This study aimed to develop and evaluate a deep learning-based surgical navigation system capable of recognizing the ureter, uterine artery, and bladder-uterine dissection plane during minimally invasive gynecologic surgery. An artificial intelligence (AI) model was developed at the University of Tokyo Hospital using videos of prior surgeries. Surgical videos of 27 laparoscopic or robot-assisted total hysterectomies were used to create training and validation datasets, with an additional set of cases serving as an independent test set. Key frames were manually annotated to train segmentation models for the ureter and uterine artery. A separate model visualized loose connective tissue fibers (LCTF) to aid in recognizing the bladder-uterine peritoneal dissection plane. Quantitative performance was assessed using standard segmentation metrics, and a qualitative evaluation was conducted by nine gynecologic surgeons using predefined scoring criteria. The segmentation models achieved moderate quantitative performance, with Dice similarity coefficients of approximately 0.51 for the ureter and 0.45 for the uterine artery. In contrast, qualitative evaluation demonstrated favorable clinical interpretability. The mean recognition scores assigned by nine expert surgeons were 4.12 for the ureter and 3.45 for the uterine artery on a five-point scale, indicating that most structures were recognized clearly with only minor misrecognition. For bladder dissection, visualization of connective tissue fibers enabled identification of the correct dissection plane in the majority of evaluated frames; more than 70-80% of connective tissue was recognizable in most frames, and substantial misrecognition was uncommon. This study demonstrates that a deep learning-based system can recognize three key elements of a total hysterectomy: the ureter, the uterine artery, and the bladder-uterine dissection plane. Despite modest quantitative metrics, qualitative assessments indicated strong clinical utility. These findings establish a foundation for an integrated AI-assisted surgical navigation platform to enhance the safety and standardization of minimally invasive gynecologic surgery.
This study compared the incidence of intraoperative significant vessel injury between robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) during major pulmonary resection. This retrospective study included 1215 patients who underwent major pulmonary resection via a minimally invasive approach between October 2012 and August 2025 at our institution: 903 underwent VATS (413 uniport, 490 multiport) and 312 underwent RATS. Propensity scores were calculated using preoperative variables, and stabilized inverse probability of treatment weighting (IPTW) was applied. The primary outcome was intraoperative significant vessel injury, defined as bleeding that required additional hemostatic intervention, such as sealant application, clipping, or suturing, after initial compression. Weighted logistic regression was used to assess the association between surgical approach and significant vessel injury. Secondary perioperative outcomes were also compared. After IPTW adjustment, baseline characteristics were well balanced. RATS was associated with a significantly lower risk of intraoperative significant vessel injury than VATS (adjusted odds ratio [OR]: 0.21, 95% confidence interval [CI], 0.08-0.54, P = 0.001). In an exploratory three-group analysis, RATS showed a lower risk than multiport VATS (OR: 0.15, 95% CI: 0.06-0.40, P < 0.001) and a borderline lower risk than uniport VATS (OR: 0.35, 95% CI: 0.12-1.00, P = 0.050). RATS was also associated with more favorable perioperative outcomes. RATS was associated with a lower risk of intraoperative significant vessel injury than VATS and with favorable short-term perioperative outcomes during major pulmonary resection.
Asymptomatic contralateral patent processus vaginalis (CPPV) is commonly detected during the laparoscopic repair of inguinal hernias in children and is a risk factor for metachronous contralateral inguinal hernias (MCIHs). However, predicting CPPV preoperatively is challenging, and evidence on its clinical predictors is limited, particularly regarding sex-specific differences. We aimed to identify preoperative predictors of CPPV and to evaluate sex-specific risk factors. This retrospective observational study was conducted at a single tertiary-care university hospital and included children (aged < 16 years) who underwent single-incision laparoscopic percutaneous extraperitoneal closure for a clinically unilateral inguinal hernia or hydrocele between 2013 and 2024. Those who underwent surgery for a recurrent inguinal hernia, MCIH, or bilateral presentation were excluded. The preoperative clinical characteristics were analyzed. Missing data were addressed using multiple imputation before conducting multivariable logistic regression analyses in the overall and sex-stratified cohorts to determine the independent predictors of CPPV. Overall, 1031 children (502 males, 529 females) were included. CPPV was identified in 511 (49.6%) patients. In the multivariable analysis of the overall cohort, left-sided presentation and history of incarceration were independently associated with CPPV, whereas sex was not. In sex-stratified analyses, hydrocele was independently associated with CPPV in males (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.06-2.45; P = 0.03). In females, left-sided presentation (OR, 2.80; 95% CI, 1.94-4.03; P < 0.001), incarceration history (OR, 5.19; 95% CI, 1.39-19.30; P = 0.014), and older age (OR, 1.01; 95% CI, 1.00-1.01; P = 0.046) were associated with CPPV. Preoperative predictors of CPPV showed sex-specific patterns. Sex was not an independent predictor; however, hydrocele was associated with CPPV in males, whereas, in females, left-sided presentation and incarceration history showed strong independent associations with CPPV. These findings may inform preoperative counseling, operative approach selection, and meticulous contralateral laparoscopic exploration, potentially reducing the risk of subsequent MCIH.
To evaluate the application value of recurrent laryngeal nerve tunnel dissection combined with mesangectomy in en-bloc resection for thyroid cancer. A retrospective analysis was conducted on 174 patients with thyroid cancer diagnosed by preoperative fine-needle aspiration cytology who underwent surgery at Shaoxing Central Hospital from January 2020 to May 2024. These patients (modified surgery group) received en-bloc resection using recurrent laryngeal nerve tunnel dissection combined with mesangectomy, including 143 cases of unilateral radical thyroidectomy, 24 cases of bilateral radical thyroidectomy, and 7 cases of isthmus thyroidectomy. A total of 178 patients diagnosed by preoperative fine-needle aspiration cytology who underwent conventional two-step surgery by the same surgical team during the same period were selected as the conventional surgery group, including 160 cases of unilateral radical thyroidectomy and 18 cases of bilateral radical thyroidectomy. All surgeries were completed successfully. Compared with the conventional surgery group, the modified surgery group showed superior outcomes in terms of operation time, intraoperative blood loss, postoperative drainage duration, and postoperative drainage volume in patients undergoing unilateral radical thyroidectomy; temporary recurrent laryngeal nerve palsy and autologous parathyroid gland transplantation rate in patients undergoing bilateral radical thyroidectomy; as well as length of hospital stay, number of central lymph nodes dissected, and number of level IVB lymph nodes dissected (all P<0.05). As of May 25, 2026, the follow-up period ranged from 15 to 77 months. No adverse events such as recurrence of thyroid cancer were reported in any patient. The modified en-bloc resection of thyroid cancer using recurrent laryngeal nerve tunnel dissection combined with mesangectomy is convenient to perform, achieves thorough lymph node dissection with less intraoperative bleeding, and provides reliable protection of the recurrent laryngeal nerve and parathyroid glands. It is worthy of clinical application. 目的: 探讨喉返神经隧道解剖法结合系膜切除在甲状腺癌整块切除术中的应用价值。方法: 回顾性分析绍兴市中心医院2020年1月至2024年5月共174例经术前穿刺明确诊断为甲状腺癌的手术病例作为改良手术组，术中均采用喉返神经隧道解剖法结合系膜切除开展整块切除术，其中单侧甲状腺癌根治术143例，双侧甲状腺癌根治术24例，峡部癌甲状腺根治7例。选取在同期相同团队进行的共178例经术前穿刺明确诊断为甲状腺癌且采用传统二步法进行手术的病例作为传统手术组，其中单侧甲状腺癌根治术160例，双侧甲状腺癌根治术18例。结果: 两组手术均顺利完成。与传统手术组比较，改良手术组单侧甲状腺癌根治术患者的手术时间、术中出血量、术后引流时间和引流量，双侧甲状腺癌根治术患者的术后暂时性喉返神经麻痹、自体旁腺移植，以及住院时间、中央区淋巴结、ⅣB区淋巴结清扫数等指标均更优（均P<0.05）。截至2026年5月25日，患者随访时间为15~77个月。所有患者均未报告甲状腺癌复发等不良情况。结论: 喉返神经隧道解剖法结合系膜切除行甲状腺癌整块切除术操作方便，创面出血少，淋巴结清扫彻底，可以保护喉返神经及甲状旁腺，值得推广应用。.
Sentio (Oticon Medical) is an active bone-conduction implant approved in 2024. This study evaluates initial clinical outcomes, safety, and audiological efficacy of the Sentio in patients with conductive or mixed hearing loss. A total of 28 patients (10 conductive, 18 mixed hearing loss) were implanted with Sentio. Preoperative assessments included pure-tone audiometry and speech recognition testing in unaided and aided conditions. Postoperative evaluations of hearing thresholds and speech recognition were performed in free field. Subjective benefit was assessed using the APHAB questionnaire before and after implantation. The first follow-up occurred 1 month after activation. All surgeries were completed without complications. One patient required revision surgery, which was successful. No other adverse events occurred. Mean hearing threshold improved from 56.3 dB HL (unaided) and 31.7 dB HL with Ponto on a softband to 25.3 dB HL post-activation and remained stable at 1-month follow-up (p < 0.001). Speech discrimination was 11.9% preoperatively (unaided) and 85.5% with Ponto. It reached 87.3% at activation and 93.3% at the follow-up (p < 0.001). Speech perception in noise was +1.97 dB SNR before implantation (unaided) and 2.22 dB SNR (aided), -2.04 dB SNR at implant activation and -2.67 dB SNR at the follow-up (p < 0.001 for implant conditions vs. unaided). APHAB global score decreased from 53.2 points preoperatively to 32.6 points postoperatively (p < 0.001). Sentio implantation appears effective and safe for the rehabilitation of conductive or mixed hearing loss. The first clinical results demonstrate audiological improvement and subjective benefit, supporting the potential of the system as a reliable bone-conduction hearing solution.
Same-day discharge (SDD) following bariatric surgery is becoming increasingly more common to reduce healthcare utilization. However, predictors of successful SDD vary across the literature. This study applied machine learning to identify predictors of SDD and evaluate the relative contributions of patient- and procedure-related factors. Patients undergoing sleeve gastrectomy and gastric bypass were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2020 and 2023. Patient, procedure and operative characteristics were analyzed. Synthetic Minority Oversampling Technique was applied given that SDD represented the minority of the cases. Machine learning models including Random Forest, Naïve Bayes, Neural Network, Extreme Gradient Boosting (XGBoost), and categorical boosting (CatBoost) were developed to predict SDD. Model performance was evaluated using the area under the receiver operating characteristic curve and compared with multivariable logistic regression. Feature importance was assessed using SHapley Additive exPlanations (SHAP). A total of 768,744 patients underwent bariatric surgery, of whom 66,809 (8.7%) underwent same-day discharge (SDD). SHAP analysis identified operative duration as the strongest predictor of SDD, while baseline patient comorbidities demonstrated comparatively smaller contributions to model predictions. Among machine learning models, CatBoost demonstrated the highest predictive performance (AUC 0.80), followed by XGBoost (AUC 0.79), whereas multivariable logistic regression had the lowest predictive performance (AUC 0.50). We developed a machine learning model that outperformed logistic regression in predicting same-day discharge following bariatric surgery. Operative duration emerged as the most important predictor of discharge status, suggesting that intraoperative events may play a greater role in determining discharge status than preoperative patient comorbidities.
Accurate acetabular cup placement is essential in total hip arthroplasty (THA). We hypothesized that the newly introduced Computed Tomography (CT)-based portable navigation system would demonstrate accuracy comparable to that of the imageless portable navigation system. The aim of this study was to compare cup placement accuracy between the CT-based and imageless portable navigation systems of the same platform in THA performed in the lateral decubitus position. This retrospective cross-sectional study included 36 patients who underwent primary THA via a direct lateral approach in the lateral decubitus position. In all cases, both imageless and CT-based portable navigation systems were used concurrently. Postoperative cup alignment was evaluated using three-dimensional CT (3D-CT). The primary outcome was the absolute error in cup inclination and anteversion, defined as the difference between intraoperative navigation values and postoperative 3D-CT measurements in the functional. Secondary outcomes included outlier rates and registration success rates. No statistically significant differences were observed between the imageless and CT-based portable navigation systems in the mean absolute error for inclination (2.2 ± 1.8° vs. 2.3 ± 1.8°, p = 0.93) or anteversion (2.3 ± 2.3° vs. 2.6 ± 2.5°, p = 0.41). There were no significant differences in outlier proportions. The registration success rate was 92% (36/39) due to three technical failures. In this preliminary study, the CT-based portable navigation system demonstrated cup placement accuracy comparable to that of the imageless portable navigation system. Although the CT-based system may provide additional spatial information intraoperatively, its impact on clinical outcomes remains unclear and requires further longitudinal investigation.
The inferiorly based dermo-glandular sling is well described for implant coverage in post-mastectomy prosthetic reconstruction and attempted restoration of upper pole fullness in (therapeutic and aesthetic) mammaplasty procedures, to variable long-term effect. We reviewed the technique modifications by a single surgeon, over 13 years, and the aesthetic outcomes achieved, when used in the context of cosmetic breast implant removal. Breast explant patients with a Wise-pattern skin incision by a single surgeon between 2011 and 2024 were identified. implant exchange, explantation only and LeJour pattern breast lift. Demographics and perioperative data were recorded. Perioperative photographs were assessed using the established Breast Cancer Conservation Treatment. Cosmetic Results (BCCT.core) software to analyse the aesthetic result. 19 patients underwent implant removal and parenchymal re-draping with an inferiorly based dermo-glandular sling. Patients were: perimenopausal women (mean=54yrs) with raised BMI (mean=27.6kg/m2). Indications (overlapping) for explantation included: disharmony between implant and breast envelope (10/19; 52.6%), discomfort/ pain (8/19; 42.1%), concerns about BIA-ALCL (5/19; 26.3%) and symptoms of "breast implant illness" (6/19; 31.6%). Others claimed their augmented breasts were simply too large (9/19; 47.4%). Bra size decreased from pre-explant size of 36E to 36C (median). Post-operative photographs were available for 18/19 patients. BCCT.core ratings were wholly favourable, with five rated Excellent and the remainder rated as Good. An inferior, de-epithelialised dermo-glandular sling can reliably rejuvenate the female breast following breast implant removal, where there is disharmony between parenchymal volume, distribution and envelope. We illustrate a reliable technique that achieves objectively good to excellent aesthetic results, with long-term efficacy. (249 words) Most common presentations for seeking explantation in our cohort were concerns about the degree of ptosis, pain, anxiety about BIA-ALCL and symptoms of breast implant illness. This technique offers a reliable and aesthetically robust option to restore some volume and uplift and reshape the explanted breast, in patients declining re-implantation or staged surgeries. Suitable patients as determined by our cohort are middle-aged women with large, previously augmented breasts (~330cc mean, 36E median), with an above-average BMI (27.6) yielding suitable inferior pole tissue for suspension. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Superior orbital sulcus hollowness is a common aesthetic concern that may result from structural changes, trauma, or excessive fat removal during upper blepharoplasty, and it can be further exacerbated by age-related orbital remodeling. Traditional corrective approaches such as fat redistribution and autologous fat grafting carry limitations, including graft atrophy and the risk of embolic complications. This study evaluated the safety and outcomes of superior orbital sulcus correction using a medial-pedicled preseptal orbicularis oculi muscle flap. This retrospective study analyzed 481 patients who underwent upper blepharoplasty between January 2017 and June 2024, of whom 45 received additional correction of superior orbital sulcus hollowness with a medial-pedicled preseptal orbicularis oculi muscle flap. Exclusion criteria included male sex, previous upper eyelid surgery, levator dehiscence, less than six months of follow-up, and refusal to complete the FACE-Q Adverse Effects questionnaire. The mean follow-up duration was 8 months, and the mean patient age was 51.4 years. Postoperative complications and patient-reported outcomes were evaluated and compared with those of patients undergoing conventional upper blepharoplasty. Early postoperative complications, including transient lagophthalmos and edema, were self-limiting. In the conventional blepharoplasty group, 16 patients developed medial canthal scarring, with four requiring revision. In the flap group, transient supraorbital hypoesthesia occurred in 71% of patients and resolved within a few months, and no cases of flap necrosis were observed. Statistical analysis using the Mann-Whitney U test demonstrated no significant difference in FACE-Q scores between the two groups (U = 8828.0, p = 0.251). The medial-pedicled preseptal orbicularis oculi muscle flap appears to be a safe, reproducible, and anatomically sound technique for selected patients with superior orbital sulcus hollowness. Although the relatively uniform flap volume may not fully correct the deformity in all cases and patient numbers were limited, this method provides a promising alternative to fat grafting without adding long-term complications, with the potential to enhance aesthetic outcomes and patient satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Liver first approach is one of the possible strategies for synchronous CRLM. Less attention is generally reserved to colorectal resection after hepatic surgery. Aim of the study is to investigate the influence of liver resection on primary tumor surgery. In the present monocentric cohort study, patients operated onlaparoscopic CR resection after open or laparoscopic liver surgery are compared (propensity score matching analysis 1:3) with laparoscopically operated non metastatic CR patients in period 2015-2023. Primary endpoint: 30 day morbidity; secondary endpoints: conversion, reintervention and 90 days mortality rate, surgery duration. Forty liver-first and 642 control patients are matched; 40 and 120 patients respectively are compared after matching. Morbidity rate 32.5% and 37.5% (p = 0.568); CCI 100 >20.9 4/40 and 21/120 (p = 0.257); conversion rate 7.5% and 10% (p = 0.638); reintervention 3/40 and 13/120 (p = 0.761); mortality 0/40 and 1/120; surgery duration 288 and 279 min (p = 0.650). No difference in hospital stay (6.5 and 7 days in liver first and control group respectively). Liver-first approach does not worsten intraoperative and post-operative short term outcomes of primary tumor resection.
Titanium clips are commonly used to close mucosal defects after gastric lesion endoscopic submucosal dissection (ESD). However, prolonged titanium clip retention beyond the healing period may have potential negative effects on postoperative outcomes. This study developed and validated a scoring model to predict titanium clip retention at six months post-gastric ESD. A multicenter retrospective study was conducted on 1,055 patients who underwent gastric ESD with titanium clips closure for wound management. Patients were grouped into a training cohort (TC, n = 509), an internal validation cohort (IVC, n = 218), and an external validation cohort (EVC, n = 328). Univariate and multivariate logistic regression were applied to identify risk factors for titanium clip retention at the 6-month follow-up. A scoring system was then built by assigning weighted scores based on the regression coefficients of independent predictors. The model's performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and predictive values. Among the patients, 132 (12.5%) experienced prolonged titanium clip retention. Multivariate analysis revealed three independent predictors: tumor in the upper third of the stomach (2 points), diabetes (1 point), and the use of ≥ 8 clips (1 point). The scoring model exhibited strong predictive ability, with AUCs of 0.809 in the IVC and 0.855 in the EVC, along with high negative predictive values (0.946 and 0.984, respectively). Risk stratification classified patients into low-risk (0-1 points), intermediate-risk (2-3 points), and high-risk (4 points) groups. The observed retention rates were 3.5%, 14.8%, and 58.8% in the IVC, and 1.6%, 20.8%, and 76.5% in the EVC, respectively. The proposed predictive score, which combines tumor location, diabetic status, and clip number, effectively stratifies the risk of long-term titanium clip retention after ESD. This tool may assist in risk stratification for personalized postoperative surveillance, pending prospective validation.
Although pelvic landmarks have traditionally been used to estimate the femoral head center (FC), their reliability may be limited in patients with developmental dysplasia of the hip (DDH). In contrast, femoral-based reference methods have been insufficiently investigated. This study aimed to evaluate the feasibility and clinical utility of estimating the FC location in DDH using a three-dimensional model derived from trochanteric landmarks. We retrospectively analyzed 128 femurs from 84 female patients with DDH (mean age, 36.9 years) who underwent curved periacetabular osteotomy (CPO) from April 1, 2010, to September 30, 2020, and had no symptoms involving the spine or knee. The FC was estimated using multiple regression models based on the three-dimensional coordinates (x, y, and z) of the greater and lesser trochanter tips. Differences between the estimated and actual FC positions were assessed along all three axes. Correlation coefficients between the estimated and actual FC ranged from 0.725 to 0.875 across the three directions. The mean absolute error was 2-3 mm, with greater errors observed in the anteroposterior direction than in the craniocaudal direction. An estimation error within 3 mm may be considered relatively small in the context of clinically acceptable ranges reported in previous studies for restoring femoral offset and leg length during total hip arthroplasty (THA), supporting the practical applicability of this method in preoperative planning. The accuracy of the present approach was comparable to that reported in healthy populations and exceeded that of previous pelvic landmark-based regression techniques. This trochanter-based three-dimensional method enables clinically acceptable estimation of the FC in patients with DDH and may serve as a useful adjunct for planning of the femoral component when the native FC is difficult to identify.
Acute inflammation, when unresolved, can lead to complications that impair tissue repair and therapeutic outcomes. In this study, we employed a model of lipopolysaccharide (LPS)-induced acute subcutaneous abdominal inflammation in mice to investigate the modulatory effects of elastic compression. LPS administration elicited a robust inflammatory response, characterized by increased leukocyte infiltration, edema, and upregulation of pro-inflammatory mediators. Elastic compression significantly attenuated this response, reducing leukocyte counts in subcutaneous lavage, histological inflammatory infiltrates, and the expression of key pro-inflammatory genes and proteins, including NF-κB, IL-1β, and TNF-α, at both 24 and 72 hours post-induction. Mechanistically, these effects may result from the compressive force altering microvascular dynamics and modulating macrophage polarization and mechanotransduction pathways, including TLR4 and integrin signaling. Additionally, compression preserved redox homeostasis, as indicated by stable oxidative stress markers and antioxidant responses. To our knowledge, this is the first study to demonstrate that elastic compression modulates inflammation at molecular, cellular, and tissue levels in an acute inflammation model. These findings support the therapeutic potential of elastic compression as a non-pharmacological strategy for managing acute inflammation, with possible applications in postoperative care, traumatic edema, and other soft tissue inflammatory conditions. Further translational and clinical studies are warranted to validate these outcomes and guide evidence-based application protocols. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
In the context of mating, individuals of the same sex often act as rivals in the pursuit, attraction, and retention of desirable partners. This study explored the relationships between intrasexual competition and various aspects of human mating psychology across three countries: Canada, Hungary, and Indonesia. A total of 661 adults (including women, men, non-binary, and gender-unspecified individuals) completed an online questionnaire assessing sensation seeking, aggression, beauty-enhancing behavior, openness to cosmetic surgery, sexual motivation, and sociosexuality. Hypotheses were tested via Bayesian multilevel modeling. Measurement invariance testing and alignment procedures were conducted to address potential cross-cultural non-invariance. Results indicated that the superiority enjoyment component of intrasexual competition showed consistent positive associations with the examined psychological variables. Associations involving inferiority frustration were generally weaker and less consistent. The findings for openness to cosmetic surgery, sociosexuality, and aggression replicate prior research, whereas the links with sensation seeking, beauty-enhancing behavior, and sexual motivation extend the literature. Cross-national comparisons revealed no significant country differences in superiority enjoyment, whereas Canadian participants scored significantly lower than Hungarian and Indonesian participants in inferiority frustration, with no significant difference between the latter two groups. Overall, the findings suggest that intrasexual competition-particularly its superiority enjoyment component-shows consistent associations with mating-relevant psychological traits across cultural contexts, even when mean levels differ between societies.
Intracerebral hemorrhage (ICH) remains associated with high mortality and treatment variability. Current workflows rely on fragmented imaging interpretation and operator-dependent surgical planning. The objective was to develop and validate an agentic artificial intelligence (AI) framework integrating automated imaging analysis, guideline-based reasoning, and trajectory optimization for ICH treatment. Fifty consecutive computed tomography (CT) and computed tomography angiography (CTA) datasets from patients with spontaneous ICH were retrospectively analyzed. The system performed multi-class anatomical segmentation of skin, skull, brain, ventricles, and hematoma, followed by volumetric quantification and JavaScript Object Notation (JSON) based structured encoding of imaging biomarkers. A knowledge-based module incorporating international ICH guidelines generated risk stratification and treatment recommendations. When evacuation was indicated, an automated trajectory modeling module proposed a patient-specific minimally invasive surgical corridor. Overall agreement between AI-generated and expert treatment recommendations was 82% (41/50 cases), with substantial agreement beyond chance (Cohen's κ = 0.71). Discrepancies occurred primarily in borderline surgical indication scenarios. In evacuation candidates, the automated planner generated feasible trajectories in all 50 cases. Median angular deviation between AI-generated and expert-defined trajectories was 7.6°, interquartile range (IQR) 5.1-9.8°. AI-generated trajectories demonstrated equal or greater safety margins relative to expert planning in the majority of cases. End-to-end processing has a potential to substantially reduce simulated decision-support time compared with manual workflow. The proposed agentic AI framework enables structured, explainable, and workflow-integrated decision support for ICH management. This system may reduce operator variability and enhance precision in minimally invasive evacuation planning.
Atherosclerotic plaque rupture is a major cause of cerebrovascular events, yet the molecular determinants underlying vulnerability-related plaque morphology, including fibrous-cap thickness, remain incompletely defined. Using histomorphology-guided spatial proteomics, here we delineate molecular programs associated with plaque cap phenotype across discrete plaque subregions. In 112 carotid endarterectomy specimens, differences between thin-cap and thick-cap plaques were predominantly localized to the necrotic core and fibrous cap. These differences were enriched for processes related to inflammation, lipid handling, extracellular matrix remodeling and ossification/calcification, and supported the presence of proteome-based plaque subtypes. PCSK9 was among the proteins most strongly associated with thin-cap plaques. Consistently, an in vitro model of necrotic core-like oxidative and inflammatory stress increased PCSK9 secretion in primary vascular smooth muscle cells. Together, these findings localize molecular programs associated with cap phenotype to plaque compartments and provide a framework for spatially informed biomarker discovery in advanced carotid atherosclerosis.
This study investigates the climatic sensitivity and long-term performance stability of a semi-transparent photovoltaic (STPV) system operating in a tropical coastal region of Indonesia. Using a decade of daily meteorological data (2012-2022), we developed a multivariate regression-based environmental modelling approach to evaluate the influence of key climatic variables on performance ratio (PR) and energy yield. Three modelling structures were considered, including a full-variable model, a simplified model based on global tilted irradiance (GTI) and ambient temperature, and a constant PR benchmark. The results indicate that GTI and temperature are the dominant climatic drivers, accounting for most of the meaningful variability in PR. The simplified GTI-temperature model achieved predictive performance comparable to the full model, suggesting that a parsimonious formulation can retain most of the explanatory power while reducing data requirements. The estimated PR values ranged between 0.78 and 0.80, consistent with reported values for tropical photovoltaic systems. Despite observable seasonal and interannual climatic variability, the system exhibited relatively stable performance over the study period, with no clear monotonic decline in energy yield. These findings highlight the applicability of simplified environmental models for performance assessment and planning in data-scarce tropical coastal regions.
Accurate MRI-based quantification of abdominal adipose tissue is critical for metabolic risk assessment but is limited by labor-intensive manual segmentation and the extensive labeled-data dependency of deep learning models. We introduce Dynamic Fuzzy-Gaussian Modeling (DynFGM), a fully automated, unsupervised framework for adipose tissue segmentation designed to operate without requiring training data, expert annotations, or anatomical priors. DynFGM was developed and validated on 776 abdominal MRI scans, using a benchmark cohort (n = 20) with expert ground truth segmentations and a large validation cohort (n = 756). The pipeline dynamically adapts its complexity for each MRI slice by using image intensity kurtosis to select the optimal number of tissue clusters. A fuzzy C-means (FCM) algorithm then initializes a Gaussian mixture model (GMM) for segmentation, providing a mathematically interpretable alternative to black-box neural networks. Finally, a radial distance transform with an adaptive cutoff differentiates subcutaneous (SAT) from visceral adipose tissue (VAT). Performance was evaluated against the ground truth using dice similarity coefficient (DSC) and intraclass correlation coefficient (ICC). DynFGM achieved strong spatial agreement with expert annotations (mean DSC: 0.94) and high volumetric reliability (ICC: 0.82-0.97), comparable to reported inter-expert variability. The framework reduced mean absolute volumetric error by 92.6% compared to standard FCM (482.2 cm3 vs. 6547.5 cm3). On the large validation cohort (n = 756), the method demonstrated operational stability, producing physiologically plausible adipose distributions with a low technical failure rate (3.0%). Furthermore, the computational throughput averaged 13.6 s per participant on standard CPU (Intel® Core™ i9, 3.0 GHz) hardware. DynFGM provides an interpretable and data-efficient approach for abdominal adipose tissue phenotyping, offering an alternative to supervised deep learning in settings where labeled data are limited or unavailable. By bridging the gap between manual segmentation and labeled-data-dependent AI, this unsupervised framework offers a scalable tool for population-level research and may serve as an automated labeling tool to facilitate future model development.
RHEBL1 (RHEB2), a member of the Ras superfamily, has established roles in tumor-promoting signaling pathways including mTOR activation and NF-κB transcription; however, its specific role in oral squamous cell carcinoma (OSCC) and its regulation by the stem cell transcription factors Oct4 and Sox2 have not been previously characterized. This study aimed to elucidate the function and mechanism of RHEBL1 in OSCC development and analyze the regulatory influence of Oct4 and Sox2 on RHEBL1 expression. Immunohistochemistry and immunofluorescence assessed RHEBL1, Oct4, and Sox2 expression in normal and precancerous tissues. RHEBL1-overexpressing and knockout cell lines were created for in vitro assessment of proliferation and self-renewal; mice models were used to evaluate tumor formation in vivo. Bioinformatics analyses predicted Oct4 and Sox2 binding sites within the RHEBL1 promoter, validated by dual-luciferase reporter assays and ChIP-PCR. RHEBL1 showed high expression in OSCC and adjacent tissues, with linear arrangement of positive cells in the basal layer. High levels of RHEBL1, Oct4, and Sox2 were observed at the tumor invasion front and the basal layer of adjacent oral epithelia. RHEBL1 overexpression enhanced sphere formation and induced subcutaneous tumor-like lesions in immunodeficient mice, characterized histologically by invasive growth patterns and vascular structures, whereas control cells showed no such phenomenon. Furthermore, RHEBL1 knockout significantly reduced in vitro sphere formation and in vivo tumorigenicity. Oct4-Sox2 complexes bound two sites in the RHEBL1 promoter; mutations in these sites reduced transcriptional activation. Thus, this study demonstrated that Oct4 and Sox2 promote OSCC initiation and proliferation by regulating RHEBL1 expression. Clinical trial number: not applicable.
Transformer self-attention and billion-node network analyses share a key limitation: all-to-all evaluation creates an [Formula: see text] computational cost. Existing methods address this by either distributing the workload across hardware or substituting recurrent operators. This trades associative recall for efficiency. We present Reduced Interaction Sampling (RIS), a stochastic sparsification framework. RIS computes only a fraction of possible pairwise interactions. By leveraging topological redundancy in real-world networks, RIS separates structural accuracy from computational expense. For example, on the com-LiveJournal graph with 4 million nodes, RIS preserves the degree centrality rank ([Formula: see text]) while using only 10% of the edges. A partition-based setup, RIS-Structural, identifies twice as many hubs as sliding-window methods under heavy sparsity (1.00% vs 0.50%, [Formula: see text]). In TinyLlama-1.1B attention tests (0.5k-65k tokens), RIS achieves a geometric reach of about 21k tokens at 65k-outperforming Longformer (≈2k) and BigBird (≈17k). Window-based models surpass [Formula: see text] Cumulative Attention Mass but lose 98% of hub recovery. This shows that dense scalar weights poorly reflect long-range geometric reach. RIS maintains a stable Hub Recall with up to 128 times longer sequences and an edge budget below 0.01%. Stochastic sampling provides a mathematically robust way to scale context architectures without structural collapse.