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BACKGROUND AND OBJECTIVE: Solid pancreatic lesions (SPLs) represent one of the most lethal forms of gastrointestinal malignancies, and Rapid on-site evaluation (ROSE) serves as an important component of intraoperative diagnosis. However, efficient and accurate ROSE slide interpretation remains challenging due to the gigapixel scale of whole-slide images, sparse distribution of diagnostically relevant regions, and the need for real-time feedback. METHODS: To address challenges, we propose a novel two-stage framework for fast and precise ROSE WSI classification, following the clinical diagnostic workflow of cytopathologists. In the first stage, we design a lightweight Transformer-based object detection network named as RoF DETR, which detects key cell clusters at 5x magnification. To further enhance detection performance, we incorporate domain-specific medical foundation model features and design a multi-scale feature fusion module for effective feature extraction. In the second stage, we design a prototype-guided multiple instance learning network (PG-MIL) based on pseudo-bag augmentation for 20x magnification patch extraction, improving feature discrimination and robustness under class imbalance. RESULTS: For comprehensive evaluation, we establish a dedicated ROSE WSI dataset and a cell cluster detection dataset. Our method achieves an AP@0.5 of 0.482 in cell cluster detection and an AUC of 92.36% in WSI-level classification. Compared to conventional WSI-level classification pipelines, the proposed framework reduces computational overhead by approximately 100× and halves the inference time. CONCLUSION: The proposed framework provides a scalable and efficient solution for rapid cytological assessment of ROSE slides, showing potential to support real-time intraoperative decision-making in clinical workflows.
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Interpretación de Imagen Asistida por Computador , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Algoritmos , Periodo Intraoperatorio , Aprendizaje Automático , Interpretación de Imagen Asistida por Computador/métodosRESUMEN
In this study, to evaluate the diagnostic accuracy and clinical reliability of intraoperative frozen sections (IFS) compared with paraffin-embedded sections (PS) in guiding surgical decision-making for endometrial carcinoma (EC) patients, we retrospectively analyzed the clinical data of 165 EC patients who underwent surgical resection with IFS evaluation. Diagnostic concordance between IFS and final PS pathology was assessed across six parameters: 1) tumor histological type, 2) tumor grade, 3) depth of myometrial invasion (MI), 4) cervical stromal involvement, 5) lymphovascular space invasion (LVSI) status, and 6) lymph node metastasis risk stratification. The data were statistically analyzed using Kappa coefficient and chi-square test. The IFS results concurred with the PS in 95.3 % for histological type (kappa 0.859, p = 0.125), 94.0 % for tumor grade (kappa 0.848, p = 0.039), 97.6 % for depth of MI (kappa 0.929, p = 0.046), 95.2 % for cervical involvement (kappa 0.481, p = 0.008), and 88.5 % for LVSI (kappa 0.155, p < 0.001). Risk assessment was accurately determined in 92.1 % of cases (kappa 0.796, p < 0.001). Final histopathology confirmed pelvic and paraaortic lymph node metastases in two patients whose metastatic risk had been underestimated based on the IFS risk stratification. High-intermediate/high-risk patients showed significantly higher lymph node involvement compared to low/intermediate-risk groups. IFS analysis demonstrates reliability and clinical utility in assessing disease extent and guiding surgical decisions regarding the need for complete staging procedures in EC patients.
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Neoplasias Endometriales , Secciones por Congelación , Humanos , Femenino , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Neoplasias Endometriales/diagnóstico , Secciones por Congelación/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Metástasis Linfática/patología , Adulto , Reproducibilidad de los Resultados , Anciano de 80 o más Años , Estadificación de Neoplasias/métodos , Clasificación del Tumor/métodos , Periodo Intraoperatorio , Invasividad Neoplásica/patologíaRESUMEN
Background: Frailty is a clinical syndrome characterized by a reduction in the functional capacity of multiple physiological systems, which increases the body's vulnerability to stressors and reduces the capacity of elderly patients to recover from stressful events such as anesthesia and surgery. Methods: A total of 142 elderly frailty patients scheduled for total knee arthroplasty were randomly assigned to either the low-level (Group L) or high-level group (Group H). Group L maintained intraoperative mean arterial pressure (MAP) at 65-85 mmHg, while Group H targeted 85-100 mmHg. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Secondary outcomes include the time-weighted average mean arterial pressure (TWA-MAP) intraoperatively, QoR-15 scores on POD2-5, the abbreviated mental test score (AMTS) at 30 days and 1-year postoperatively, the incidence of myocardial injury after noncardiac surgery (MINS) and acute kidney injury (AKI), 1-year mortality postoperatively. Results: There was no significant difference in QoR-15 values on POD1 between Group L and Group H (mean [SD] 99 [9.89] vs 98 [12.82], mean difference 95% confidence interval (CI) 0.91 (-3.08-4.91)). TWA-MAP was 93.1 ± 2.29 mmHg in Group H and 78.6 ± 2.97 mmHg in Group L (P < 0.05, mean difference 95% CI -14.5 (-15.4, -13.6)), indicating a statistically significant difference between the two groups. Conclusion: Maintaining higher or lower MAP intraoperatively had no significant effect on the quality of postoperative recovery in elderly frailty patients undergoing knee arthroplasty under the conditions studied in this trial.
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Artroplastia de Reemplazo de Rodilla , Presión Sanguínea , Anciano Frágil , Humanos , Femenino , Masculino , Anciano , Anciano de 80 o más Años , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Periodo Intraoperatorio , Lesión Renal Aguda/epidemiología , Recuperación de la FunciónRESUMEN
Surgical workflow is a major component of successful surgery, and intraoperative distractions (IDs) within the operating room (OR) can have a major adverse impact on outcomes. IDs could increase surgeons' mental fatigue, increase stress, and reduce overall performance. However, more studies are needed to classify and quantify all possible distractions during surgery and their sources. Therefore, this study aims to evaluate the quantity and type of IDs during different types of surgical procedures.
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Atención , Fatiga Mental , Quirófanos , Cirujanos , Servicio de Cirugía en Hospital , Procedimientos Quirúrgicos Operativos , Humanos , Procedimientos Quirúrgicos Operativos/psicología , Flujo de Trabajo , Fatiga Mental/etiología , Cirujanos/psicología , Periodo Intraoperatorio , Hospitales Universitarios , MasculinoRESUMEN
OBJECTIVE: To estimate the workload of the nursing team and its associated factors during the intraoperative period for adult patients undergoing elective and urgent/emergency surgeries. DESIGN: Cross-sectional study. SETTING: Surgical units of two hospitals in Brazil. DATA SOURCES AND SAMPLE SIZE: We prospectively assessed the workload using the National Aeronautics and Space Administration - Task Load Index (NASA-TLX) score and analysed the electronic medical records of patients who agreed to participate in the study, from November 2023 to February 2024. We included data from 116 nursing professionals and 402 surgeries. RESULTS: Among the procedures analysed, the median raw NASA-TLX score in cardiac surgery was significantly higher (60.8; IQR 40.0-72.5 points) compared with the others. We observed that in the generalised linear model procedures over minutes presented around 25% greater workload compared with 120 min surgeries (1.252; 95% CI 1.1018 to 1.549) and patients classified as American Society of Anesthesiologists (ASA) physical status classification (ASA) III and IV exhibited approximately 24% higher workload compared with those classified as ASA I (1.241; 95% CI 1.003 to 1.550). CONCLUSIONS: Surgical length and ASA physical status influence the workload. Thus, we suggest that surgical unit leaders give special attention to long-term surgical procedures and patient severity on perioperative workload when dimensioning nursing staff.
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Personal de Enfermería en Hospital , Servicio de Cirugía en Hospital , Carga de Trabajo , Humanos , Carga de Trabajo/estadística & datos numéricos , Estudios Transversales , Brasil , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Prospectivos , Personal de Enfermería en Hospital/estadística & datos numéricos , Anciano , Periodo IntraoperatorioRESUMEN
BACKGROUND: Two-dimensional to three-dimensional (2D/3D) registration is critical in image-guided interventions, particularly in vascular procedures such as endovascular therapy (EVT), where accurate alignment between preoperative 3D images and intraoperative 2D x-ray angiography can improve procedural safety and precision. However, achieving both real-time and precise 2D/3D registration remains challenging due to high computational demands. PURPOSE: This study aims to develop a fast 2D/3D registration method that directly optimizes the in-plane alignment between digitally reconstructed radiographs (DRRs) and x-ray angiography images, thereby eliminating the need for forward projection at each objective function evaluation and improving computational efficiency without compromising registration accuracy. METHODS: We propose a registration method that solves an alternative 2D/2D registration problem to estimate in-plane transformation parameters and iteratively updates the underlying 2D/3D registration parameters. The method incorporates a skull region-of-interest (ROI) map to reduce anatomical mismatches between DRRs and angiography images, and maximizes a similarity metric, normalized cross-correlation (NCC), in an iterative manner. The algorithm was evaluated using both numerical simulations (XCAT phantom) and clinical angiography data, comparing performance to an intensity-based 2D/3D registration and a version of our method without skull ROI guidance. The success rate was evaluated differently depending on the data source: based on the NCC in simulations, and on parameter accuracy compared to manual estimations by two experts in clinical data. Also, registration parameter accuracy, runtime, number of forward projections, and convergence behavior were assessed. RESULTS: In the numerical simulation, the proposed method reduced runtime by more than 10 × $ \times $ compared to conventional 2D/3D registration, while maintaining an equivalent success rate. In the clinical study, it achieved runtime reduction of approximately 6 × $ \times $ and a 100% success rate in non-truncated cases, where the head was mostly captured within the x-ray angiography field of view, and demonstrated strong visual agreement with the manual estimation results. In truncated cases, although the registration performance decreased across all methods, the proposed method outperformed the 2D/3D registration. CONCLUSIONS: We proposed a fast 2D/3D registration method that achieved significantly reduced runtime and improved accuracy. Despite being limited to rigid registration, it shows promise for real-time clinical use with further optimization.
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Angiografía , Cabeza , Imagenología Tridimensional , Cirugía Asistida por Computador , Imagenología Tridimensional/métodos , Cirugía Asistida por Computador/métodos , Humanos , Angiografía/métodos , Factores de Tiempo , Cabeza/diagnóstico por imagen , Fantoma de Imagenología , Periodo Intraoperatorio , AlgoritmosRESUMEN
BACKGROUND: One of the important factors in evaluating the effectiveness of cochlear implants in children is the level of neural response thresholds (NRT). This study aims to assess and compare intraoperative and postoperative NRT concerning their ability to predict postoperative speech perception in cochlear implant patients. METHODS: In this observational study, two groups of cochlear implant recipients who underwent surgery between April 2011-March 2022 and met the inclusion criteria were selected using purposive sampling. Intra- and postoperative neural response telemetry (NRT) data were collected, along with postoperative outcomes from the Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) questionnaires, administered at six and nine months after implantation. One group consisted of patients with negative intraoperative NRT, while the other included patients with positive intraoperative NRT. Comparisons between groups were performed, data were analyzed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, Illinois, USA) version 22.0. RESULTS: There was a significant improvement in NRT values following surgery. Additionally, intra- and postoperative thresholds showed a significant correlation. Both CAP and SIR scores also improved significantly during follow-up. Postoperative NRT significantly correlated with CAP and SIR scores after six and nine months, whereas intraoperative NRT did not demonstrate this correlation. Nonetheless, the feasibility of measuring intraoperative NRT significantly indicated better future speech perception. DISCUSSION: Postoperative NRT may serve as an indicator of the trajectory of auditory functioning in CI patients. However, there remains uncertainty regarding the correlation between intraoperative NRT and outcomes. It sems that the inability to measure intraoperative NRT is associated with poorer speech perception outcomes.
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Percepción Auditiva , Umbral Auditivo , Implantación Coclear , Implantes Cocleares , Inteligibilidad del Habla , Percepción del Habla , Humanos , Masculino , Femenino , Implantación Coclear/métodos , Inteligibilidad del Habla/fisiología , Percepción del Habla/fisiología , Periodo Posoperatorio , Preescolar , Niño , Umbral Auditivo/fisiología , Resultado del Tratamiento , Lactante , Percepción Auditiva/fisiología , Periodo IntraoperatorioRESUMEN
BACKGROUND: Image-guided surgery is a critical technique in maxillofacial surgery. The foundation of image-guided surgery is image registration. Traditional image registration methods have limitations in terms of invasiveness, complexity, and unsatisfied accuracy. Freehand 3D ultrasound (US) imaging using a tracked 2D US probe may offer a non-invasive, real-time, and accurate alternative. Purpose This study aims to develop a novel freehand 3D US imaging framework for midfacial bone surface reconstruction and registration with preoperative 3D data (e.g., computed tomography), enabling accurate intraoperative surgical navigation in maxillofacial surgery. METHODS: First, a customized stereo camera is used to track the pose of a 2D US probe during the freehand US scanning toward the midfacial bone surface. Then, a short-term dense concatenate network (STDC) is employed to segment the bone surface from the US image. The segmented pixels with spatial information form a coarse 3D volume in real time. The 3D volume's voxels are then converted to a coarse point cloud. A template matching denoising technique is utilized to remove noisy and outlier points, followed by a self-supervised Freehand 3D Ultrasound Neural Surface Reconstruction network (FUNSR) to reconstruct the point cloud to a smooth surface mesh. Finally, the resulting fine bone surface is registered with preoperative 3D data for quantitative evaluation. A total of 1000 zygomatic ultrasound images (split into 700 training, 150 validation, and 150 test images) were used to train the segmentation network. The reconstruction network was trained with self-supervision. The reconstruction accuracy of the network was validated using surface registration error (SRE), and the registration accuracy was verified using target registration error (TRE). Method performance improvement was evaluated using t-tests and analysis of variance, with Tamhane's T2 test applied for multiple comparison correction to control the false discovery rate. Cohen's effect sizes were calculated to quantify performance differences. RESULTS: In the phantom experiment, the average SRE was 0.387 ±$\pm$ 0.034 mm, and the average TRE was 0.802 ±$\pm$ 0.177 mm. Compared with registration using only voxel reconstruction results (SRE = 1.301 ±$\pm$ 0.133 mm, TRE = 1.155 ±$\pm$ 0.359 mm), the accuracy was improved (Cohen's d = 9.416 for SRE, Cohen's d = 1.247 for TRE, and p<$p<$ 0.01 for both). Also, the accuracy remained uniform across various regions of the midface ( p=$p =$ 0.918). When using only local region reconstruction for registration, the decrease in overall accuracy is relatively minor ( p=$p =$ 0.025). In the volunteer trials, the average SRE was 0.445 ±$\pm$ 0.099 mm. Compared with the fundamental framework of our method (SRE = 0.955 ±$\pm$ 0.204 mm), the proposed template matching denoising and surface reconstruction components further enhance the registration accuracy ( p<$p<$ 0.001, Cohen's d >$>$ 2.0). CONCLUSIONS: The proposed freehand 3D US imaging framework could offer a noninvasive, accurate, and quasi-real-time solution for midfacial bone surface reconstruction and image registration in maxillofacial surgery.
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Huesos Faciales , Imagenología Tridimensional , Cirugía Asistida por Computador , Imagenología Tridimensional/métodos , Ultrasonografía , Cirugía Asistida por Computador/métodos , Huesos Faciales/diagnóstico por imagen , Huesos Faciales/cirugía , Humanos , Periodo Intraoperatorio , Propiedades de SuperficieRESUMEN
INTRODUCTION: The relationship between intraoperative end-tidal carbon dioxide (EtCO
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Dióxido de Carbono , Náusea y Vómito Posoperatorios , Humanos , Antieméticos/uso terapéutico , Dióxido de Carbono/análisis , Dióxido de Carbono/metabolismo , Periodo Intraoperatorio , Náusea y Vómito Posoperatorios/epidemiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Diffuse gliomas are the most common primary brain tumors in adults in the Western world. According to the 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors, the assessment of isocitrate dehydrogenase (IDH1/2)-mutation status is essential for accurate patient stratification. In this study, we performed a comprehensive evaluation of IDH-mutation status in the intraoperative setting using the Idylla platform. The reference cohort comprised 30 formalin-fixed paraffin-embedded (FFPE) tissue samples with known IDH status, while the exploration cohort included 35 intraoperative snap-frozen and native-tissue specimens. The results were compared with those of a standard next-generation sequencing (NGS) analysis. Our findings demonstrate that the Idylla IDH-mutation assay provides 100% concordance compared with NGS analysis for both FFPE and intraoperative tissue samples. The Idylla system delivers results within approximately 90 min, significantly outperforming NGS, which requires between 7 and 27 days. This rapid turnaround facilitates timely interdisciplinary case discussions and enables timely therapy planning, within the framework of neuro-oncological molecular tumor boards. The ultra-fast intraoperative IDH-mutation analysis using the Idylla platform, in combination with intraoperative histopathological assessment, enables rapid patient stratification and treatment planning in diffuse gliomas.
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Neoplasias Encefálicas , Glioma , Isocitrato Deshidrogenasa , Mutación , Humanos , Isocitrato Deshidrogenasa/genética , Glioma/genética , Glioma/cirugía , Glioma/patología , Glioma/terapia , Glioma/diagnóstico , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Femenino , Masculino , Análisis Mutacional de ADN/métodos , Adulto , Persona de Mediana Edad , Periodo Intraoperatorio , AncianoRESUMEN
BACKGROUND: Remimazolam is an ultrashort-acting benzodiazepine that maintains stable hemodynamics during anesthesia. However, few reports have focused on hemodynamic stability and opioid use during cardiac surgery with remimazolam. We hypothesized that administration of remimazolam for induction and maintenance of anesthesia for transcatheter aortic valve implantation would maintain hemodynamics as effectively as conventional anesthetics and allow use of an appropriate dose of opioids. We compared intraoperative hemodynamics and opioid use in patients with severe aortic stenosis who received remimazolam or conventional anesthetics. METHODS: This retrospective cohort study analyzed data for patients who underwent transcatheter aortic valve implantation from October 2022 to September 2023. The 23 patients were divided into two groups: a remimazolam group and midazolam + sevoflurane group. The primary outcome was intraoperative blood pressure. The secondary outcomes were the doses of vasoconstrictors, vasodilators, and opioids used. RESULTS: There was no significant difference in any patient characteristic or intraoperative blood pressure between the two groups (before anesthesia: 92.0 [87.0-99.8] vs. 91.0 [86.0-107.0] mm Hg, P=0.935; 1 minute after induction of anesthesia: 91.0 [83.0-98.5] vs. 90.0 [86.3-95.3] mm Hg, P=0.843; at the start of surgery: 77.0 [70.0-79.0] vs. 82.5 [75.5-105.5] mm Hg, P=0.072; at the end of surgery: 74.0 [71.0-78.0] vs. 82.5 [75.5-90.8] mm Hg, P=0.082). The maximum rate of remifentanil administration was significantly higher in the remimazolam group (0.10 [0.10-0.20] vs. 0.10 [0.013-0.10] µg/kg/min, P=0.012). CONCLUSIONS: Remimazolam maintained hemodynamics as effectively as midazolam + sevoflurane, even when used in combination with opioids. Remimazolam thus appears to be noninferior to midazolam + sevoflurane.
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Analgésicos Opioides , Benzodiazepinas , Hemodinámica , Midazolam , Sevoflurano , Humanos , Sevoflurano/administración & dosificación , Sevoflurano/farmacología , Estudios Retrospectivos , Masculino , Hemodinámica/efectos de los fármacos , Femenino , Midazolam/administración & dosificación , Midazolam/farmacología , Analgésicos Opioides/administración & dosificación , Anciano , Benzodiazepinas/administración & dosificación , Benzodiazepinas/farmacología , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Periodo Intraoperatorio , Estenosis de la Válvula Aórtica/cirugíaRESUMEN
BACKGROUND: Intraoperative electron radiation therapy (IOERT) relies on accurate and precise dose delivery to the tumor or tumor bed using mobile accelerators and interchangeable applicators, while critical organs are typically displaced or shielded during surgery. Treatment planning and linac commissioning are often based on water measurements, Monte Carlo (MC) simulations of the accelerator head and applicator system provide detailed insights into dose distributions and beam characteristics, offering additional support for clinical evaluation. PURPOSE: This study develops an MC model of the Liac HWL mobile accelerator using a hypothetical linac head geometry, due to the limited availability of detailed information on its internal components resulting from manufacturer disclosure policies. The model is optimized by adjusting three geometric parameters of the linac head and the initial beam energy spectrum to match experimental data. Additionally, it provides a set of Phase Space Files (PSFs) to support research and clinical applications. METHODS: The MC code PENELOPE, integrated with the penEasy framework, was used to simulate the Liac HWL. The hypothetical head geometry was defined by parameters such as the inner diameter of the head, the thickness of the scattering foil, and the thickness of the exit window. Output factors (OFs), percentage depth doses (PDDs), and off-axis ratios (OARs) were calculated in a virtual water phantom for different applicator sizes, bevel angles, and energies. Gamma analysis was employed to validate the model by comparing calculated and measured dose distributions. PSFs were made available in the IAEA PHSP format at four energies (6, 8, 10, and 12 MeV). RESULTS: The model matched measured OFs within 2.5%. PDDs and OARs met the gamma analysis criteria (2% dose difference and 1 mm distance-to-agreement) in more than 93% of the studied cases, with the worst-case scenario occurring for the smallest applicator (3 cm diameter) with a 45° bevel angle at 6 MeV, resulting in OAR gamma passing rates of 85.7% at z m a x $z_{max}$ and 86.1% at R 90 $R_{90}$ . CONCLUSIONS: Despite the use of a hypothetical geometry, the model offers accurate dosimetric data and practical guidance for IOERT commissioning and treatment planning. It highlights potential dosimetric issues, particularly the lack of homogeneity in OARs for large-diameter applicators, and allows fine-tuning based on real-world data. Additionally, the PSFs generated in this study provide a reliable resource for simulating IORT dose distributions and analyzing the characteristics of IOERT beams.
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Método de Montecarlo , Aceleradores de Partículas , Radioterapia , Aceleradores de Partículas/instrumentación , Periodo Intraoperatorio , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Humanos , Radioterapia/instrumentaciónRESUMEN
Background and Objectives: One of the most critical areas of measurement and evaluation in healthcare is pathological evaluation, especially intraoperative consultation. Studies conducted to identify sources of error in this field are usually one-sided; however, in evaluation processes with multiple sources of error, such as intraoperative consultation, generalizability theory can evaluate these sources of error simultaneously in a single analysis, thereby contributing to the field. In this study, the reliability of intraoperative and permanent histopathological evaluations of glial tumors was analyzed using generalizability theory to identify the sources of error in the observed evaluation inconsistencies. Materials and Methods: The study included 319 glial tumor cases that underwent intraoperative evaluation and were analyzed using generalizability theory. Three pathologists performed independent evaluations in two stages. Results: The reliability coefficient calculated for all cases was 0.9234 without radiological information and 0.9243 after learning the radiological information. The reliability coefficient was 0.8875 and 0.8989, respectively, in cases over 18 years of age, and 0.8845 and 0.9062 in cases under 18 years of age. These findings indicate that the addition of radiological information to the evaluation resulted in a slight increase in reliability, particularly in cases under 18 years of age. In all of our reliability assessments for different conditions, the highest variability was found to originate from the rater. Conclusions: The findings suggest that intraoperative evaluation demonstrates a high degree of reliability in the pathological assessment of glial tumors. When differences between the rater and the technique are evaluated together, it is observed that the rater has a more significant impact on reliability. While radiological information is generally considered a factor that increases reliability, it is partially more effective, especially in cases involving individuals under the age of 18, which highlights the importance of multidisciplinary data sharing in intraoperative diagnostic processes.
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Neoplasias Encefálicas , Glioma , Cuidados Intraoperatorios , Humanos , Reproducibilidad de los Resultados , Femenino , Glioma/diagnóstico , Glioma/cirugía , Glioma/patología , Masculino , Persona de Mediana Edad , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Periodo Intraoperatorio , Variaciones Dependientes del Observador , Adolescente , Niño , Cuidados Intraoperatorios/normas , Cuidados Intraoperatorios/métodosRESUMEN
BACKGROUND AND PURPOSE: Intraoperative radiotherapy (IORT) for breast cancer offers a promising alternative to conventional external beam radiotherapy by delivering high-dose radiation directly to the tumor bed during surgery. However, accurate dosimetry is critical to ensure the safety and efficacy of this procedure. This study aimed to develop and validate a reliable dosimetry using GAFchromic EBT-3 films for precise in vivo and in vitro dosimetry during IORT. The primary objective was to verify the accuracy of absorbed delivered doses during IORT using GAFchromic EBT-3 films, in comparison with that of Monte Carlo simulations. METHODS: This observational study included 38 patients with breast cancer who underwent IORT at Kaohsiung Municipal Ta-Tung Hospital and Kaohsiung Medical University Chung-Ho Memorial Hospital in Taiwan. Patients were selected based on predefined inclusion criteria. Using GAFchromic EBT-3 films during IORT, absorbed doses, including the applicator surface, excision wound, and surrounding breast tissue, were measured at various critical points. Monte Carlo simulations were conducted to validate the accuracy of these manufacturer-provided data. RESULTS: The mean measured dose was 20.37 ± 0.67 Gy, which had a 1.2 % discrepancy from the planned dose of 20 Gy. Dose measurements at other surrounding tissues indicated effective protection, with mean doses of 1.36 ± 0.92 Gy on the excision wound and 1.08 ± 1.18 Gy on the surrounding breast edge. Monte Carlo simulations confirmed a high level of consistency with the manufacturer's data, with an error margin of <3 %. CONCLUSIONS: The use of GAFchromic EBT-3 films for dosimetry during IORT was feasible and reliable and provided an independent verification method to ensure accurate dose delivery. This study demonstrates that accurate dosimetric validation supports the clinical optimization of intraoperative radiotherapy (IORT), enabling precise dose delivery while reducing exposure to surrounding healthy tissues. These findings may contribute to enhanced treatment safety, improved local control, and favorable cosmetic outcomes in breast-conserving therapy. Further research is warranted to refine this technique and explore its applicability in other radiotherapy contexts.
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Neoplasias de la Mama , Dosimetría por Película , Humanos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Método de Montecarlo , Persona de Mediana Edad , Dosificación Radioterapéutica , Dosimetría por Película/métodos , Anciano , Adulto , Periodo Intraoperatorio , Cuidados IntraoperatoriosRESUMEN
Objective: To investigate the diagnostic efficacy of intraoperative direct sonication in periprosthetic joint infection (PJI). Methods: This is a retrospective case series study. The clinical data of 490 patients with PJI or aseptic prosthesis loosening after hip or knee arthroplasty admitted to the Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2023 were retrospectively analyzed. There were 209 male cases, 281 female cases, aged (M(IQR)) 63 (19) years (range: 15 to 89 years). There were 328 cases of PJI (123 cases of traditional sonication, 205 cases of intraoperative direct sonication, and 204 cases had simultaneous intraoperative synovial fluid), and 162 patients of aseptic loosening (89 cases of traditional sonication, 73 cases of intraoperative direct sonication, and 96 cases had simultaneous intraoperative synovial fluid). The method of traditional sonication: the prosthesis components were placed in a sterile container, vortexed for 30 seconds, then placed in an ultrasound bath to sonication (frequency:(40±2) kHz, power density:(0.22±0.04) W/cm²) for 5 minutes, vortexed again for 30 seconds, and the resulting sonicate fluid was extracted for culture. The method of intraoperative direct sonication: during the operation, the surgical area, the prosthesis and the tissues around the prosthesis which were placed in a sterile container were respectively subjected to sonication for 5 minutes using a portable handheld ultrasonic cell disruptor device (frequency: 25 kHz, power density:(0.22±0.04) W/cm²), and the fluids before and after sonication were extracted for culture. The method of intraoperative synovial fluid: during the operation, the joint capsule was incised, and the synovial fluid was extracted under direct vision for culture. The sensitivity, specificity, positive and negative predictive values, Youden index, the effect of preoperative antimicrobial agents on culture results, and culture duration for different culture methods. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of these methods for PJI was compared using the χ² test, the Wilcoxon signed-rank test, and other appropriate statistical methods. Results: The sensitivity of intraoperative direct sonication was significantly higher than that of intraoperative synovial fluid culture (89.8%(184/205) vs.56.9%(116/204),χ²=44.457,P<0.01) and traditional sonication (89.8%(184/205) vs.66.7%(82/123), χ²=121.588,P<0.01). However, its specificity was lower compared to intraoperative synovial fluid (87.5%(64/73) vs. 99.0%(95/96), χ²=9.491, P=0.002). The culture duration for intraoperative direct sonication was shorter than for intraoperative synovial fluid 87.0 (41.8) hours vs. 112.5 (78.5) hours, Z=-5.121, P<0.01) and traditional sonication (87.0 (41.8) hours vs. 119.0 (67.5) hours, Z=-7.119, P<0.01). Gram-positive bacteria (predominantly Staphylococcus aureus and Staphylococcus epidermidis) were the most common isolates across all three culture methods. Furthermore, intraoperative direct sonication was more likely to detect polymicrobial infections compared to traditional sonication (38.6% vs. 2.4%, χ²=37.223, P<0.01) and intraoperative synovial fluid (38.6% vs. 0.9%, χ²=55.527, P<0.01). The ROC curve revealed that the area under the curve of intraoperative direct sonication,intraoperative synovial fluid culture and traditional sonication were 0.886 (95%CI:0.843 to 0.930), 0.779 (95%CI:0.743 to 0.815) and 0.788 (95%CI: 0.736 to 0.839). Conclusions: Compared with intraoperative synovial fluid and traditional sonication, intraoperative direct sonication has excellent sensitivity, the shortest appropriate culture duration for pathogenic bacteria, and it is more likely to diagnose PJI patients with polymicrobial infections, having better diagnostic efficacy in the diagnosis of PJI.
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Infecciones Relacionadas con Prótesis , Sonicación , Humanos , Infecciones Relacionadas con Prótesis/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Sonicación/métodos , Adulto , Anciano de 80 o más Años , Adolescente , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Líquido Sinovial/microbiología , Adulto Joven , Prótesis de la Rodilla , Periodo IntraoperatorioRESUMEN
Histological staining has long been the gold standard for cancer detection, but it is limited by subjectivity and delayed results. Fourier Transform Infrared Spectroscopy (FTIR) has emerged as a promising technique, offering the advantages of objectivity and real-time analysis. Despite its potential, IR biomarkers developed in different studies are based on varying experimental conditions, including different tissue preparation methods, instrumentation, and patient heterogeneity, which hinder their generalizability and transferability. In this study, tissue spectra from various colorectal cancer cases were systematically collected, and IR biomarkers were developed using the band ratios identified in these spectra. Their ability to differentiate cancer-bearing from non-cancer-bearing tissues was evaluated using a machine learning technique. The results show that the top three biomarkers are b1 (1740/1236), b2 (1740/1162) and b3 (1740/1080). When transferring these biomarkers to a new case (approved under the Ohio State University Institutional Review Board # 2011C0085), b1 effectively differentiates tumor, normal, and margin tissues, while the performance of the b2 and b3 are less satisfactory. This suggests that b1 is more robust and sensitive to key molecular features, whereas b2 and b3 are more likely to be affected by tissue heterogeneity or experimental variations. Combining biomarkers enhances tissue differentiation, but the enhancement plateaus after two to three key biomarkers, as adding more introduces overlapping or redundant information. This study provides a benchmark for future research, with the aim of advancing the clinical translation of noninvasive infrared spectroscopy for intraoperative applications.
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Biomarcadores de Tumor , Neoplasias Colorrectales , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patología , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Biomarcadores de Tumor/análisis , Femenino , Masculino , Aprendizaje Automático , Persona de Mediana Edad , Anciano , Periodo IntraoperatorioRESUMEN
Background and Objectives: The aim of this prospective study was to evaluate the diagnostic accuracy of the one-step nucleic acid amplification (OSNA) assay for the intraoperative assessment of sentinel lymph node (SN) metastases, including micrometastases in patients with stage IA low-grade endometrial cancer. Materials and Methods: A prospective analysis was conducted on 204 patients with low-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and sentinel node navigation surgery. SNs were analyzed intraoperatively using the OSNA assay, and positive patients underwent systematic pelvic lymphadenectomy. Results: Among the 204 patients included, SN metastases were identified in 12 patients (6%), including 10 patients with micrometastases and 2 patients with macrometastases. No metastases were detected in non-SNs in any of the 12 patients. Recurrence occurred in two patients (1%), involving the vaginal stump and pelvic cavity dissemination, but no lymph node recurrence was observed. The OSNA assay identified a proportion of micrometastases in low-risk endometrial cancer. While a direct comparison with conventional pathological ultra-staging was not performed in this study, the detection rate of micrometastases appears higher than that reported in historical controls. Conclusions: This is the first prospective study to evaluate the intraoperative use of the OSNA assay for whole SNs in endometrial cancer. The results suggest that the OSNA assay enhances the detection of micrometastases, enabling a more accurate assessment of SN metastases. In low-risk endometrial cancer, systematic pelvic lymphadenectomy may be safely omitted in patients with SN-positive micrometastases. Further prospective studies are necessary to validate these findings and support the adoption of this approach in clinical practice.
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Neoplasias Endometriales , Técnicas de Amplificación de Ácido Nucleico , Ganglio Linfático Centinela , Humanos , Femenino , Neoplasias Endometriales/cirugía , Neoplasias Endometriales/patología , Neoplasias Endometriales/diagnóstico , Estudios Prospectivos , Técnicas de Amplificación de Ácido Nucleico/métodos , Persona de Mediana Edad , Ganglio Linfático Centinela/patología , Anciano , Metástasis Linfática/diagnóstico , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Anciano de 80 o más Años , Micrometástasis de Neoplasia/diagnóstico , Escisión del Ganglio Linfático , Periodo Intraoperatorio , Cuidados Intraoperatorios/métodosRESUMEN
BACKGROUND: Intraoperative radiation therapy (IORT) using the INTRABEAM system has shown promise in glioblastoma treatment. However, accurate dosimetry remains challenging due to the low-energy photons used and the heterogeneity of tissues in the brain. Current clinical practice relies on the TARGIT method, but more robust approaches, including the TG-43 formalism and Monte Carlo (MC) simulations, warrant investigation for potential improvements in dose calculation accuracy. PURPOSE: To evaluate the TG-43 dosimetry formalism for IORT dose calculations in glioblastoma treatment using the INTRABEAM system, comparing it with the TARGIT method and MC simulations. METHODS: We analyzed the dose distributions in 20 patients from the INTRAGO trial. The TG-43 formalism was validated against MC simulations in water ( MC w ${\rm MC}_{\rm w}$ ) using global/local dose differences and gamma analysis (1%/1mm). Organ at risk (OAR) doses were calculated using TG-43, TARGIT, MC w ${\rm MC}_{\rm w}$ , and MC in heterogeneous media ( MC het ${\rm MC}_{\rm het}$ ). Combined IORT and external beam radiotherapy (EBRT) doses were evaluated. RESULTS: TG-43 showed good agreement with MC w ${\rm MC}_{\rm w}$ , with a 98.0% gamma pass rate. The mean global dose difference was 0.07% ± $\pm$ 0.29%, with TG-43 slightly overestimating dose compared to MC w ${\rm MC}_{\rm w}$ . For OAR dose comparisons using TG-43 as reference, TARGIT underestimated doses by 0.1%-1.7%, while MC het ${\rm MC}_{\rm het}$ showed larger differences near bony structures (up to 1.9% ± $\pm$ 1.4% for optic nerves). Combined IORT+EBRT analysis revealed more OAR constraint violations than identified by current clinical practice. Calculation times for TG-43 (0.6 s on average) were significantly shorter than for MC simulations (16-18 h on a computing cluster). CONCLUSIONS: The TG-43 formalism provides a reasonable compromise between accuracy and computational efficiency for IORT dose calculations in glioblastoma treatment. It offers improved accuracy over TARGIT while being significantly faster and thus more feasible for intraoperative use than full MC simulations. Implementation of validated volumetric dose calculation methods like TG-43 has the potential to improve the accuracy of IORT treatment planning and OAR dose assessment.
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Neoplasias Encefálicas , Glioblastoma , Radiometría , Glioblastoma/radioterapia , Glioblastoma/cirugía , Humanos , Radiometría/métodos , Método de Montecarlo , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Periodo Intraoperatorio , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodosRESUMEN
This study aims to explore potential biomarkers correlated with the clinical outcome only in patients with intraoperative hypothermia undergoing cardiac surgery. The clinical data of patients with or without intraoperative hypothermia, and 8 blood indicators both in preoperative and intraoperative periods, were obtained from the Medical Information Mart for Intensive Care-IV database. The associations of indicators with the length of hospital stay (LOS) were explored in non-hypothermia and hypothermia groups, respectively. The key indicator showing the association only in hypothermia groups was selected for further analysis. The detailed association between the key indicator and LOS was further determined by a series of analyses, including restricted cubic spline, generalized additive model, generalized linear regression, trend regression, threshold effects analysis, and quartile regression. Their clinical value was explored by the receiver operating characteristic analysis and decision curve analysis. Among 16 indicators, only the intraoperative lactate was identified to correlate with the LOS in patients with hypothermia rather than normal group (all Pâ <â .05). Lactate showed a positive and nonlinear association with LOS (all Pâ <â .05), and their association was especially observed when log-lactateâ >â 2.420 (all Pâ <â .05). Quartile regression showed that the associations of lactate with LOS quartiles from 40% and 80% were stably increased when log-lactateâ >â 2.420 (all Pâ <â .05). However, no association was observed in any analyses when log-lactateâ ≤â 2.420. We also confirmed the favorable prediction performance and clinical net benefit of lactate on the LOS. Intraoperative lactate is significantly associated with the LOS of patients with hypothermia and is a useful biomarker.
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Procedimientos Quirúrgicos Cardíacos , Hipotermia , Complicaciones Intraoperatorias , Ácido Láctico , Tiempo de Internación , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Femenino , Ácido Láctico/sangre , Hipotermia/sangre , Persona de Mediana Edad , Anciano , Biomarcadores/sangre , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Intraoperatorias/sangre , Estudios Retrospectivos , Periodo Intraoperatorio , Curva ROCRESUMEN
BACKGROUND: Hyperlactatemia and acute kidney injury (AKI) represent significant perioperative complications in cardiac surgery. This study investigated their relationship by analyzing multiple lactate parameters during on-pump cardiac procedures. METHODS: In this dual-center retrospective analysis of 5255 cardiac surgery patients, we evaluated the relationship between AKI and four distinct lactate parameters: baseline, mean, peak, and time-weighted average (TWA) concentrations. The association between lactate levels and outcomes was evaluated using restricted cubic spline functions with five knots in our retrospective statistical modeling approach. Concurrently, optimal lactate thresholds were determined through the application of a classification and regression tree algorithm. RESULTS: Among the 5255 patients analyzed, 931 (17.72%) developed acute kidney injury. Statistical analysis revealed distinct patterns of association between lactate parameters and AKI risk. We identified an L-shaped relationship for mean, peak, and TWA lactate levels, contrasting with a linear association for baseline values. The study established critical thresholds for AKI risk prediction: mean lactate (2.96 mmol/L), peak lactate (4.50 mmol/L), and TWA lactate (2.33 mmol/L). Risk stratification demonstrated that patients in higher lactate quintiles faced substantially increased AKI risk, with odds ratios ranging from 1.34 to 4.37 across different lactate parameters. CONCLUSION: These findings established specific lactate thresholds as valuable predictive markers for AKI risk in cardiac surgery, offering clinically applicable parameters for perioperative risk assessment and management. This data supported the implementation of targeted lactate monitoring strategies during cardiac procedures. TRIAL REGISTRATION: The study was registered at www.chictr.org.cn (Registration number: ChiCTR2200057320, Data of Registration: 2022-03-08).