Minimal Invasive Therapy Research Articles

Percutaneous Nerve Evaluation Test Versus Staged Test Trials for Sacral Neuromodulation: Sensitivity, Specificity, and Predictive Values of Each Technique.

PurposeInterStim device is an U.S. Food and Drug Administration approved minimal invasive therapy for sacral neuromodulation for lower urinary tract dysfunction. Before InterStim implantation, a trial with the appropriate screening tests is required to determine patient therapy eligibility. There are two different techniques for patient screening: percutaneous nerve evaluation (PNE) test and staged test. Few studies have reported success and failure rates for each technique. However, test sensitivity and predictive values of either test have not been studied. The aim of our study was to determine the sensitivity and specificity of each test and to establish a decision algorithm for the most appropriate testing method to be used as a screening test.MethodsThis cross-sectional study was conducted from August 2009 to February 2012 and included patients with lower urinary tract dysfunction who participated in the stimulation test trial. Patients underwent PNE as the first stimulation test, while those who encountered technical difficulty during PNE or electrode migration underwent staged testing.ResultsA total of 213 patients, including 172 female and 41 male subjects, underwent PNE. The patients’ diagnoses included refractory overactive bladder (47.9%), nonobstructive urinary retention (29.6%), and frequency urgency syndrome (22.1%). A total of 202 patients were screened with PNE and 10 patients with staged testing. Overall sensitivity of PNE was 87.3%, and it was 90% for staged test. PNE specificity was 98.5% as compared to 92.9% for staged test. Positive and negative predictive values for PNE were 99% and 82.1% and for staged test were 90% and 92.9%, respectively.ConclusionsPNE test has high specificity and positive predictive value. We recommend PNE, a simple office-based, less expensive procedure as the first option for screening.

Hemodynamic peculiarities and timing may impact on assessment of risks and benefits of the Kohl procedure to treat flow-related cardiovascular hypoplasia in human fetuses.

In their recent paper, Diego Lara and colleagues report on a pilot study of the effect of chronic maternal hyperoxygenation on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia1. I congratulate the authors for providing further and independent evidence, for the first time in a controlled fashion, that chronic intermittent maternofetal hyperoxygenation (Kohl procedure) may result in a measurable and statistically significantly faster growth rate of a hypoplastic left heart structure over time. In their analysis, these authors observed that a small subgroup of fetuses with this condition, which were subjected to more than 9 h supplemental oxygen therapy per day, exhibited two-fold greater aortic annulus growth per week than did untreated control fetuses (0.16 ± 0.03 mm/week vs 0.08 ± 0.02 mm/week; P = 0.014). Lastly, a final call for caution. By stating in their article that chronic intermittent maternofetal hyperoxygenation ‘can be accomplished at home, [and] requires few personnel to arrange and supervise, …’ the authors seem to advocate a more informal approach, without close patient monitoring. Such an approach may not be wise during the study phase of a novel therapeutic approach, as non-invasive as it seems. Another important issue raised by the study of Lara et al. is that it is not only fetal and maternal hemodynamic peculiarities, but also the extent of daily exposure to supplemental oxygen administration that may impact on therapeutic effects and outcome. This needs to be taken into account during the design of, and candidate selection for, randomized controlled trials, in order to assess the potential of the approach to reduce the need for coarctation surgery and – of far greater promise – to reduce the need for univentricular palliation in fetuses at risk for functional left heart hypoplasia4. T. Kohl German Center for Fetal Surgery and Minimally-Invasive Therapy, Justus-Liebig-University, Klinikstr. 33, Giessen 35395, Germany (e-mail: [email protected])

EP 94. Fecal incontinence treated by sacral neuromodulation: Worldwide largest single center study

Fecal incontinence (FI) is an embarrassing condition, which leads to social isolation. The first treatment option of FI is conservative therapy. If this fails, surgery is the next step. In the past, only invasive options like a colostomy were possible. In 1995 sacral neuromodulation (SNM) was introduced as a minimal invasive surgical therapy. The last 2 decades literature shows that it’s a safe and effective option for treatment of FI. However, long outcome results of large patient cohorts with fecal incontinence treated by SNM are limited. This study shows the long term results of SNM for FI of a single high-volume center. All patients eligible for treatment of fecal incontinence with SNM between March 2000 and July 2015 were evaluated. Fecal incontinence was defined as involuntary fecal loss at least once per week. All patients underwent pre-operative work-up consisting of a defaecography, endo-anal ultrasound and a manometry. Besides they all filled in a 3 week bowel habit diary; objectifying decrease of involuntary fecal loss for the last 3 weeks, increase in time postponing defecation and decrease in defecation frequency. Post-operative follow-up was scheduled at 1, 3, 6 and 12 months after implantation and annually afterwards. Finally, all patients were asked to complete several quality of life questionnaires: Fecal Incontinence Quality of Life Score (FIQL), Short-Form 36 (SF-36) and the Vaizey-score. 374 patients were included (37 male) for a SNM screening-period after failing conservative treatment. In total, 334 (89.3%) patients received a permanent SNM. Mean age was 56.5 (17–82) years and mean follow-up was 85.1 months (3.0–183.4). Data showed a decrease in episodes of fecal loss per 3 weeks from 16.1 (3.0–107.0) at baseline to 3.0 (0.0–24.0) after SNM ( p 0.001 ). Time postponing defecation increased from 1.48 min at baseline (0.0–30.0) to 7.5 (0.0–90.0) minutes after SNM implantation ( p 0.001 ). Defecation frequency decreased from 2.7 at baseline (0.3–10.0) to 1.87 (0.3–6.0) defecations per day after SNM implantation ( p 0.001 ). SNM was removed due to unsatisfactory results in 63 patients (16.8%). Quality of life evaluation using the SF-36 at different time points during follow-up was not significantly different from the general Dutch population. The FIQL demonstrated no changes in quality of life during follow-up between different follow-up moments. Mean Vaizey score was 11.47 (1.0–22.0). Major incontinence, defined as a Vaizey score of >6, was seen in 103 (79.2%) patients. This study shows long-term efficacy for SNM in the treatment of fecal incontinence with a stable reduction of episodes of fecal loss up to 10 years.

Theranostic microwave applicator suitable for minimal invasive therapy of malignant tissue.

A microwave applicator is presented that realizes the theranostic approach by providing two operation modes to detect and treat tumor cells, exemplary in the liver. The tool is based on a planar sensor structure with Split Ring Resonators (SRR) as key elements. For the detection, changes in dielectric properties caused by tissue abnormalities are evaluated by analyzing shifts in the resonance frequency of the SRR. For the treatment mode, the input power is amplified to the specific resonance frequency and microwave ablation is performed. The device is designed to fit into a needle like operation tool for minimal invasive therapies. From this requirement, challenges concerning size limitation, packaging, and bio compatibility can be derived. Therefore, novel shapes of the SRR and substrate materials are investigated by full wave simulations and measurements. Material models and phantoms mimicking dielectric properties of healthy and malignant tissue are introduced. Clear resonance shifts of 100 MHz are detected for loading the sensor with corresponding phantoms. In order to examine the treatment mode characteristics, thermal simulations and measurements exhibit a significant temperature increase up to 62 °C for an input power of 500 mW.

1043 Into the Mediastinum and out of the Papilla - Minimal Invasive Endoscopic Therapy in Two Body Cavities With One Instrument

1043 Into the Mediastinum and out of the Papilla - Minimal Invasive Endoscopic Therapy in Two Body Cavities With One Instrument

MP72-18 ENDOSCOPIC INJECTION OF TRIAMCINOLONE: A SIMPLE, MINIMALLY INVASIVE AND EFFECTIVE THERAPY FOR HUNNER’S LESIONS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis1 Apr 2016MP72-18 ENDOSCOPIC INJECTION OF TRIAMCINOLONE: A SIMPLE, MINIMALLY INVASIVE AND EFFECTIVE THERAPY FOR HUNNER’S LESIONS Michael Funaro, Alexandra King, Robert Moldwin, and Sonia Bahlani Michael FunaroMichael Funaro More articles by this author , Alexandra KingAlexandra King More articles by this author , Robert MoldwinRobert Moldwin More articles by this author , and Sonia BahlaniSonia Bahlani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1631AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hunner's lesions (HL) or inflammatory bladder wall changes are identified in 5-10% of Interstitial Cystitis/Bladder Pain Syndrome patients and are classically treated with fulguration. This study aimed to evaluate the potential role of endoscopic submucosal injection of triamcinolone into Hunner's lesions (HL), with consideration for its effectiveness and durability. METHODS Clinical data from 36 patients with HL who underwent endoscopic submucosal injection of triamcinolone between January 2011 and June 2014 were reviewed. Patient demographics, clinical characteristics, intraoperative findings and long-term clinical outcomes were assessed. The Kaplan-Meier product limit method was used to evaluate time to the first repeat procedure. RESULTS 36 patients who had received injections of triamcinolone between January 2011 and January 2015 were included. Median age ± SD patients was 61.5 ± 12.0 years 23; 28 (77.8%) of patients were female and 8 (22.2%) were male. 24 (82.8%) patients had multiple lesions, 5 (17.2%) patients had only one lesion. The average number of lesions was 2.93 with a range of 1-8 lesions per patient. 26 patients (72.2%) received only 1 set of injections, 8 (22.2%) received 2 sets of injections, and 2 (5.56%) received 3 or more sets of injections. Average time between injections in those receiving more than one set of injections was 344.9 days (median: 313.5, range: 77-714). The mean pre-procedural pain score was 8.3 ± 1.2 (0-10, where 10 is worst pain conceivable) and the mean pre-procedural nocturia bother score was 7.5 ± 2.2 (0-10 where 10 is the greatest bother conceivable. Mean post procedural pain scales at approximately one month were 3.8 ± 2.2, and mean post procedural nocturia bother scores were 5.1 ± 2.5. Complete pre and post-procedural pain and bother scores were available from 24 (66.7%) of patients who received injections. CONCLUSIONS Endoscopic submucosal injection of triamcinolone in IC/BPS patients with HL is an effective and durable adjunct to existing treatment modalities. This approach is associated with low morbidity and can be performed on an outpatient basis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e959 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Michael Funaro More articles by this author Alexandra King More articles by this author Robert Moldwin More articles by this author Sonia Bahlani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

347 Developing minimally-invasive therapy for sphincter urinary incontinence: New guidance system based on surgical navigation for percutaneous peri-urethral external compression

347 Developing minimally-invasive therapy for sphincter urinary incontinence: New guidance system based on surgical navigation for percutaneous peri-urethral external compression

Sedation during Minimal Invasive Surfactant Therapy in Preterm Infants

Background: There is no data available whether sedation should be given during minimally invasive surfactant therapy (MIST). Objective: To compare the level of comfort of preterm infants receiving sedation versus no sedation for MIST. Methods: A retrospective study of preterm infants receiving MIST was performed in Leiden University Medical Center in 2014. Sedation (propofol 1 mg/kg) was optional and left to the discretion of the caregiver. Standardized COMFORTneo scores were compared, and COMFORTneo <14 was considered comfortable. Basic characteristics and complications were noted. Results: In 38 infants receiving MIST, 23 received propofol and 15 were not sedated. Mean (SD) gestational age [29 (2) vs. 29 (3) weeks] and birth weight [1,312 (483) vs. 1,469 (588) g] were not different. Median (IQR) COMFORTneo was not different between the groups before [11 (9-15) vs. 10 (8-12)] and after MIST [10 (8-12) vs. 9 (8-10)], but lower in the sedated group during MIST [12 (9-17) vs. 20 (15-23)] with more often COMFORTneo <14 (56 vs. 11%). Duration of MIST [2 (2-4) vs. 3 (2-7) min] and occurrence of bradycardia (13 vs. 33%) and hypotension (21 vs. 18%) were not different. Although not significant, intubation occurred more often in the sedated group (during MIST: 9 vs. 0%, <24 h after MIST: 26 vs. 13%). During MIST, oxygen saturation <80% lasted longer in the sedated group [3 (2-4) vs. 1 (0-2) min], and nasal intermittent positive pressure ventilation was applied more (100 vs. 33%). Conclusions: Preterm infants receiving MIST were more comfortable when sedation was given, but needed ventilation more often. A randomized controlled trial is warranted to test whether the benefit of sedation outweighs the risks of complications.

Application of 3D imaging in the real-time US–CT fusion navigation for minimal invasive tumor therapy

Image-guided minimally invasive treatment (IG-MIT) has been widely used for local therapy of both benign and malignant tumors. However, precise needle targeting is a very important step in the minimally invasive treatment. Nowadays, minimally invasive treatment is usually performed with the guidance of the two-dimensional (2D) image. The tip of the puncture needle is difficult to place with precise positioning into the three-dimensional (3D) space of the tumor. This study was an experimental ex vivo study in porcine liver and heart samples with internal targets, focusing on the accuracy with the guidance of the real-time 3D imaging using a self-developed real-time ultrasonography and preoperative computed tomography (CT) fusion navigation system for minimal invasive tumor (liver tumor and uterine fibroid) therapy. There are thirty porcine liver samples and thirty porcine heart samples used in the experiments. The average weight of the porcine liver samples was 2216.8 g, and the average weight of the porcine heart samples was 510.5 g. We conducted statistical analysis of the experimental results obtained by five medical students and five interventional radiologists. The puncture precision of the needle placement under the guidance of 3D imaging was significantly higher than that of the other groups, and the assistant function is more obvious for medical students than that for interventional radiologists [Formula: see text]. Assistant function of the US-CT fusion imaging is higher than that of the first group too [Formula: see text]. The precision of the puncture with guidance of the 3D imaging was very satisfied in the fact that it was found that there was a mean discrepancy of [Formula: see text] (medical students) and [Formula: see text] (interventional radiologists) in porcine livers and there was a mean discrepancy of [Formula: see text] (medical students) and [Formula: see text] (interventional radiologists) in porcine hearts. Experimental results showed that the accuracy of needle targeting can be improved with the guidance of the real-time 3D imaging than that with the guidance of both 2D US images and US-CT fusion images in IG-MIT. Assistant function of 3D imaging is obviously for medical students.

Minimal invasive treatments for liver malignancies

Minimal invasive therapies have proved useful in the management of primary and secondary hepatic malignancies. The most relevant aspects of all these therapies are their minimal toxicity profiles and highly effective tumor responses without affecting the normal hepatic parenchyma. These unique characteristics coupled with their minimally invasive nature provide an attractive therapeutic option for patients who previously may have had few alternatives. Combination of these therapies might extend indications to bring curative treatment to a wider selected population. The results of various ongoing combination trials of intraarterial therapies with targeted therapies are awaited to further improve survival in this patient group. This review focuses on the application of ablative and intra-arterial therapies in the management of hepatocellular carcinoma and hepatic colorectal metastasis.

Application and development of C-arm computed tomography as a diagnostic and minimally-invasive therapy for liver malignant tumors

Application and development of C-arm computed tomography as a diagnostic and minimally-invasive therapy for liver malignant tumors

Prostate Cancer Claims for a Personalized Medicine.

Hippocrates (Kos, Greece c. 460-c. 370 BC), generally referred to as the “Father of Western Medicine” remembers us “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” Understanding the personal qualities of the patient, his lifestyle, and his previous medical history is a necessary base to approach prostate cancer (PCa). In times of worldwide changes, globalization, and migration, there is one value that needs maximum protection, since it represents a steady value and it is capable of representing a safe path through the difficulties of the present medicine toward the light of the future. That value is, undeniably, the human being. We have to pursue such commitment by our humanism and our medical culture. They are not a sheer amount of mere human attitude, or technical knowledge, or the tradition of a particular social group but they represent a theoretical and practical attitude consisting of multiple skills concerning the understanding of a disease in its personal and social implications and the ability to develop a balanced and sensible treatment. The ideal PCa decision-making process is a wise balance between idealism and realism. PCa screening and diagnosis should lead not only to discriminate men with or without cancer, but also should emerge and discriminate indolent from clinically significant tumors. It is just a single step in the long journey of our PCa patients. Our medical skill has to dictate the treatment, counseling patients about prognosis, and take the responsibility of a life-long follow-up. PCa is to be put into the contest of many variables: Race, family history, age, obesity, previous negative biopsies, local inflammation (prostatitis), and new minimally-invasive therapies. In 2012, the most recent year for which numbers have been adequately reported, black men had the highest rate of getting PCa, followed by American and European white, Hispanic, American Indian/Alaska Native men, and Asian/Pacific Islander.[1] However, in the next years, those population are expected to mix each other, and PCa incidence and prevalence might significantly change. PCa incidence increases with age and because of the aging of the population and longevity of older persons, clinicians will increasingly be faced with balancing risks and benefits of PCa treatment. Given that older patients with PCa often have other significant medical problems, it is crucial to stage the aging to assess the patient's physiologic age as opposed to chronologic age when making the treatment decisions.[2] PCa is dogmatically regarded as a genetically heterogeneous and pathologically multifocal disease, and is, therefore, usually treated with a radical whole-gland approach. Radical prostatectomy and radiotherapy are effective therapies for patients with clinically localized PCa. Despite improvements in surgical techniques, such as the introduction of robotic-assisted laparoscopic prostatectomy, or new machine for delivery target energy, urinary incontinence, erectile dysfunction, and bowel dysfunction are not uncommon. Physicians and the public have started to be interested in the notion of prostate-sparing focal therapy.[3] Finally, our understanding of PCa biology is rapidly increasing, as is the availability and affordability of high throughput technologies for comprehensive molecular characterization of PCa and the individual's own genetic makeup.[4] We are entering an exciting era in which it is possible to provide rational therapy to patients on the basis of their omni-comprehensive drivers. This may provide the greatest opportunity in history to take giant steps forward a PCa personalized medicine.

Poly(methyl methacrylate) particles for local drug delivery using shock wave lithotripsy: In vitro proof of concept experiment.

To leverage current local drug delivery systems methodology, there is vast use of polymeric particles serving as drug carriers to assure minimal invasive therapy with little systemic distribution of the released drug. There is an increasing interest in poly(methyl methacrylate) (PMMA) serving as carriers in drug delivery. The study aims to develop PMMA carriers for localized drug delivery and release system, combining innovative biomaterial technology and shock wave lithotripsy (SWL), and to study the effect of SWL on various concentrations of PMMA particles. We prepared PMMA particles that contain horseradish peroxidase (HRP) using a double emulsion technique, and investigated the mechanism of in vitro drug release from the carriers following exposure to SWL. We investigated the correlation between production method modifications, concentrations of the carriers subjected to SWL, and shock wave patterns. We successfully produced PMMA particles as drug carriers and stimulated the release of their contents by SWL; their polymeric shell can be shattered externally by SWL treatment, leading to release of the encapsulated drug. HRP enzyme activity was maintained following the encapsulation process and exposure to high dose of SWL pulses. Increased shock wave number results in increased shattering and greater fragmentation of PMMA particles. The results demonstrate a dose-response release of HRP; quantitation of the encapsulated HRP from the carriers rises with the number of SWL. Moreover, increased concentration of particles subjected to the same dose of SWL results in a significant increase of the total HRP release. Our research offers novel technique and insights into new, site-specific drug delivery and release systems.

Double J stenting compared with ureteral catheterization in percutaneous Nephrolithotomy

Background:Nephrolithiasis represents a large portion in the field of Urological pathology. Minimal invasive and non-invasive therapies have become more accessible and efficient in the treatment of nephrolithiasis. Percutaneous nephrolithotomy (PCNL) is an effective minimal invasive modality of treating kidney stones.Objectives: To evaluate the outcome of standard percutaneous nephrolithotomy (PCNL) using two different stenting techniques i.e. externalized ureteral catheter placement compared with Double-J stent placement.Methods: This is a prospective study conducted from January 2012 to June 2013 at Kathmandu Medical College Teaching Hospital among patients undergoing percutaneous nephrolithotomy (PCNL). Fifty patients who underwent PCNL were divided into two equal groups: Group 1 (PCNL with Double-J stent placement) and Group 2 (PCNL with externalized ureteral catheter placement). Factors evaluated included stent-related symptoms, postoperative morbidity, and the cost. Morbidity was classified according to the Modified Clavien classification. SPSS 20 was used for statistical evaluation. P value less than 0.05 was considered significant.Results: Stent related morbidity were fever, dysuria, hematuria, burning micturition. Total of 16 stent related complications were seen in group 1 with four of the patients needing early surgical intervention to remove the Double J stent and injectable antibiotics for urinary tract complication due to in dwelling stent. In Group 2, seven patients experienced postoperative complications, out of which six were managed conservatively and one patient had grade III A dysuria and hematuria, who underwent immediate stent removal and received injectable antibiotics. There was no reported sepsis and mortality in both groups. Stent was removed in 3-4 weeks’ time in group 1 and 3-4 days in group 2. In Group 1, patients had to come one day prior for stent removal. Cost for DJ stent was significantly higher in group I than group II.Conclusion: Standard PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Less cost can be a huge relief to the patients in the third world developing country.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11228Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page : 63-67

PO-0733 Minimal Invasive Surfactant Therapy: Cui Bono?

Background Minimal invasive surfactant therapy (MIST) is associated with a diminished need for mechanical ventilation. Insufficient insight exists in predictive success factors. Aim Defining success factors for MIST. Methods From 2011–2013 preterm infants admitted to the NICU with respiratory distress and radiographically established IRDS with FiO2 Results 40 neonates (GA 24 +2 –37 +1 weeks [30 weeks], birth weight 600–3330 gram [1375 gram], IRDS grade I-III) were eligible. In 38 patients MIST was performed (2/40 were nonetheless intubated due to unrest). Tube insertion caused bradycardia with spontaneous recovery in one patient. Surfactant administration caused desaturation with spontaneous recovery in all patients and apnea in one patient. There were no complications. Therapeutic success was reached in 24/38 (63,2%) patients. In 6/24 (25%) respiratory adjustments were necessary; increasing PEEP in 2/24, starting nIPPV in 4/24. Causes for intubation 14/38 (27,8%) were rebound IRDS (6/14), sepsis (5/14) and insufficient drive to breath 2/14. Gestational age, birth weight, FiO2/IRDS degree, timing of MIST and gastric tube route (nasal/oral) were not correlated with success. Conclusion Success factors for MIST are a calm patient, an adequate drive to breathe and the absence of sepsis.

Computer-supported diagnosis for endotension cases in endovascular aortic aneurysm repair evolution

An abdominal aortic aneurysm (AAA) is a localized abnormal enlargement of the abdominal aorta with fatal consequences if not treated on time. The endovascular aneurysm repair (EVAR) is a minimal invasive therapy that reduces recovery times and improves survival rates in AAA cases. Nevertheless, post-operation difficulties can appear influencing the evolution of treatment. The objective of this work is to develop a pilot computer-supported diagnosis system for an automated characterization of EVAR progression from CTA images. The system is based on the extraction of texture features from post-EVAR thrombus aneurysm samples and on posterior classification. Three conventional texture-analysis methods, namely the gray level co-occurrence matrix (GLCM), the gray level run length matrix (GLRLM), the gray level difference method (GLDM), and a new method proposed by the authors, the run length matrix of local co-occurrence matrices (RLMLCM), were applied to each sample. Several classification schemes were experimentally evaluated. The ensembles of a k-nearest neighbor (k-NN), a multilayer perceptron neural network (MLP-NN), and a support vector machine (SVM) classifier fed with a reduced version of texture features resulted in a better performance (Az=94.35±0.30), as compared to the classification performance of the other alternatives.

Amniotic fluid stem cells for minimally invasive prenatal cell therapy

Abstract Amniotic fluid stem cells can be expanded without feeder layers and can differentiate into mesenchymal and hematopoietic lineages. Long-term engraftment has been difficult to achieve after prenatal stem cell transplantation, mainly because of allogeneic rejection. Autologous cells can be obtained from amniotic fluid with minimal risk. This review aims to define the potential of human amniotic fluid stem cells as an autologous stem cell source for minimal invasive prenatal cell or cell-based gene therapy. We conclude that amniotic fluid-derived stem cells are an important source of autologous cells that may have prenatal therapeutic value in cell or cell-based gene therapy in the near future.

Evaluation of Caries Dentin using Light- Induced Fluorescence: A Case Report

Minimal invasive therapy has been becoming more important day by day in dentistry. In minimally invasive dentistry, only the infected dentin is removed and the affected dentin is left behind while preparing to repair a cavity. Healthy enamel and dentin have particular fluorescence properties, compared to demineralized dental tissues, which absorb less light and thereby have a lower level of fluorescence properties. It helps clinicians detect caries and apply the most appropriate treatment strategy during cavity preparation. This study investigated the efficacy of the SoproLife camera system which is a novel light-induced fluorescence camera system.

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.