[Technological development of robot-assisted radical prostatectomy].

The surgical outcomes of robot-assisted radical prostatectomy have shown remarkable improvement over the last two decades since its advent, due to advances in surgical concepts, techniques, and equipment. Today, ongoing research aims to compare the benefits and drawbacks of various surgical approaches, such as anterior, posterior, lateral, transvesical, and transperineal approaches, in terms of tumor control, functional recovery, and complication reduction in order to achieve the goal of pentafecta (no postoperative complications and negative surgical margins in addition to trifecta) to the maximum extent. It is imperative to explore and integrate novel technologies such as 5G remote surgery and artificial intelligence into the clinical practice of robot-assisted radical prostatectomy while ensuring patient safety, which has immense potential for substantial benefits to patients with prostate cancer.

[Functional outcomes of robot-assisted radical prostatectomy with preservation of pelvic stabilized structure and early elevated retrograde liberation of neurovascular bundle].

Objectives: To examine the functional outcomes of robot-assisted radical prostatectomy (RARP) with preservation of pelvic floor stabilized structure and early elevated retrograde liberation of the neurovascular bundle (PEEL). Methods: This study was a retrospective cohort study. Between June 1, 2022, and March 20, 2023, 27 cases of RARP with PEEL and 153 cases of RARP with preservation of pelvic floor stabilized structure (PPSS) were included in this study. All patients were males, aged (62.5±5.2) years (range: 50 to 73 years). There were 18 cases of ≤T2b stage and 9 cases of T2c stage. After 1∶1 propensity score matching, the postoperative functional outcomes of 27 cases of RARP with PEEL and 27 cases of RARP with PPSS were compared. All surgeries were performed by a single surgeon and included patients were clinically staged as cT1-2N0M0 without preoperative urinary incontinence or erectile dysfunction. In RARP with PEEL, the prostate was cut near the midline at the front when dissecting the neurovascular bundle, dissection was performed between the visceral layer of the pelvic fascia and the prostatic fascia, preserving the parietal layer and the visceral layer of the pelvic fascia, and the neurovascular bundle was retrogradely released from the apex. The cumulative probability curve was plotted using the Kaplan-Meier method and the Log-rank test was used to compare the differences in functional outcomes between the two groups. Univariate and multivariate analysis with the Cox proportional hazards model was used to compare postoperative urinary continence and sexual function. Results: The recovery time of continence and potency was significantly longer in the PPSS group than in the PEEL group (all P<0.05). The continence rate of the PEEL group was significantly higher than that of the PPSS group (92.59% vs. 68.10%, P=0.026) at 3 months after surgery. The potency rate of the PEEL group was also significantly higher than that of the PPSS group (40.70% vs. 15.10%, P=0.037) at 3 months after surgery. In the univariate analysis, compared to the PPSS technique, the PEEL technique was associated with a shorter recovery time of continence (HR=1.94, 95%CI: 1.08 to 3.48, P=0.027) and a shorter recovery time of potency (HR=2.06, 95%CI: 1.03 to 4.13, P=0.042). In the multivariate analysis, the PEEL technique was an independent prognosis factor for postoperative recovery of continence (HR=2.05, 95%CI: 1.01 to 4.17, P=0.047) and potency (HR=3.57, 95%CI: 1.43 to 8.92, P=0.007). All the cases of the PPSS group and the PEEL group were performed successfully with negative surgical margins. Conclusion: Compared with PPSS, PEEL may be more conducive to the recovery of urinary continence and sexual function after RARP.

[Treatment of giant cell tumor of distal radius with vascular anastomosis with proximal graft of vascular].

Objective: To evaluate the curative effect of proximal fibula graft of vascular anastomosis for giant cell tumor(GCT) of distal radius of bone. Methods: 38 patients with distal radius GCT were treated with proximal articular graft of anastomotic vessels. We evaluated the wrist joint function before and after surgery using wrist activity, visual analogue scale(VAS)pain score, grip recovery rate and Cooney scoring system. Results: All patients' wounds healed in stage I, and recovered smoothly during the perioperative period. No obvious wrist deformity was observed during the follow-up period. Bony union was achieved at the tibial and humerus osteotomy ends. The average healing time was 11 weeks. At third month postoperatively, the patient's wrist motion ranged from dorsiflexion to palmar flexion (69.15±15.24)°, ulnar/spasm deviation was (22.74±10.55)°, grip strength was (88.69±12.75)%, wrist VAS pain The score was (2.45±1.11) points and the Cooney score was (89.58±11.25) points, which was significantly better than preoperation (all P<0.05). No recurrence or metastasis occurred during follow-up in all patients. Conclusions: Distal humerus GCT treated with distal radius with vascular anastomosis with proximal graft of vascular has little effect on the activity of the lower extremities. However, its reconstruction of the wrist joint function might achieve better results.

Nanocomposited silicone hydrogels with a laser-assisted surface modification for inhibiting the growth of bacterial biofilm.

Surface and interface modifications of synthetic silicone hydrogels used for wearable and implantable medical devices, e.g. catheters and contact lenses, are critical to overcome their poor mechanical properties and biofouling. In this paper, silica nanoparticles (SiO2 NPs) were incorporated within silicone hydrogels through photo-polymerization. As compared to the silicone hydrogel, the nanocomposited silicone hydrogel shows highly textured microstructures, increased swelling behaviour and improved stiffness. Meanwhile, a hydrophilic surface of silicone hydrogel is important to minimize protein fouling which forms a conditioning layer for the growth of bacterial biofilm. Here, we applied matrix-assisted pulsed laser evaporation (MAPLE) with a pulsed Nd:YAG laser at 532 nm to deposit polyethylene glycol (PEG) on the surface of the nanocomposited silicone hydrogels. The PEG deposited on the nanocomposited silicone hydrogels forms islands at the submicron-scale, which increase with increasing irradiation time (t). The protein adsorption on nanocomposited silicone hydrogel with PEG deposition decreases over 40 ± 2% when t = 2 h. Compared to the commercial silicone catheters, the nanocomposited silicone hydrogel with PEG deposition can reduce the growth of bacteria from 1.20 × 106 CFU cm-2 to 3.69 × 105 CFU cm-2. In addition, the relative cell viabilities of NIH/3T3 mouse fibroblast cells treated using the nanocomposited silicone hydrogels coated with/without PEG were studied. No toxic effect is imposed on the cells. Consequently, the MAPLE process is a controllable, contamination-free technique to modify the surface of silicone hydrogels. We expect that the nanocomposited silicone hydrogels with appropriate surface treatment can be applied in various wearable and implantable medical devices.

Automated segmentation of multiple sclerosis lesions in multispectral MR imaging using fuzzy clustering.

A method is presented for fully automated detection of Multiple Sclerosis (MS) lesions in multispectral magnetic resonance (MR) imaging. Based on the Fuzzy C-Means (FCM) algorithm, the method starts with a segmentation of an MR image to extract an external CSF/lesions mask, preceded by a local image contrast enhancement procedure. This binary mask is then superimposed on the corresponding data set yielding an image containing only CSF structures and lesions. The FCM is then reapplied to this masked image to obtain a mask of lesions and some undesired substructures which are removed using anatomical knowledge. Any lesion size found to be less than an input bound is eliminated from consideration. Results are presented for test runs of the method on 10 patients. Finally, the potential of the method as well as its limitations are discussed.