Kidney targeting and puncturing during percutaneous nephrolithotomy: recent advances and future perspectives

Background and Purpose: Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies. Results: A total of 911 abstracts and 346 full-text articles were assessed and discussed; 52 were included in this review as a summary of the main contributions to kidney targeting and puncturing. Conclusions: Multiple paths and technologic advances have been proposed in the field of urology and minimally invasive surgery to improve PCNL puncture. The most relevant contributions, however, have been provided by the applicationofmedical imaging guidance, newsurgical tools,motion tracking systems, robotics, andimage processing and computer graphics. Despite the multiple research paths for PCNL puncture guidance, no widely acceptable solution has yet been reached, and it remains an active and challenging research field. Future developments should focus on real-time methods, robust and accurate algorithms, and radiation free imaging techniques

Kidney targeting and puncturing during percutaneous nephrolithotomy:recent advances and future perspectives

Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies.

Remote Patient Monitoring Based on ZigBee: Lessons from a Real-World Deployment

AIM: This work presents detailed experimental performance results from tests executed in the hospital environment for Health Monitoring for All (HM4All), a remote vital signs monitoring system based on a ZigBee® (ZigBee Alliance, San Ramon, CA) body sensor network (BSN). MATERIALS AND METHODS: Tests involved the use of six electrocardiogram (ECG) sensors operating in two different modes: the ECG mode involved the transmission of ECG waveform data and heart rate (HR) values to the ZigBee coordinator, whereas the HR mode included only the transmission of HR values. In the absence of hidden nodes, a non-beacon-enabled star network composed of sensing devices working on ECG mode kept the delivery ratio (DR) at 100%. RESULTS: When the network topology was changed to a 2-hop tree, the performance degraded slightly, resulting in an average DR of 98.56%. Although these performance outcomes may seem satisfactory, further investigation demonstrated that individual sensing devices went through transitory periods with low DR. Other tests have shown that ZigBee BSNs are highly susceptible to collisions owing to hidden nodes. Nevertheless, these tests have also shown that these networks can achieve high reliability if the amount of traffic is kept low. Contrary to what is typically shown in scientific articles and in manufacturers' documentation, the test outcomes presented in this article include temporal graphs of the DR achieved by each wireless sensor device. CONCLUSIONS: The test procedure and the approach used to represent its outcomes, which allow the identification of undesirable transitory periods of low reliability due to contention between devices, constitute the main contribution of this work.

Loneliness in Middle and Old Age

Purpose of the research: (a) To identify the degree of much loneliness reported in the Portuguese population over 50 years of age and (b) test whether loneliness can be predicted by socio-demographic, health related or social characteristic of the sample other than age. Materials and methods: 1174 late middle age and older adults were interviewed face to face by different interviewers across the country; after the informed consent was signed, we asked the participants several socio-demographic and health-related questions; finally we asked ‘‘How often do you feel lonely?’’ and participants responded according to a five point Likert scale. Principal results: The results showed that 12% of participants reporting feeling lonely often or always, whereas 40% reporting never feeling lonely. The remaining 48% self-reported they felt lonely seldom or sometimes. Additionally, results show that, when taken together, variables such as marital status, type of housing, residence settings, health conditions, social satisfaction, social isolation, lack of interest, transportation, and age were predictors of loneliness. Major conclusions: (1) The association of loneliness with advanced age has been greatly exaggerated by mass media and common sense; (2) But although our findings did not confirm the most alarmist views, the 12% of older adults reporting that they are feeling lonely always or often should be cause for attention and concern. It is necessary to understand the meaning, reasons and level of suffering implied on those feelings of loneliness. (3) Our findings suggest that it makes no sense to construe age as a singular feature or cause for feelings of loneliness. Instead, age and also a number of other features combine to predict feelings of loneliness. But even with our predictor variables there was a substantial of variance left unexplained. Therefore it is necessary to continue exploring how feelings of loneliness arise from the experience of living and how they can be changed.

Accuracy Comparison of Implant Impression Techniques: A Systematic Review

Background: Several studies link the seamless fit of implant-supported prosthesis with the accuracy of the dental impression technique obtained during acquisition. In addition, factors such as implant angulation and coping shape contribute to implant misfit. Purpose: The aim of this study was to identify the most accurate impression technique and factors affecting the impression accuracy. Material and Methods: A systematic review of peer-reviewed literature was conducted analyzing articles published between 2009 and 2013. The following search terms were used: implant impression, impression accuracy, and implant misfit.A total of 417 articles were identified; 32 were selected for review. Results: All 32 selected studies refer to in vitro studies. Fourteen articles compare open and closed impression technique, 8 advocate the open technique, and 6 report similar results. Other 14 articles evaluate splinted and non-splinted techniques; all advocating the splinted technique. Polyether material usage was reported in nine; six studies tested vinyl polysiloxane and one study used irreversible hydrocolloid. Eight studies evaluated different copings designs. Intraoral optical devices were compared in four studies. Conclusions: The most accurate results were achieved with two configurations: (1) the optical intraoral system with powder and (2) the open technique with splinted squared transfer copings, using polyether as impression material.

Assessment of Laparoscopic Skills Performance: 2D Versus 3D Vision and Classic Instrument Versus New Hand-Held Robotic Device for Laparoscopy

Introduction and Objectives. Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons’ performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert. Materials and Methods. Each participant performed 3 laparoscopic tasks—Peg transfer, Wire chaser, Knot—in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance. Results. Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the new device improved the execution of all laparoscopic tasks (P < .05). For expert group, the 3D video system benefited them in Peg transfer and Wire chaser 1 hand, and the robotic device in Peg transfer, Wire chaser 1 hand, and Wire chaser 2 hands (P < .05). Conclusion. The HHRDL helps the execution of difficult laparoscopic tasks, such as Knot, in the naïve group. Three-dimensional vision makes the laparoscopic performance of the participants without laparoscopic experience easier, unlike those with experience in laparoscopic procedures.