Microscopic Guidance Research Articles

Spinal Hernia Repair and Cauda Equina Repositioning after Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review.

Cauda equina herniation (CEH) is a relatively rare and severe perioperative complication that may occur after lumbar spine surgery. Here, we present a case report of a 36-year-old female patient who experienced CEH after an endoscopic L5-S1 laminectomy and discectomy. The patient presented with right L5-S1 radiculopathy that correlated with findings in medical imaging and physical examination. Subsequently, she underwent endoscopic L5-S1 laminotomy and discectomy. A day after the operation, the patient developed urine leakage, hematochezia, aggravated constipation, and found no relief from pain in the right lower limb. MRI revealed cerebrospinal fluid leakage at the surgical site. After consultation with the urology and anorectal department, the patient was fitted with a urinary catheter, prescribed hemorrhoid medication, and underwent anal sphincter training as recommended by the doctor. After 1 week of treatment, the patient's urinary function returned to normal, but constipation persisted while the pain in the right lower limb eased. After 5 months, the patient was hospitalized due to radiating pain in both lower limbs and constipation. An MRI revealed herniation of the L5/S1 nerve root sac. Subsequently, L5/S1 total laminectomy decompression and dural sac repair were performed under a three-dimensional (3D) microscopy. Postoperatively, lower limb pain and constipation were alleviated. CEH following spinal endoscopy, though rare, demands significant clinical attention. The successful outcome in this case illustrates the value of surgical revision under 3D microscopic guidance, offering a viable strategy for patients presenting with this complication.

Removal of soft tissue foreign bodies in the hand under microscopy: a retrospective observational study

Purpose: Numerous studies have focused on techniques for detecting foreign bodies in soft tissue in the hand, but removal remains a subject of interest. In this study, we describe the microscope-assisted removal of foreign bodies in the hand. Methods: We reviewed records of patients treated for foreign bodies in the hand at our department from July 2013 to May 2023. In 16 patients aged 23 to 55 years, the following variables were analyzed: the cause of trauma; the time interval from trauma to surgery; the location, type, size, and number of foreign bodies; patient complaints; imaging technique; and procedure type. Under local anesthesia, a slit incision was made at the suspected site. Foreign bodies were completely removed using micro-instruments under microscopic guidance. Results: Stab injuries were the most common (n=13), and there was one case each of abrasion, traffic accident, and bee sting. The middle finger (n=5) was the most affected, followed by the thumb (n=4), index (n=3), little finger (n=2), ring finger (n=1), and palm (n=1). Foreign bodies included glass (n=6), wood (n=4), seashell (n=2), fish bone, a pencil tip, a bee stinger, and metal. Their size ranged from 1 to 20 mm. Patient complaints included a foreign body sensation, localized pain, swelling, discoloration, and a skin lesion. X-ray examinations were performed in all cases, and ultrasonography was conducted in five cases. Conclusion: A microscopic approach allows precise, safe, and complete removal of foreign bodies without tissue damage, highlighting the efficacy of this technique in hand surgery.

Transoral non-robotic surgery for oropharyngeal squamous cell carcinoma

PurposeThis retrospective cohort study aims to evaluate the clinical, oncological, and functional outcomes of transoral non-robotic surgery for oropharyngeal squamous cell carcinoma (OPSCC). Materials and methodsData from 131 patients with surgically treated OPSCC (2010-2022) were analyzed. Patients who underwent exclusively transoral surgery were included in the study. The surgeries were performed under microscopic or endoscopic guidance and either a CO2 laser or an ultrasound/radiofrequency scalpel was used as a cutting instrument, depending on the characteristics and location of the tumor. Functional outcomes were assessed in terms of length of hospital stay, tracheostomy rate, duration of feeding tube dependency and complications. Survival outcomes were assessed in terms of overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS). ResultsOf 74 included patients, transoral surgery demonstrated safety with no major complications. Tracheotomy was performed in 51.4 % of cases, and was maintained for a median of 10 days. Complete swallowing recovery was restored in 97.3 % of cases, after a median of 5 days. The median length of hospital stay was 12 days. At 5 years, OS was 68.2 %, PFS was 58.2 % and DSS was 83.6 %. ConclusionThe study confirms the safety and efficacy of a transoral approach for OPSCC. Having the capability to utilize and access a variety of tools provides the opportunity to tailor the technique to the individual patient and specific circumstances.

From microscope to head-mounted display: integrating hand tracking into microsurgical augmented reality.

The operating microscope plays a central role in middle and inner ear procedures that involve working within tightly confined spaces under limited exposure. Augmented reality (AR) may improve surgical guidance by combining preoperative computed tomography (CT) imaging that can provide precise anatomical information, with intraoperative microscope video feed. With current technology, the operator must manually interact with the AR interface using a computer. The latter poses a disruption in the surgical flow and is suboptimal for maintaining the sterility of the operating environment. The purpose of this study was to implement and evaluate free-hand interaction concepts leveraging hand tracking and gesture recognition as an attempt to reduce the disruption during surgery and improve human-computer interaction. An electromagnetically tracked surgical microscope was calibrated using a custom 3D printed calibration board. This allowed the augmentation of the microscope feed with segmented preoperative CT-derived virtual models. Ultraleap's Leap Motion Controller 2 was coupled to the microscope and used to implement hand-tracking capabilities. End-user feedback was gathered from a surgeon during development. Finally, users were asked to complete tasks that involved interacting with the virtual models, aligning them to physical targets, and adjusting the AR visualization. Following observations and user feedback, we upgraded the functionalities of the hand interaction system. User feedback showed the users' preference for the new interaction concepts that provided minimal disruption of the surgical workflow and more intuitive interaction with the virtual content. We integrated hand interaction concepts, typically used with head-mounted displays (HMDs), into a surgical stereo microscope system intended for AR in otologic microsurgery. The concepts presented in this study demonstrated a more favorable approach to human-computer interaction in a surgical context. They hold potential for a more efficient execution of surgical tasks under microscopic AR guidance.

A hierarchical control framework for vehicle repositioning in ride-hailing systems

This paper introduces a multi-layer control strategy for efficiently repositioning empty ride-hailing vehicles, aiming to bridge the gap between proactive repositioning strategies and micro-management. The proposed framework consists of three layers: an upper-layer employing an aggregated model based on the Macroscopic Fundamental Diagram (MFD) and model predictive control (MPC) to determine optimal vehicle repositioning flows between each pair of regions, a middle-layer converting macroscopic decisions into dispatching commands for individual vehicles, and a lower-layer utilizing a coverage control algorithm for demand-aligned positioning guidance within regions. The upper-layer contributes to the proposed framework by providing a global (macroscopic) view and predictive capabilities including traffic and congestion features. The middle-layer contributes by ensuring and optimal assignment of repositioning vehicles, considering the decision from the upper- and lower- layers. Finally, the lower-layer contributes with operational details at the intersection or node level providing the precision required for microscopic vehicle guidance. Experimental validation using an agent-based simulator on a real network in Shenzhen confirms the effectiveness and efficiency of the framework in improving empty vehicle repositioning strategies for ride-hailing services in terms of average passenger waiting time and abandonment rates.

Clinical Efficacy of Neuroendoscopy Combined with Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage

ObjectiveTo compare the differences in postoperative complications and prognosis between patients treated with neuroendoscopy versus conventional craniotomy surgery for hypertensive intracerebral hemorrhage (HICH). MethodsIn this retrospective study, a total of 107 patients with HICH were included. Among them, 58 underwent neuroendoscopy (Group A), while 49 underwent conventional craniotomy under microscopic guidance (Group B). Intracranial pressure monitoring (ICPM) was applied in both groups. The clinical data, incidence of postoperative complications, preoperative and postoperative intracranial pressure values, and rate of favorable prognosis were compared between the two groups. ResultsNo significant difference in baseline clinical data upon admission was observed between the two groups (P > 0.05). The preoperative intracranial pressure did not differ between the two groups (P > 0.05), but the postoperative intracranial pressure in Group A was significantly lower than that in Group B (P < 0.05). After intervention with the different surgical approaches, Group A showed a significantly lower incidence of postoperative cerebral infarction and a significantly higher rate of favorable prognosis compared with Group B (P < 0.05). ConclusionNeuroendoscopy combined with ICPM is a safe and reliable approach for the treatment of HICH that reduces the incidence of postoperative cerebral infarction and improves the recovery of neurological function after surgery.

Scattering-Based Light-Sheet Microscopy Imaging of Human Papillomavirus–Associated Squamous Lesions of the Anal Canal: A Proof-of-Principle Study

Demand for anal cancer screening is expected to rise following the recent publication of the Anal Cancer–HSIL Outcomes Research trial, which showed that treatment of high-grade squamous intraepithelial lesions significantly reduces the rate of progression to anal cancer. While screening for human papillomavirus–associated squamous lesions in the cervix is well established and effective, this is less true for other sites in the lower anogenital tract. Current anal cancer screening and prevention rely on high-resolution anoscopy with biopsies. This procedure has a steep learning curve for providers and may cause patient discomfort. Scattering-based light-sheet microscopy (sLSM) is a novel imaging modality with the potential to mitigate these challenges through real-time, microscopic visualization of disease-susceptible tissue. Here, we report a proof-of-principle study that establishes feasibility of dysplasia detection using an sLSM device. We imaged 110 anal biopsy specimens collected prospectively at our institution’s dysplasia clinic (including 30 nondysplastic, 40 low-grade squamous intraepithelial lesion, and 40 high-grade squamous intraepithelial lesion specimens) and found that these optical images are highly interpretable and accurately recapitulate histopathologic features traditionally used for the diagnosis of human papillomavirus–associated squamous dysplasia. A reader study to assess diagnostic accuracy suggests that sLSM images are noninferior to hematoxylin and eosin images for the detection of anal dysplasia (sLSM accuracy = 0.87; hematoxylin and eosin accuracy = 0.80; P = .066). Given these results, we believe that sLSM technology holds great potential to enhance the efficacy of anal cancer screening by allowing accurate sampling of diagnostic tissue at the time of anoscopy. While the current imaging study was performed on ex vivo biopsy specimens, we are currently developing a handheld device for in vivo imaging that will provide immediate microscopic guidance to high-resolution anoscopy providers.

Research on a multi-scale emission factor dataset constructing method

This paper proposes a multi-scale emission factor dataset constructing method. Firstly, actual road driving and pollutant emission data of heavy-duty trucks are obtained. Subsequently, a method for dividing multi-scale Bin intervals based on engine load, vehicle speed, and acceleration is proposed to establish suitable multi-scale Bin intervals for the driving characteristics of heavy-duty trucks. Finally, based on the proposed method, an emission factor dataset highlighting typical driving characteristics of heavy-duty trucks is constructed. The research findings will provide government regulatory authorities with more microscopic and multi-scale guidance on motor vehicle emissions.

(520) The Use of Gracilis Muscle Flap in Radial Forearm Free Flap Phalloplasty to Decrease Urethral Fistula Rate: Initial Outcome

Abstract Introduction `- Chang and Hwang, in 1984, described the technique of Radial Forearm Free Flap Phalloplasty (RFFFP). It is now considered to be the standard surgery for phallic reconstruction. Urethral fistula is the most common complication reported in RFFFP and may reach up to 60-70%. Most commonly, the fistula site is at the anastomosis between the native urethra and the neo-urethra. Objective `- to study the impact of gracilis muscle flap wrapping around the native urethra/neo-urethral anastomosis on decreasing the fistula rate. Methods `- A prospective study was conducted at our urology department, from January 2018 till December 2020. - Patients presenting with a micropenis (Stretched penile length &amp;lt;7 cm) underwent RFFFP with gracilis muscle flap wrapping. - The free-flap was harvested from the non-dominant forearm. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein, and the medial and lateral antecubital nerves with the ilio-inguinal and the dorsal penile nerves respectively. - A pedicled gracilis muscle flap was then wrapped around the neo-urethera/native urethral anastomosis to assess its possible role in decreasing the postoperative urinary fistula rate. Results `- Nineteen patients were included in the study with a median age of 26 years (16 - 43) and a BMI of 24 (22-25). The median hospital stay of 14 days (14 - 21) and the median follow-up was 11 months (4 - 13). The median cold ischemia time was 90 mins (70 - 100), estimated blood loss was 500 cc (400 - 500) and operative time was 11 hrs (10 - 12). - A viable phallus was achieved in 13 patients (overall free flap survival 68.4%). - Of the successfully viable phallus cases, 8 cases (42.1%) were complicated by complete disruption of the urethra and the remaining five cases (26.3%) had complete urethral tube. - One case of them developed a fistula at the neo-urethera/native urethral anastomosis, one case had a distal fistula and one case had a ring stricture at the site of anastomosis. - The gracilis muscle flap prevented urethral fistula formation in 4 out of 5 cases (80%) with complete urethral tube. Conclusions `- The use of pedicled garcilis muscle flap wrapping around the neo-urethra/native urethral anastomosis during RFFP might be helpful in reducing the urinary fistulae rates at this site. However, larger comparative studies are needed. Disclosure No

MP43-01 DOES INTRA-OPERATIVE MICROSCOPIC SPERM EVALUATION IMPACT MTESE SPERM RETRIEVAL RATES FOR MEN WITH NOA?: A PROPORTIONAL META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP43-01 DOES INTRA-OPERATIVE MICROSCOPIC SPERM EVALUATION IMPACT MTESE SPERM RETRIEVAL RATES FOR MEN WITH NOA?: A PROPORTIONAL META-ANALYSIS Brittany Berk, John Ernandez, Catherine Gu, Alexandra Berger, and Martin Kathrins Brittany BerkBrittany Berk More articles by this author , John ErnandezJohn Ernandez More articles by this author , Catherine GuCatherine Gu More articles by this author , Alexandra BergerAlexandra Berger More articles by this author , and Martin KathrinsMartin Kathrins More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Microsurgical testicular sperm extraction (mTESE) is the gold standard for surgical sperm retrieval in men with nonobstructive azoospermia (NOA). Intraoperative table-top microscopic specimen analysis can be utilized to identify viable sperm for in-vitro fertilization, and also provides information regarding the necessity of bilateral testicular exploration and helps determine the end of the surgery. In this study, we investigated the impact of intraoperative microscopic analysis on mTESE sperm retrieval rates (SRR). METHODS: A PubMed search was performed for studies on men with NOA undergoing mTESE with a primary outcome of SRR. Studies on obstructive azoospermia, Klinefelter’s syndrome cohorts, and review articles were excluded. Only the most recent publication from a given academic institution’s cohort was considered (Figure 1). Each study was categorized based on whether the manuscript described utilization of intraoperative microscopy to identify viable sperm. The number of patients who underwent mTESE, and the number of patients who had successful sperm retrieval, were recorded for each study and combined within groups. Differences in SRR between the groups was determined using Chi-square testing. RESULTS: 182 articles were identified in our initial search, of which 36 were included in the final analysis. 20 studies were categorized as “(+) Intraoperative Microscopic Guidance”, and 7 studies were “(-) Intraoperative Microscopic Guidance”. In the (+) group, a total of 3923 cases were included with a cumulative SRR of 51.0% (95% CI 49.4–52.5, and in the (-) group, a total of 877 cases were included with a cumulative SRR of 46.0% (95% CI 42.7–49.4). The estimated difference in SRR between the two groups was 4.94% [95% CI 1.28%-8.57%]. On chi-squared analysis, there was a statistically significant difference in SRR [X2=7.007; p = 0.0081]. CONCLUSIONS: In this proportional meta-analysis, we found a significantly higher SRR for men with NOA undergoing mTESE with intraoperative microscopic analysis. These findings support increased utilization of real time microscopic assessment of specimens to guide intraoperative decision-making and optimize outcomes while also possibly preventing unnecessary extensive exploration. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e601 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Berk More articles by this author John Ernandez More articles by this author Catherine Gu More articles by this author Alexandra Berger More articles by this author Martin Kathrins More articles by this author Expand All Advertisement PDF downloadLoading ...

Computational Simulations of Fabrication of Aluminum-Based Josephson Junctions: Topological Aspects of the Barrier Structure

Although the performance of qubits has been improved in recent years, the differences in the microscopic atomic structure of the Josephson junctions, the core devices prepared under different preparation conditions, are still underexplored. In this paper, the effects of the oxygen temperature and upper aluminum deposition rate on the topology of the barrier layer in the aluminum-based Josephson junctions have been presented by classical molecular dynamics simulations. We apply a Voronoi tessellation method to characterize the topology of the interface and central regions of the barrier layers. We find that when the oxygen temperature is 573 K and the upper aluminum deposition rate is 4 Å/ps, the barrier has the fewest atomic voids and the most closely arranged atoms. However, if only the atomic arrangement of the central region is considered, the optimal rate of the aluminum deposition is 8 Å/ps. This work provides microscopic guidance for the experimental preparation of Josephson junctions, which helps to improve the performance of qubits and accelerate the practical application of quantum computers.

MICROSURGERY FOR THE CREATION OF ARTERIOVENOUS FISTULAS IN PATIENTS WITH RADIAL ARTERIES DIAMETER SMALLER THAN 1.6 MM

In End-stage Renal Disease patients, the distal forearm is the preferred site for hemodialysis access, however forearm vessels have small diameter and according to Guidelines a radial artery internal diameter smaller than 1.6-2 mm is strongly predictive of early failure of the arteriovenous fistula (AVF) because of stenosis and obstruction. It could happen for some patients to not be considered suitable for distal forearm AVF because of poor peripheral vessels, so in these cases the micrusurgical technique can be very helpful in handling such “inadequates” vessels for lower-arm fistula creation. This study is an investigation of long-term patency of distal radio-cephalic AVFs created under microscopic guidance by using small radial arteries (less the 1.6 mm diameter) in adult patients with chronic renal failure and without severe comorbidities. In a sample of 31 patients, at 1 year postoperatively, the mean primary patency rate was 67.7% (21 functioning AVFs out of 31) and that is quite the same result of AVFs’ made with arteries larger than 2 mm.

Differentiating the dominant intrinsic kinetics for lithium dendrite growth under different circumstances by computational study

Although many works have been devoted to designing the dendrite-suppression lithium anodes through modifying the growth environments or electrode configurations, studies on their related intrinsic kinetics processes are still lacking. Using DFT calculations, the intrinsic kinetics processes to control the dendrite growth in different environments are investigated herein. Under different coverage concentrations and distributions of lithium, three types of competitive kinetics processes have been identified and defined as the two-dimensional (2D) accumulation, 2D dispersion, and 3D accumulation kinetics processes based on the near-neighboring interactions in the same layer. It was found that the dendrite-free condition can be realized under the natural growth processes based on the dominant 2D accumulation processes, but the dominant kinetics processes can be replaced by the 3D accumulation processes during the nonuniform deposition processes under the condition of moderate coverage concentration, leading to the formation of dendrites. Correspondingly, the suppression condition for the dendrite growth requires that the 2D dispersion kinetics processes can triumph over the 3D accumulation kinetics processes. Therefore, we employed the lithium-affinity molecules to illustrate how to adjust the 2D dispersion kinetics processes to suppress dendrite growth. These results provide microscopic guidance suppressing dendrite growth.

Behavior model and guidance strategies of the crossing behavior at unsignalized intersections in the connected vehicle environment

The connected vehicle environment is considered to be a disruptive technology that reconstructs the way people travel and road transport, and more importantly, ensures traffic safety. This study aims on investigating drivers’ interactive behavior at an unsignalized intersection in the connected vehicle environment. Specifically, a simplified iterative behavior model was established to predict the potential conflicting vehicles’ behavior. Furthermore, based on principles of safety, efficiency, and comfort, the guidance strategies were proposed to help the subject vehicles cross intersections. A multi-user driving simulator experiment was carried out and 48 participants were divided into 24 pairs to complete the test. The simplified iterative behavior model was constructed based on the dynamic interaction of each participant pair as they approached the intersection from straight-crossing directions. The comparison results showed the behavior model was an effective microscopic simulation tool for vehicles at unsignalized intersections with high accuracy and good applicability. Then, the guidance strategies under different compliance rates (baseline, 50 % compliance, 100% compliance) were evaluated based on three indexes i.e. standard deviation of speed (SDS), duration of crossing the intersection (DCI), and time exposed post-encroachment-time (TEP). The numerical simulation results showed that the guidance strategies could effectively improve the safety and efficiency of drivers crossing the intersection under both 50% and 100% compliance rates. Besides, with the increase of compliance rate, the comfort level also increased evidently. This study can provide theoretical and algorithmic references for microscopic simulation and guidance strategy at unsignalized intersections in the connected vehicle environment.

MP07-18 IDENTIFICATION OF THE MAJOR NADPH OXIDASE SUBTYPE IN THE MICTURITION CENTRE – PATHOLOGICAL IMPLICATIONS

You have accessJournal of UrologyCME1 May 2022MP07-18 IDENTIFICATION OF THE MAJOR NADPH OXIDASE SUBTYPE IN THE MICTURITION CENTRE – PATHOLOGICAL IMPLICATIONS Qin Wu, Ayse Gurpinar, Patrizia Camelliti, Maxwell Roberts, Michael Ruggieri, and Changhao Wu Qin WuQin Wu More articles by this author , Ayse GurpinarAyse Gurpinar More articles by this author , Patrizia CamellitiPatrizia Camelliti More articles by this author , Maxwell RobertsMaxwell Roberts More articles by this author , Michael RuggieriMichael Ruggieri More articles by this author , and Changhao WuChanghao Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002529.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Oxidative inflammatory damage to the brain may lead to dysfunction of peripheral organs including bladder disorders. However, the source of reactive oxygen species (ROS) in specific brain regions that regulate the function of peripheral systems is poorly understood. Of all ROS-generating enzymes, the NADPH oxidase (Nox) family produces ROS as its sole function and offers an advantage over other enzymes as a drug targetable molecule to selectively control excessive ROS. Our pilot study demonstrated such system in the bladder. This study tested the hypothesis that the major Nox subtype, Nox 2 is expressed in the micturition regulatory regions - Pontine micturition centre (PMC) and periaqueductal gray (PAG), and such system is able to produce substantial superoxide. METHODS: Male adult C57BL/6J mice (2-5 months) were used. PAG, PMC were dissected according to a mouse stereotaxic atlas. Cardiac and bladder tissues were isolated under microscopic guidance. Western blot determined Nox 2 expression using Nox 2 primary antibody and Infra-red dye-conjugated secondary antibodies. Lucigenin enhanced chemiluminescence quantified real-time superoxide production in live tissues, verified by the superoxide scavenger Tiron. Paired and non-paired t-test tested the difference in two group means and ANOVA with pairwise comparisons tested multiple means. RESULTS: Western blot experiments demonstrated the presence of Nox 2 in PAG and PMC tissues, with a density comparable to that of positive control (n=6). There was a significant level of NADPH dependent superoxide production in both brain tissues (RLU/mg, PMC: 127±17; PAG102±13, N=11, higher than that from cardiac tissue (32±3, P<0.01); similar to that from bladder smooth muscle (91±19, p>0.05) and lower than that in bladder mucosa (262±55, p<0.01). The time course analysis shows that the rise of superoxide production in these two brain tissues was more sustained than in bladder mucosa and smooth muscle (Half peak duration PD50, minutes: PMC, 101±2; PAG, 99±2; bladder mucosa, 48±3, p<0.01; smooth muscle, 67±9, p<0.01). The superoxide generation from these brain tissues was significantly suppressed by the Nox inhibitor diphenyleneiodonium (DPI). CONCLUSIONS: These data provide the first evidence for the presence of Nox 2 in brain micturition centres and its high capacity to produce superoxide. The study has also identified the sustained nature of the superoxide rise from this ROS-generating pathway. The predominance of this system and its characteristics revealed by this study provide mechanistic basis for the pathology of aging and inflammation associated neurogenic bladder disorders. Source of Funding: BBSRC (BB/P004695/1)NIA (NIA1R01AG049321-01A1)QW: Jiangsu Overseas Visiting Scholar Program for University Prominent Young and Middle-aged Teachers and Presidents © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e122 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Qin Wu More articles by this author Ayse Gurpinar More articles by this author Patrizia Camelliti More articles by this author Maxwell Roberts More articles by this author Michael Ruggieri More articles by this author Changhao Wu More articles by this author Expand All Advertisement PDF DownloadLoading ...

The outcome of gracilis muscle flap wrapping around the neourethra-native urethral anastomosis after radial forearm free flap phalloplasty on the incidence of fistula formation

ABSTRACT Introduction The radial artery-based free-flap phalloplasty (RFFP) is accompanied by high rates of fistula formation and urological complications. We thought to investigate the impact of pedicled gracilis muscle flap wrapping around the urethral anastomosis on the occurrence of fistula at the neourethra-native urethral junction. Materials and Methods Prospective study was conducted at the urology department of Cairo University Hospitals. Patients presenting with micropenis (stretched penile length ≤7 cm) underwent RFFP. The RFF was harvested from the non-dominant forearm after ensuring of good collateral supply to the hand. All patients underwent RFFP with pedicled gracilis muscle flap wrapping. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein and the medial and the lateral ante-brachial nerves with the ilioinguinal nerve and the dorsal penile nerve, respectively. Data were reviewed for demographics and perioperative outcomes. Results Nineteen patients were included in the study with a median follow up of 11 months (3, 22). Median age of 26 yrs (16, 43), hospital stay was 7 days (7, 30) and. Indications for RFFP were: micropenis (40%), post-surgery crippled penis (25%), amputated penis (20%), aphallia (5%), epispadias (5%) and gender dysphoria (5%). Median ischemia time was 88 mins (60, 120), ebl was 600 cc (300, 2000) and operative time 11 hrs (8, 14). Intraoperative complications were a case of transection of the radial artery during graft harvesting, failure to tubularize the graft and significant blood loss during vaginectomy. Overall success rate was 70%. 5 cases had a complete success, only one case had a fistula at the neo-uretheral native urethral anastomosis, one patient had a distal fistula and another patient had a ring stricture at site of anastomosis. 8 cases were complicated by complete disruption of the urethra. 6 cases were complicated by total graft loss (2 cases due to arterial causes and 4 cases due to venous congestion). No donor site morbidity was noted. During follow up patients reported shortness in the mean length of the phallus was 2.1cms. All patients reported recovery of both general and erogenous sensations in the neo-phallus. The recovery of the general sensation (tactile stimulation and two-point discriminations) ranged between 2 to 4 weeks post-operatively while recovery of the erogenous sensation occurred between 8 to 16 weeks. Conclusion The use of pedicled garcilis flap during RFFP resulted in a fistulae rate of 20%. Disclosure Work supported by industry: no.

Use of Collagen Sheets as Graft Material for Myringoplasty.

The purpose of the study is to investigate how Collagen sheet used as graft material in Myringoplasty improves hearing and tympanic membrane tissue repair in patients with tympanic membrane perforation (TMP) in an office based procedure. Total 50 cases included in the study where Collagen sheet used as graft material for myringoplasty in small to moderate size tympanic membrane perforations(TMP) and procedure performed in an office based set up with the help of a High definition endoscope and camera. Cases followed up regularly and results observed in terms of graft uptake and complete closure of TMP and hearing improvement. Out of 50, complete closure of TMP observed in 39 cases and an average hearing gain of 9.9 db noted in these cases. Success rate of 78% achieved and failed cases were subjected to traditional post auricular method of myringoplasty under microscopic guidance. Myringoplasty with the help of collagen sheet material in an office based set up is an easy, minimally invasive and effective technique and it avoids need for major invasive intervention in a significant number of patients.

Facial nerve regeneration with bioabsorbable collagen conduits filled with collagen filaments: An experimental study.

IntroductionA bioabsorbable collagen conduit (Renerve™) filled with collagen filaments is currently approved as an artificial nerve conduit in Japan and is mainly used for connecting and repairing peripheral nerves after traumatic nerve injury. However, there are few reports on its applications for reconstructing and repairing the facial nerve. The present study evaluated the efficacy of the conduit on promoting nerve regeneration in a murine model with a nerve defect at the buccal branch of the facial nerve.MethodsUnder inhalational anesthesia and microscopic guidance, the buccal branch of the left facial nerve in an 8-week-old Lewis rat was exposed, and a 7 mm gap was created in the nerve. The gap was then connected with either the nerve conduits (NC group) or an autologous nerve graft (the autograft group). At 13 weeks after the procedure, we compared the histological and physiological regenerations in the both groups.ResultsWe found compound muscle action potential amplitude is significantly larger in the autograft group (2.8 ± 1.4 mV) than in NC group (1.3 ± 0.5 mV) (p < 0.05). The number of myelinated fibers of the autograft group was higher (3634 ± 1645) than that of NC group (1112 ± 490) (p < 0.01). The fiber diameter of the autograft group (4.8 ± 1.9 μm) was larger than that of NC group (3.8 ± 1.4 μm) (p < 0.05). The myelin thickness of the autograft group was thicker than that of NC group (0.6 ± 0.3 μm vs. 0.4 ± 0.1 μm) (p < 0.05). G-ratio of the autograft group (0.74 ± 0.19) was lower than that of NC group (0.79 ± 0.10) (p < 0.05).ConclusionThis study demonstrated the efficacy of collagen nerve conduit for facial nerve reconstruction following nerve injury. However, the effectiveness of the conduit on the promotion of nerve regeneration was inferior to that of the autograft.

The role of Helicobacter pylori and gastroesophageal reflux disease in otitis media with effusion and evaluation of MUC4, MUC5B mucin genes and inflammatory cytokines in guinea pig middle ears

Objectives: This study aims to investigate the role of Helicobacter pylori (H. pylori) and gastroesophageal reflux disease (GERD) in otitis media with effusion (OME) and to examine the MUC4, MUC5B mucin genes in the guinea pig middle ears to analyze the inflammatory cytokines including tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1beta (IL-1b), and IL-8. Patients and Methods: This study was conducted using eight guinea pigs. In the experimental group, H. pylori ATCC strain culture was injected transtympanically with microscopic guidance. The animals in the control group were injected with phosphate buffered saline (PBS) solution transtympanically. At 12, 24, 48, and 168 h after the injection, transtympanic PBS solution injection and aspiration of the middle ear were applied to all animals. After decapitation, the samples were taken. Results: In the histopathological examination, grading according to the degree of inflammation showed no statistically significant difference between the two groups (p&gt;0.05). No statistically significant difference was determined in the analysis results of MUC4 and MUC5B genes in the middle ears of the two groups (p&gt;0.05), the right and left ear values of IL-8, IL-1b, and TNF-a (p=0.999, p=0.610, and p=0.691, respectively). Conclusion: Based on our study results, there was no relationship between H. pylori injection in the middle ear and the histopathological changes of the middle ear mucosa. The results of the analysis of MU

A Vehicle Guidance Model with a Close-to-Reality Driver Model and Different Levels of Vehicle Automation

This paper presents a microscopic vehicle guidance model which adapts to different levels of vehicle automation. Independent of the vehicle, the driver model built is different from the common microscopic simulation models that regard the driver and the vehicle as a unit. The term “Vehicle Guidance Model” covers, here, both the human driver as well as a combination of human driver and driver assistance system up to fully autonomously operated vehicles without a (human) driver. Therefore, the vehicle guidance model can be combined with different kinds of vehicle models. As a result, the combination of different types of driver (human/machine) and different types of vehicle (internal combustion engine/electric) can be simulated. Mainly two parts constitute the vehicle guidance model in this paper: the first part is a traditional microscopic car-following model adjusted according to different degrees of automation level. The adjusted model represents the automation level for the present and the near and the more distant future. The second part is a fuzzy control model that describes how humans adjust the pedal position when they want to reach a target speed with their vehicle. An experiment with 34 subjects was carried out with a driving simulator based on the experimental data and the fuzzy control strategy was determined. Finally, when comparing the simulated model data and actual driving data, it is found that the fuzzy model for the human driver can reproduce the behavior of human participants almost accurately.