Minimally-invasive Technologies Research Articles

The Minimally-Invasive Oral Glucose Minimal Model: Estimation of Gastric Retention, Glucose Rate of Appearance, and Insulin Sensitivity From Type 1 Diabetes Data Collected in Real-Life Conditions.

Modeling the effect of meal composition on glucose excursion would help in designing decision support systems (DSS) for type 1 diabetes (T1D) management. In fact, macronutrients differently affect post-prandial gastric retention (GR), rate of appearance (R[Formula: see text]), and insulin sensitivity (S[Formula: see text]). Such variables can be estimated, in inpatient settings, from plasma glucose (G) and insulin (I) data using the Oral glucose Minimal Model (OMM) coupled with a physiological model of glucose transit through the gastrointestinal tract (reference OMM, R-OMM). Here, we present a model able to estimate those quantities in daily-life conditions, using minimally-invasive (MI) technologies, and validate it against the R-OMM. Forty-seven individuals with T1D (weight =78±13 kg, age =42±10 yr) underwent three 23-hour visits, during which G and I were frequently sampled while wearing continuous glucose monitoring (CGM) and insulin pump (IP). Using a Bayesian Maximum A Posteriori estimator, R-OMM was identified from plasma G and I measurements, and MI-OMM was identified from CGM and IP data. The MI-OMM fitted the CGM data well and provided precise parameter estimates. GR and R[Formula: see text] model parameters were not significantly different using the MI-OMM and R-OMM (p 0.05) and the correlation between the two S[Formula: see text] was satisfactory ( ρ =0.77). The MI-OMM is usable to estimate GR, R[Formula: see text], and S[Formula: see text] from data collected in real-life conditions with minimally-invasive technologies. Applying MI-OMM to datasets where meal compositions are available will allow modeling the effect of each macronutrient on GR, R[Formula: see text], and S[Formula: see text]. DSS could finally exploit this information to improve diabetes management.

What is Happening in the Ambulatory Space? Past Challenges and Future Directions

Despite reimbursement pressures and scrutiny on procedural appropriateness, the demand for peripheral vascular ambulatory services remains strong. Improvements in minimally-invasive technologies, coupled with a supportive regulatory environment and considerable preference for ambulatory services among purchasers, patients, and providers, have resulted in the rapid proliferation of ambulatory facilities in a number of markets. Emerging ecosystem dynamics, notably the rapid growth of Medicare Advantage and the growing presence of private equity and venture capital within healthcare, will likely have an impact on future growth trends but will not fundamentally alter the incentives driving the ambulatory shift. Indeed, it is likely that the dynamics currently at work within peripheral vascular services will become come to characterize a variety of other services, as more care shifts away from the hospital.

A critical mini-review on the low-field nuclear magnetic resonance investigation of pore coupling effects in near-surface environments

The assessment and monitoring of groundwater resources is of increasing importance to ensure the continuous supply of fresh water for human activity and endangered ecosystems. These groundwater resources include fully saturated aquifers, water in unsaturated soil, and water trapped as rock moisture in weathered bedrocks. Low-field nuclear magnetic resonance (NMR) is a method with unique sensitivity to pore water, as it is based on the magnetization and relaxation behavior of the spin magnetic moment of hydrogen atoms forming water molecules. It is a cost-effective and minimally-invasive technology that can help characterize the pore structures and the groundwater distribution and transport in different types of subsurface materials. However, the interpretation of NMR data from samples with complex bimodal or multimodal porous geometries requires the consideration of pore coupling effects. A pore-coupled system presents significant magnetization exchange between macro- and micropores within the measurement time, making the independent characterization of each pore environment difficult. Developing a better understanding of pore coupling is of great importance for the accurate estimation of hydrogeological parameters from NMR data. This mini-review presents the state-of-art in research exploring the two factors controlling pore coupling: surface geochemistry and network connectivity, summarizes existing experimental and numerical modeling approaches that have been used to study pore coupling and discusses the pore coupling effects in fully and partially saturated conditions. At the end of this review, we outline major knowledge gaps and highlight the research needs in the vadose zone.

Neuronal maturation-dependent nano-neuro interaction and modulation.

Nanotechnology-enabled neuromodulation is a promising minimally-invasive tool in neuroscience and engineering for both fundamental studies and clinical applications. However, the nano-neuro interaction at different stages of maturation of a neural network and its implications for the nano-neuromodulation remain unclear. Here, we report heterogeneous to homogeneous transformation of neuromodulation in a progressively maturing neural network. Utilizing plasmonic-fluors as ultrabright fluorescent nanolabels, we reveal that negative surface charge of nanoparticles renders selective nano-neuro interaction with a strong correlation between the maturation stage of the individual neurons in the neural network and the density of the nanoparticles bound on the neurons. In stark contrast to homogeneous neuromodulation in a mature neural network reported so far, the maturation-dependent density of the nanoparticles bound to neurons in a developing neural network resulted in a heterogeneous optical neuromodulation (i.e., simultaneous excitation and inhibition of neural network activity). This study advances our understanding of nano-neuro interactions and nano-neuromodulation with potential applications in minimally-invasive technologies for treating neuronal disorders in parts of the mammalian brain where neurogenesis persists throughout aging.

MODERN APPROACHES TO THE TREATMENT OF HEPATIC ECHINOCOCCOSIS AT A HIGH-VOLUME SURGICAL CENTER

The development of modern minimally invasive technologies makes it possible to use them for treating patients with the liver damaged by echinococcosis. The study included 303 patients with hepatic echinococcosis who were treated at the Botkin Hospital Surgical Clinic from 2007 to 2021. Conservative therapy was used as the main treatment method in 23 patients, but 11 of them were subsequently operated on. Open echinococcectomy was performed in 22 patients. Pericystectomy was performed in 134 patients by a laparotomy technique, 23 patients underwent laparoscopic pericystectomy or liver resection, 17 patients underwent robot assisted pericystectomy, and 82 patients underwent right hemihepatectomy. Thirteen patients underwent physical effect methods on echinococcus cysts. The evaluation criteria of surgical treatment results were patient age, gender, surgical and anesthetic risks according to the ASA grading and localization of parasitic cysts. We considered the immediate results of surgical interventions such as surgery duration, blood loss, hospitalization period, postoperative complications according to the ClavienDindo classification, and specific complications according to the ISGLS. When comparing the immediate surgical treatment results, minimally invasive surgeries were accompanied by less blood loss, number of postoperative complications, and in-patient day. Laparotomy interventions were associated with complex localization of cysts, as well as previous non-radical surgical interventions. Modern minimally invasive technologies can improve immediate treatment results for patients with hepatic echinococcosis.

Robot-assisted pancreatic surgery—optimized operating procedures: set-up, port placement, surgical steps

Even in most complex surgical settings, recent advances in minimal-invasive technologies have made the application of robotic-assisted devices more viable. Due to ever increasing experience and expertise, many large international centers now offer robotic-assisted pancreatic surgery as a preferred alternative. In general however, pancreatic operations are still associated with high morbidity and mortality, while robotic-assisted techniques still require significant learning curves. As a prospective post-marketing trial, we have established optimized operating procedures at our clinic. This manuscript intends to publicize our standardized methodology, including pre-operative preparation, surgical set-up as well as the surgeons’ step-by-step actions when using pancreatic-assisted robotic surgery. This manuscript is based on our institutional experience as a high-volume pancreas operating center. We introduce novel concepts that should standardize, facilitate and economize the surgical steps in all types of robotic-assisted pancreatic surgery. The “One Fits All” principle enables single port placement irrespective of the pancreatic procedure, while the “Reversed 6-to-6 Approach” offers an optimized manual for pancreatic surgeons using the robotic console. Novel and standardized surgical concepts could guide new centers to establish a robust, efficient and safe robotic-assisted pancreatic surgery program.

Minimally invasive technologies for surgical treatment of kidney cancer

The OBJECTIVE was to analyze the developmental trends, possibilities and outcomes of applying minimally invasive technologies in surgical treatment for kidney cancer.METHODS AnD MATERIALS. The study included 368 surgeries for kidney tumors which were performed from 2012 to 2019. Partial nephrectomy (Pn) was performed in 228 (60.6 %) cases, radical nephrectomy (Rn) – in 148 (39.4 %) cases. Tumors of the stage cT1a detected in 148 (39.4 %), сТ1b – 145 (38.6 %), сT2a – 58 (15.4 %), сТ2b-cTxn1M1 – 25 (6.7 %) patients. Operations were performed using open (3.7 %), laparoscopic (50.3 %), robotic (46.0 %) approaches with assessment of surgical and oncological outcomes of treatment.RESULTS. The incidence rate of Pn in patients with kidney cancer at the stages cT1a, cT1b and cT2a was 89.9, 57.2 and 20.7 %. Rn was performed in all cases of tumor stage сТ2b-cTxn1M1. The frequency of Pn at the stages cT1a, cT1b and cT2a in 2019 exceeded 80 %. Minimally invasive technologies (MIT) for Pn was used in 98.3 %, for Rn – in 92.2 % of cases. The incidence rate of postoperative complications after Pn and Rn at stages сТ1а, сT1b, сТ2а was 14.3and 6.7, 16.9 and 3.2, 16.7 and 2.2 %, respectively. Complications after Rn at tumors of the stage cT2bcTxn1M1 occurred in 20.0 % of patients. Positive surgical margin (PSM) occurred after Pn for tumors of the stage cT1a in 0.7 % of cases; for cT1b – in 2.4 %; for cT2a and after Rn – was not determined.CONCLUSION. Our study demonstrates a steady tendency towards an increase in the number of MIT for kidney tumors, including when performing organ-preserving surgeries. Robot-assisted surgery allows to expand the indications to use a minimally MIT even in the most difficult clinical cases. The frequency of complications after RP compared with Rn is higher because the complexity of the operation increases, and these complications did not affect the outcome of treatment, taking into account the functional advantages provided for patients. The development and widespread introduction of minimally MIT into clinical practice is an evident and inevitable way to develop surgical treatment of kidney cancer.

Minimally-invasive technologies in the treatment of choledocholithiasis complicated by biliary pancreatitis

Minimal invasive endoscopic technologies are used in the treatment of patients with biliary pancreatitis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with biliary pancreatitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of biliary pancreatitis and biliary sepsis was noted.

Minimally-invasive technologies in the treatment of choledocholithiasis complicated by purulent cholangitis

Minimal invasive endoscopic technologies are used in the treatment of patients with choledocholithiasis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with acute cholangitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of cholangitis and biliary sepsis was noted.

ПРИМЕНЕНИЕ ПУНКЦИОННО-ДРЕНАЖНОГО МЕТОДА ЛЕЧЕНИЯ ПСЕВДОКИСТ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ

The result of treatment was carried out in 26 patients with pancreatic pseudocysts divided into two subgroups — up to 5 cm in diameter and more than 5 cm. The control group consisted of 14 people who underwent traditional surgery to drain cystic formations. The advantages of minimal-invasive technologies for cysts with a diameter of less than 5 cm are in reducing the residence time by 11 days have been proven, which made it possible to obtain a significant economic effect. With a pseudocyst diameter of more than 5 cm and the phenomenon of its suppuration, confirmed by bacteriological research, the optimal type of intervention is pancreatobureostomy with the formation of permanent vacuum drainage systems.

The Mechanism and Therapeutic Effect of Lumbar Intervertebral Disc Foramen Puncture on Neuropathic Pain Based on Digital Medical Technology

Lumbar disc herniation is a relatively common disease in orthopedics, most patients will experience varying degrees of waist pain after suffering from this disease, and severe cases may even be paralysed. In recent years, with the rapid progress of science and technology, minimally invasive surgery technology is also developing rapidly, and its advantages are also very prominent. Puncture technology, as one of the most important and difficult points, has a high requirement for doctors, so it is particularly important to master this technology thoroughly. In order to apply this technique more in clinical practice, improve its accuracy and success rate, and increase the efficiency of operation, 40 patients with lumbar intervertebral disc herniation were selected and randomly divided into experimental group (20 cases) and control group (20 cases). According to the principle of lumbar intervertebral space puncture, its length and angle were adjusted with high precision. Percutaneous lumbar intervertebral foramen puncture locator was used for treatment in the experimental group and the control group was treated with routine nursing intervertebral foramen puncture. The number of punctures, the time needed for successful puncture, the number of successful projections, puncture complications, and clinical efficacy of the two puncture methods were analyzed. The results showed that in the analysis of clinical puncture indicators, the number of punctures, the time needed for puncture, and fluoroscopy times in the experimental group were significantly different from those in the control group (P < 0.01). The puncture method was determined through the design of the surgical approach to alleviate the symptoms as much as possible after operation. In the visual analogue score, follow-up showed that the visual analogue score of the experimental group was significantly lower than that of the previous one month and the last follow-up, with statistical significance (P < 0.01), and the excellent and good rate was significantly increased by using lumbar intervertebral disc puncture, which was 94.7%. Therefore, through this study, it is found that the new type of lumbar intervertebral perforation positioning designed in this study can significantly improve the accuracy of puncture, the success rate increased significantly, and the experiment achieved the desired results. Although there are some shortcomings in the experiment, it still provides experimental basis for the clinical application of lumbar intervertebral disc puncture in the later stage.

Minimally-invasive technologies in the treatment of choledocholithiasis complicated by cholangitis and biliary sepsis

Minimally-invasive endoscopic technologies are used in the treatment of patients with choledocholithiasis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014–2018, aged 65,5 ± 15,18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) – surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) – by needle. In all cases, subtotal papilloprotectomy was performed, supplemented by balloon sphincteroplasty. In the I group, the patients included patients with acute cholangitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock.
 In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observe during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of cholangitis and biliary sepsis was noted.

Anthropometry based Predictive Equations for Estimating Nigerian Women Percentage Body Fat using Stable Isotope Technique as Reference

The direct measurement of body composition using innovative non-or minimally-invasive technologies such as stable isotope technique, despite its reliability and precision remains a significant challenge.  This study was designed to develop predictive equations for estimating the percentage body fat of Nigerian women using isotope dilution (ISD) or gold standard technique (as in IAEA procedure) as reference and validated by bioelectrical impedance technique.The percentage body fats (% BF) of 173 Nigerian women (aged 18-55 yrs) were estimated using isotope dilution (ISD) or gold standard technique (as in IAEA procedure) as reference and validated by bioelectrical impedance technique. The skinfold thicknesses (mm) such as biceps, triceps, subscapular, suprailiac and abdominal were measured using skinfold langre callipers while body circumferences such as forearm, wrist, waist, abdominal and hip were measured using standard tape rule and in accordance with WHO guidelines. The subjects’ percentage body fat (%BF) ranged from 8.0 to 48.5. Generally, at 0.01 level of significance (Using Statistical Package for Social Scientists (SPSS), higher positive significant correlations were obtained between % BF by ISD and body circumferences (r=0.503-0.874) than skinfold thicknesses (r=0.503-0.739). Using forward selection regression procedure, three sex-specific based predictive equations for estimating %BF (incorporating subjects’ weight and body circumferences such as hip, abdominal and waist) were developed based on the subjects’ ethnic groups (Yoruba, Hausa and Ibos) with high R2 (0.853, 0.953 & 0.867) and low Pure errors (3.316, 2.791 & 2.324) respect. These equations provide easy way of measuring percentage body fat and are recommended for use in clinical or epidemiological settings in populations with similar ethnic background and in lieu of isotope dilution method.

Сроки рецидивирования после полного удаления конкрементов в разных отделах мочевой системы. Опыт пятилетнего наблюдения

The usage of minimally invasive technologies (MIT), such as: extracorporeal shock wave lithotripsy (ESWL), transurethral ureterolithotripsy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotripsy (PNL), allows to remove the stones from the calyx and pelvis system with 71- 96% of patients, and those from the ureter in 96.2% cases. However, a high incidence of stone recurrences (35-75%) demands the necessity of repeated lithotripsies and the search of the most appropriate methods of lithotripsy for reduction this indicator. The main goal. To determine the number of patients with recurrence of stone formation during five years after different types of lithotripsy in different parts of the urinary system. The results of the process were analyzed with 491 patients, who had been devided into two groups: group I - 358 patients suffering from the concrements of the ureter; group II - 133 patients having stones in kidney. According to the age criterion, the sample data did not differ from each other (50 years for both groups (p=0.576). The initial number of lithotripsies with complete removal of stones was 80.7% in group I and 70.7% in gr. II, the repeated lithotripsy with usage of the same method was 5.9% and 12.8%, respectively. The usage of an additional method in repeated lithotripsy was necessary in 13.4% and 16.5% of cases respectively. There were differences between the sizes of stones in groups (p<0.0001), besides both groups showed the difference in recurrence time of stone formation (p=0,014). In gr. I weak negative correlation (-0.28) between age and time of recurrence was revealed. The age difference between men and women in both groups (p=0.00001 and p=0.0492, respectively) was found. There occurred differences in the size of stones in men and women groups (p=0.0000001 and p=0.0000001, respectively) and in the time of recurrence between men and women in I gr. (p=0.043). Most of stones were compose of CaOx, the second most important element was Uric Acid. All this testifies to peculiarities of the diet in the region of residence of the patients under control - the Republic of Bashkortostan, where people generally use meat and milk products. The usage of MIT opened the possibility of complete stone removal from the urinary system with the most sparing technique. The lithotripsy of stones with any composition having been conducted, additional stone crushing is carried out with 21-59% of patients within 5 years. The investigation of patients detected a great number of recurrences of stones in the kidney stones group. 1. After lithotripsy the recurrences during two years did not exceed 4,2% with patients in gr. I and 8,2% in gr. II patients. 2. Significant dependence of recurrent stone formation of gender composition was identified in gr. I and the time of recurrence was less in women. 3. The quantity of CaOx urolithiasis corresponds to global indicators. However, a large number of stones with Uric Acid in the composition indicates possible peculiarities of the patients diet. 4. The highest number of recurrences were in patients with CaOx (42.3%) and CaOx with CaF in the composition (23.1%), and in third place were patients with uric acid stones (19.2%).

Minimally-invasive and endovideosurgical technologies in diagnosis and treatment of choledocholithiasis.

. The paper presents the results of the use of minimally-invasive methods in the diagnosis and treatment of choledocholithiasis. The results of treatment of 595 patients aged from 24 to 92 years with the diagnosis of choledocholithiasis were evaluated. In 552 (93,0%) patients, clinical ma­nifestations of mechanical icterus were noted. In 508 (85,3%) patients, choledocholithiasis was combined with the presence of gallstones, in 15 (2,5%) cases – with calculous cholecystitis, in 69 (11,6%) cases - choledocholithiasis was residual. For the diagnosis of choledocholithiasis, ultrasound of the abdominal cavity, computed tomography, endoscopic retrograde cholangiopancreatogy, percutaneous fistulocholangiography, intraoperative cholangiography or cholangiography were used. Surgical treatment included both mini-invasive interventions and traditional operations. 227 (38,1%) patients underwent endoscopic papillosphincterotomy, which was effective in a size of concrement up to 7 mm in 83,7%. The percutaneous drainage of the bille ducts was performed in 88 (14,7%) patients, the efficacy was achieved in 82,9%. 313 (52,6%) patients subsequently underwent the second stage of surgical treatment of choledocholithiasis by laparoscopy – 263 (84,0%) and laparotomy – 50 (16,0%) with cholecystectomy with choledocholithoextraction and subsequent external or internal drainage of choledochus. Comparison of different methods of investigation showed that none of the diagnostic techniques had 100% of accuracy and informative value. The efficacy of transpapillary manipulation directly depended on the size of the stones.

Detection of Norepinephrine in Whole Blood via Fast Scan Cyclic Voltammetry.

Bioelectronic Medicines is an emerging field that capitalizes on minimally-invasive technology to stimulate the autonomic nervous system in order to evoke therapeutic biomolecular changes at the end-organ. The goal of Bioelectronic Medicines is to realize both 'precision and personalized' medicine. 'Precise' stimulation of neural circuitry creates biomolecular changes targeted exactly where needed to maximize therapeutic effects while minimizing off-target changes associated with side-effects. The therapy is then 'personalized' by utilizing implanted sensors to measure the biomolecular concentrations at, or near, the end-organ of interest and continually adjusting therapy to account for patient-specific biological changes throughout the day. To realize the promise of Bioelectronic Medicines, there is a need for minimally invasive, real-time measurement of biomarkers associated with the effects of autonomic nerve stimulation to be used for continuous titration of therapy. In this study we examine the feasibility of using fast scan cyclic voltammetry (FSCV) to measure norepinephrine levels, a neurochemical relevant to end-organ function, directly from blood. FSCV is a well-understood method for measuring electroactive neurochemicals in the central nervous system with high temporal and high spatial resolution that has yet to be adapted to the study of the autonomic nervous system. The results demonstrate that while detecting the electroactive neurochemical norepinephrine in blood is more challenging than obtaining the same FSCV measurements in a buffer solution due to biofouling of the electrode, it is feasible to utilize a minimally invasive FSCV electrode to obtain neurochemical measurements in blood.

PD64-11 NEW NOVEL CHRONIC TIBIAL NEUROMODULATION (CTNM) TREATMENT OPTION FOR OAB SIGNIFICANTLY IMPROVES URGENCY (UI)/URGE INCONTINENCE (UUI) AND NORMALIZES SLEEP PATTERNS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction II1 Apr 2017PD64-11 NEW NOVEL CHRONIC TIBIAL NEUROMODULATION (CTNM) TREATMENT OPTION FOR OAB SIGNIFICANTLY IMPROVES URGENCY (UI)/URGE INCONTINENCE (UUI) AND NORMALIZES SLEEP PATTERNS Karl-Dietrich Sievert, Lilliana Milinovic, Esra Foditch, Stefan DeWachter, Anne Roggenkamp, and Thomas Kessler Karl-Dietrich SievertKarl-Dietrich Sievert More articles by this author , Lilliana MilinovicLilliana Milinovic More articles by this author , Esra FoditchEsra Foditch More articles by this author , Stefan DeWachterStefan DeWachter More articles by this author , Anne RoggenkampAnne Roggenkamp More articles by this author , and Thomas KesslerThomas Kessler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2948AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous tibial nerve stimulation (PTNS) has been successfully used to treat symptoms of overactive bladder(OAB). PTNS currently relies on episodic stimulation of the tibial nerve once/week for 30min in an outpatient setting using an acupuncture needle and a ground pad to create electrical stimulation. We investigated CTNM in OAB patients using this new minimal invasive chronic implantable device (StimGuard LLC). METHODS In 2014, two male patients (82y old with Parkinson's disease for 6y and 69y old with MS for 16 years) with neurogenic lower urinary tract dysfunction (nLUTD) received those implants. Both patients suffered from refractory UI and nocturia; detrusor overactivity and detrusor sphincter dyssynergia. In February-April 2016, six additional patients (1 male: spina bifida; 5 female: iOAB) received the implants through a <5mm skin incision. Patients were asked to use the device while sleeping (max 8h). Patients were followed with bladder diary, maximum flow rate (ml/sec), post void residual (PVR) and questionnaires on a regular basis (1 month prior to surgery and 2, 4 weeks, 3 and 6 months postop). RESULTS Implantation of the electrode was well-tolerated by all patients and performed as an outpatient procedure without perioperative complication. The initial two patients reported significant improvement of nLUTD within 48 hours. Both neurogenic patients were completely dry two months post-op; UI and nocturia disappeared (bladder diary). Both patients stopped CTNM due to the progression of their comorbidity, though a causal correlation could not be drawn. After 1.5 years the electrode of one patient migrated through the implantation path. In the second group, the male was excluded due to lack of improvement and required an alternative treatment. Five female iOAB patients documented major improvements in their bladder diaries. UUI episodes significantly decreased (base: 2.1/day vs. 2.5/month 6 months post-op) and nocturia vanished. Mean voided volume significantly increased by 70ml, without or increased PVR. In the five iOAB patients, all implants are currently in place and their efficacy confirmed. CONCLUSIONS CTNM offers a promising treatment option using a novel chronic implantable device using an external charger. The new minimalinvasive technology might revolutionize neuromodulation and offers those patients suffering from refractory OAB an opportunity to perform CTNM over several hours, even while sleeping with low or no stimulation related morbidities. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1264-e1265 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Karl-Dietrich Sievert More articles by this author Lilliana Milinovic More articles by this author Esra Foditch More articles by this author Stefan DeWachter More articles by this author Anne Roggenkamp More articles by this author Thomas Kessler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Components of a Heart Catheter System for High Risk Patients

As late as fifteen years ago the intracardiac catheter was only used for diagnostic purposes. Since then it has also been established as a therapeutic method. The latest studies have shown that the reduction in convalescence that normally follows a catheter-interventional implantation of aortic valves by transcatheter aortic valve implantation is less significant in comparison to that of a cardiac surgery operation. It is expected that such minimal-invasive technologies will grow to a great extent, also helping to reduce socio-economic costs for the European health care system. Patients of higher ages with acquired cardiac defects or children with congenital cardiac defects of heart valves, especially of the pulmonary valve, are currently the main target groups. We present an alternative and optimized mechanism for stent placement and similar therapeutical interventions. This project focuses on the manipulation unit and tube system. It carries out a highly precise and repeatable linear motion. Ergonomic requirements are taken into account. Furthermore a possibility to support the linear motion by minimal strain is presented. The product is designed for disposable applications but is generally also suitable for long-term applications.

Recommendations for the delivery of focal tumor ablation services.

106 Background: The objective of this work was to develop recommendations for the organization and delivery of focal tumor ablation services. New, minimally-invasive ablation technologies such as radiofrequency ablation (RFA), microwave ablation (MWA), and transcatheter arterial chemoembolization (TACE) offer treatment options for patients with a variety of cancers. These emerging therapies can improve patient care (minimize side-effects, offer more rapid recovery with comparable or enhanced outcomes) compared to traditional approaches. However, they are often resource intensive, necessitating a planned system-level approach to ensure appropriate access to high quality services while optimizing care and resource utilization. Methods: This work was led by an Advisory Committee with regional, clinical, administrative and patient representatives and was based on best available evidence, current practice in Ontario, Canada, and guidance from other jurisdictions and experts in the field. A variety of data sources (clinical, system, provider), consultation with external stakeholders and consensus building supported the final recommendations. Results: Thirteen recommendations were developed. Clinical criteria are detailed for RFA for liver, kidney and lung tumors and TACE for hepatocellular carcinoma. MWA is not recommended for lung, liver or kidney tumors. System recommendations include infrastructure (capital equipment, multidisciplinary management and case conference review), the importance of volume-related expertise, and oversight for funding and collaborative planning. Results were broadly disseminated through 12 stakeholder groups connecting with over 40,000 individuals. Conclusions: A systematic approach to understanding opportunities and challenges for focal tumor ablation therapies resulted in multi-level recommendations spanning clinical criteria through to quality oversight. These recommendations will support improvements in care delivery in daily practice and at the system level.

Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis.

Several minimally-invasive technologies are available for cardiac output (CO) measurement in children, but the accuracy and precision of these devices have not yet been evaluated in a systematic review and meta-analysis. We conducted a comprehensive search of the medical literature in PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science from its inception to June 2014 assessing the accuracy and precision of all minimally-invasive CO monitoring systems used in children when compared with CO monitoring reference methods. Pooled mean bias, standard deviation, and mean percentage error of included studies were calculated using a random-effects model. The inter-study heterogeneity was also assessed using an I(2) statistic. A total of 20 studies (624 patients) were included. The overall random-effects pooled bias, and mean percentage error were 0.13±0.44lmin(-1) and 29.1%, respectively. Significant inter-study heterogeneity was detected (P<0.0001, I(2)=98.3%). In the sub-analysis regarding the device, electrical cardiometry showed the smallest bias (-0.03lmin(-1)) and lowest percentage error (23.6%). Significant residual heterogeneity remained after conducting sensitivity and subgroup analyses based on the various study characteristics. By meta-regression analysis, we found no independent effects of study characteristics on weighted mean difference between reference and tested methods. Although the pooled bias was small, the mean pooled percentage error was in the gray zone of clinical applicability. In the sub-group analysis, electrical cardiometry was the device that provided the most accurate measurement. However, a high heterogeneity between studies was found, likely due to a wide range of study characteristics.