Surgical Applications Research Articles

Thermal Ablation, Nonthermal Ablation And Surgical Striping Applications: 1-Year Single Center Early Results

ABSTRACT: Objectives : Starting from the 1900's minimally invasive methods such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) developed. Methods: This study includes a total of 136 patients (81 women/55 men), of whom 22 (10 women/12 men) were treated with classic surgical stripping, 54 (32 women/22 men) with thermal ablation and 60 (39 women/55 men) with non-thermal ablation. Results: Twenty-two patients (10 women/12 men) were treated with surgical stripping. In one female patient a hematoma arose in the medial crural region postoperatively. A radiofrequency catheter (ThermoBLOCK TM) was used in the thermal ablation procedures in 54 patients (32 female/22 male). It is believed that permanent paresthesia occured in one female patient after the procedure. In 3 male patients temporary paresthesia occured postoperatively. Non- thermal ablation was performed in 60 patients(39 female/55 male). Even through a severe burning sensation was present in 6 patients (5 female/1 male) during the procedure, this symptom was only transient. In one of the patients, deep venous thrombosis (DVT) occured at the level of the popliteal vein postoperatively at the sixth day. Conclusion: Even if thermal and non-thermal ablation and surgical procedures have the same pain decreasing rates, hematomas and a longer hospital stay are more frequent in surgical procedures.

Impact of the coronavirus disease 2019 pandemic on ear, nose, and throat diseases services

Objectives: The goal of this study was to compare the services provided by the ear, nose, and throat department between March 1st 2020 and May 31st 2020 during the COVID-19 (coronavirus disease 2019) pandemic to the same date range in the years 2017, 2018, and 2019 and examine the changes that occurred and thus form an idea about what precautions should be taken and what should be considered in the delivery of health services to patients in the ear, nose, and throat department. Patients and Methods: In March, April, and May of the years 2017, 2018, 2019, and 2020, the outpatient clinic and surgery admission numbers were scanned by the patient information management systems. Whether or not there was a difference between the pandemic and the prepandemic period was statistically evaluated. Results: The total number and rate of surgical applications and outpatient visits were determined to be significantly lower during the pandemic than in previous years (p<0.001). The proportion of surgeries performed for malignant conditions in the total number of surgeries performed during the pandemic was found to be statistically significantly increased (p<0.001). Conclusion: There was a significant decrease in hospital admissions during the pandemic. As all elective procedures were not postponed and the rate of some did not alter compared to past years, it is possible that the precautions taken are not strictly followed. Physicians should postpone elective procedures to prioritize malignant patients within the limits of their facilities.

Alveolar Disease of the Liver: Classification and Surgical Interventions

Introduction. There are several classifications of alveolar disease of the liver, but they do not provide complete information regarding all possible surgical interventions in terms of this pathology. Our study was aimed at identifying and structuring various approaches to staged surgical treatment of the disease, taking into account the current possibilities of minimally invasive surgery.Materials and methods. After carrying out a retrospective analysis of surgical treatment of 72 patients with alveolar disease of liver, we have developed a classification of the surgical interventions and 6 main staged approaches to surgical treatment for the disease. Results and discussion. The presented classification of surgical interventions for alveolar disease of the liver is entirely sufficient to divide all surgeries into the following groups: radical/ relatively-radical surgical interventions that make the patient free or nearly free of the disease, and palliative/diagnostic surgeries, that focus on alleviation of the patient’s condition. In addition, the volume and radicality of the liver resection as well as the drainage of the bile ducts and liver decay cavities can be clarified. Based on the developed classification of surgical interventions, we presented 6 main staged, case-centered approaches to the surgical treatment for liver alveolar disease and its complications.Conclusion. The presented classification of surgical interventions for alveolar disease of the liver is a way to explicitly divide the surgeries according to several criteria. Surgical treatment for alveolar disease of the liver includes various parts, which made it possible to develop 6 main options for a staged approach to surgical interventions, ensuring scientific and practical applications.

Human amniotic membrane application in oral surgery—An ex vivo pilot study

Objectives: The purpose of this pilot porcine study was to explore and illustrate the surgical application of human amniotic membrane (hAM) in an ex vivo model of medication-related osteonecrosis of the jaw (MRONJ). Material and methods: Five oral and maxillofacial surgeons participated to this study. MRONJ was simulated on porcine mandible specimens. hAM was applied using four different techniques: implantation with complete coverage, implantation with partial coverage, apposition and covering graft material. At the same time, the surgeons evaluated how well the hAM handled and its physical properties during the surgery. Results: Surgeons found that hAM had suitable mechanical properties, as it was easy to detach from the support, handle, bind to the defect and bury. hAM was also found to be strong and stable. The "implantation with complete coverage" and "implantation with partial coverage" techniques were the preferred choices for the MRONJ indication. Conclusion: This study shows that hAM is a graft material with suitable properties for oral surgery. It is preferable to use it buried under the gingiva with sutures above it, which increases its stability. This technical note aims to educate surgeons and provide them with details about the handling of hAM in oral surgery. Clinical relevance: Two surgical techniques for hAM application in MRONJ were identified and illustrated. hAM handling and physical properties during surgery were reported.

A Stacked Multi-Sensor Platform for Real-Time MRI Guided Interventions

We present a stacked temperature, pressure, and localization platform, targeted for minimally invasive surgical and diagnostic applications under Magnetic Resonance Imaging. The platform comprises a micro-fabricated three-layer (Titanium-Parylene-Titanium) membrane pressure sensor, a Gallium Arsenide band-gap temperature sensor, and a magnetic material on double prism retro-reflector that benefits from Magneto-Optic Kerr effect as a magnetic field sensor, to provide localization feedback under Magnetic Resonance Imaging. All sensors can be addressed with a single fiber optic cable, where the collected light is directed to a spectrometer and a polarimeter. For the three-layer microfabricated membrane sensor, an analytical formulation is derived, linking the pressure to optical intensity. Moreover, finite-element simulation results are provided, verifying analytical findings. Wavelength division multiplexing is exploited to address the sensors simultaneously. We measured sensitivities of 0.025 millidegree/Gauss rotation of polarization, 1.5 nm/mmHg displacement (in agreement with simulation results and analytical findings), 0.36 nm/°C bandgap wavelength shift for magnetic field, pressure, and temperature sensors; respectively. With further development, the proposed device can be adapted to a clinical setting for use in Magnetic Resonance assisted surgical procedures.

A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021).

Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research. Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference. 2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends. The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.

Enhanced Authenticated Key Agreement for Surgical Applications in a Tactile Internet Environment.

The Tactile Internet enables physical touch to be transmitted over the Internet. In the context of electronic medicine, an authenticated key agreement for the Tactile Internet allows surgeons to perform operations via robotic systems and receive tactile feedback from remote patients. The fifth generation of networks has completely changed the network space and has increased the efficiency of the Tactile Internet with its ultra-low latency, high data rates, and reliable connectivity. However, inappropriate and insecure authentication key agreements for the Tactile Internet may cause misjudgment and improper operation by medical staff, endangering the life of patients. In 2021, Kamil et al. developed a novel and lightweight authenticated key agreement scheme that is suitable for remote surgery applications in the Tactile Internet environment. However, their scheme directly encrypts communication messages with constant secret keys and directly stores secret keys in the verifier table, making the scheme vulnerable to possible attacks. Therefore, in this investigation, we discuss the limitations of the scheme proposed by Kamil scheme and present an enhanced scheme. The enhanced scheme is developed using a one-time key to protect communication messages, whereas the verifier table is protected with a secret gateway key to mitigate the mentioned limitations. The enhanced scheme is proven secure against possible attacks, providing more security functionalities than similar schemes and retaining a lightweight computational cost.

The Impact of the COVID-19 Pandemic on the Experiences of Female, Underrepresented-in-Medicine Surgical Applicants During the 2020-2021 Residency Match

INTRODUCTION: Persons from backgrounds underrepresented-in-medicine (UiM) face disparities in the residency application process, manifested as leading to a lower likelihood of invitations to interview for and therefore match into surgical residency programs. Given the unique challenges imposed by the global pandemic during the 2020−2021 application cycle, we aimed to describe the impact of COVID-19, transition to virtual interviews, and simultaneous social unrest surrounding UiM identities among UiM applicants. METHODS: An anonymous electronic survey was distributed to applicants who responded to a surgical society’s emails/social-media posts between October and December 2020. Differences between self-identified female UiM and non-UiM respondents were compared using descriptive-statistics (quantitative-questions) and grounded-theory determination of emergent-themes (qualitative-questions). RESULTS:N = 238 applicants responded; 45.8% (n = 109) identified as UiM. Compared to non-UiM applicants, UiM applicants reported greater concern about: delayed board examinations (44.0% vs 29.5%, p = 0.042), missed mentorship (38.5% vs 19.4%, p = 0.001), and lack of research experiences (27.5% vs 14.0%, p = 0.020). They focused on the importance of a “holistic” review of applications, concern for interview monopolization, detrimental effects on mental health due to social and political events, and prioritization of diversity/equity/inclusion initiatives when selecting residency programs. CONCLUSION: UiM applicants faced important challenges in their surgical residency applications during 2020-2021. Medical education governing bodies, program directors, and resident selection committees should be vigilant about mitigating these challenges in post-pandemic years. Strategies to increase recruitment of UiM applicants include: transparency/adaptation of holistic application review practices, strategic distribution of interview invitations with discouragement of interview hoarding, and formalization of program’s diversity, equity, and inclusion initiatives.

Quantifying the Suture Pullout Forces of Small Bowel Anastomosis for Surgical and Simulation Applications

Quantifying the Suture Pullout Forces of Small Bowel Anastomosis for Surgical and Simulation Applications

The experience of the Republican Research Centre for Radiation Medicine and Human Ecology in the implementation of the Union State measure to provide comprehensive medical care to the population affected by the Chernobyl disaster

The implementation of targeted medical care to the population of the Republic of Belarus and Russia affected by the Chernobyl disaster is carried out within the framework of national targeted programs, as part of the Union State event «Providing comprehensive medical care to certain categories of citizens of Belarus and Russia exposed to radiation as a result of the Chernobyl disaster» based on medical centers in Russia and Belarus. The relevance of the Measure for the provision of certain types of specialized, including hightech, medical care to citizens of the Republic of Belarus exposed to radiation as a result of the disaster at the Chernobyl nuclear power plant is based on the data on morbidity. The analysis of diseases showed an increase in morbidity rates for such nosological forms as chronic renal failure, secondary and tertiary hypoparathyroidism, diseases of the retina and vitreous body, immunodeficiency states, varicose veins of the lower extremities, acute lymphoblastic leukemia and lymphomas in children. On the territory of the Republic of Belarus in 2016-2021, the provision of comprehensive medical care within the framework of the Measure was carried out at the Republican Scientific and Practical Center for Radiation Medicine and Human Ecology. In 2016-2021, on the base of the Republican Research Centre for Radiation Medicine and Human Ecology 1607 citizens of the Republic of Belarus who suffered from the Chernobyl disaster received high-tech and specialized medical care (in 2016 – 238, in 2017 – 260, in 2018 – 264, in 2019 – 264, in 2020 – 278, in 2021 – 303). The main part of medical care was provided in the surgical applications: transplantation of the kidney and parathyroid glands, surgeries on the posterior segment of the eye, reconstructive surgeries of the pelvic floor in women, laser vein correction. The successful implementation of the Measure in 2016–2021 made it possible to work out the possibility of holding the Measure of the Union State for subsequent years, specifying the amount of funding and additional volumes of comprehensive medical care for citizens in need who were exposed to radiation due to the Chernobyl disaster.

X23D—Intraoperative 3D Lumbar Spine Shape Reconstruction Based on Sparse Multi-View X-ray Data

Visual assessment based on intraoperative 2D X-rays remains the predominant aid for intraoperative decision-making, surgical guidance, and error prevention. However, correctly assessing the 3D shape of complex anatomies, such as the spine, based on planar fluoroscopic images remains a challenge even for experienced surgeons. This work proposes a novel deep learning-based method to intraoperatively estimate the 3D shape of patients’ lumbar vertebrae directly from sparse, multi-view X-ray data. High-quality and accurate 3D reconstructions were achieved with a learned multi-view stereo machine approach capable of incorporating the X-ray calibration parameters in the neural network. This strategy allowed a priori knowledge of the spinal shape to be acquired while preserving patient specificity and achieving a higher accuracy compared to the state of the art. Our method was trained and evaluated on 17,420 fluoroscopy images that were digitally reconstructed from the public CTSpine1K dataset. As evaluated by unseen data, we achieved an 88% average F1 score and a 71% surface score. Furthermore, by utilizing the calibration parameters of the input X-rays, our method outperformed a counterpart method in the state of the art by 22% in terms of surface score. This increase in accuracy opens new possibilities for surgical navigation and intraoperative decision-making solely based on intraoperative data, especially in surgical applications where the acquisition of 3D image data is not part of the standard clinical workflow.

Force Sensor Chip With High Lateral Resolution for Artificial Skin and Surgical Applications

The growing interest in artificial skin-based tactile systems requires sufficiently accurate, stretchable, low-power mechanical sensors. In this study, we present a novel capacitive device and an evaluation method capable of retrieving the force vector and determining the position of the loading point on an extended area without the application of a large matrix of individual sensors. With this tool, we can simultaneously increase the extractable information from an extended surface area and reduce the complexity, thereby the power consumption of the system. Thus, an alternative path is opened toward robotic tactile sensing by using a small array of sensors but covering a relatively large receptive field. Even a single sensor can meet the requirements of specific devices—for example, in catheters—to detect tissue hardness, bending, or narrowing of the arteries or veins. Apart from the medical and robotic applications, the flexibility in processing the Flex2Rigid platform enables the mimicry of human fingers or hands with integrated sensors and driving circuits.

An Analysis of Underrepresented in Medicine Away Rotation Scholarships in Surgical Specialties.

Underrepresented in medicine (UIM) visiting student clerkship scholarships provide an opportunity for supporting diversity. Although these scholarships have become a popular initiative to recruit diverse surgical applicants, they have not been thoroughly analyzed regarding which programs offer scholarships and the characteristics of the scholarships. UIM scholarship opportunity disparities may exist depending on location, funding, reputation, and program size among different specialties. To describe the characteristics and prevalence of UIM visiting student scholarships by examining institutional and program websites for the surgical specialties. Using the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System for 2021, residency training and diversity websites were identified and evaluated for the availability of UIM visiting student scholarships in July 2021. Eight surgical specialties were examined. Scholarships were categorized by how UIM was defined, the funding amount provided, and scholarship application requirements. We analyzed the association of the program's National Institutes of Health funding, size, type, region, reputation, and population density of the program's area via Doximity on scholarship availability using chi-square and multivariate analysis. Of the 1058 analyzed programs, 314 (29.7%) had a UIM visiting student scholarship. There were 4 different definitions of UIM used among the analyzed programs. The average scholarship amount offered was $1,852.25 ($500-$4,000). Depending on the specialty, different variables were associated with whether a program had a UIM scholarship. Currently, UIM scholarship offerings were variable between programs and surgical specialties.

Rethinking Feature Extraction: Gradient-Based Localized Feature Extraction for End-To-End Surgical Downstream Tasks

Several approaches have been introduced to understand surgical scenes through downstream tasks like captioning and surgical scene graph generation. However, most of them heavily rely on an independent object detector and region-based feature extractor. Encompassing computationally expensive detection and feature extraction models, these multi-stage methods suffer from slow inference speed, making them less suitable for real-time surgical applications. The performance of the downstream tasks also degrades from inheriting errors of the earlier modules of the pipeline. This work develops a detector-free gradient-based localized feature extraction approach that enables end-to-end model training for downstream surgical tasks such as report generation and tool-tissue interaction graph prediction. We eliminate the need for object detection or region proposal and feature extraction networks by extracting the features of interest from the discriminative regions in the feature map of the classification models. Here, the discriminative regions are localized using gradient-based localization techniques (e.g. Grad-CAM). We show that our proposed approaches enable the real-time deployment of end-to-end models for surgical downstream tasks. We extensively validate our approach on two surgical tasks: captioning and scene graph generation. The results prove that our gradient-based localized feature extraction methods effectively substitute the detector and feature extractor networks, allowing end-to-end model development with faster inference speed, essential for real-time surgical scene understanding tasks. The code is publicly available at <uri xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">https://github.com/PangWinnie0219/GradCAMDownstreamTask</uri> .

Morphometric comparison of Fisch type A and endoscopic endonasal far-medial supracondylar approaches to the jugular foramen.

The jugular foramen (JF) is one of the most complex and challenging skull base regions to approach surgically. The extreme medial approach to access the JF provides the approach angle from an anterior direction and does not require dissection and sacrifice of the jugular bulb (JB) to reach the pars nervosa. The authors compared the Fisch type A approach to the extreme medial approach to access the JF and evaluated the usefulness of the extreme medial approach. This study was performed at the Anatomical Laboratory for Visuospatial Innovations in Otolaryngology and Neurosurgery of The Ohio State University. For the comparison of surgical maneuverability and visualization, two angles were measured: 1) the angle of attack (AoA), defined as the widest angle of movement achieved with a straight dissector; and 2) the angle of endoscopic exposure (AoEE), defined as the widest angle of movement in the nasal cavity. The differences in eustachian tube (ET) management, approach angle, surgical maneuverability, and surgical application of the Fisch type A approach to the extreme medial approach were compared. There was no difference between ET mobilization and transection regarding cranial-caudal (CC) or medial-lateral (ML) AoA (p = 0.646). The CC-AoA of the Fisch type A approach was significantly wider than the CC-AoA of the extreme medial approach (p = 0.001), and the CC-AoEE was significantly wider than the CC-AoA of the extreme medial approach (p < 0.001). There was no significant difference between the CC-AoA of the Fisch type A approach and the CC-AoEE. The ML-AoA of the Fisch type A approach was significantly wider than the ML-AoA of the extreme medial approach (p = 0.033), and the ML-AoEE was significantly wider than ML-AoA in the extreme medial approach (p < 0.001). The ML-AoEE was significantly wider than the ML-AoA in the Fisch type A approach (p = 0.033). The surgical maneuverability of the extreme medial approach was not inferior to that of the Fisch type A approach. The extreme medial approach can provide excellent surgical field visualization, while preserving the JB. Select cases of chordomas, chondrosarcomas, and JF schwannomas should be considered for an extreme medial approach. These two approaches are complementary, and a case-by-case detailed analysis should be conducted to decide the best approach.

A unified structure-based constitutive model for both tension and shear of passive myocardium

This paper presents a hyperelastic model for replicating the passive response of ventricular myocardium and pericardium using fourth-order structural tensors. Models that can accurately predict mechanical response of cardiac samples are useful in understanding diseased tissues or postulating potential biomaterials for the replacement of damaged tissue in surgical applications. An orthotropic model is postulated here and is demonstrated to perform well in recreating experimental results in a variety of planar biaxial testing protocols and six modes of simple shear. The work outlines the fourth-order structural tensor (FOST) approach to representations of hyperelasticity for prescribing individual microstructural components (or interaction between them) that contribute to the overall elastic response of a biological tissue, through selection of specific FOSTs and constructing fourth-order material tensors possessing the constitutive properties and directional biases of that constituent. A fourth-order scalar product is then performed between this and an appropriately chosen fourth-order finite strain measure that returns a physically meaningful contribution to the strain energy density function for the overall tissue. A structure-based model for ventricular myocardium and pericardium is presented in this work using this approach. In the case of human myocardium, a consistent set of seven material constants simultaneously replicates five planar biaxial tension protocols and six modes of simple shear response.

Use of 3D printed model as an aid in surgical removal of dentigerous cyst in the left medio-lateral aspect of mandible associated with an impacted canine – A case report

Dentigerous cyst is the second most common developmental odontogenic cyst affecting 0.91-7.3% of population and always associated with an impacted tooth. They are commonly found associated with the lower third molars followed by the upper canines, lower premolars, and upper third molars.The current treatment protocol for treatment is surgical enucleation or marsupialization followed by surgical enucleation with extraction of an associated tooth. Three-dimensional (3D) printing is an industrial revolution, in which 3D models of any object are constructed using images obtained via MRI and CT. The procedure uses materials like plastic or metal, which are deposited layer by layer to prepare model. In the medicine, 3D printing has been growing from assistance in diagnosis to surgical applications and used widely for replacement of malfunctioning tissues and organs, customization of prosthesis, manufacturing of surgical implants and anatomical models for surgical diagnosis and planning.This case report highlights the effective usage of 3D printing as an aid in the surgical removal of dentigerous cyst and impacted canine in mandibular anterior region.

When the End Effector Is a Laser: A Review of Robotics in Laser Surgery

Combining laser technology with robotic precision and accuracy promises to introduce significant advances in minimally invasive surgical interventions. Lasers have already become a widespread tool in numerous surgical applications. They are proposed as a replacement for traditional tools (i.e., scalpels and electrocautery devices) to minimize surgical trauma, decrease healing times, and reduce the risk of postoperative complications. Compared to other energy sources, laser energy is wavelength‐dependent, allowing for preferential energy absorption in specific tissue types. This potentially leads to minimizing damage to healthy tissue and increasing surgical outcomes control and quality. Merging robotic control with laser techniques can help physicians achieve more accurate laser aiming and pave the way to automatic control of laser–tissue interactions in closed loop. Herein, a review of the state‐of‐the‐art robotic systems for laser surgery is presented. The goals of this paper are to present recent contributions in advanced intelligent systems for robot‐assisted laser surgery, provide readers with a better understanding of laser optics and the physics of laser–tissue interactions, discuss clinical applications of lasers in surgery, and provide guidance for future systems design.

Are maxillary sinus variations related to maxillary sinus diameters?

The reasons why the maxillary posterior region is challenging for dentists are its structure and anatomical variations. For this reason, it is necessary to have complete knowledge about the anatomy of this region. In dentistry, necessary information for the desired evaluation in this region can be provided by CBCT. The fact that it provides a three-dimensional evaluation and has measurement reliability emphasizes its importance in surgical applications. The septa, haller cell, and accessory ostium are variations of the maxillary sinus. There are few studies in the literature examining the relationship between maxillary sinus diameters and its variations. The aims of this study are to determine the prevalence of maxillary sinus variations and the average of maxillary sinus diameters, to examine their relationships according to age and gender, and to evaluate the effects of maxillary sinus diameters on variations. In this retrospective study, CBCT images of 212 patients were examined. The examined CBCT images were analysed and recorded in more than one section. Descriptive statistics, chi-square tests, independent t test, one-way Anova tests were used to evaluate the data. As a result, a statistically significant difference was observed between the variations, gender and age groups in terms of morphometric characteristics of the maxillary sinus. The most common variation was observed to be accessory ostium. The rate of patients with at least one anatomical variation was 77.8%. For this reason, a detailed analysis should be performed to avoid complications before surgical procedures are performed in the area.

Molecularly Engineered Protein Glues with Superior Adhesion Performance.

Naturally inspired proteins are investigated for the development of bioglues that combine adhesion performance and biocompatibility for biomedical applications. However, engineering such adhesives by rational design of the proteins at the molecular level is rarely reported. Herein, it is shown that a new generation of protein-based glues is generated by supramolecular assembly through de novo designed structural proteins in which arginine triggers robust liquid-liquid phase separation. The encoded arginine moieties significantly strengthen multiple molecular interactions in the complex, leading to ultrastrong adhesion on various surfaces, outperforming many chemically reacted and biomimetic glues. Such adhesive materials enable quick visceral hemostasis in 10 s and outstanding tissue regeneration due to their robust adhesion, good biocompatibility, and superior antibacterial capacity. Remarkably, their minimum inhibitory concentrations are orders of magnitude lower than clinical antibiotics. These advances offer insights into molecular engineering of de novo designed protein glues and outline a general strategy to fabricate mechanically strong protein-based materials for surgical applications.