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In patients with respiratory failure, mechanical ventilation aims to balance respiratory muscle loading and gas exchange. The interplay between the ventilator and the respiratory muscles is an increasingly recognized factor in tailoring ventilatory support. Surface electromyography (sEMG) offers a non-invasive modality to monitor the respiratory muscles. The sEMG signal, however, requires elaborate processing, which is limitedly standardized and documented. This paper presents the Respiratory Surface Electromyography (ReSurfEMG) package, an open-source Python package for respiratory sEMG analysis developed to address these challenges. ReSurfEMG integrates denoising, feature extraction, and quality assessment in one dedicated library. The effects of over- and under-filtering were compared to ReSurfEMG default settings regarding waveform duration, time-to-peak, amplitude, electrical time product (ETP), pseudo-slope, pseudo-signal-to-noise ratio (SNR), area under the baseline (AUB), and bell-curve error. Under-filtering increased amplitudes (+21%) and ETPs (+10%). Over-filtering smoothed sEMG waveforms, reducing amplitude (−58%), ETP (−39%), and pseudo-slope (−49%), while waveform duration and time-to-peak increased. Default ReSurfEMG settings provided the highest SNRs with similar or lower AUBs and bell-curve errors. The ReSurfEMG library integrates advanced methods dedicated to respiratory sEMG analysis. Systematic assessment using ReSurfEMG showed that signal processing settings affect sEMG features. ReSurfEMG enables reproducible signal processing, facilitating the standardization of respiratory sEMG analysis.

The COVID-19 outbreak has triggered a global health and economic crisis, necessitating widespread testing to control viral spread amidst rising cases and fatalities. The recommended testing method, a combined naso- and oropharyngeal swab, poses risks and demands limited protective gear. In response to the COVID-19 pandemic, we developed and tested the first autonomous swab robot station for Naso- and Oropharyngeal Coronavirus Screening (SR-NOCS). A force-sensitive robot running under a Cartesian impedance controller is employed to drive the swab to the sampling area. This groundbreaking device underwent two clinical studies-one conducted during the initial pandemic lockdown in Europe (early 2021) and the other, more recently, in a public place after the pandemic had subsided earlier in the year 2023. In total, 52 patients suspected of COVID-19 infection were included in these clinical studies. The results revealed a complete positive correlation between autonomous and manual sampling. The test subjects exhibited a high acceptance rate, all expressing a willingness to undergo future tests with SR-NOCS. Based on our findings, such systems could enhance testing capabilities, potentially conducting up to 300 tests per robot per day with consistent precision. The tests can be carried out with minimal supervision, reducing infection risks and effectively safeguarding patients and healthcare workers.

Prevention of intestinal fibrosis remains an unresolved problem in the treatment of Crohn’s disease (CD), as specific antifibrotic therapies are not yet available. Appropriate analysis of fibrosis severity is essential for assessing the therapeutic efficacy of potential antifibrotic drugs. The aim of this study was to develop an observer-independent method to quantify intestinal fibrosis in surgical specimens from patients with CD using structural analysis of the extracellular matrix (ECM). We performed fractal analysis in fibrotic and control histological sections of patients with surgery for CD (n = 28). To specifically assess the structure of the collagen matrix, polarized light microscopy was used. A score to quantify collagen fiber alignment and the color of the polarized light was established. Fractal dimension as a measure for the structural complexity correlated significantly with the histological fibrosis score whereas lacunarity as a measure for the compactness of the ECM showed a negative correlation. Polarized light microscopy to visualize the collagen network underlined the structural changes in the ECM network in advanced fibrosis. In conclusion, observer-independent quantification of the structural complexity of the ECM by fractal analysis is a suitable method to quantify the degree of intestinal fibrosis in histological samples from patients with CD.

Our understanding of pilonidal sinus disease (PSD) is based on a paper published 29 years ago by Karydakis. Since then, surgeons have been taught that hair more easily penetrates wet skin, leading to the assumption that sweating promotes PSD. This postulate, however, has never been proven. Thus we used pilocarpine iontophoresis to assess sweating in the glabella sacralis. 100 patients treated for PSD and 100 controls were matched for sex, age and body mass index (BMI). Pilocarpine iontophoresis was performed for 5 min, followed by 15 min of sweat collection. PSD patients sweated less than their matched pairs (18.4 ± 1.6 µl vs. 24.2 ± 2.1 µl, p  = 0.03). Men sweated more than women (22.2 ± 1.2 µl vs. 15.0 ± 1.0 µl in non-PSD patients ( p  < 0.0001) and 20.0 ± 1.9 µl vs. 11.9 ± 2.0 µl in PSD patients ( p  = 0.051)). And regular exercisers sweated more than non-exercisers (29.1 ± 2.9 µl vs. 18.5 ± 1.6 µl, p  = 0.0006 for men and 20.7 ± 2.3 µl vs. 11.4 ± 1.4 µl, p  = 0.0005 for women). PSD patients sweat less than matched controls. Thus sweating may have a protective effect in PSD rather than being a risk factor.

Background High-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders. However, its short-term laboratory setting often fails to capture intermittent abnormalities. Long-term HRM (LTHRM, up to 24h) provides richer insights into swallowing behavior, but the resulting data volume is immense. Manual analysis by medical experts is laborious, time-consuming, and prone to errors, limiting its clinical feasibility. Methods We propose a deep learning-based approach for automatic analysis of LTHRM data. Our method detects both swallow events and secondary non-deglutitive motility disorders with high accuracy. Detected swallows are then clustered into distinct classes of similar events, creating a structured overview of motility patterns and their frequency. This reduces the analytical burden by allowing clinicians to focus on a small number of representative swallows rather than manually reviewing thousands of individual events. We evaluate our pipeline on 25 LTHRMs that were meticulously annotated, resulting in a dataset of more than 23,000 expert-labeled events. Results Our approach is able to detect more than 94% of all relevant events in LTHRM sequences, while the subsequent clustering is able to capture and group all relevant events into distinct swallow groups. To evaluate the overall approach, we conduct a user study with medical experts, demonstrating its effectiveness and positive clinical impact. Conclusions Our findings demonstrate that deep learning-based approaches to analyze LTHRM examinations are capable of providing a more reliable and efficient diagnostic process, ultimately making LTHRM assessments more feasible in clinical care. Plain language summary High-resolution manometry (HRM) is the standard test for diagnosing swallowing and esophageal motility disorders by analyzing swallowing and pressure patterns in a patient. This method uses short recording time and can often miss intermittent problems. Long-term HRM (LTHRM) captures a fuller picture but produces large datasets that are difficult to analyze manually. We present a computer learning-based method that automatically detects swallow events and abnormal motility patterns in these larger datasets and clusters them into groups of similar events. This structured representation reduces the data burden and allows experts to focus on representative examples. Evaluated on 25 recordings with over 23,000 labeled events, our method is able to detect more than 94% of all relevant events and is shown in a user study to improve efficiency in clinical interpretation. Geiger et al. present a deep learning-based pipeline for analyzing long-term high-resolution manometry (LTHRM) data by detecting swallow events and clustering them into representative groups. The approach achieves over 94% detection accuracy and is shown to reduce the overall LTHRM evaluation time while preserving diagnostic quality.

PurposeSurgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances.MethodsTo analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration.ResultsForty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment.ConclusionThese results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.

Digitalization affects almost every aspect of modern daily life, including a growing number of health care services along with telemedicine applications. Fifth-generation (5G) mobile communication technology has the potential to meet the requirements for this digitalized future with high bandwidths (10 GB/s), low latency (<1 ms), and high quality of service, enabling wireless real-time data transmission in telemedical emergency health care applications. The aim of this study is the development and clinical evaluation of a 5G usability test framework enabling preclinical diagnostics with mobile ultrasound using 5G network technology. A bidirectional audio-video data transmission between the ambulance car and hospital was established, combining both 5G-radio and -core network parts. Besides technical performance evaluations, a medical assessment of transferred ultrasound image quality and transmission latency was examined. Telemedical and clinical application properties of the ultrasound probe were rated 1 (very good) to 2 (good; on a 6 -point Likert scale rated by 20 survey participants). The 5G field test revealed an average end-to-end round trip latency of 10 milliseconds. The measured average throughput for the ultrasound image traffic was 4 Mbps and for the video stream 12 Mbps. Traffic saturation revealed a lower video quality and a slower video stream. Without core slicing, the throughput for the video application was reduced to 8 Mbps. The deployment of core network slicing facilitated quality and latency recovery. Bidirectional data transmission between ambulance car and remote hospital site was successfully established through the 5G network, facilitating sending/receiving data and measurements from both applications (ultrasound unit and video streaming). Core slicing was implemented for a better user experience. Clinical evaluation of the telemedical transmission and applicability of the ultrasound probe was consistently positive.

Purpose Integrating robotic scrub nurses in the operating room has the potential to help overcome staff shortages and limited use of available operating capacities in hospitals. Existing approaches of robotic scrub nurses are mainly focused on open surgical procedures, neglecting laparoscopic procedures. Laparoscopic interventions offer great potential for the context-sensitive integration of robotic systems due to possible standardization. However, the first step is to ensure the safe manipulation of laparoscopic instruments. Methods A robotic platform with a universal gripper system was designed to pick up and place laparoscopic as well as da Vinci ® instruments in an efficient workflow. The robustness of the gripper system was studied using a test protocol, which included a force absorption test to determine the operational safety limits of the design and a grip test to determine the system performance. Results The test protocol shows results regarding force and torque absorption capabilities of the end effector, which are essential when transferring an instrument to the surgeon to enable a robust handover. The grip tests show that the laparoscopic instruments can be safely picked up, manipulated and returned independent of unexpected positional deviations. The gripper system also enables the manipulation of da Vinci ® instruments, opening the door for robot–robot interaction. Conclusion Our evaluation tests have shown that our robotic scrub nurse with the universal gripper system can safely and robustly manipulate laparoscopic and da Vinci ® instruments. The system design will continue with the integration of context-sensitive capabilities.

Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery. A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK). All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques' current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions. Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons' levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body's natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.

Purpose Besides classical colorectal adenocarcinomas (AC), mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC) occur. Controversy remains regarding their prognostic role. Aim of this study was to define prognostic and histopathological specifications of mucinous and signet-ring cell colorectal cancer. Methods A total of 28,056 patients with AC, MAC, and SC between 1998 and 2012 in the catchment area of the Munich Cancer Registry were analyzed. Time to locoregional recurrence and distant recurrence was calculated by cumulative incidence. Survival was analyzed by the Kaplan–Meier method, calculation of relative survival, and Cox proportional hazards regression. Results AC occurred in 25,172 patients (90 %), MAC in 2724 (9.7 %), and SC in 160 (0.6 %). AC were less frequently localized in the proximal colon (34 %) compared to MAC (57 %, p  < 0.001) and SC (76 %, p  < 0.001). Both, MAC and SC had higher T, N, and M categories, lymphatic invasion, and worse grading ( p  < 0.001 for each). There were significant differences regarding the 10-year cumulative incidence of locoregional recurrence ( p  < 0.001), and distant recurrence ( p  < 0.001). For AC, the 5-year overall survival was 59 % (95 % confidence interval 58.0; 59.3), for MAC 52 % (50.2; 54.2), and for SC 40 % (32.1; 48.5; p  < 0.001). However, MAC or SC did not remain independent prognostic factors for overall survival compared to AC upon multivariable analysis ( p  = 0.981). Conclusion This large cohort reveals specific histopathological and recurrence patterns for patients with colorectal AC, MAC, and SC. MAC and SC are diagnosed at more advanced tumor stages and therefore entail reduced survival rates.