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Adjuvant radiation therapy and chemotherapy in Merkel cell carcinoma: survival analyses of 6908 cases 123 medications used to treat anxiety generic 800mg nootropil overnight delivery. Density medications and mothers milk 2014 discount nootropil online master card, distribution medications identification buy genuine nootropil online, carcinoma of the head and neck: effect of surgical excision and radiation and composition of immune infiltrates correlate with survival in Merkel cell on recurrence and survival treatment yeast infection home remedies purchase nootropil overnight. Merkel cell carcinoma: an adverse prognostic marker in Merkel cell carcinoma: report on a does tumor size or depth of invasion correlate with recurrence chi royal treatment discount 800mg nootropil, metastasis medicine woman dr quinn buy nootropil amex, Canadian cohort. Benefits of combined modality treatment of Merkel cell carcinoma of the head and neck: single 136. Clinical stage of Merkel cell carcinoma and survival are not associated with Breslow thickness of biopsied tumor. J Am Acad Dermatol the diagnosis of Merkel cell carcinoma: a nationwide cohort study. Available at: intratumoral infiltration as a stage-independent predictor of Merkel cell. Further insights into the natural history and management of primary cutaneous neuroendocrine (Merkel cell) 152. Available at: associated with Merkel cell carcinoma in Queensland, Australia, 1982. Association between neuroendocrine (Merkel cell) carcinoma and squamous carcinoma of the 146. Detection of squamous and atypical fibroxanthoma-like differentiation in successive Merkel cell polyomavirus and human papillomaviruses in Merkel cell local tumor recurrences. Available at: carcinoma combined with squamous cell carcinoma in immunocompetent. The spectrum of Merkel cell synchronously with multiple actinic keratoses, squamous cell carcinomas polyomavirus expression in Merkel cell carcinoma, in a variety of and basal cell carcinoma. Available at: cutaneous neoplasms, and in neuroendocrine carcinomas from different. Association of Merkel cell polyomavirus infection with morphologic differences in Merkel cell 160. Merkel cell carcinoma with systemic metastases in Merkel cell carcinoma by imaging. Acta Radiol cytokeratin 20-negative and thyroid transcription factor-1-positive Open 2017;6:2058460117700449. The predictive value of imaging studies in evaluating regional lymph node involvement in Merkel 178. Available at: and powerful prognostic stratification in the staging of Merkel cell. Arch Dermatol tomography/computed tomography imaging in Merkel cell carcinoma: a 1992;128:818-821. Available at: study of 270 scans in 97 patients at the Dana-Farber/Brigham and. Indium-111 octreotide scintigraphy of Merkel cell carcinomas and their metastases. Available at: fluorodeoxyglucose positron emission tomography-computed tomography. Somatostatin receptor expression in Merkel cell carcinoma as target for molecular imaging. Unknown primary Merkel fluorodeoxyglucose positron emission tomography with simultaneous cell carcinoma: 23 new cases and a review. Available at: concurrent sentinel lymph node biopsy staging: A single institutional. Merkel cell carcinoma: a 15-year institutional experience and statistical analysis of 721 reported cases. Available at: immunosuppression: recurrence factors in localized Merkel cell carcinoma. Chemotherapy for patients with locally advanced or metastatic Merkel cell carcinoma. Detection of Merkel cell virus sentinel lymph-node status and adjuvant radiation therapy. Ann Oncol and correlation with histologic presence of Merkel cell carcinoma in 2016;27:914-919. An ultrasonography-cytology is associated with improved survival in Merkel cell carcinoma. Ann Surg protocol for the diagnostic management of regional nodes in a subset of Oncol 2014;21:1624-1630. Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma. Available at: Merkel cell carcinoma of the skin with cytomorphology and. Immunostaining for cytokeratin 20 improves detection of micrometastatic Merkel cell carcinoma in sentinel 211. Cytological and lymph node biopsy for regional staging of head and neck Merkel cell immunocytochemical features of Merkel cell carcinoma on fine needle carcinoma. Impact of sentinel lymph node biopsy in patients with Merkel cell carcinoma: results of a prospective study and review of the literature. Eur J Surg Oncol population-based epidemiological study in Finland with a clinical series of 2017;43:1536-1541. Available at: with resected Merkel cell carcinoma: a propensity score surveillance. Merkel cell carcinoma in East Yorkshire: A case series and literature review of current management. Merkel cell carcinoma: Overall survival after open biopsy versus wide local excision. Available at: an Australian perspective and the importance of addressing the regional. Adjuvant radiation therapy analyses of 6908 cases from the National Cancer Data Base. J Natl improves patient survival in early-stage merkel cell carcinoma: A 15-year Cancer Inst 2017;109. Merkel cell carcinoma: a report residual disease volume on time to locoregional failure in cutaneous of 34 cases and literature review. Cancer Comparison of Mohs micrographic surgery and wide excision in eighty-six 1997;80:881-885. Local control of radiation therapy in securing locoregional control of Merkel cell carcinoma. Postoperative radiation therapy is associated with a reduced risk of local recurrence among low 240. Available at: patients with inoperable Merkel cell carcinoma: the Westmead Hospital. Outcomes of Merkel cell carcinoma treated regional treatment for lymph node-positive Merkel cell carcinoma. Radiotherapy alone in patients with Merkel cell associated with greater tumor size and poorer outcome in Merkel cell carcinoma: the Westmead Hospital experience of 41 patients. Ann Surg Oncol Merkel cell carcinoma confers clinically meaningful in-field locoregional 2012;19:2556-2562. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. The role of radiotherapy patients with Merkel cell carcinoma undergoing surgery without adjuvant alone in patients with merkel cell carcinoma: reporting the Australian radiation therapy to the primary site. Negative sentinel lymph postoperative radiation therapy in the treatment of Merkel cell carcinoma. Int J chemoradiation in merkel cell carcinoma: a systematic review of the Radiat Oncol Biol Phys 2006;64:114-119. Adjuvant local control with radiotherapy for Merkel cell carcinoma of the head and neck. Multimodality management for 145 radiotherapy in the treatment of Merkel cell carcinoma: a study from the cases of Merkel cell carcinoma. Merkel cell carcinoma of the head and neck: lymph node biopsy predicts local metastases during the course of disease pathogenesis, current and emerging treatment options. Organ transplant recipients with Merkel treatment for Merkel cell carcinoma improves outcome. Am J Surg cell carcinoma have reduced progression-free, overall, and disease 1997;174:688-693. Role of platinum-based Resected Merkel Cell Carcinoma With Immune Checkpoint Blocking chemotherapy for Merkel cell tumor in adjuvant and metastatic settings. Adjuvant Avelumab in Merkel Cell metastatic Merkel cell carcinoma metastatic to the heart and pancreas. Available at: chemotherapy among 62 patients with metastatic Merkel cell carcinoma. Available at: outcomes in patients with metastatic Merkel cell carcinoma treated with. Available at: treatment outcomes in patients with distant metastatic Merkel cell. Available at: patients with virus-associated tumors (CheckMate 358): Efficacy and. Laherparepvec) With or Without Radiotherapy for Melanoma, Merkel Cell Available at. Talimogene Laherparepvec and Nivolumab in Treating Patients With Refractory Lymphomas or Advanced or Refractory Non-melanoma Skin Cancers. One alternative pathway in humans which removes the pleasure sensation created by endorphins. Through the work of Bihari and in determining patterns of gene expression in cancer [6]. Similar results were obtained with iron excellent book by Gonzalez & Miranda-Massari[4] that reviewed supplementation. These results indicate that both ascorbate and the use and role of high dose vitamin C in cancer patients. A review of medical literature was done, and 60 with a life expectancy between two and six months. Two were this is the second time where this combination got published as lung cancer, two of colon, one ovarian, one esophageal, one uterine an effective therapy for cancer patients. Maneckjee& Minna [12] found that methadone has had no toxicity, and the diseases were either stable or very slowly significant growth inhibitory effect on lung cancer cells in Nitro progressive, although two of them expired. They performed growth assays such as the colorimetric reasonable option for patients with advanced disease. Only brief exposure to methadone was required One study with 10 metastatic renal cell cancer patients [17], for loss of cell viability and this is referred by cycloheximide who had progressed on a previous immunotherapeutic treatment and Actinomycin D. The clinical response consisted of a partial response in 1 and a stable disease in 5 patients, whereas the other 4 patients Liu et al. She is currently receiving treatment and expired 14 months following initial diagnosis. She is refusing to had better symptoms and inclusive pain-free and off pain killers. Low-Dose Naltrexone in Combination with High-Dose Vitamin C in Cancer 0030 Patients: Our Experience and Medical Literature Review it should be Reinforced in Our Practices of Integrative Oncology. Brown N, Panksepp J (2009) Low-dose naltrexone for disease metastatic disease to bones and lungs, visited me for a second prevention and quality of life. Proc Soc Exp Biol Med 161(1): Squamous Cell Carcinoma of Pyriform Sinus (head and neck 18-20. The combination makes the cancer cell more susceptible to anti-cancer modalities and bring them a better quality of life 16. Khan A (2014) Long-term remission of adenoid cystic tongue Endocrinol Lett 23(3): 255-258. Low-Dose Naltrexone in Combination with High-Dose Vitamin C in Cancer 0031 Patients: Our Experience and Medical Literature Review it should be Reinforced in Our Practices of Integrative Oncology. Annals of Reviews and Research this work is licensed under Creative Your next submission with Juniper Publishers Commons Attribution 4. Low-Dose Naltrexone in Combination with High-Dose Vitamin C in Cancer 0032 Patients: Our Experience and Medical Literature Review it should be Reinforced in Our Practices of Integrative Oncology. The plan pays a cash beneft upon initial diagnosis of a covered cancer, with a variety of other benefts payable throughout cancer treatment. For costs and complete details of the coverage, contact your Afac insurance agent/producer. Lodging Beneft $65 per day; limited to 90 days per year the policy has limitations and exclusions that may affect benefts payable. Bone Marrow Donor Screening Beneft $40; limited to one beneft per Covered Person, per lifetime this brochure is for illustrative purposes only. CanCeR DiaGnoSiS BenefitS: a very brief description of some of the important features of your 1. 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National Cancer Institute safety standards for research involving oncogenic viruses treatment hypercalcemia buy 800 mg nootropil overnight delivery. History and epidemiology of laboratory-acquired infections (in relation to the cancer research program) medicine 66 296 white round pill discount nootropil 800mg on-line. Successful control of hazards in the laboratory also protects persons not directly associated with the laboratory medications for anxiety buy nootropil in india, such as other occupants of the same building symptoms kidney problems 800mg nootropil for sale, and the public medicine hat purchase 800mg nootropil with visa. By contrast medicine reactions cheap 800mg nootropil, imposition of safeguards more rigorous than actually needed may result in additional expense and burden for the laboratory, with little safety enhancement. The primary factors to consider in risk assessment and selection of precautions fall into two broad categories: agent hazards and laboratory procedure hazards. Biological Risk Assessment 9 Hazardous Characteristics of an Agent the principal hazardous characteristics of an agent are: its capability to infect and cause disease in a susceptible human or animal host, its virulence as measured by the severity of disease, and the availability of preventive measures and effective treatments for the disease. See Section 3 for a further discussion of the differences and relatedness of risk groups and biosafety levels. Risk Group 2 Agents associated with human (Moderate individual risk; low community disease that is rarely serious risk) A pathogen that can cause human and for which preventive or or animal disease but is unlikely to be a therapeutic interventions are serious hazard to laboratory workers, the often available. Reports seldom provide incidence data, making comparative judgments on risks among agents diffcult. The number of infections reported for a single agent may be an indication of the frequency of use as well as risk. For example, transmission of infectious agents can occur by direct contact with discharges from respiratory mucous membranes of infected persons, which would be a clear indication that a laboratory worker is at risk of infection from mucosal membrane exposure to droplets generated while handling that agent. Infective dose and agent stability are particularly important in establishing the risk of airborne transmission of disease. Evidence that experimental animals can shed zoonotic agents and other infectious agents under study in saliva, urine, or feces is an important indicator of hazard. Experiments that do not demonstrate transmission, however, do not rule out hazard. The identifcation and assessment of hazardous characteristics of genetically modifed agents involve consideration of the same factors used in risk assessment of the wild-type organism. The risk assessment can be diffcult or incomplete, because important information may not be available for a newly engineered agent. Several investigators have reported that they observed unanticipated enhanced virulence in recent studies with engineered agents. It also suggests that risk assessment is a continuing process that requires updating as research progresses. Many other institutions have adopted these guidelines as the best current practice. These are parenteral inoculations with syringe needles or other contaminated sharps, spills and splashes onto skin and mucous membranes, ingestion through mouth pipetting, animal bites and scratches, and inhalation exposures to infectious aerosols. Procedures and equipment used routinely for handling infectious agents in laboratories, such as pipetting, blenders, non-self contained centrifuges, sonicators and vortex mixers are proven sources of aerosols. The larger size droplets settle out of the air rapidly, contaminating the gloved hands and work surface and possibly the mucous membranes of the persons performing the procedure. For example, the hurried worker may operate a sonic homogenizer with maximum aeration whereas the careful worker will consistently operate the device to assure minimal aeration. Protection depends on the conscientious and profcient use of good microbiological practices and the correct use of safety equipment. A risk assessment should identify any potential defciencies in the practices of the laboratory workers. Training, experience, knowledge of the agent and procedure hazards, good habits, caution, attentiveness, and concern for the health of coworkers are prerequisites for a laboratory staff in order to reduce the inherent risks that attend work with hazardous agents. Not all workers who join a laboratory staff will have these prerequisite traits even though they may possess excellent scientifc credentials. Laboratory directors or principal investigators should train and retrain new staff to the point where aseptic techniques and safety precautions become second nature. Inadequate training in the proper use of personal protective equipment may reduce its effectiveness, provide a false sense of security, and could increase the risk to the laboratory worker. For example, a respirator may impart a risk to the wearer independent of the agents being manipulated. The safety characteristics of modern centrifuges are only effective if the equipment is operated properly. This safeguard helps to prevent aerosol transmission from a laboratory into other areas of the building. This section describes a fve-step approach that gives structure to the risk assessment process. Consider the principal hazardous characteristics of the agent, which include its capability to infect and cause disease in a susceptible human host, severity of disease, and the availability of preventive measures and effective treatments. Several excellent resources provide information and guidance for making an initial risk assessment. A thorough examination of the agent hazards is necessary when the intended use of an agent does not correspond with the general conditions described in the summary statement or when an agent summary statement is 16 Biosafety in Microbiological and Biomedical Laboratories not available. Identifcation of agent hazards associated with newly emergent pathogens also requires judgments based on incomplete information. When assessing the hazards of a newly attenuated pathogen, experimental data should support a judgment that the attenuated pathogen is less hazardous than the wild-type parent pathogen before making any reduction in the containment recommended for that pathogen. Procedures involving animals can present a number of hazards such as bites and scratches, exposure to zoonotic agents, and the handling of experimentally generated infectious aerosols. The agent summary statement provides information on the primary laboratory hazards associated with typically routine procedures used in handling an agent. Biological Risk Assessment 17 Third, make a determination of the appropriate biosafety level and select additional precautions indicated by the risk assessment. An obvious example would be a procedure for exposing animals to experimentally generated infectious aerosols. It is unlikely that a risk assessment would indicate a need to alter the recommended facility safeguards specifed for the selected biosafety level. Fourth, evaluate the profciencies of staff regarding safe practices and the integrity of safety equipment. The protection of laboratory workers, other persons associated with the laboratory, and the public will depend ultimately on the laboratory workers themselves. The laboratory director or principal investigator should also ensure that the necessary safety equipment is available and operating properly. The director should have all equipment defciencies corrected before starting work with an agent. Adopting this step voluntarily will promote the use of safe practices in work with hazardous agents in microbiological and biomedical laboratories. Expression of mouse interleukin-4 by a recombinant ectromelia virus suppresses cytolytic lymphocyte responses and overcomes genetic resistance to mousepox. Hypervirulent mutant of Mycobacterium tuberculosis resulting from disruption of the mce1 operon. Genetic analysis of a sarcoma accidentally transplanted from a patient to a surgeon. Lymphocytic choriomeningitis outbreak associated with nude mice in a research institute. Particle size distribution of Serratia marcescens aerosols created during common laboratory procedures and simulated laboratory accidents. The risk assessment of the work to be done with a specifc agent will determine the appropriate combination of these elements. Laboratory Practices and Technique the most important element of containment is strict adherence to standard microbiological practices and techniques. Persons working with infectious agents or potentially infected materials must be aware of potential hazards, and must be trained and profcient in the practices and techniques required for handling such material safely. The director or person in charge of the laboratory is responsible for providing or arranging the appropriate training of personnel. This individual should consult with biosafety or other health and safety professionals with regard to risk assessment. Appropriate facility design and engineering features, safety equipment, and management practices must supplement laboratory personnel, safety practices, and techniques. An example of another primary barrier is the safety centrifuge cup, an enclosed container designed to prevent aerosols from being released during centrifugation. Safety equipment also may include items for personal protection, such as gloves, coats, gowns, shoe covers, boots, respirators, face shields, safety glasses, or goggles. Examples include certain animal studies, animal necropsy, agent production activities, and activities relating to maintenance, service, or support of the laboratory facility. The recommended secondary barrier(s) will depend on the risk of transmission of specifc agents. Secondary barriers in these laboratories may include separation of the laboratory work area from public access, availability of a decontamination facility. When the risk of infection by exposure to an infectious aerosol is present, higher levels of primary containment and multiple secondary barriers may become necessary to prevent infectious agents from escaping into the environment. Such design features include specialized ventilation systems to Principles of Biosafety 23 ensure directional airfow, air treatment systems to decontaminate or remove agents from exhaust air, controlled access zones, airlocks at laboratory entrances, or separate buildings or modules to isolate the laboratory. Each combination is specifcally appropriate for the operations performed, the documented or suspected routes of transmission of the infectious agents, and the laboratory function or activity. Risk groups are the result of a classifcation of microbiological agents based on their association with, and resulting severity of, disease in humans. The laboratory director is specifcally and primarily responsible for assessing the risks and applying the appropriate biosafety levels. Often an increased volume or a high concentration of agent may require additional containment practices. Biosafety Level 2 practices, equipment, and facility design and construction are applicable to clinical, diagnostic, teaching, and other laboratories in which work is done with the broad spectrum of indigenous moderate-risk agents that are present in the community and associated with human disease of varying severity. With good microbiological techniques, these agents can be used safely in activities conducted on the open bench, provided the potential for producing splashes or aerosols is low. Louis encephalitis virus, and Coxiella burnetii are representative of the microorganisms assigned to this level. Biosafety Level 4 practices, safety equipment, and facility design and construction are applicable for work with dangerous and exotic agents that pose a high individual risk of life-threatening disease, which may be transmitted via the aerosol route and for which there is no available vaccine or therapy. When suffcient data are obtained, work with these agents may continue at this level or at a lower level. All manipulations of potentially infectious diagnostic materials, isolates, and naturally or experimentally infected animals, pose a high risk of exposure and infection to laboratory personnel, the community, and the environment. His/her knowledge and judgment are critical in assessing risks and appropriately applying these recommendations. Special characteristics of the agents used, the training and experience of personnel, procedures being conducted and the nature or function of the laboratory may further infuence the director in applying these recommendations. Clinical Laboratories Clinical laboratories, especially those in health care facilities, receive clinical specimens with requests for a variety of diagnostic and clinical support services. Typically, the infectious nature of clinical material is unknown, and specimens are often submitted with a broad request for microbiological examination for multiple agents. Biological safety cabinets also should be used for the initial processing of clinical specimens when the nature of the test requested or other information suggests the likely presence of an agent readily transmissible by infectious aerosols. Importation and Interstate Shipment of Certain Biomedical Materials the importation of etiologic agents and vectors of human diseases is subject to the requirements of the Public Health Service Foreign Quarantine regulations. Companion regulations of the Public Health Service and the Department of Transportation specify packaging, labeling, and shipping requirements for etiologic agents and diagnostic specimens shipped in interstate commerce. Nevertheless, adequate containment of biological materials is a fundamental program component for both biosafety and biosecurity. The levels are designated in ascending order, by degree of protection provided to personnel, the environment, and the community. Work is typically conducted on open bench tops using standard microbiological practices. Special containment equipment or facility design is not required, but may be used as determined by appropriate risk assessment. Laboratory personnel must have specifc training in the procedures conducted in the laboratory and must be supervised by a scientist with training in microbiology or a related science. Used disposable needles and syringes must be carefully placed in conveniently located puncture-resistant containers used for sharps disposal. Non-disposable sharps must be placed in a hard walled container for transport to a processing area for decontamination, preferably by autoclaving. Decontaminate all cultures, stocks, and other potentially infectious materials before disposal using an effective method. Depending on where the decontamination will be performed, the following methods should be used prior to transport. Wear protective eyewear when conducting procedures that have the potential to create splashes of microorganisms or other hazardous materials.

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Methods: Review of 191 robotic assisted microsurgical cases performed with the new platform from Dec 2010 to March 2012 by a single microsurgeon medications names and uses buy nootropil canada. Results: All cases were completed successfully without any technical difficulties medicine to stop runny nose cheap 800 mg nootropil free shipping. The enhanced platform provided the microsurgeon with improved visual acuity at higher magnifications medicine 5 rights nootropil 800mg online. The microsurgeon had a cockpit view of all three simultaneous video images in the surgeon console kerafill keratin treatment buy 800 mg nootropil with visa. Conclusion: this novel five-arm robotic microsurgical approach appears to overcome the magnification caveat of the standard robotic platform symptoms jaw pain and headache purchase generic nootropil online. During robotic or laparoscopic nephron sparing surgery renal hilar clamping is often employed symptoms anemia order generic nootropil from india. Unfortunately, there is no simple technique to cool renal parenchyma during laparoscopic surgery and longer warm ischemia times are associated with renal damage. Our purpose was to analyze outcomes of patients undergoing laparoscopic and robotic partial nephrectomies without hilar clamping. Methods: A retrospective database of patients undergoing partial nephrectomy from 2003-2010 was reviewed. No intra-operative complications occurred and 6 (20%) post-operative complications occurred without any reoperation. One positive margin occurred, but at a median follow -up of 34 months there have been no recurrences in these patients. Conclusion: Laparoscopic partial nephrectomy with or without robotic assistance can be performed safely without hilar clamping in select patients providing renal functional protection. Intraoperative ultrasound can help with tumor identification during partial nephrectomy. Bertolina, PhD* 1 2 3 University of Michigan, Department of Urology, HistoSonics, Inc. Methods: Following animal care and use committee approval, histotripsy treatment of the prostate was performed on ten male canine subjects. The therapy transducer (36-element, 700 kHz, 11 cm focal distance) delivered acoustic bursts (3-cycle, 500 Hz pulse repetition frequency) transabdominally to the prostate. Though not producing clinical signs or symptoms, notable pathologic findings at necropsy consisted of rectal wall muscle degeneration (2 subjects) concerning for potential histotripsy effect and 1 cm diameter areas of fibrosis in the abdominal rectus muscle (2 subjects) consistent with thermal injury along the acoustic propagation path to the prostate. Although not producing clinical effects, the pathologic findings of degeneration of muscle in the rectal wall and zones of fibrosis in the abdominal rectus muscle are of concern as they may represent suboptimal confinement of cavitation activity and heating of overlying tissues respectively. Further work is underway to quantify the pre and post-focal acoustic and thermal fields to eliminate these effects prior to human application. However, concerns over the potential risks related to ionizing radiation may limit its use. The 40 total series were anonymized and interpreted in random order for urolithiasis detection. Overall sensitivity was 76%, however, subgroup analysis by stone size showed improved detection rates for stones 3 mm, i. Typically the clinical ramifications of these stones (2 mm) is less relevant acutely. The degree of dose reduction that preserves diagnostic accuracy for tiny calculi remains uncertain, but may be influenced by further improvements in iterative reconstruction techniques. Thus we developed a robotic tool and video tracking platform, SurgTrak (White, et. The objective of both studies is to elucidate the potential benefit of virtual reality based training and warm-up on surgical performance. Conclusion: the SurgTrak system is configurable, deployable and capable of capturing many facets of surgical performance on the da Vinci surgical robot including surgeon motion, cognitive and psychomotor skills, mental workload, and surgery video documentation. A total of 13 ureteroscopy procedures for ureteral stones were performed with the XenX at two institutions by five board certified physicians. We present results from in vitro testing designed to validate modifications based on issues encountered during the first clinical evaluations. Physician feedback with regard to the ability to gain ureteral access, deploy the occluding braid, prevent stone migration, basket alongside the device, radiopacity, kink resistance, and retrieval of the device, was used to identify the most effective modifications for improving performance. Some modifications include increasing the occluding braid diameter for retention in dilated ureters, varying floppy tip length for improved maneuverability, and reducing sheath diameter for improved stent compatibility. Methods: Device migration as a result of ureteroscope manipulation within the ureter was found to affect several feedback areas and reduce overall efficiency associated with the use of this device during multiple cases. Forces were measured throughout the entire extraction, and a total of 5 repetitions were conducted using a new device each time. A similar set-up was used to conduct a comparative assessment of the extent to which device migration occurs as a result of scope movement. The average displacement of 5 repetitions was calculated and compared to results using a Sensor (Boston Scientific) guidewire. Recent modifications suggest the XenX holds promise for performing similar to commercially available guidewires, such as the Sensor, in an in vivo setting with regard to ureteroscope compatibility. Following each treatment, stone debris was collected and sequentially sieved through 8-mm, 6-mm, 4-mm, and 2-mm filters. When applied prior to lithotripsy, it is likely that surface defects induced by histotripsy erosion act as nuclei for shockwave crack propagation. When applied after lithotripsy, the increased stone surface area afforded by shockwave stone subdivision enhances the efficacy of histotripsy stone erosion. It is likely that both these effects are at play to some extent during the interleaved therapy. However, further optimization of this interleaved pulse scheme is required in order to minimize potential microbubble shielding effects of remnant histotripsy nuclei on subsequent shockwaves. Jong Yoon Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar Introduction: Bladder cancer has the highest recurrent rate. Several years of diligent and accurate postoperative surveillance are necessary to monitor the recurrences of tumors. The current surveillance procedure is carried out by an urologist who manually manipulates a cystoscope to visually inspect the bladder inner surface. In order to improve the efficiency and accuracy of cystoscopies, an automated cystoscope is proposed to scan the entire bladder surface by steering an imaging probe to follow an optimal pre-programmed scan trajectory. Images abstracted from the cystoscopic video can be used for building a 3D panorama of the bladder surface [1]. Methods: the proposed cystoscopic system consists of a three-segment bending mechanism. With the flexibility of multi-segmented mechanism, the positions and the orientations of the camera located at the tip of the imaging probe can be controlled independently. Therefore, perpendicular views on the bladder surface and the safety distance between the camera and the bladder wall are guaranteed. Compared to the previous design based on shape-memory alloy actuators [2], the proposed design is driven by thin mechanical wires. Results: the simulation results prove that with synchronized bending motions of all three segments, the distal camera can follow different specified scan trajectories. Using an optimized spiral scan trajectory with minimized translation/rotation motions and appropriate view center (camera position) density control, the anticipated time required for a complete scan is simulated as less than three minutes. In order to maintain the best quality in 3D panorama construction, this optimized trajectory maintains 50% spatial overlap between the adjacent image frames. Conclusion: A new automated cystoscopic procedure is designed to improve the overall performance of the bladder cancer surveillance and this can reduce the workload of urologists as well. The simulated results show a significant reduction in surveillance time for a complete scan compared to the previous study. The miniaturized flexible robotic articulation combined with the 3D image reconstruction is under construction and may open up the new potential to revolutionize the bladder cancer examination. Seibel, Development of and Automated Steering Mechanism for Bladder Urothelium Surveillance, Journal of Medical Devices, 2009, 3(1): 11004. Although vasectomy is more effective and less likely to have complications than tubal ligation, the number of men undergoing surgical sterilization is about three times less than women. Fear of complications related to surgical vasectomy is a major factor in a coupleschoice of surgical sterilization. A completely noninvasive technique for male sterilization may improve acceptance of vasectomy. Our laboratory is currently developing a noninvasive vasectomy technique using near-infrared laser irradiation in conjunction with cryogen spray cooling of the scrotal skin for thermal occlusion of the vas. During preliminary studies, we reported successful thermal occlusion and scarring of the vas in ex vivo and in vivo canine models, with the thermally coagulated vas segment withstanding burst pressures over twice that of normal ejaculation pressures. However, rare complications associated with sub-optimal alignment of laser and cryogen spots with the vas. These problems were in part due to misalignment and may be solved using an improved vas clamp. Methods: We describe the design and testing of a novel vasectomy ring clamp attachment which allows the surgeon to rapidly and precisely co-align both the laser spot and cryogen spot with the vas deferens for consistent and reproducible targeting of the vas. An additional fourth degree of freedom, roll, provides the user with the ability to correct for any rotation of the clamp inside the secured device. By using a cylindrical coordinate system it is possible to minimize the material necessary to achieve all three orthogonal degrees of freedom (,z), and thus provide a lightweight, handheld stainless steel design. Roll is then added by allowing the stabilizing arm which controls the component to rotate freely before it is locked into place with a set screw Figure 1). Previous problems involving misalignment of the sprayvalve roll laser and cryogen spots with the vas were eliminated. Azospermia and recanalization studies are currently being Laserdelivery fiber z conducted to determine the long-term efficacy of this andcollim ating lens technique. Using Wilcoxon Signed Rank Test, suturing and knot tying was significantly longer (p = 0. Moreland 1 University of Wisconsin School of Medicine and Public Health, Dept of Urology 2 University of Wisconsin School of Medicine and Public Health, Dept of Radiology 3 Mount Sinai School of Medicine, Dept of Radiology Introduction: Microwave ablation offers the potential advantages of high temperature and faster tissue heating, but prior instrument development has been limited by overheating of the antenna shaft and supply cables. We report the feasibility, safety, and preliminary effectiveness of this high powered, gas-cooled microwave ablation system in the treatment of renal parenchymal tumors. Tumors included biopsy-proven renal cell carcinoma (n=13; grade 1=4; grade 2=6, ungraded=3), oncocytoma (n=1), insufficient tissue for diagnosis (n=1), and angiomyolipoma (n=2, diagnosis made by imaging). Two minor complications occurred, each consisting of small, asymptomatic sub-capsular hematomas. Length of hospitalization following the ablation procedure was 1 day in each case. Among the patients who have reached follow-up imaging time-points, no local tumor progression was identified in any case (n=1, 4-month; n=1, 6-month; n=1, 12-month). Conclusion: Preliminary experience with high-powered, gas-cooled percutaneous renal microwave ablation demonstrates immediate technical success in treatment of small renal tumors. Further studies are warranted to demonstrate long-term oncologic outcomes and optimal surveillance protocols after ablation. Pathology and anatomical studies have identified specific nerve bundles within the spermatic cord that may be responsible for chronic pain in these men. There were two testicular artery and one vasal injury: these were repaired intra-operatively with robotic assisted microsurgical techniques without any further sequela. The 4th robotic arm allowed the surgeon to control one additional instrument (micro Doppler) leading to less reliance on the microsurgical assistant. Conclusion: Targeted robotic assisted microsurgical denervation of the spermatic cord is feasible and the preliminary results appear promising. Mechanical tissue shear and puncture properties where modeled to mimic human vas deferens tissue. The new model was then tested on 21 trainee microsurgeons during a hands-on microsurgical training lab. Measures recorded where ease of use, tactile similarity to human vas and suturing ability. During the 21 microsurgeon trainee lab, all the surgeons reported ease of use, tactile sensation similar to human vas and ability to suture an anastomosis similar to human vas. Conclusion: the preliminary results in the mechanical and clinical testing of the synthetic vas deferens model appear promising. This model may provide a very cost-effective, portable alternative to our current microsurgical training models. Figure: Synthetic vas deferens during robotic assisted microsurgical vasovasostomy training. While endoscope damage due to laser energy is well recognized, mechanical damage to the working channel due to repeated insertions of laser fibers is a less understood and appreciated mechanism for ureteroscope damage via working channel perforation. We evaluated ureteroscope performance metrics and working channel damage with ScopeSafe fibers and the Scope Guardian Sheath.

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