A"messenger zone hypothesis"based on the visual three-dimensional spatial distribution of motoneurons innervating deep limb muscles

Coordinated contraction of skeletal muscles relies on selective connections between the muscles and multiple classes of the spinal motoneuro ns.Howeve r,current research on the spatial location of the spinal motoneurons innervating differe nt muscles is limited.In this study,we investigated the spatial distribution and relative position of different motoneurons that control the deep muscles of the mouse hindlimbs,which were innervated by the obturator nerve,femoral nerve,inferior gluteal nerve,deep pe roneal nerve,and tibial nerve.Locations were visualized by combining a multiplex retrograde tracking technique compatible with three-dimensional imaging of solvent-cleared o rgans(3DISCO)and 3-D imaging technology based on lightsheet fluorescence microscopy(LSFM).Additionally,we propose the hypothesis that"messenger zones"exist as interlaced areas between the motoneuron pools that dominate the synergistic or antagonist muscle groups.We hypothesize that these interlaced neurons may participate in muscle coordination as messenger neurons.Analysis revealed the precise mutual positional relationships among the many motoneurons that innervate different deep muscles of the mouse.Not only do these findings update and supplement our knowledge regarding the overall spatial layout of spinal motoneurons that control mouse limb muscles,but they also provide insights into the mechanisms through which muscle activity is coordinated and the architecture of motor circuits.

Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

AIM:To investigate the difference of medial rectus(MR)and lateral rectus(LR)between acute acquired concomitant esotropia(AACE)and the healthy controls(HCs)detected by magnetic resonance imaging(MRI).METHODS:A case-control study.Eighteen subjects with AACE and eighteen HCs were enrolled.MRI scanning data were conducted in target-controlled central gaze with a 3-Tesla magnetic resonance scanner.Extraocular muscles(EOMs)were scanned in contiguous image planes 2-mm thick spanning the EOM origins to the globe equator.To form posterior partial volumes(PPVs),the LR and MR cross-sections in the image planes 8,10,12,and 14 mm posterior to the globe were summed and multiplied by the 2-mm slice thickness.The data were classified according to the right eye,left eye,dominant eye,and non-dominant eye,and the differences in mean cross-sectional area,maximum cross-sectional area,and PPVs of the MR and LR muscle in the AACE group and HCs group were compared under the above classifications respectively.RESULTS:There were no significant differences between the two groups of demographic characteristics.The mean cross-sectional area of the LR muscle was significantly greater in the AACE group than that in the HCs group in the non-dominant eyes(P=0.028).The maximum cross-sectional area of the LR muscle both in the dominant and non-dominant eye of the AACE group was significantly greater than the HCs group(P=0.009,P=0.016).For the dominant eye,the PPVs of the LR muscle were significantly greater in the AACE than that in the HCs group(P=0.013),but not in the MR muscle(P=0.698).CONCLUSION:The size and volume of muscles dominant eyes of AACE subjects change significantly to overcome binocular diplopia.The LR muscle become larger to compensate for the enhanced convergence in the AACE.

Catalpa bignonioides extract improves exercise performance through regulation of growth and metabolism in skeletal muscles

Objective:To evaluate the effects of Catalpa bignonioides fruit extract on the promotion of muscle growth and muscular capacity in vitro and in vivo.Methods:Cell viability was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.Cell proliferation was assessed using a 5-bromo-2’-deoxyuridine(BrdU)assay kit.Western blot analysis was performed to determine the protein expressions of related factors.The effects of Catalpa bignonioides extract were investigated in mice using the treadmill exhaustion test and whole-limb grip strength assay.Chemical composition analysis was performed using high-performance liquid chromatography(HPLC).Results:Catalpa bignonioides extract increased the proliferation of C2C12 mouse myoblasts by activating the Akt/mTOR signaling pathway.It also induced metabolic changes,increasing the number of mitochondria and glucose metabolism by phosphorylating adenosine monophosphate-activated protein kinase.In an in vivo study,the extract-treated mice showed improved motor abilities,such as muscular endurance and grip strength.Additionally,HPLC analysis showed that vanillic acid may be the main component of the Catalpa bignonioides extract that enhanced muscle strength.Conclusions:Catalpa bignonioides improves exercise performance through regulation of growth and metabolism in skeletal muscles,suggesting its potential as an effective natural agent for improving muscular strength.

Dual-Ion Co-Regulation System Enabling High-Performance Electrochemical Artificial Yarn Muscles with Energy-Free Catch States

Artificial yarn muscles show great potential in applications requiring low-energy consumption while maintaining high performance. However, conventional designs have been limited by weak ion-yarn muscle interactions and inefficient “rocking-chair” ion migration. To address these limitations, we present an electrochemical artificial yarn muscle design driven by a dual-ion co-regulation system. By utilizing two reaction channels, this system shortens ion migration pathways, leading to faster and more efficient actuation. During the charging/discharging process, PF_6~- ions react with carbon nanotube yarn, while Li~+ ions react with an Al foil. The intercalation reaction between PF_6~- and collapsed carbon nanotubes allows the yarn muscle to achieve an energy-free high-tension catch state. The dual-ion coordinated yarn muscles exhibit superior contractile stroke, maximum contractile rate, and maximum power densities, exceeding those of “rocking-chair” type ion migration yarn muscles. The dual-ion co-regulation system enhances the ion migration rate during actuation, resulting in improved performance. Moreover, the yarn muscles can withstand high levels of isometric stress, displaying a stress of 61 times that of skeletal muscles and 8 times that of “rocking-chair” type yarn muscles at higher frequencies. This technology holds significant potential for various applications, including prosthetics and robotics.

Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

Electromyographic study of shoulder and acromioclavicular joint muscles in women who underwent unilateral breast surgery of the types mastectomy and quadrantectomy

We studied 20 women with mean age 57.7 years, being 9 with unilateral quadrantectomy surgery, 1 with surgery type bilateral quadrantectomy and 10 with unilateral mastectomy surgery. The average operative time was 9.8 (nine years and eight months). We studied using surface electromyography the mean deltoid, upper trape-zius and latissimus dorsi muscles in order to check the action potentials of these muscles when performing a sequence of movements of these joints. It was used for the study, an Acquisition Data System ADS1000 containing 12 channels. The electromyography (EMG) results expressed in RMS (Root Mean Square) were analyzed and compared between the surgical and nonsurgical side, among the three repetitions of the sequence of movements and between mastectomy and quadrantectomy for each muscle. For statistical analysis we used analysis of variance (ANOVA) with a double repetition factor

How to make the "jump" on understanding the importance of the intrinsic foot muscles for propulsion

In this issue of the Journal of Sport and Health Science,Smith and colleagues1addressed a unique aspect of human locomotion;they evaluated the effects of the intrinsic foot musculature on the mechanical properties and energetic function of the human foot.By performing a controlled jumping experiment to mimic components of human locomotion.

Diffusion tensor imaging of horizontal extraocular muscles in patients with concomitant and paralytic esotropia

AIM:To assess metrics of diffusion tensor imagining(DTI)in evaluating microstructural abnormalities of horizontal extraocular muscles(EOM)in esotropia.METHODS:Six adult concomitant esotropia patients,5 unilateral abducent paralysis patients and 2 healthy volunteers were enrolled.Conventional magnetic resonance imaging(MRI)and DTI were performed on all subjects using 3T MR scanner.Fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),and radial diffusivity(RD)of medial and lateral rectus muscles were measured and compared between patients group and control group.RESULTS:Medial rectus MD and RD within the adducted eye of concomitant patients was significantly greater than that in unilateral abducent paralysis patients(0.259×10-2 mm^(2)/s vs 0.207×10-2 mm^(2)/s,P=0.014;0.182×10-2 mm^(2)/s vs 0.152×10-2 mm^(2)/s,P=0.017).Both strabismus patients showed a significantly decreased MD and AD than that obtained in normal controls for lateral rectus muscles(P<0.05).Medial rectus MD of the adducted eye in concomitant strabismus patients was significantly decreased than that in healthy controls(0.259×10-2 mm^(2)/s vs 0.266×10-2 mm^(2)/s,P=0.010).Lateral rectus AD of the adducted eye in concomitant strabismus patients was significantly decreased as compared with that in healthy controls(0.515×10-2 mm^(2)/s vs 0.593×10-2 mm^(2)/s,P=0.013).No statistically significant differences were present between the adducted and fixating eyes in concomitant strabismus patients.CONCLUSION:DTI represents a feasible technique to assess tissue characteristics of EOM.The effects of eye position changes on DTI parameters are subtle.Decreased MD and RD could be evidence for remodeling of the medial rectus muscle contracture.Lower medial and lateral recuts MD of concomitant esotropia patients indicates a thinner fibrous structure of the EOM.Lower MD and AD should be general character of esotropia.

Pathophysiological changes of muscle after ischemic stroke:a secondary consequence of stroke injury

Sufficient clinical evidence suggests that the damage caused by ischemic stroke to the body occurs not only in the acute phase but also during the recovery period,and that the latter has a greater impact on the long-term prognosis of the patient.However,current stroke studies have typically focused only on lesions in the central nervous system,ignoring secondary damage caused by this disease.Such a phenomenon arises from the slow progress of pathophysiological studies examining the central nervous system.Further,the appropriate therapeutic time window and benefits of thrombolytic therapy are still controversial,leading scholars to explore more pragmatic intervention strategies.As treatment measures targeting limb symptoms can greatly improve a patient’s quality of life,they have become a critical intervention strategy.As the most vital component of the limbs,skeletal muscles have become potential points of concern.Despite this,to the best of our knowledge,there are no comprehensive reviews of pathophysiological changes and potential treatments for post-stroke skeletal muscle.The current review seeks to fill a gap in the current understanding of the pathological processes and mechanisms of muscle wasting atrophy,inflammation,neuroregeneration,mitochondrial changes,and nutritional dysregulation in stroke survivors.In addition,the challenges,as well as the optional solutions for individualized rehabilitation programs for stroke patients based on motor function are discussed.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.

Effect of ultrasound-guided lumbar square muscle block on stress response in patients undergoing radical gastric cancer surgery

BACKGROUND Radical surgery is a common treatment for patients with gastric cancer;however,it can lead to postoperative complications and intestinal barrier dysfunction.Ultrasound-guided quadratus lumborum block is often used for postoperative analgesia,but its effects on stress response and intestinal barrier function are not well understood.AIM To investigate the effects of an ultrasound-guided quadratus lumborum block on stress response and intestinal barrier function in patients undergoing radical surgery for gastric cancer.METHODS A total of 100 patients undergoing radical surgery for gastric cancer were randomly categorized into observation and control groups.Plasma adrenaline and cortisol levels,intestinal mucosal barrier indexes,and complication rates were compared between the two groups before,during,and 1 day after surgery.RESULTS The observation group had significantly lower plasma adrenaline and cortisol levels during surgery and at 1 day postoperatively than that of the control group(P<0.05).Additionally,intestinal barrier indexes(endotoxin and D-dimer)at 1 day postoperatively were significantly lower in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided quadratus lumborum block could reduce stress response,protect intestinal barrier function,and decrease the incidence of complications in patients undergoing radical surgery for gastric cancer.This technique has the potential for clinical applications.

The Suh Muscle Hook: A New Muscle Hook for Tight Extraocular Muscles during Strabismus Surgery

Purpose: To introduce an advanced muscle hook to decrease risks and create more feasible extraocular muscle surgeries for physicians. Case Report: Tight extraocular muscles during strabismus surgery could be extremely challenging even in experienced hands due to restricted globe rotation, limited view, and lack of muscle elasticity. Although a variety of surgical instruments have been introduced through the years, traditional muscle hooks such as the Jameson hook are largely unchanged and are bulky and cumbersome. Using the traditional muscle hook under situations such as pediatric strabismus surgery with smaller eyes and extraocular muscles may increase the risk of perforating the globe or even rupturing the muscles. We developed the “Suh muscle hook”, which has a 0.55 mm wide grooved track in a 1.1 mm wide horizontal bar, a semi-sharp dissecting tip, and a 30-degree bending near the handle accommodating for nasal bridge to better facilitate surgeons dealing with tight extraocular muscles and minimize risks during strabismus surgery.

Indocyanine green:The guide to safer and more effective surgery

In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.

Effects of Purified Indian Cattle Tick Rhipicephalus microplus Saliva Toxins on Various Enzymes in Blood Serum, Liver and Muscles of Albino Mice

In the present investigation, in vivo effects of purified ticks’ saliva toxin were evaluated on the level of certain important cellular metabolic enzymes i.e. acid phosphatase (ACP), alkaline phosphatase (ALP), glutamate pyruvate transaminase, glutamate oxaloacetate transaminase and lactic dehydrogenase. For this purpose, sub-lethal doses, 40% and 80% of 24 h LD50 purified saliva toxins of Rhipicephalus microplus (Canestrini, 1888) were injected subcutaneously in the albino mice. In treated mice saliva toxins targeted membrane-bound enzymes i.e. serum acid phosphatase and alkaline phosphatase, its level was increased from 118.30% to 163.63% at the 6th hr in comparison to the control. Besides this, the levels of serum glutamate pyruvate transaminase (GPT) and glutamate oxaloacetate transaminase (GOT) and lactic dehydrogenase (LDH) also increased up to 161.11% (at 6th hr), 148.27 (at 8th hr) and 125.45% (at 6th hr) respectively in comparison to control. An increase in the level of LDH showed insufficient oxygen supply, massive disintegration of cells and leakage of the enzyme into the circulation. It clearly indicated the toxic effects of saliva toxins on the membrane of blood cells, hepatocytes and myocardial muscle cell functions in albino mice. On the other hand activity of acetyl cholinesterase was reduced by 65.51% at the 6th hr of the saliva toxin injection in comparison to the control. This inhibition of acetyl cholinesterase activity caused the accumulation of acetylcholine molecules at the synaptic junctions and led to prolonged activation of acetylcholine receptors. It caused permanent stimulation of nerves and muscle cells that may result in muscular paralysis and finally death of the animal.

非均匀结构网格上MUSCL和WENO格式的精度

基于一维均匀网格条件下构造的差分格式,在实际应用中须推广到非均匀或者曲线网格上,坐标变换过程引入几何诱导误差。目前常用收敛解误差随着网格细化变化的精度测试方法评估差分格式的精度。在二维柱坐标均匀网格上,采用1阶迎风、2阶MUSCL和5阶WENO计算流场参数为常数的自由流问题,按照精度测试方法比较收敛曲线斜率,发现1阶迎风的网格收敛精度是2阶的,5阶WENO的网格收敛精度不到1阶。理论分析表明,这种精度测试方法与差分格式精度定义不等价,而且所采用的数据无法反映差分格式的固有缺陷,因此,不能用来作为差分格式精度评价指标。很多研究WENO的文献经常模拟双Mach反射问题、二维Riemann问题等经典算例,把接触间断是否演变成不稳定涡结构作为特征,理论上可以证明涡结构是非物理现象,因此用是否出现涡结构作为算法高精度的论据并不合适。

SWIR FluorescenceImaging In Vivo Monitoring and Evaluating Implanted M2 Macrophages in Skeletal Muscle Regeneration

Skeletal muscle has a robust regeneration ability that is impaired by severe injury,disease,and aging.resulting in a decline in skeletal muscle function.Therefore,improving skeletal muscle regeneration is a key challenge in treating skeletal muscle-related disorders.Owing to their significant role in tissue regeneration,implantation of M2 macrophages(M2MФ)has great potential for improving skeletal muscle regeneration.Here,we present a short-wave infrared(SWIR)fluorescence imaging technique to obtain more in vivo information for an in-depth evaluation of the skeletal muscle regeneration effect after M2MФtransplantation.SWIR fluorescence imaging was employed to track implanted M2MФin the injured skeletal muscle of mouse models.It is found that the implanted M2MФaccumulated at the injury site for two weeks.Then,SWIR fluorescence imaging of blood vessels showed that M2MФimplantation could improve the relative perfusion ratio on day 5(1.09±0.09 vs 0.85±0.05;p=0.01)and day 9(1.38±0.16 vs 0.95±0.03;p=0.01)post-injury,as well as augment the degree of skeletal muscle regencration on day 13 post-injury.Finally,multiple linear regression analyses determined that post-injury time and relative perfusion ratio could be used as predictive indicators to evaluate skeletal muscle regeneration.These results provide more in vivo details about M2MФin skeletal muscle regeneration and confirm that M2MФcould promote angiogenesis and improve the degree of skeletal muscle repair,which will guide the research and development of M2MФimplantation to improve skeletal muscle regeneration.

Clinical Study of Shentong Zhuyu Decoction Combined with Massage Therapy in the Treatment of Exertional Chronic Lumbar Muscle Strain

[Objectives]To explore the effects of Shentong Zhuyu decoction combined with massage therapy in the treatment of exertional chronic lumbar muscle strain.[Methods]Sixty-four cases of exertional chronic lumbar muscle strain were randomly divided into two groups(32 cases each group).The patients in the control group only took celecoxib capsules,and those in the treatment group additionally took Shentong Zhuyu decoction combined with massage therapy.TCM syndrome score,lumbar function,hemorrheology index and clinical effect were compared between the two groups before and after treatment.[Results]After treatment,the TCM syndrome scores of lumbar distension/dull pain,tingling-like lumbago,adverse lateral turn,body weight loss,dark purple tongue,slow or astringent pulse,and Oswestry disability index(ODI)score in the treatment group were lower than those in the control group,and the levels of plasma viscosity,red blood cell aggregation index,platelet aggregation rate(PAG)and fibrinogen(Fib)were lower than those in the control group,showing statistical significance(P<0.05).The overall clinical effect distribution of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).[Conclusions]Shentong Zhuyu decoction combined with massage therapy can effectively relieve the symptoms of patients with lumbago and improve the lumbar mobility function and hemorrheology,with obvious therapeutic effects in the treatment of exertional chronic lumbar muscle strain.

Cerebral and muscle tissue oxygenation during exercise in healthy adults: A systematic review

Background:Near-infrared spectroscopy(NIRS)technology has allowed for the measurement of cerebral and skeletal muscle oxygenation simultaneously during exercise.Since this technology has been growing and is now successfully used in laboratory and sports settings,this systematic review aimed to synthesize the evidence and enhance an integrative understanding of bloodflow adjustments and oxygen(O_(2))changes(i.e.,the balance between O_(2) delivery and O_(2) consumption)within the cerebral and muscle systems during exercise.Methods:A systematic review was conducted using PubMed,Embase,Scopus,and Web of Science databases to search for relevant studies that simultaneously investigated cerebral and muscle hemodynamic changes using the near-infrared spectroscopy system during exercise.This review considered manuscripts written in English and available before February 9,2023.Each step of screening involved evaluation by 2 inde-pendent authors,with disagreements resolved by a third author.The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the methodological quality of the studies.Results:Twenty studies were included,of which 80%had good methodological quality,and involved 290 young or middle-aged adults.Different types of exercises were used to assess cerebral and muscle hemodynamic changes,such as cycling(n=11),treadmill(n=1),knee extension(n=5),isometric contraction of biceps brachii(n=3),and duet swim routines(n=1).The cerebral hemodynamics anal-ysis was focused on the frontal cortex(n=20),while in the muscle,the analysis involved vastus lateralis(n=18),gastrocnemius(n=3),biceps brachii(n=5),deltoid(n=1),and intercostal muscle(n=1).Overall,muscle deoxygenation increases during exercise,reaching a plateau in voluntary exhaustion,while in the brain,oxyhemoglobin concentration increases with exercise intensity,reaching a plateau or declining at the exhaustion point.Conclusion:Muscle and cerebral oxygenation respond differently to exercise,with muscle increasing O_(2) utilization and cerebral tissue increasing O_(2) delivery during exercise.However,at the exhaustion point,both muscle and cerebral oxygenation become compromised.This is characterized by a reduction in bloodflow and a decrease in O_(2) extraction in the muscle,while in the brain,oxygenation reaches a plateau or decline,potentially resulting in motor failure during exercise.

Parallel pathways:A chronicle of evolution in rectal and breast cancer surgery

In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.

Artificial Intelligence and Computer Vision during Surgery: Discussing Laparoscopic Images with ChatGPT4—Preliminary Results

Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.