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“VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes
摘要： “VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes. A prospective trial was conducted for patients undergoing holmium laser lithotripsy for ureteral stones. Patients were randomly assigned to have holmium laser lithotripsy with or without Vapor Tunnel technology. All procedures were performed by four experienced urologists. Quanta Cyber Ho 100 W generator with 365 μ fiber was used for all cases. Demographic data, stone parameters, perioperative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero-no retropulsion to 3-maximum retropulsion. Results: A total of 80 patients were included in the study (40 per each group). Both groups were comparable in terms of age, and pre-operative stone size (1.2 vs. 1.1 cm, p > 0.05). When compared with the Regular mode, Vapor Tunnel Technology was associated with significantly lower fragmentation time (20.4 vs. 16.1 min, p < 0.05) and total procedural time (49 vs. 35.7 min, p < 0.05). However, there were no significant differences in terms of total energy applied to the stones (9.9 vs. 10.7 KJ, p > 0.05). Vapor Tunnel technology was associated with significantly less retropulsion. There was no significant difference between both modes in terms of intraoperative complications. The success rate at the end of 1 month was comparable between both groups (92.3 vs. 88.3%, p > 0.05). Discussion: Vapor Tunnel technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy; thus improving stone fragmentation efficiency.
关键词： holmium laser lithotripsy,intraoperative,VaporTunnel,ureteroscopic,postoperative outcomes
更新于2025-09-23 15:19:57
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P2653Visually Guided Laser Ablation in patients with paroxysmal and persistent atrial fibrillation - a single center experience
摘要： Predictive value of left atrial emptying fraction and late gadolinium enhancement for the clinical outcomes in atrial fibrillation patients undergoing ablation. Background: A dimension, volume and function of left atrium (LA) and late gadolinium enhancement (LGE) of the LA are known as a prognostic factor for the clinical outcome of atrial fibrillation (AF) ablation. However, which of those parameters provide a best predictive power remains unclear. Purpose: We aimed to compare the efficiency of prediction among those parameters using echocardiography and cardiac magnetic resonance (CMR). Methods: Eighty-eight consecutive patients (67 males; 56±10 years old; 45 persistent AF) underwent transthoracic echocardiography (TTE) and CMR was performed one day before AF ablation. LA anterior-posterior dimension (LAD) was measured at the phase of maximal LA size on M-mode of TTE. Maximal and minimal volume indexed to body surface area (LVAi) from CMR and Area Length Method ALM. Phasic volumes were used to calculate LA emptying fraction (LAEF) ([maximum-minimum LAV]/maximum LAVx100). LGE was defined as areas with thresholds of 6-SD above mean signal in unenhanced LV wall. The LGE stage was defined based on delayed enhancement (DE) volume area divided by LA volume (Stage 1: ≤5%, Stage 2: ≤5%, Stage 3: ≤25%, Stage 4: ≤35%). Results: During mean follow-up duration: 10±3 months, AT/AF recurred in 19/88 patients (21.5%; 3/43 in PAF; 16/45 in PeAF). Compared to patients without recurrence, those with recurrence had larger maximal/minimal LAVi (maximal: 54±21 VS. 45±16, p=0.07; minimal: 40±22 VS. 26±14, p=0.02) and LAD (45.5±6.5 VS. 40.1±5.8, p=0.001) and lower LAEF (24±10 VS. 45±16, P=0.001). ROC analysis for recurrence showed that LAEF had the largest area under curve (AUC =0.86, p=0.0001) compared to maximal LAVi, minimal LAVi and LAD. LGE stage was insignificantly higher in patients with recurrence (3.6±0.7 VS. 2.9±0.9, p=0.46). Cut-off value of LAEF for freedom from recurrence was 31.0% (sensitivity = 0.82, specificity = 0.78, p=0.001). In case of PeAF, only lower LAEF (23±11 VS. 40±7, p=0.001) and larger LAD (45.5±7.1 VS. 40.5±6.3, p=0.02) were significantly related with recurrence. Adjusting clinical risk factor, Cox-regression analysis showed that LAEF was only independent predictor for freedom from recurrence (HR = 0.88; 95% CI; 0.82–0.95; p=0.001). Conclusion: LAEF measured by CMR was superior to maximal/minimal LAVi, LAD and LGE stage in predicting the AT/AF recurrence after AF ablation. Moreover, patients with PeAF and LAEF>31% had excellent clinical outcome.
关键词： left atrial emptying fraction,ablation,atrial fibrillation,late gadolinium enhancement,clinical outcomes
更新于2025-09-23 15:19:57
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Extrusion of Femtosecond Laser-Implanted Intrastromal Corneal Ring Segments in Keratoconic Eyes: Prevalence, Risk Factors, and Clinical Outcomes
摘要： Purpose. To evaluate the prevalence, possible risk factors, and clinical results of femtosecond laser implanted intrastromal corneal ring segment (ICRS) extrusion in keratoconic eyes. Patients and Methods. This is a retrospective observational study evaluating 333 eyes of 269 patients who were subjected to femtosecond laser-implanted Keraring ICRS in the Sohag Refractive Center, Sohag, Egypt, from January 2014 to January 2019. The study included eyes with channels created by a femtosecond laser (60 kHz IntraLase femtosecond system; Advanced Medical Optics, Santa Ana, California, USA) with implantation of Keraring intrastromal corneal ring segments (Mediphacos, Belo Horizonte, Brazil). Patient data and causes of Keraring extrusions were identi?ed as being those rings that migrated or showed melting of the cornea with no other reason which required segment removal. Results. Seven eyes were found to ?t the criteria of ring extrusion (2.1%) out of the 333 eyes which had Keraring implantation. All extruded rings were from patients with keratoconus grade 3, with eccentric cones, and with femtosecond creation of the tunnel. Four eyes belonging to 3 patients (57.1%) had a history of vernal Keratoconjunctivitis, yet they did not show signs of activity at the time of implantation. They reported excessive rubbing just before they presented with conjunctival hyperemia and foreign body sensation. Five eyes (71.4%) showed chronic sun exposure. The mean minimal corneal thickness was 401.85 μm (range 384–420 μm), while the mean maximum keratometry was 61 D (range 55.18–68.96 D). Most of the extruded rings had large arcs. Six eyes had crosslinking (CXL) at the same session of the Keraring implantation. The simultaneous CXL treatment is considered as a possible signi?cant risk factor for ring extrusion. Conclusion. ICRS is an e?ective reversible option for patients with keratoconus who are intolerant to hard contact lenses, yet the choice of cases and ring segments is mandatory for satisfactory results. Moreover, meticulous history taking and examination reduces the incidence of complications including extrusion.
关键词： clinical outcomes,risk factors,keratoconus,femtosecond laser,extrusion,intrastromal corneal ring segment
更新于2025-09-23 15:19:57
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Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review
摘要： Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
关键词： sexual function,outcomes,urinary function,Benign prostatic hyperplasia (BPH),prostate,photoselective vaporization of the prostate (PVP)
更新于2025-09-19 17:15:36
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Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Mode of Holmium Laser Lithotripsy
摘要： Objective: To compare Regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and methods: After obtaining ethics approval, a prospective double‐blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either Regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, peri‐ operative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero‐no retropulsion to 3‐maximum retropulsion. Results: A total of 72 patients were included in the study (36 per each arm). Both groups were comparable in terms of age, and pre‐operative stone size (1.4 vs. 1.7 cm, p>0.05). When compared with the Regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 vs. 14.2 min; p=0.03) and procedural time (50.9 vs. 41.1 min, p=0.03). However, there were no significant differences in terms of lasing time (7.4 vs. 6.1 min, p>0.05) and total energy applied to the stones (11.1 vs. 10.8 KJ, p>0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs. 0.5, p=0.01). There were no significant differences between both modes in terms of intra‐operative complications (11.1% vs. 8.3%, p>0.05), with one patient requiring endo‐ureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs. 88.4%, p> 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.
关键词： technology assessment,ureteroscopy,randomized clinical trial,holmium laser,Laser lithotripsy,outcomes assessment
更新于2025-09-19 17:13:59
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National Trends and Factors Predicting Outcomes Following Laser Interstitial Thermal Therapy for Brain Lesions: Nationwide Inpatient Sample Analysis
摘要： Introduction: Laser interstitial thermal therapy (LITT) is a stereotactic-guided technique, which is increasingly being performed for brain lesions. The aim of our study was to report the national trends and factors predicting the clinical outcomes following LITT using the Nationwide Inpatient Sample (NIS). Methods: We extracted data from 2011-2016 using ICD-9/10 codes. Patients with a primary procedure of LITT were included. Patient demographics, complications, length of hospital stay (LOS), discharge disposition and index-hospitalization charges were analyzed. Results: A cohort of 1768 patients was identified from the database. Mean LOS was 3.2 days, 82% of patients were discharged to home and in-hospitalization cost was $124,225. Complications and mortality were noted in 12.9% and 2.5% of patients following LITT, respectively. Non-Caucasian patients (ER 4.26), those with other insurance (compared to commercial, ER: 5.35), 3 and 4+ comorbidity indexes, patients with higher quartile median household income (2nd, 3rd and 4th quartile compared to first quartile) and those who underwent non-elective procedures were likely to have higher complications and less likely to be discharged home. Patients with 4+ comorbidity indexes were likely to have longer LOS (ER 1.39), higher complications (ER: 7.95), less likely to be discharged home (ER: 0.17) and higher in-hospitalization cost (ER: 1.21). Conclusion: LITT is increasingly being performed with low complication rates. Non-Caucasian race, higher comorbidity index, non-commercial insurance and non-elective procedures were predictors of higher complications and less likely to be discharged home. In-hospitalization charges were higher in patients with higher comorbidity index and those with non-commercial insurance.
关键词： LITT,nationwide inpatient sample,outcomes,National trends
更新于2025-09-19 17:13:59
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Comparison of Clinical Outcomes of CO2 Laser-Assisted Blepharoplasty Using Two Different Methods
摘要： Numerous methods have been developed for blepharoplasty, including carbon dioxide (CO2) laser-assisted blepharoplasty. Although the superiority of CO2 laser compared with the scalpel for blepharoplasty has been proposed, to the best of our knowledge, no study has compared the clinical outcomes of blepharoplasty with the CO2 laser alone versus the combined use of a scalpel and CO2 laser. In the present randomized clinical trial, 21 healthy patients underwent bilateral upper eyelid blepharoplasty. For each patient, an initial skin incision was made using the CO2 laser (setting, continuous emission; ultrapulse mode; 3 W of power) on 1 side and a scalpel on the other side. The remaining blepharoplasty steps were conducted using the CO2 laser (setting, continuous emission; 9 W of power) in both groups. The patients were evaluated on postoperative days 1, 3, 7, 14, and 30 using the postoperative repair criteria, including edema and ecchymosis. The Manchester scar scale was used to evaluate the results at 60 days after surgery. Our comparison of the 2 methods showed no signi?cant differences at 1 month after surgery using the evaluation criteria. The scar index was not signi?cantly different after 60 days, despite lower scores in the scalpel group. In upper eyelid blepharoplasty, making an initial incision with a scalpel, followed by use of a laser provides advantages similar to those found by performing the entire procedure with a CO2 laser alone.
关键词： Scalpel,CO2 Laser-Assisted Blepharoplasty,Clinical Outcomes,Upper Eyelid Blepharoplasty
更新于2025-09-19 17:13:59
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Cognitive outcomes following laser interstitial therapy for mesiotemporal epilepsies
摘要： Objective To provide a review of cognitive outcomes across a full neuropsychological profile in patients who underwent laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). Methods We examined cognitive outcomes following LiTT for mTLE by reviewing a consecutive series of 26 patients who underwent dominant or nondominant hemisphere procedures. Each patient’s pre- and postsurgical performance was examined for clinically significant change (>1SD improvement or decline on standardized scores), with a neuropsychologic battery that included measures of language, memory, executive functioning, and processing speed. Results Presurgical performance was largely consistent with previous research, where patients suffering from dominant hemisphere epilepsies demonstrated deficits in verbal learning and memory, whereas patients with nondominant hemisphere scored lower on visually mediated tests. Case-by-case review comparing presurgical to postsurgical scores revealed clinically significant improvement in both dominant and nondominant patients in learning and memory and other aspects of cognition such as processing speed and executive functioning. Of the few patients who did experience clinically significant decline following LiTT, a greater proportion had undergone dominant hemisphere procedures. Conclusions Compared with the outcome literature of dominant open anterior temporal lobectomies (ATLs), where postsurgical decline has been documented in up to 40%–60% of cases, our LiTT case series exhibited a much lower incidence of postoperative language or verbal memory decline. Moreover, promising rates of postoperative improvements were also observed across multiple cognitive domains. Future studies exploring cognitive outcomes following LiTT should include comprehensive neuropsychological findings, rather than only select domains, as clinically significant change can occur in areas other than those typically associated with mesiotemporal structures.
关键词： cognitive outcomes,mesiotemporal epilepsy,laser interstitial thermal therapy,neuropsychological profile
更新于2025-09-16 10:30:52
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Comparing Patient-Reported Outcomes of Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction
摘要： Laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) are popular refractive surgeries. The objective refractive outcomes of LASIK and SMILE have been studied extensively; both procedures have comparable safety, efficacy, and predictability. However, owing to various psychosocial factors, refractive patients may report dissatisfaction despite good postoperative vision. Hence the importance of studies on subjective patient-reported outcomes. This review discusses the role of psychometric-technique-based validated questionnaires when evaluating subjective outcomes. It also summarizes the literature on patient-reported outcomes for LASIK and SMILE.
关键词： SMILE,LASIK,patient-reported outcomes
更新于2025-09-16 10:30:52
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Drivers and Anticipated Outcomes of Solar Photovoltaic Projects –The Construction Practitioners’ Perspectives
摘要： Despite Australia receives high levels of solar radiation annually, contributions to energy production from solar sources are significantly low across the country. Whist there is no lack of studies reviewing the initiatives of solar photovoltaic (PV) projects in Australia; few have been conducted in an approach that target construction industry’s view and their professionals’ perspectives on the solar PV projects. With the growing consensus that climate change is a threat facing today’s society, this study aims to identify the relevant drivers and outcomes of solar PV projects for today’s construction industry professionals and subsequently prioritise these phenomenon in terms of their importance and anticipation. Therefore, this study approached construction industry professionals to solicit their views regarding drivers and outcomes of solar PV implementation through an online questionnaire survey. The data received from the survey was subsequently analysed through an entropy ranking approach, facilitating prioritisation and ranking of both the drivers and outcomes. The findings reveal that construction professionals prioritise lowering the cost of solar PV technology as the most effective driver to result in their increased PV uptake, and resultantly anticipate greater solar PV efficiency and energy storage as the most important outcome. The findings of this study are insightful as they deconstruct barriers that may prevent construction professionals from implementing solar PV projects. Future study in this field is suggested to focus on ways in which lowered costs of solar PV technology can be achieved and technology efficiency levels increased.
关键词： construction industry,solar photovoltaic projects,entropy ranking,outcomes,drivers
更新于2025-09-12 10:27:22