Biomechanics on Ultra-Sensitivity of Venus Flytrap's Micronewton Trigger Hairs.

Numerous plants evolve ingeniously microcantilever-based hairs to ultra-sensitively detect out-of-plane quasi-static tactile loads, providing a natural blueprint for upgrading the industrial static mode microcantilever sensors, but how do the biological sensory hairs work mechanically? Here, the action potential-producing trigger hairs of carnivorous Venus flytraps (Dionaea muscipula) are investigated in detail from biomechanical perspective. Under tiny mechanical stimulation, the deformable trigger hair, composed of distal stiff lever and proximal flexible podium, will lead to rapid trap closure and prey capture. The multiple features determining the sensitivity such as conical morphology, multi-scale functional structures, kidney-shaped sensory cells, and combined deformation under tiny mechanical stimulation are comprehensively researched. Based on materials mechanics, finite element simulation, and bio-inspired original artificial sensors, it is verified that the omnidirectional ultra-sensitivity of trigger hair is attributed to the stiff-flexible coupling of material, the double stress concentration, the circular distribution of sensory cells, and the positive local buckling. Also, the balance strategy of slender hair between sensitivity and structural stability (i.e., avoiding disastrous collapse) is detailed revealed. The unique basic biomechanical mechanism underlying trigger hairs is essential for significantly enhancing the performance of the traditional industrial static mode microcantilever sensors, and ensure the stability of arbitrary load perception.

Magnetically Actuated Soft Microrobot with Environmental Adaptative Multimodal Locomotion Towards Targeted Delivery.

The development of environmentally adaptive solutions for magnetically actuated microrobots to enable targeted delivery in complex and confined fluid environments presents a significant challenge. Inspired by the natural locomotion of crucian carp, a barbell-shaped soft microrobot (MBS2M) is proposed. A mechano-electromagnetic hybrid actuation system is developed to generate oscillating magnetic fields to manipulate the microrobot. The MBS2M can seamlessly transition between three fundamental locomotion modes: fast navigation (FN), high-precision navigation (HPN), and fixed-point rotation (FPR). Moreover, the MBS2M can move in reverse without turning. The multimodal locomotion endows the MBS2M's adaptability in diverse environments. It can smoothly pass through confined channels, climb over obstacles, overcome gravity for vertical motion, track complex pathways, traverse viscous environments, overcome low fluid resistance, and navigate complex spaces mimicking in vivo environments. Additionally, the MBS2M is capable of drug loading and release in response to ultrasound excitation. In an ex vivo porcine liver vein, the microrobot demonstrated targeted navigation under ultrasound guidance, showcasing its potential for specialized in vivo tasks.

Tactile Sensing and Rendering Patch with Dynamic and Static Sensing and Haptic Feedback for Immersive Communication.

Wearable human-machine interface (HMI) with bidirectional and multimodal tactile information exchange is of paramount importance in teleoperation by providing more intuitive data interpretation and delivery of tactilely related signals. However, the current sensing and feedback devices still lack enough integration and modalities. Here, we present a Tactile Sensing and Rendering Patch (TSRP) that is made of a customized expandable array which consists of a piezoelectric sensing and feedback unit fused with an elastomeric triboelectric multidimensional sensor and its inner pneumatic feedback structure. The primary functional unit of TSRP is mainly featured with a soft silicone substrate with compact multilayer structure integrating static and dynamic multidimensional tactile sensing capabilities, which synergistically leverage both triboelectric and piezoelectric effects. Additionally, based on the air chamber created by the triboelectric sensor and the converse piezoelectric effect, it provides pneumatic and vibrational haptic feedback simultaneously for both static and dynamic perception regeneration. With the aid of the other variants of this unit, the array shaped TSRP is capable of simulating different terrains, geometries, sliding, collisions, and other critical interactive events during teleoperation via skin perception. Moreover, immediate manipulation can be done on TSRP through the tactile sensors. The preliminary demonstration of TSRP interface with a completed control module in robotic teleoperation is provided, which shows the feasibility of assisting certain tasks in a complex environment by direct tactile communication. The proposed device offers a potential method of enabling bidirectional tactile communication with enriched key information for improving interaction efficiency in the fields of robot teleoperation and training.

Deep learning-based segmentation for high-dose-rate brachytherapy in cervical cancer using 3D Prompt-ResUNet.

Objective.To develop and evaluate a 3D Prompt-ResUNet module that utilized the prompt-based model combined with 3D nnUNet for rapid and consistent autosegmentation of high-risk clinical target volume (HRCTV) and organ at risk (OAR) in high-dose-rate brachytherapy for cervical cancer patients.Approach.We used 73 computed tomography scans and 62 magnetic resonance imaging scans from 135 (103 for training, 16 for validation, and 16 for testing) cervical cancer patients across two hospitals for HRCTV and OAR segmentation. A novel comparison of the deep learning neural networks 3D Prompt-ResUNet, nnUNet, and segment anything model-Med3D was applied for the segmentation. Evaluation was conducted in two parts: geometric and clinical assessments. Quantitative metrics included the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (HD95%), Jaccard index (JI), and Matthews correlation coefficient (MCC). Clinical evaluation involved interobserver comparison, 4-grade expert scoring, and a double-blinded Turing test.Main results.The Prompt-ResUNet model performed most similarly to experienced radiation oncologists, outperforming less experienced ones. During testing, the DSC, HD95% (mm), JI, and MCC value (mean ± SD) for HRCTV were 0.92 ± 0.03, 2.91 ± 0.69, 0.85 ± 0.04, and 0.92 ± 0.02, respectively. For the bladder, these values were 0.93 ± 0.05, 3.07 ± 1.05, 0.87 ± 0.08, and 0.93 ± 0.05, respectively. For the rectum, they were 0.87 ± 0.03, 3.54 ± 1.46, 0.78 ± 0.05, and 0.87 ± 0.03, respectively. For the sigmoid, they were 0.76 ± 0.11, 7.54 ± 5.54, 0.63 ± 0.14, and 0.78 ± 0.09, respectively. The Prompt-ResUNet achieved a clinical viability score of at least 2 in all evaluation cases (100%) for both HRCTV and bladder and exceeded the 30% positive rate benchmark for all evaluated structures in the Turing test.Significance.The Prompt-ResUNet architecture demonstrated high consistency with ground truth in autosegmentation of HRCTV and OARs, reducing interobserver variability and shortening treatment times.

A piezoresistive-based 3-axial MEMS tactile sensor and integrated surgical forceps for gastrointestinal endoscopic minimally invasive surgery.

In robotic-assisted surgery (RAS), traditional surgical instruments without sensing capability cannot perceive accurate operational forces during the task, and such drawbacks can be largely intensified when sophisticated tasks involving flexible and slender arms with small end-effectors, such as in gastrointestinal endoscopic surgery (GES). In this study, we propose a microelectromechanical system (MEMS) piezoresistive 3-axial tactile sensor for GES forceps, which can intuitively provide surgeons with online force feedback during robotic surgery. The MEMS fabrication process facilitates sensor chips with miniaturized dimensions. The fully encapsulated tactile sensors can be effortlessly integrated into miniature GES forceps, which feature a slender diameter of just 3.5 mm and undergo meticulous calibration procedures via the least squares method. Through experiments, the sensor's ability to accurately measure directional forces up to 1.2 N in the Z axis was validated, demonstrating an average relative error of only 1.18% compared with the full-scale output. The results indicate that this tactile sensor can provide effective 3-axial force sensing during surgical operations, such as grasping and pulling, and in ex vivo testing with a porcine stomach. The compact size, high precision, and integrability of the sensor establish solid foundations for clinical application in the operating theater.

Mechanical Property Analysis of a Boom-Membrane Structure Used for Aerospace Technologies.

Traditional deployable truss space structures previously had upper limits on their key indicators, such as the deployed area, folded ratio and total weight, and hence, the application of new extendable mechanisms with novel deployment types is desired. Foldable extendable tape spring booms made from FRP (fiber-reinforced polymer) laminate composites and their corresponding boom-membrane structures were invented in recent years to satisfy the needs of the large-scale requirements of spacecraft, especially for antennas, solar sails and solar arrays. This paper aimed to analyze the properties of the deployed states of extendable tape spring booms and their boom-membrane structures. By establishing an analytical model of the boom and the structure, the bending stiffness, critical buckling load of the boom and the fundamental frequency of the membrane structure were acquired. To provide more guidance on the boom-membrane structure design, a geometric and material parametric study was carried out. Meanwhile, an experimental study to investigate the deployed properties of the booms and membrane structures was introduced to afford some practical verification.

Analysis of In Situ Electroporation Utilizing Induced Electric Field at a Wireless Janus Microelectrode.

In situ electroporation, a non-invasive technique for enhancing the permeability of cell membranes, has emerged as a powerful tool for intracellular delivery and manipulation. This method allows for the precise introduction of therapeutic agents, such as nucleic acids, drugs, and proteins, directly into target cells within their native tissue environment. Herein, we introduce an innovative electroporation strategy that employs a Janus particle (JP)-based microelectrode to generate a localized and controllable electric field within a microfluidic chip. The microfluidic device is engineered with an indium tin oxide (ITO)-sandwiched microchannel, where the electric field is applied, and suspended JP microelectrodes that induce a stronger localized electric field. The corresponding simulation model is developed to better understand the dynamic electroporation process. Numerical simulations for both single-cell and chain-assembled cell electroporation have been successfully conducted. The effects of various parameters, including pulse voltage, duration medium conductivity, and radius of Janus microelectrode, on cell membrane permeabilization are systematically investigated. Our findings indicate that the enhanced electric intensity near the poles of the JP microelectrode significantly contributes to the electroporation process. In addition, the distribution for both transmembrane voltage and the resultant nanopores can be altered by conveniently adjusting the relative position of the JP microelectrode, demonstrating a selective and in situ electroporation technique for spatial control over the delivery area. Moreover, the obtained differences in the distribution of electroporation between chain cells can offer insightful directives for the electroporation of tissues or cell populations, enabling the precise and targeted modulation of specific cell populations. As a proof of concept, this work can provide a robust alternative technique for the study of complex and personalized cellular processes.

Prolonged administration of the granisetron transdermal delivery system reduces capecitabine plus oxaliplatin regimen induced nausea and vomiting.

OBJECTIVE: To evaluate the safety and efficacy of the granisetron transdermal delivery system (GTDS) combined with Dexamethasone for preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving Capecitabine plus Oxaliplatin (CapeOX) therapy. DESIGN: Open-label, prospective, multi-center phase II trial. SETTING: Three institutions. PARTICIPANTS: Fifty-four patients scheduled to receive CapeOX chemotherapy. INTERVENTIONS: Participants received GTDS (3.1 mg applied to the upper arm 48 h before chemotherapy, replaced on day 5, and discarded on day 12) and Dexamethasone. MAIN OUTCOME MEASURES: The primary endpoint was the complete control rate of CINV. Secondary endpoints included the duration of delayed complete control, complete control rate in the acute phase, safety, and quality of life. RESULTS: The complete control rate for delayed CINV over the entire period (25-480 h) was 72.7% (95% CI 0.57-0.88). The duration of delayed complete control was 17.2 ± 4.5 days, with 51.5% of patients experiencing no nausea during the delayed phase. The complete control rate in the acute phase was 81.8% (95% CI 0.69-0.95). No serious adverse events related to the antiemetic regimen were reported. CONCLUSION: Prolonged administration of GTDS is safe and effective for preventing CINV in patients with gastrointestinal malignancies treated with CapeOX. TRIAL REGISTRATION: ClinicalTrials.gov registry (NCT05325190); registered on October 10, 2021.

Humidity-Responsive Liquid Metal Core-Shell Materials for Enduring Heat Retention and Insulation.

High humidity in extremely cold weather can undermine the insulation capability of the clothing, imposing serious life risks. Current clothing insulation technologies have inherent deficiencies in terms of insulation efficiency and humidity adaptability. Here, humidity-stimulated self-heating clothing using aluminum core-liquid metal shell microparticles (Al@LM-MPs) as the filler is reported. Al@LM-MPs exhibit a distinctive capability to react to water molecules in the air to generate heat, exhibiting remarkable sensitivity across a broad temperature range. This ability leads to the creation of intelligent clothing capable of autonomously responding to extreme cold and wet weather conditions, providing both enduring heat retention and insulation capabilities.

Sensitive detection of choline and nicotine in real samples by switching upconversion luminescence.

Nicotine (3-(1-methyl-2-pyrrolidinyl)pyridine) is one of the most common addictive substances, causing the trace detection of nicotine to be very necessary. Herein, we designed and prepared a functionalized nanocomposite CS-PAA (NaYF4:19.5%Yb,0.5%Tm@NaYF4-PAA) using a simple method. The nicotine concentration was quantitatively detected through the inhibition of choline oxidase activity by nicotine and the luminescence intensity of CS-PAA being quenched by Fe3+. The mechanism of Fe3+ quenching CS-PAA emission was inferred by luminescence lifetime and UV-vis absorption spectra characterization. During the nicotine detection, both excitation (980 nm) and emission (802 nm) wavelengths of CS-PAA enable the avoidance of the interference of background fluorescence in complicated food objects, thus providing high selectivity and sensitivity with a linear range of 5-750 ng/mL and a limit of detection of 9.3 nM. The method exhibits an excellent recovery and relative standard deviation, indicating high accuracy and repeatability of the detection of nicotine.

Capillary-based, multifunctional manipulation of particles and fluids via focused surface acoustic waves.

Surface acoustic wave (SAW)-enabled acoustofluidic technologies have recently atttracted increasing attention for applications in biology, chemistry, biophysics, and medicine. Most SAW acoustofluidic devices generate acoustic energy which is then transmitted into custom microfabricated polymer-based channels. There are limited studies on delivering this acoustic energy into convenient commercially-available glass tubes for manipulating particles and fluids. Herein, we have constructed a capillary-based SAW acoustofluidic device for multifunctional fluidic and particle manipulation. This device integrates a converging interdigitated transducer to generate focused SAWs on a piezoelectric chip, as well as a glass capillary that transports particles and fluids. To understand the actuation mechanisms underlying this device, we performed finite element simulations by considering piezoelectric, solid mechanic, and pressure acoustic physics. This experimental study shows that the capillary-based SAW acoustofluidic device can perform multiple functions including enriching particles, patterning particles, transporting particles and fluids, as well as generating droplets with controlled sizes. Given the usefulness of these functions, we expect that this acoustofluidic device can be useful in applications such as pharmaceutical manufacturing, biofabrication, and bioanalysis.

Opsonization Inveigles Macrophages Engulfing Carrier-Free Bilirubin/JPH203 Nanoparticles to Suppress Inflammation for Osteoarthritis Therapy.

Osteoarthritis (OA) is a chronic inflammatory disease characterized by cartilage destruction, synovitis, and osteophyte formation. Disease-modifying treatments for OA are currently lacking. Because inflammation mediated by an imbalance of M1/M2 macrophages in the synovial cavities contributes to OA progression, regulating the M1 to M2 polarization of macrophages can be a potential therapeutic strategy. Basing on the inherent immune mechanism and pathological environment of OA, an immunoglobulin G-conjugated bilirubin/JPH203 self-assembled nanoparticle (IgG/BRJ) is developed, and its therapeutic potential for OA is evaluated. After intra-articular administration, IgG conjugation facilitates the recognition and engulfment of nanoparticles by the M1 macrophages. The internalized nanoparticles disassemble in response to the increased oxidative stress, and the released bilirubin (BR) and JPH203 scavenge reactive oxygen species (ROS), inhibit the nuclear factor kappa-B pathway, and suppress the activated mammalian target of rapamycin pathway, result in the repolarization of macrophages and enhance M2/M1 ratios. Suppression of the inflammatory environment by IgG/BRJ promotes cartilage protection and repair in an OA rat model, thereby improving therapeutic outcomes. This strategy of opsonization involving M1 macrophages to engulf carrier-free BR/JPH203 nanoparticles to suppress inflammation for OA therapy holds great potential for OA intervention and treatment.

Optical Upconversion in Mononuclear Lanthanide Co-Crystal Assemblies.

In this work, we developed two kinds of co-crystal assemblies systems, consisting of discrete mononuclear Yb3+ and Er3+ and mononuclear Yb3+ and Pr3+, which can achieve Er3+ and Pr3+ upconversion luminescence, respectively, by Yb3+ sensitization under 980 nm excitation. The structure and composition of two co-crystal assemblies were determined by single crystal X-ray diffraction. By investigation of the series of two assemblies, respectively, it is found that the strongest upconversion luminescence is both obtained when the molar ratio of Yb3+ and Ln3+ (Ln=Er or Pr) is 1 : 1. The energy transfer mechanism of Er3+ assemblies is determined as energy transfer upconversion, while that of Pr3+ assemblies is determined as energy transfer upconversion and cooperative sensitization upconversion. This is the first example of Pr3+ upconversion luminescence at the molecular dimension at room temperature, which enriches the research in the field of upconversion luminescence with lanthanide complexes.

Human skill knowledge guided global trajectory policy reinforcement learning method.

Traditional trajectory learning methods based on Imitation Learning (IL) only learn the existing trajectory knowledge from human demonstration. In this way, it can not adapt the trajectory knowledge to the task environment by interacting with the environment and fine-tuning the policy. To address this problem, a global trajectory learning method which combinines IL with Reinforcement Learning (RL) to adapt the knowledge policy to the environment is proposed. In this paper, IL is proposed to acquire basic trajectory skills, and then learns the agent will explore and exploit more policy which is applicable to the current environment by RL. The basic trajectory skills include the knowledge policy and the time stage information in the whole task space to help learn the time series of the trajectory, and are used to guide the subsequent RL process. Notably, neural networks are not used to model the action policy and the Q value of RL during the RL process. Instead, they are sampled and updated in the whole task space and then transferred to the networks after the RL process through Behavior Cloning (BC) to get continuous and smooth global trajectory policy. The feasibility and the effectiveness of the method was validated in a custom Gym environment of a flower drawing task. And then, we executed the learned policy in the real-world robot drawing experiment.

A study on the aerodynamic behaviors learned from microscopy imaging of beetle corrugated hindwing.

Beetle hindwings have the unique advantages of lightweight and high strength, which play a key role in flight. In this study, the beetle hindwings were cut along the chordal direction, then the first groove microstructure of different vein cross sections was investigated using the 3D microscope system and the laser scanning confocal microscope. It was found that the position of the first groove relative to the entire chordal cross section of the wing gradually moves backward, which has an effect on the flying aerodynamic behaviors of the beetle. Next, three corrugated airfoils learned from the microscopy imaging of the ladybird beetle hindwing were designed. Then, aerodynamic behaviors were calculated by the ANSYS Fluent software, and it was confirmed that the position of the first groove microstructure affects the aerodynamic performance of the airfoil. For further study, the influence of corrugated structural and motion parameters on the aerodynamic, 2D 'simplified' airfoil models with triangular wave airfoil models (TWA models) was developed and studied. RESEARCH HIGHLIGHTS: The position of the first groove microstructure affects the aerodynamic performance of the airfoil. The pressure difference of different corrugation patterns shows significantly asymmetric during the upstroke and downstroke. The aerodynamic is optimal of 2D-TWA models, when the number of corrugations is five, the corrugation is right angle, and the flapping frequency is 75 Hz.

Microfluidic device featuring micro-constrained channels for multi-parametric assessment of cellular biomechanics and high-precision mechanical phenotyping of gastric cells.

BACKGROUND: Cellular biomechanics plays a significant role in the regulation of cellular physiological and pathological processes. In recent years, multiple methods have been developed to evaluate cellular biomechanics, such as atomic force microscopy (AFM), micropipette aspiration, and magnetic tweezers. However, most of these methods only focus on a single parameter and cannot automate the process at a high-efficiency level. A novel microfluidic method is necessary to achieve the simultaneous multi-parametric measurement of cellular biomechanics and high-precision cellular mechanical phenotyping at high throughput. RESULTS: To tackle the issue concerning the low-throughput and cellular single-parameter evaluation, we designed and fabricated a microfluidic chip featuring multiple micro-constrained channels structure, providing a simultaneous multi-parametric assessment of cellular biomechanics, including elastic modulus, recovery capability, and deformability. We compared the biomechanical properties of normal human gastric mucosal epithelial cells (GES-1) and human gastric cancer cells (AGS and MKN-45) by the chip. Results demonstrated that the elastic modulus of GES-1, AGS, and MKN-45 cells decreased sequentially, which was the opposite of their invasiveness and metastasis potential, suggesting the inverse correlation between cellular elastic modulus and malignancy. Meanwhile, the recovery capability and deformability of GES-1, AGS, and MKN-45 cells increased sequentially, demonstrating the positive correlation between cellular deformability and malignancy. Furthermore, multiple parameters were used to distinguish gastric cancer cells from normal gastric cells via machine learning. An accuracy of over 94.8% for identifying gastric cancer cells was achieved. SIGNIFICANCE: This study provides a deep insight into the biophysical mechanism of gastric cancer metastasis at the single-cell level and possesses great potential to function as a valuable tool for single-cell analysis, thereby facilitating high-precision and high-throughput discrimination of cellular phenotypes that are not easily discernible through single-marker analysis.

Motion planning framework based on dual-agent DDPG method for dual-arm robots guided by human joint angle constraints.

Introduction: Reinforcement learning has been widely used in robot motion planning. However, for multi-step complex tasks of dual-arm robots, the trajectory planning method based on reinforcement learning still has some problems, such as ample exploration space, long training time, and uncontrollable training process. Based on the dual-agent depth deterministic strategy gradient (DADDPG) algorithm, this study proposes a motion planning framework constrained by the human joint angle, simultaneously realizing the humanization of learning content and learning style. It quickly plans the coordinated trajectory of dual-arm for complex multi-step tasks. Methods: The proposed framework mainly includes two parts: one is the modeling of human joint angle constraints. The joint angle is calculated from the human arm motion data measured by the inertial measurement unit (IMU) by establishing a human-robot dual-arm kinematic mapping model. Then, the joint angle range constraints are extracted from multiple groups of demonstration data and expressed as inequalities. Second, the segmented reward function is designed. The human joint angle constraint guides the exploratory learning process of the reinforcement learning method in the form of step reward. Therefore, the exploration space is reduced, the training speed is accelerated, and the learning process is controllable to a certain extent. Results and discussion: The effectiveness of the framework was verified in the gym simulation environment of the Baxter robot's reach-grasp-align task. The results show that in this framework, human experience knowledge has a significant impact on the guidance of learning, and this method can more quickly plan the coordinated trajectory of dual-arm for multi-step tasks.

AI-enhanced biomedical micro/nanorobots in microfluidics.

Human beings encompass sophisticated microcirculation and microenvironments, incorporating a broad spectrum of microfluidic systems that adopt fundamental roles in orchestrating physiological mechanisms. In vitro recapitulation of human microenvironments based on lab-on-a-chip technology represents a critical paradigm to better understand the intricate mechanisms. Moreover, the advent of micro/nanorobotics provides brand new perspectives and dynamic tools for elucidating the complex process in microfluidics. Currently, artificial intelligence (AI) has endowed micro/nanorobots (MNRs) with unprecedented benefits, such as material synthesis, optimal design, fabrication, and swarm behavior. Using advanced AI algorithms, the motion control, environment perception, and swarm intelligence of MNRs in microfluidics are significantly enhanced. This emerging interdisciplinary research trend holds great potential to propel biomedical research to the forefront and make valuable contributions to human health. Herein, we initially introduce the AI algorithms integral to the development of MNRs. We briefly revisit the components, designs, and fabrication techniques adopted by robots in microfluidics with an emphasis on the application of AI. Then, we review the latest research pertinent to AI-enhanced MNRs, focusing on their motion control, sensing abilities, and intricate collective behavior in microfluidics. Furthermore, we spotlight biomedical domains that are already witnessing or will undergo game-changing evolution based on AI-enhanced MNRs. Finally, we identify the current challenges that hinder the practical use of the pioneering interdisciplinary technology.

Novel miniature transendoscopic telerobotic system for endoscopic submucosal dissection (with videos).

BACKGROUND AND AIMS: The lack of tissue traction and instrument dexterity to allow for adequate visualization and effective dissection were the main issues in performing endoscopic submucosal dissection (ESD). Robot-assisted systems may provide advantages. In this study we developed a novel transendoscopic telerobotic system and evaluated its performance in ESD. METHODS: A miniature dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) was developed. The DREAMS system contained the current smallest robotic ESD instruments and was compatible with the commercially available dual-channel endoscope. After the system was established, a prospective randomized controlled study was conducted to validate the performance of the DREAMS-assisted ESD in terms of efficacy, safety, and workload by comparing it with the conventional technique. RESULTS: Two robotic instruments can achieve safe collaboration and provide sufficient visualization and efficient dissection during ESD. Forty ESDs in the stomach and esophagus of 8 pigs were completed by DREAMS-assisted ESD or conventional ESD. Submucosal dissection time was comparable between the 2 techniques, but DREAMS-assisted ESD demonstrated a significantly lower muscular injury rate (15% vs 50%, P = .018) and workload scores (22.30 vs 32.45, P < .001). In the subgroup analysis of esophageal ESD, DREAMS-assisted ESD showed significantly improved submucosal dissection time (6.45 vs 16.37 minutes, P = .002), muscular injury rate (25% vs 87.5%, P = .041), and workload (21.13 vs 40.63, P = .001). CONCLUSIONS: We developed a novel transendoscopic telerobotic system, named DREAMS. The safety profile and technical feasibility of ESD were significantly improved with the assistance of the DREAMS system, especially in the narrower esophageal lumen.

Technologies evolution in robot-assisted fracture reduction systems: a comprehensive review.

Background: Robot-assisted fracture reduction systems can potentially reduce the risk of infection and improve outcomes, leading to significant health and economic benefits. However, these systems are still in the laboratory stage and not yet ready for commercialization due to unresolved difficulties. While previous reviews have focused on individual technologies, system composition, and surgical stages, a comprehensive review is necessary to assist future scholars in selecting appropriate research directions for clinical use. Methods: A literature review using Google Scholar identified articles on robot-assisted fracture reduction systems. A comprehensive search yielded 17,800, 18,100, and 16,700 results for "fracture reduction," "computer-assisted orthopedic surgery," and "robot-assisted fracture reduction," respectively. Approximately 340 articles were selected, and 90 highly relevant articles were chosen for further reading after reviewing the abstracts. Results and Conclusion: Robot-assisted fracture reduction systems offer several benefits, including improved reduction accuracy, reduced physical work and radiation exposure, enhanced preoperative planning and intraoperative visualization, and shortened learning curve for skill acquisition. In the future, these systems will become integrated and practical, with automatic preoperative planning and high intraoperative safety.