Search Results (662)

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

Posterior capsule opacification (PCO), a frequent complication of cataract surgery, arises from dysregulated wound healing and fibrotic transformation of residual lens epithelial cells. While transcriptomic and machine learning (ML) approaches have elucidated fibrosis-related pathways in other tissues, the molecular divergence between regenerative and fibrotic outcomes in the lens remains unclear. Here, we used an ex vivo chick lens injury model to simulate post-surgical conditions, collecting RNA from lenses undergoing either regenerative wound healing or fibrosis between days 1–3 post-injury. Bulk RNA sequencing data were normalized, log-transformed, and subjected to univariate filtering prior to training LASSO, SVM, and RF ML models to identify discriminatory gene signatures. Each model was independently validated using a held-out test set. Distinct gene sets were identified, including fibrosis-associated genes (VGLL3, CEBPD, MXRA7, LMNA, gga-miR-143, RF00072) and wound-healing-associated genes (HS3ST2, ID1), with several achieving perfect classification. Gene Set Enrichment Analysis revealed divergent pathway activation, including extracellular matrix remodeling, DNA replication, and spliceosome associated with fibrosis. RT-PCR in independent explants confirmed key differential expression levels. These findings demonstrate the utility of supervised ML for discovering lens-specific fibrotic and regenerative gene features and nominate biomarkers for targeted intervention to mitigate PCO. Full article

Background/Objectives: Accurate and accessible perioperative health information empowers patients and enhances recovery outcomes. Artificial intelligence tools, such as ChatGPT, have garnered attention for their potential in health communication. This study evaluates the accuracy and readability of responses generated by ChatGPT to questions commonly asked about breast cancer. Methods: Fifteen simulated patient queries about breast cancer surgery preparation and recovery were prepared. Responses generated by ChatGPT (4o version) were evaluated for accuracy by a pool of breast surgeons using a 4-point Likert scale. Readability was assessed with the Flesch–Kincaid Grade Level (FKGL). Descriptive statistics were used to summarize the findings. Results: Of the 15 responses evaluated, 11 were rated as “accurate and comprehensive”, while 4 out of 15 were deemed “correct but incomplete”. No responses were classified as “partially incorrect” or “completely incorrect”. The median FKGL score was 11.2, indicating a high school reading level. While most responses were technically accurate, the complexity of language exceeded the recommended readability levels for patient-directed materials. Conclusions: The model shows potential as a complementary resource for patient education in breast cancer surgery, but should not replace direct interaction with healthcare providers. Future research should focus on enhancing language models’ ability to generate accessible and patient-friendly content. Full article

Orthognathic surgery (OS) is a complex procedure commonly used to treat dentofacial deformities (DFDs). These conditions, related to jaw position or size and often involving malocclusion, affect approximately 15% of the population. Due to the complexity of OS, accurate planning is essential. Digital assessment using computer-aided design (CAD) and computer-aided manufacturing (CAM) tools enhances surgical predictability. However, limitations in soft tissue simulation often require surgeon input to optimize aesthetic results and minimize surgical impact. This study aimed to evaluate the accuracy of virtual surgery planning (VSP) by analyzing the relationship between planning deviations and surgical satisfaction. A single-center, retrospective study was conducted on 16 patients who underwent OS at San Pedro University Hospital of La Rioja. VSP was based on CT scans using Dolphin Imaging software (v12.0, Patterson Dental, St. Paul, MN, USA) and surgeries were guided by VSP-designed occlusal splints. Outcomes were assessed using the Orthognathic Quality of Life (OQOL) questionnaire and deviations were measured through pre- and postoperative imaging. The results showed high satisfaction scores and good overall outcomes, despite moderate deviations from the virtual plan in many cases, particularly among Class II patients. A total of 63% of patients required VSP modifications due to poor soft tissue fitting, with 72% of these being Class II DFDs. Most deviations involved less maxillary advancement than planned, while maintaining optimal occlusion. This suggests that VSP may overestimate advancement needs, especially in Class II cases. No significant differences in satisfaction were observed between patients with low (<2 mm) and high (>2 mm) deviations. These findings support the use of VSP as a valuable planning tool for OS. However, surgeon experience remains essential, especially in managing soft tissue behavior. Improvements in soft tissue prediction are needed to enhance accuracy, particularly for Class II DFDs. Full article

Surgery remains a healthcare intervention with significant risks for patients. Novel technologies can now enhance the peri-operative workflow, with artificial intelligence (AI) and extended reality (XR) to assist with pre-operative planning. This review focuses on innovation in AI, XR and imaging for hepato-biliary surgery planning. The clinical challenges in hepato-biliary surgery arise from heterogeneity of clinical presentations, the need for multiple imaging modalities and highly variable local anatomy. AI-based models have been developed for risk prediction and multi-disciplinary tumor (MDT) board meetings. The future could involve an on-demand and highly accurate AI-powered decision tool for hepato-biliary surgery, assisting the surgeon to make the most informed decision on the treatment plan, conferring the best possible outcome for individual patients. Advances in AI can also be used to automate image interpretation and 3D modelling, enabling fast and accurate 3D reconstructions of patient anatomy. Surgical navigation systems utilizing XR are already in development, showing an early signal towards improved patient outcomes when used for hepato-biliary surgery. Live visualization of hepato-biliary anatomy in the operating theatre is likely to improve operative safety and performance. The technological advances in AI and XR provide new applications in pre-operative planning with potential for patient benefit. Their use in surgical simulation could accelerate learning curves for surgeons in training. Future research must focus on standardization of AI and XR study reporting, robust databases that are ethically and data protection-compliant, and development of inter-disciplinary tools for various healthcare applications and systems. Full article

(1) Background: A decrease in corneal hydration during refractive surgery is observed clinically as well as in laboratory settings, but the associated consequences are not yet fully understood. The purpose of this paper is to analyze the impact of the gain of ablation efficiency due to hydration changes during cornea refractive surgery. (2) Methods: We developed a simulation model to evaluate the influence of hydration changes on the ablation algorithms used in laser refractive surgery. The model simulates different physical effects of an entire surgical process, simulating the shot-by-shot ablation process based on a modeled beam profile. The model considers corneal hydration, as well as environmental humidity, along with the laser beam characteristics and ablative spot properties for evaluating any hydration changes and their effect on laser refractive surgery. (3) Results: Using pulse lists collected from actual treatments, we simulated the gain of efficiency during the ablation process. Ablation efficiency is increased due to dehydration effects during laser treatments. Longer treatments suffer larger dehydration effects and are more prone to overcorrections due to gain of efficiency than shorter treatments. (4) Conclusions: The improper use of a model that overestimates or underestimates the effects derived from the hydration dynamics during treatment may result in suboptimal refractive corrections. This model may contribute to improving emmetropization and the correction of ocular aberrations with improved laser parameters that can compensate for the changes in ablation efficiency due to hydration changes in the cornea. Full article

Background/Objectives: This case study presents the first documented use of a low-cost, simulated, patient-specific three-dimensional (3D) printed model to support presurgical planning for an infant with Apert syndrome in a resource-limited setting. The primary objectives are to (1) demonstrate the value of 3D printing as a simulation tool for preoperative planning in low-resource environments and (2) identify opportunities for future AI-enhanced simulation models in craniofacial surgical planning. Methods: High-resolution CT data were segmented using InVesalius 3, with mesh refinement performed in ANSYS SpaceClaim (version 2021). The cranial model was fabricated using fused deposition modeling (FDM) on a Creality Ender-3 printer with Acrylonitrile Butadiene Styrene (ABS) filament. Results: The resulting 3D-printed simulated model enabled the surgical team to assess cranial anatomy, simulate incision placement, and rehearse osteotomies. These steps contributed to a reduction in operative time and fewer complications during surgery. Conclusions: This case demonstrates the value of accessible 3D printing as a simulation tool in surgical planning within low-resource settings. Building on this success, the study highlights potential points for AI integration, such as automated image segmentation and model reconstruction, to increase efficiency and scalability in future 3D-printed simulation models. Full article

Background/Objectives: To assess the optical performance of two refractive premium IOLs across pupil sizes and values of corneal spherical aberration (SA). Methods: Two refractive IOLs were evaluated in this study: Tecnis Eyhance and Mini Well. The surface profiles were obtained to calculate the through-object MTF (TO MTF) curves and simulate optotype images. Entrance pupil sizes ranging from 2 to 5.5 and three corneal models were analyzed in the simulation: an average population aberrated cornea, an aberration-free cornea and a post-Lasik myopic cornea. Results: For Model 1 and pupil sizes between 3.0 and 3.5 mm, Mini Well provided acceptable visual quality from far to near distances, whereas Eyhance struggled to maintain visual quality at distances closer than intermediate. For patients with lower-than-normal corneal SA (i.e., more prolate corneas, such as post-hyperopic LASIK) both IOLs exhibited a hyperopic shift in far focus. Conversely, for patients with higher-than-normal corneal SA (i.e., more oblate corneas, such as post-myopic LASIK), the shift occurred in the myopic direction. Despite the implementation of an optimized IOL power to circumvent any shift, the TO MTF nevertheless reflected the interaction between corneal and IOL SA. Furthermore, the Mini Well demonstrated increased tolerance to less negative SA values, while Eyhance exhibited behavior consistent with a monofocal lens for more positive SA values. Conclusions: Surgeons should consider each patient’s corneal asphericity and typical pupil diameter when selecting and calculating the power of the premium IOLs studied, particularly in patients with a history of refractive surgery. Full article

Background: Short-stem hip replacements are designed to provide improved load distribution and to mimic natural biomechanics. The interplay between implant design, positioning, and resulting bone biomechanics in individual patients remains underexplored, and the relationship between radiographically assessed bone remodeling around short stems and biomechanical predictions has not been previously reported. Methods: This study evaluated three short-stem hip implant designs: Proxima, Collo-MIS, and Minima. Postoperative bone remodeling patterns were analyzed, categorizing remodeling as bone gain, bone loss, or no observable activity, with changes tracked over time. Patient-specific biomechanical models were generated from 6-week postoperative radiographs. Finite element simulations incorporated body weight and gluteal muscle forces to estimate stress and strain distributions within the proximal femur. Strain energy was then applied to a mechanostat-based remodeling algorithm to predict bone remodeling patterns. These biomechanical predictions were compared to observed radiographic remodeling at 2 years post-surgery. A validated biomechanical model was further used to simulate different postoperative positions of the three types of stems. Results: No differences in bone remodeling patterns were observed among the three short-stem designs. Computational modeling demonstrated a statistically significant correlation between predicted remodeling and radiographic measurements at 2 years (p < 0.001). Proxima stems showed a tendency towards increased cortical bone loading under pronounced varus or valgus position in comparison to other two stems, although this observation requires further validation. Conclusions: This exploratory study demonstrates the feasibility of using biomechanical modeling to estimate bone remodeling around short-stem hip implants based on early postoperative radiographs. While the results are promising, they should be interpreted with caution due to the limited cohort size. The proposed modeling approach may offer clinical value in evaluating implant behavior and informing patient-specific treatment strategies. However, further research with larger populations is necessary to refine and validate these predictive tools. Full article

Background: Diabetes mellitus is a chronic metabolic disorder that increases mortality and morbidity rates. Infections of the hand can easily cause long-term morbidity and dysfunction, but despite their associated high morbidity, diabetic hand infections are more neglected than diabetic foot infections. Objectives: This study was conducted over a one-year follow-up period, considering the total costs of treatment over one year post discharge for patients with diabetic hand infections that required surgery. A Monte Carlo Simulation was used in this study as a sensitivity analysis of all the cost calculations. Materials and Methods: A total of 62 out of 75 patients were diagnosed with Type 2 diabetes; 11 were female, and 64 were male. Out of all the patients, 15 visited outpatient clinics 30 times or more, and due to their recurrent visits, the outpatient treatment costs reached USD 5162.41 ± 3838.55. The total cost incurred over the period from the patients’ first hospitalization to the completion of all treatments and the end of the one-year follow-up was USD 24,602.22 ± 5257.15. Conclusions: The cost of hospitalization was the most important factor affecting the total expenses. Therefore, taking precautions before a diabetic hand infection occurs, or when one does occur, performing treatment without delay is expected to reduce the economic burden. Full article

Background: Inadequate presurgical planning is a key contributor to suboptimal outcomes in orthognathic surgery. This study aims to assess the accuracy of a digital surgical planning workflow conducted prior to any orthodontic intervention. Methods: Digital planning was performed for 26 patients before orthodontic treatment (T0) and compared to the actual preoperative planning (T1). Digitized plaster casts were merged with CBCT data and converted to orthodontic setups to create a 3D virtual head model. After voxel-based registration of T0 and T1, dental arches were virtually osteotomized and repositioned according to planned outcomes. These T0 segments were then aligned with T1 planning using bony landmarks of the maxilla. Anatomical landmarks were used to construct virtual triangles on maxillary and mandibular segments, enabling assessment of positional and orientational differences. Transformations between T0 and T1 were translated into clinically meaningful metrics. Results: Significant differences were found between T0 and T1 at the dental level. T1 exhibited a greater clockwise rotation of the dental maxilla (mean: 2.85°) and a leftward translation of the mandibular dental arch (mean: 1.19 mm). In SARME cases, the bony mandible showed larger anti-clockwise roll differences. Pitch variations were also more pronounced in maxillary extraction cases, with both the dental maxilla and bony mandible demonstrating increased clockwise rotations. Conclusions: The proposed orthognathic surgical planning workflow shows potential for simulating mandibular outcomes but lacks dental-level accuracy, especially in maxillary anterior torque. While mandibular bony outcome predictions align reasonably with pretreatment planning, notable discrepancies exceed clinically acceptable thresholds. Current accuracy limits routine use; further refinement and validation in larger, homogeneous patient groups are needed to enhance clinical reliability and applicability. Full article

We present a novel method to estimate blood cortisol concentration from sweat cortisol measurements, incorporating a kinetic model to simulate cortisol transport dynamics. Cortisol dysregulation is observed in conditions like Cushing’s syndrome, characterized by excessive cortisol production, and stress-related disorders, which can lead to metabolic disturbances, anxiety, and impaired overall health. Sweat-sensing technology offers a non-invasive and continuous alternative to blood sampling. However, the limited research exploring the sweat–blood cortisol relationship in patients shows a moderate correlation ($R<0.6$), hindering its clinical application for long-term monitoring. In this paper, we propose a novel kinetic model describing cortisol transport from blood to sweat. The model was validated using data from 44 patients before and after cardiac surgery. A high Pearson correlation coefficient of 0.95 (95% CI: 0.92–0.97) was observed between our model’s estimated and experimental blood cortisol concentrations. Moreover, the method enables personalized estimation of physiological parameters, accurately reflecting patients’ status under varying clinical conditions. The method paves the way for the clinical application of long-term, non-invasive monitoring of cortisol using sweat-sensing technology. Enabling the personalized estimation of physiological parameters could potentially support clinical decision-making, helping doctors diagnose and monitor patients with health conditions involving cortisol dysregulation. Full article

The aim of this study was to evaluate structural and micro-architectural changes in the mandible, parietal bone, femur, and tibia in OVX rats at different time periods after ovariectomy. Forty-two 11-month-old female Wistar rats were used. Six rats without surgery were euthanized to serve as a baseline. Eighteen rats were ovariectomized and fed with a calcium-deficient diet, and eighteen animals were used as controls (Ctrls) and fed with a standard diet. Six OVX rats and six Ctrls were euthanized at 3, 6, and 9 months. Qualitative histology and dual-energy X-ray absorptiometry (DXA) were performed. Histological evaluation of bones harvested from the OVX groups revealed trabecular bone reduction, while no significant differences in the cortical bone of OVX and Ctrls were observed. DXA measurements of (1) femoral diaphysis showed a significant decrease in the OVX group compared to the Ctrl groups at 3 (p = 0.041), 6 (p < 0.001), and 9 months (p < 0.001); (2) the proximal tibia showed a significant decrease in the OVX group compared to the Ctrl groups (p < 0.001); (3) parietal bone showed a significant difference between OVX and Ctrls at 6 months (p = 0.012); and (4) the mandible showed no significant differences between the OVX and Ctrl groups. OVX aged rats might present reductions in the density of the femoral diaphysis, proximal tibia, parietal bone, and mandible at different time points. These findings contribute to the field of biomimetics by providing more details for the understanding of age- and hormone-related bone changes in the osteoporotic-like rat model. Such data are critical for the development of biomimetic materials and structures that attempt to simulate natural bone adaptation and deterioration, especially in the context of postmenopausal or osteoporotic conditions. Full article

Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. Methods: A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. Results: All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Conclusions: Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy. Full article

Introduction: This manuscript addresses the limitations of traditional orthognathic surgery in achieving both functional and aesthetic correction in patients with Class II malocclusion and severe mandibular retrusion. Current techniques often struggle to simultaneously address mandibular deficiency and inadequate transverse dimension, leading to unsatisfactory outcomes. Methods: Seven male patients underwent bimaxillary osteotomy with mandibular advancement. A novel surgical plate, Implate, was used, which was designed to facilitate precise osteotomy and stabilization. Pre-surgical planning included CBCT scanning, 3D modeling, and surgical simulation. Postoperative assessments included clinical examinations, CT and OPT scans. Results: Implate successfully addressed the challenges of conventional techniques, minimizing the formation of bony steps and achieving a more harmonious facial profile. The minimally invasive procedure, with careful periosteal and muscle management, contributed to stable outcomes, and no complications were reported. At the 6-month follow-up, OPT analysis showed a mean mandibular width increase of 18.1 ± 6.2 mm and vertical ramus height gains of 6.0 ± 3.1 mm (left) and 5.8 ± 1.7 mm (right). Conclusions: According to our preliminary experience, the integration of Implate into surgical practice offers a significant improvement in treating complex Class II malocclusions. By simultaneously correcting mandibular retrusion and width while minimizing complications, Implate provides a superior solution compared to traditional methods. This innovative approach highlights the potential of combining advanced surgical techniques with personalized 3D-printed implants to achieve optimal functional and aesthetic outcomes. Further prospective studies with controls and longer follow-up are needed to validate the efficacy and reproducibility of Implate in wider clinical use. Full article