BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the ...BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the use of both anteroposterior(AP)and lateral views—on surgical outcomes remains insufficiently studied.Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre(URTT)within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.AIM To evaluate how intraoperative imaging adequacy influences unplanned returnto-theatre rates,focusing on AP and lateral fluoroscopic views.METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022.Data on intraoperative imaging adequacy,screw placement,and URTT events were collected and statistically analyzed using IBM SPSS v23.Imaging adequacy was assessed based on the presence of both AP and lateral views,and outcomes were compared between imaging groups.RESULTS A total of 9016 pedicle screws were inserted,with 82 screws identified as malplaced in 52 patients.Of these,46 patients required URTT due to screw malplacement,with 37 returning within 90 days(URTT90).Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved,demonstrating the critical role of imaging adequacy in improving surgical outcomes.CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns,improves outcomes,enhances precision,and offers a cost-effective approach for better spinal surgery results.展开更多
Histopathological examination is still the gold standard for diagnoses of oral-maxillofacial lesions,but it is invasive and time-consuming.Optical coherence tomography(OCT)provides a kind of noninvasive,label-free,rea...Histopathological examination is still the gold standard for diagnoses of oral-maxillofacial lesions,but it is invasive and time-consuming.Optical coherence tomography(OCT)provides a kind of noninvasive,label-free,real-time and high-resolution imaging technology.In this study,in order to assess the feasibility of OCT in oral clinical application,fresh excised tissue specimens from 59 patients undergoing oral-maxillofacial surgery were imaged in detail by using a benchtop sweptsource OCT system.It is shown that different lesions or tissues can be obviously distinguished based on their different microstructural features in OCT images,and the features are similar to those of their corresponding histopathological images.It is proven that OCT has great feasibility and potential as a diagnostic aid for surgeons in oral medicine.展开更多
Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pat...Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.展开更多
Surgical revascularization with coronary artery bypass grafting(CABG) has become established as the most effective interventional therapy for patients with moderately severe and severe stable ischemic heart disease(SI...Surgical revascularization with coronary artery bypass grafting(CABG) has become established as the most effective interventional therapy for patients with moderately severe and severe stable ischemic heart disease(SIHD). This recommendation is based on traditional 5-year outcomes of mortality and avoidance of myocardial infarction leading to reintervention and/or cardiac death. However, these results are confounded in that they challenge the traditional CABG surgical tenets of completeness of anatomic revascularization, the impact of arterial revascularization on late survival, and the lesser impact of secondary prevention following CABG on late outcomes. Moreover, the emergence of physiologic-based revascularization with percutaneous cardiovascular intervention as an alternative strategy for revascularization in SIHD raises the question of whether there are similar physiologic effects in CABG. Finally, the ongoing ISCHEMIA trial is specifically addressing the importance of the physiology of moderate or severe ischemia in optimizing therapeutic interventions in SIHD. So it is time to address the role that physiology plays in surgical revascularization. The long-standing anatomic framework for surgical revascularization is no longer sufficient to explain the mechanisms for short-term and long-term outcomes in CABG. Novel intraoperative imaging technologies have generated important new data on the physiologic blood flow and myocardial perfusion responses to revascularization on an individual graft and global basis. Long-standing assumptions about technical issues such as competitive flow are brought into question by real-time visualization of the physiology of revascularization. Our underestimation of the impact of Guideline Directed Medical Therapy, or Optimal Medical Therapy, on the physiology of preoperative SIHD, and the full impact of secondary prevention on post-intervention SIHD, must be better understood. In this review, these issues are addressed through the perspective of multi-arterial revascularization in CABG, which is emerging(after 30 years) as the "standard of care" for CABG. In fact, it is the physiology of these arterial grafts that is the mechanism for their impact on long-term outcomes in CABG. Moreover, a better understanding of all of these preoperative, intraoperative and postoperative components of the physiology of revascularization that will generate the next, more granular body of knowledge about CABG, and enable surgeons to design and execute a better surgical revascularization procedure for patients in the future.展开更多
Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a nov...Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.展开更多
Objective To explore the value of clinical application of a navigation system with three-dimensional(3D)imaging for thermal ablation of liver tumors.Methods The study cohort comprised 60 patients who underwent compute...Objective To explore the value of clinical application of a navigation system with three-dimensional(3D)imaging for thermal ablation of liver tumors.Methods The study cohort comprised 60 patients who underwent computer tomography-(CT)guided thermal ablation(radiofrequency or microwave ablation)of liver tumors in our department from August 2021 to October 2022.A random envelope method was used to allocate the study patients randomly to two groups of 30 patients each:a navigation and a control group.An intraoperative 3D imaging navigation system with CT guidance was used in the navigation group,whereas traditional CT guidance was used in the control group.During the thermal ablation process,the number of puncture needle adjustments,time to target puncture,and number of CT scans were recorded and compare between the two groups.Results The average number of punctures and needle adjustments was significantly lower in the navigation group(2.7±1.1 mins)than in the control group(4.9±3.7 mins).The average time taken to puncture the target was significantly shorter in the navigation group(11.3±4.2 mins)than in the control group(15.5±4.8 mins).There average number of CT scans was significantly smaller in the navigation group(4.5±1.6)than in the control group(8.4±4.5)(all P<0.05).Conclusion Use of an intraoperative 3D imaging navigation system in thermal ablation of liver tumors can improve the accuracy of tumor thermal ablation puncture and reduce the number of punctures,number of CT scans,and average puncture time.Such systems can play an important role in the clinic.展开更多
Objective:Indocyanine green(ICG)with near-infrared fluorescence absorption is approved by the United States Food and Drug Administration for clinical applications in angiography,blood flow evaluation,and liver functio...Objective:Indocyanine green(ICG)with near-infrared fluorescence absorption is approved by the United States Food and Drug Administration for clinical applications in angiography,blood flow evaluation,and liver function assessment.It has strong optical absorption in the near-infrared region,where light can penetrate deepest into biological tissue.We sought to review its value in guiding prostate cancer treatment.Methods:All related literature at PubMed from January 2000 to December 2020 were reviewed.Results:Multiple preclinical studies have demonstrated the usefulness of ICG in identifying prostate cancer by using different engineering techniques.Clinical studies have demonstrated the usefulness of ICG in guiding sentinel node dissection during radical prostatectomy,and possible better preservation of neurovascular bundle by identifying landmark prostatic arteries.New techniques such as adding fluorescein in additional to ICG were tested in a limited number of patients with encouraging result.In addition,the use of the ICG was shown to be safe.Even though there are encouraging results,it does not carry sufficient sensitivity and specificity in replacing extended pelvic lymph node dissection during radical prostatectomy.Conclusion:Multiple preclinical and clinical studies have shown the usefulness of ICG in identifying and guiding treatment for prostate cancer.Larger randomized prospective studies are warranted to further test its usefulness and find new modified approaches.展开更多
Pre-operative X ray mammography and int raoperative X-ray specimen radiography are routinely used to identify breast cancer pathology.Recent advances in optical coherence tomography(OCT)have enabled its 1use for the i...Pre-operative X ray mammography and int raoperative X-ray specimen radiography are routinely used to identify breast cancer pathology.Recent advances in optical coherence tomography(OCT)have enabled its 1use for the intraoperative assessment of surgical margins during breast cancer surgery.While each modality offers distinct contrast of normal and pathological features,there is an essential need to correlate image based features between the two modalities to take adv antage of the diagnostic capabilities of each technique.We compare OCT to X-ray images of resected human breast tissue and correlate different tissue features between modalities for future use in real-tine intraoperative OCT imaging.X ray imaging(specimen radiography)is currently used during surgical breast cancer procedures to verify tumor margins,but cannot image tissue in situ.OCT has the potential to solve this problem by providing intrao-perative imaging of the resected specimen as well as the in situ tumor cavity.OCT and micro-CT(X-ray)images are automatically segmented using different computational approaches,and quantitatively compared to determine the ability of these algorithms to automat ically differentiate regions of adipose tissue from tumor.Furthermore,two-dimensional(2D)and three-dimensional(3D)results are compared.These correlations,combined with real-time intraoperative OCT,have the potential to identify possible regions of tumor within breast tissue which correlate to tumor regions identified previously on X-ray imaging(mammography or specimen radiography).展开更多
Background:The most common causes of early graft loss in pancreas transplantation are insufficient blood supply and leakage of the intestinal anastomosis.Therefore,it is critical to monitor graft perfusion and oxygena...Background:The most common causes of early graft loss in pancreas transplantation are insufficient blood supply and leakage of the intestinal anastomosis.Therefore,it is critical to monitor graft perfusion and oxygenation during the early post-transplant period.The goal of our pilot study was to evaluate the utility of hyperspectral imaging(HSI)in monitoring the microcirculation of the graft and adequate perfusion of the intestinal anastomosis during pancreatic allotransplantation.Methods:We imaged pancreatic grafts and intestinal anastomosis in real-time in three consecutive,simultaneous pancreas-kidney transplantations using the TIVITA®HSI system.Further,the intraoperative oxygen saturation(StO_(2)),tissue perfusion(near-infrared perfusion index,NIR),organ hemoglobin index(OHI),and tissue water index(TWI)were measured 15 minutes after reperfusion by HSI.Results:All pancreas grafts showed a high and homogeneous StO_(2)(92.6%±10.45%).Intraoperative HSI analysis of the intestinal anastomosis displayed significant differences of StO_(2)(graft duodenum 67.46%±5.60%vs.recipient jejunum:75.93%±4.71%,P<0.001)and TWI{graft duodenum:0.63±0.09[I(Index)]vs.recipient jejunum:0.72±0.09[I],P<0.001}.NIR and OHI did not display remarkable differences{NIR duodenum:0.68±0.06[I]vs.NIR jejunum:0.69±0.04[I],P=0.747;OHI duodenum:0.70±0.12[I]vs.OHI jejunum:0.68±0.13[I],P=0.449}.All 3 patients had an uneventful postoperative course with one displaying a Banff 1a rejection which was responsive to steroid treatment.Conclusions:Our study shows that contact-free HSI has potential utility as a novel tool for real-time monitoring of human pancreatic grafts after reperfusion,which could improve the outcome of pancreas transplantation.Further investigations are required to determine the predictive value of intraoperative HSI imaging.展开更多
Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experien...Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China. Methods From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency. Results All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas （n=161） was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients （12.42%） suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients （3.16%）. Twenty-one of 161 patients （13.04%） had early speech deficit and late speech deficit was only observed in six of 158 patients （3.80%）. The ratio of gross total resection for pituitary adenomas （n=49） was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy. Conclusion The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.展开更多
Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating ...Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Methods: Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative“visu-alization”of surrounding eloquent structures,“brain shift”corrections, and navigational plan updates. Results: All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely deterred locating of the lesions;however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Conclusions: Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.展开更多
The arcuate fasciculus is a critical component of the neural substrate of human language function.Surgical resection of glioma adjacent to the arcuate fasciculus likely damages this region.In this study,we evaluated t...The arcuate fasciculus is a critical component of the neural substrate of human language function.Surgical resection of glioma adjacent to the arcuate fasciculus likely damages this region.In this study,we evaluated the outcome of surgical resection of glioma adjacent to the arcuate fasciculus under the guidance of magnetic resonance imaging and diffusion tensor imaging,and we aimed to identify the risk factors for postoperative linguistic deficit.In total,54 patients with primary glioma adjacent to the arcuate fasciculus were included in this observational study.These patients comprised 38 men and 16 women(aged 43±11 years).All patients underwent surgical resenction of glioma under the guidance of magnetic resonance imaging and diffusion tensor imaging.Intraoperative images were updated when necessary for further resection.The gross total resection rate of the 54 patients increased from 38.9%to 70.4%by intraoperative magnetic resonance imaging.Preoperative language function and glioma-to-arcuate fasciculus distance were associated with poor language outcome.Multivariable logistic regression analyses showed that glioma-to-arcuate fasciculus distance was the major independent risk factor for poor outcome.The cutoff point of glioma-to-arcuate fasciculus distance for poor outcome was 3.2 mm.These findings suggest that intraoperative magnetic resonance imaging combined with diffusion tensor imaging of the arcuate fasciculus can help optimize tumor resection and result in the least damage to the arcuate fasciculus.Notably,glioma-to-arcuate fasciculus distance is a key independent risk factor for poor postoperative language outcome.This study was approved by the Ethics Committee of the Chinese PLA General Hospital,China(approval No.S2014-096-01)on October 11,2014.展开更多
Fluorescence intraoperative cholangiography（IOC） is a potential alternative for identifying anatomical variation and preventing iatrogenic bile duct injuries by using the near-infrared probe indocyanine green（ICG）...Fluorescence intraoperative cholangiography（IOC） is a potential alternative for identifying anatomical variation and preventing iatrogenic bile duct injuries by using the near-infrared probe indocyanine green（ICG）. However, the dynamic process and mechanism of fluorescence IOC have not been elucidated in previous publications. Herein, the optical properties of the complex of ICG and bile, dynamic fluorescence cholangiography and iatrogenic bile duct injuries were investigated. The emission spectrum of ICG in bile peaked at 844 nm and ICG had higher tissue penetration. Extrahepatic bile ducts could fluoresce 2 min after intravenous injection, and the fluorescence intensity reached a peak at 8 min. In addition, biliary dynamics were observed owing to ICG excretion from the bile ducts into the duodenum. Quantitative analysis indicated that ICG-guided fluorescence IOC possessed a high signal to noise ratio compared to the surrounding peripheral tissue and the portal vein. Fluorescence IOC was based on rapid uptake of circulating ICG in plasma by hepatic cells, excretion of ICG into the bile and then its interaction with protein molecules in the bile. Moreover, fluorescence IOC was sensitive to detect bile duct ligation and acute bile duct perforation using ICG in rat models. All of the results indicated that fluorescence IOC using ICG is a valid alternative for the cholangiography of extrahepatic bile ducts and has potential for measurement of biliary dynamics.展开更多
Background:Intraparenchymal cerebral cavernous malformation is difficult to localize intraoperatively with conventional frameless navigation due to the"brain shift"effect.We conducted this study to evaluate ...Background:Intraparenchymal cerebral cavernous malformation is difficult to localize intraoperatively with conventional frameless navigation due to the"brain shift"effect.We conducted this study to evaluate the efficacy and safety of intraoperative magnetic resonance image(iMRl)-assisted neuro-port surgery for the resection of cerebral intraparenchymal cavernous malformation.Methods:Between April 2016 and December 2017,54 consecutive patients with intraparenchymal cerebral cavernous malformation who get surgical treatment in our hospital were enrolled into this study.Twenty-one patients were treated using iMRI-assisted neuro-port surgery(experiment group),and 33 patients underwent treatment by conventional microsurgery(control group).The iMRI was used in all cases for the compensation of the"brain shift"effect and keeping the navigation system up-to-date.The surgical resection rate,the total operation time,and the preoperative and postoperative Karnofsky Performance Status(KPS)scores were determined to evaluate the operative procedures.Results:There were no significant differences between the two groups in mean age,gender ratio,and volume of lesions(P>0.05).For the experiment group,the average duration of the procedure was 188.8 min with total resection of the lesions achieved in all 21 cases.For the control group,the average duration of the procedure was 238.2 min with total resection of the lesions achieved in 25 of 33 cases.The differences in the average duration of the procedure and the number of totally resected lesions between the two groups were statistically significant(P<0.05).Regarding postoperative neurological function,postoperative KPS scores for the experiment group were significantly higher than those of the control group(P=0.018).Conclusion:Our results show that iMRl-assisted neuro-port surgery is helpful for intraparenchymal cerebral cavernous malformation surgery.The method provides high accuracy and efficiency for lesion targeting and permits excellent anatomic orientation.With the assistance of iMRI technology,we achieved a higher resection rate and a lower incidence of postoperative neurological deficits.Additionally,iMRI is helpful for the compensation of the"brain shift"effect,and it can update the navigation system.展开更多
In this paper we propose a new method for evaluating image recording strategies for limited angle tomography. In limited angle tomography exact three-dimensional （3-D） reconstruction is not achievable. With this met...In this paper we propose a new method for evaluating image recording strategies for limited angle tomography. In limited angle tomography exact three-dimensional （3-D） reconstruction is not achievable. With this method a metric for the reachable reconstruction quality by defined X-ray source trajectories is calculated. The result of our method is independent of reconstruction algorithms. Our approach is based on the gradients of the scanned volume and their grade of determinability. Compared to simulated reconstruction accuracy with simultaneous algebraic reconstruction techniques, the method of evaluation shows the same dependencies on X-ray source trajectories. By using the proposed method different source trajectories for a limited angle range are comparable with respect to the reachable reconstruction quality.展开更多
文摘BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the use of both anteroposterior(AP)and lateral views—on surgical outcomes remains insufficiently studied.Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre(URTT)within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.AIM To evaluate how intraoperative imaging adequacy influences unplanned returnto-theatre rates,focusing on AP and lateral fluoroscopic views.METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022.Data on intraoperative imaging adequacy,screw placement,and URTT events were collected and statistically analyzed using IBM SPSS v23.Imaging adequacy was assessed based on the presence of both AP and lateral views,and outcomes were compared between imaging groups.RESULTS A total of 9016 pedicle screws were inserted,with 82 screws identified as malplaced in 52 patients.Of these,46 patients required URTT due to screw malplacement,with 37 returning within 90 days(URTT90).Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved,demonstrating the critical role of imaging adequacy in improving surgical outcomes.CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns,improves outcomes,enhances precision,and offers a cost-effective approach for better spinal surgery results.
基金supported by National Natural Science Foundation of China(NSFC)(61875092 and 11374167)State Key Project of Research and Development Plan(2016YFC0101002)+1 种基金Science and Technology Support Program of Tianjin(17YFZCSY00740)Fundamental Research Funds for the Central Universities of Nankai University(63191203).
文摘Histopathological examination is still the gold standard for diagnoses of oral-maxillofacial lesions,but it is invasive and time-consuming.Optical coherence tomography(OCT)provides a kind of noninvasive,label-free,real-time and high-resolution imaging technology.In this study,in order to assess the feasibility of OCT in oral clinical application,fresh excised tissue specimens from 59 patients undergoing oral-maxillofacial surgery were imaged in detail by using a benchtop sweptsource OCT system.It is shown that different lesions or tissues can be obviously distinguished based on their different microstructural features in OCT images,and the features are similar to those of their corresponding histopathological images.It is proven that OCT has great feasibility and potential as a diagnostic aid for surgeons in oral medicine.
基金supported by the Taishan Scholar Project(No.ts20190991,tsqn202211378)the Key R&D Project of Shandong Province(No.2022CXPT023)the General Program of National Natural Science Foundation of China(No.82371933)。
文摘Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.
基金supported by a Sponsored Research Agreement between ECU and Novadaq Technologies,Inc.,Toronto,Ontario,Canada
文摘Surgical revascularization with coronary artery bypass grafting(CABG) has become established as the most effective interventional therapy for patients with moderately severe and severe stable ischemic heart disease(SIHD). This recommendation is based on traditional 5-year outcomes of mortality and avoidance of myocardial infarction leading to reintervention and/or cardiac death. However, these results are confounded in that they challenge the traditional CABG surgical tenets of completeness of anatomic revascularization, the impact of arterial revascularization on late survival, and the lesser impact of secondary prevention following CABG on late outcomes. Moreover, the emergence of physiologic-based revascularization with percutaneous cardiovascular intervention as an alternative strategy for revascularization in SIHD raises the question of whether there are similar physiologic effects in CABG. Finally, the ongoing ISCHEMIA trial is specifically addressing the importance of the physiology of moderate or severe ischemia in optimizing therapeutic interventions in SIHD. So it is time to address the role that physiology plays in surgical revascularization. The long-standing anatomic framework for surgical revascularization is no longer sufficient to explain the mechanisms for short-term and long-term outcomes in CABG. Novel intraoperative imaging technologies have generated important new data on the physiologic blood flow and myocardial perfusion responses to revascularization on an individual graft and global basis. Long-standing assumptions about technical issues such as competitive flow are brought into question by real-time visualization of the physiology of revascularization. Our underestimation of the impact of Guideline Directed Medical Therapy, or Optimal Medical Therapy, on the physiology of preoperative SIHD, and the full impact of secondary prevention on post-intervention SIHD, must be better understood. In this review, these issues are addressed through the perspective of multi-arterial revascularization in CABG, which is emerging(after 30 years) as the "standard of care" for CABG. In fact, it is the physiology of these arterial grafts that is the mechanism for their impact on long-term outcomes in CABG. Moreover, a better understanding of all of these preoperative, intraoperative and postoperative components of the physiology of revascularization that will generate the next, more granular body of knowledge about CABG, and enable surgeons to design and execute a better surgical revascularization procedure for patients in the future.
文摘Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.
基金Beijing You’an Hospital Affiliated to Capital Medical University Youth Talent Incubation Project(BJYAYYYN2022-25)
文摘Objective To explore the value of clinical application of a navigation system with three-dimensional(3D)imaging for thermal ablation of liver tumors.Methods The study cohort comprised 60 patients who underwent computer tomography-(CT)guided thermal ablation(radiofrequency or microwave ablation)of liver tumors in our department from August 2021 to October 2022.A random envelope method was used to allocate the study patients randomly to two groups of 30 patients each:a navigation and a control group.An intraoperative 3D imaging navigation system with CT guidance was used in the navigation group,whereas traditional CT guidance was used in the control group.During the thermal ablation process,the number of puncture needle adjustments,time to target puncture,and number of CT scans were recorded and compare between the two groups.Results The average number of punctures and needle adjustments was significantly lower in the navigation group(2.7±1.1 mins)than in the control group(4.9±3.7 mins).The average time taken to puncture the target was significantly shorter in the navigation group(11.3±4.2 mins)than in the control group(15.5±4.8 mins).There average number of CT scans was significantly smaller in the navigation group(4.5±1.6)than in the control group(8.4±4.5)(all P<0.05).Conclusion Use of an intraoperative 3D imaging navigation system in thermal ablation of liver tumors can improve the accuracy of tumor thermal ablation puncture and reduce the number of punctures,number of CT scans,and average puncture time.Such systems can play an important role in the clinic.
文摘Objective:Indocyanine green(ICG)with near-infrared fluorescence absorption is approved by the United States Food and Drug Administration for clinical applications in angiography,blood flow evaluation,and liver function assessment.It has strong optical absorption in the near-infrared region,where light can penetrate deepest into biological tissue.We sought to review its value in guiding prostate cancer treatment.Methods:All related literature at PubMed from January 2000 to December 2020 were reviewed.Results:Multiple preclinical studies have demonstrated the usefulness of ICG in identifying prostate cancer by using different engineering techniques.Clinical studies have demonstrated the usefulness of ICG in guiding sentinel node dissection during radical prostatectomy,and possible better preservation of neurovascular bundle by identifying landmark prostatic arteries.New techniques such as adding fluorescein in additional to ICG were tested in a limited number of patients with encouraging result.In addition,the use of the ICG was shown to be safe.Even though there are encouraging results,it does not carry sufficient sensitivity and specificity in replacing extended pelvic lymph node dissection during radical prostatectomy.Conclusion:Multiple preclinical and clinical studies have shown the usefulness of ICG in identifying and guiding treatment for prostate cancer.Larger randomized prospective studies are warranted to further test its usefulness and find new modified approaches.
基金supported in part by a grant from the U.S.National Institutes of Health,R01 EB012479(S.A.B.).
文摘Pre-operative X ray mammography and int raoperative X-ray specimen radiography are routinely used to identify breast cancer pathology.Recent advances in optical coherence tomography(OCT)have enabled its 1use for the intraoperative assessment of surgical margins during breast cancer surgery.While each modality offers distinct contrast of normal and pathological features,there is an essential need to correlate image based features between the two modalities to take adv antage of the diagnostic capabilities of each technique.We compare OCT to X-ray images of resected human breast tissue and correlate different tissue features between modalities for future use in real-tine intraoperative OCT imaging.X ray imaging(specimen radiography)is currently used during surgical breast cancer procedures to verify tumor margins,but cannot image tissue in situ.OCT has the potential to solve this problem by providing intrao-perative imaging of the resected specimen as well as the in situ tumor cavity.OCT and micro-CT(X-ray)images are automatically segmented using different computational approaches,and quantitatively compared to determine the ability of these algorithms to automat ically differentiate regions of adipose tissue from tumor.Furthermore,two-dimensional(2D)and three-dimensional(3D)results are compared.These correlations,combined with real-time intraoperative OCT,have the potential to identify possible regions of tumor within breast tissue which correlate to tumor regions identified previously on X-ray imaging(mammography or specimen radiography).
基金Part of the technical equipment for data analysis was funded by Project nr:BGAAF-0839The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013)The study was approved by institutional ethics committee of the University of Leipzig(No.AZ:Nr:111–1614,032,016)。
文摘Background:The most common causes of early graft loss in pancreas transplantation are insufficient blood supply and leakage of the intestinal anastomosis.Therefore,it is critical to monitor graft perfusion and oxygenation during the early post-transplant period.The goal of our pilot study was to evaluate the utility of hyperspectral imaging(HSI)in monitoring the microcirculation of the graft and adequate perfusion of the intestinal anastomosis during pancreatic allotransplantation.Methods:We imaged pancreatic grafts and intestinal anastomosis in real-time in three consecutive,simultaneous pancreas-kidney transplantations using the TIVITA®HSI system.Further,the intraoperative oxygen saturation(StO_(2)),tissue perfusion(near-infrared perfusion index,NIR),organ hemoglobin index(OHI),and tissue water index(TWI)were measured 15 minutes after reperfusion by HSI.Results:All pancreas grafts showed a high and homogeneous StO_(2)(92.6%±10.45%).Intraoperative HSI analysis of the intestinal anastomosis displayed significant differences of StO_(2)(graft duodenum 67.46%±5.60%vs.recipient jejunum:75.93%±4.71%,P<0.001)and TWI{graft duodenum:0.63±0.09[I(Index)]vs.recipient jejunum:0.72±0.09[I],P<0.001}.NIR and OHI did not display remarkable differences{NIR duodenum:0.68±0.06[I]vs.NIR jejunum:0.69±0.04[I],P=0.747;OHI duodenum:0.70±0.12[I]vs.OHI jejunum:0.68±0.13[I],P=0.449}.All 3 patients had an uneventful postoperative course with one displaying a Banff 1a rejection which was responsive to steroid treatment.Conclusions:Our study shows that contact-free HSI has potential utility as a novel tool for real-time monitoring of human pancreatic grafts after reperfusion,which could improve the outcome of pancreas transplantation.Further investigations are required to determine the predictive value of intraoperative HSI imaging.
基金This study was supported by grants of the Ministry of Health of China （2010-2012）, National Natural Science Foundation of China （No. 81071117, No. 81171295）, and Shanghai Municipal Health Bureau （No. XBR2011022）. Conflicts of interest： none.
文摘Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China. Methods From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency. Results All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas （n=161） was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients （12.42%） suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients （3.16%）. Twenty-one of 161 patients （13.04%） had early speech deficit and late speech deficit was only observed in six of 158 patients （3.80%）. The ratio of gross total resection for pituitary adenomas （n=49） was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy. Conclusion The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.
基金This study was supported by the National NaturalScience Foundation (NCSF) of China (81271515)The Science Technological Innovation Nursery Fundof PLA General Hospital (16KMM14).
文摘Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Methods: Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative“visu-alization”of surrounding eloquent structures,“brain shift”corrections, and navigational plan updates. Results: All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely deterred locating of the lesions;however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Conclusions: Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.
基金Clinical Research Fostering Fund of Chinese PLA General Hospital in China,No.2017FC-TSYS-2012(to FYL)Youth Program of the Natural Science Foundation of Hainan Province of China,No.819QN378(to FYL)+2 种基金the National Natural Science Foundation of China,No.81771481(to XLC)China National Key R&D Program,No.2018YFC1312602(to XLC)National Clinical Research Center for Geriatric Diseases of China,No.NCRCGPLAGH-2017007(to XLC)。
文摘The arcuate fasciculus is a critical component of the neural substrate of human language function.Surgical resection of glioma adjacent to the arcuate fasciculus likely damages this region.In this study,we evaluated the outcome of surgical resection of glioma adjacent to the arcuate fasciculus under the guidance of magnetic resonance imaging and diffusion tensor imaging,and we aimed to identify the risk factors for postoperative linguistic deficit.In total,54 patients with primary glioma adjacent to the arcuate fasciculus were included in this observational study.These patients comprised 38 men and 16 women(aged 43±11 years).All patients underwent surgical resenction of glioma under the guidance of magnetic resonance imaging and diffusion tensor imaging.Intraoperative images were updated when necessary for further resection.The gross total resection rate of the 54 patients increased from 38.9%to 70.4%by intraoperative magnetic resonance imaging.Preoperative language function and glioma-to-arcuate fasciculus distance were associated with poor language outcome.Multivariable logistic regression analyses showed that glioma-to-arcuate fasciculus distance was the major independent risk factor for poor outcome.The cutoff point of glioma-to-arcuate fasciculus distance for poor outcome was 3.2 mm.These findings suggest that intraoperative magnetic resonance imaging combined with diffusion tensor imaging of the arcuate fasciculus can help optimize tumor resection and result in the least damage to the arcuate fasciculus.Notably,glioma-to-arcuate fasciculus distance is a key independent risk factor for poor postoperative language outcome.This study was approved by the Ethics Committee of the Chinese PLA General Hospital,China(approval No.S2014-096-01)on October 11,2014.
基金partially sponsored by Natural Science Foundation of Hubei Province,China(No.2015CFB688)
文摘Fluorescence intraoperative cholangiography（IOC） is a potential alternative for identifying anatomical variation and preventing iatrogenic bile duct injuries by using the near-infrared probe indocyanine green（ICG）. However, the dynamic process and mechanism of fluorescence IOC have not been elucidated in previous publications. Herein, the optical properties of the complex of ICG and bile, dynamic fluorescence cholangiography and iatrogenic bile duct injuries were investigated. The emission spectrum of ICG in bile peaked at 844 nm and ICG had higher tissue penetration. Extrahepatic bile ducts could fluoresce 2 min after intravenous injection, and the fluorescence intensity reached a peak at 8 min. In addition, biliary dynamics were observed owing to ICG excretion from the bile ducts into the duodenum. Quantitative analysis indicated that ICG-guided fluorescence IOC possessed a high signal to noise ratio compared to the surrounding peripheral tissue and the portal vein. Fluorescence IOC was based on rapid uptake of circulating ICG in plasma by hepatic cells, excretion of ICG into the bile and then its interaction with protein molecules in the bile. Moreover, fluorescence IOC was sensitive to detect bile duct ligation and acute bile duct perforation using ICG in rat models. All of the results indicated that fluorescence IOC using ICG is a valid alternative for the cholangiography of extrahepatic bile ducts and has potential for measurement of biliary dynamics.
文摘Background:Intraparenchymal cerebral cavernous malformation is difficult to localize intraoperatively with conventional frameless navigation due to the"brain shift"effect.We conducted this study to evaluate the efficacy and safety of intraoperative magnetic resonance image(iMRl)-assisted neuro-port surgery for the resection of cerebral intraparenchymal cavernous malformation.Methods:Between April 2016 and December 2017,54 consecutive patients with intraparenchymal cerebral cavernous malformation who get surgical treatment in our hospital were enrolled into this study.Twenty-one patients were treated using iMRI-assisted neuro-port surgery(experiment group),and 33 patients underwent treatment by conventional microsurgery(control group).The iMRI was used in all cases for the compensation of the"brain shift"effect and keeping the navigation system up-to-date.The surgical resection rate,the total operation time,and the preoperative and postoperative Karnofsky Performance Status(KPS)scores were determined to evaluate the operative procedures.Results:There were no significant differences between the two groups in mean age,gender ratio,and volume of lesions(P>0.05).For the experiment group,the average duration of the procedure was 188.8 min with total resection of the lesions achieved in all 21 cases.For the control group,the average duration of the procedure was 238.2 min with total resection of the lesions achieved in 25 of 33 cases.The differences in the average duration of the procedure and the number of totally resected lesions between the two groups were statistically significant(P<0.05).Regarding postoperative neurological function,postoperative KPS scores for the experiment group were significantly higher than those of the control group(P=0.018).Conclusion:Our results show that iMRl-assisted neuro-port surgery is helpful for intraparenchymal cerebral cavernous malformation surgery.The method provides high accuracy and efficiency for lesion targeting and permits excellent anatomic orientation.With the assistance of iMRI technology,we achieved a higher resection rate and a lower incidence of postoperative neurological deficits.Additionally,iMRI is helpful for the compensation of the"brain shift"effect,and it can update the navigation system.
基金Supported by the German Federal Ministry of Education and Research (No.01EZ0839)
文摘In this paper we propose a new method for evaluating image recording strategies for limited angle tomography. In limited angle tomography exact three-dimensional （3-D） reconstruction is not achievable. With this method a metric for the reachable reconstruction quality by defined X-ray source trajectories is calculated. The result of our method is independent of reconstruction algorithms. Our approach is based on the gradients of the scanned volume and their grade of determinability. Compared to simulated reconstruction accuracy with simultaneous algebraic reconstruction techniques, the method of evaluation shows the same dependencies on X-ray source trajectories. By using the proposed method different source trajectories for a limited angle range are comparable with respect to the reachable reconstruction quality.
