Immunosuppression by Mutated Calreticulin Released from Malignant Cells.

Mutations affecting exon 9 of the CALR gene lead to the generation of a C-terminally modified calreticulin (CALR) protein that lacks the KDEL endoplasmic reticulum (ER) retention signal and consequently mislocalizes outside of the ER where it activates the thrombopoietin receptor in a cell-autonomous fashion, thus driving myeloproliferative diseases. Here, we used the retention using selective hooks (RUSH) assay to monitor the trafficking of CALR. We found that exon-9-mutated CALR was released from cells in response to the biotin-mediated detachment from its ER-localized hook, in vitro and in vivo. Cellular CALR release was confirmed in suitable mouse models bearing exon-9-mutated hematopoietic systems or tumors. Extracellular CALR mediated immunomodulatory effects and inhibited the phagocytosis of dying cancer cells by dendritic cells (DC), thereby suppressing antineoplastic immune responses elicited by chemotherapeutic agents or by PD-1 blockade. Altogether, our results demonstrate paracrine immunosuppressive effects for exon-9-mutated CALR.

Ingestion of fishing gear and Anisakis sp. infection in a beached Indo-Pacific finless porpoise (Neophocaena phocaenoides) in the Jeju Island, Republic of Korea: findings from post-mortem computed tomography and necropsy.

BACKGROUND: Human fishing activities have significantly affect environmental concern for marine ecosystems, conservation of marine mammals, and human health. Coastal cetaceans are highly vulnerable to ingestion of fishing gear, bycatching, or entanglement, all of which can be fatal for these animals. In particular, certain coastal dolphins and porpoises are heavily impacted by fishing gear such as angling gear or stownet, as their food often overlap with the target fish species of human fisheries. CASE PRESENTATION: This study presents a case of an Indo-Pacific finless porpoise (Neophocaena phocaenoides) beached on the coast of Jeju Island, Republic of Korea, with ingestion of fishing gear and severe Anisakis infection. Although this species inhabits waters ranging from the Persian Gulf to Taiwan, several stranded carcasses have been reported on Jeju Island in recent years. Post-mortem computed tomography revealed a bundle of four fishing hooks in the forestomach, along with nylon lines and steel lines with connectors, which were assumed to be angling gear for Jeju hairtail (Trichiurus lepturus). Further necroscopic investigation revealed that the forestomach contained a large number of Anisakis spp. (Nematoda: Anisakidae). Histological examination revealed a thickened forestomach wall with pinpoint and volcanic ulcerations, a thickened layer of stratified squamous epithelium, and infiltrated stroma in the squamous epithelium. CONCLUSIONS: This study emphasizes the urgent need to address the impact of fishing activities on marine mammals, marine litter pollution, and the bycatch problem in Korean seawater. In addition, the occurrence of N. phocaenoides in seawater around Jeju Island should be raised in future geographical ecology or veterinary pathology studies and when its distribution is updated.

Proximal junctional kyphosis after adult spinal deformity operated patients with long fusion to the pelvis. Does the type of proximal anchor matter?

PURPOSE: To assess, in a large population of Adult Spinal Deformity (ASD) patients, the true interest of varying the upper anchors as a protective measure against Proximal Junctional Kyphosis (PJK), by analyzing and comparing 2 groups of patients defined according to their proximal construct. Another objective of the study is to look for any other factors, radiological or clinical, that would affect the occurrence of the proximal failure. METHODS: Retrospective review of a prospective ASD database collected from 5 centers. Inclusion criteria were age of at least 18 years, presence of a spinal deformity with instrumentation from T12 or above to the pelvis, with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Multiple logistic regression analysis was performed to identify the risk factors that would affect the occurrence of PJK. RESULTS: 254 patients were included. 166 in the group "screws proximally" (SP) and 88 in the group "hooks proximally" (HP). There was no difference between both groups for PJK (p = 0.967). The occurrence of PJK was rather associated with greater age and BMI, higher preoperative kyphosis, worst preoperative SRS22 and SF36 scores, greater postoperative Sagittal Vertical Axis (SVA), coronal malalignment and kyphosis. CONCLUSION: The use of proximal hooks was not effective to prevent PJK after ASD surgery, when compared to proximal screws. Worse preoperative functional outcomes and worse postoperative sagittal and also coronal malalignment were the main drivers for the occurrence of PJK regardless the type of proximal implant.

Efficacy of Using Maryland Forceps Versus Electrocoagulation Hooks in RATS Lung Cancer Surgery: A Propensity Score-Matched Study.

BACKGROUND: Here we compare the difference in recent outcomes between the use of Maryland forceps (MF) and electrocoagulation hooks (EH) in robotic-assisted thoracoscopic radical lung cancer resection. PATIENTS AND METHODS: We retrospectively analyze the clinical data of 247 patients with lung cancer who underwent robotic-assisted thoracoscopic surgery from February 2018 to December 2022. On the basis of the intraoperative use of energy devices, we divided the clinical data into two groups, including 84 cases in the MF group and 163 cases in the EH group, respectively. The patients in the two groups were matched with propensity score matching analysis, and further, the perioperative clinical data of the two groups were compared. RESULTS: Compared with the EH group, patients in the MF group had shorter operative time, lesser intraoperative bleeding, shorter postoperative drainage time, and shorter postoperative hospital stay (P < 0.05). By comparing the intraoperative and postoperative complications in the two groups, it was found that the incidence of intraoperative lymph node fragmentation, the incidence of postoperative celiac disease, and the incidence of postoperative food choking were significantly lower in the MF group than that in the EH group. The increase of CRP, IL-6, IL-8, and TNF-α levels in the MF group was less than that in the EH group. CONCLUSIONS: The use of MF in robotic-assisted thoracoscopic radical lung cancer surgery is safe and effective, with advantages in lymph node dissection, reduced surgical trauma, and fewer postoperative complications.

Efficacy of using Maryland forceps versus electrocoagulation hooks in da Vinci robot-assisted thoracoscopic mediastinal tumor resection.

BACKGROUND: To compare the difference of short-term curative effect between the use of Maryland forceps (MF) and electrocoagulation hooks (EH) in da Vinci robot-assisted thoracoscopic mediastinal tumor resection. METHODS: Retrospectively analyze 84 patients with mediastinal tumors who underwent robot-assisted thoracoscopic surgery (RATS) at the Department of Thoracic Surgery in Gansu Provincial Hospital from February 2019 to February 2023. Two groups were divided according to the intraoperative use of energy devices, including 41 cases in the MF group and 43 cases in the EH group. Perioperative clinical data was gathered to compare the short-term efficacy of patients in both groups. RESULTS: There were no significant differences in baseline characteristics such as sex (P = 0.685), age (P = 0.165), and tumor size (P = 0.339) between the two groups. Compared with the EH group, patients in the MF group have shorter operative time (P = 0.030), less intraoperative bleeding (P = 0.010), less total postoperative drainage volume (P = 0.001), shorter postoperative drainage time (P = 0.022), shorter hospital stay (P = 0.019), and lower levels of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and cortisol. No statistically significant differences were found between the two groups in terms of total hospitalization costs (P = 0.123), postoperative visual analog scale (VAS) pain scores (P = 0.064), and postoperative complications (P = 0.431). CONCLUSION: Using MF in RATS for mediastinal tumor is safe and effective, which can reduce the amount of bleeding, reduce the degree of inflammatory reaction, and conducive to the quick recovery of patients.

Incomplete meniscal healing in early second-look arthroscopy does not indicate failure of repair: a case series.

PURPOSE: To assess if incomplete meniscal healing during second-look arthroscopy at six to eight weeks after all-inside suture hook meniscus repair results in longer-term failure of repair in patients with restored knee stability. METHODS: From 2008 to 2013, 41 patients with post-traumatic, longitudinal, vertical, complete meniscal tears with concomitant ACL injury were treated via a two-stage surgical procedure and prospectively evaluated. In the first stage, all-inside meniscus repair was performed using suture hook passers and non-absorbable sutures. In total, there were 26 medial and 16 lateral meniscus tears. A second-stage ACL reconstruction, performed six to eight weeks later, served as an early second-look arthroscopic evaluation of meniscal healing. Clinical follow-up was performed at a minimum of 24 months. RESULTS: Second-look arthroscopy revealed 31 cases (75.6%) of complete and ten cases (24.4%) of incomplete meniscal healing. Two patients were lost prior to follow-up, and three were excluded due to recurrent instability. Therefore, 36 patients were assessed at the final follow-up. All patients with complete meniscal healing during second-look arthroscopy achieved clinical success at follow-up. Six out of nine (66.7%) of patients with incomplete meniscal healing during second-look arthroscopy achieved clinical success at follow-up (p = 0.012). One saphenous neuropathy occurred (2.4%). CONCLUSION: Incomplete meniscal healing during early second-look arthroscopy after all-inside meniscal repair using suture hook passers and non-absorbable sutures did not necessarily result in longer-term failure in patients with restored knee stability. The described method of meniscal repair was associated with a low rate of symptomatic re-tears and complications.

Direct trafficking pathways from the Golgi apparatus to the plasma membrane.

In eukaryotic cells, protein sorting is a highly regulated mechanism important for many physiological events. After synthesis in the endoplasmic reticulum and trafficking to the Golgi apparatus, proteins sort to many different cellular destinations including the endolysosomal system and the extracellular space. Secreted proteins need to be delivered directly to the cell surface. Sorting of secreted proteins from the Golgi apparatus has been a topic of interest for over thirty years, yet there is still no clear understanding of the machinery that forms the post-Golgi carriers. Most evidence points to these post-Golgi carriers being tubular pleomorphic structures that bud from the trans-face of the Golgi. In this review, we present the background studies and highlight the key components of this pathway, we then discuss the machinery implicated in the formation of these carriers, their translocation across the cytosol, and their fusion at the plasma membrane.

Computational Study on E-Hooks of Tubulins in the Binding Process with Kinesin.

Cargo transport within cells is essential to healthy cells, which requires microtubules-based motors, including kinesin. The C-terminal tails (E-hooks) of alpha and beta tubulins of microtubules have been proven to play important roles in interactions between the kinesins and tubulins. Here, we implemented multi-scale computational methods in E-hook-related analyses, including flexibility investigations of E-hooks, binding force calculations at binding interfaces between kinesin and tubulins, electrostatic potential calculations on the surface of kinesin and tubulins. Our results show that E-hooks have several functions during the binding process: E-hooks utilize their own high flexibilities to increase the chances of reaching a kinesin; E-hooks help tubulins to be more attractive to kinesin. Besides, we also observed the differences between alpha and beta tubulins: beta tubulin shows a higher flexibility than alpha tubulin; beta tubulin generates stronger attractive forces (about twice the strengths) to kinesin at different distances, no matter with E-hooks in the structure or not. Those facts may indicate that compared to alpha tubulin, beta tubulin contributes more to attracting and catching a kinesin to microtubule. Overall, this work sheds the light on microtubule studies, which will also benefit the treatments of neurodegenerative diseases, cancer treatments, and preventions in the future.

mTOR controls endoplasmic reticulum-Golgi apparatus trafficking of VSVg in specific cell types.

BACKGROUND: Mammalian/mechanistic target of rapamycin (mTOR) complexes are essential for cell proliferation, growth, differentiation, and survival. mTORC1 hyperactivation occurs in the tuberous sclerosis complex (TSC). mTORC1 localizes to the surface of lysosomes, where Rheb activates it. However, mTOR was also found on the endoplasmic reticulum (ER) and Golgi apparatus (GA). Recent studies showed that the same inputs regulate ER-to-GA cargo transport and mTORC1 (e.g., the level of amino acids or energy status of the cell). Nonetheless, it remains unknown whether mTOR contributes to the regulation of cargo passage through the secretory pathway. METHODS: The retention using selective hooks (RUSH) approach was used to image movement of model cargo (VSVg) between the ER and GA in various cell lines in which mTOR complexes were inhibited. We also investigated VSVg trafficking in TSC patient fibroblasts. RESULTS: We found that mTOR inhibition led to the overall enhancement of VSVg transport through the secretory pathway in PC12 cells and primary human fibroblasts. Also, in TSC1-deficient cells, VSVg transport was enhanced. CONCLUSIONS: Altogether, these data indicate the involvement of mTOR in the regulation of ER-to-GA cargo transport and suggest that impairments in exocytosis may be an additional cellular process that is disturbed in TSC.

Pathological effects of Cichlidogyrus philander Douëllou, 1993 (Monogenea, Ancyrocephalidae) on the gills of Pseudocrenilabrus philander (Weber, 1897) (Cichlidae).

Histopathological changes of Cichlidogyrus philander Douëllou, 1993 on the gills of Pseudocrenilabrus philander (Weber, 1897) were studied using light and scanning electron microscopy. Observations revealed that C. philander attaches to its host by alternating the prohaptor (for temporary attachment or feeding) or haptor (using haptoral parts for firm and secured attachment). The sharp terminal ends of the anchors are inserted basally into the gill lamella, between two adjacent secondary gill lamellae and the marginal hooklets assist by superficially penetrating, holding and lifting epithelial tissue in the proximal region of the secondary gill lamella. The attachment of C. philander resulted in compression, rupturing of the interlamellar epithelium, change in the organization of epithelial cells in both primary and secondary gill lamella, displacement of the extracellular cartilaginous matrix, occasional rupturing of blood vessels and erythrocytes and some cells becoming ill-defined. At the site of attachment, the host response comprises of hyperplasia, increase in the number of mucous cells and infiltration with neutrophils. It was concluded that the effect of C. philander is mild in natural conditions.

Small-scale fishers' perception of the implementation of the EU Landing Obligation regulation in the outermost region of the Azores.

The archipelago of the Azores (mid-north Atlantic Ocean) is an outermost region of the European Union (EU) in which small-scale fisheries are a strong component of the local economy. Bottom longlining and handlining are the most important Azorean fisheries in landing values, fishing vessels and fishers. Despite their high selectivity and low discards, these fisheries can be highly impacted by the implementation of the Landing Obligation (LO). Semi-structured interviews were conducted with Azorean small-scale fishers to document their perceptions about discards and the LO, and to ascertain the mitigation measures they already implement or could further implement to avoid unwanted catch. Results suggest that most fishers strongly oppose the LO, perceiving it as inadequate to their fisheries. Several discard avoidance measures are already commonly used by most fishers, of which hook size and changing areas where there are too many undersized or over-quota individuals, are believed to be the most efficient. Additional measures to further improve selectivity and avoid unwanted catch appear limited. The recent conversion of many bottom longliners to handlining and the exemptions foreseen as part of the LO for the region might help Azorean fishers to mitigate the potential impacts of the LO.

First molecular identification of hydatid tapeworm Echinococcus granulosus sensu lato G6/G7 in Ecuador.

Echinococcosis is a zoonotic parasitic illness that can cause significant disabilities, and even death for sick people. The disease is caused by the larval stage of cestodes belonging to the Echinococcus genus. In this study, multiple hydatid cysts were excised from an infected porcine liver. The identification of the parasitic species was made by the morphometric assessment of rostellar hooks and molecular detection of ribosomal DNA extant in protoscoleces of the hydatid sand. Rostellar hooks presented an average length of 27.4 µm by optical microscopy. Parasite DNA were detected in samples of hydatid sediment and positive controls by polymerase chain reaction. In conclusion, Echinococcus granulosus was recognized in samples of porcine hydatid cysts by microscopic observation, and the E. granulosus sensu lato strain E. canadensis G6/G7 was identified by molecular assay.

Climbing plants: attachment adaptations and bioinspired innovations.

Climbing plants have unique adaptations to enable them to compete for sunlight, for which they invest minimal resources for vertical growth. Indeed, their stems bear relatively little weight, as they traverse their host substrates skyward. Climbers possess high tensile strength and flexibility, which allows them to utilize natural and manmade structures for support and growth. The climbing strategies of plants have intrigued scientists for centuries, yet our understanding about biochemical adaptations and their molecular undergirding is still in the early stages of research. Nonetheless, recent discoveries are promising, not only from a basic knowledge perspective, but also for bioinspired product development. Several adaptations, including nanoparticle and adhesive production will be reviewed, as well as practical translation of these adaptations to commercial applications. We will review the botanical literature on the modes of adaptation to climb, as well as specialized organs-and cellular innovations. Finally, recent molecular and biochemical data will be reviewed to assess the future needs and new directions for potential practical products that may be bioinspired by climbing plants.

Echinococcus multilocularis (Cestoda, Cyclophyllidea, Taeniidae): origin, differentiation and functional ultrastructure of the oncospheral tegument and hook region membrane.

Both the oncospheral tegument and the hook region membrane (HRM) of Echinococcus multilocularis hexacanths originate from a syncytial binucleate complex that appears in the early stage of morphogenesis and organogenesis of the hexacanth larva. The primordium of this binucleate complex forms a binucleate syncytial cap or "calotte" situated beneath the inner envelope at one pole of the developing embryo. During oncospheral differentiation, the binucleate perikaryon of the syncytial cap is sunk progressively deeper into the central part of the embryo, but remains always connected with the distal cytoplasm by a tendrillar cytoplasmic connection or bridge. Following migration or sinking of the binucleate perikaryon, numerous cytoplasmic vesicles appear in the distal cytoplasm. These vesicles fuse progressively together and form a single large cavity or lacuna. The walls of this cavity are becoming at this point the walls of two delaminated layers: (1) the distal anucleated cytoplasmic layer is transformed into the oncospheral tegument and (2) the proximal thin cytoplasmic layer is transformed into the "hook region membrane". This delamination of the initially compact layer of distal cytoplasm into two layers seems to be closely associated with differentiation of oncospheral hooks, the elongating blades of which protrude progressively into a newly formed cavity. The pressure of hook blades on the hook region membrane appears to facilitate its further separation from the basal layer of distal cytoplasm which is transformed into the peripheral layer of oncospheral tegument. In the mature oncosphere, the surface of this peripheral layer forms a regular brush border of cytoplasmic processes or microvilli and represents the true body covering of the hexacanth. The very thin cytoplasmic connection between the peripheral layer of tegument and binucleate perikaryon appears only very seldom in the ultrathin sections as a narrow cytoplasmic strand and has a plasma membrane that is reinforced by a single row of cortical microtubules. The HRM covers only one pole of the oncosphere and is attached to the oncosphere surface. The HRM is clearly visible in the mature oncosphere and is draped over the hook blades, the sharp points of which are protected by moderately electron-dense caps. Comparison of the above morphology with that of TEM study of the tegument of adult cestodes shows a great similarity as well as homology in the body covering of both larval and adult cestodes.

Development of secondary sexual characters and their relationship to ontogeny and seasonal reproductive period in Hyphessobrycon igneus (Ostariophysi: Characiformes).

Sexual dimorphism in size, anal-fin shape and coloration of Hyphessobrycon igneus, Characidae, were examined. Males were more frequent at larger body sizes, confirming body size as a sexually dimorphic trait. Anal-fin shape and the colour of all fins were the same for females and juveniles, differing only in adult males. Likewise, only adult males had bony hooks on fin rays; larger and more sexually mature males had the most numerous and developed hooks and hooks were most developed in degree and number during peak reproductive periods. Fin hooks regressed in number and developmental degree after the reproductive period, but restarted development with the beginning of the new reproductive period without completely disappearing. Results show that bony hooks have a development and regression cycle related to reproductive seasonality.

A pedicle screw system and a lamina hook system provide similar primary and long-term stability: a biomechanical in vitro study with quasi-static and dynamic loading conditions.

PURPOSE: For the stabilization of the thoracolumbar spine area, various stabilization techniques have been developed in recent decades. The aim of these techniques is to immobilize the treated segment to repositioning or correct the spine and guaranty long-term stability to achieve a reliable fusion. The aim of this study was to simulate in an in vitro experiment the postoperative long-term situation in elderly osteoporotic patients to compare two different stabilization principles; a pedicle screw system and a lamina hook system. METHODS: Two comparable groups with respect to age and bone mineral density with each n = 6 fresh-frozen human, bi-segmental thoracolumbar spine specimens (T11-L1) were used. Antero-posterior and lateral radiographs were taken before the test, to assess the spinal status. Then the intact specimens were biomechanically characterized with pure moments in the three anatomical planes in different states in terms of range of motion and neutral zone. After implantation of either, a pedicle screw system or a lamina hook system, the primary stability was determined under the same conditions. Subsequently the specimens were cyclically loaded under complex loading, using a custom-made set-up in a dynamic materials testing machine with increasing moments from 3 to 66 Nm until 100,000 cycles or until one of the three defined "failure" criteria was reached. (1) A failure of a bony structure. (2) Exceeding of the threefold ROM of the primary stability after implantation in flexion plus extension. (3) Reaching of the ROM based on the intact state before implantation both in flexion plus extension. RESULTS: The results showed that the ROM was strongly reduced after instrumentation similar for both implant systems in all motion planes. The highest stabilization was found in flexion/extension. During cyclic loading with increasing moments, the ROM increased continuously for both systems. The number of load cycles until one of the failure criteria was reached varied only slightly between the two groups. In the pedicle screw group 30,000 (median) loading cycles (range 5000-80,000) with a corresponding moment of 24 Nm (range 9-54) could be reached. In the lamina hook group 32,500 load cycles (range 20,000-45,000) could be achieved with a corresponding moment of 25.5 Nm (range 18-33). There was a slight trend that the pedicle screw system is influenced more by bone mineral density. CONCLUSION: Both implant systems provide similar primary stability and similar long-term stability. In the pedicle screw group, there was a stronger correlation between bone mineral density and the reached number of load cycles.

HOOK ASSISTED REDUCTION IN CEPHALOMEDULLARY NAILING WITHOUT TRACTION TABLE.

Introduction: Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern. We aimed to overcome this difficulty with the hook. Materials and Methods: A retrospective study of 60 patients. 28 of the patients reduction was necessitated with a hook (group 1). The other patients did not need to use this technique (group 2, n=32). The collo-diaphyseal angle, lag screw placement, and tip-apex distance were measured using radiographs. Results: There were statistically significant differences between the two groups regarding the Garden Alignment Index, postoperative collo-diaphyseal angle measurements, and tip-apex distance. The Garden Alignment Index was found as 163.92 degrees (dg.) In the frontal plane in group 1, and 154.78 dg in group 2, respectively. In group 1, the tip-apex distance was 16.05 cm, whereas it was 25.32 cm in group 2. The collo-diaphyseal angle was 133.1º in group 1, and 128.65º in group 2. Conclusions: The hook-assisted reduction is beneficial when operating without a traction table; however, it can also be a part of the surgeons' equipment even when operating on a traction table. When difficulties in obtaining an ideal anatomical reduction in displaced intertrochanteric femoral fractures, we suggest using the hook-assisted reduction technique. Level of Evidence III; Case-control Study.

Introdução: Frequentemente, a fixação do fêmur proximal para fratura intertrocantérica do fêmur sem uma mesa de tração é um procedimento desafiador, especialmente se o padrão da fratura for complicado. O objetivo foi superar essa dificuldade utilizando um gancho. Materiais e métodos: Trata-se de um estudo retrospectivo de 60 pacientes. Em 28 desses, a redução foi necessária com um gancho (grupo 1). Os outros pacientes não precisaram usar essa técnica (grupo 2, n=32). O ângulo colo-diafisário, a colocação do parafuso lag e a distância ponta-ápice foram medidos por meio de radiografias. Resultados: Houve diferenças estatisticamente significativas entre os dois grupos com relação ao Índice de Alinhamento de Garden, às medidas do ângulo colo-diafisário pós--operatório e à distância ponta-ápice. O índice de alinhamento de Garden foi de 163,92 graus (dg.) No plano frontal no grupo 1 e 154,78 dg no grupo 2, respectivamente. No grupo 1, a distância ponta-ápice foi de 16,05 cm, enquanto no grupo 2 foi de 25,32 cm. O ângulo colo-diafisário foi de 133,1 graus no grupo 1 e 128,65 graus no grupo 2. Conclusão: A redução assistida por gancho é benéfica quando se opera sem uma mesa de tração; no entanto, ela também pode fazer parte do equipamento do cirurgião mesmo quando se opera em uma mesa de tração. Quando houver dificuldades em obter uma redução anatômica ideal em fraturas femorais intertrocantéricas deslocadas, sugerimos o uso da técnica de redução assistida por gancho. Nível de Evidência III; Estudo de Caso-controle.

Comparative analysis of medical glue and positioning hooks for preoperative localization of pulmonary nodules.

Background: Through preoperative localization, surgeons can easily locate ground glass nodules (GGNs) and effectively control the extent of resection. Therefore, it is necessary to choose an appropriate puncture positioning method. The purpose of this study was to evaluate the effectiveness and safety of medical glue and positioning hooks in the preoperative positioning of GGNs and to provide a reference for clinical selection. Methods: From March 30, 2020 to June 13, 2022, a total of 859 patients with a CT diagnosis of GGNs requiring surgical resection were included in our study at the hospital. Among them, 21 patients who either opted out or could not undergo preoperative localization for various reasons were excluded. Additionally, 475 patients who underwent preoperative localization using medical glue and 363 patients who underwent preoperative localization through positioning hooks were also excluded. We conducted statistical analyses on the baseline data, success rates, complications, and pathological results of the remaining patients. The success rates, complication rates, and pathological results were compared between the two groups-those who received medical glue localization and those who received positioning hook localization. Results: There was no statistically significant difference between the two groups of patients in terms of age, body mass index, smoking history, location of the nodule, distance of the nodule from the pleura, or postoperative pathological results (P > 0.05). The success rate of medical glue and positioning hooks was 100%. The complication rates of medical glue and positioning hooks during single nodule positioning were 39.18% and 23.18%, respectively, which were significantly different (p < 0.001); the complication rates during multiple nodule positioning were 49.15% and 49.18%, respectively, with no statistically significant differences (p > 0.05). In addition, the method of positioning and the clinical characteristics of the patients were not found to be independent risk factors for the occurrence of complications. The detection rate of pulmonary nodules also showed some positive correlation with the spread of COVID-19 during the 2020-2022 period when COVID-19 was prevalent. Conclusion: When positioning a single node, the safety of positioning hooks is greater than when positioning multiple nodes, the safety of medical glue and positioning hooks is comparable, and the appropriate positioning method should be chosen according to the individual situation of the patient.

ROAD2H: Development and evaluation of an open-source explainable artificial intelligence approach for managing co-morbidity and clinical guidelines.

Introduction: Clinical decision support (CDS) systems (CDSSs) that integrate clinical guidelines need to reflect real-world co-morbidity. In patient-specific clinical contexts, transparent recommendations that allow for contraindications and other conflicts arising from co-morbidity are a requirement. In this work, we develop and evaluate a non-proprietary, standards-based approach to the deployment of computable guidelines with explainable argumentation, integrated with a commercial electronic health record (EHR) system in Serbia, a middle-income country in West Balkans. Methods: We used an ontological framework, the Transition-based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR-based implementation of the Assumptions-Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed-methods evaluation was conducted with 20 simulated cases and five pulmonologists. Results: Pulmonologists agreed 97% of the time with the GOLD-based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co-morbidities was suggested in the future along with customisation of the level of explanation with expertise. Conclusion: An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long-term condition. Extension to other guidelines and multiple co-morbidities is needed to test the approach further.

A novel Y-shaper and chopper for small pupil management in cataract surgery: The initial experience.

Small pupil is a well-known risk factor for causing cataract surgery complications such as vitreous loss, anterior capsular tear, increased inflammation, and an irregular pupil shape. Because all currently available pharmacological approaches of dilating the pupil before or during cataract surgery cannot guarantee the result, the surgeon sometimes resorts to the use of mechanical pupil-expanding devices. However, these devices can increase the overall surgical cost and operative time. Very frequently, a combination of the two is needed; thus, we present the Y-shaped chopper designed by the authors, which serves the purpose of managing the intra-operative miosis and allows simultaneous nuclear emulsification.