Post-surgery Monitoring Research Articles

Machine-learning and mechanistic modeling of metastatic breast cancer after neoadjuvant treatment.

Clinical trials involving systemic neoadjuvant treatments in breast cancer aim to shrink tumors before surgery while simultaneously allowing for controlled evaluation of biomarkers, toxicity, and suppression of distant (occult) metastatic disease. Yet neoadjuvant clinical trials are rarely preceded by preclinical testing involving neoadjuvant treatment, surgery, and post-surgery monitoring of the disease. Here we used a mouse model of spontaneous metastasis occurring after surgical removal of orthotopically implanted primary tumors to develop a predictive mathematical model of neoadjuvant treatment response to sunitinib, a receptor tyrosine kinase inhibitor (RTKI). Treatment outcomes were used to validate a novel mathematical kinetics-pharmacodynamics model predictive of perioperative disease progression. Longitudinal measurements of presurgical primary tumor size and postsurgical metastatic burden were compiled using 128 mice receiving variable neoadjuvant treatment doses and schedules (released publicly at https://zenodo.org/records/10607753). A non-linear mixed-effects modeling approach quantified inter-animal variabilities in metastatic dynamics and survival, and machine-learning algorithms were applied to investigate the significance of several biomarkers at resection as predictors of individual kinetics. Biomarkers included circulating tumor- and immune-based cells (circulating tumor cells and myeloid-derived suppressor cells) as well as immunohistochemical tumor proteins (CD31 and Ki67). Our computational simulations show that neoadjuvant RTKI treatment inhibits primary tumor growth but has little efficacy in preventing (micro)-metastatic disease progression after surgery and treatment cessation. Machine learning algorithms that included support vector machines, random forests, and artificial neural networks, confirmed a lack of definitive biomarkers, which shows the value of preclinical modeling studies to identify potential failures that should be avoided clinically.

MNGIE Patients Undergoing Liver and Intestinal Transplantation Require Close Postsurgery Monitoring of Neurological Involvement

MNGIE Patients Undergoing Liver and Intestinal Transplantation Require Close Postsurgery Monitoring of Neurological Involvement

PMMA/PDMS/MXene Nanofibers for Postsurgery Monitoring of Vascular Implants

PMMA/PDMS/MXene Nanofibers for Postsurgery Monitoring of Vascular Implants

Parental use and acceptance of an accessible, commercially available intraoral camera for teledentistry in their children.

The potential of combining teledentistry and engaging parents as underutilised resources to monitor paediatric dental health was emphasised during the COVID-19 pandemic and remains underexplored. This study aims to assess parental acceptance and use of a commercially available intraoral camera (IOC) for effective remote monitoring. 47 child-parent dyads, where the parent was the main caregiver and the child was treated under general anaesthesia for early childhood caries, were recruited. Caregivers were trained to image their child's teeth on a commercially available IOC. Subsequently, submitted images were reviewed asynchronously by dentists for image quality, presence of dislodged fillings, abscesses, cavitation, and oral hygiene. Post-surgery monitoring was performed using teledentistry at 1 and 2months and in-person at 4months. A modified Telehealth Usability Questionnaire (TUQ) was used to record caregiver acceptance for study procedures. A mean TUQ of 6.09 out of 7 was scored by caregivers. Caregiver-reported issues were limited to problems with technique and child uncooperativeness. The number of clear images during the second teledentistry review was improved compared to the first (p = 0.007). 68% of children liked having images of their teeth taken. This study supports the feasibility of using an IOC as a clinically appropriate avenue for teledentistry with a high level of caregiver-child acceptance.

A 56-Year-Old Man with an Unusual Projectile Trajectory of Gunshot Wound at Head and Neck Region: A Rare Case Report

Background: Gunshot injuries to the neck are linked to a substantial risk of high mortality and morbidity due to the presence of critical vascular and vital structures. However, there are rare instances where a bullet trajectory through the neck region avoids damaging these vital structures. In this context, we report a specific case involving a 56-year-old male who presented to the emergency department with a gunshot wound to the right maxilla through the left anterior neck region.
 Case presentation: During the examination, a hematoma was observed in the left neck without an apparent entrance wound. The occurrence of a bullet injury to the neck without affecting any vital structures is exceptionally uncommon. Effectively managing patients with high-velocity penetrating injuries to the head and neck entails prioritizing tasks such as securing the airway, controlling hemorrhage, and promptly addressing any residual traumatic deformities for optimal outcomes. The presented case involves a gunshot injury to the head and neck, and a comprehensive review of the literature is provided.
 Conclusion: Gunshot injuries to the head and neck are complex and serious, demanding swift and thorough medical attention. The case emphasizes the significance of post-surgery monitoring for potential complications, contributing valuable insights to the ongoing discourse on managing such injuries.

A reliable, battery-free and implantable magnetic sensing system for wireless monitoring of spinal motion in rats and humans

Continuous monitoring of spinal and joint motions in patients allows surgeons to optimize patient rehabilitation. However, the current monitoring approaches are achieved via tethered devices, which are inconvenient and associated with a risk of infections. In this study, we developed and validated a new type of reliable wireless, battery-free, and implantable sensing system (RWBS) for the real-time monitoring of physiological bending of spines and joints. The RWBS exploits the unique movement-sensing capabilities of an implantable flexible magnetic strip, the signals from which are detected with an external receiver. We implanted this magnetic strip beneath the skins of Sprague Dawley rats and human cadavers and demonstrated that in combination with the receiver, the magnetic strip enabled real-time in vivo and wireless monitoring of motions in both rats (anesthetized/awake) and human cadavers. The adaptability of RWBS in other human bones has been verified by sensing the motions of elbow joints and knee joints. The simple design of the RWBS allowed it to continue functioning in vivo after the magnetic strip had been broken into two or more pieces, indicating its high reliability. Thus, the RWBS is biocompatible, exhibits excellent functionalities, and can be conveniently implemented in both rats and humans. This device will help to facilitate the post-surgery monitoring of spinal and joint movements of human patients.

Radiofrequency induced heating of biodegradable orthopaedic screw implants during magnetic resonance imaging.

Magnesium (Mg)-based implants have re-emerged in orthopaedic surgery as an alternative to permanent implants. Literature reveals little information on how the degradation of biodegradable implants may introduce safety implications for patient follow-up using medical imaging. Magnetic resonance imaging (MRI) benefits post-surgery monitoring of bone healing and implantation sites. Previous studies demonstrated radiofrequency (RF) heating of permanent implants caused by electromagnetic fields used in MRI. Our investigation is the first to report the effect of the degradation layer on RF-induced heating of biodegradable orthopaedic implants. WE43 orthopaedic compression screws underwent in vitro degradation. Imaging techniques were applied to assess the corrosion process and the material composition of the degraded screws. Temperature measurements were performed to quantify implant heating with respect to the degradation layer. For comparison, a commercial titanium implant screw was used. Strongest RF induced heating was observed for non-degraded WE43 screw samples. Implant heating had shown to decrease with the formation of the degradation layer. No statistical differences were observed for heating of the non-degraded WE43 material and the titanium equivalent. The highest risk of implant RF heating is most pronounced for Mg-based screws prior to degradation. Amendment to industry standards for MRI safety assessment is warranted to include biodegradable materials.

The effectiveness of MRI and CT with intravenous contrast in the assessment of carotid chemodectoma at the preoperative stage and in dynamics after surgery

Background. Carotid chemodectoma is rare, slow growing, richly vascularized lesion. It is a single unilateral or bilateral tumor, localized mainly in the area of the carotid triangle. Different forms and bilateral cases are also known. A complex of radiological studies, including MRI and CT with intravenous contrast, can help in determining the surgical treatment strategy, as well as treatment monitoring. Objective. To determine the role of MRI and CT with intravenous contrast in the assessment of carotid chemodectoma at the preoperative stage and at post-surgery monitoring. Materials and Methods. We analyzed the results of a comprehensive radiological examination of 12 patients with suspected carotid chemodectoma, including MRI and MSCT with intravenous contrast, and X-ray angiography. All patients got operated, the results were confirmed by histological and immunohistochemical study. Results. Multislice computed tomography, supplemented by CT angiography, allows visualizing chemodectoma, determining its size, shape, structure, and relations with the nearby vessels. In addition to size, shape, structure of chemodectoma MRI can provide a detailed picture of the internal vascular network, the walls of adjacent vascular structures, as well as the soft tissue structures of the peripharyngeal area, which is helpful for vascular surgeons in surgical intervention. It was not possible to determine the histogenesis of the tumor according to the methods of radiation diagnostics. Conclusions. In order to determine the option of surgical treatment of carotid chemodectomas and reduce the risk of intraoperative complications at the preoperative stage, it is necessary to carry out the entire spectrum of radiation diagnostic methods (including ultrasound, MSCT, MRI and X-ray angiography).

Plasma nanoDSF Denaturation Profile at Baseline Is Predictive of Glioblastoma EGFR Status.

Glioblastoma (GBM) is the most frequent and aggressive primary brain tumor in adults. Recently, we demonstrated that plasma denaturation profiles of glioblastoma patients obtained using Differential Scanning Fluorimetry can be automatically distinguished from healthy controls with the help of Artificial Intelligence (AI). Here, we used a set of machine-learning algorithms to automatically classify plasma denaturation profiles of glioblastoma patients according to their EGFR status. We found that Adaboost AI is able to discriminate EGFR alterations in GBM with an 81.5% accuracy. Our study shows that the use of these plasma denaturation profiles could answer the unmet neuro-oncology need for diagnostic predictive biomarker in combination with brain MRI and clinical data, in order to allow for a rapid orientation of patients for a definitive pathological diagnosis and then treatment. We complete this study by showing that discriminating another mutation, MGMT, seems harder, and that post-surgery monitoring using our approach is not conclusive in the 48 h that follow the surgery.

Artificial intelligence and machine learning as a viable solution for hip implant failure diagnosis-Review of literature and in vitro case study.

The digital health industry is experiencing fast-paced research which can provide digital care programs and technologies to enhance the competence of healthcare delivery. Orthopedic literature also confirms the applicability of artificial intelligence (AI) and machine learning (ML) models to medical diagnosis and clinical decision-making. However, implant monitoring after primary surgery often happens with a wellness visit or when a patient complains about it. Neglecting implant design and other technical errors in this scenario, unmonitored circumstances, and lack of post-surgery monitoring may ultimately lead to the implant system's failure and leave us with the only option of high-risk revision surgery. Preventive maintenance seems to be a good choice to identify the onset of an irreversible prosthesis failure. Considering all these aspects for hip implant monitoring, this paper explores existing studies linking ML models and intelligent systems for hip implant diagnosis. This paper explores the feasibility of an alternative continuous monitoring technique for post-surgery implant monitoring backed by an in vitro ML case study. Tribocorrosion and acoustic emission (AE) data are considered based on their efficacy in determining irreversible alteration of implant material to prevent total failures. This study also facilitates the relevance of developing an artificially intelligent implant monitoring methodology that can function with daily patient activities and how it can influence the digital orthopedic diagnosis. AI-based non-invasive hip implant monitoring system enabling point-of-care testing.

MO782: Evaluation of Acceleromet Reuse for Method of Measurement for Turbulent Blood Flow in Arteriovenous Fistulas in Haemodialysis Patients

Abstract BACKGROUND AND AIMS Haemodialysis (HD) is the primary treatment for end-stage renal disease. HD therapy requires access to the vascular system. This can be achieved through surgically constructing an arteriovenous fistula (AVF). Post-surgery up to 30% of patients experience dysfunction of the AVF, which may lead to a chronically damaged AVF and render the patient without HD treatment [1]. At present no satisfactory post-surgery monitoring of the AVF exist and, therefore, malfunction of the AVF is recognized too late at a time where no rescue is possible. The functionality of the AVF is normally assessed by auscultation of the murmurs produced by the blood flow. Narrowing of the AVF caused by thrombosis or stenosis causes changes in the blood flow, thus causing changes in the murmurs [2]. The changes in murmurs have not been widely studied but may be of importance to gain knowledge on AVF malfunction. This could be used in developing a method for monitoring the AVF post-surgery. METHOD Acoustic recordings was obtained from 21 patient post AVF-surgery at Aalborg University Hospital. Recordings were made with a Silicon Designs 1521 accelerometer encapsulated in a 3D printed box, attached to the skin using double adhesive tape 2–5 cm proximal to the AVF. A total of 11 patients were recorded twice resulting in a total of 32 recordings. Data were sampled at 5000Hz. All data processing and analysis were performed using MATLAB 2021b (MathWorks Inc.). Every recording was manually analysed and labelled with or without audible murmurs. Before processing every recording was split into segments of 3 sec length resulting in a total of 697 segments. Data was processed with a signal processing method [wavelet packet decomposition (Daubechies 4)] to analyse if the frequencies of the sounds differed between recordings with and without murmurs. Energy of the wavelet scales (Scale Energy) was calculated for each frequency band. The scale energy was then log-transformed using natural logarithm to make data normally distributed, and converted to decibel (dB). RESULTS A total of 654 segments contained murmurs and 43 segments did not contain murmurs. In all frequency bands, murmurs resulted in a significant change in energy level (P < 0.05). CONCLUSION This study shows AVF murmurs results in a significant change in acoustic energy across all frequency bands. This demonstrates that accelerometers can be used to quantify murmurs from AVFs post-surgery.

LAPORAN KASUS : PENANGANAN OBSTRUKSI USUS PADA ANJING DI BALI VETERINARY CLINIC

A local breed dog was brought to the veterinary clinic with signs of vomiting and decreased appetite. Physical examination revealed a pale mucosa of the eye and nose, 2 seconds of CRT, abdomen distention and stiffness. A haematology examination indicated WBC drop into 4.9, lymphocyte into 5.4, MCV to into 55.42 and Plate Distribusi Wide 8.1. The X-ray test showed the presence of an unknown mass around the intestine. Therefore, the dog was then diagnosed with intestinal obstruction. A laparotomy exploration with an enterotomy technique was performed to treat the condition. The surgery procedure found a mass of stone-like faeces that also consist of a mix of grass. The stone-like faeces were then removed from the intestine. Post-surgery monitoring was performed routinely and the dog received Cefotaxime Sodium (Claforan®) 22 mg/kg, Odansentron HCl (Zofran®) 0.2 mg/kg, Sucralfate (Carafate®) 0.8 gram, Lactulose (Cephulac®) 25 mL, Dexamethasone (Dexasone®) 1 mg/kg, Diphenhydramine HCl (Benadryl®) 3mg/kg, along with antiseptic treatment for the surgical incision. 3 days after the operation the dog began to show signs of recovery where the dog appeared to start moving and showed the desire to eat food. This condition can be prevented by not giving the dog food that bones. Lastly, the dog should be only released in a safe and knowledgeable environment.

Non-Contact Sensing Testbed for Post-Surgery Monitoring by Exploiting Artificial-Intelligence

Non-contact health care monitoring is a unique feature in the emerging 5G networks that is achieved by exploiting artificial intelligence (AI). The ratio of the number of health care problems and patients is increasing exponentially and creating burgeoning data. The integration of AI and Internet of things (IoT) systems enables us to increase the huge volume of data to be generated. The approach by which AI is applied to the IoT systems enhances the intelligence of the health care system. In post-surgery monitoring of the patient, timely consultation is essential before further loss. Unfortunately, even after the advice of the doctor to the patient, he/she may forget to perform the activity in the correct way, which may lead to complications in recovery. In this research, the idea is to design a non-contact sensing testbed using AI for the classification of post-surgery activities. Universal software-defined radio peripheral (USRP) is utilized to collect the data of spinal cord operated patients during weight lifting activity. The wireless channel state information (WCSI) is extracted by using orthogonal frequency division multiplexing (OFDM) technique. AI applies machine learning to classify the correct and wrong way of weight lifting activity that was considered for experimental analysis. The accuracy achieved by the proposed testbed by using a fine K-nearest neighbor (FKNN) algorithm is 99.6%.

Post-surgery monitoring and in vitro EGFR functional testing using short-time expanded circulating tumor cells (ECTCS) isolated from patients with triple negative breast cancer

The present study represents an attempt to develop an in vitro test for EGFR protein function amd post-surgery monitoring.

Biodegradable and Highly Deformable Temperature Sensors for the Internet of Things

Recent advances in biomaterials, thin film processing, and nanofabrication offer the opportunity to design electronics with novel and unique capabilities, including high mechanical stability and biodegradation, which are relevant in medical implants, environmental sensors, and wearable and disposable devices. Combining reliable electrical performance with high mechanical deformation and chemical degradation remains still challenging. This work reports temperature sensors whose material composition enables full biodegradation while the layout and ultrathin format ensure a response time of 10 ms and stable operation demonstrated by a resistance variation of less than 0.7% when the devices are crumpled, folded, and stretched up to 10%. Magnesium microstructures are encapsulated by a compostable‐certified flexible polymer which exhibits small swelling rate and a Young's modulus of about 500 MPa which approximates that of muscles and cartilage. The extension of the design from a single sensor to an array and its integration onto a fluidic device, made of the same polymer, provides routes for a smart biodegradable system for flow mapping. Proper packaging of the sensors tunes the dissolution dynamics to a few days in water while the connection to a Bluetooth module demonstrates wireless operation with 200 mK resolution prospecting application in food tracking and in medical postsurgery monitoring.

Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN.

The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.

Restoring walking after total knee arthroplasty: Symmetries of 3D body centre of mass trajectory and mechanical work

INTRODUCTION Osteoarthritis (OA) is a degenerative joint disease constantly increasing in elderly population and the knee is one of the most affected joints. It contributed together with other musculoskeletal disorders to the 2nd greatest cause of disability in the WHO Global Burden of Disease [1] and patients no more responding to conservative treatments undergo total knee-arthroplasty (TKA) to remove pain and permit an asymptomatic walking. Radiological reports and questionnaires are the current diagnostic tools employed both for the diagnosis and monitoring of OA progression. However, substantial discordance exists between current diagnostic outcomes using those tools and OA symptoms [2]. Further investigation need to identify more reliable biomarkers for early detection of the disease, correct timing for TKA and post-surgery monitoring. Therefore in this study we aim to describe quantitatively the gait of OA patients undergoing to the TKA, with a specific focus on the 3D body centre of mass (BcOM) trajectory (Locomotion 3D Lissajous Countours [3]). METHODS 7 patients with unilateral knee OA (68.9 ± 4.8 years, 69.1 ± 9.1 kg, 1.60 ± 0.07 m) were tested for 4 times: before surgery (PRE), after 2 months (POST2), after 6 months (POST6) and after 12 months (POST12) from TKA. Each time patients were asked to i) complete a WOMAC questionnaire, ii) walk on a 5-force plates (Bertec, Columbus, OH, U.S.A) corridor to estimate spontaneous velocity (vs), and iii) walk for 1 min on a treadmill at 3 selected velocities (vs, v1 and v2). Two velocities, lower than vs, were calculated starting from the Froude Number (Fr): v1 = -30% Fr and v2 = -15% Fr, respectively). A 18 marker model was used to calculate (VICON, Oxford UK) the 3D BCoM trajectory, its symmetries, stride frequency (SF), double contact (DC) time, right and left duty factor, mechanical external and internal work (Wext and Wint respectively), total work (Wtot) and energy recovery (RE). RESULTS WOMAC indices improved significantly already after 6 months and vs significantly increased from 0.89 ± 0.14 (PRE) to 1.13 ± 0.07 m/s (POST12). The figure shows the average BCoM profiles during walking (pointed arrows refer to vertical (z) and progression (x) axes), where upper boundary reaches a higher vertical position (3%) in the POST12 condition compared to the PRE condition and a more symmetrical shape, significantly in x and z directions. For the same walking speed SF decreased significantly already after two months from TKA, DC time decreased to 20% of the stride length and duty factor also assumed lower values after surgery. Patients after TKA improved their locomotor energy recovery mechanisms, reducing mechanical external work by 10%. WINT was constant along the months, while RE slightly increased after TKA. DISCUSSION The group of quantitatively analysed variables, suggest as patients with prosthesis tend to re-establish their natural locomotion pattern after TKA. Body centre of mass analysis during walking, including symmetry and mechanical energy evaluations, quantitatively assess osteoarthritis disease level and can be employed to monitor patients before and after pharmacological and surgical interventions. The same methodology could be applicable to neurological pathologies and to patients affected by other orthopaedic pathologies affecting other limb joints, like hip or ankle. The effects of different prosthesis or surgical techniques on a single pathology/joint could be equally investigated.

Mental health evaluations for adolescents prior to bariatric surgery: a review of existing practices and a specific example of assessment procedures

Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m2) presenting for bariatric surgery. A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.

A miniaturized bulk micromachined triaxial accelerometer fabricated using deep reactive etching through a multilevel thickness membrane

We present the design, fabrication and characterization of an application specific triaxial accelerometer for post-surgery heart monitoring. The accelerometer chip is designed as a 2 × 4 × 1.2 mm3 chip with nominal acceleration range of ±4 g and frequencies below 50 Hz. It has been fabricated using a multiproject wafer service with an additional deep reactive ion etching process to obtain controlled etch-through of membranes of 3, 23 and 400 μm thicknesses simultaneously. The novelty of the work presented here is the bulk micromachining technique using both deep reactive dry etching and alkali-based anisotropic wet etching of single crystal (100) silicon wafers used to obtain a space efficient design. Proof of concept is demonstrated with preliminary testing, with an acceleration sensitivity of ~0.04 mv/V/g for out of plane (z axis) acceleration.

The learning curve in head and neck reconstruction with microvascular free flaps: a retrospective review

Abstract Background: Tissue defect around the head and neck region is a great challenge for reconstructive surgeons. Successful outcomes of surgery is influenced by many factors such as surgical technique in recipient and donor site, meticulous microvascular anastomosis, position of vascular pedicle, and post-surgery monitoring. The learning curve is important for any new microvascular surgeons. Objectives: Evaluate the quality of training for a new otolaryngologist, head and neck surgeon, on their performance of free flaps in facial plastic and reconstructive surgery using a retrospective review. Methods: Nineteen microvascular free flaps in patients from the ENT Center of Rajavithi Hospital were reviewed between November 2008 and October 2009. Incidences of free flap survival, and partial and complete necrosis were examined. Results: Eighteen patients with microvascular free flaps had head and neck cancer. 88.9% of the patients had squamous cell carcinoma. There were nine radial forearm free flaps, five anterolateral thigh free flaps, two rectus abdominis free flap, two iliac-free flap, and one fibular-free flap. The overall success rate of the free flap reconstructions was 84%. One partial and three total necrosis were done on the 19 flaps. Conclusion: Causes of free flap failure were similar and not dependent on the experienced of the surgeons. The postgraduate training program in facial plastic and reconstructive surgery is effective in providing new microvascular surgeons the skills to perform successful microvascular and reconstructive surgeries.