An objective skill assessment framework for microsurgical anastomosis based on ALI scores.

INTRODUCTION: The current assessment and standardization of microsurgical skills are subjective, posing challenges in reliable skill evaluation. We aim to address these limitations by developing a quantitative and objective framework for accurately assessing and enhancing microsurgical anastomosis skills among surgical trainees. We hypothesize that this framework can differentiate the proficiency levels of microsurgeons, aligning with subjective assessments based on the ALI score. METHODS: We select relevant performance metrics from the literature on laparoscopic skill assessment and human motor control studies, focusing on time, instrument kinematics, and tactile information. This information is measured and estimated by a set of sensors, including cameras, a motion capture system, and tactile sensors. The recorded data is analyzed offline using our proposed evaluation framework. Our study involves 12 participants of different ages ([Formula: see text] years) and genders (nine males and three females), including six novice and six intermediate subjects, who perform surgical anastomosis procedures on a chicken leg model. RESULTS: We show that the proposed set of objective and quantitative metrics to assess skill proficiency aligns with subjective evaluations, particularly the ALI score method, and can effectively differentiate novices from more proficient microsurgeons. Furthermore, we find statistically significant disparities, where microsurgeons with intermediate level of skill proficiency surpassed novices in both task speed, reduced idle time, and smoother, briefer hand displacements. CONCLUSION: The framework enables accurate skill assessment and provides objective feedback for improving microsurgical anastomosis skills among surgical trainees. By overcoming the subjectivity and limitations of current assessment methods, our approach contributes to the advancement of surgical education and the development of aspiring microsurgeons. Furthermore, our framework emerges to precisely distinguish and classify proficiency levels (novice and intermediate) exhibited by microsurgeons.

Hand pose selection in a bimanual fine-manipulation task.

Many daily tasks involve the collaboration of both hands. Humans dexterously adjust hand poses and modulate the forces exerted by fingers in response to task demands. Hand pose selection has been intensively studied in unimanual tasks, but little work has investigated bimanual tasks. This work examines hand poses selection in a bimanual high-precision-screwing task taken from watchmaking. Twenty right-handed subjects dismounted a screw on the watch face with a screwdriver in two conditions. Results showed that although subjects used similar hand poses across steps within the same experimental conditions, the hand poses differed significantly in the two conditions. In the free-base condition, subjects needed to stabilize the watch face on the table. The role distribution across hands was strongly influenced by hand dominance: the dominant hand manipulated the tool, whereas the nondominant hand controlled the additional degrees of freedom that might impair performance. In contrast, in the fixed-base condition, the watch face was stationary. Subjects used both hands even though single hand would have been sufficient. Importantly, hand poses decoupled the control of task-demanded force and torque across hands through virtual fingers that grouped multiple fingers into functional units. This preference for bimanual over unimanual control strategy could be an effort to reduce variability caused by mechanical couplings and to alleviate intrinsic sensorimotor processing burdens. To afford analysis of this variety of observations, a novel graphical matrix-based representation of the distribution of hand pose combinations was developed. Atypical hand poses that are not documented in extant hand taxonomies are also included.NEW & NOTEWORTHY We study hand poses selection in bimanual fine motor skills. To understand how roles and control variables are distributed across the hands and fingers, we compared two conditions when unscrewing a screw from a watch face. When the watch face needed positioning, role distribution was strongly influenced by hand dominance; when the watch face was stationary, a variety of hand pose combinations emerged. Control of independent task demands is distributed either across hands or across distinct groups of fingers.

An inverse optimization approach to understand human acquisition of kinematic coordination in bimanual fine manipulation tasks.

Tasks that require the cooperation of both hands and arms are common in human everyday life. Coordination helps to synchronize in space and temporally motion of the upper limbs. In fine bimanual tasks, coordination enables also to achieve higher degrees of precision that could be obtained from a single hand. We studied the acquisition of bimanual fine manipulation skills in watchmaking tasks, which require assembly of pieces at millimeter scale. It demands years of training. We contrasted motion kinematics performed by novice apprentices to those of professionals. Fifteen subjects, ten novices and five experts, participated in the study. We recorded force applied on the watch face and kinematics of fingers and arms. Results indicate that expert subjects wisely place their fingers on the tools to achieve higher dexterity. Compared to novices, experts also tend to align task-demanded force application with the optimal force transmission direction of the dominant arm. To understand the cognitive processes underpinning the different coordination patterns across experts and novice subjects, we followed the optimal control theoretical framework and hypothesize that the difference in task performances is caused by changes in the central nervous system's optimal criteria. We formulated kinematic metrics to evaluate the coordination patterns and exploit inverse optimization approach to infer the optimal criteria. We interpret the human acquisition of novel coordination patterns as an alteration in the composition structure of the central nervous system's optimal criteria accompanied by the learning process.

Exploring the therapeutic potential of interleukin-6 receptor blockade in cardiovascular disease treatment through Mendelian randomization.

Interleukin-6 (IL-6) plays a crucial role in the pathogenesis of cardiovascular disease (CVD), and IL-6 receptor (IL-6R) blockade has emerged as a promising therapeutic option. However, their specific therapeutic effects in different types of CVDs remain unclear. This study aimed to assess the efficacy of IL-6R blockade in the management of various CVDs, including hypertension (HTN), coronary heart disease (CHD), myocardial infarction (MI), atrial fibrillation (AF), and heart failure (HF). The Mendelian randomization (MR) approach was utilized to investigate the therapeutic impact of IL-6R blockade on HTN, CHD, MI, AF, and HF based on the genome-wide association study (GWAS) summary statistics. MR-Egger intercept test, Cochran's Q test, and leave-one-out analysis were used for sensitivity analysis to verify the reliability of the MR results. The Bonferroni method was used to correct for bias caused by multiple comparisons. Inverse variance weighted (IVW) results demonstrated that IL-6R blockade significantly influenced CHD (odds ratio (OR) = 0.757, 95% confidence interval (CI): 0.690 - 0.832, P = 5.804 × 10-9) and MI (OR = 0.840, 95% CI: 0.744 - 0.949, P = 0.005). However, IL-6R blockade had no significant effect on HTN (OR = 1.015, 95% CI: 0.950 - 1.084, P = 0.663), AF (OR = 0.905, 95% CI: 0.800 - 1.025, P = 0.116) and HF (OR = 1.012, 95% CI: 0.921 - 1.113, P = 0.805). Genetically predicted IL-6R blockade was associated with a protective effect on CHD and MI, but not HTN, AF and HF. This study's findings offer valuable insights for tailoring IL-6R blockade treatment for different types of CVD, and serve as a reference for future research.

Up-regulation of miR-155 protects against chronic heart failure by inhibiting HIF-1α.

BACKGROUND: Despite a crucial role of miR-155 in human cancers, its function in heart failure (HF) is still under investigation. This study was designed to explore its association with HF. METHODS: The abdominal transverse aortic constriction (TAC) was adopted for establishment of mouse HF models. qRT-PCR and WB were adopted to detect the changes of miR-155, HIF-1α, Cle-caspase-3, BCL2 and Bax levels in myocardial cells and heart tissues. The changes of cardiac function were checked by ultrasound. Additionally, luciferase reporter gene was adopted for interaction analysis of miR-155 with HIF-1α, and in situ end labelling method was used for detecting myocardial apoptosis. RESULTS: MiR-155 in myocardial tissue of HF mice was significantly down regulated. In HF mice injected with agomiR-155, the up-regulation of miR-155 strongly improved cardiac function, and also significantly lowered the protein levels of apoptosis-associated markers, C-caspase-3 and Bax, but up regulated Bcl-2. Additionally, HIF-1α was identified as the direct target of miR-155. As expected, over-expression of HIF-1α greatly reversed the effects of agomiR-155 on cardiac function and the expression of apoptosis-associated markers in heart tissues of HF mice. CONCLUSION: MiR-155 overexpression can suppress myocardial cell apoptosis through HIF-1α, and strongly alleviate the cardiac function damage in HF mice, indicating the potential of miR-155/HIF-1α axis to be a target for the diagnosis and therapy of HF.

Potential molecular mechanism of the Xiexin capsule in the intervention of dyslipidemia based on bioinformatics and molecular docking.

Introduction: Objective: bioinformatic methods and molecular docking technology were used to predict the active components, targets, and related biological pathways of the Xiexin capsule in the intervention for dyslipidemia, exploring its mechanism. Methods: the active components and targets of the Xiexin capsule were screened by the TCMSP (Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform )database. Genecards (The Human Gene Database), OMIM (Online Mendelian Inheritance in Man), PharmGkb (Pharmacogenomics Knowledge Base database), TTD (Therapeutic Target Database), and Drugbank platforms were used to search the disease targets of dyslipidemia. The Cytoscape 3.8.0 software was used to construct the 'component-target' network diagram, and the STRING (functional protein association networks) platform was used to analyze protein-protein interaction (PPI). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomics (KEGG) enrichment analyses were performed by R language data packets to predict the mechanism of action. The AutoDockVina and PyMol software were used to dock the key active components in the Xiexin capsule and the core proteins in PPI. Results: a total of 66 effective components were screened, involving 114 targets; 87 key active compounds were screened from the 'drug-component-target' diagram. The PPI network mainly involved core proteins such as PTGS2 (prostaglandin-endoperoxide synthase 2), PTGS1 (prostaglandin-endoperoxide synthase 1), and HSP90AA1 (heat shock protein 90 alpha family class A member 1). GO and KEGG enrichment analysis results of common targets mainly involved hormone-mediated signaling pathway, steroid hormone response, lipid transport and metabolism, regulation of cholesterol storage, cyclooxygenase pathway, and other biological pathways, as well asMM PPAR (peroxisome proliferators-activated receptor) signaling pathway, IL-17 (interleukin 17) signaling pathway, PI3K-Akt (protein kinase b) signaling pathway, FcεRI signaling pathway, and other related pathways. Molecular docking verification showed that quercetin had the best binding with the core target protein HSP90AA1, and HSP90AA1 was the target protein with the best binding activity for the key chemical components in Xiexin capsules. Conclusion: the main chemical components in the Xiexin capsules may participate in the regulation of PPAR and other signaling pathways by regulating key genes such as ESR1 (estrogen receptor 1), MAPK14 (mitogen-activated protein kinase 14), and HSP90AA1, to exert the pharmacological effect of the intervention on dyslipidemia.

Introducción: Objetivo: se utilizaron métodos bioinformáticos y técnicas de acoplamiento molecular para predecir componentes efectivos, objetivos y vías biológicas relacionadas de la cápsula Xiexin en la intervención de dislipidemia y explorar su mecanismo. Métodos: los componentes activos y los objetivos de la cápsula Xiexin fueron seleccionados por la base de datos TCMSP. Se utilizaron plataformas Genecards, OMIM, PharmGkb, Therapeutic Target Database y Drugbank para buscar dianas de la enfermedad en la dislipidemia. El diagrama reticular "componente-diana" fue construido por el software Cytoscape 3.7.0, y la interacción proteína-proteína (PPI) fue analizada por la plataforma STRING. Los análisis de enriquecimiento de Gene Ontology (GO) y Kyoto Encyclopedia of Genes and Genomics se realizaron mediante paquetes de datos en lenguaje R para predecir mecanismo de acción. El software AutoDockVina y PyMol se utilizó para unir componentes activos clave de la cápsula Xiexin y las proteínas clave de la PPI. Resultados: se seleccionaron 65 componentes activos y 114 dianas. Veintitrés compuestos activos clave fueron seleccionados a partir de la tabla "componentes farmacéuticos-dianas". Las redes PPI incluyen principalmente proteínas básicas como PTGS2, PTGS1 y HSP90AA1. Los resultados del análisis de enriquecimiento de GO y KEGG en los objetivos comunes se refieren principalmente a la vía de señalización mediada por esteroides, la respuesta hormonal esteroidea, el transporte y metabolismo lipídicos, la regulación del almacenamiento de colesterol, la vía de la ciclooxigenasa y otras vías biológicas, así como la vía de señalización de PPAR, IL-17, PI3K-Akt, FcεRI y otras vías relacionadas. La prueba de acoplamiento molecular mostró que la quercetina se une mejor a la proteína diana central HSP90AA1, que es la proteína diana con la mejor actividad de unión de los componentes químicos clave de la cápsula Xiexin. Conclusión: los principales componentes químicos de la cápsula Xiexin pueden participar en la regulación de la PPAR y otras vías de señalización mediante la regulación de genes clave como ESR1, MAPK14 (mitogen-activated protein kinase 14), HSP90AA1, por lo que pueden desempeñar un papel farmacológico en la intervención de dislipidemia.