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Objectives: This review aims to explore recent advancements in optical imaging techniques for monitoring the viability of Deep Inferior Epigastric Perforator (DIEP) flap reconstruction. The objectives include highlighting the principles, applications, and clinical utility of optical imaging modalities such as near-infrared spectroscopy (NIRS), indocyanine green (ICG) fluorescence angiography, laser speckle contrast imaging (LSCI), hyperspectral imaging (HSI), dynamic infrared thermography (DIRT), and short-wave infrared thermography (SWIR) in assessing tissue perfusion and oxygenation. Additionally, this review aims to discuss the potential of these techniques in enhancing surgical outcomes by enabling timely intervention in cases of compromised flap perfusion., Materials and Methods: A comprehensive literature review was conducted to identify studies focusing on optical imaging techniques for monitoring DIEP flap viability. We searched PubMed, MEDLINE, and relevant databases, including Google Scholar, Web of Science, Scopus, PsycINFO, IEEE Xplore, and ProQuest Dissertations & Theses, among others, using specific keywords related to optical imaging, DIEP flap reconstruction, tissue perfusion, and surgical outcomes. This extensive search ensured we gathered comprehensive data for our analysis. Articles discussing the principles, applications, and clinical use of NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR in DIEP flap monitoring were selected for inclusion. Data regarding the techniques' effectiveness, advantages, limitations, and potential impact on surgical decision-making were extracted and synthesized., Results: Optical imaging modalities, including NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation in DIEP flap reconstruction. These techniques provide objective and quantitative data, enabling surgeons to monitor flap viability accurately. Studies have demonstrated the effectiveness of optical imaging in detecting compromised perfusion and facilitating timely intervention, thereby reducing the risk of flap complications such as partial or total loss. Furthermore, optical imaging modalities have shown promise in improving surgical outcomes by guiding intraoperative decision-making and optimizing patient care., Conclusions: Recent advancements in optical imaging techniques present valuable tools for monitoring the viability of DIEP flap reconstruction. NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation, enabling accurate evaluation of flap viability. These modalities have the potential to enhance surgical outcomes by facilitating timely intervention in cases of compromised perfusion, thereby reducing the risk of flap complications. Incorporating optical imaging into clinical practice can provide surgeons with objective and quantitative data, assisting in informed decision-making for optimal patient care in DIEP flap reconstruction surgeries.

Competing Interests: Consulting fees from Madtronic and Fluoptics received by FT. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Astrocytes are a direct target of neuromodulators and can influence neuronal activity on broad spatial and temporal scales in response to a rise in cytosolic calcium. However, our knowledge about how astrocytes are recruited during different animal behaviors remains limited. To measure astrocyte activity calcium in vivo during normative behaviors, we utilize a high-resolution, long working distance multicore fiber optic imaging system that allows visualization of individual astrocyte calcium transients in the cerebral cortex of freely moving mice. We define the spatiotemporal dynamics of astrocyte calcium changes during diverse behaviors, ranging from sleep-wake cycles to the exploration of novel objects, showing that their activity is more variable and less synchronous than apparent in head-immobilized imaging conditions. In accordance with their molecular diversity, individual astrocytes often exhibit distinct thresholds and activity patterns during explorative behaviors, allowing temporal encoding across the astrocyte network. Astrocyte calcium events were induced by noradrenergic and cholinergic systems and modulated by internal state. The distinct activity patterns exhibited by astrocytes provides a means to vary their neuromodulatory influence in different behavioral contexts and internal states., (© 2024. The Author(s).)

Pediatric brain tumors are the second most common type of cancer, accounting for one in four childhood cancer types. Brain tumor resection surgery remains the most common treatment option for brain cancer. While assessing tumor margins intraoperatively, surgeons must send tissue samples for biopsy, which can be time-consuming and not always accurate or helpful. Snapshot hyperspectral imaging (sHSI) cameras can capture scenes beyond the human visual spectrum and provide real-time guidance where we aim to segment healthy brain tissues from lesions on pediatric patients undergoing brain tumor resection. With the institutional research board approval, Pro00011028, 139 red-green-blue (RGB), 279 visible, and 85 infrared sHSI data were collected from four subjects with the system integrated into an operating microscope. A random forest classifier was used for data analysis. The RGB, infrared sHSI, and visible sHSI models achieved average intersection of unions (IoUs) of 0.76, 0.59, and 0.57, respectively, while the tumor segmentation achieved a specificity of 0.996, followed by the infrared HSI and visible HSI models at 0.93 and 0.91, respectively. Despite the small dataset considering pediatric cases, our research leveraged sHSI technology and successfully segmented healthy brain tissues from lesions with a high specificity during pediatric brain tumor resection procedures.

Background: Treatment options for thyroid pathologies have expanded to include scarless and remote access methods such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Currently, no standardized methods exist for locating parathyroid glands (PGs) in patients undergoing TOETVA, which can lead to parathyroid injury and subsequent hypocalcemia. This early feasibility study describes and evaluates the hANDY-i endoscopic attachment for detecting PGs in transoral thyroidectomy., Methods: We used a prototype parathyroid autofluorescence imager (hANDY-i) that was mounted to a 10-mm 0-degree endoscope. The device delivers a split screen view of Red-green-blue (RGB) and near-infrared autofluorescence (NIRAF) which allows for simultaneous anatomical localization and fluorescence visualization of PGs during endoscopic thyroid dissection., Results: One cadaveric case and two patient cases were included in this study. The endoscopic hANDY-i imaging system successfully visualized PGs during all procedures., Conclusion: The ability to leverage parathyroid autofluorescence during TOETVA may lead to improved PG localization and preservation. Further human studies are needed to assess its effect on postoperative hypocalcemia and hypoparathyroidism., Competing Interests: YK is an employee of Optosurgical LLC. RC has ownership stake in Optosurgical LLC. JR is a consultant for Baxter Scientific. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Seo, Ali, Wolfe, Nagururu, Ding, Desai, Harbison, Kim, Ning, Cha and Russell.)

Introduction: Parathyroid glands may be compromised during thyroid surgery which can lead to hypoparathyroidism and hypocalcemia. Identifying the parathyroid glands relies on the surgeon's experience and the only way to confirm their presence was through tissue biopsy. Near infrared autofluorescence technology offers an opportunity for real-time, non-invasive identification of the parathyroid glands., Methods: We used a new research prototype (hANDY-I) developed by Optosurgical, LLC. It offers coaxial excitation light and a dual-Red Green Blue/Near Infrared sensor that guides anatomical landmarks and can aid in identification of parathyroid glands by showing a combined autofluorescence and colored image simultaneously., Results: We tested the imager during 23 thyroid surgery cases, where initial clinical feasibility data showed that out of 75 parathyroid glands inspected, 71 showed strong autofluorescence signal and were correctly identified (95% accuracy) by the imager., Conclusions: The hANDY-I prototype demonstrated promising results in this feasibility study by aiding in real-time visualization of the parathyroid glands. However, further testing by conducting randomized clinical trials with a bigger sample size is required to study the effect on levels of hypoparathyroidism and hypocalcemia., Competing Interests: Author SH was employed by i2KIE LLC. Author RC has an ownership interest in Optosurgical, LLC. Authors EO and YK were employees of Optosurgical, LLC when the study was carried out. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ali, Wolfe, Nagururu, Seo, Han, Kim, Oh, Kim, Ning, Lee, Cha, Tufano and Russell.)

Objectives: Postoperative bile leakage is a common complication of hepatobiliary surgery and frequently requires procedural intervention. Bile-label 760 (BL-760), a novel near-infrared dye, has emerged as a promising tool for identifying biliary structures and leakage, owing to its rapid excretion and strong bile specificity. This study aimed to assess the intraoperative detection of biliary leakage using intravenously administered BL-760 compared with intravenous (IV) and intraductal (ID) indocyanine green (ICG)., Materials and Methods: Laparotomy and segmental hepatectomy with vascular control were performed on two 25-30 kg pigs. ID ICG, IV ICG, and IV BL-760 were administered separately, followed by an examination of the liver parenchyma, cut liver edge, and extrahepatic bile ducts for areas of leakage. The duration of intra- and extrahepatic fluorescence detection was assessed, and the target-to-background (TBR) of the bile ducts to the liver parenchyma was quantitatively measured., Results: In Animal 1, after intraoperative BL-760 injection, three areas of leaking bile were identified within 5 min on the cut liver edge with a TBR of 2.5-3.8 that was not apparent to the naked eye. In contrast, after IV ICG administration, the background parenchymal signal and bleeding obscured the areas of bile leakage. A second dose of BL-760 demonstrated the utility of repeated injections, confirming two of the three previously visualized areas of bile leakage and revealing one previously unseen leak. In Animal 2, neither ID ICG nor IV BL-760 injections showed obvious areas of bile leakage. However, fluorescence signals were observed within the superficial intrahepatic bile ducts after both injections., Conclusions: BL-760 enables the rapid intraoperative visualization of small biliary structures and leaks, with the benefits of fast excretion, repeatable intravenous administration, and high-fluorescence TBR in the liver parenchyma. Potential applications include the identification of bile flow in the portal plate, biliary leak or duct injury, and postoperative monitoring of drain output. A thorough assessment of the intraoperative biliary anatomy could limit the need for postoperative drain placement, a possible contributor to severe complications and postoperative bile leak., (© 2023 Wiley Periodicals LLC.)

54 consecutive cases of small cell lung cancer (SCLC) were treated with longterm short-interval combined treatment modalities of chemotherapy, radiotherapy (55-65 GY), immunotherapy, traditional Chinese medicine (leaf of Asiatic Ginseng, root of Astragalus membranaceus Bge, etc) and other adjuvants. Chemotherapy consisted of vincristine, cyclophosphamide, methotrexate and carmustine. A complete response of 59.2%, partial response of 38.9% and an overall response of 98.1% were achieved. According to Kaplan-Meier, the survival rates of SCLC with limited disease for 1, 3, 5 and 10 years were 78.1%, 42.6%, 32.1% and 21.4% respectively; while those with extensive disease for 1, 3, and 5 years 90.5%, 13.4% and 13.4%. According to classification of international TNM staging (1988), the survival rates of stage II SCLC for 1, 3, 5 and 10 years were 92.9%, 61.9%, 53.1% and 31.8% respectively; of stage IIIa for 1, 3 and 5 years 80.0%, 30.0% and 20.0%, and of stage IIIb 83.3%, 20.8% and 15.6%. Our combined modalities raised the survival rates considerably; the improved effect was mainly due to the long-term (especially more than 2 years or 10 courses), short-interval, effective and timely combined treatment with chemotherapy, radiotherapy and adjuvants such as traditional Chinese medicine and immunotherapy. By using the above therapeutic strategy, 10 out of 12 SCLC patients including 4 with extensive disease, who were relatives of our hospital staffs, have gained more than 3-17 years of survival. Therefore small cell lung cancer even with extensive disease was a hopeful curable disease.

The combined modality treatment consisted mainly of long-term intermittent combination chemotherapy (VCMB being in the majority) and radiotherapy combined with immunotherapy as well as Chinese traditional medicine. The patients treated with this therapy were observed in 1974-1986, till successive fifty, and followed up to January 1988. They were of the stage I, II, III and IV including 3, 10, 20 and 17 patients respectively. The complete remission rate was 54% (27/50); the partial remission rate, 40% (20/50). The total effective rate was 94% (47/50). According to the calculation of life-table, 2-year survival rate for the stage I-II (n = 13) was 76.2%; 5-year survival rate, 55.5%. For the stage III (n = 20), 2-year survival rate was 46.9%; 5-year, 18.8%. By long-term combined modality, the survival rate has obviously improved, and the possibility of cure has evidently increased.

In patients with bronchogenic carcinoma of various types and stages, serum beta 2-microglobulin (beta 2-M) and carcinoembryonic antigen (CEA) were assayed simultaneously. The concentrations of serum beta 2-M and CEA were found to be statistically related to complete remission of the tumor (P less than 0.01). But it was also found that there was no correlation between the levels of beta 2-M and CEA (r = 0.0621). In follow-up, the CEA was found to be increasing incessantly as the disease progressed. For the level of serum beta 2-M, as the patients' condition got worse, it first rose, then dropped and became markedly lower before the patient died. The serum beta 2-M was often elevated 3-5 months earlier than CEA, and frequently resumed the normal level later than CEA after the carcinoma had a complete remission. With the progression of the bronchogenic carcinoma, elevation of beta 2-M was not necessarily a sign of poor prognosis. In contrast, with the serum beta 2-M markedly lowered after an initial elevation, the serum CEA became elevated, the prognosis was usually poor. The authors believe that, in patients with lung cancer, CEA produced from the lung cancer cells would give a level fluctuating with the size of the primary focus and the extent of the metastasis. But its positive rate is rather low. The serum beta 2-M is produced indirectly by certain immunologic function against bronchogenic carcinoma or its metabolites and not by the cancer cells directly. The positive rate of beta 2-M is high, so slightly is its false positive rate.(ABSTRACT TRUNCATED AT 250 WORDS)