretreatment prostate-specific antigen (PSA) level of 42.4 ng/mL decreased to 3.1 ng/mL, with marked disease regression. The concordant dual-tracer findings, lack of response to antibiotics, and subsequent radiographic and biochemical response to systemic therapy favored nodal and pulmonary metastases from prostate cancer. However, without histopathologic confirmation, the diagnosis remains presumptive, highlighting the need to integrate PET biodistribution, semiquantitative uptake, anatomic imaging, and longitudinal clinical findings. Full article

Background: Exercise rehabilitation (ER) has become an important treatment regimen during the recovery phase of acute ischemic stroke (AIS). Optimal exercise prescriptions for post-stroke motor recovery remain controversial. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched through November 2025. The Cochrane risk-of-bias (RoB 1) assessment tool was utilized to assess the risk of bias in the original studies. Results: This study included 66 trials comprising 3675 patients. For balance, whole-body tilting postural training (WTPT), unilateral strength training (UST) and robot-assisted unilateral gait training (RAUGT) showed high SUCRA rankings. Activities of daily living likely improved most with robot-assisted Tai Chi training (RATCT), home rehabilitation guidance (HRG) and robot-assisted gait training (RAGT). Fugl-Meyer Assessment (FMA) gains appeared greatest following robot-assisted hand training with electrical stimulation (RAHT + ES), neural inhibition therapy (NIT) and graded motor imagery with electrical stimulation (GMI + ES). Walking endurance seemed most responsive to visual feedback training (VFT), UST and visual aids training (VAT), while functional mobility showed greatest improvement with tilt sensor-assisted gait training with electrical stimulation (TAGT + ES), gait training (GT) and virtual reality therapy with motor imagery (VRT + MI). Conclusions: This study provides the first comprehensive evidence synthesis evaluating the comparative effectiveness of specific exercise modalities across distinct recovery domains after AIS. Rather than supporting generic interventions, the findings highlight the distinct comparative advantages of various emerging technologies and traditional practices. These results offer an evidence-based framework for clinicians to optimize post-stroke rehabilitation protocols and highlight priority areas for future research on dose–response and long-term outcomes. Full article

Background/Objectives: Prostate cancer is one of the most common non-skin solid malignancies among male solid organ transplant recipients (SOTRs), in whom radical prostatectomy is technically demanding. We report the first use of indocyanine green (ICG) fluorescence for simultaneous transplanted-ureter identification and renal graft vascular mapping during robot-assisted radical prostatectomy (RARP), and the first use of the CMR Versius^® platform in a SOTR. Methods: Retrospective case series of four consecutive male SOTRs (two renal [RTRs], two hepatic) undergoing RARP. In both RTRs, a dual-route ICG protocol was used on the da Vinci Xi with Firefly^® imaging: pre-docking intraureteral ICG via a ureteral catheter for ureter identification, plus an intravenous ICG bolus for graft vascular mapping and cortical perfusion. One hepatic recipient was operated with the CMR Versius^® system using an infra-umbilical port configuration to avoid the chevron transplant scar. Results: All four procedures were completed robotically without conversion. Median operative time was 176 min and median estimated blood loss 350 mL. Surgical margins were negative (R0) in all four; final pathology was pT3aN0 in three and pT2N0 in one, although in the renal recipients nodal staging reflected a contralateral-only dissection. PSA was undetectable at three months in all patients. One hepatic recipient later developed biochemical recurrence, managed with salvage radiotherapy and androgen deprivation therapy, with subsequent undetectable PSA. One hepatic recipient had a Clavien–Dindo IIIa complication. No graft dysfunction occurred. Conclusions: ICG-guided RARP and the CMR Versius^® platform appear technically feasible in carefully selected solid organ transplant recipients treated at an experienced multidisciplinary centre, with no graft-related complications observed in this small initial series. These preliminary findings require validation in larger, multicenter studies before general safety and oncological efficacy can be established. Full article

Since decades, surgery of pancreatic adenocarcinoma is confronted with two major challenges. First, the prognosis of pancreatic adenocarcinoma is the worst of all gastrointestinal malignancies, characterized by late diagnosis and aggressive tumor biology. Second, postoperative mortality and morbidity have been exceptionally high, giving pancreatic resection a reputation of being one of the most dangerous procedures. This narrative review concentrates on the progress in decreasing postoperative mortality by centralization and standardization, the exertion of extended resections for local tumor clearance and multimodal strategies to improve oncologic survival. Research regarding surgical techniques, especially robotic assistance, indicated further progress in minimizing the perioperative trauma. Multimodal treatment concepts have been implemented with adjuvant therapy in resectable and neoadjuvant regimen in borderline and locally advanced cancer. However, significant problems have to be solved. Postoperative morbidity remains high, hindering the administration of adjuvant therapy, and toxicity is an essential factor in neoadjuvant strategies. Despite neoadjuvant therapies, resection rates of locally advanced carcinoma are modest and tumor progression hinders resection of borderline and resectable carcinomas. Obviously, deficits in understanding tumor biology are a central obstacle in improving resection rates and overall survival. Hence, improvement in selection of patients for surgical resection apart from using preoperative anatomical findings is mandatory. The progression of current standards, future developments and the status of surgery in multimodal concepts to treat pancreatic adenocarcinoma are delineated using historical and recent reports, registry data, meta-analysis and randomized controlled trials. Full article

Objective: This study aimed to determine whether robot-assisted therapy, low-frequency rTMS, or intensive therapist-guided upper-limb training provides additional recovery beyond self-directed training in individuals 4–9 months post-stroke. Design: A five-phase single-case experimental study was conducted with two baseline phases and three randomized 3-week intervention phases. Subjects/Patients: Sixteen adults with moderate-to-severe upper-limb motor impairment in the late subacute phase after stroke (4–9 months post-stroke) were included. Methods: Participants completed intensive task-oriented training, low-frequency rTMS, and robot-assisted therapy in a randomized order. Primary outcomes were Fugl–Meyer Assessment for the Upper Extremity (FMA-UE), active range of motion, and muscle strength. Secondary outcomes included EQ-5D and WHODAS 2.0. Results: FMA-UE motor scores improved significantly over the study period (8–10 points). However, comparable gains occurred during baseline phases. rTMS and intensive training produced within-phase improvements, whereas robotic therapy did not. Participants with higher initial FMA-UE scores improved, while those with severe paresis showed minimal benefit and occasional decline during rTMS. Disability and quality-of-life measures remained stable. Gains were maintained at 1-year follow-up. Conclusions: In the late subacute phase after stroke, modest upper-limb motor improvements occurred, but effects were not clearly attributable to specific interventions beyond ongoing recovery. Treatment response depended strongly on baseline motor severity, with limited benefit in severe paresis. Full article

Background/Objectives: Thoracoscopic esophagectomy is an accepted minimally invasive approach for resectable esophageal and esophagogastric junction cancer in Japan. Whether robot-assisted minimally invasive esophagectomy (RAMIE) improves short- and long-term outcomes compared with video-assisted thoracoscopic esophagectomy (VATS) remains clinically relevant. Methods: We retrospectively reviewed patients who underwent VATS or RAMIE between January 2017 and April 2026. Patients who underwent open esophagectomy, non-gastric conduit reconstruction, or staged operation were excluded. Propensity score matching (PSM) was performed using age, sex, body mass index, histology, tumor location, clinical stage, preoperative therapy, extent of lymph node dissection, abdominal approach, and reconstruction route. Long-term outcomes were explored in a PSM cohort limited to patients treated between January 2017 and December 2023. Results: The main cohort included 369 patients (VATS, n = 186; RAMIE, n = 183). Overall complications of Clavien–Dindo (CD) grade ≥ II were comparable between VATS and RAMIE (32.8% vs. 32.8%, p = 0.999), whereas RLNP CD ≥ I (9.7% vs. 3.8%, p = 0.025) and RLNP CD ≥ II (3.8% vs. 0.5%, p = 0.034) were less frequent after RAMIE. PSM yielded 128 matched pairs; RLNP remained less frequent after RAMIE (CD ≥ I, 10.9% vs. 3.1%, p = 0.015; CD ≥ II, 4.7% vs. 0%, p = 0.013), while other short-term outcomes were comparable. In the survival PSM cohort (79 pairs), 3-year overall survival (66.0% vs. 73.4%, p = 0.203) and recurrence-free survival (62.3% vs. 59.3%, p = 0.651) did not differ significantly between VATS and RAMIE. Conclusions: RAMIE showed comparable short-term safety to VATS and was associated with lower RLNP after adjustment for clinicopathological, treatment-related, and surgical factors. Exploratory long-term analysis was limited by cohort size and follow-up duration but suggested that RAMIE did not compromise oncologic outcomes. Full article

Upper-limb impairments affect a substantial portion of the global population, often limiting the ability to perform daily activities. Robotic rehabilitation systems offer a promising solution by enabling high-dose, task-oriented therapy with consistent and objective feedback. However, user acceptance and perceived comfort are critical for their successful adoption. This work presents a feasibility, performance, and comfort evaluation of a 2-degree-of-freedom upper-limb rehabilitation exoskeleton capable of performing elbow flexion/extension and forearm pronation/supination. A total of 47 healthy participants were enrolled and tested across three rehabilitation modalities: passive assist, active assist, and active resist. Passive assist enabled full range-of-motion execution, active assist supported movement, and active resist provided variable resistance via a sliding bar (0–100%). Objective performance metrics, including position, current, and temperature, were recorded and analyzed, revealing trajectory-tracking errors during passive assistance of 4.82° ± 0.02° for forearm movement and 1.20° ± 0.04° for elbow movement, with actuator temperatures remaining below their rated limits throughout the study. The active assist mode did not achieve a true assist-as-needed performance, indicating a need for further refinement. Subjective evaluation included the System Usability Scale, yielding a score of 87.1 ± 9.6, indicating excellent usability, and a safety and comfort assessment averaging 4.4 ± 0.4 out of 5. Perceived effort was assessed using the Borg CR-10 scale and generally scaled appropriately across modalities, although some variability suggests the need for further investigation. Qualitative feedback identified areas for improvement, particularly in ergonomics and control behavior. Overall, the results support the feasibility, usability, and safe operation of the proposed exoskeleton and provide insights for future device refinement and evaluation with target user populations. Full article

Background: Mitral regurgitation (MR) is one of the most prevalent valvular heart diseases, with a rising global incidence. The 2025 European Society of Cardiology (ESC) guidelines introduced updated pathophysiological and morphological concepts for secondary MR, distinguishing ventricular and atrial mechanisms. Concurrent advances in cardiovascular imaging and therapeutic technologies have transformed the diagnostic and management landscape of MR. Methods: This review summarizes current evidence on the diagnosis and treatment of MR, with a focus on the updated ESC classification, multimodality cardiovascular imaging, minimally invasive surgical techniques, and contemporary transcatheter repair strategies. Recent literature was evaluated to highlight advances in anatomical assessment and individualized therapeutic approaches. Results: Multimodality imaging provides comprehensive evaluation of mitral valve anatomy, ventricular remodeling, and disease mechanisms, enabling accurate patient selection and procedural planning. Surgical management has evolved from conventional repair or replacement to minimally invasive approaches, including video-assisted right thoracotomy and robotic-assisted surgery, which have demonstrated favorable perioperative and clinical outcomes. In parallel, transcatheter interventions have expanded the therapeutic armamentarium for patients at high surgical risk or with complex anatomy. These include direct and indirect annuloplasty, transcatheter edge-to-edge repair, and emerging catheter-based repair technologies targeting specific structural abnormalities of the mitral valve apparatus. Conclusions: Contemporary management of MR requires an integrated understanding of disease pathophysiology, advanced imaging, and patient-specific anatomical characteristics. The combination of minimally invasive surgical techniques and rapidly evolving transcatheter interventions has broadened treatment options and supports a tailored, multidisciplinary approach to improve clinical outcomes and expand access to effective therapy for patients with severe MR. Full article

Background: The study aimed to investigate the effects of non-suspended robot-assisted ambulatory training with approximately 80–100% weight-bearing during the stance phase on one leg and 0% weight-bearing support during the swing phase on the other leg on hemiplegic stroke patients who were unable to ambulate at baseline. Traditional robot-assisted gait training commonly provided substantial body-weight support (approximately 0–20% weight-bearing during the stance phase on one leg), whereas the present system enables near-normal weight-bearing during gait training. Methods: Pre- and post-assessments of Brunnstrom stage, standing balance, and the Barthel Index of Activities of Daily Living (ADL) were performed in sixty hemiplegic stroke patients (30 right-sided and 30 left-sided hemiplegia) with stroke onset less than 6 months and without ambulatory ability. A retrospective controlled study was performed using a non-suspended robot-assisted ambulatory training machine (RAATM) that provides approximately 80–100% weight-bearing during the stance phase on one leg for more than 150 min a month (>4500 guided steps), combined with a 4-week conventional rehabilitation program (RAATM group, n = 30). Outcomes were compared with those of an age-, affected side-, and baseline walking-ability-matched control group (control group, n = 30) that received only a 4-week conventional rehabilitation program. Results: The average accumulated intervention duration in the RAATM group was 246 ± 74 min, which received intervention of RAATM with 80–100% weight-bearing during the stance phase on one leg and 0% weight-bearing during the swing phase on the other leg. The pre-to-post changes in the Brunnstrom stage of the lower extremities, static standing balance score, dynamic standing balance score, mobility on level surfaces, stairs, and total Barthel Index score were significantly higher in the RAATM group than in the control group. Conclusions: Functions of lower extremities, standing balance, and mobility ability can be improved after intervention of non-suspended RAATM within a month. Non-suspended robot-assisted ambulatory training appeared to be an effective therapeutic approach for hemiplegic stroke patients pre-assessed without ambulatory ability. Full article

Falls represent a severe public health issue and a primary cause of impairment across both geriatric and adults clinical populations, underscoring the importance of early and tailored prevention. Research evidence shows that technology-assisted rehabilitation may enhance balance and reduce fall risk; however, long-term real-world evidence remains limited. This retrospective study evaluated the impact of personalized balance training by hunova^® robotic platform on fall risk in a heterogeneous clinical cohort (n = 355; mean age 58.24 ± 19.63 years) comprising neurological and orthopedic conditions. Fall risk was assessed using the Silver Index, a sensor-based robotic posturographic score to predict 12-month fall probability at baseline (T0), after 6 weeks (T1), and at 6 months (T6). Robotic rehabilitation was provided to 162 patients (TREAT-G), while 193 served as a control group (NOTREAT-G). TREAT-G demonstrated a significant reduction in fall risk over time (p = 0.036), with improvements from T0–T1 (p < 0.001) and T0–T6 (p = 0.009). Domain-specific analysis showed significant increases in limits of stability, sit-to-stand, and gait speed (p < 0.001). Significant time × group interactions were observed for limits of stability (p = 0.004) and sit-to-stand (p < 0.001). Based on the occurrence of falls in the previous six months, the sample was then divided into ‘Fallers’ (at least one fall) and ‘No-Fallers’ (no falls). Subgroup analysis revealed significant improvements in ‘Fallers’ (p = 0.016) and ‘No-Fallers’ (p = 0.034) following treatment in contrast to untreated patients—both ‘Fallers’ and ‘No-Fallers’. These results indicate that tailored robot-assisted therapy with hunova^® significantly reduces risk of fall and improves long-term dynamic balance. This study supports the clinical integration of robotic assessment and therapy as a robust tool for proactive fall prevention in diverse clinical settings. Full article

Background/Objectives: Adult Polyglucosan Body Disease (APBD) is a rare neurodegenerative glycogen storage disorder characterized by progressive gait disturbance, sensory impairment, and balance dysfunction. Although rehabilitation is recommended for functional maintenance, evidence regarding robot-assisted gait training (RAGT) in APBD remains extremely limited. Methods: A 58-year-old man with progressive lower extremity sensory and motor symptoms was diagnosed with APBD in 2026. Neurological examination revealed severe proprioceptive impairment in both great toes, generalized sensory deficits, gait instability, and impaired balance. Functional assessment demonstrated mild balance impairment with generally preserved muscle strength except for mild weakness in the lower extremities. RAGT was initiated and performed for 19 sessions over approximately 6 weeks in combination with conventional rehabilitation therapy, including gait and balance training with visual feedback. Results: Following the combined rehabilitation program, improvements were observed in balance function, postural stability and proprioceptive function. Conclusions: This case suggests that RAGT combined with conventional rehabilitation may improve balance and gait-related function in patients with APBD. Repetitive task-specific gait training with enhanced sensory feedback may be particularly beneficial in APBD, where proprioceptive impairment and sensory ataxia are major contributors to gait dysfunction; however, this remains a hypothesis that requires validation in future studies. This report highlights the feasibility and potential applicability of RAGT in rare neurodegenerative disorders such as APBD. Full article

Background: Drug-coated balloons (DCBs) have emerged as a “leave-nothing-behind” strategy in percutaneous coronary intervention (PCI), with potential advantages over drug-eluting stents (DES) in selected patients with acute coronary syndrome (ACS). Methods: We performed a narrative review of randomized controlled trials, registries, and meta-analyses evaluating DCB therapy in ACS, including PEPCAD NSTEMI, REVELATION, BASKET-SMALL 2, AGENT IDE, REC-CAGEFREE I/II, and the ongoing TRANSFORM II trial. Articles were identified through searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL covering January 2005 to February 2026. Results: Across published studies, DCBs have shown outcomes that are non-inferior to those of DES in selected ACS subsets, together with a lower risk of major bleeding attributable to shorter dual antiplatelet therapy (DAPT) requirements. Advances in intravascular imaging and lesion preparation, alongside emerging applications of artificial intelligence (AI) and robotic-assisted PCI, may further improve DCB performance, although evidence specific to DCB use in ACS remains limited for these adjunctive technologies. Conclusions: DCBs are a reasonable alternative to DES in selected patients with ACS, particularly those at high bleeding risk or with lesion subsets in which DES perform less well (small vessels, in-stent restenosis, bifurcations, diffuse disease). Adequately powered randomized trials with long-term follow-up are required before broader recommendations can be made. Full article