Next-Generation Surgical Navigation Systems in Sinus and Skull Base Surgery

Over the past 25 years, rhinologists have adopted surgical navigation technology for endoscopic sinus and skull base procedures. Navigation systems often produce a wide target registration error (TRE). Ideally, next-generation systems will include a leap in target registration error reduce TRE through innovative hardware and software. Incorporation of microsensors will be another important innovation. Future systems are likely to include augmented reality, which can project overlays of critical anatomy on real-world endoscopic images. Recent trends in surgical navigation suggest a phase of rapid evolution.

Laser-generated shockwaves enhance antibacterial activity against biofilms in vitro

BACKGROUND AND OBJECTIVES

Bacterial biofilm formation within chronic wound beds, which provides an effective barrier against antibiotics, is a known cause of recalcitrant infections and a significant healthcare burden, often requiring repeated surgical debridements. Laser-generated shockwaves (LGS) is a novel, minimally invasive, and nonthermal modality for biofilm mechanical debridement which utilizes compressive stress waves, generated by photonic absorption in thin titanium films to mechanically disrupt the biofilm. Prior studies have demonstrated LGS monotherapy to be selectively efficacious for biofilm disruption and safe for host tissues. In this study, we sought to determine if LGS can enhance the antimicrobial activity and biofilm disruption capability of topical antibiotic therapy.

STUDY DESIGN/MATERIALS AND METHODS

Staphylococcus epidermidis biofilms grown in vitro on glass were treated with topical gentamicin (31, 62, and 124 μg/ml) with and without LGS (n = 3-11/treatment group). Mechanical shockwaves were generated with a 1,064 nm Nd:YAG laser (laser fluence 110.14 mJ/mm² , pulse duration 5 ns, spot size 3 mm). Following a 24-hour incubation period, bacterial viability was assessed by determining the number of colony-forming units (CFU) via the Miles and Misra method. Residual biofilm bioburden was analyzed using the crystal violet biofilm assay.

RESULTS

With gentamicin monotherapy, CFU density (CFU/mm² ) at 31, 62, and 124 μg/ml were (282 ± 84) × 10⁴ , (185 ± 34) × 10⁴ , and (113 ± 9) × 10⁴ , respectively. With LGS and gentamicin therapy, CFU density decreased to (170 ± 44) × 10⁴ , (89 ± 24) × 10⁴ , and (43 ± 3) × 10⁴ , respectively (P = 0.1704, 0.0302, and 0.0004 when compared with gentamicin alone). Biofilm burden as measured by the assay in the gentamicin 31, 62, and 124 μg/ml groups was reduced by 80%, 95%, and 98% when LGS was added (P = 0.0102, >0.0001, and 0.0001 for all groups when compared with gentamicin alone). Furthermore, samples treated with LGS saw an increase in susceptibility to gentamicin, in terms of reduced biofilm bioburden and CFU densities.

CONCLUSION

LGS enhances the efficacy of topical antibiotics in an in vitro model. This has significant implications for clinical applications in the management of chronic soft tissue infections and recalcitrant chronic rhinosinusitis. Lasers Surg. Med. 49:539-547, 2017. © 2017 Wiley Periodicals, Inc.

Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation

Background:

Microsensor navigation has the potential to aid balloon sinus ostial dilation by providing real-time tracking of balloon devices within the complex anatomy of the sinonasal cavities.

Objective:

This feasibility study evaluated the incorporation of a new microsensor technology into a flexible guidewire for use with current instruments in balloon sinus ostial dilation.

Methods:

A retrospective study was conducted to include seven men and one woman (age range, 33–68 years), who underwent balloon sinus ostial dilation with flexible microsensor navigation in the operating room setting. All the procedures were performed at target sinuses with the patient under general anesthesia, in conjunction with subsequent endoscopic sinus surgery.

Results:

Balloon dilation was attempted at the maxillary (n = 3), frontal (n = 14), and sphenoid (n = 1) sinuses. In all the cases, the surgical navigation system displayed the flexible wire tip as it was advanced to the target sinus ostia; this visual feedback for wire position guided the balloon placement. Successful balloon dilation with assistance of flexible microsensor navigation was performed on most sinuses, except a single frontal sinus with adjacent type 2 frontal cells.

Conclusion:

Flexible navigation technology may be combined with balloon sinus technology to facilitate localization of instruments in the sinus anatomy. Additional optimization of both the device and software technology is warranted.

[Comparison of intensified myeloablative conditioning regime without antithymocytic globulin (ATG) with myeloablative conditioning regime for single-unit unrelated umbilical cord blood transplantation in hematological malignancies]

OBJECTIVE

To campare the effect and tolerance beween intensified myeloablative conditioning regime (IMCR) without antithymocyte globulin (ATG) and myeloablative conditioning regime (MCR) for single-unit unrelated umbilical cord blood transplantation (sUCBT) in hematological malignancies.

METHODS

The clinical data of 190 patients with hematological malignancies undergoing sUCBT between April 2000 and December 2013 at Department of Hematology, Anhui Provincial Hospital were retrospectively analyzed, of whom 156 received IMCR without ATG (IMCR group), including 79 patient receiving total body irradiation (TBI)/cytosine arabinoside (Ara-C)/cyclophosphamide (CY) regime, 47 receiving fludarabine (Flu)/busulfan (Bu)/CY regime, and 30 receiving Ara-C/Bu/CY regime, and all of the 156 received a combination of cyclosporine A (CsA) and mycophelonate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD); the remaining 34 patients received MCR (MCR group), 30 patients receiving Bu/CY regime, and 4 receiving TBI/CY regime, all using CsA/MMF±ATG or methotrexate (MTX) for the prophylaxis of GVHD. The two groups were compared in disease status at the time of transplantation, characteristics of graft, transplantation effect, and transplantation-related complications.

RESULTS

There were no statistically significant differences between the two groups in gender, disease type, human leukocyte antigen match, ABO blood type match, and disease status at the time of transplantation (all P>0.05). The median age and body weight at transplantation in the IMCR group were significantly higher than those in the MCR group (13 years vs 9 years, P=0.003; 44 kg vs 26 kg, P=0.000). The median doses of infused total nucleated cells (×10(7)/kg) and CD34(+) cells (×10(5)/kg) in the IMCR group were significantly lower than in the MCR group (3.87 vs 4.99, P=0.002; 2.00 vs 3.17, P=0.000). The cumulative incidence of myeloid engraftment on the 42th day and platelet engraftment on the 120th day in the IMCR group were remarkably higher than in the MCR group [96.33%(95%CI: 96.27%-96.39%)vs 82.30%(95%CI: 80.67%-83.93%), P=0.000; 86.44%(95%CI: 86.28%-86.60%)vs 51.17%(95%CI: 49.02%-53.32%), P=0.002]. There were no statistically significant differences in the incidences of grade Ⅱ to Ⅳ acute GVHD, grade Ⅲ to Ⅳ acute GVHD, and 2-year chronic GVHD(P=0.482, 0.928, 0.579). The incidence of pre-engraftment syndrome in the IMCR group was higher than in the MCR group(82.70% vs 47.06%, P=0.000). And 180-day transplantation-related mortality (TRM) in the IMCR group was lower than that in the MCR group [20.50%(95%CI: 20.28%-20.71%)vs 42.20% (95%CI: 41.32%-45.09%), P=0.004]. Up to October 2015, with a median follow-up of 44.2(22.7-188.9)months, the estimated 3-year overall survival and disease-free survival in the IMCR group were both significantly higher than those in the MCR group (62.90% vs 34.10%, P=0.000; 58.60% vs 34.10%, P=0.001).

CONCLUSION

IMCR without ATG may improve the engraftment without increasing complications, reduce early transplantation-related mortality, and improve survival.

[Prognostic factors for inability to walk independently in patients with multiple system atrophy]

Objective: To explore the prognostic factors for inability to walk independently in patients with multiple system atrophy (MSA). Methods: A total of 123 patients with clinically confirmed MSA admitted to Navy General Hospital and Dongfang Hospital affiliated to the Second Clinical Medical College of Beijing University of Chinese Medicine, from February 2013 to February 2016, were retrospectively reviewed. Clinical data and all records were collected and all subjects were followed up by a telephone call in February 2016. The second milestone of activities of daily living scale (ADL), defined as inability to walk independently, was taken as the primary outcome. Eight possible prognostic factors were investigated and the survival analysis was performed with Cox proportional hazards model regression. Results: Of all the MSA patients, 74 subjects were men and 49 were women with a sex radio of 1.51∶1(M∶F). Seventy cases were diagnosed with MSA-cerebellar type (MSA-C) and 53 with MSA-Parkinson type (MSA-P) (C∶P=1.32∶1). Mean age at the onset of first symptom was (53±8) years old. All patients had severe autonomic nervous dysfunction. At the last follow-up, 56 cases (45.5%) were unable to walk independently. The median survival time from the onset of MSA to inability to walk independently was 73 months. The age of onset ≥ 55 years (HR=1.969, 95%CI 1.095-3.542, P=0.024) and the interval time from disease onset to combined motor and autonomic involvement≤3 years (HR=2.308, 95%CI 1.158-4.600, P=0.017) were independent prognostic factors for inability to walk independently, while gender, MSA clinical subtypes, initial symptoms, alcohol intake, smoking and toxic exposure were not indicators for independent walking (P>0.05). Conclusions: The prognostic factors for inability to walk independently in patients with MSA are the age of onset ≥55 years and the interval time from disease onset to combined motor and autonomic involvement≤3 years. Although factors including gender, MSA clinical subtypes, initial symptoms, alcohol intake, smoking and toxic exposure are not the predictive factors for inability to walk independently in our MSA patients, their roles in the prognosis of MSA still need further investigation.

Transfer and expression of the rabbit defensin NP-1 gene in lettuce (Lactuca sativa)

Lettuce (Lactuca sativa L.) is an annual plant of the daisy family, Asteraceae, with high food and medicinal value. However, the crop is susceptible to several viruses that are transmitted by aphids and is highly vulnerable to post-harvest diseases, as well as insect and mammal pests and fungal and bacterial diseases. Here, the rabbit defensin gene NP-1 was transferred into lettuce by Agrobacterium-mediated transformation to obtain a broad-spectrum disease-resistant lettuce. Transgenic lettuce plants were selected and regenerated on selective media. The presence of the NP-1 gene in these plants was confirmed by western blot analyses. Resistance tests revealed native defensin NP-1 expression conferred partial resistance to Bacillus subtilis and Pseudomonas aeruginosa, which suggests new possibilities for lettuce disease resistance.

[The clinical analysis and surgical management of infant nasopharyngeal neoplasms]

Objective:To analysis the clinical features, diagnosis and treatment experience of nasopharyngeal neoplasm in infants.Method:Twenty infants cases of nasopharyngeal neoplasm, from June 2002 to March 2015, admitted in our department were retrospectively studied. Nasopharyngeal neoplasm in all cases were ablated with low temperature plasma radiofrequency ablation after anesthesia downlink preoperative 70 degrees endoscope, and new biological routine pathologic examination were done.Result:The low temperature plasma radiofrequency ablation has several advantages,such as simple and convenient operating, short operating time, intraoperative blood loss and clear vision.Five cases were diagnosed as postoperative pathological cyst,4 cases were teratoma, 4 cases were hairy polyps,3 cases were hamartoma, 2 cases were hyperplasia of lymphoid tissue, 1 case was glioma, and 1 case was rhabdomyosarcoma. Postoperative follow-up for 6 months to 12 years, recurrence were found in 2 cases, including 1 death case.Conclusion:Infants nasopharyngeal neoplasm are almost benign, clinical rare congenital nasopharyngeal tumor more than the early detection of an infant. CT and MRI examination has important significance to the diagnosis. Low temperature plasma radiofrequency ablation with Seventy degrees nasal endoscope is worth extending.

Effects of arginine supplementation during early gestation (day 1 to 30) on litter size and plasma metabolites in gilts and sows

Two experiments were conducted, under typical commercial swine production conditions, to determine effects of dietary arginine supplementation during early gestation on the performance of gilts and sows. In Exp. 1, between d 1 and 30 of gestation, 62 Landrace gilts and 113 sows consumed a corn- and soybean meal-based diet supplemented with 1.3% -arginine HCl or 2.2% -alanine. Total numbers of piglets born ( < 0.05) and born alive ( < 0.01) per litter and litter birth weights of piglets born ( < 0.05) and born alive ( < 0.05) were increased in the arginine group compared with the control. In Exp. 2, 155 multiparous Landrace sows received 1.3% -arginine HCl supplementation between d 1 and 14 (T2; = 41), d 15 and 30 (T3; = 40), or d 1 and 30 (T4; = 37), whereas the control group received 2.2% -alanine supplementation between d 1 and 30 (T1; = 37). Blood samples were randomly obtained from 6 sows per group on d 1, 14, and 28 of gestation to determine plasma concentrations of AA and related metabolites. Total numbers of piglets born ( = 0.084) and born alive ( = 0.080) per litter tended to be higher for sows supplemented with arginine between d 1 and 14 of gestation (T2) than for control sows (T1). Concentrations of arginine and nitric oxide metabolites were greater ( < 0.05) in T4 compared with T1 and T3 on d 14 of gestation and were also greater in T4 compared with T1 and T2 on d 28 of gestation. Plasma concentrations of spermidine ( < 0.001) were increased in T3 and T4 compared with T1 and T2 on d 28. These results indicate that dietary arginine supplementation during early gestation improves the reproductive performance of gilts and sows, possibly via nitric oxide and polyamine-dependent mechanisms.

Benefit of Preoperative Oral Steroids during Sinus Surgery when Utilizing Concentrated Topical Epinephrine

BACKGROUND/AIMS

Oral steroids have been advocated in the preoperative setting as a means of reducing intraoperative blood loss and surgical time during sinus surgery. The purpose of this study was to analyze the impact of preoperative oral steroid administration on intraoperative bleeding and surgical duration when coupled with concentrated topical epinephrine.

METHODS

The medical records of 302 patients who underwent bilateral 'full house' sinus surgery were reviewed. Concentrated topical epinephrine and inhalational anesthesia was used in all patients. Surgical duration and estimated blood loss were compared between the preoperative steroid-exposed and steroid-naive groups. χ2 and Student's t tests were used for statistical analysis.

RESULTS

One hundred and forty-two patients were exposed to steroid, while the remaining 160 were steroid naive. No significant differences were found with respect to surgical time between the steroid-exposed (96.91 ± 25.97 min) and steroid-naive patients (91.24 ± 32.29 min, p = 0.100). The steroid-exposed group demonstrated a marginally increased blood loss (66.03 ± 55.81 ml) as compared to steroid-naive patients (55.00 ± 38.71 ml, p = 0.048).

CONCLUSION

When coupled with intraoperative concentrated topical epinephrine use, preoperative oral steroid administration provides no clinically significant benefit with respect to reduced intraoperative bleeding or surgical duration.

Laser-Generated Shockwaves as a Treatment to Reduce Bacterial Load and Disrupt Biofilm

OBJECTIVE

The goal of this paper is to demonstrate and evaluate the potential efficacy of laser-generated shockwave (LGS) therapy on biofilm infected tissue.

METHODS

To demonstrate proof of concept, Staphylococcus epidermidis was allowed to proliferate on ex vivo pigskin, until mature biofilm formation was achieved, and then subjected to LGS. Bacterial load between control and treated samples was compared using the swab technique and colony counting. Scanning electron microscopy (SEM) was then used to visualize the biofilm growth and resulting reduction in biofilm coverage from treatment. Images were false colored to improve contrast of biofilm, and percent biofilm coverage was computed, along with biofilm cluster size.

RESULTS

LGS reduced bacterial load by 69% (p = 0.008). Imaging showed biofilm coverage reduced by 52% and significantly reduced average cluster size (p 0.001).

CONCLUSION

LGS therapy reduced the burden of bacterial biofilm on ex vivo pigskin and can be visualized using SEM imaging.

SIGNIFICANCE

LGS therapy is a new treatment for infected wounds, allowing rapid disruption of biofilm to 1) remove bacteria and 2) increase susceptibility of remaining biofilm to topical antibiotics. This can lead to improved wound healing times, reduced patient morbidity, and decreased healthcare costs.

[Effect and mechanism of interleukin-8 expression induced by wood smoke particles in primary human airway epithelial cells]

OBJECTIVE

To investigate the effect and mechanism of interleukin-8 expression induced by wood smoke particles (WSP) in primary human airway epithelial cells.

METHODS

Primary human bronchial epithelial cells (HBEC) were collected through fiberbronchoscopic brushing and incubated with different concentration of WSP (0, 12.5, 25.0, 50.0, 100.0 μg/ml). Levels of IL-8 protein in cell culture supernatant were measured using enzyme-linked immune sorbent assay. The specific inhibitors for epidermal growth factor receptor (EGFR) and p38 kinase signaling pathways were employed to pretreat HBEC, respectively, prior to incubation with 100 μg/ml WSP to investigate the mechanism of IL-8 expression induced by WSP.

RESULTS

The expression of IL-8 was significant increased in a dose-dependent manner after exposure HBEC to different concentration of WSP for 24h. The levels of IL-8 expression were (4546.67±1421.42) ρg/ml in (PD153035+WSP) group and (2803.33±865.00) ρg/ml in (SB203580+WSP) group respectively, which were significant decreased compared with the level of (12896.67±1373.11) ρg/ml in WSP group (P<0.05).

CONCLUSION

WSP could induce IL-8 expression by means of EGFR and p38 signaling pathways.

High-bandwidth uni-traveling carrier waveguide photodetector on an InP-membrane-on-silicon platform

A uni-traveling carrier photodetector (UTC-PD), heterogeneously integrated on silicon, is demonstrated. It is fabricated in an InP-based photonic membrane bonded on a silicon wafer, using a novel double-sided processing scheme. A very high 3 dB bandwidth of beyond 67 GHz is obtained, together with a responsivity of 0.7 A/W at 1.55 μm wavelength. In addition, open eye diagrams at 54 Gb/s are observed. These results promise high speed applications using a novel full-functionality photonic platform on silicon.

An apparatus for studying electrical breakdown in liquid helium at 0.4 K and testing electrode materials for the neutron electric dipole moment experiment at the Spallation Neutron Source

We have constructed an apparatus to study DC electrical breakdown in liquid helium at temperatures as low as 0.4 K and at pressures between the saturated vapor pressure and ∼600 Torr. The apparatus can house a set of electrodes that are 12 cm in diameter with a gap of 1-2 cm between them, and a potential up to ±50 kV can be applied to each electrode. Initial results demonstrated that it is possible to apply fields exceeding 100 kV/cm in a 1 cm gap between two electropolished stainless steel electrodes 12 cm in diameter for a wide range of pressures at 0.4 K. We also measured the current between two electrodes. Our initial results, I < 1 pA at 45 kV, correspond to a lower bound on the effective volume resistivity of liquid helium of ρV > 5 × 10(18) Ω cm. This lower bound is 5 times larger than the bound previously measured. We report the design, construction, and operational experience of the apparatus, as well as initial results.

Randomised clinical trial: prucalopride, a colonic pro-motility agent, reduces the duration of post-operative ileus after elective gastrointestinal surgery

BACKGROUND

Previous studies have shown that recovery of colonic transit is a major determinant of post-operative ileus and clinical recovery after gastrointestinal surgery. Prucalopride is a highly selective 5-hydroxytryptamine receptor-4 agonist with colonic pro-motility effects.

AIM

To evaluate the effect and safety of prucalopride on post-operative ileus and surgical outcomes after elective gastrointestinal surgery.

METHODS

In this phase II randomised clinical trial, 110 patients undergoing elective gastrointestinal surgery were randomised to either oral prucalopride (2 mg/day) (n = 55) or placebo (n = 55). Intervention was started 24 h after surgery and stopped after defecation or maximally at 7 days. The primary outcome was time to defecation. Secondary outcomes included time to first passage of flatus, tolerance of solid food, nasogastric tube reinsertion, post-operative length of stay, hospital readmission, overall cost, time to walk independently, surgical complications and inflammatory parameters.

RESULTS

Patients who received prucalopride had a shorter time to defecation (65.0 vs. 94.5 h, P = 0.001), passage of flatus (53.0 vs. 73.0 h, P < 0.001), and post-operative length of stay (7.0 vs. 8.0 days, P = 0.001) than controls. The number of patients with prolonged ileus (>5 days) (16.4% vs. 34.5%, P = 0.026) and the C-reactive protein level on post-operative day 5 (35.67 vs. 59.07 mg/L, P = 0.040) were lower in the prucalopride group. There was no significant difference in post-operative Clavien-Dindo grade III and IV complications (P = 0.606) between the groups.

CONCLUSION

Prucalopride is a safe and effective treatment to reduce post-operative ileus and systemic inflammation without affecting post-operative complications in patients undergoing elective gastrointestinal surgery. ClinicalTrials.gov: NCT02004652.

-1 V bias 67 GHz bandwidth Si-contacted germanium waveguide p-i-n photodetector for optical links at 56 Gbps and beyond

We demonstrate a 67 GHz bandwidth silicon-contacted germanium waveguide p-i-n photodetector operating at -1 V with 6.8 fF capacitance. The dark current is below 4 nA. The responsivity is 0.74 A/W at 1550 nm and 0.93 A/W at 1310 nm wavelength. 56 Gbps on-off-keying data reception is demonstrated with clear open eye diagrams in both the C-band and O-band.

Sclerostin-antibody treatment of glucocorticoid-induced osteoporosis maintained bone mass and strength

This study was to determine if antibody against sclerostin (Scl-Ab) could prevent glucocorticoid (GC)-induced osteoporosis in mice. We found that Scl-Ab prevented GC-induced reduction in bone mass and bone strength and that the anabolic effects of Scl-Ab might be partially achieved through the preservation of osteoblast activity through autophagy.

INTRODUCTION

Glucocorticoids (GCs) inhibit bone formation by altering osteoblast and osteocyte cell activity and lifespan. A monoclonal antibody against sclerostin, Scl-Ab, increased bone mass in both preclinical animal and clinical studies in subjects with low bone mass. The objectives of this study were to determine if treatment with the Scl-Ab could prevent loss of bone mass and strength in a mouse model of GC excess and to elucidate if Scl-Ab modulated bone cell activity through autophagy.

METHODS

We generated reporter mice that globally expressed dsRed fused to LC3, a protein marker for autophagosomes, and evaluated the dose-dependent effects of GCs (0, 0.8, 2.8, and 4 mg/kg/day) and Scl-Ab on autophagic osteoblasts, bone mass, and bone strength.

RESULTS

GC treatment at 2.8 and 4 mg/kg/day of methylprednisolone significantly lowered trabecular bone volume (Tb-BV/TV) at the lumbar vertebrae and distal femurs, cortical bone mass at the mid-shaft femur (FS), and cortical bone strength compared to placebo (PL). In mice treated with GC and Scl-Ab, Tb-BV/TV increased by 60-125 %, apparent bone strength of the lumbar vertebrae by 30-70 %, FS-BV by 10-18 %, and FS-apparent strength by 13-15 %, as compared to GC vehicle-treated mice. GC treatment at 4 mg/kg/day reduced the number of autophagic osteoblasts by 70 % on the vertebral trabecular bone surface compared to the placebo group (PL, GC 0 mg), and GC + Scl-Ab treatment.

CONCLUSIONS

Treatment with Scl-Ab prevented GC-induced reduction in both trabecular and cortical bone mass and strength and appeared to maintain osteoblast activity through autophagy.