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Background A comprehensive understanding of birth mechanics is essential for safe and competent practice in obstetrics and midwifery. These dynamic, three-dimensional processes occur internally and are not directly observable, making them challenging to teach with traditional methods. Virtual Reality (VR) offers unique potential to visualize such complex, invisible mechanisms. This nationwide survey assessed the perceived need, curricular contexts, and preferred content for a high-fidelity VR application to teach birth mechanics in midwifery and medical education. Methods An anonymous, digital survey was distributed to all study programs in midwifery science and medicine in Germany via program coordinators, department heads, and teaching leads in obstetrics and gynecology. Separate questionnaires for students and teaching professionals included 17 items on demographics, prior VR experience, attitudes toward VR, curricular timing, relevant learning objectives, and prioritized birth mechanics deviations. Responses were collected using Likert scales and multiple-choice questions, with non-parametric group comparisons (Mann–Whitney U, Chi-square test) and Bonferroni correction. Results A total of 1,249 complete responses were analyzed with 22.4% ( n  = 280) teaching professionals and 77.6% ( n  = 969) students; 65.7% ( n  = 821) medicine, 34.3% ( n  = 428) midwifery. Overall, 76.3% reported a high or very high need for VR, and 90.2% held a positive or rather positive attitude toward its use. Midwifery teaching professionals reported more prior VR experience (56.7%) than medical ones (12.7%). Midwifery students favored early integration, while medical students preferred later, clinically oriented phases. The most frequently prioritized deviations in birth mechanics were occiput posterior position (73.3%), breech presentation (51.4%), and direct occiput position with high station (44.0%), with notable differences between disciplines and educational roles. Conclusion This study reveals a strong perceived need for a VR application uniting anatomical accuracy with the dynamic processes of childbirth. Birth mechanics deviations were considered particularly suitable for simulation when they represent significant clinical challenges or are rarely demonstrated in current teaching. Tailored, interprofessional VR tools are perceived as potentially valuable for addressing these needs and may enhance obstetric and midwifery education. As part of the V.T.O.B.S. project (Virtual training for obstetric birth simulations), the next step will be the development and evaluation of such an application. Trial registration The study protocol was preregistered in the German Clinical Trials Register (DRKS00035186 27.09.2024).

BackgroundFast and accurate diagnostics are key for personalised medicine. Particularly in cancer, precise diagnosis is a prerequisite for targeted therapies, which can prolong lives. In this work, we focus on the automatic identification of gastroesophageal adenocarcinoma (GEA) patients that qualify for a personalised therapy targeting epidermal growth factor receptor 2 (HER2). We present a deep-learning method for scoring microscopy images of GEA for the presence of HER2 overexpression.MethodsOur method is based on convolutional neural networks (CNNs) trained on a rich dataset of 1602 patient samples and tested on an independent set of 307 patient samples. We additionally verified the CNN’s generalisation capabilities with an independent dataset with 653 samples from a separate clinical centre. We incorporated an attention mechanism in the network architecture to identify the tissue regions, which are important for the prediction outcome. Our solution allows for direct automated detection of HER2 in immunohistochemistry-stained tissue slides without the need for manual assessment and additional costly in situ hybridisation (ISH) tests.ResultsWe show accuracy of 0.94, precision of 0.97, and recall of 0.95. Importantly, our approach offers accurate predictions in cases that pathologists cannot resolve and that require additional ISH testing. We confirmed our findings in an independent dataset collected in a different clinical centre. The attention-based CNN exploits morphological information in microscopy images and is superior to a predictive model based on the staining intensity only.ConclusionsWe demonstrate that our approach not only automates an important diagnostic process for GEA patients but also paves the way for the discovery of new morphological features that were previously unknown for GEA pathology.

Pancreatic cancer features elaborate mechanisms of immune evasion. The potential of new immune molecules was explored to restore the antitumor immune response. If these immune molecules are associated with poor survival, specific drugs could take effect. Here, we analyze the expression of VISTA, LAG3, IDO, and TIM3 on tumor-infiltrating lymphocytes (TILs) and its impact on patient survival. We analyzed 153 pancreatic cancer patients from the prospectively managed database of the multicentered PANCALYZE study. Immunohistochemistry on a tissue microarray assessed VISTA, LAG3, IDO, and TIM3 expression of TILs from the patients undergoing primary resection. Complementarily, we analyzed publicly available transcriptomic data (n = 903). Successful completion of chemotherapy, and lymph node status were independent predictors of survival in the multivariate analysis of the clinicopathologic parameters. Fifteen tumors were exclusively VISTA-positive, thirteen tumors expressed VISTA together with TIM3, and ten tumors expressed VISTA together with IDO. Patients featuring tumors with high numbers of IDO-positive TILs had better patient survival (p = 0.037). VISTA, LAG3, and TIM3 expression did not correlate with survival. The analysis of publicly available data did not show survival differences. Tumors rarely co-express more than two immune molecules at the same time, and VISTA is most frequently co-expressed. Although IDO generally inhibits T-cell proliferation, a high expression of IDO was associated with improved survival. We expect immune checkpoint inhibitors against VISTA, LAG3, and TIM3 to be inefficient in a clinical application.

Both laparoscopic surgery and computer games make similar demands on eye-hand coordination and visuospatial cognitive ability. A possible connection between both areas could be used for the recruitment and training of future surgery residents. The goal of this study was to investigate whether gaming skills are associated with better laparoscopic performance in medical students. 135 medical students (55 males, 80 females) participated in an experimental study. Students completed three laparoscopic tasks (rope pass, paper cut, and peg transfer) and played two custom-designed video games (2D and 3D game) that had been previously validated in a group of casual and professional gamers. There was a small significant correlation between performance on the rope pass task and the 3D game, Kendall's [tau](111) = -.151, P = .019. There was also a small significant correlation between the paper cut task and points in the 2D game, Kendall's [tau](102) = -.180, P = .008. Overall laparoscopic performance was also significantly correlated with both the 3D game, Kendall's [tau](112) = -.134, P = .036, and points in the 2D game, Kendall's [tau](113) = -.163, P = .011. However, there was no significant correlation between the peg transfer task and both games (2D and 3D game), P = n.s.. This study provides further evidence that gaming skills may be an advantage when learning laparoscopic surgery.

Surgery faces significant challenges resulting from changes in medical education and the declining attractiveness of the surgical career path for aspiring doctors in the western world. For example, students' expectations of their future workplace have changed, with issues such as career planning uncertainties, an unbalanced work-life balance, and a lack of compatibility of family and occupation becoming increasingly more relevant. The entry of Generation Z into the workforce will also impact surgery. Although women comprise the largest proportion of graduates only a few opt for a career in surgery. The resulting shortage of young surgeons will negatively impact medical care in German surgical units. Intense competition for talents is already emerging in all medical specialties. Thus, hospitals and academic centers are taking various measures to counteract the impending staff shortage, such as summer schools or scholarships with work commitments. Furthermore, regional funding laws are being established. In addition, as there is a declining interest in surgical training, particularly during the course of medical studies, early integration of surgical skills is crucial to counteract this trend. For this reason, we have developed the \"surgical track\", designed to offer targeted innovative teaching concepts to get students attracted to surgery at an early stage. The \"surgical track\" is based on virtual reality (VR) and robotics. Students can practice operations and emergency scenarios through VR simulations and complete practical exercises with robotic systems. High-quality training concepts such as the \"surgical track\" can help to promote enthusiasm for surgery and impart knowledge at the same time, even if the long-term benefits still need to be evaluated. Through virtual simulations, robotic surgery and innovative teaching, students gain insights into visceral surgery that combine theoretical understanding and practical experience.

Virtual reality (VR) is increasingly applied in medical education to enhance learning and patient care. Teaching birth mechanics poses particular challenges, as students must understand complex, dynamic, and rotating intrauterine processes that traditional models cannot adequately represent. VR offers immersive, interactive visualization and has shown promise in other fields, but its role in obstetrics remains underexplored. This study evaluated a novel VR module (Virtual Training for Obstetric Birth Simulation, V.T.O.B.S.) for undergraduate obstetrics education. In this single-center study, 46 medical students used V.T.O.B.S. during their obstetrical block internship and were compared with 120 students without VR exposure (non-equivalent intervention group design). The module consisted of a single, self-directed session. Knowledge retention was assessed 11-17 weeks later in a theoretical Objective Structured Clinical Examination (OSCE) station consisting mainly of image-based questions on birth mechanics. Secondary outcomes included acceptance, motion sickness, and free-text feedback. No significant differences were found in long-term scores of the OSCE study station between VR and control groups. Subgroup analyses showed no consistent effects, except that visual impairment was associated with significantly lower performance (median 13 [IQR 11-15] vs. 14.5 [12-16], = 0.003). Acceptance of VR was very high (median = 5 [IQR 4-5]), and motion sickness was rare and mild (median = 2 [1-3]). Free-text responses emphasized the innovative nature of the module, immersive 3D visualization, and the value of VR exposure in a university setting. Observed between-group effects were small and below the detectable threshold, suggesting that minor advantages may have remained uncaptured. Although no significant knowledge gain was demonstrated, the strong acceptance and usability support the feasibility of VR in undergraduate obstetrics curricula. The absence of measurable effects may relate to the broad learning objective, brief OSCE assessment, single self-directed exposure, and heterogeneous timing between intervention and assessment. V.T.O.B.S. nonetheless represents an innovative educational tool addressing curricular gaps in visualizing dynamic birth mechanics. Future research should explore repeated exposures, assessment formats that directly capture spatial-conceptual understanding, and integration into interprofessional formats for medical and midwifery students as well as postgraduate training.

BackgroundMinimally invasive single-port surgery is often associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. Aim of this prospective study was to perform true single-port surgery (cholecystectomy) without the use of assisting trocars using a new surgical platform that allows for triangulation incorporating robotic features, and to measure the perioperative outcome and cosmetic results.MethodsAs the first European site after FDA and CE-mark approval, the new device has been introduced to our academic center. In patients with cholecystitis and cholecystolithiasis, the operation was performed through only one 15-mm trocar. For patients safety, intraoperative cholangiography using intravenous ICG and a standard Stryker 1588 system was routinely performed.ResultsSymphonx was used in n = 12 patients for abdominal surgery (6 females, mean age 42.5 [30–77], mean BMI 26.2 [19.3–38.9]. A total of 8 patients underwent surgery using no additional ports besides the 15-mm trocar; in the remaining patients, one assisting instrument (3–5 mm) was used. Mean OR time was 107 [72–221] minutes. The postoperative course was uneventful in 11 patients; in one patient, a seroma at the surgical site required interventional drainage 1 month postoperatively. No intraoperative complications occurred.ConclusionThis is the first human case series using the commercially available symphonX platform for abdominal laparoscopic surgery and the first series using the system without assisting instruments. Laparoscopic cholecystectomy in patients with cholecystitis and cholecystolithiasis using the symphonX platform through only one 15-mm trocar is feasible, safe, and more cost-efficient compared to robotic platforms.

BackgroundThe use of 3D technique compared to high-resolution 2D-4K-display technique has been shown to optimize spatial orientation and surgical performance in laparoscopic surgery. Since women make up an increasing amount of medical students and surgeons, this study was designed to investigate whether one gender has a greater benefit from using a 3D compared to a 4K-display system.MethodsIn a randomized cross-over trial, the surgical performance of male and female medical students (MS), non-board certified surgeons (NBCS), and board certified surgeons (BCS) was compared using 3D- vs. 4K-display technique at a minimally invasive training parkour with multiple surgical tasks and repetitions.Results128 participants (56 women, 72 men) were included. Overall parkour time in seconds was 3D vs. 4K for all women 770.7 ± 31.9 vs. 1068.1 ± 50.0 (p < 0.001) and all men 664.5 ± 19.9 vs. 889.7 ± 31.2 (p < 0.001). Regarding overall mistakes, participants tend to commit less mistakes while using the 3D-vision system, showing 10.2 ± 1.1 vs. 13.3 ± 1.3 (p = 0.005) for all women and 9.6 ± 0.7 vs. 12.2 ± 1.0 (p = 0.001) for all men. The benefit of using a 3D system, measured by the difference in seconds, was for women 297.3 ± 41.8 (27.84%) vs. 225.2 ± 23.3 (25.31%) for men (p = 0.005). This can be confirmed in the MS group with 327.6 ± 65.5 (35.82%) vs. 249.8 ± 33.7 (32.12%), p = 0.041 and in the NBCS group 359 ± 52.4 (28.25%) vs. 198.2 ± 54.2 (18.62%), p = 0.003. There was no significant difference in the BCS group.Conclusion3D laparoscopic display technique optimizes surgical performance compared to the 2D-4K technique for both women and men. The greatest 3D benefit was found for women with less surgical experience. As a possible result of surgical education, this gender specific difference disappears with higher grade of experience. Using a 3D-vision system could facilitate surgical apprenticeship, especially for women.

BackgroundMinimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique.MethodsA set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded.ResultsA total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05).ConclusionThis is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising.

Background The usage of smartphones in the daily clinical routine is an essential aspect however it seems that they also present an important distractor that needs to be evaluated. The aim of this prospective study was the evaluation of the influence of phone calls as distractors on the performance levels of medical students during an objective structured clinical examination (OSCE), simulating the normal clinical practice. Methods As the goal of an OSCE presents the examination of clinical skills of medical students in a realistic setting, more than 100 students recruited from the university hospital of Cologne participated in either OSCE I or II. During the OSCE I intravenous cannulation was simulated while OSCE II simulated an acute abdominal pain station. Participants had to perform each of these stations under two circumstances: a normal simulated OSCE and an OSCE station with phone call distraction. Their performance during both simulations was then evaluated. Results In OSCE I students achieved significantly more points in the intravenous cannulation station if they were not distracted by phone calls (M=6.44 vs M=5.95). In OSCE II students achieved significantly more points in the acute abdominal pain station if they were not distracted by phone calls (M=7.59 vs M=6.84). While comparing only those students that completed both stations in OSCE I/II participating students achieved significantly more points in both OSCE I and II if they were not distracted by phone calls. Conclusion The presented data shows that phone call distraction decreases the performance level of medical students during an OSCE station. Therefore, it is an indicator that distraction especially for younger doctors should be held to a minimum. On a second note distraction should be integrated in the medical education system as it plays an important role in clinical routine.