Low Invasiveness Research Articles

Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: Long Term Results.

Initial results after autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis have been promising. But long-term results have not yet been available. In a prospective study, 42 patients with thumb carpometacarpal joint osteoarthritis were observed for a mean time of 5 years after autologous fat transfer. Manual liposuction and centrifugation were performed. Pain rating according to numerous analogue pain scale; objective force of pinch grip and fist closure; and Disabilities of the Arm, Shoulder, and Hand questionnaire score (DASH score) before and after treatment were analysed. The average pain preoperatively was 8.0±1.6 and 4.0±3.0 after 5 years overall. Force and pinch force of the treated hand improved from 71% and 60% preoperative in comparison to the non-treated hand to 100% and 96%, respectively, 5 years after fat transplantation. There were similar improvements for the parameters strength and DASH score. All improvements were statistically significant. No serious adverse events were observed. Autologous fat transplantation is a real alternative to trapeziectomy even in the long term in basal joint osteoarthritis of the thumb. The low invasiveness of the procedure and early recovery of patients compared with classical procedures such as trapeziectomy, and the superior long-term results compared with classical injection therapy, make this approach feasible as a first-line therapy in basal joint osteoarthritis of the thumb as it offers stable results and warrants a high patient satisfaction rate.

An innovative eye-tracker: Main features and demonstrative tests.

We present a set of results obtained with an innovative eye-tracker based on magnetic dipole localization by means of an array of magnetoresistive sensors. The system tracks both head and eye movements with a high rate (100-200 Sa/s) and in real time. A simple setup is arranged to simulate head and eye motions and to test the tracker performance under realistic conditions. Multimedia material is provided to substantiate and exemplify the results. A comparison with other available technologies for eye-tracking is drawn, discussing advantages (e.g., precision) and disadvantages (e.g., invasivity) of the diverse approaches, with the presented method standing out for low cost, robustness, and relatively low invasivity.

Exosomal miRNA-455 from Bone Marrow Stromal Cells (BMSCs) Promotes Macrophage Phagocytosis and Restrains Progression of Gastric Cancer (GC)

Multiple miRNAs are differentially expressed in gastric cancer (GC). Herein, this study aims to investigate miR-455’s role in GC and its mechanism. Exosomes (exo) separated from BMSCs after transfection were co-cultured with either phagocytes, GC cells (NCI-N87 cell), or macrophages combined with NCI-N87cells (mixed group) followed by analysis of the expression of PTEN, N-cadherin, E-cadherin, and PI3K, and AKT by RT-qPCR and Western blot. Increased miR-455 expression was observed in GC cells upon transfection. GC cells in the mixed group relative to NCI-N87 group exhibited a lower cell migration and invasion and impaired proliferative capacity (p < 0.05), accompanied with higher expressions of N-cadherin, E-cadherin, PI3K, and AKT, and decreased level of PTEN (p < 0.05). The combined treatment resulted in a higher phagocytic rate (12.38±0.21%) and phagocytic index (14.29±2.11%) compared to treatment with only phagocytes (p < 0.05). In conclusion, BMSC-derived exosomal miR-455 inhibits the growth of GC cells and promotes the phagocytosis through inactivating PI3K/AKT signaling pathway.

Management of Simple Hepatic Cyst.

Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities. They arise from aberrant bile duct cells that develop during embryonic development. With the development of diagnostic modalities such as ultrasonography (US), CT, and MRI, simple hepatic cysts are frequently detected in clinical examinations. US is the most useful and noninvasive tool for diagnosis of simple hepatic cysts and can usually differentiate simple hepatic cysts from abscesses, hemangiomas, and malignancies. Cysts with irregular walls, septations, calcifications, or daughter cysts on US should be evaluated with enhanced CT or MRI, to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts. Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension, and dietary symptoms such as nausea, vomiting, a feeling of fullness, and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels. Asymptomatic simple hepatic cysts do not require treatment. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration because of its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence. Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and selection of a reliable treatment.

Evolution of cooperation in public goods games with segregated networks and periodic invasion

Despite the cost, rational individuals routinely modify their relationships in social networks to optimize their payoffs. To develop this observation, we propose a segregation strategy that impels individuals to sever the adverse ties between defectors and their group at some cost, and then we randomly rewire the link-broken cooperative individuals. Moreover, time-varying environmental factors impact the relationships between interacting individuals, in particular certain periodic changes such as the circadian rhythm and seasonality, thus affecting the evolution of cooperation in spatial public goods games. By this means, periodic invasion is taken into account, which allows defectors with lower degrees than the initial value to randomly restore links and invade the population again. Through simulation, we find that the segregation strategy involving periodic invasion can effectively facilitate cooperation by formatting assortative and heterogeneous topology. Furthermore, we observe a subtle interplay between the costly topology control strategy and the exogenous changes in temporal factors that alter the spatiotemporal dynamics of coevolution and promote cooperation. We conclude that a relatively low periodic invasion frequency contributes to increasing the level of cooperation, but the threshold of cooperation is not sensitive to the change in invasion period when at longer intervals. We present our interpretations of these phenomena, which thus allow us to better understand the role of this new machine in the emergence of cooperation.

LGR5 expression and clinicopathological features of the invasive front in the fat infiltration area of pancreatic cancer

BackgroundLeucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5) is a strong cancer stem cell marker in colorectal cancer; however, there are many unclear aspects of LGR5 expression in pancreatic cancer. It has been reported that the interaction between tumor cells and stroma at the fat infiltration site has a significant effect on pancreatic cancer prognosis. Therefore, we report a clinicopathological study of LGR5 expression at the fat invasion front in pancreatic cancer.MethodsLGR5 expression was analyzed in 40 pancreatic ductal adenocarcinoma cases with RNAscope, which is a newly developed high-sensitivity in situ hybridization method. Epithelial-mesenchymal transition (EMT) was analyzed by the expression of E-cadherin and vimentin via immunohistochemistry.ResultsLGR5-positive dots were identified in all cases, especially with glandular formation. In the fat invasion front, a high histological grade showed significantly reduced LGR5 expression compared with a low histological grade (p=0.0126). LGR5 expression was significantly higher in the non-EMT phenotype group than in EMT phenotype group (p=0.0003). Additionally, LGR5 expression was significantly lower in cases with high vascular invasion than in those with low vascular invasion (p=0.0244).ConclusionsThese findings suggest that decreased LGR5 expression in the fat invasion front is associated with more aggressive biological behavior in pancreatic ductal adenocarcinoma, with higher tumor grade, EMT phenotype, and higher vascular invasion.

Utilization potential of alien plants in nature-based tourism sites: A case study on Agave americana (century plant) in the Ogasawara Islands

Introduction of alien species is a severe problem in nature-based tourism sites, particularly in islands. However, majority of alien species does not show severe invasive characteristics. Many alien species originate from ornamental species preferred by the general public. Therefore, using these alien species that do not exhibit high invasiveness as tourism resources may be practical in nature-based tourism sites. We evaluated invasiveness using Species Distribution Models and attractiveness for visitors using questionnaire surveys on Agave americana, an alien plant with high ornamental value in Chichijima, Ogasawara Islands, Japan. The Ogasawara Islands are oceanic islands with important tourism value that are also vulnerable to alien invasive species. Our results showed A. americana was distributed in relatively low conservation value where many visitors enjoyed tourist landscape pictures with the species. Therefore, A. americana showed relatively low invasiveness and was preferred by visitors, which are ideal conditions for their use as tourism resources. However, visitor preference of plant species was strongly influenced by their perceptions. Visitors did not prefer alien invasive species, but also could not identify which plant species were alien invasive. When using alien species as a tourism resource, supporting identification of problematic invasive species is required.

Tau proteins in blood as biomarkers of Alzheimer's disease and other proteinopathies.

Alzheimer's disease (AD), the most common age-dependent neurodegenerative disorder, is characterized neuropathologically by extracellular Aβ plaques and intracellular tau neurofibrillary tangles. While in AD tau pathology probably follows early alterations in Aβ metabolism, it develops independently in the so-called primary tauopathies, the main form being frontotemporal lobar degeneration with tau pathology. Tau pathology in AD brain is reflected in the cerebrospinal fluid (CSF) by elevated levels of the two AD tau biomarkers total and phosphorylated tau, which are now used for routine diagnostic purposes. On the contrary, no established neurochemical biomarkers exist for tau pathology in primary tauopathies. Thanks to recent technological advances, total and phosphorylated tau can now be quantified also on peripheral blood, and accumulating evidence shows that measurement of plasma phosphorylated tau species (P-tau181, P-tau217, and P-tau231) has high performances in discriminating AD patients from cognitively unimpaired subjects but also from patients with other dementias. Moreover, plasma P-tau levels are associated with tracer uptake on tau- and amyloid-PET as well as with brain atrophy, cognitive measures and longitudinal changes of these parameters. These features, together with the low invasiveness, scalability, and ease of longitudinal sampling, which differentiate plasma P-tau species from their CSF counterparts, make these proteins promising peripheral biomarkers for AD in both research and clinical setting. This review discusses the recent developments in the field of plasma tau proteins as diagnostic, pathophysiological and prognostic biomarkers of Alzheimer's disease; additional findings from the fields of genetic forms of AD and of non-AD proteinopathies are also summarized.

Evaluation of Trans-epithelial Electrical Resistance by Removal and Replenishment of Extracellular Ca<sup>2+</sup>

We developed a bi-channel microfluidic device integrated with a four-probe electrode system to measure the trans-epithelial electrical resistance (TEER). Time course of TEER was monitored when the extracellular Ca2+ was removed and replenished both from the upper and lower channels. We showed that tight junctions were disrupted rapidly once Ca2+ was removed from the basal side. However, when Ca2+ was removed from the apical side such disruption progressed slowly. Upon replenishing Ca2+ content at the basal side the TEER recovery pace was also faster than the case of replenishing it at the apical side. We conclude that cell polarity needs to be taken into account during the process of Ca2+ removal/replacement in explaining the dynamics of tight junction disruption/recovery. These results indicate that our approach can be utilized in detecting cell polarity in real time and low invasion.

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery-A Scoping Review.

BackgroundThere is a trend toward minimally invasive and more automated procedures in orthopedic surgery. An important aspect in the further development of these techniques is the quantitative assessment of the surgical approach. The aim of this scoping review is to deliver a structured overview on the currently used methods for quantitative analysis of a surgical approaches' invasiveness in orthopedic procedures. The compiled metrics presented in the herein study can serve as the basis for digitization of surgery and advanced computational methods that focus on optimizing surgical procedures.MethodsWe performed a blinded literature search in November 2020. In-vivo and ex-vivo studies that quantitatively assess the invasiveness of the surgical approach were included with a special focus on radiological methods. We excluded studies using exclusively one or multiple of the following parameters: risk of reoperation, risk of dislocation, risk of infection, risk of patient-reported nerve injury, rate of thromboembolic event, function, length of stay, blood loss, pain, operation time.ResultsThe final selection included 51 articles. In the included papers, approaches to 8 different anatomical structures were investigated, the majority of which examined procedures of the hip (57%) and the spine (29%). The different modalities to measure the invasiveness were categorized into three major groups “biological” (23 papers), “radiological” (25), “measured in-situ” (14) and their use “in-vivo” or “ex-vivo” was analyzed. Additionally, we explain the basic principles of each modality and match it to the anatomical structures it has been used on.DiscussionAn ideal metric used to quantify the invasiveness of a surgical approach should be accurate, cost-effective, non-invasive, comprehensive and integratable into the clinical workflow. We find that the radiological methods best meet such criteria. However, radiological metrics can be more prone to confounders such as coexisting pathologies than in-situ measurements but are non-invasive and possible to perform in-vivo. Additionally, radiological metrics require substantial expertise and are not cost-effective. Owed to their high accuracy and low invasiveness, radiological methods are, in our opinion, the best suited for computational applications optimizing surgical procedures. The key to quantify a surgical approach's invasiveness lies in the integration of multiple metrics.

In vivo spatiotemporal control of voltage-gated ion channels by using photoactivatable peptidic toxins

Photoactivatable drugs targeting ligand-gated ion channels open up new opportunities for light-guided therapeutic interventions. Photoactivable toxins targeting ion channels have the potential to control excitable cell activities with low invasiveness and high spatiotemporal precision. As proof-of-concept, we develop HwTxIV-Nvoc, a UV light-cleavable and photoactivatable peptide that targets voltage-gated sodium (NaV) channels and validate its activity in vitro in HEK293 cells, ex vivo in brain slices and in vivo on mice neuromuscular junctions. We find that HwTxIV-Nvoc enables precise spatiotemporal control of neuronal NaV channel function under all conditions tested. By creating multiple photoactivatable toxins, we demonstrate the broad applicability of this toxin-photoactivation technology.

Laparoscopic salpingectomy in Papio hamadryas for birth control in captivity.

To evaluate the feasibility of laparoscopic salpingectomy in baboons (Papio hamadryas). We hypothesized that laparoscopic salpingectomy could be performed in baboon species within a reasonable amount of surgical time, with minor complications occurring at low rates. Case series and technique description. Sixteen baboons (n=16). The surgical procedures were performed using the 3-port technique, with 5 mm instruments and a telescope placed at the umbilical and hypogastric regions. A salpinx dissection was performed, using a radiofrequency bipolar vessel sealing device, from the fimbriae to the uterine attachments. We evaluated the surgical duration, learning curve, and intraoperative and early postoperative complications. Ten adult and 6 subadult baboons with a mean weight of 9.32 kg, a range of 4-14.2 kg, and a standard deviation (SD) of 3.09 kg were included in the study. The total duration of surgery was 28.75 min (range, 16-50 min; SD, 9.60 min). The installation phase was completed in a mean time of 7.68 min (range, 3-15 min; SD, 3.43 min), and the time to complete the salpingectomy of both salpinges was 9.68 min (range, 4-20 min; SD, 3.97 min). No complications were observed in the postoperative period. Laparoscopic salpingectomy in Papio hamadryas was feasible, with an acceptable surgical time, low invasiveness, and only minor technical perioperative complications. Laparoscopic salpingectomy could be a viable and safe therapeutic option in nonhuman primate birth-control programs.

Biocompatible polymer-modified gold nanocomposites of different shapes as radiation sensitizers.

Radiation therapy is a powerful approach for cancer treatment due to its low invasiveness. The development of radiation sensitizers is of great importance as they assist in providing radiation therapy at a low dose. In this study, poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-modified gold nanocomposites of different shapes were created using the grafting-to approach to serve as a novel radiation sensitizer with high cellular uptake. The effect of the shape of the nanocomposite on cellular uptake by the breast cancer cell line MCF-7 was also investigated. The PMPC-modified gold nanostars showed the highest cellular uptake compared to the other gold nanocomposites (spheres and rods), whereas cell cytotoxicity was negligible among all candidates. Furthermore, the therapeutic effect of radiation of PMPC-modified nanostars was the highest among all the gold nanocomposites. These results clearly indicate that the shape of the gold nanocomposite is an important parameter for cellular uptake and radiation sensitizing effects in breast cancer cells.

Oscillatory brain network changes after transcranial magnetic stimulation treatment in patients with major depressive disorder

• Oscillatory network changes during rTMS in MDD were evaluated by clinical EEG. • Functional connectivity changes were observed in MDD after rTMS. • Improved theta-band functional connectivity was associated with improved cognition. : Repetitive transcranial magnetic stimulation (rTMS) has attracted attention for treating treatment-resistant major depressive disorder (MDD) because of its effectiveness and low invasiveness. Recent neuroimaging studies suggest that the effects of rTMS in MDD may be based on improvements in abnormal brain networks. However, oscillatory network changes after rTMS remain unclear. This study aimed to detect oscillatory electroencephalography (EEG) markers that reflect the therapeutic effects of rTMS. : We treated 15 treatment-resistant MDD patients with high-frequency (10 Hz) rTMS over the left prefrontal cortex for 6 weeks. The power spectral density at each electrode and the phase lag index between all electrode pairs were compared before and after rTMS using clinical EEG data. The relationships between EEG indices, depressive symptoms, and cognitive function were also examined. : Depressive symptoms were significantly improved after rTMS. Additionally, functional connectivity between the left frontal–temporal and occipital regions in the theta band and gamma power in the anterior–central area were increased in both hemispheres after rTMS. Increased functional connectivity in the theta band was correlated with improved cognitive function, while increased gamma power was correlated with worsened depressive symptoms. : The sample size was relatively small. : Our results demonstrated oscillatory changes in theta-band functional connectivity after rTMS in MDD patients. These findings, obtained using clinical EEG methods, provide evidence of the underlying neurophysiological effects of rTMS on MDD within the context of functional brain network changes, and may constitute a biomarker for evaluating MDD treatments.

Endovascular Aortic Repair of Mycotic Abdominal Aortic Aneurysm with Multiple Systemic Abscesses

Mycotic abdominal aortic aneurysms (MAAAs) are rare, but severe aortic infection and subsequently infected aortic aneurysms can cause a lethal condition. The gold standard for treatment is resection, infected tissue debridement, and graft replacement. Despite meticulous surgical planning, the mortality rate after open surgical repair can reach 40%. Endovascular aortic repair (EVAR) is another treatment option because of its simplicity and low invasiveness. We report a case of symptomatic MAAA successfully treated with EVAR and antibiotic therapy. EVAR is valuable for postoperative physical recovery. Here, the endovascular approach was feasible, and an acceptable outcome could be obtained.

Heat Shock Protein 70 Inhibition Effect on Inflammatory Receptors via Nuclear Factor Kappa B on Melanoma Cell Lines, A-375 and C8161

The aim of this study was evaluation of effect of heat shock protein 70 on toll-like receptor 4 and toll-like receptor 2 in melanoma cell line, A-375. The melanoma cell lines were stimulated in time course with heat shock protein 70 protein and incubation was performed. After 48 h, the cells were collected and total messenger ribonucleic acid was extracted and the expression of toll-like receptor 2 and toll-like receptor 4 was determined by quantitative reverse transcription polymerase chain reaction. The results showed that the appearance of toll-like receptor 2, toll-like receptor 4 in melanoma cell line, A-375 decreased in exposure to heat shock protein 70. The results showed the expression of nuclear factor kappa B in melanoma cell line. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide evaluation results of melanoma cell death were compared at different times and statistical analysis showed a significant difference (p<0.001). The role of heat shock protein 70 has been identified as a tumor suppressor in melanoma cancer. Heat shock protein 70 is a new treatment for melanoma in the near future. Heat shock protein 70 can be considered as a potential target in gene therapy for patients with melanoma cancer and the advantages of gene therapy by heat shock protein 70 in this type of cancer over chemotherapy can reduce cytotoxic effects and its low invasiveness.

Declining Cancer Incidence in the Elderly: Decreasing Diagnostic Intensity or Biology?

Advanced age is a consistent risk factor for cancer; nonetheless, cancer incidence typically declines after age 75-85 for most solid tumors. To delineate the true cancer age-incidence pattern, we performed a population-based cohort study using Swedish Cancer Register data from 1970-2014 on nine common, adult (age 20-99) cancers categorized as requiring high (pancreatic, lung, non-meningioma brain), medium (anorectal, urinary bladder, non-Hodgkin lymphoma), and low (melanoma skin, breast, prostate) diagnostic invasiveness based on the perceived risk of complications associated with histopathologic verification. We estimated the reported incidence and the proportion of autopsy-detected cancers by age but also projected a corrected incidence assuming the same proportion of unexpected cancer findings if all deaths underwent autopsy. The registered cancer incidence dropped after peak age around 65-84, with the exception of melanoma skin. This pattern was attenuated when exploring the proportion of incident, unexpected cancer findings in autopsy material by age. The "total" cancer incidence, reported plus projected incident autopsy cases, increased monotonously with age. The long-established cancer incidence decline in elderly is most probably an artifact due to reduced diagnostic intensity. Biological drivers to the cancer incidence decline in elderly are unlikely and resources are better allocated to prepare for the anticipated cancer pandemic when numbers of healthy elderly increase. Cancer alarm symptoms in elderly fit for cancer therapy should be investigated promptly and clinical cancer trials focus to also include elderly to set updated standards for cancer therapy in the dominating age group.

Spyglass percutaneous transhepatic lithotripsy of symptomatic recurrent lithiasis of the intrahepatic bile duct with distal stenosis.

In patients with symptomatic intrahepatic biliary lithiasis, the treatment is usually discussed by a multidisciplinary team. Although hepatectomy is considered as definitive treatment, when lobar atrophy is absent, endoscopic procedures are frequently proposed as first-line treatment due the low invasiveness and for sparing liver parenchyma. Percutaneous route is used in case of peroral approach failure. We present a case of recurrent symptomatic intrahepatic biliary lithiasis of the right posterior hepatic duct, sustained by downstream biliary stenosis. Peroral cholangioscopy failed to visualize the stone for the accompanying stenosis. Thus, the patient was successfully treated with percutaneous transhepatic lithotripsy performed with Spyglass direct visualization system II (Boston Scientific Inc., Natick, Massachusetts, USA). During the procedure, the biopsy of the biliary stenosis revealed fibrosis, which was treated by cholangioplasty with cutting balloon. After 15 months, the patient is asymptomatic, with moderate residual stenosis in absence of calculi at follow-up magnetic resonance cholangiography.

Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability: Case Series

Category:Arthroscopy; SportsIntroduction/Purpose:The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Maintenance of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability.Methods:This is a retrospective study with patients diagnosed with multidirectional instability, submitted to an ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the VAS and the AOFAS Score at a mean of 14.8 months (5-27 months) in follow-up.Results:A total of 30 ankles (29 patients) were included in the study. AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (p=0.001) and was followed by significant improvement in the mean VAS (6.83; CI 0.37 to 0.95; CI 0.31). The majority of patients had associated procedures (53.3%) and a low complication rate was found (16.6%).Conclusion:Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique can improve the clinical outcomes of these patients.

Новая малотравматичная пункционная игла MG. Результаты сравнительного морфологического исследования

Despite the low invasiveness of percutaneous nephrolithotripsy, this surgery is not without complications. One of the most important stages of the operation, on which depends not only the success of the patient completely getting rid of calculus, but the likelihood of complications, is the puncture of the pelvic-pelvic system.Determination of the effectiveness and security of the new less-traumatic puncture needle MG under experimental conditions.A series of pork kidney punctures with a new less-traumatic needle MG and standard Chiba and Troakar needles (Coloplast A/S, Denmark) were performed under experimental conditions, followed by a comparative morphological assessment. The staining of the slides was performed with hematoxylin and eosin. For the purpose of additional assessment of the structures of the kidney punctured with a low-traumatic MG needle, a morphological assessment of the parenchyma stained with picrofuchsin according to Van Gieson was performed.On parenchymal slides with punctures with Chiba and Trocar needles, the passage places with multiple large fragments of desquamated (damaged) epithelium are visualized. On preparations of the parenchyma punctured with a less-traumatic needle MG, the place of passage of the needle is presented with clear contours. The damaged epithelium in the lumen of the formed defect is practically absent. With additional staining according to Van Gieson (magnification x200), the integrity of the full-blooded vessel adjacent to the limited focus of the needle MG was visualized. Output. The new less-traumatic puncture needle MG is an innovative development in urology. The design of the needle with an atraumatic mandrel-bulb atraumatic mandrel-bulb on a spring basis made it possible to significantly reduce the trauma to the structures of the kidney and perirenal tissues due to the bougienage effect.