Purpose: Semantic segmentation is a fundamental part of the surgical application of deep learning. Traditionally, segmentation in vision tasks has been performed using convolutional neural networks (CNNs), but the transformer architecture has recently been introduced and widely investigated. We aimed to investigate the performance of deep learning models in segmentation in robot-assisted radical prostatectomy (RARP) and identify which of the architectures is superior for segmentation in robotic surgery. Materials and Methods: Intraoperative images during RARP were obtained. The dataset was randomly split into training and validation data. Segmentation of the surgical instruments, bladder, prostate, vas and seminal vesicle was performed using three CNN models (DeepLabv3, MANet, and U-Net++) and three transformers (SegFormer, BEiT, and DPT), and their performances were analyzed. Results: The overall segmentation performance during RARP varied across different model architectures. For the CNN models, DeepLabV3 achieved a mean Dice score of 0.938, MANet scored 0.944, and U-Net++ reached 0.930. For the transformer architectures, SegFormer attained a mean Dice score of 0.919, BEiT scored 0.916, and DPT achieved 0.940. The performance of CNN models was superior to that of transformer models in segmenting the prostate, vas, and seminal vesicle. Conclusions Deep learning models provided accurate segmentation of the surgical instruments and anatomical structures observed during RARP. Both CNN and transformer models showed reliable predictions in the segmentation task; however, CNN models may be more suitable than transformer models for organ segmentation and may be more applicable in unusual cases. Further research with large datasets is needed.

Objective: Emergency medical system reform is an important part of the 4th Emergency Medical Care 5-year plan in Korea, published in 2023. However, little is known about the current emergency department (ED) utilization status of local emergency medical agencies (EMAs). We sought to compare the ED utilization code between the emergency medical centers (EMCs) (n=58) and the local EMAs (n=152) based on parameters such as the admission rate or transfer rate in patients with a critical illness. Methods: Consecutive emergency patients registered on the National Emergency Department Information System from January 2022 to December 2022 were included in this study and their records were analyzed. The study included critically ill patients who were defined as having a critical illness code. Results: Among 590,878 (EMC of 450,007; local EMA of 140,871) critical illness code patients, the admission rate was 76.2% for EMCs and 52.9% for local EMAs. Of the critical illness code patients who visited local EMAs, 89.4% were Korean Triage and Acuity Scale (KTAS) grade 3-5 patients. The hospitalization volume of critical illness code patients in the local EMAs was 74,571, mostly major trauma (47.5%) and ischemic stroke (11.5%). If KTAS grade 1 or 2 patients could not be transferred to the local EMAs, the EMCs covered up to 14,989 ED patients and 74,571 admitted patients additionally. Conclusion If the local EMAs maintain their current roles in the areas of major trauma and ischemic stroke, and take charge of the admission of patients with critical illness codes transferred from the EMC after emergency treatment, then the local EMAs can still maintain their functions even after the proposed emergency medical system reform.

Background: Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). This study aimed to determine the relative efficacy of regional analgesic interventions for VATS using a network meta-analysis (NMA). Methods: We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary outcome was opioid consumption during the first 24-h postoperative period. Pain scores were also collected during three different postoperative periods: the early (0–6 h), middle (6–18 h), and late (18–24 h) periods. Results: A total of 21 RCTs (1391 patients) were included. TPVB showed the greatest effect on opioid consumption compared with the control (mean difference [MD] = −13.2 mg; 95% CI [−16.2, −10.1]). In terms of pain scores in the early period, ESPB had the greatest effect compared to control (MD = −1.6; 95% CI [−2.3, −0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB and INB had superior analgesic effects compared to controls, while SPB did not. Conclusions TPVB had the best analgesic efficacy following VATS, though the analgesic efficacy of ESPBs was comparable. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following VATS.

Purpose: To calculate the intraocular lens (IOL) power using the Shammas-PL formula after laser in-situ keratomileusis (LASIK). Methods: Forty-one eyes of 29 patients that had undergone cataract surgery from September 2018 to September 2019 after LASIK were enrolled in this study. A preoperative AL-Scan® (Nidek Co., Gamagori, Japan) was used to measure the axial length, anterior chamber depth, and corneal curvature. An IOL power calculation was performed using the Shammas-PL (post LASIK) formula. Mean absolute error (MAE) and mean arithmetic error (MARE) were calculated using preoperative manifest refraction and postoperative manifest refraction. Results: Of the 41 eyes, 15 eyes (36.6%) were relatively hyperopic-shifted after surgery compared to the predicted refractive error before surgery, 25 eyes (61%) showed a relative myopic shift, and one eye (2.4%) showed no change with respect to the previous refractive predicted error. Refractive errors before cataract surgery were not related to myopic, emmetropic, or hyperopic shifting after surgery (p > 0.05). Conclusions When cataract surgery using the Shammas-PL formula was performed after LASIK, myopic shifting was more common than hyperopic shifting. The MAE was greater in myopic-shifted cases than that of hyperopic-shifted cases. Thus, it is better to determine IOL power toward the hyperopic side than the target refractive prediction.

Purpose: To seek Pearson correlations of tear film osmolarity measured by the I-PEN® (I-MED Pharma Inc., Dollard-des-Ormeaux, Canada) with Schirmer test result, tear break-up time, and Ocular Surface Disease Index score in patients with mild dry eye syndrome. Methods: Patients with mild dry eye syndrome were divided into two groups according to Ocular Staining Score: group 1 (50 patients; 67 eyes) and group 2 (59 patients; 91 eyes), 90 patients and 158 eyes in total. The above mentioned correlations were derived. Results: No significant correlations were observed between tear film osmolarity and Schirmer test result (r < -0.01, p = 0.97), tear break-up time (r = 0.05, p = 0.54), or Ocular Surface Disease Index score (r = 0.03, p = 0.76). When the two groups were compared, the Ocular Surface Disease Index score significantly differed between groups (p < 0.01), whereas the Schirmer test result (p = 0.31), tear break-up time (p = 0.11), and tear film osmolarity (p = 0.12) did not. Conclusions No significant correlations were found between tear film osmolarity and other dry eye indicators in patients with mild dry eye syndrome. The diagnostic utility of tear film osmolarity in patients with moderate dry eye syndrome is should be evaluated.

Purpose: To seek Pearson correlations of tear film osmolarity measured by the I-PEN® (I-MED Pharma Inc., Dollard-des-Ormeaux, Canada) with Schirmer test result, tear break-up time, and Ocular Surface Disease Index score in patients with mild dry eye syndrome. Methods: Patients with mild dry eye syndrome were divided into two groups according to Ocular Staining Score: group 1 (50 patients; 67 eyes) and group 2 (59 patients; 91 eyes), 90 patients and 158 eyes in total. The above mentioned correlations were derived. Results: No significant correlations were observed between tear film osmolarity and Schirmer test result (r < -0.01, p = 0.97), tear break-up time (r = 0.05, p = 0.54), or Ocular Surface Disease Index score (r = 0.03, p = 0.76). When the two groups were compared, the Ocular Surface Disease Index score significantly differed between groups (p < 0.01), whereas the Schirmer test result (p = 0.31), tear break-up time (p = 0.11), and tear film osmolarity (p = 0.12) did not. Conclusions No significant correlations were found between tear film osmolarity and other dry eye indicators in patients with mild dry eye syndrome. The diagnostic utility of tear film osmolarity in patients with moderate dry eye syndrome is should be evaluated.

Purpose: To investigate the safety of laser epithelial keratomileusis (LASEK) by drawing a comparison between two groups divided according to age (18-19 vs. 20-21 years old). Methods: The study was conducted as a retrospective analysis including 339 patients (678 eyes) who underwent LASEK between January 2017 and April 2020. Patients were divided by age group, group I (18-19 years old) and group II (20-21 years old). The objectives of the study included determination of visual acuity and refractive errors before and at 1, 3, and 6 months after the procedure. Results: The preoperative mean spherical equivalents (SEs) were -4.73 ± 0.88 diopters (D) in group I and -4.58 ± 0.87 D in group II (p = 0.34). At 1 month postoperatively, mean SEs were 0.32 ± 0.46 D in group I and 0.26 ± 0.59 D in group II (p = 0.18). At 3 months postoperatively, the mean SEs were 0.30 ± 0.47 D in group I and 0.28 ± 0.50 D in group II (p = 0.67). At 6 months postoperatively, the mean SEs were 0.15 ± 0.47 D in group I and 0.14 ± 0.50 D in group II (p = 0.89). There were no significant differences in postoperative best corrected visual acuity between group I and group II at 1, 3, or 6 months (p = 0.20, p = 0.13, and p = 0.11, respectively). Conclusions There were no significant differences in postoperative mean SE or safety of LASEK between moderate myopia patients 18-19 years old and those 20-21 years old.

Adenosine Triphosphate ; Dialysis ; Humans ; Luciferases ; Peritoneal Dialysis ; Prospective Studies ; Receptors, Aryl Hydrocarbon ; Renal Dialysis ; Renal Insufficiency, Chronic ; Risk Factors ; Uremia

Purpose: To compare contrast sensitivity before and after surgery in patients who underwent laser in situ keratomileusis (LASIK)and small-incision lenticule extraction (SMILE). Methods: From February 2019 to April 2019, 20 patients who underwent LASIK, and 21 who underwent SMILE, were comparedbefore, one day, one week, and one month after surgery. Results: On postoperative day (POD) 1, contrast sensitivity was better in the LASIK group than in the SMILE group under all conditionsfor 1.6, 1, and 0.64 cycles per degree (cpd). One week after surgery, the contrast sensitivity of the LASIK group was betterthan that of the SMILE group under photopic conditions with glare for 1.6, 1, and 0.64 cpd, under photopic conditions withoutglare for 1 and 0.64 cpd, and under all scotopic conditions for 2.5, 1.6, and 0.64 cpd (p< 0.05). There was no significant differencebetween the two groups, except under the scotopic conditions without glare for 0.64 cpd at one month after surgery. In theLASIK group, the contrast sensitivity was best at one week after surgery. The SMILE group showed the poorest contrast sensitivityon POD 1, but this gradually improved. Conclusions The LASIK group had better contrast sensitivity on one day and one week after surgery than the SMILE group, butthere was no significant difference at one month after surgery. In the LASIK group, the contrast sensitivity was best at one weekafter surgery. In the SMILE group, the contrast sensitivity was worst on POD 1.

Purpose: To report a case of central toxic keratopathy after femtosecond laser in-situ keratomileusis (LASIK).Case summary: A 26-year-old male developed diffuse lamellar keratitis bilaterally on day 2 after femtosecond LASIK. He was applying topical steroid frequently, while also using topical antibiotics. On day 6 after LASIK, slit-lamp biomicroscopy showed a thick central corneal opacity on the right eye so a flap irrigation was performed. He was then treated with systemic methylprednisolone. A corneal epithelial crack and stromal striae were noted by slit-lamp biomicroscopy on postoperative day 10. Four weeks after LASIK, the refractive error was +4.25 Dsph = -1.25 Dcyl Axis 80°. He was treated with topical steroid, topical antibiotics, and oral doxycycline until eight weeks after LASIK. Eight weeks after LASIK, the patient was observed without treatment. The central corneal thickness recovered from 488 μm at eight weeks to 540 μm, and the refractive error was +1.25 Dsph = -0.75 Dcyl Axis 85° at postoperative 72 weeks. The central corneal opacity also recovered. Conclusions Because femtosecond LASIK may result in a combination of diffuse lamellar keratitis and central toxic keratopathy, the clinical characteristics and natural course of both diseases should be understood and timely treatment should be available.