Background ERCP can be associated with serious complications. Difficulty in common bile duct (CBD) cannulation is one of the main risk factors for post-ERCP pancreatitis. The double-guidewire ...technique (DGT) has been considered a promising alternative approach in difficult cannulation situations. Objective To compare the performance of DGT with the standard cannulation technique (SCT) in patients in whom CBD cannulation is difficult to perform. Design Multicenter randomized, controlled trial. Setting Six tertiary referral centers. Patients A total of 188 patients with difficult CBD cannulation defined by completion of 5 unsuccessful cannulation attempts were enrolled. Interventions Ninety-seven patients were assigned to the DGT group and 91 to the SCT group. Both techniques were compared for an extra 10 cannulation attempts. Main Outcome Measurements CBD cannulation rate, number of attempts required to cannulate, and ERCP-related complications. Results Successful CBD cannulation was achieved in 46 of 97 (47%) patients in the DGT group compared with 51 of 91 (56%) in the SCT group (OR 0.85; 95% CI, 0.64-1.12). The median number of attempts required for each group was 9 and 7, respectively ( P = .128). The incidence of post-ERCP pancreatitis was 17% in the DGT group and 8% in the SCT group (OR 2.13; 95% CI, 0.89-5.05). Limitations Reduced number of enrolled subjects and a lack of detailed information regarding the number and extent of pancreatic duct contrast injections. Conclusions In patients with difficult CBD cannulation, DGT was not superior to SCT in achieving CBD cannulation. DGT might be associated with a higher risk of post-ERCP pancreatitis. (This study has been registered in ClinicalTrials.gov with identifier NCT00270868 .)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background Robot-assisted and laparoscopic partial nephrectomies (PNs) for medial tumors are technically challenging even with the hilum clamped and, until now, were impossible to perform ...with the hilum unclamped. Objective Evaluate whether targeted vascular microdissection (VMD) of renal artery branches allows zero-ischemia PN to be performed even for challenging medial tumors. Design, setting, and participants A prospective cohort evaluation of 44 patients with renal masses who underwent robot-assisted or laparoscopic zero-ischemia PN either with anatomic VMD (group 1; n = 22) or without anatomic VMD (group 2; n = 22) performed by a single surgeon from April 2010 to January 2011. Intervention Zero-ischemia PN with VMD incorporates four maneuvers: (1) preoperative computed tomographic reconstruction of renal arterial branch anatomy, (2) anatomic dissection of targeted, tumor-specific tertiary or higher-order renal arterial branches, (3) neurosurgical aneurysm microsurgical bulldog clamp(s) for superselective tumor devascularization, and (4) transient, controlled reduction of blood pressure, if necessary. Measurements Baseline, perioperative, and postoperative data were collected prospectively. Results and limitations Group 1 tumors were larger (4.3 vs 2.6 cm; p = 0.011), were more often hilar (41% vs 9%; p = 0.09), were medial (59% and 23%; p = 0.017), were closer to the hilum (1.46 vs 3.26 cm; p = 0.0002), and had a lower C index score (2.1 vs 3.9; p = 0.004) and higher RENAL nephrometry scores (7.7 vs 6.2; p = 0.013). Despite greater complexity, no group 1 tumor required hilar clamping, and perioperative outcomes were similar to those of group 2: operating room time (4.7 and 4.1 h), median blood loss (200 and 100 ml), surgical margins for cancer (all negative), major complications (0% and 9%), and minor complications (18% and 14%). The median serum creatinine level was similar 2 mo postoperatively (1.2 and 1.3 mg/dl). The study was limited by the relatively small sample size. Conclusions Anatomic targeted dissection and superselective control of tumor-specific renal arterial branches facilitate zero-ischemia PN. Even challenging medial and hilar tumors can be excised without hilar clamping. Global surgical renal ischemia has been eliminated for most patients undergoing PN at our institution.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective
To assess the advantages of cancer image visibility when using multiparametric transrectal ultrasonography (TRUS) in potential candidates for focal therapy for prostate cancer.
Patients and ...Methods
A total of 93 potential candidates for focal cryotherapy underwent grey‐scale and Doppler TRUS‐guided biopsy.
All real‐time TRUS images were recorded, allowing subsequent reviewing for the planning of targeted focal cryotherapy, and/or follow‐up targeted biopsy. The spatial mapping of TRUS‐visible lesions and targeted sampling areas were individually documented in schematic anatomic drawings of the prostate.
Data from the baseline imaging‐targeted biopsies were compared with systematic (non‐targeted) biopsies. Of the 93 patients, 73 patients with low‐ to intermediate‐risk disease were eventually considered to be candidates for hemi‐ablative focal cryosurgery, i.e. cryoablation of one lobe.
Results
Among the 93 patients, a total of 681 biopsy cores were available for analysis, including imaging‐targeted (n = 256, 37.5%) and systematic (n = 425, 62.5%) cores. Of the 256 targeted biopsy cores, 65% (n = 167) were positive for cancer, compared with 6.2% (26/425) in systematic (non‐targeted) cores (P < 0.001). A total of 88% (82/93) of the biopsy‐proven cancer index lesions were TRUS‐visible.
When comparing TRUS‐visible with image‐invisible index lesions, the cancer‐involved core length was 6.1 vs 1.5 mm (P < 0.001), respectively. Furthermore, the percent of core with involved cancer was 48 vs 16% (P < 0.001), and the mean Gleason score was 7.0 vs 6.2 (P < 0.001).
With increasing TRUS‐visible lesion size (<10, 11–15, 16–20, >20 mm), cancer‐involved core length and percent of core with cancer also significantly increased (P = 0.009 and P = 0.008, respectively).
Conclusions
TRUS‐guided targeted biopsies significantly improved the detection and staging of higher grade and larger volume cancer, compared with image‐blind (non‐targeted systematic) biopsies.
Image visibility enhanced the precise targeting and accurate spatial mapping of cancer to help identify more appropriate candidates for focal therapy.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
We will prove an analogue of Landauʼs necessary conditions H.J. Landau, Necessary density conditions for sampling and interpolation of certain entire functions, Acta Math. 117 (1967) 37–52 for spaces ...of functions whose Hankel transform is supported in a measurable subset
S of the positive semi-axis. As a special case, necessary density conditions for the existence of Fourier–Bessel frames are obtained.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This paper presents a qualitative analysis of transportation system changes that occurred in New York City (NYC) from the beginning of the COVID-19 pandemic until the city began its first phase of ...reopening in June 2020. The study was conducted by tracking publicly available transportation-related news articles and publications, 1) to capture key issues and challenges and 2) to identify changes in policies, services, and infrastructure that occurred in response across five passenger transportation modes: public transit; taxis; ridesharing; personal driving; and cycling and micromobility. Results were assessed to identify common issues and interactions between modes. The paper concludes with key lessons learned from this event, and recommendations for future policy.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Nonuniform local flow inside randomly porous media of gas–solid packed beds of low aspect ratios ranging from 1.5 to 5 was investigated by three-dimensional modeling and near-infrared tomography. ...These beds are known to demonstrate heterogeneous mixing and uneven distributions of mass and heat. The effects of the confining wall on flow dynamics were found nonlinear, particularly for aspect ratios lower than 3. High velocities were mainly observed in regions near the wall of aspect ratio value of 1.5 and those of values higher than 3, owing to high local porosities in these zones. Mass dispersion characterized both by experimental near-infrared imaging and by particle tracking showed discrepancies with literature models, particularly for aspect ratios lower than 3. Uncertainties were more significant with the radial dispersion due to bed size limits. Beyond this value, the wall affected more the axial dispersion, confirming the nonlinear impact of the wall on global hydrodynamics.
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IJS, KILJ, NUK, PNG, UL, UM
ObjectivesTo assess the feasibility of a novel percutaneous navigation system (Translucent Medical, Inc., Santa Cruz, CA, USA) that integrates position‐tracking technology with a movable tablet ...display.
Materials and Methods
A total of 18 fiducial markers, which served as the target centres for the virtual tumours (target fiducials), were implanted in the prostate and kidney of a fresh cadaver, and preoperative computed tomography (CT) was performed to allow three‐dimensional model reconstruction of the surgical regions, which were registered on the body intra‐operatively. The position of the movable tablet's display could be selected to obtain the best recognition of the interior anatomy. The system was used to navigate the puncture needle (with position‐tracking sensor attached) using a colour‐coded, predictive puncture‐line. When the operator punctured the target fiducial, another fiducial, serving as the centre of the ablative treatment (treatment fiducial), was placed. Postoperative CT was performed to assess the digitized distance (representing the real distance) between the target and treatment fiducials to evaluate the accuracy of the procedure.
Results
The movable tablet display, with position‐tracking sensor attached, enabled the surgeon to visualize the three‐dimensional anatomy of the internal organs with the help of an overlaid puncture line for the puncture needle, which also had a position‐tracking sensor attached. The mean (virtual) distance from the needle tip to the target (calculated using the computer workstation), was 2.5 mm. In an analysis of each digitalized axial component, the errors were significantly greater along the z‐axis (P < 0.01), suggesting that the errors were caused by organ shift or deformation.
Conclusion
This virtual navigation system, integrating a position‐tracking sensor with a movable tablet display, is a promising advancement for facilitating percutaneous interventions. The movable display over the patient shows a preoperative three‐dimensional image that is aligned to the patient. Moving the display moves the image, creating the feeling of looking through a window into the patient, resulting in instant perception and a direct, intuitive connection between the physician and the anatomy.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Nummular headache (NH) is an unusual disorder attributed to a dysfunction of the epicranial nerves. We report a new series of cases, highlighting some clinical features, the association with other ...headaches, and the therapeutic response. Data of patients with NH, fulfilling ICHD-3 criteria, observed in a Headache Outpatient clinic during 5 years, were retrieved from records. Response to onabotulinumtoxinA was recorded prospectively and evaluated with a Headache Impact Test (HIT). Twenty-four patients, aged 53.8 (±14.6) years at diagnosis, 13 women, had definitive (N = 21) or probable (N = 3) NH for an average of 2.4 years. Headache was consistently localized, more frequently extratrigeminal (N = 15) and parietal, and confined to the scalp. Pain was unremitting since onset in 58.3% of mild-to-moderate severity often with superimposed paroxysms (66.7%) and local allodynia (70.8%). In five cases, there was a possible precipitant. Thirteen patients reported other headaches, preceding NH by 8.2 years. In eight persistent cases, there was a significant improvement on HIT, after onabotulinumtoxinA. Despite its persistence, NH may go unrecognized for years. It often follows other headache types and has some tropism for hair-covered regions of the scalp. OnabotulinumtoxinA seems effective in persistent cases.
Objectives
To describe, step‐by‐step, our hands‐free technique for focal cryoablation of prostate cancer.
Materials and Methods
After detailed discussion of its limitations and benefits, consent was ...obtained to perform focal cryoablation in patients with biopsy‐proven unilateral low‐ to intermediate‐risk prostate cancer. The procedure was performed transperineally, using a hands‐free technique (without an external grid template) under real‐time bi‐plane transrectal ultrasonography (TRUS) guidance, using an argon/helium‐gas‐based third generation cryoablation system. Follow‐up consisted of validated questionnaires, physical examination, PSA measures, multiparametric TRUS and/or magnetic resonance imaging (MRI) and mandatory biopsy.
Results
The important steps for achieving safety, satisfactory oncological and functional outcomes included: patient selection, including TRUS/MRI fusion target biopsy; thermocouple and cryoprobe placement with a hands‐free technique, allowing delivery in unrestricted angulations according to the prostatic contour, the course of the neurovascular bundle and the rectal wall angle; and hands‐free bi‐plane TRUS probe manipulation to facilitate real‐time monitoring of anatomical landmarks at the ideal angle of the image plane. To achieve a lethal temperature in the known cancer area, while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall, continuous intraoperative control of the thermocouple temperatures was necessary, as were real‐time TRUS monitoring of ice‐ball size, control of the energy delivered and the use of a warming urethral catheter.
Conclusion
We have described step‐by‐step the focal cryoablation of prostate cancer using a hands‐free technique. This technique facilitates the effective delivery of cryoprobes and the intra‐operative real‐time quick manipulation of the TRUS probe.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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