tbuckley/cabot-search huggingface dataset:
Essential components and validation of multi-specialty robotic surgical training curricula: a systematic review
Authors: Josephine Walshaw, Michael G Fadel, Matthew Boal, Marina Yiasemidou, Muhammed Elhadi, Francesca Pecchini, Francesco Maria Carrano, Lisa H Massey, Matyas Fehervari, Omar Khan, Stavros A Antoniou, Felix Nickel, Silvana Perretta, Hans F Fuchs, George B Hanna, Nader K Francis, Christos Kontovounisios
Journal: International Journal of Surgery (2025)

Introduction: The rapid adoption of robotic surgical systems has overtook the development of standardised training and competency assessment for surgeons, resulting in an unmet educational need in this field. This systematic review aims to identify the essential components and evaluate the validity of current robotic training curricula across all surgical specialties. Methods: A systematic search of MEDLINE, EMBASE, Emcare, and CINAHL databases was conducted to identify studies reporting on multi-specialty or specialty-specific surgical robotic training curricula, between January 2000 and January 2024. We extracted data according to Kirkpatrick’s curriculum evaluation model and Messick’s concept of validity. The quality of studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Results: From the 3,687 studies retrieved, 66 articles were included. The majority of studies were single-centre (n = 52, 78.8%) and observational (n = 58, 87.9%) in nature. The most commonly reported curriculum components included didactic teaching (n = 48, 72.7%), dry laboratory skills (n = 46, 69.7%), and virtual reality (VR) simulation (n = 44, 66.7%). Curricula assessment methods varied, including direct observation (n = 44, 66.7%), video assessment (n = 26, 39.4%), and self-assessment (6.1%). Objective outcome measures were used in 44 studies (66.7%). None of the studies were fully evaluated according to Kirkpatrick’s model, and five studies (7.6%) were fully evaluated according to Messick’s framework. The studies were generally found to have moderate methodological quality with a median MERSQI of 11. Conclusions: Essential components in robotic training curricula identified include didactic teaching, dry laboratory skills, and VR simulation. However, variability in assessment methods used and notable gaps in curricula validation remain evident. This highlights the need for standardised, evidence-based development, evaluation, and reporting of robotic curricula to ensure the effective and safe adoption of robotic surgical systems.
Innovative logic “AND” gate gene circuits for bladder cancer treatment: preclinical study
Authors: Chaojie Xu, Ying Dong, Dongchen Pei, Xintao Zhang, Xiaohong Han, Congcong Cao, Baorui Wu, Changning Lv, Zhengjun Kang, Liqun Zhou, Yuchen Liu, Lin Yao
Journal: International Journal of Surgery (2025)

In the evolving field of precision oncology, the synthesis of gene circuits that specifically target cancer cells while preserving normal tissue marks a significant breakthrough. However, traditional approaches typically concentrate on single-gene targets, lacking the directed recognition and control among the intricate networks of signaling pathways. Our study presents a synthetic gene circuit, the Logic “AND” Gate Dual-Target Genetic Circuit (LAG-DTGC), which integrates multiple signals to achieve comprehensive reprogramming of various signaling pathways in bladder cancer (BC) cells. This circuit’s development hinged on detailed bioinformatics analysis, pinpointing more unique biomarkers with similar expression pattern in BC. LAG-DTGC is engineered to selectively activate in cells where these biomarkers are abnormally expressed. Its precision and the remodeling cell behavior capability are further enhanced by incorporating a logic “AND” gate, triggering the circuit only in the presence of these aberrant cancer-specific biomarkers. LAG-DTGC exhibits an extraordinary ability to reprogram cancer cell signaling pathways, turning the cells’ own mechanisms against them for therapeutic effect. This work highlights the potential of synthetic biology in developing precise, less toxic treatments for BC. The LAG-DTGC represents a promising new paradigm in cancer therapy.
AI-driven evidence synthesis: data extraction of randomized controlled trials with large language models
Authors: Jiayi Liu, Honghao Lai, Weilong Zhao, Jiajie Huang, Danni Xia, Hui Liu, Xufei Luo, Bingyi Wang, Bei Pan, Liangying Hou, Yaolong Chen, Long Ge
Journal: International Journal of Surgery (2025)

The advancement of large language models (LLMs) presents promising opportunities to enhance evidence synthesis efficiency, particularly in data extraction processes, yet existing prompts for data extraction remain limited, focusing primarily on commonly used items without accommodating diverse extraction needs. This research letter developed structured prompts for LLMs and evaluated their feasibility in extracting data from randomized controlled trials (RCTs). Using Claude (Claude-2) as the platform, we designed comprehensive structured prompts comprising 58 items across six Cochrane Handbook domains and tested them on 10 randomly selected RCTs from published Cochrane reviews. The results demonstrated high accuracy with an overall correct rate of 94.77% (95% CI: 93.66% to 95.73%), with domain-specific performance ranging from 77.97% to 100%. The extraction process proved efficient, requiring only 88 seconds per RCT. These findings substantiate the feasibility and potential value of LLMs in evidence synthesis when guided by structured prompts, marking a significant advancement in systematic review methodology.
Evaluating the learning curve for flexible ureteroscopic thulium fiber laser lithotripsy using CUSUM analysis
Authors: Zhilong Li, Shaojie Wu, Xiaoyu Tang, Yongwen Luo, Du Wang, Tongzu Liu, Sheng Li, Xinghuan Wang
Journal: International Journal of Surgery (2025)

Objectives: Effective training methods and learning curve (LC) assessment are crucial for more difficult endoscopic procedures. The present study sought to assess the LC of ureteral flexible scopes for thulium fiber laser (TFL) lithotripsy and determine the effectiveness of using a porcine kidney model in training modality, to inform future training. Methods: Postgraduate medical students without experience in ureteroscopy were recruited, and surgical data were collected from 10 consecutive flexible ureteroscopic (fURS) lithotripsy procedures performed on our homemade porcine kidney training model. Cumulative sum (CUSUM) analysis and pooled mean CUSUM curves were applied to determine the LC turning points (TPs), and pre-LC and post-LC data were compared with that of an experienced attending physician. Results: Data from 110 surgeries were included in the analysis. The mean number of surgical units to overcome the LC for the duration of fURS TFL lithotripsy was 4. The operation time, number of tissue damage, and number of central visual shifts were significantly lower in students after the TP than before. No statistically significant difference in operation time was found between the students after the LC (817.50 [703.75-964.75]) and the surgeon group (732.50 [51.00-822.25]). Conclusion: Overcoming the LC of fURS TFL lithotripsy requires four surgeries, and the developed ex vivo porcine kidney is a conveniently accessible and effective clinical training model.
Development, validation, and clinical evaluation of a machine-learning based model for diagnosing early infection after cardiovascular surgery (DEICS): a multi-center cohort study
Authors: Tuo Pan, Haitao Zhang, Chuangshi Wang, Hanghang Wang, Yusanjian Matniyaz, Zhi-Kang Lv, Tong Tong Zhu, Ya-Peng Wang, Zhi-Zhao Song, Yu-Xian Tang, He Zhang, Hao-Dong Pan, Chen Li, Lin-Shan Yang, Shi-Yu Guan, Wen Bian, Xiateke Hafu, Xiang Li, Yang Li, Xiao-Ting Wu, Zhi-Wei Fan, Yuan-Xi Luo, Yi Jiang, Ya-Xuan Gao, Wen-Zhe Wang, Yun-Xing Xue, Fu-Dong Fan, Jun Pan, Qing Zhou, Bo-Min Zhang, Wei Wang, Qiang Wang, Guo-Liang Fan, Dong-Jin Wang
Journal: International Journal of Surgery (2025)

Background: This study addresses the critical need for timely and accurate diagnosis of early postoperative infection (EPI) following cardiac surgery. EPI significantly impacts patient outcomes and healthcare costs, making its early detection vital. Objectives: To develop, validate, and clinically implement a machine-learning-based model for diagnosing EPI post-cardiac surgery, enhancing postoperative care. Methods: In this multi-center cohort study spanning 2020 to 2022, data from four medical centers involved 2001 participants. Of these, 1400 were used for trainingand 601 for validation. Several machines-learning algorithms, including XGBoost, random forest, support vector machines, least absolute shrinkage and selection operator, and single-layer neural networks, were applied to develop predictive models. These were compared against a traditional logistic regression model. The model with the highest area under the receiver operating characteristic curve (AUROC) was deemed optimal. Implemented across four centers since 1 January 2023, a retrospective real-world study assessed its clinical applicability. Among 400 patients with an estimated EPI risk above 10%, identified by the optimal model, 55 followed its antibiotic upgrade recommendations (DEICS group). The remaining 345 patients upgraded antibiotics empirically, with 55 in the control group, matched 1:1 with the DEICS group. Clinical utility was evaluated through antibiotic use density (AUD), hospital costs, and ICU stay duration. Results: The XGBoost model achieved the highest performance with an AUROC of 0.96 (95% CI: 0.93–0.98). The calibration curve exhibited strong agreement with Brier scores of 0.02. According to the XGBoost model, the DEICS group significantly demonstrated reduced AUD ( P &lt; 0.01) in the matched cohort, along with decreased ICU stay time (median: 5 vs. 6 days, P = 0.01) and hospital costs (median: ¥150 000 vs. median: ¥200 000, P = 0.01) in the EPI cohort. Conclusion: The successful implementation of the XGBoost model facilitates accurate EPI diagnosis, improves postoperative recovery, and lowers hospital costs.
Comparison of submucosal and subserosal approach in ICG-guided laparoscopic lymphadenectomy in gastric cancer patients: long-term outcomes of a phase 3 randomized clinical trial
Authors: Qing Zhong, Zhi-Xin Shang-Guan, Zhi-Yu Liu, Dong Wu, Ze-Ning Huang, Hua-Gen Wang, Jun-Yun Chen, Jin-Xun Wu, Ping Li, Jian-Wei Xie, Chao-Hui Zheng, Qi-Yue Chen, Chang-Ming Huang
Journal: International Journal of Surgery (2025)

Previous studies have demonstrated similar short-term efficacy between subserosal (SSA) and submucosal (SMA) approaches for ICG injection in gastric cancer (GC). This study aims to compare the long-term oncological outcomes of these two injection methods for lymph node (LN) tracing in ICG-guided laparoscopic gastrectomy. This study was a phase 3, open-label, randomized clinical trial (FUGES-019). A total of 266 patients with resectable gastric adenocarcinoma (cT1-4a, N0/ +, M0) were enrolled. We report predefined long-term secondary outcomes, including three-year actual overall survival (OS), three-year actual disease-free survival (DFS), and recurrence patterns. Of the 266 participants, 259 patients were included in the per-protocol analysis; 129 in the SSA group and 130 in the SMA group. The actual OS in the SSA group (87.6%) was comparable to that in the SMA group (90.8%, P = 0.41), as were the 3-year actual DFS rates (SSA: 82.9% vs. SMA: 88.5%, Log-rank P = 0.19). Per-protocol analysis confirmed the equivalence of the SSA compared with the SMA. The most common type of recurrence was multiple site metastasis (11 of 259[4.24%]), with no differences in recurrence types across cancer stages. Further stratified analysis based on pT, pN staging, tumor size, and BMI showed no significant differences between the two groups. The 3-year outcomes of the FUGES-019 trial confirm the equivalence of SSA and SMA in ICG-guided laparoscopic lymphadenectomy for GC, supporting the previous short-term findings. The subserosal approach can be recommended for ICG administration based on clinical considerations.
ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study
Authors: Wenyi Gan, Jianfeng Ouyang, Guorong She, Zhaowen Xue, Lingxuan Zhu, Anqi Lin, Weiming Mou, Aimin Jiang, Chang Qi, Quan Cheng, Peng Luo, Hua Li, Xiaofei Zheng
Journal: International Journal of Surgery (2025)

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P &lt;.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.
Development and prospects of natural orifice specimen extraction surgery for colorectal cancer: a review article
Authors: Xingxiang Huang, Ran Wei, Qinghai Li, Xingfeng Qiu, Peng Li, Weiling He
Journal: International Journal of Surgery (2025)

The natural orifice specimen extraction surgery (NOSES) procedure is an innovative approach to treating colorectal cancer that offers several advantages. First, the NOSES technique is minimally invasive, reducing the incidence of postoperative complications such as wound infection and fat liquefaction. Second, it provides excellent pain relief and improves cosmetic outcomes by requiring fewer abdominal incisions, thereby increasing patient satisfaction. Additionally, NOSES provides all of the advantages of minimally invasive surgery and enables patients to recover quickly, helping patients return to their normal lives faster. This approach aligns with the concept of patient-centered care and significantly improves patient quality of life. The positive results noted at both short- and long-term postoperative follow-up indicate that NOSES is a valuable option in cancer care. Despite its many benefits, NOSES has also been challenged by bacteriology, oncology, and ethics. This paper presents a review of recent research progress regarding NOSES in the treatment of colorectal cancer. In this article, we examined the advantages and disadvantages of NOSES in clinical practice and discussed potential issues and solutions.
Baseline Liquid Biopsy in Relation to Tissue-Based Parameters in Metastatic Colorectal Cancer: Results From the Randomized FIRE-4 (AIO-KRK-0114) Study
Authors: Sebastian Stintzing, Susanne Klein-Scory, Ludwig Fischer von Weikersthal, Martin Fuchs, Florian Kaiser, Kathrin Heinrich, Dominik Paul Modest, Ralf-Dieter Hofheinz, Thomas Decker, Armin Gerger, Stefan Angermeier, Holger Rumpold, Andreas Dickhut, Leopold Öhler, Birgit Gruenberger, Dora Niedersuess-Beke, Matthias Sandmann, Thomas Winder, Joerg Trojan, Gerald Prager, Swantje Held, Jörg Kumbrink, Wolff Schmiegel, Alexander Baraniskin, Volker Heinemann
Journal: Journal of Clinical Oncology (2025)

PURPOSE The FIRE-4 study randomly assigned patients with first-line RAS wild-type ( RAS wt) metastatic colorectal cancer to either flourouracil (FU), folinic acid, and irinotecan (FOLFIRI) plus cetuximab until progression or intolerable toxicity (standard arm) or to FOLFIRI plus cetuximab followed by a switch maintenance treatment using FU plus bevacizumab (experimental arm). Here, we investigate the relevance of liquid biopsy (LB) RAS and BRAF testing compared with tissue-based analyses. PATIENTS AND METHODS LBs were taken at baseline and during treatment and were analyzed for RAS and BRAF V600E mutations using the in vitro diagnostics–certified ONCOBEAM RAS procedure (Sysmex Inostics) and digital-droplet polymerase chain reaction technology. RESULTS Six hundred seventy-two RAS wt patients were randomly assigned. LBs of 540 patients were evaluable at baseline. Of those, 70 (13%) were RAS mutant ( RAS mut) and 38 (7%) BRAF V600E mutant. RAS mut patients had significantly shorter survival compared with RAS wt patients (progression-free survival [PFS], 9.0 months v 11.5 months; P &lt; .001; hazard ratio [HR], 1.66; overall survival [OS], 22.1 months v 33.6 months; P &lt; .001; HR, 1.85). RAS mut patients had a numerically greater benefit from early switch maintenance compared with continuation of FOLFIRI/cetuximab (PFS, 10.1 months v 6.4 months; HR, 0.82; OS, 24.9 months v 16.3 months; HR, 0.57). Patients with a BRAF V600E mutation in LB showed poor outcome (PFS, 5.4 months; OS, 12.0 months). On the basis of serial LB analyses, the conversion rate from RAS wt to RAS mut at disease progression was significantly higher in the arm with continuous cetuximab administration than in the switch maintenance arm. CONCLUSION LB allows the detection of RAS and BRAF mutations in patients deemed RAS wt on the basis of tissue analyses. These patients show outcome characteristics expected for RAS - and BRAF -mutant patients in tissue. The study thus confirms the high clinical relevance of LB performed at baseline before the start of therapy.
Combined Analyses of Circulating Tumor DNA and Immunoscore in Patients With Stage III Colon Cancer: A Post Hoc Analysis of the PRODIGE-GERCOR IDEA-France/HORG-IDEA-Greece Trials
Authors: Julien Taieb, John Souglakos, Ioannis Boukovinas, Antoine Falcoz, Franck Pages, Ippokratis Messaritakis, Jaafar Bennouna, Pascal Artru, Christophe Louvet, Celine Lepere, Jean Francois Emile, Olivier Bouche, Thibault Mazard, Dewi Vernerey, Konstantinos Vogiatzoglou, Maria Tzardi, Shruti Sharma, Minetta C. Liu, Himanshu Sethi, Thierry André, Jérome Galon, Pierre Laurent-Puig
Journal: Journal of Clinical Oncology (2025)

PURPOSE Immunoscore (IS) and circulating tumor DNA (ctDNA) are two emerging technologies in improving prognostication and tailoring adjuvant treatments in patients resected from a stage III colon cancer (CC). Here, we analyzed the prognostic value of the two biomarkers in patients who participated in the randomized phase III IDEA-France and HORG trials. METHODS Plasma samples were collected after surgery and before adjuvant chemotherapy. ctDNA analysis was performed using a clinically validated, personalized, tumor-informed 16-plex protein chain reaction assay. Multivariable analyses for time to recurrence (TTR; patients without recurrence or death due to CC) and overall survival (OS) were performed using ctDNA and IS results, along with other parameters including treatment duration and disease risk group. RESULTS Of the 554 patients with available ctDNA results, 445 were ctDNA-negative (80.3%) and 109 were ctDNA-positive (19.7%); baseline characteristics showed more T4/N2 and venous embolism/lymphatic invasion/perineural invasion+ in ctDNA-positive patients. With a median follow-up of 6.7 years, the 2-year TTR rate was 43.5% (95% CI, 34.1 to 52.6) for ctDNA-positive patients and 88.1% (95% CI, 84.7 to 90.8) for ctDNA-negative patients ( P &lt; .0001). ctDNA was confirmed as an independent prognostic marker for both TTR (adjusted hazard ratio [adjHR], 5.21 [95% CI, 3.59 to 7.58]; P &lt; .001) and OS (adjHR, 4.84 [95% CI, 3.40 to 6.89]; P &lt; .001). ctDNA remained the most significant prognostic factor irrespective of disease stage, treatment duration, and IS results. IS was not prognostic in ctDNA-positive patients but remained a significant prognostic tool for ctDNA-negative patients. CONCLUSION In this combined analysis of two adjuvant trials dedicated to patients with stage III CC after surgery, ctDNA was detectable in 19.7% of the patients and was confirmed as a major independent prognostic biomarker. IS seems to bring additional prognostic information in the 80.3% of patients who are ctDNA-negative.
Hyodeoxycholic acid ameliorates cholestatic liver fibrosis by facilitating m6A-regulated expression of a novel anti-fibrotic target ETV4
Authors: Xiaoyong Xue, Runping Liu, Yajie Cai, Liping Gong, Guifang Fan, Jianzhi Wu, Xin Li, Xiaojiaoyang Li
Journal: Journal of Hepatology (2025)
Clinical, immunologic and genetic characteristics of 148 patients with NK cell deficiency
Authors: Manar Abdalgani, Evelyn R. Hernandez, Luis A. Pedroza, Ivan K. Chinn, Lisa R. Forbes Satter, Nicholas L. Rider, Pinaki P. Banerjee, M. Cecilia Poli, Sanjana Mahaptra, Debra Canter, Tram Cao, Linda M. Shawver, Sara Nandiwada, James R. Lupski, Jennifer Posey, Rajasekhar Ramakrishnan, Emily M. Mace, Jordan S. Orange
Journal: Journal of Allergy and Clinical Immunology (2025)

Natural killer (NK) cell deficiency (NKD) is an immunodeficiency phenotype in which abnormality of NK cells is the major clinically relevant immune defect. We sought to define the clinical, immunologic and genetic characteristics of patients with NKD to aid in the understanding of these individuals and this cell type, and guide future research and clinical practice. During 2006-2022, 168 individuals suspected of having NKD were enrolled, with comprehensive clinical, immunological and genetic data collected and analyzed. Research exome sequencing was performed to identify both known and novel genetic associations. NK cell abnormalities consistent with NKD were confirmed in 148 individuals. Most presented during childhood (median age 13y, range 0-76y), though 34% were adults. All tested individuals exhibited reduced NK cell cytotoxic function; 44% also had decreased NK cell numbers and/or mature NK cells. Herpesvirus and/or papillomavirus infections were observed in 71%, malignancies in 7%, and a 5% case-fatality rate was noted. Among the 99 individuals who underwent research exome sequencing, 29% were considered solved for a likely contributing variant allele, 52% of these cases involving known genes and 48% involving novel genes. NKD is a phenotypic immunodeficiency associated with increased susceptibility to certain viral infections and cancer, with multiple genetic etiologies, revealing key biological pathways for NK cell development and function. This research underscores the role of NK cells in human immune defenses, and helps advance the identification of at-risk populations, precise genetic diagnoses, and informed clinical management for those with NKD.