Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

CONTEXT Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed. OBJECTIVE To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted. EVIDENCE SYNTHESIS The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-25% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC. Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-29% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 67-76%, 68-83%, and 61-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. CONCLUSIONS Oncologic and functional data from RARC remain immature, and longer-term prospective studies are needed. Cumulative analyses demonstrated that lymph node yields and PSM rates were similar between RARC and ORC. Conclusive long-term survival outcomes for RARC were limited, although oncologic outcomes up to 5 yr were similar to those reported for ORC. PATIENT SUMMARY Although open radical cystectomy (RC) is still regarded as the standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RCs are becoming more popular. Templates of lymph node dissection, lymph node yields, and positive surgical margin rates are acceptable with robot-assisted RC. Although definitive comparisons with open RC with respect to oncologic or functional outcomes are lacking, early results appear comparable.

An image-guided robot system for direct cochlear access

The aim of direct cochlear access (DCA) is to replace the standard mastoidectomy with a small diameter tunnel from the lateral bone surface to the cochlea for electrode array insertion. In contrast to previous attempts, the approach described in this work not only achieves an unprecedented high accuracy, but also contains several safety sub-systems. This paper provides a brief description of the system components, and summarizes accuracy results using the system in a cadaver model over the past two years.

Manual Electrode Array Insertion Through a Robot-assisted Minimal Invasive Cochleostomy: Feasibility and Comparison of Two Different Electrode Array Subtypes.

HYPOTHESIS To evaluate the feasibility and the results of insertion of two types of electrode arrays in a robotically assisted surgical approach. BACKGROUND Recent publications demonstrated that robot-assisted surgery allows the implantation of free-fitting electrode arrays through a cochleostomy drilled via a narrow bony tunnel (DCA). We investigated if electrode arrays from different manufacturers could be used with this approach. METHODS Cone-beam CT imaging was performed on fivecadaveric heads after placement of fiducial screws. Relevant anatomical structures were segmented and the DCA trajectory, including the position of the cochleostomy, was defined to target the center of the scala tympani while reducing the risk of lesions to the facial nerve. Med-El Flex 28 and Cochlear CI422 electrodes were implanted on both sides, and their position was verified by cone-beam CT. Finally, temporal bones were dissected to assess the occurrence of damage to anatomical structures during DCA drilling. RESULTS The cochleostomy site was directed in the scala tympani in 9 of 10 cases. The insertion of electrode arrays was successful in 19 of 20 attempts. No facial nerve damage was observed. The average difference between the planned and the postoperative trajectory was 0.17 ± 0.19 mm at the level of the facial nerve. The average depth of insertion was 305.5 ± 55.2 and 243 ± 32.1 degrees with Med-El and Cochlear arrays, respectively. CONCLUSIONS Robot-assisted surgery is a reliable tool to allow cochlear implantation through a cochleostomy. Technical solutions must be developed to improve the electrode array insertion using this approach.

Außerordentliches Extrablatt: Die erste goldene Frucht des Reichstages! Kein Robot! Kein Zehnt mehr! Die Stunde der Befreiung hat geschlagen, das schreckliche Wort "Unterthan" ist aus der deutschen Sprache verschwunden ...

Welsch (Projektbearbeiter): Vollendung der Bauernbefreiung, nachdem die Leibeigenschaft bereits 1781/82 unter Kaiser Joseph II. aufgehoben wurde: Bekanntgabe der Aufhebung der obrigkeitlichen Gewalt der Grundherren (ohne Entgelt) sowie der Aufhebung der Dienste und Abgaben (gegen Entschädigung). (Einstimmiger Beschluß des österreichischen Reichstages nach dem diesbezüglichen Antrag des Abgeordneten Hans Kudlich vom 26. Juli 1848)

Der Bauer ist frei: Kein Zehent, keine Robot mehr, beschlossen und mit allgemeine [sic!] Stimmenmehrheit angenommen durch die hohe Reichsversammlung, am 30. und 31. August 1848: Heute endlich gelangte der hohe Reichstag dahin, über des Abgeordneten Lasser's Antrag abzustimmen ...

Welsch (Projektbearbeiter): Der Kudlichsche Antrag auf Bauernbefreiung (26. Juli 1848) wird mit einigen Modifikationen (Abgeordneter Lasser) vom österreichischen Reichstag angenommen. Nebst Abdruck von Redebeiträgen aus den Vordebatten

Die letzte Robot: Die Bauern: "Der Wagen ist schwer, aber wir wollen hoffen ..."

Welsch (Projektbearbeiter): Satirische Kommentierung der Amendements zum Kudlichschen Antrag über die Aufhebung der bäuerlichen Untertänigkeit, die Entschädigungsfrage betreffend

Age, Growth and Population Structure of Jumbo Flying Squid, Dosidicus Gigas, Based on Statolith Microstructure Off the Exclusive Economic Zone of Chilean Waters

The jumbo flying squid, Dosidicus gigas, support an important squid fishery off the Exclusive Economic Zone of Chilean waters. However, we only have limited information about their biology. In this study, age, growth and population structure of D. gigas were studied using statoliths from 333 specimens (386 females and 147 males) randomly sampled in the Chinese squid jigging surveys from 2007 to 2008 off the Exclusive Economic Zone of Chile. Mantle lengths (MLs) of the sample ranged from 206 to 702 mm, and their ages were estimated from 150 to 307 days for females and from 127 to 302 days for males. At least two spawning groups were identified, the main spawning peak tended to occur between August and November (austral spring group), and the secondary peak appeared during March to June (austral autumn group). The ML-age relationship was best modelled by a linear function for the austral spring group and a power function for the austral autumn group, and the body weight (BW)-age relationship was best described by an exponential function for both the groups. Instantaneous relative growth rates and absolute growth rates for ML and BW did not differ significantly between the two groups. The growth rate of D. gigas tended to be high at young stages, and then decreased after the sub-adult stage (>180 days old). This study suggests large spatial and temporal variability in key life history parameters of D. gigas, calling for the collection of more data with fine spatial and temporal scales to further improve our understanding of the fishery biology of D. gigas.

Influence of Surface Oceanographic Variability on Abundance of the Western Winter-Spring Cohort of Neon Flying Squid Ommastrephes Bartramii in the Nw Pacific Ocean

Abundance of the Ommastrephes bartramii winter-spring cohort fluctuated greatly from 1995 to 2004. To understand how abundance was influenced by sea surface conditions, we examined the variations in the proportion of thermal habitats with favourable sea surface temperature (SST). The SST data of both the spawning and feeding grounds were used to calculate the monthly proportion of favourable-SST areas (PFSSTA). Catch per fishing day per fishing boat (catch per unit effort, CPUE) of the Chinese mainland squid-jigging fleet was used as squid abundance index. The relationships between CPUE and monthly PFSSTA at spawning and feeding grounds were analyzed, and the relationship between CPUE and selected PFSSTA was quantified with a multiple linear regression model. Results showed that February PFSSTA at the spawning ground and August to November PFSSTA at the feeding ground could account for about 60% of the variability in O. bartramii abundance between 1995 and 2004, that February was the most important period influencing squid recruitment during the spawning season, and that feeding ground PFSSTA during the fishing season would influence CPUE by causing squid to aggregate. Our forecast model was found to perform well when we compared the model-predicted CPUEs and the average CPUEs observed during August to November in 2005 and 2006 from the Chinese squid-jigging fishery.

Trace Elements in the Statoliths of Jumbo Flying Squid Off the Exclusive Economic Zones of Chile and Peru

Ontogenetic variation in 4 trace element ((88)Sr, (137)Ba, (24)Mg, (23)Na) concentrations and their ratios to Ca were measured in statoliths of the jumbo flying squid Dosidicus gigas off the Exclusive Economic Zone of Chilean and Peruvian waters using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The element compositions of statoliths showed no significant differences between females and males. All of the elements in different growth zones showed significant variations, except for Mg. Sr:Ca and Mg:Ca were good indicators for distinguishing squid from autumn and winter spawning seasons. Sr:Ca and Ba:Ca distribution patterns in statoliths confirmed that paralarvae and juvenile squid inhabit surface waters, while subadult squid migrate into deeper waters. An increasing Sr: Ca ratio of subadult squid could be explained by declining temperature gradients from northern to southern sampling locations, although no significant Sr: Ca differences were observed (p > 0.05). Mg:Ca ratios decreased progressively from the nucleus to the peripheral zone, which might be correlated with statolith growth rates. Na:Ca ratios slightly declined from paralarvae to the subadult phase. Quantitative relationships between statolith trace elements and environmental conditions under different growth stages are needed to improve our understanding of life history of D. gigas.

Des Kaisers Gespräch in Schönbrunn mit dem Bauer Nikolaus B... aus G... : der ihm über das gewordene Geschenk der Robot- und der Zehent-Aufhebung dankend zu den Füßen fallen wollte

P. Pichler

A journey through the secret history of the Flying Geese Model

Economic development in East Asia is characterized by the sequential "take-off" of member countries. This multi-tiered economic development in East Asia is often termed the “Flying Geese” pattern of economic development. However, some authors argue that the traditional Flying Geese pattern is not applicable to some industries such as electronics. Here, Japan may no longer be the sole "leading goose", with "followers" such as China (now producing cutting-edge products) having "caught-up". Does this mean that the Flying Geese Model has become "obsolete" in the 21st century? The main objective of this paper is to clarify the two concepts of Flying Geese which now seem confused: (1) application of the pattern of economic development in one specific country, and (2) application of the pattern of economic development to multiple countries in sequence. This paper provides validity checks of Flying Geese Models after differentiating these two concepts more clearly