Comparison of mean operative time in patients undergoing Ho: YAG laser lithotripsy and pneumatic lithotripsy in ureterorenoscopy for ureteric calculus.

OBJECTIVE: To compare the mean operative time (MOT) in patients undergoing Ho: YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for ureteric stones. METHODS: This randomized study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan from July 2016 to November 2018. Non probability consecutive sampling technique utilized to enroll 60 patients of both gender aged 18-60 years, having ureteric calculus ≤1.5cm. Randomization was done into group I (LL) and II (PL) via computer generated number tables. Six Consultant Urologists performed surgeries under spinal anesthesia utilizing Swiss Lithoclast® Master (EMS+ S.A. Switzerland) in group II and holmium laser fiber (365µm, 8-10Hz, 9.6-16W, 2100nm wavelength) in group I respectively. MOT was noted from insertion of cystoscope till removal out of meatus. Data obtained was analyzed through IBM SPSS 24.0. RESULTS: Analysis involved 60 patients (30 each group) having similar baseline characteristics (age, gender, laterality, location). There was statistically significant different MOT between LL & PL (25.48±6.99 vs 34.83± 7.47 minutes, p < 0.001). Data stratification with respect to age, gender, laterality and stone location revealed similar trend. Lithotripsy technique significantly affected MOT (p < 0.001) on Multiple Linear Regression Analysis. CONCLUSIONS: Ho: YAG LL is an efficient technique when compared with PL in terms of MOT for ureteric stones.

Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution.

Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.

Breast cancer cells mechanosensing in engineered matrices: Correlation with aggressive phenotype.

The pathogenesis of cancer is often driven by the modulation of the tumor microenvironment. Recent reports have highlighted that the progressive stiffening of tumor matrix is crucial for malignant transformation. Though extensive work has been done analyzing the mechanotransductive signals involved in tumor progression, it is still not clear whether the stiffness induced changes in cancer cell behavior is conserved across the invasive/aggressive phenotype of cells. Here, we used synthetic hydrogel based cell culture platform to correlate the aggressive potential of the breast cancer cells to the responses to matrix stiffness. The cellular functions such as proliferation, migration, and angiogenic capability were characterized. We report that the proliferation and motility of the highly aggressive cell line MDA-MB-231 increased with increase in matrix rigidity. We also demonstrated for the first time that the change in matrix stiffness stimulated the angiogenic activity of these cells as manifested from enhanced expression of vascular endothelial growth factor (VEGF). Inhibition of actomyosin contractility attenuated proliferation of MDA-MB-231 cells on stiff matrices while promoted the growth on soft gels. In addition, the release of VEGF was reduced upon inhibition of contractility. The less and non-aggressive breast cancer cells, SKBr3 and MCF-7 respectively displayed less dependency on matrix stiffness.

On-chip porous microgel generation for microfluidic enhanced VEGF detection.

Advances in medical diagnostics and personalized therapy require sensitive and rapid measurement of minute amounts of proteins from patients. Standard ELISA is difficult to prepare and involves lengthy protocols. Here we report a novel method using capture antibody immobilized porous poly (ethylene) glycol diacrylate (PEGDA) hydrogel microspheres to enable high sensitivity VEGF detection in arrayed microfluidics. Our technique incorporates antibody encapsulation, trapping, and flow perfusion on a single device. We showed that the convergence of tunable porous hydrogel with efficient microfluidics improved the sensitivity of the assay. The detection limit of this microfluidic porous microgel based assay was 0.9 pg/mL, with only 1+ hour of assay time, demonstrating a novel assay that exceeded conventional technologies in terms of sensitivity and speed.

Sensitive, quantitative, and high-throughput detection of angiogenic markers using shape-coded hydrogel microparticles.

Elevated serum concentrations of angiogenic markers including vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and platelet-derived growth factor (PDGF) have been correlated with various clinical disorders including cancer, cardiovascular diseases, diabetes mellitus, and liver fibrosis. In addition, the correlation between the serum concentrations of these factors, clinical diagnosis, prognosis, and response to therapeutic agents is significant. Thereby suggesting high-throughput detection of serum levels of angiogenic markers has important implications in early detection of different clinical disorders as well as for subsequent therapy monitoring. Here, we demonstrate the feasibility of utilization of shape-coded hydrogel microparticle based suspension arrays for quantitative and reproducible measurement of VEGF, FGF, and PDGF in single and multiplexed assays. Bio-inert PEG hydrogel attenuated the background signal thereby improving the sensitivity of the detection method as well as eliminating the need for blocking the proteins. In the singleplexed assay, the detection limits of 1.7 pg ml(-1), 1.4 pg ml(-1), and 1.5 pg ml(-1) for VEGF, FGF, and PDGF respectively indicated that the sensitivity of the developed method exceeds that of the conventional technologies. We also demonstrated that in the multiplexed assays, recovery of the proteins was within 20% of the expected values. The practical applicability of the hydrogel microparticle based detection system was established by demonstrating the ability of the system to quantify the production of VEGF, FGF, and PDGF by breast cancer cells (MDA-MB-231).

Missed pulmonary metastasis.

OBJECTIVE: To assess the rate of detection of pulmonary nodules on preoperative computed tomography, based on intraoperative palpation of non-imaged pulmonary nodules, in patients who underwent thoracotomy for metastasectomy with bimanual lung palpation. METHODS: A retrospective study carried out on all cases of pulmonary metastasectomy performed in King Faisal Specialist Hospital and Research Center over a 10-year period (2001-2011). The number of nodules detected on preoperative computed tomography by a radiologist was compared with the number of nodules identified on pathology. Resected pulmonary nodules were classified to benign or malignant. Secondary outcomes were operative approach and primary malignancy. RESULTS: 215 metastasectomies were performed by thoracotomy. The incidence of nodules that were not imaged preoperatively was 36% (41% of mesenchymal tumors, 28% of epithelial tumors). CONCLUSION: Metastasectomy by an open approach, which affords bimanual palpation of the entire lung, discovered ipsilateral non-imaged malignant pulmonary metastases in 36% of cases (41% of mesenchymal tumors).

Integrated effects of matrix mechanics and vascular endothelial growth factor (VEGF) on capillary sprouting.

Angiogenesis is the growth of new capillaries from existing vasculature. Vascular network formation is known to be regulated by the biophysical and biochemical signals emanating from the microenvironment. However, it is not clear how endothelial cells integrate these signals to drive the capillary morphogenesis. In this study, human umbilical endothelial cells (HUVECs) were seeded on scaffolds with varying stiffness and capillary formation was quantified. Our study revealed that cells formed well defined networks on compliant gels. Increase in stiffness resulted in a decrease in sprouting. VEGF was encapsulated within the scaffolds at concentrations ranging from 0 to 100 ng/mL to investigate the interplay between VEGF concentration profiles and matrix stiffness in guiding network formation. Quantitative analysis revealed that while VEGF disrupted sprout formation on compliant substrates, it elicited a sprouting response in cells seeded on scaffolds of intermediate rigidity. Additionally, we also observed that a minimum cell density is required for the formation of well-connected vascular networks.

Sensitive quantification of vascular endothelial growth factor (VEGF) using porosity induced hydrogel microspheres.

Vascular endothelial growth factor (VEGF) plays a crucial role in vasculogenesis (blood vessel formation) and angiogenesis (capillary formation from a pre-existing blood vessel). Dysregulation of VEGF has been associated with several diseases including cancer, rheumatoid arthritis, and psoriasis. As a result, serum level of VEGF has important implications as biomarker for different clinical disorders as well as for subsequent therapy monitoring. A simple detection method capable of rapid and sensitive analysis of VEGF in serum of patients with different clinical disorders is of paramount importance. Here, we report the fabrication and utilization of capture-antibody immobilized macro-porous poly(ethylene) glycol diacrylate (PEGDA) hydrogel microspheres for quantitative and reproducible measurement of VEGF. We demonstrate that induction of porosity using PEG porogen improves the sensitivity of this simple hydrogel microsphere based system with a detection limit of 2.5 pg/ml; indicating that the sensitivity of the assay exceeds that of the conventional technologies.