Artificial intelligence (AI)–based anatomical recognition has emerged to support intraoperative cognition; however, its clinical utility beyond education remains limited. This study aimed to develop an AI model for suprapancreatic lymph node dissection during robotic distal gastrectomy (RDG) and evaluate its utility for intraoperative decision-making by surgeons. We developed a deep learning model using 67 RDG videos (54 for training and 13 for testing) to recognize the pancreas, common hepatic artery (CHA), left gastric artery (LGA), and left gastric vein (LGV). Model performance was evaluated using Intersection over Union (IoU). Twenty surgeons participated in two experiments: experiment 1 assessed peritoneal incision line selection, rated by three experts on a 5-point scale, and experiment 2 assessed the time to CHA identification in a crossover design. The IoU values for the pancreas, CHA, LGA, and LGV were 0.66, 0.28, 0.216, and 0.232, respectively. In mixed-effects models, experiment 1 showed that AI assistance reduced the proportion of unsafe peritoneal incision lines (scores 1–2) compared with no assistance (odds ratio, 0.25; 95
We evaluated radiation dose and detectability changes with automatic exposure control (AEC) according to object size in dual-source (DS) and fast kV switching (FS) dual-energy computed tomography (DECT). A phantom with five section diameters (16–36 cm) was scanned using different AEC settings (DS: Quality Reference mAs [QRmAs] 300–700; FS: Noise Index [NI] 8–12). Volume CT dose index (CTDIvol) and detectability index (d′) for iodine were measured. Clinical CTDIvol data from 40 to 80 kg patients undergoing liver dynamic DECT were retrospectively analyzed. In DS-DECT, CTDIvol increased slightly with section diameter but plateaued at QRmAs 600–700 for 31–36 cm (31 cm: 24.1 mGy; 36 cm: 22.5–22.7 mGy), and d’ decreased for larger sections. Clinical CTDIvol did not differ significantly among weight groups (40–<50 kg: 21.5 mGy; 50–<60 kg: 22.2 mGy; 60–<70 kg: 22.8 mGy; mean; p = 0.13). In FS-DECT, CTDIvol and d’ varied with NI and section diameter: for the 26-cm section, CTDIvol ranged from 15.0 to 30.8 mGy and d’ from 37.5 to 59.0; for 36-cm section, CTDIvol was 39.9 mGy and d’ 24.0–27.8, with smaller variations than single-energy CT (SECT). Clinical CTDIvol increased with patient weight up to 70 kg (40–<50 kg: 20.3 mGy, 50–<60 kg: 25.8 mGy, 60–<70 kg: 29.2 mGy; mean; p < 0.05). AEC behavior in DECT differs from SECT, causing variations in dose and detectability. Appropriate AEC settings in DECT can achieve image quality comparable to SECT.
Antibody-drug conjugates (ADCs) are emerging as a promising class of targeted cancer therapy. Trastuzumab deruxtecan (T-DXd), a human epidermal growth factor receptor 2 (HER2)-directed ADC, has demonstrated clinical efficacy in HER2-positive gastric and breast cancers, as well as in HER2-mutant non-small cell lung cancer. However, the development of acquired resistance limits their long-term efficacy. To elucidate the resistance mechanism, we established T-DXd-resistant cell lines derived from HER2-amplified gastric xenografts (N87 acquired resistance [AR]) and leptomeningeal carcinomatosis (Calu-3 AR) lung cancer cells. N87 AR cells exhibited cross-resistance to T-DXd, payload DXd, and topoisomerase I inhibitor SN-38 despite preserved HER2 expression and intact drug internalization. As payload resistance-related molecules, ATP-binding cassette (ABC) transporter ABCG2 and ABCB1 were markedly upregulated in N87 AR and Calu-3 cells, respectively. Inhibition of ABCG2 and ABCB1 in N87 AR and Calu-3 cells, respectively, through siRNA-mediated knockdown restored T-DXd sensitivity in both models. As a strategy to overcome resistance, pharmacological inhibitors of ABCG2 and ABCB1 restored the T-DXd sensitivity of N87 AR and Calu-3 cells, respectively. Moreover, BB-1701, a novel HER2-ADC containing eribulin as a payload, to which N87 AR cells are sensitive, exhibited antitumor effects in N87 AR cells in vitro and in vivo. These findings indicate that ABC transporter-mediated drug efflux is an important mechanism underlying T-DXd resistance in HER2-positive gastric and lung cancer models. Furthermore, our study suggests that both targeting drug efflux pathways and utilizing alternative payloads may be effective strategies for overcoming T-DXd resistance in HER2-positive gastric and lung cancers.
To characterize the ultrasonographic findings of patients with early knee osteoarthritis (KOA) and determine which findings were associated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. The study included 98 knees (35 men, 63 women, 60.3 ± 11.5 years) diagnosed with early KOA with no major deformity radiographically, but with pain during activity and tenderness in the medial knee. Synovial hyperplasia in the suprapatellar bursa, knee joint effusion, horizontal tear of the medial meniscus (MM), osteophytes of the medial condyle of the femur and tibia, blood flow signals in the synovium of the suprapatellar bursa, medial collateral ligament bursa, infrapatellar fat pad, MM extrusion (MME) in the supine and upright positions, and the amount of change in MME were observed using ultrasonography. Correlations (p < 0.05) were found between the presence of synovial hyperplasia of the suprapatellar bursa (r<-0.20) and amount of MME in the upright position (r< − 0.24) and all KOOS subscales. Presence of joint effusion and the four KOOS subscales except quality of life (QOL) were correlated (p < 0.05). Partial correlation coefficients showed correlations (p < 0.05) between knee joint effusion and symptoms (r = 0.299) and activities of daily living (ADL) (r = 0.254) of the KOOS subscales, and between MME in the upright position and symptoms (r= − 0.263), pain (r= − 0.256), and ADL (r= − 0.212). Quality and difficulty of life of patients with early KOA may be influenced by synovial hyperplasia in the suprapatellar bursa, joint effusion, and MME values in the upright position. Among them, synovial hyperplasia of the suprapatellar bursa and amount of MME in the upright position were independently associated with the KOOS subscales.
BACKGROUND:To provide evidence from randomized controlled trials (RCTs) for large-vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), to inform the forthcoming 2026 Japanese Circulation Society (JCS) clinical practice guideline. METHODS AND RESULTS:We drafted 4 and 7 clinical questions for TAK and GCA, respectively. A systematic review (SR) of RCTs was conducted using PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society through March 2024. Assessed with the GRADE approach, the certainty of evidence was very low for the most critical outcomes, low for some outcomes, and moderate for only 1 outcome. Evidence for TAK was limited. Tocilizumab (TCZ) resulted in a numerically lower relapse rate vs. placebo (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.39-1.37) and was similar to adalimumab. No clear difference between mycophenolate mofetil (MMF) and methotrexate (MTX), or between abatacept (ABA) and placebo was observed. In GCA, TCZ reduced relapse (RR 0.29, 95% CI 0.09-0.98) and increased remission (RR 3.56, 95% CI 2.29-5.54) over placebo at 52 weeks. Tumor necrosis factor inhibitor, ABA, and MTX showed no benefit in cranial GCA. Serious adverse events were comparable between treatment groups. Geographic variation and differences in entry criteria were noted. CONCLUSIONS:This SR was comprehensive synthesis of evidence from RCTs for LVV therapies to support the 2026 JCS guideline.
