Single port robotic assisted sacrocolpopexy: technique and tips.

INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy is the most durable surgical procedure for the treatment of symptomatic pelvic organ prolapse (Maher et al. Cochrane Database Syst Rev. 2013;(4):CD004014). The single port robotic platform has recently been approved in the USA for use in urological surgery. Innovation in robotic surgery continues to evolve, minimizing abdominal wall trauma while improving instrumentation and technical feasibility. Identifying the appropriate procedures to utilize novel technology is important to understand the role of new surgical tools. Sacrocolpopexy procedure, when performed with supracervical hysterectomy, requires extension of an incision for specimen retrieval, making it ideal for single port surgery. The technique and adaptation to new instrumentation is demonstrated in this video. METHOD: A surgical demonstration of single port robotic sacrocolpopexy is shown. RESULTS: Sacrocolpopexy was successfully completed using the single port robotic platform. CONCLUSIONS: Sacrocolpopexy is technically feasible with use of the single port robotic platform.

Excitation wavelength dependence of the photoluminescence quantum yield and decay behavior of CdSe/CdS quantum dot/quantum rods with different aspect ratios.

The excitation wavelength (λexc) dependence of the photoluminescence (PL) quantum yield (ΦPL) and decay behavior (τPL) of a series of CdSe/CdS quantum dot/quantum rods (QDQRs), consisting of the same spherical CdSe core and rod-shaped CdS shells, with aspect ratios ranging from 2 to 20 was characterized. λexc between 400-565 nm were chosen to cover the first excitonic absorption band of the CdSe core material, the onset of absorption of the CdS shell, and the region of predominant shell absorption. A strong λexc dependence of relative and absolutely measured ΦPL and τPL was found particularly for the longer QDQRs with higher aspect ratios. This is attributed to combined contributions from a length-dependent shell-to-core exciton localization efficiency, an increasing number of defect states within the shell for the longest QDQRs, and probably also the presence of absorbing, yet non-emitting shell material. Although the ΦPL values of the QDQRs decrease at shorter wavelength, the extremely high extinction coefficients introduced by the shell outweigh this effect, leading to significantly higher brightness values at wavelengths below the absorption onset of the CdS shell compared with direct excitation of the CdSe cores. Moreover, our results present also an interesting example for the comparability of absolutely measured ΦPL using an integrating sphere setup and ΦPL values measured relative to common ΦPL standards, and underline the need for a correction for particle scattering for QDQRs with high aspect ratios.

The times are changing: temporal shifts in patterns of fish invasions in central European fresh waters.

This study examines the invasion history of alien fish species based on exhaustive national data sets on fish invasions of two contiguous central European countries (Germany and Austria). Fifteen alien fish species are currently established in both countries, constituting 14 and 17% of the total freshwater fish fauna of Germany and Austria, respectively. In both countries, six alien species are present, but not established. The status of five alien species in Germany and three species in Austria remains unknown. Accumulation rates of alien fish species have increased in recent decades with >50% of them reported after 1971. North America and Asia were the primary sources of alien fish species in Germany and Austria up to the 1980s, whereas European species of Ponto-Caspian origin dominate now. Fisheries (including aquaculture) and the animal trade were responsible for most earlier introductions, whereas waterways were the main pathway for recent invaders. The extent of the spatial distribution of alien species was positively correlated with residence time, i.e. the time elapsed since the first national record. Different thermal preferences of early invaders (mostly coldwater species) and new invaders (typically warmwater adapted) may benefit the latter in the face of climate change. It is concluded that new challenges for alien fish management arise and that ecosystem-based approaches as endorsed by the E.U. Water Framework Directive (maintaining or restoring good ecological status of rivers and streams) should become the centrepiece of river management in Europe.

Note: unique characterization possibilities in the ultra high vacuum scanning transmission x-ray microscope (UHV-STXM) "MAXYMUS" using a rotatable permanent magnetic field up to 0.22 T.

Using the x-ray magnetic circular dichroism effect, the soft x-ray range provides powerful detection capabilities concerning element specific structural, chemical, and magnetic properties. We present the implementation of a variable 0.22 T magnet system based on permanent magnets into the new UHV scanning microscope "MAXYMUS" at HZB/BESSY II, allowing surface sensitive and simultaneous standard transmission microscopic investigations in a variable external magnetic field. The outstanding potential of these new investigation possibilities will be demonstrated showing the development of the magnetic domain structure concurrently at the surface and in the bulk, providing a profound understanding of fundamental mechanisms in coupled magnetic systems.

Experimental assessment of the probabilistic maturation reaction norm: condition matters.

The probabilistic maturation reaction norm (PMRN) describes an individual's probability of maturing at a given age as a function of size and other relevant phenotypic traits. Population-level shifts in the PMRN are often interpreted to indicate genetic as opposed to phenotypic changes in maturation in fish. Inferences derived from trends in the PMRN have been challenged, warranting an experimental assessment of the method. This was accomplished in a laboratory experiment using zebrafish (Danio rerio). Fish were reared under different food levels to induce variation in growth and maturation. Plasticity in maturation was not entirely captured by the demographic age- and length-based PMRN. Adding condition to the PMRN captured a greater amount of environmental variation in maturation probability. Nevertheless, significant differences in the PMRNs among the food levels remained after accounting for the influences of age, size and condition on maturation probability indicating plasticity of the PMRN. This was particularly pronounced between fish held on low food levels as compared with fish experiencing abundant resources, with the latter experiencing higher size-specific maturation probabilities. Our analysis emphasizes the need for incorporating salient physiological traits influencing maturation, such as condition, to make accurate inferences about documented shifts observed in the position of PMRNs on maturation trends in wild fish stocks.

Size-dependent reproductive success of wild zebrafish Danio rerio in the laboratory.

Size-dependent reproductive success of wild zebrafish Danio rerio was studied under controlled conditions in the laboratory to further understand the influence of spawner body size on reproductive output and egg and larval traits. Three different spawner size categories attained by size-selective harvesting of the F(1)-offspring of wild D. rerio were established and their reproductive performance compared during a 5 day period. As to be expected, large females spawned more frequently and had significantly greater clutch sizes than small females. Contrary to expectations, small females produced larger eggs when measured as egg diameter with similar amounts of yolk compared to eggs spawned by large spawners. Eggs from small fish, however, suffered from higher egg mortality than the eggs of large individuals. Embryos from small-sized spawners also hatched later than offspring from eggs laid by large females. Larval standard length (L(S))-at-hatch did not differ between the size categories, but the offspring of the large fish had significantly larger area-at-hatch and greater yolk-sac volume indicating better condition. Offspring growth rates were generally similar between offspring from all size categories, but they were significantly higher for offspring spawned by small females in terms of L(S) between days 60 and 90 post-fertilization. Despite temporarily higher growth rates among the small fish offspring, the smaller energy reserves at hatching translated into lower condition later in ontogeny. It appeared that the influence of spawner body size on egg and larval traits was relatively pronounced early in development and seemed to remain in terms of condition, but not in growth, after the onset of exogenous feeding. Further studies are needed to explore the mechanisms behind the differences in offspring quality between large- and small-sized spawners by disentangling size-dependent maternal and paternal effects on reproductive variables in D. rerio.

Permanent pacemaker therapy before and after the reunification of Germany: 16 years of experience at an East German regional pacing center.

The reunification of Germany had a significant influence on the management of patients with bradyarrhythmias. The current study was performed in a regional pacing center located in the former German Democratic Republic. It compares the situation of patients with critical bradyarrhythmias before and after the reunification of Germany in 1990 focusing on (1) indication for pacemaker implantation, (2) pacemaker modalities and function, (3) type of leads, (4) frequency of reintervention, and (5) early and late complications. The study covers 9 years before and 7 years after the reunification. A total of 1,125 patients were included, and the database was formed by the patients' files and the protocols of implantation. The situation before reunification was characterized by a nonavailability of modern physiological pacing devices and insufficient diagnostic equipment. Between 1981 and 1990, 384 patients underwent pacemaker implantation solely receiving single chamber devices with no or only minimal feasibility of programming. Between 1990 and 1996, 741 patients were treated, and they all received modern pacemakers having the capability of multiprogramming and telemetry. Regarding complications of pacemaker therapy, lead related problems significantly decreased after the reunification (dislocation, 5.3% vs 1.7%, P < 0.05; exit block, 6.7% vs 1.4%, P < 0.05) opposite to pacemaker infections, which significantly increasing after dual chamber pacemakers were implanted (2.2% vs 6.0%, P < 0.05). The reunification of Germany dramatically improved the situation of patients with critical bradyarrhythmias leading to free access to high-tech pacing equipment within a few months. However, the abrupt change from antiquated to modern pacemaker therapy created some new problems, especially regarding application and handling of modern physiological pacing devices.

Value of free prostate-specific antigen (Hybritech Tandem-R) in symptomatic patients consulting the urologist.

INTRODUCTION: Prostate-specific antigen (PSA) is a widely used tumor marker in the detection and follow-up of adenocarcinoma of the prostate. Selection of candidates for prostate biopsies is hampered by the lack of specificity resulting in a large number of unnecessary biopsies. The intention of our study was to compare the percent free PSA (f-PSA; Hybritech Tandem-R) with total PSA and age-specific PSA reference values to evaluate the clinical benefit in detecting patients with prostate cancer (PC) in a selected group of patients consulting the urologist. The question was whether cutoff points are influenced by this selection of patients. METHODS: A total of 188 patients, 114 with benign prostate hyperplasia (BPH) and 74 with PC were selected. It is a selected group of patients consulting the urologist. Diagnosis was confirmed in the BPH and PC groups by either ultrasound-guided biopsy or transurethral resection of the prostate or suprapubic adenomectomy or cystoprostatectomy. Total PSA (t-PSA) and f-PSA of all patients were measured before any manipulation by Tandem-R assay for f-PSA and Tandem-E assay for t-PSA (Hybritech). Mean values of age, prostate volume, t-PSA, f-PSA, percent f-PSA were compared in patients with BPH and PC by Mann-Whitney U test. The sensitivity and specificity of t-PSA and age-specific PSA were compared to the sensitivities and specificities of different cutoff points of percent f-PSA. RESULTS: The mean value of t-PSA, f-PSA and percent f-PSA in patients with BPH (n = 114) and PC (n = 74) were statistically significantly different. At PSA levels between 4 and 10 ng/ml 19% of negative biopsies could be avoided by the use of percent f-PSA (cutoff point 25%). There was no additional benefit of age-specific PSA. At a PSA of <4 ng/ml 6 of 7 PCs could be diagnosed by percent f-PSA (cutoff point 25%), whereas only 1 patient would be diagnosed by age-specific PSA. CONCLUSION: Percent f-PSA seems to decrease the biopsy rate at PSA levels from 4 to 10 ng/ml without missing a relevant number of cancers and to increase the detection rate at PSA <4 ng/ml. Our data indicate that it might be necessary to choose high cutoff points (25%; Tandem-E and R assay, Hybritech) in a selected study population consulting the urologist with large glands and a high prevalence of disease. However, this situation is not comparable to testing of screening populations. No benefit of age-specific PSA could be observed in this study.

Local drug delivery: impact of pressure, substance characteristics, and stenting on drug transfer into the arterial wall.

Injection parameters for local drug delivery are frequently determined by studies with marker substances. However, the pharmacologic properties of the actual drug may influence delivery efficiency and lead to different results. Aim of this study was to assess the delivery capacities of two device-drug combinations in order to verify this approach for further in vivo studies. Tritiated (3H) preparations (5 ml) of the hydrophylic low-molecular-weight heparin reviparin and the lipophilic taxane paclitaxel were injected into the left anterior descending artery of freshly explanted porcine hearts with the Infusasleeve II catheter system. A balloon support pressure of 6 atm and infusion pressures of 40, 60, 80, or 100 psi were used. In three additional groups, reviparin was injected following stent implantation and paclitaxel was injected prior to or following stent implantation. Arteries along with surrounding myocardium were harvested. The artery was carefully dissected, and artery and myocardium were separately homogenized, and activity was measured. Of the totally delivered activity, 0.09%+/-0.03% (40 psi) to 0.17%+/-0.13% (100 psi) of reviparin and 2.03%+/-0.67% (60 psi) to 2.68%+/-1.57% (100 psi) of paclitaxel were found in the vessel wall. The results for different injection pressures were not significantly different for either drug. The percentage activity delivered to the vessel wall was substantially larger in the paclitaxel group as compared to reviparin delivery (P < 0.01 at 60, 80, and 100 psi). The mean concentration of reviparin in the artery was 20 to 33 times higher than in the myocardium. For paclitaxel the factors were 110 to 243. Stent implantation prior to or following local delivery did not result in a different delivery efficiency. The results demonstrate that the characteristics of the delivered drug contribute largely to the delivery efficiency. Using identical injection parameters, drug concentrations in the arterial wall were significantly higher for the lipophilic paclitaxel as compared to the hydrophilic reviparin. Stenting of the artery did not influence delivery efficiency.

Optimizing frequency and number of controls for automatic multichannel analyzers.

Sampling strategy fundamentally influences the effectiveness of quality control with control charts. This study shows a simple approach for optimizing the control strategy for automatic multichannel analyzers that takes into account cost-efficiency considerations. Our main focus is on the frequency of controls necessary. The methods used are based on a field study (on a Hitachi/BM 747), the views of experts, and computer simulations of customary cost-models together with a survey of the literature. We found that industrial cost-models are applicable only with distinct limitations, but-unlike the test-yield model-they offer consistent solutions. On the basis of the field study and the opinions of experts, we adjusted the control strategy to account for inadequacies in the theoretical models. The combined result is that, for effective operation, the number of samples between controls may reach values up to 100 and should not require controls more often than every 30 samples on comparable multichannel analyzers. For adequate statistical performance, a simple 3-SD Shewhart chart usually requires not more than two controls of the same material at each time.

[Examination of the effect of aorto-coronary revascularisation by means of exercise tests (author's transl)]. / Aussagekraft von Belastungsuntersuchungen zur Beurteilung des Therapieerfolges nach koronarer Revaskularisation.

The purpose of this study was to determine the value of exercise tests in the examination of the effect of aorto-coronary revascularisation. 48 patients (mean age 52 +/- 6 years) were examined 5.0 +/- 1.9 months before and 4.9 +/- 3.0 months after coronary revascularisation by means of coronary and left ventricular angiography. Left ventricular function at rest was unchanged. 122 grafts were constructed, the patency rate was 86%. Preoperatively two exercise tests with a bicycle ergometer were performed, some days before angiography and some days before operation, respectively. A third test was performed postoperatively (again some days before angiography). During exercise at identical work load, heart rate and systolic blood pressure did not change significantly pre- and postoperatively. At the second preoperative examination, pulmonary artery pressure (31.6 +/- 11.3 mm Hg) was significantly lower than at the first examination (36.3 +/- 10.8 mm Hg). Postoperatively there was a further decrease of mean pulmonary artery pressure (27.6 +/- 6.5 mm Hg). At the highest work load, mean pulmonary artery pressure was significantly lower at the second preoperative and at the postoperative examination (34.4 +/- 11.6 and 31.3 +/- 8.1 mm Hg versus 39.6 +/- 9.8 mm Hg). The explanation of the preoperative reduction of pulmonary artery pressure is not clear. The pressure decrease must be considered in the examination of the effect of aorto-coronary revascularisation by means of exercise tests.

Low-dose versus high-dose insulin therapy for diabetic ketoacidosis.

The effects of low-dose continuous insulin therapy were compared to those of high-dose subcutaneous and intravenous insulin therapy in six episodes of diabetic ketoacidosis. Time for correction of acidosis, ketosis, and hyperglycemia were similar for both regimens. The high-dose method required more exogenous glucose and supplemental potassium to avoid hypoglycemia and/or hypokalemia during treatment. Levels of cortisol, human growth hormone, and glucagon, initially elevated in most patients, showed a progressive decline with both modes of therapy. Plasma insulin remained remarkably stable during both treatment regimens, but remained within the physiologic range only in patients receiving low-dose therapy. Our study suggest that either modality is effective in the treatment of diabetic ketoacidosis.