Augmented Reality (AR)-assisted telesurgery has proven its effectiveness in enhancing situational awareness for clinician-side teleoperators. However, for patient-side surgical assistants, existing systems lack intuitive and safe interaction strategies to mitigate preoperative infection risks and intraoperative collisions. To address these challenges, this paper introduces a multifunctional proximity-aware skin that integrates multizone Time-of-Flight (ToF) sensing for interaction during both preoperative and intraoperative phases of AR-assisted telesurgery. On the patient side, a monocular camera providing AR visualization is mounted at the end of a robotic arm equipped with the skin. The skin uses a time-division multiplexing strategy to eliminate crosstalk and ensure reliable proximity awareness. During preoperative preparation, the skin-based contactless teleoperation allows surgical assistants to adjust the AR robotic arm for a high-quality field of view, while the contactless gesture recognition enables mode switching between rotation, translation, and locking. In the intraoperative phase, the skin facilitates obstacle avoidance to ensure patient-side safe assistance. Accuracy evaluations demonstrate effective crosstalk suppression under the proposed time-division multiplexing strategy. Functional experiments, laparoscopic phantom and tissue tests, as well as user studies validate the system's effectiveness to improve patient-side assistance.

BackgroundUreteral stricture (US), characterized by fibrotic remodeling of the ureteral wall, represents an obstructive urological disorder with incompletely characterized pathophysiological mechanisms. This study integrates single-cell RNA sequencing (scRNA-seq) with immunohistochemical validation in human tissues to investigate the molecular and cellular mechanisms underlying US pathogenesis.MethodsSpecimens of US (n = 7) and normal ureters (n = 8) were collected from patients prospectively. Single-cell RNA sequencing was performed to dissect the transcriptomic landscape of US, with subsequent immunohistochemical and immunofluorescence staining employed to validate key molecular and cellular findings at the protein level.ResultsIn US tissues, we identified significant downregulation of urothelial cell-specific gene signatures, accompanied by attenuated intercellular crosstalk between urothelial cells and fibroblasts. The urothelial cells exhibited reduced expression of reactive oxygen species (ROS)-associated functional clusters, with ANXA1 gene demonstrating particularly pronounced downregulation compared to control samples. Additionally, fibroblasts in US tissues displayed decreased expression of the THBS1 subtype and significant reduction in fibroblast-specific FPR2 receptor.ConclusionsOur findings establish that impaired urothelial cell function and disrupted urothelial-fibroblast communication are critically associated with or contributing to fibrotic remodeling in US. Specifically, control urothelial cells secrete ANXA1 as a ligand to interact with the fibroblast-expressed FPR2 receptor, maintaining fibroblast homeostasis. Clinically, these insights provide novel theoretical foundations for US prevention and highlight potential therapeutic targets for antifibrotic intervention.

While α-ketoglutarate (α-KG) has traditionally been viewed as an anti-inflammatory metabolite, we uncover its paradoxical role in driving pathological inflammation during sepsis. This study reveals that α-KG, a tricarboxylic acid cycle (TCA) intermediate elevated in septic patients, drives inflammatory macrophage death through absent in melanoma 2 (AIM2) -PANoptosome activation. Using both clinical samples and experimental models, we demonstrate that the cell-permeable derivative dimethyl-α-ketoglutarate (DM-α-KG) exacerbates lipopolysaccharide (LPS)-induced tissue injury and cell death, whereas isocitrate dehydrogenase (IDH1) inhibition (IDH-305) or genetic ablation reduces α-KG levels and confers protection. Mechanistically, α-KG enhances the dioxygenase activity of Ten-eleven translocation 2 (TET2), promoting its binding to the AIM2 promoter, reducing methylation, and increasing AIM2 expression, thereby triggering PANoptosome assembly. The pathophysiological relevance of this axis was confirmed by attenuated inflammation following either TET inhibition (dimethyloxallyl glycine, DMOG) or AIM2 deletion. These findings establish α-KG as a critical immunometabolic checkpoint in sepsis that licenses inflammatory cell death via TET2-mediated epigenetic control of AIM2. Our work not only elucidates a novel α-KG/TET2/AIM2 signaling axis in sepsis pathogenesis but also highlights the therapeutic potential of targeting this pathway to modulate immune responses. In sepsis, LPS challenge upregulates IDH1 expression, leading to the accumulation of α-KG. This increase in α-KG enhances dioxygenase activity of TET2, and promotes its recruitment to the AIM2 promoter, where it catalyzes local DNA demethylation and drives AIM2 transcription. The upregulated AIM2 protein then recruits the adaptor ASC to assemble the PANoptosome, a multiprotein complex that integrates key effector molecules from apoptosis, necroptosis, and pyroptosis pathways. This platform coordinately activates all three forms of programmed cell death, resulting in PANoptosis, a potent inflammatory cell death modality.Ultimately, this signaling cascade exacerbates multi-organ injury, a hallmark of severe sepsis.

Continuum robots are widely used in endoluminal intervention and treatment due to their dexterity and compliance. However, it is challenging to achieve simultaneous shape and force estimation of continuum robots under the requirement of robot miniaturization. To address it, this article proposes a learning-based real-time tip force and shape estimation for continuum robots using distributed tensions and proximal displacements of actuation fibers. It only needs the tension-sensing fibers for the actuation and sensing without using additional sensors. First, each utilized actuation cable is an optical fiber with inscribed distributed fiber Bragg grating sensors on it to provide distributed tension sensing. Finally, a neural network-based method is proposed to estimate the external force at the tip using the wavelength shifts of the fiber Bragg grating sensors on the actuating fibers and cable length changes as inputs, also the kinetostatic model is established to reconstruct the robot's shape in real time. Then, experimental results show that the average static force estimation error is 6.2 mN and the average tip position error from shape estimation is 3 mm. Furthermore, an augmented reality platform was developed to overlay the real-time estimated external forces and robot shape onto two-dimensional video images from an external monocular camera. This work would provide a potential to promote the embodied intelligence of continuum robots with miniaturization and integration.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is routinely performed under general anesthesia (GA) or sedation. However, there were few studies focused on the anesthesia method when transcatheter tricuspid valve replacement (TTVR) was performed. This study aimed to investigate whether TTVR procedures can be performed effectively under sedation. METHODS: We conducted a retrospective analysis of 45 patients who underwent TAVR and 56 patients who underwent TTVR at Shanghai General Hospital between August 2023 and November 2024. The primary endpoints were the incidence of hemodynamic fluctuations and the administration of vasoactive drugs during the surgical procedures. The secondary outcomes included perioperative complications. All relevant clinical data were meticulously collected and analyzed using standardized protocols. RESULTS: The groups did not differ in characteristics, comorbidities and cardiac function, or myocardial injury indicators. More patients in the TAVR group experienced post-induction hypotension. The duration of hypotension was significantly longer in the TAVR group. The magnitude of MAP decline and the heart rate were more considerable in the TAVR group than in the TTVR group during the operation. The dosage of vasopressor agents was higher in the TAVR group than in the TTVR group. Finally, the clinical outcomes of patients from both groups did not differ between the two groups after surgery. CONCLUSIONS: Performing TTVR have fewer harmful effects on hemodynamic stability and a lower likelihood of sudden incidents under GA. The results suggested that sedation may be a suitable and safe anesthesia method for TTVR and is worthy of future investigation. TRIAL REGISTRATION: The study was registered with ChiCTR (No: ChiCTR2500099352|| http://www.chictr.org.cn/ ), 21 March 2025.

Current exploration in confined environments for hyper-redundant robots (HRRs) requires prior knowledge of the space, and its planning and control are typically performed offline. However, plenty of operating conditions are unstructured, which require online perception, online decision-making, and online observation by operators. To address this limitation, this article develops a distributed proximity sensors-integrated and augmented reality (AR)-enabled HRR. It aims to provide both proximity and visual sensing to assist safe exploration toward tortuous and confined unstructured space. The robot integrates a customized on-body electronic skin with time-of-flight arrays on each segment’s outer surface for ranging measurement. The collected data is utilized as the input for the proposed proximity-assisted exploration algorithm to achieve the exploration in confined scenes. The operator can use the AR head-mounted display to observe the virtual HRR overlay and magnified endoscopic image screen, helping avoid environmental occlusion and improve visual intuition. Experiments are carried out in open and unstructured confined environments to evaluate its performance. Results and demonstrations show that the developed perception-enhanced HRR and perception-enabled exploration strategies exhibit its great capability to explore the unstructured environment.

Millimeter cable-driven continuum robots exhibit shape conforming, dexterous manipulation capabilities in constrained environments. They are increasingly used for narrow space and endoluminal intervention. For delicate manipulation, quantifying the force interaction between the robot and its surrounding environment is important for both shape adjustment and avoiding damages to luminal structures. In this work, we propose a real-time, whole-body contact estimation framework for small-scale continuum robots, based on actuation fibers and model-informed neural networks. The physical relationship among external body contact, internal actuation, and shape sensing of the continuum robot is formulated based on rod theory, and body contact estimation is treated as an inverse problem given the actuation tension profile and robot shape as inputs. The contact position and force are estimated using a neural network, and a generative adversarial network-based data augmentation strategy is proposed to reduce the need for large amounts of real data from the continuum robot under external forces. In addition, an automatic data acquisition platform is developed to efficiently collect the small amount of required data. Experiments with notched continuum robots were conducted to demonstrate the general applicability and accuracy of the proposed approach. The results show that the mean estimation errors for the three-dimensional (3D) contact position and contact force magnitude are 1.7 mm (2.3%) and 8.7 mN (5.8%), respectively, with an estimation frequency of 25 Hz. It paves the way for embodied integration using multiplexed fibers for the simultaneous actuation and sensing of millimeter-scale continuum robots, enabling their safer operation in confined spaces through machine intelligence.

Delicate manual microsurgeries rely on sufficient hands-on experience for safe manipulations. Automated surgical devices can enhance the effectiveness, but developing high-resolution, multi-axis force-sensing devices for micro operations remains challenging. In this study, a 6-axis force-sensing pneumatic forceps with a serial-parallel robotic platform for cochlear implantation is developed. The forceps features a curved body shape embedded with parallel and inclined fiber Bragg grating sensors for 6-axis force sensing, and a pneumatic gripper with decoupled actuation is located at its end for actively grasping and releasing the electrode array. The robotic platform comprises a customized spherical parallel mechanism and a robotic arm, which can provide independent 3-DOF rotations and 3-DOF translations. The feasibility of the developed robotic forceps is validated through cadaveric studies on a temporal bone and a human cadaveric head. In summary, the robotic forceps provides a decoupled mechanism for pneumatic actuation and force sensing, further demonstrating its potential for force interaction and stable operation during robotic microsurgery. Cochlear implantation requires highly accurate multi-axis force sensing in the constrained operating environment. Here, the authors present a multi-axis pneumatic forceps capable of independent rotations and translations, enhancing operation precision and stability during robotic microsurgery.

Micro-motion augmentation of macro-motion continuum robot can largely enhance its micro-operation capability during surgery. However, most existing micro-motion continuum robots have non-compact mechanical structure or non-smooth micro tip motion, which leads to complicated control in micro lumens. This paper proposes a micro-motion augmentation method by rotating eccentrically arranged fibres with eccentric lumens for cable-driven continuum robots. Two thermal drawn polymer fibres with an eccentric lumen on each are inserted into its eccentric lumens of the continuum robot. The micro-motion mechanism relies on small changes in the neutral axis of the continuum robot due to the rotation of the eccentrically arranged fibres. A kinematic model considering variable neural axis is built to describe the micro motion, and a simulation is conducted to investigate the deformation characteristics. The resolution and micro motion with respect to different structural parameters are also analysed. Detailed experiments are performed to validate the effectiveness of the proposed method, and results indicate that the repeatability of micro-motion is 10.1 mu m (4.0 %).

BACKGROUND:Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN). OBJECTIVE:We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response. METHODS AND MATERIALS:Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator's global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment. RESULTS:Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05). CONCLUSION:The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.

Congenital melanocytic nevi (CMN) are common skin tumors. Large and specially located nevi cannot be completely removed by surgery, posing the risks of both cosmetic deformities and potential malignancy. Nonsurgical treatments, such as laser therapy and physical dermabrasion, can overcome the limitations of surgery; however, the high rate of repigmentation remains an unresolved global challenge. We conducted a self-controlled observational study of a patient with a nevus on the chest. Two areas of the lesion were treated with an Er:YAG laser and 5% imiquimod cream was applied to one of these areas. After nearly 7-months of follow-up, we observed a significant difference in color between the two areas, suggesting that topical imiquimod may inhibit repigmentation and significantly enhance the effectiveness of laser treatment.

Background Both reconstructive outcomes and donor site deformities should be considered in forehead expander selection for resurfacing facial skin defects. Cranial bone deformity as well as bone resorption always cannot be completely normalized after tissue expander extraction. This study aimed to investigate the correlation between the degree of frontal deformity, the reconstruction outcomes, and the expander size. Patients and Methods Cases of forehead tissue expansion performed from 2011 to 2020 with 50/80 mL sized expanders and 150/200 mL expanders were retrospectively reviewed and separated into 2 groups. Demographic and clinical data were collected. Two plastic surgeons (Y.Z. and L.L.) who were not involved in the operation process compared the patient's preoperative photos with their final follow-up photos. The Fisher exact, 2-sample t tests, and the Wilcoxon rank-sum test were performed in this study. Results Ultimately, 51 patients were included in the 50/80ml sized expander group, and 28 patients were included in the 150/200 mL expander group. Demographic data were collected and had no statistically significant differences between the 2 groups. There was no statistical difference in the frontal deformation rate between the 2 groups. The degree of frontal deformation was significantly different, and a large expander could significantly reduce the frontal deformation degree (P < 0.05) and acquire a higher evaluation of the whole reconstruction outcomes (P = 0.007). Conclusions The large-sized (150/200 mL) expander sited on the forehead was shown to have a slighter postoperative forehead change and better reconstruction effect. It is advisable to choose expanders with relatively larger sizes in the application of the forehead expand flap.

Endoluminal and endocavitary intervention via natural orifices of the body is an emerging trend in medicine, further underpinning the future of early intervention and precision surgery. This motivates the development of small continuum robots to navigate freely in confined and tortuous environment. The trade-off between a large range of motion and high precision with concomitant actuation cross-talk poses a major challenge. Here, we present a submillimeter-scale fiber robot (~1 mm) capable of decoupled macro and micro manipulations for intervention and operation. The thin optical fibers, working both as mechanical tendons and light waveguides, can be pulled/pushed to actuate the macro tendon-driven continuum robot and transmit light to actuate the liquid crystal elastomer-based micro built-in light-driven parallel robot. The combination of the decoupled macro and micro motions can accomplish accurate cross-scale motion from several millimeters down to tens of micrometers. In vivo animal studies are performed to demonstrate its positioning accuracy of precise micro operations in endoluminal or endocavitary intervention.

Abstract Cystoscopy is the current gold standard for diagnosing bladder cancer (Bca), but its invasive nature often results in patient discomfort. This study aims to debise a new strategy to enhance BCa detection. We collected data from 30 BCa patients between January and June 2022. We obtained spontaneously voided urine specimens from these patients before and after administering extracorporeal bladder vibration. These specimens underwent routine cytologic examination and fluorescence in situ hybridization (FISH). Furthermore, we conducted a follow‐up 3 months postoperation. We recollected urine specimens before and after extracorporeal bladder vibration, repeating the cytologic examination and FISH. Our findings indicated an increase in the number of exfoliated cells in patients' urine postvibration compared to previbration. The liquid‐based cell staining results showed an increased detection rate of abnormal cells in the urinary sediment of patients with both low and high‐grade urothelial carcinoma postvibration. Similarly, the FISH results revealed an increased detection rate of CEP3 and CEP7 positive cells postvibration. Additionally, 3 months postoperation, we found abnormal cells in the urine of one patient previbration and in three patients postvibration. Further cystoscopic biopsy confirmed that these three patients had developed tumor recurrence. Our study substantiates that the extracorporeal bladder vibration assay significantly enhances BCa detection and the prediction of tumor recurrence. This method is simple, quick, and cost‐effective, making it a promising approach worthy of widespread clinical application.

Introduction: Ferroptosis is a new type of regulated cell death that is characterized by the overwhelming iron-dependent accumulation of lethal lipid reactive oxygen species and is involved in various diseases. However, the relationship between ferroptosis and lipo-polysaccharide (LPS)-induced acute lung injury (ALI) remains largely unknown.Methods: In this study, iron metabolism and ferroptosis-related gene mRNA levels in the lung tissues of LPS-induced ALI mice at different time points were detected. Then, the histological, cytokines production, and iron levels of LPS-induced ALI mice with or without the pretreatment of the ferroptosis inhibitor ferrostatin-1 (Fer-1) were measured after mice received the ferroptosis inhibitor ferrostatin-1 (Fer-1) intraperitoneally before LPS admin-istration. Ferroptosis-related protein (GPX4, NRF2, and DPP4) expression was measured in the in vivo and in vitro ALI model. Finally, ROS accumulation and lipid peroxidation was measured in in vivo and in vitro study.Results: Our results showed that iron metabolism and ferroptosis-related gene mRNA demonstrated significant variation in LPS-treated pulmonary tissues. The ferroptosis in-hibitor Fer-1 markedly attenuated the histologic injuries of the lung tissue and suppressed the production of cytokines in bronchoalveolar lavage fluid (BALF). Fer-1 administration reduced the levels of NRF2 and DPP4 protein induced by the LPS challenge. Furthermore, Fer-1 reversed the tendency of iron metabolism, MDA, SOD, and GSH levels induced by LPS administration in in vivo and in vitro.Conclusions: Taken together, ferroptosis inhibition by ferrostatin-1 alleviated acute lung injury through modulating oxidative lipid damages induced by the LPS challenge.& COPY; 2023 Elsevier Inc. All rights reserved.

[This corrects the article on p. 697 in vol. 12, PMID: 32194916.].

Hyperreflexia develops after spinal cord injury (SCI) in the human and in the spinal cord transected animal, and can be measured by the loss of low frequency-dependent depression of the H-reflex. Previous studies demonstrated normalization of low frequency-dependent depression of the H-reflex using passive exercise when initiated prior to the development of hyperreflexia. We examined the effects of passive exercise prior to compared to after the development of hyperreflexia in the transected rat. Adult female rats underwent complete transection (Tx) at T10. Frequency-dependence of the H-reflex was tested following passive exercise for 30 days, initiated prior to hyperreflexia in one group compared to initiation after hyperreflexia became established, and compared to intact and untreated Tx groups. An additional Tx group completed 60 days of exercise initiated after hyperreflexia was established. Lumbar enlargement tissue was harvested for western blot to compare Connexin-36 protein levels in control vs Tx animals vs Tx animals that were passively exercised. No differences in whole tissue were evident, although regional differences may still be present in Connexin-36 levels. Statistically significant decreases in low frequency-dependent depression of the H-reflex were observed following 30 days of exercise initiated prior to the onset of hyperreflexia, and also after 60 days of exercise when initiated after hyperreflexia had been established, compared with Tx only animals. We concluded that modulation of spinal circuitry by passive exercise took place when initiated before and after the onset of hyperreflexia, but different durations of exercise were required.

目的 探索巨大先天性黑素细胞病的分子遗传学特征与临床意义.方法 采用二代高通量测序技术对确诊巨大先天性黑素细胞病患者样本进行全外显子测序和生信分析.结果 25例患者的50个样本(25对组织与血液配对)中,21 例患者存在体细胞突变,突变基因包括NRAS基因(19 例)、BRAF基因(1 例),2 例患者病灶以及血液中均检测到新的突变,突变基因为MET基因(1 例)、IDH1 基因(1 例);另外 4 例患者未检测出致病突变.结论NRAS是巨大先天性黑素细胞病的最主要的基因突变类型,BRAF基因也被检出;同时还发现了潜在的新突变IDH1和MET基因.