The role of flexible ureteroscopy (FURS) in the management of nephrolithiasis has increased due to the improved armamentarium. However, FURS still represents a challenging technique limiting its ...diffusion. Similar to previous experiences in laparoscopy, recently developed robotic devices may significantly compensate for the ergonomic deficiencies of FURS. Based on a short description of the history of robotic devices for laparoscopy, this article summarizes all current developments of robotic FURS. In 2008, robotic FURS was first reported using the Sensei–Magellan system designed for interventional cardiology. However, with this device the ureteroscope was only passively manipulated, which represented the main reason why this project has been discontinued after 18 clinical cases. Avicenna Roboflex™ was especially developed for FURS. It consists of a surgeon’s console and manipulator of a flexible ureterorenoscope. The console provides an adjustable seat with armrests and two manipulators of the endoscope: the right wheel enables deflection and the left horizontal joystick allows rotation as well as advancing and retracting the instrument. The speed of rotation and advancement can be regulated at the screen of the console. Using the IDEAL system for evaluation of new robotic devices, safety and efficacy of the system could be demonstrated in two multi-centric studies providing significant improved ergonomics for the surgeon (IDEAL stage 1 and 2). Future studies are necessary to determine the final role of robotic FURS.
Central nervous system involvement is one important clinical aspect of myotonic dystrophy type 1 and 2 (DM1 and DM2). We assessed CNS involvement DM1 and DM2 by 3T MRI and correlated clinical and ...neuocognitive symptoms with brain volumetry and voxel-based morphometry (VBM).
12 patients with juvenile or classical DM1 and 16 adult DM2 patients underwent 3T MRI, a thorough neurological and neuropsychological examination and scoring of depression and daytime sleepiness. Volumes of brain, ventricles, cerebellum, brainstem, cervical cord, lesion load and VBM results of the patient groups were compared to 33 matched healthy subjects.
Clinical symptoms were depression (more pronounced in DM2), excessive daytime sleepiness (more pronounced in DM1), reduced attention and flexibility of thinking, and deficits of short-term memory and visuo-spatial abilities in both patient groups. Both groups showed ventricular enlargement and supratentorial GM and WM atrophy, with prevalence for more GM atrophy and involvement of the motor system in DM1 and more WM reduction and affection of limbic structures in DM2. White matter was reduced in DM1 in the splenium of the corpus callosum and in left-hemispheric WM adjacent to the pre- and post-central gyrus. In DM2, the bilateral cingulate gyrus and subgyral medio-frontal and primary somato-sensory WM was affected. Significant structural-functional correlations of morphological MRI findings (global volumetry and VBM) with clinical findings were found for reduced flexibility of thinking and atrophy of the left secondary visual cortex in DM1 and of distinct subcortical brain structures in DM2. In DM2, depression was associated with brainstem atrophy, Daytime sleepiness correlated with volume decrease in the middle cerebellar peduncles, pons/midbrain and the right medio-frontal cortex.
GM and WM atrophy was significant in DM1 and DM2. Specific functional-structural associations related morphological changes to cognitive impairment, depression and daytime sleepiness, partly indicating involvement of complex neuronal networks.
Introduction: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. Objective: We conducted an ...individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. Methods: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. Results: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6–12 weeks; Hedges’ g = 0.39 95% CI: 0.25–0.53; follow-up 1: 3–6 months; g = 0.30 95% CI: 0.15–0.45; follow-up 2: 12 months, g = 0.27 95% CI: 0.07–0.47, compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. Conclusions: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.
We conduct a systematic exploratory investigation of the effects of firms’ existing service productivity on the success of their new service innovations. Although previous research extensively ...addresses service productivity and service innovation, this is the first empirical study that bridges the gap between these two research streams and examines the links between the two concepts. Based on a comprehensive data set of new service introductions in a financial services market over a 14-year period, we empirically explore the relationship between a firm’s existing service productivity and the firm’s success in introducing new services to the market. The results unveil a fundamental service productivity-service innovation dilemma: Being productive in existing services increases a firm’s willingness to innovate new services proactively but decreases the firm’s capabilities of bringing these services to the market successfully. We provide specific insights into the mechanism underlying the complex relationship between a firm’s productivity in existing services, its innovation proactivity, and its service innovation success. For managers, we not only unpack and elucidate this dilemma but also demonstrate that a focused customer scope and growth market conditions may enable firms to mitigate the dilemma and successfully pursue service productivity and service innovation simultaneously.
Self-tracking technologies (STTs) in the form of smart devices and mobile applications enable consumers to monitor, analyze, and interpret personal performance data on health and physical or ...financial well-being. As a result of self-tracking, consumers are not only expected to check their personal performance more actively but also to implement service professionals’ advice to improve their well-being more accurately. Despite the growing popularity of STTs, empirical evidence on the extent to which STT use enhances advice compliance remains scant. A field experiment with 538 participants in a health-care setting suggests that STT use does not increase advice compliance per se. Rather, the effectiveness of STTs depends on consumers’ self-efficacy. For consumers low in self-efficacy, STT use can even undermine advice compliance. A lab experiment with 831 participants replicates and generalizes the findings to a nonmedical professional service (i.e., fitness training). As assessments of self-efficacy might be difficult in practice, service providers in health care can use consumers’ body mass index as an easy-to-measure proxy to predict STT effectiveness. Finally, the lab experiment also identifies perceived empowerment and personalization as psychological mechanisms mediating the influence of STT use on advice compliance.
Epigenetic changes have been implicated in the malignant phenotype of Hodgkin Reed Sternberg (HRS) cells in Hodgkin lymphoma (HL), where HRS survival and proliferation depends on the ...microenvironment. The histone-deacetylase (HDAC) inhibitor LBH589 (panobinostat) showed clinical efficacy but its impact on the HRS microenvironment is unclear. Hence, we analysed the effects of LBH589 on lymphocytes and also potential combination therapies. In lymphocyte-target cell killing assays, LBH589-treatment triggered an enhanced lymphocyte-dependent lysis of HL cells despite of mild lymphocytopenic effects. In co-culture experiments of lymphocytes with HL cells, LBH589 suppressed the IFNgamma-release but increased the TNFalpha secretion. Recombinant TNFalpha boosted the lymphocyte-dependent lysis of HL target cells. In HL cell lines, LBH589 induced cell death, autophagy, and an increase of MICA/B that are ligands to natural killer cell receptors. The combination of LBH589 with Brentuximab Vedotin was inefficient due to down-regulation of CD30 as a target. Combination with gemcitabine revealed highly significant effects, suggesting a potential combination for future therapy. Based on these data we suggest that LBH589 favourably modulates the cytokine network and lymphocyte activity in the HL microenvironment.
Purpose
Neurosurgeons can have a better understanding of surgical procedures by comparing ultrasound images obtained at different phases of the tumor resection. However, establishing a direct mapping ...between subsequent acquisitions is challenging due to the anatomical changes happening during surgery. We propose here a method to improve the registration of ultrasound volumes, by excluding the resection cavity from the registration process.
Methods
The first step of our approach includes the automatic segmentation of the resection cavities in ultrasound volumes, acquired during and after resection. We used a convolution neural network inspired by the 3D U-Net. Then, subsequent ultrasound volumes are registered by excluding the contribution of resection cavity.
Results
Regarding the segmentation of the resection cavity, the proposed method achieved a mean DICE index of 0.84 on 27 volumes. Concerning the registration of the subsequent ultrasound acquisitions, we reduced the mTRE of the volumes acquired before and during resection from 3.49 to 1.22 mm. For the set of volumes acquired before and after removal, the mTRE improved from 3.55 to 1.21 mm.
Conclusions
We proposed an innovative registration algorithm to compensate the brain shift affecting ultrasound volumes obtained at subsequent phases of neurosurgical procedures. To the best of our knowledge, our method is the first to exclude automatically segmented resection cavities in the registration of ultrasound volumes in neurosurgery.
The acronym Mhc, major histocompatibility complex, is customarily not allied with topics in evolutionary biology. Here, however, we attempt to demonstrate that the Mhc has much to offer to this ...discipline and intimate that evolutionary biologists who ignore its contributions miss out on a chance of applying a new approach to vexing questions. One aspect of the Mhc in particular affords a fresh look at the population processes that transform one species into another: the trans-species polymorphism, the passage of allelic lineages from ancestral to descendant species. We provide examples of using the Mhc polymorphism in estimating the size of the founding population of new species, and of analyzing the long-term population demographies of phylogenetic lineages. We then extend the concept of trans-species polymorphism to other genes, even those not evolving under balancing selection, and argue that the phenomenon is widespread between closely related species. On the example of the cichlid fishes of Lake Victoria, we demonstrate how the concept changes the interpretation of this so-called "species flock." We contend that the conclusions reached regarding the cichlid fishes apply also to other examples of adaptive radiation, for example that of Darwin's finches, and so provide new insights into the nature of speciation in general.
The quality of histopathological specimens obtained from the upper urinary tract with conventional flexible ureterorenoscopic biopsy needs to be improved. We investigated the feasibility and biopsy ...quality of specimens obtained by cryobiopsy, compared with standard ureterorenoscopic biopsy techniques in a human ex vivo model.
Human ureters obtained from nephrectomy specimens (N=12) were dissected and canulated with an ureteral access sheath. Ureterorenoscopic biopsies were randomly obtained from different sites of the renal pelvic caliceal system using different types of instruments. The performance of two newly developed flexible cryoprobes with outer diameters of 1.1 mm (CB11) and 0.9 mm (CB09) was compared with that of the biopsy forceps(FB) and Bigopsy®(BiG) and two different Dormia baskets N-Gage (NG) and Zero-Tip (ZT). We assessed the feasibility of the various biopsy techniques based on the number of biopsy attempts needed to obtain macroscopically discernible biopsies. The specimens were examined histopathologically for size, biopsy quality, presence of various artifact types, and representativeness.
Biopsies taken with the cryoprobes showed a higher biopsy quality than biopsies taken with the comparative instruments. The CB11 provided significantly larger biopsies than forceps biopsies and also than biopsies with ZT. The CB09 was able to collect larger samples when compared with the FB and BiG biopsy forceps. There were no significant differences in artifact area, except for the CB11 cryoprobe compared with the NG. To clarify the results a subdivision of larger or smaller than 20% artifact area was performed. A significant difference was found between CB11 and the forceps biopsies, as well as between CB11 and NG and ZT in favor of the cryoprobe. The representation of the histopathological sample was also determined. Biopsies taken with CB11 were more representative compared with forceps biopsies BiG and FB and basket biopsies NG and ZT.
In a standardized comparative ex vivo setting, larger biopsies were obtained by using the cryobiopsy technique with the CB11 probe. Qualitatively, cryobiopsy specimens were overlaid by fewer artifacts and a higher biopsy quality was achieved in histopathologic examination compared with standard instrumentation. Further stepwise development will transfer the promising cryobiopsy technique into the clinical setting.
Multi-Material Jetting (MMJ) is an additive manufacturing process empowering the printing of ceramics and hard metals with the highest precision. Given great advantages, it also poses challenges in ...ensuring the repeatability of part quality due to an inherent broader choice of built strategies. The addition of advanced quality assurance methods can therefore benefit the repeatability of part quality for widespread adoption. In particular, quality defects caused by improperly configured droplet overlap parameterizations, despite droplets themselves being well parameterized, constitute a major challenge for stable process control. This publication deals with the automated classification of the adequacy of process parameterization on green parts based on in-line surface measurements and their processing with machine learning methods, in particular the training of convolutional neural networks. To generate the training data, a demo part structure with eight layers was printed with different overlap settings, scanned, and labeled by process engineers. In particular, models with two convolutional layers and a pooling size of (6, 6) appeared to yield the best accuracies. Models trained only with images of the first layer and without the infill edge obtained validation accuracies of 90%. Consequently, an arbitrary section of the first layer is sufficient to deliver a prediction about the quality of the subsequently printed layers.
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