Success Rate Research Articles

Angle Robustness Unmanned Aerial Vehicle Navigation in GNSS-Denied Scenarios

Due to the inability to receive signals from the Global Navigation Satellite System (GNSS) in extreme conditions, achieving accurate and robust navigation for Unmanned Aerial Vehicles (UAVs) is a challenging task. Recently emerged, vision-based navigation has been a promising and feasible alternative to GNSS-based navigation. However, existing vision-based techniques are inadequate in addressing flight deviation caused by environmental disturbances and inaccurate position predictions in practical settings. In this paper, we present a novel angle robustness navigation paradigm to deal with flight deviation in point-to-point navigation tasks. Additionally, we propose a model that includes the Adaptive Feature Enhance Module, Cross-knowledge Attention-guided Module and Robust Task-oriented Head Module to accurately predict direction angles for high-precision navigation. To evaluate the vision-based navigation methods, we collect a new dataset termed as UAV_AR368. Furthermore, we design the Simulation Flight Testing Instrument (SFTI) using Google Earth to simulate different flight environments, thereby reducing the expenses associated with real flight testing. Experiment results demonstrate that the proposed model outperforms the state-of-the-art by achieving improvements of 26.0% and 45.6% in the success rate of arrival under ideal and disturbed circumstances, respectively.

Abstract 2755: Characterizing breast cancer cells following immune pruning in mice

Abstract In cancer patients, metastasis is the leading cause of death. Indeed, primary tumors which are diagnosed early and treated in a timely manner have the highest rate of success. In contrast, metastatic disease and late diagnosis of tumors portend poor outcomes. Thus, understanding the underlying biology and developing novel therapeutic approaches for metastatic cancers is pivotal. Most cancer-based mutational characteristics are tissue-dependent, and cancers with higher mutational load are generally more susceptible to immunotherapy. We observed that poorly metastatic, murine breast cancer cells established a clear phenotypic difference in lung metastasis formation assays. Upon injection of these cells into immune-proficient mice, few, large metastases developed, whereas in immuno-deficient mice, many small metastases grew instead. To determine the molecular features which enable escape under immune editing, we designed the following workflow. We intravenously injected immune-proficient and immune-deficient mice with our poorly metastatic, murine breast cancer cells. As expected, cells readily engrafted in the lungs, causing a significant reduction in survival of immune-deficient mice. Furthermore, liver metastases were observed only in immune-deficient mice. Upon euthanasia, we resected and dissociated both organs. To isolate the tumor cells from these samples, we flow-sorted and subjected them to next-generation sequencing. To elucidate the epigenomic, genomic, and transcriptomic differences between metastases of each background, we performed ATAC, WGS, and RNAseq, respectively. By dissecting the evolutionary mechanisms which allow cancer cells to evade immune detection in metastasis, we can develop targeted immunotherapy strategies to diminish the spread (and lethality) of metastatic cancers. In the future, we plan to examine the descriptive discrepancies between the tissues reared with and without immune pruning in order to put forward innovative therapeutic strategies. Citation Format: Sarina McElduff, Daniel Bronder, Mercedes Duran, Samuel Bakhoum. Characterizing breast cancer cells following immune pruning in mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2755.

Abstract 1514: A novel workflow to assess the T-cell and patient-derived organoid interaction

Abstract Immunotherapy is increasingly popular as a type of cancer treatment. These therapies include the use of Chimeric Antigen Receptor-engineered T-cells (CAR T-cells), tumor-infiltrating lymphocytes (TIL), and other genetically modified T-cells to specifically target the cancer cells. Although much success has been achieved with immunotherapy for treatment of blood cancers, its efficacy remains limited in solid tumors. One of the reasons for the low success rate is attributed to the solid tumor microenvironment (TME) where suppressive cytokines limit the tumor killing ability of T-cells. Thus, understanding the role the TME plays in T-cell responses is essential for the development of effective cancer therapies. The benefits of using 3-dimensional (3D) PDOs lie in the physical and chemical cues present within the TME that cannot be mimicked in traditional 2D monolayer cultures. Studies show that PDOs show similar responses to drugs as original tumors, suggesting the value of using PDOs to improve therapeutic outcomes. Thus, PDOs can provide more relevant physiological and pathological cancer models that recapitulate the basic features of primary tumors and is more suited for assessing the effectiveness of T-cell killing than 2D cell models. Despite the benefits associated with the use of PDOs, there are significant barriers to widespread adoption of PDOs in drug discovery. Organoid production is a costly and highly labor-intensive process. Moreover, organoid culture is a skilled manual process, and thus there can be significant variability between operators. To address the challenges associated with the use of PDOs in large scale applications, a semi-automated bioprocess has been developed for the large-scale expansion of assay ready organoids. Here, we developed a method to assess the effectiveness of T-cell invasion in solid tumors using patient derive organoids (PDOs). Using bioreactor expanded patient-derived colorectal cancer organoids (CRCs), activated PBMCs (human peripheral blood mononuclear cells) stained with CellTracker were added to CRCs (stained with MitoTracker) in a 96well microtiter plate and monitored on every 4 hours for 3 days using high content imager. To quantify T-cell invasion, we developed an image analysis method to measure the distance of each T-cell to the nearest organoid (interaction distance). We find that stimulated T-cell resulted in smaller interaction distance than non-stimulated T-cells. The results demonstrate the utility of the bioreactor-expanded organoids in large scale T-cell based screens. Citation Format: Zhisong Tong, Angeline Lim, Oksana Sirenko. A novel workflow to assess the T-cell and patient-derived organoid interaction [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1514.

Design of air-ground cooperative landing platform and autonomous landing strategy

This paper studies innovative design for landing platform design and autonomous landing strategies for unmanned aerial vehicles (UAVs). First, a self-leveling landing platform on a mobile unmanned ground vehicle (UGV) is designed, which can be maintained even when the UGV moves on uneven terrain. Then, with the cooperation of the UAV and the UGV, they are controlled to reach the same velocity in the horizontal direction, which helps avoid the UAV’s rollover caused by horizontal velocity difference. Meanwhile, a buffering strategy is designed to reduce the vertical velocity difference, which helps avoid a hard landing. Finally, a combined landing code is designed to improve the accuracy and success rate of UAV landing. Experiments are carried out to demonstrate the effectiveness of the proposed design of a self-leveling platform and autonomous landing strategies.

Abstract 3761: A modified SELEX enables the efficient identification of DNA aptamers with potential for specific cancer targeting

Abstract Background: Aptamers have sparked significant interest in cell recognition due to their superior binding specificity and biocompatibility. Cell recognition can be mediated by targeting the major histocompatibility complex (MHC) that presents short peptides derived from intracellular antigens. Although numerous antibodies have demonstrated a specific affinity for the peptide-MHC complex, the number of aptamers that exhibit comparable characteristics is limited. However, the success rate of aptamer identification is low. This is possibly due to the presence of complementary sequences or sequences rich in quinine and cytosine that are less accessible for primers. Here, we use ovalbumin model antigen to explore whether aptamers with specificity for binding to a defined peptide-MHC complex can be identified. We developed DNA aptamers with modified SELEX by employing systemic consecutive selections with minimal PCR amplification. Furthermore, the other tumour antigen, claudin-6, was also used as a target to determine whether our modification for SELEX can be used with any selection technology. Methods: To determine whether our modified SELEX has potential for selecting aptamer capable of cancer-specific targeting, we used ovalbumin presented by H-2Kb (to represent the specific antigen presented by MHC) and claudin-6 (a cancer-associated adhesion molecule) as a target for the selection of aptamers. This modified SELEX consisted of consecutive positive and negative selections with minimal PCR amplification. Meanwhile, the selection of candidate aptamers is based on their appearance in multiple rounds rather than enrichment, and is facilitated by several computational tools. The specificity and affinity of the candidate aptamer are validated by flow cytometry, immunohistochemistry, and immunofluorescence analysis with cells with or without these molecules. Results: After high-throughput sequencing, a total of 211 candidate aptamers were selected for further analysis. The quadruplex forming G-rich sequences (QGRS) mapper, mFold modeling, and NUPACK web servers were used to predict the potential of G-quadruplex formation, resulting in only four potential aptamers. Using MTCQ1-OVA cells with FITC-conjugated aptamers, two aptamers showed selective binding to MTCQ1-OVA cells and had no binding specificity to MTCQ1-WT cells. The binding specificity was further validated by immunohistochemistry in tumour derived from mice inoculated with MTCQ1-WT or MTCQ1-OVA cells. In the pull-down assay, the binding affinity of these two candidate aptamers was 136.2 nM and 155.1 nM affinity. Conclusions: This preliminary study demonstrated that our modification for SELEX is effective in the selection of aptamers with promising potential for specific cancer targeting. The identification of aptamers may facilitate further application in diverse biomedical fields. Citation Format: Yang Lin, Cho-Yi Chen, Zhi-Qian Lin, Bing-Hong Chen, Yi-Chen Sun, Kai-Feng Hung. A modified SELEX enables the efficient identification of DNA aptamers with potential for specific cancer targeting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3761.

A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution

ObjectiveWe aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University of Graz.Materials and methodsIn a single-institution study, we analysed data from January 2005 to January 2021 of patients with histological/radiological diagnosis of OO. CT and MRI scans were reviewed for typical findings. Means (with SD) and medians (with IQR) were reported for normally and non-normally distributed variables. Differences between groups were assessed using chi-squared tests and t-tests.ResultsOne hundred nineteen patients (mean age: 21.6 ± 10.9 years; 63.9% males) with confirmed OO were retrospectively evaluated. 73 and 43 patients underwent RFA and surgery, respectively. In three cases, RFA combined with surgery was performed. Pre-intervention, 103 patients (88.8%) had undergone CT, and 101 had an MRI (87.1%). The nidus was confirmed in 82.5% of cases with CTs (85/103) and 63.4% with MRIs (64/101). The majority of nidi were located cortically (n = 96; 82.8%), most frequently in the femur (38 patients, 33.3%) with a median size of 8.0 mm (IQR: 5.0–12.0 mm). Median symptom duration before treatment was 6.0 (IQR: 4.0–13.0) months. The complication rate was 12.1% (14/116; 15.1% RFA vs. 7.0% surgery; p = 0.196). In total, 11.2% of patients had persistent symptoms after one week with clinical success rates of RFA and surgery, 86.3% and 90.7% (p = 0.647), respectively.ConclusionCompared to surgical treatment, CT-guided percutaneous RFA is a safe, minimally invasive, reliable, and efficient treatment option for OO.Critical relevance statementThis article critically assesses the diagnosis and treatment of osteoid osteoma, emphasising accurate imaging, and detailing a non-invasive option for effective management.Key points• This study analyses 116 cases of OO at one institution, focusing on symptom persistence, recurrence in short-term follow-up, and complications in two study groups.• Surgery showed higher, though not statistically significant, success despite comparable symptom persistence; CT displayed typical OO features more than MRI, regardless of the intramedullary, cortical and subperiosteal location as well as the site of the affected bone.• CT-guided RFA is an effective therapeutic alternative for OO compared to surgical intervention. In case of atypical OO appearance, RFA is not the first-line treatment.Graphical

Abstract 6900: Patient-derived xenografts from circulating cancer stem cells and their potential utility in personalized medicine of pancreatic cancer

Abstract Background: Pancreatic cancer carries a poor prognosis in the majority of patients, with an overall 5-year survival rate of less than 10%. Therefore, the development of new therapies and preclinical models is crucial and urgently needed. Circulating cancer stem cells (cCSCs) are a subset of circulating cancer cells that have stem cell-like properties and play a significant role in tumor progression, metastasis, and treatment resistance. Patient-derived xenografts (PDX) reflect the genotypic and phenotypic landscape of patients' cancers and are useful for drug screening, biomarker development, and preclinical evaluation of personalized medicine strategies. In this study, we describe a fast, simple, and cost effective method to generate PDX on Chorioallantoic Membrane (CAM) from circulating cancer stem cells. Methods: In this study, primary cultures from circulating cancer stem cells were established using sphere-forming assays from 30 patients with newly diagnosed pancreatic cancer. Subsequently, tumorspheres were transplanted onto the CAM membrane of fertilized chicken eggs to form patient- derived xenografts. Results: For the identification of cCSCs from peripheral blood of pancreatic cancer patients, an innovative in vitro sphere-forming assay was established. The number of tumorspheres was correlated with clinicopathological parameters like tumor size, lymph node involvement and grading status of the primary tumor. Implantation of tumorspheres onto the CAM was successful in ~90 % of the applied samples. The histological analysis suggests that the PDX tumors were morphologically and pathologically identical to primary tumor tissue. Conclusions: The number of tumorspheres was associated with clinicopathological parameters. Further follow-up is needed to evaluate the prognostic significance of tumorsphere detection in pancreatic cancer. Generation of PDX from cCSCs on CAM has a high success rate and may become an integral part of the drug development arena, including drug screening and biomarker development. Citation Format: Monika Pizon, Dorothea Schott, Andreas Ettner-Sittner, Benedikt J. Wagner, Katharina Pachmann, Thiha Aung, Christina Hackl, Silke Haerteis. Patient-derived xenografts from circulating cancer stem cells and their potential utility in personalized medicine of pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6900.

Abstract 4233: Rapid and robust generation of ex vivo tumoroid samples from fresh patient samples in a serum-free, conditioned medium-free system

Abstract Functional precision oncology describes a method in which an individual patient’s cancer cells are tested for response to various treatments ex vivo to aid in therapy selection. In many cases, these cultures take the form of tumoroids, which are 3D, patient-derived “mini tumors” that retain phenotypic and genotypic characteristics of the patient cancer. While interest in functional precision oncology is increasing due to strong correlation between patient responses and those experimentally observed using matched tumoroid models in the literature, a lack of standardization has precluded its widespread translation to clinical settings. To study the ability to generate short-term tumoroid cultures using a commercially available, serum-free, and conditioned medium-free system, we processed fresh tumor resection samples and performed culture in Gibco™ OncoPro™ Tumoroid Culture Medium. Tumor resection samples spanning a variety of indications were stored in supplemented Hibernate™-A Medium (including antibiotics) and shipped overnight on gel packs to a central tissue processing site. Samples were minced, enzymatically dissociated, and counted. Average yields of ~2000-12,000 cells per mg of tumor resection tissue were observed, with lower yields in lung, head and neck, and breast cancer samples and higher yields in endometrial and colorectal cancer samples. Donor-to-donor variability generated a wide range of yields within a given indication. Similarly, cell viability following dissociation ranged widely, reaching as low as 20% for some samples and exceeding 90% for others. Though yields and initial viability varied, dissociated cells that were plated in OncoPro Tumoroid Culture Medium formed tumoroids in >85% of samples within 7 days of tissue receipt. Both mutational profiles and gene expression patterns were highly conserved (>90%) between initial tumor samples and cells cultured in OncoPro for 7 days. Computational approaches designed to identify cell-type specific signatures from bulk RNA sequencing data indicated that immune cell population signatures were present after one week in OncoPro medium. Additionally, we have developed methods to analyze tumoroid response to compounds and candidate cell therapies by both plate reader- and imaging-based analyses using ~1.2e6 initial tumor cells per 96-well plate. Due to the high success rate of tumoroid formation from fresh tumor samples and retention of donor-specific characteristics in OncoPro Tumoroid Culture Medium, we believe that it will be a valuable tool for functional precision oncology of solid tumor samples. Citation Format: Colin Paul, Amber Bullock, Anthony Chatman, Brittany Balhouse, Chris Yankaskas, Pradip Shahi Thakuri, Matt Dallas, David Kuninger. Rapid and robust generation of ex vivo tumoroid samples from fresh patient samples in a serum-free, conditioned medium-free system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4233.

Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran.

Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.

Constraining the giant radio galaxy population with machine learning and Bayesian inference

Large-scale sky surveys at low frequencies, such as the LOFAR Two-metre Sky Survey (LoTSS), allow for the detection and characterisation of unprecedented numbers of giant radio galaxies (GRGs, or `giants', of at least $l_ p,GRG Mpc $ long). This, in turn, enables us to study giants in a cosmological context. A tantalising prospect of such studies is a measurement of the contribution of giants to cosmic magnetogenesis. However, this measurement requires en masse radio--optical association for well-resolved radio galaxies and a statistical framework to infer GRG population properties. By automating the creation of radio--optical catalogues, we aim to significantly expand the census of known giants. With the resulting sample and a forward model that takes into account selection effects, we aim to constrain their intrinsic length distribution, number density, and lobe volume-filling fraction (VFF) in the Cosmic Web. We combined five existing codes into a single machine learning (ML)--driven pipeline that automates radio source component association and optical host identification for well-resolved radio sources. We created a radio--optical catalogue for the entire LoTSS Data Release 2 (DR2) footprint and subsequently selected all sources that qualify as possible giants. We combined the list of ML pipeline GRG candidates with an existing list of LoTSS DR2 crowd-sourced GRG candidates and visually confirmed or rejected all members of the merged sample. To infer intrinsic GRG properties from GRG observations, we developed further a population-based forward model and constrained its parameters using Bayesian inference. Roughly half of all GRG candidates that our ML pipeline identifies indeed turn out to be giants upon visual inspection, whereas the success rate is 1 in 11 for the previous best giant-finding ML technique in the literature. We confirm $5,647$ previously unknown giants from the crowd-sourced LoTSS DR2 catalogue and $2,597$ previously unknown giants from the ML pipeline. Our confirmations and discoveries bring the total number of known giants to at least $11,585$. Our intrinsic GRG population forward model provides a good fit to the data. The posterior indicates that the projected lengths of giants are consistent with a curved power law probability density function whose initial tail index $ p,GRG changes by $ 0.3$ over the interval up to $l_ p Mpc $. We predict a comoving GRG number density $n_ GRG Mpc $, close to a recent estimate of the number density of luminous non-giant radio galaxies. With the projected length distribution, number density, and additional assumptions, we derive a present-day GRG lobe VFF $ V GRG-CW (z=0) = 1.4 $ in clusters and filaments of the Cosmic Web. We present a state-of-the-art ML-accelerated pipeline for finding giants, whose complex morphologies, arcminute extents, and radio-emitting surroundings pose challenges. Our data analysis suggests that giants are more common than previously thought. More work is needed to make GRG lobe VFF estimates reliable, but tentative results imply that it is possible that magnetic fields once contained in giants pervade a significant ($ gtrsim 10<!PCT!>$) fraction of today's Cosmic Web.

Object-Centric Scene Representations Using Active Inference.

Representing a scene and its constituent objects from raw sensory data is a core ability for enabling robots to interact with their environment. In this letter, we propose a novel approach for scene understanding, leveraging an object-centric generative model that enables an agent to infer object category and pose in an allocentric reference frame using active inference, a neuro-inspired framework for action and perception. For evaluating the behavior of an active vision agent, we also propose a new benchmark where, given a target viewpoint of a particular object, the agent needs to find the best matching viewpoint given a workspace with randomly positioned objects in 3D. We demonstrate that our active inference agent is able to balance epistemic foraging and goal-driven behavior, and quantitatively outperforms both supervised and reinforcement learning baselines by more than a factor of two in terms of success rate.

Feature Extraction Matters More: An Effective and Efficient Universal Deepfake Disruptor

Face manipulation can modify a victim’s facial attributes, e.g., age or hair color, in an image, which is an important component of DeepFakes. Adversarial examples are an emerging approach to combat the threat of visual misinformation to society. To efficiently protect facial images from being forged, designing a universal face anti-manipulation disruptor is essential. However, existing works treat deepfake disruption as an end-to-end process, ignoring the functional difference between feature extraction and image reconstruction. In this work, we propose a novel F eature- O utput ensemble UN iversal D isruptor (FOUND) against face manipulation networks, which explores a new opinion considering attacking feature-extraction (encoding) modules as the critical task in deepfake disruption. We conduct an effective two-stage disruption process. We first perform ensemble disruption on multi-model encoders, maximizing the Wasserstein distance between features before and after the adversarial attack. Then develop a gradient-ensemble strategy to enhance the disruption effect by simplifying the complex optimization problem of disrupting ensemble end-to-end models. Extensive experiments indicate that one FOUND generated with a few facial images can successfully disrupt multiple face manipulation models on cross-attribute and cross-face images, surpassing state-of-the-art universal disruptors in both success rate and efficiency.

Advanced Interventional Treatments in Retinoblastoma Management: A Comprehensive Review.

Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.

Efficacy and safety of low profile stents in Y-stent assisted coil embolization of wide-necked bifurcation aneurysms: a systematic review and meta-analysis.

Low-profile stents may provide significant advantages in Y-stent-assisted coiling due to their miniaturized design and capability to be delivered through a 0.0165-inch microcatheter. We aim to investigate the safety and efficacy of using these newer versions of stents in Y-stent-assisted coiling for the treatment of wide-necked bifurcation aneurysms. We conducted a systematic review of the PubMed, Embase, Cochrane Library, and Web of Science databases up to September 2023, following the PRISMA guidelines. Eligible studies included ≥ 5 patients with intracranial wide-necked bifurcation aneurysms treated with Y-stent-assisted coiling using low-profile stents, providing angiographic and clinical outcomes. Two authors independently handled the search and selection. Primary outcomes were immediate and follow-up aneurysm occlusion, procedure-related complications, aneurysm recanalization, and retreatment. Secondary outcomes included technical success, procedure-related morbidity, procedure-related mortality, procedure-related stroke, and in-stent stenosis at follow-up. We analyzed the data using random-effects meta-analysis. In total, 19 studies including 507 patients with 509 aneurysms were included. 95% of the treated aneurysms were managed using the crossing Y-configuration. Technical success rate was 99%. Immediate adequate aneurysm occlusion was 90%. Follow-up angiographies were available for 443 aneurysms. The mean angiographic follow-up duration was 15.6 ± 1.9 months. The rates for follow-up adequate aneurysm occlusion and complete occlusion were 98% and 89%, respectively. After a mean clinical follow-up of 15 ± 2.4 months, a good clinical outcome was observed in 98% of patients. Overall, procedure-related morbidity and mortality rates were 1.3%, and 0.4%, respectively. Low-profile stents in Y-stent-assisted coiling outperform previous stent versions in terms of safety, efficacy, and technical success rates.

Teaching Ultrasonographic Basic Examination Skills (TUBES): Assessment of an Ultrasound Skill Simulator in Teaching Ultrasound-Guided Paracentesis, a Prospective Observational Study

Ultrasound guidance during centesis is recommended to reduce the risk of serious complications, improve success rate, and to choose appropriate sampling locations and equipment. The aim of this study was to develop an accessible and reusable ultrasound skill simulator for ultrasound guided centesis (USGC). Fifty second year veterinary students reviewed an instructional video prior to performing two USGC skill tests on the simulator, separated by a period of practice. Following practice there was a significant improvement in score ( p < .0001), and average score and time improved by 8.6% and 163.3 seconds respectively. The proportion of successful aspirates improved by 9%, from 66% to 75%. Most post-session survey feedback was positive, and none was negative. Thirty-eight of 49 participants (78%) indicated they would prefer learning this skill with the simulator or in combination with individual practice and/or observation. Ninety-eight percent (49/50) strongly agreed that “this training simulator should be incorporated into the veterinary curriculum,” and 94% (47/50) strongly agreed with “I would use this training simulator again to practice basic ultrasound skills.” Eighty-four percent (42/50) strongly agreed their skills and knowledge improved using the simulator and 82% (41/50) strongly agreed they gained confidence with ultrasound using the simulator. The remainder of the responses for these four questions was agreement, and no student disagreed with any of the statements. The authors conclude this is an effective and well-received simulator for teaching ex vivo USGC and recommend incorporation into the veterinary curriculum for basic ultrasound skill training.

Preliminary report on embolization with quick-soluble gelatin sponge particles for angiographically negative acute gastrointestinal bleeding

Prophylactic embolization is usually performed using gelatin sponge particles, which are absorbed within several weeks, for managing angiographically negative gastrointestinal bleeding. This study aimed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with quick-soluble gelatin sponge particles (QS-GSP) that dissolve in less than 4 h for treating angiographically negative gastrointestinal bleeding. We included ten patients (M:F = 7:3; mean age, 64.3 years) who underwent prophylactic TAE with QS-GSP for angiographically negative acute gastrointestinal bleeding between 2021 and 2023. The technical success rate of TAE, clinical outcomes focusing on rebleeding, and procedure-related complications were evaluated. The embolized arteries were the gastroduodenal (n = 3), jejunal (n = 4), and ileal (n = 3) arteries. QS-GSP (150–350 µm or 350–560 µm) were used alone (n = 8) or in combination with a coil (n = 1). A 100% technical success rate was accomplished. In 1 patient (10%), rebleeding occurred 2 days after prophylactic TAE of the gastroduodenal artery, and this was managed by repeat TAE. There were no procedure-related complications. The use of QS-GSP for prophylactic TAE appears to be safe and effective for controlling bleeding among patients with angiographically negative gastrointestinal bleeding. There were no cases of related ischemic complications of the embolized bowels likely attributable to recanalization of the affected arteries following biodegradation of QS-GSP.

Feasibility and clinical value of linear endoscopic ultrasonography imaging in the lower gastrointestinal subepithelial lesions.

Linear endoscopic ultrasonography (EUS) has been extensively utilized as a novel diagnostic and therapeutic modality across various fields. However, there have been relatively few studies focusing on lower gastrointestinal lesions. The aim of our study was to investigate the feasibility, safety and clinical value of linear EUS in the lower gastrointestinal subepithelial lesions. This was a retrospective study involving patients with lower gastrointestinal subepithelial lesions diagnosed by linear EUS from August 2019 to April 2023 at the Second Affiliated Hospital of Anhui Medical University. The data, including basic clinical information, linear EUS features, technical success rate, complications, and follow-up, were retrospectively collected and analyzed. A total of 69 patients with lower gastrointestinal subepithelial lesions underwent examination by linear EUS. Excluding the rectum, the technical success rate of linear EUS was 90.6% (29/32). Apart from the 7 patients whose diagnosis remained unknown, 3 patients with no abnormal EUS findings, and 3 patients failed the procedure, 56 patients were included in the final diagnostic performance analysis. The most common locations of the lesions were the rectum (37/56, 66.1%) and sigmoid colon (7/56, 12.5%). Based on endoscopy findings and pathological results, the most prevalent types of subepithelial lesions in the lower gastrointestinal tract were neuroendocrine tumor (NET) (12/56, 20.3%), lipoma (8/56, 13.6%) and extraluminal compression (8/56, 13.6%). The majority of lesions ranged in diameter from 1 to 3cm (χ2 = 18.750, p < 0.001). After undergoing linear EUS examination, 36 patients received EUS-FNA (3/36), biopsy (5/36), endoscopic resection (25/36), or surgical excision (3/36) respectively. The pathological results of 29 patients were entirely consistent with the diagnosis made using linear EUS, with an 80.6% (29/36) diagnostic accuracy rate. Follow-up indicated that the lesions remained unchanged within 6-36months. All patients tolerated the procedure well without any complications. In conclusion, linear EUS demonstrates technical feasibility, safety, and a high diagnostic accuracy for subepithelial lesions in the lower gastrointestinal tract.

Real-time active constraint generation and enforcement for surgical tools using 3D detection and localisation network.

Introduction: Collaborative robots, designed to work alongside humans for manipulating end-effectors, greatly benefit from the implementation of active constraints. This process comprises the definition of a boundary, followed by the enforcement of some control algorithm when the robot tooltip interacts with the generated boundary. Contact with the constraint boundary is communicated to the human operator through various potential forms of feedback. In fields like surgical robotics, where patient safety is paramount, implementing active constraints can prevent the robot from interacting with portions of the patient anatomy that shouldn't be operated on. Despite improvements in orthopaedic surgical robots, however, there exists a gap between bulky systems with haptic feedback capabilities and miniaturised systems that only allow for boundary control, where interaction with the active constraint boundary interrupts robot functions. Generally, active constraint generation relies on optical tracking systems and preoperative imaging techniques. Methods: This paper presents a refined version of the Signature Robot, a three degrees-of-freedom, hands-on collaborative system for orthopaedic surgery. Additionally, it presents a method for generating and enforcing active constraints "on-the-fly" using our previously introduced monocular, RGB, camera-based network, SimPS-Net. The network was deployed in real-time for the purpose of boundary definition. This boundary was subsequently used for constraint enforcement testing. The robot was utilised to test two different active constraints: a safe region and a restricted region. Results: The network success rate, defined as the ratio of correct over total object localisation results, was calculated to be 54.7% ± 5.2%. In the safe region case, haptic feedback resisted tooltip manipulation beyond the active constraint boundary, with a mean distance from the boundary of 2.70 mm ± 0.37 mm and a mean exit duration of 0.76 s ± 0.11 s. For the restricted-zone constraint, the operator was successfully prevented from penetrating the boundary in 100% of attempts. Discussion: This paper showcases the viability of the proposed robotic platform and presents promising results of a versatile constraint generation and enforcement pipeline.

Cryoballoon ablation for atrial fibrillation in South Africa: One-year outcome from the Cryo Global Registry

Background. Pulmonary vein isolation (PVI) with cryoballoon catheter ablation (CBA) is a well-established and widely adopted method for the treatment of patients with atrial fibrillation (AF) to prevent recurrences of AF. CBA adoption in South Africa (SA) and outcome data in SA patients are limited.Objectives. To evaluate real-world usage, safety and effectiveness of CBA in SA. Methods. In this sub-analysis of the Cryo Global Registry, 81 participants with paroxysmal AF (PAF) and persistent AF (PsAF) were enrolled between 2017 and 2021 across two private SA hospitals. Baseline characteristics, procedural characteristics, 12-month safety, effectiveness (atrial arrhythmia recurrence), healthcare utilisation (repeat ablation and all-cause hospitalisation), quality of life (QoL; measured by EQ-5D-3L) and predefined symptoms were reported on. Results. Participants in the SA cohort were a mean (standard deviation) of 60 (12) years old, 19 (23.5%) were female, and 48 (59.3%) presented with PAF. The overall presence of baseline comorbidities in the SA cohort was relatively low compared with the entire Cryo Global Registry cohort. The acute PVI success rate was high (98.8%). Two serious procedure-related adverse events occurred in 2 (2.5%) participants in the SA cohort. Freedom from arrhythmia recurrence was 97.4% (95% confidence interval (CI) 83.2 - 99.6%) in PAF and 78.4% (95% CI 58.1 - 89.7%) in persistent AF (p=0.035). Kaplan-Meier estimates for freedom from repeat ablations and all-cause hospitalisations were 97.0% (95% CI 88.4 - 99.2%) and 98.5% (95% CI 90.0 - 99.8%), respectively. Participants reported significant improvement in EQ-5D-3L index score and symptoms from baseline (0.90 (0.11)) - 12 months (0.97 (0.07), p&lt;0.001). Conclusion. CBA standard-of-care procedures in SA resulted in a high clinical freedom from arrhythmia recurrence, with a low risk of safety events within 12 months post ablation. In addition, participants experienced an improvement in QoL and high freedom from healthcare utilisation at 12 months. The obtained results will be important for guiding clinical decisions around CBA in SA.

Access to Total Knee Arthroplasty in Medicare Advantage Patients

Background: Total knee arthroplasty (TKA) is one of the most frequently performed procedures in Medicare patients in the United States. Among this population, enrollment in Medicare Advantage (MA) plans is rising but rates of elective TKA are 10-20% lower in MA health maintenance organization (HMO) plans compared to Traditional Medicare (TM). The purpose of this study was to evaluate the effect of Medicare type on patient access to TKA within the large population in Florida. Methods: The AAOS directory was queried for total joint surgeon practices within five Florida counties. Each office was called to assess the response to four insurance scenarios (Traditional Medicare, Blue Medicare Select PPO, Humana Gold Plus HMO, and commercial Cigna). Investigators used a Secret Shopper methodology with a standardized script to request a TKA. Data was gathered on insurance types accepted and number of business days to the next available appointment. Results: Of the 133 orthopaedics clinics called, 63 were accepting new TKA patients. Of those accepting new TKA patients, 91.7% accepted commercial Cigna, 96.8% accepted TM, 70.5% accepted MA HMO Humana Gold Plus, and 50.8% accepted MA PPO Blue Medicare Select. Compared to TM and commercial Cigna, both MA plans had significantly lower appointment success rates (all p&lt;.003). Time to earliest appointment did not significantly vary by insurance type or county (p&gt;.14). Conclusions: Patients in Florida with MA have decreased access to TKA compared to those with TM or commercial insurance, possibly explaining the lower rates of TKA utilization in the MA population.