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BACKGROUND: During fluoroscopy, radiologists and gastroenterologists are able to manipulate live fluoroscopic video for better orientation and visualization. During endoscopy and natural orifice transluminal endoscopic surgery (NOTES), this function is not currently available. Particularly during NOTES, the endoscopic image is sometimes inverted, and off-axis operation is required. OBJECTIVE: Our purpose was to develop and test a prototype live video manipulator (LVM) for endoscopy, laparoscopy, and NOTES. DESIGN: Prospective ex vivo and in vivo feasibility study. INTERVENTIONS: We developed a prototype LVM software for video image manipulation that can be easily installed on any computer. The video input is streamed into the computer and can be displayed on a standard monitor. LVM was tested ex vivo in the following functions: (1) instant live video rotation, (2) vertical or horizontal video inversion, (3) mirror imaging, and (4) digital zooming. These functions were also tested during upper and lower GI endoscopy, ERCP, diagnostic laparoscopy, and various transvaginal NOTES procedures (cholecystectomy, gastroenterostomy, and sleeve gastrectomy) in porcine models. MAIN OUTCOME MEASUREMENTS: Image quality observation between unmanipulated and manipulated live videos. RESULTS: LVM reliably and easily performed live video manipulation during these tests. Besides standard definition video signals, LVM is fully compatible with high-definition video endoscopy. Three observers reported that the subjective image quality was the same in specified areas between manipulated and unmanipulated live videos. LIMITATIONS: Observation and feasibility study. CONCLUSIONS: LVM reliably and conveniently performed live video manipulations. LVM requires minimal equipment, capital investment, and maintenance, and is easy to set up. LVM can be a useful tool in many medical imaging studies, including endoscopy, laparoscopy, and NOTES, either as a built-in technology or as an as-needed add-on feature. [ABSTRACT FROM AUTHOR]

Self-identification as a victim of violence may lead to increased negative emotions and stress and thus, may change both structure and function of the underlying neural network(s). In a trans-diagnostic sample of individuals who identified themselves as victims of violence and a matched control group with no prior exposure to violence, we employed a social exclusion paradigm, the Cyberball task, to stimulate the re-experience of stress. Participants were partially excluded in the ball-tossing game without prior knowledge. We analyzed group differences in brain activity and functional connectivity during exclusion versus inclusion in exclusion-related regions. The victim group showed increased anger and stress levels during all conditions. Activation patterns during the task did not differ between groups but an enhanced functional connectivity between the IFG and the right vmPFC distinguished victims from controls during exclusion. This effect was driven by aberrant connectivity in victims during inclusion rather than exclusion, indicating that victimization affects emotional responses and inclusion-related brain connectivity rather than exclusion-related brain activity or connectivity. Victims may respond differently to the social context itself. Enhanced negative emotions and connectivity deviations during social inclusion may depict altered social processing and may thus affect social interactions., (© 2024. The Author(s).)

Violence is a known risk factor for health problems. In this epidemiological study across 5,385 male patients, we investigate the prevalence of perpetrated violence, exposure to violence, their overlap and the relationship between violence, mental, and psychosomatic health, as well as adverse health behaviors, such as self-harming behavior and the consumption of drugs. Participants completed an anonymous questionnaire addressing violence experience (i.e., both expose and perpetration), age of victimization/perpetration, frequency, and perceived severity of violence exposure. We considered physical, psychological as well as sexual violence. Information on health status and adverse health behaviors complemented the data. Results showed that 48.4% of the sample reported having experienced violence (perpetration, victimization, or both). The victim-perpetrator overlap formed the largest group, in which the incidence of having experienced multiple types of violence was significantly higher compared to victims and perpetrators. The age-crime curve flattened more slowly with increasing age in this group. Although the perceived severity of exposure to violence is lower in the overlap group, its health status and adverse health behaviors were worse. Interventions should focus on this group since they constitute a burden for the healthcare system., Competing Interests: RB is employed by “Berufsförderungswerk Düren GmbH”. He was not employed there during the project period of the survey and evaluation of the study. The “Berufsförderungswerk Düren” was not involved in the study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Leiding, Kaiser, Hüpen, Kirchhart, Puiu, Steffens, Bergs and Habel.)

Power law distributions characterise several natural and social phenomena. Zipf's law for cities is one of those. The study views the question of whether that global regularity is independent of different spatial distributions of cities. For that purpose, a typical Zipfian rank-size distribution of cities is generated with random numbers. This distribution is then cast into two different settings of spatial coordinates. For the estimation, the variables rank and size are supplemented by considerations of spatial dependence within a spatial econometric approach. Results suggest that distance potentially matters. This finding is further corroborated by four country analyses even though estimates reveal only modest effects., Competing Interests: The author is affiliated with PRAC. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Social stress has a major detrimental impact on subjective well-being. Previous research mainly focused on two methods to induce and measure social stress: social exclusion and performance evaluation. For social exclusion researchers frequently focused on the Cyberball task, which in contrast to many psychosocial stress paradigms does not include a performance component. The aim of the current study was to establish an optimized psychosocial stress paradigm by combining both, social exclusion as well as performance evaluation within a single fMRI paradigm. We implemented a modification of the Cyberball task including a performance game (with exclusion and inclusion periods) in addition to the already established exclusion and inclusion periods. This indeed resulted in increased subjective stress in the performance game. Hence, the modified Cyberball version seems to be superior in mapping relevant neural social stress correlates more pronounced and reliably. Exclusion within the performance-related context contrasted to the unmodified exclusion was associated with higher activation in the dorsal anterior cingulate cortex and the anterior insula. Moreover, the modified exclusion reflected greater social processing in the precuneus, several temporo-parietal and medial prefrontal areas, as suggested by the additional task aspects of social evaluation and social perspective taking. The findings emphasize that public negative evaluation is effective in substantially enlarging and potentiating the distressing effect of exclusion on a subjective as well as on a neural level. This may have a great potential for further experimental research on social stress.

Stress affects the brain at a network level: the salience network is supposedly upregulated, while at the same time the executive control network is downregulated. While theoretically described, the effects in the aftermath of stress have thus far not been tested empirically. Here, we compared for the first time resting-state functional connectivity in a large sample of healthy volunteers before and after a mild social stressor. Following the theoretical prediction, we focused on connectivity of the salience network (SN), the executive control network (ECN) and the default mode network (DMN). The DMN exhibited increased resting-state functional connectivity following the cyberball task to the key nodes of the SN, namely the dorsal anterior cingulate cortex (dACC) and the anterior insula, as well as sensorimotor regions and higher-order visual areas. We conclude that this increased connectivity of the DMN with key nodes of the SN and regions responsible for preparatory motor activity and visual motion processing indicates a shift towards an 'alerted default mode' in the aftermath of stress. This brain response may be triggered or aggravated by (social) stress induced by the cyberball task, enabling individuals to better reorient attention, detect salient external stimuli, and deal with the emotional and affective consequences of stress.

Recent evidence suggests that humans can communicate emotion via chemosensory signals. Olfactory cues signaling anxiety can bias the perception of ambiguous stimuli, but the underlying neurobiological mechanisms of this effect are currently unknown. Here, we investigated the brain responses to subtle changes in facial expressions in response to anxiety chemosensory cues. Ten healthy individuals donated their sweat in two situations: while anticipating an important oral examination (anxiety condition) and during physical exercise (control condition). Subsequently, 24 participants completed a parametrically morphed (neutral to fearful) emotion recognition task under exposure to the olfactory cues of anxiety and sports, in the fMRI scanner. Behaviorally, the participants rated more discernible fearful faces as more fearful and neutral faces as more neutral under exposure to the anxiety cues. For brain response, under exposure to the anxiety cues, increased fearfulness of the face corresponded to increased activity in the left insula and the left middle occipital gyrus extending into fusiform gyrus. Moreover, with higher subjective ratings of facial fearfulness, participants additionally showed increased activity in the left hippocampus. These results suggest that chemosensory anxiety cues facilitate processing of socially relevant fearful stimuli and boost memory retrieval due to enhanced emotional context., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Violence has many faces and often results in a variety of consequences. Some studies indicated different types of violence and health consequences in men and women. However, it is still unclear whether this is reflected in clinical context, for example in a patient sample of a German university hospital., Objectives: The primary goal of the present study was to analyze associations of violence with health, gender and social, economic, job-related, psychological and physical consequences. In addition, the effects of psychological treatment were examined., Materials and Methods: One line of research refers to the survey of more than 5000 patients of the university hospital Aachen, evaluating violence experience and several health complaints anonymously. Another line of research deals with detailed interviews with victims of violence and their experienced consequences. A final data source stems from the evaluation of psychological counseling of patients with prior experience of violence. Changes in subjectively perceived depressive symptoms and acceptance of the treatment are evaluated., Results and Conclusions: Experience of violence increases the risk for several health problems, especially the experience of multiple types of violence. The interviews showed that more than 60% of the victims had a clinical diagnosis--independent of sex. The risk for a clinical diagnosis increased with multiple violence experiences during childhood. Patients with a clinical diagnosis indicated more subjective consequences of violence, and consequences of violence were more pronounced in patients that experienced multiple types of violence. The good acceptance as well as the effects on symptomatology and other relevant therapeutic variables provides a first indication for a successful treatment of victims of violence in a clinical context.

Recent evidence suggests that the experience of stress can be communicated between individuals via chemosensory cues. Little is known, however, about the impact of these cues on neurophysiological responses during a socially threatening situation. In the current investigation we implemented a widely used paradigm to study social exclusion-Cyberball-to examine whether chemosensory cues signaling anxiety modulate the neuronal effects of ostracism. In a double-blind, within-subjects design, 24 healthy, normosmic participants were presented with chemosensory cues of anxiety (or control samples) and completed the Cyberball task while in a 3T fMRI scanner. Axillary sweat collected from male students awaiting an oral examination served as the anxiety cues while the chemosensory control stimuli consisted of sweat collected from the same individuals participating in an ergometer training session. The neuroimaging data revealed that under the control chemosensory condition, exclusion from Cyberball was associated with significantly higher orbitofrontal cortex and anterior cingulate cortex activity, which is consistent with previous studies in the field. However, when participants were primed with the anxiety sweat, the activity in these regions was not observed. Further, under exposure to anxiety cues during ostracism the participants showed deactivations in brain regions involved in memory (hippocampus), social cognition (middle temporal gyrus, superior temporal gyrus) and processing of salience (inferior frontal gyrus). These results suggest that successful communication of anxiety via the chemosensory domain may moderate the experience of social exclusion. It is possible that the anxiety signals make it easier for the individuals to detach from the group, pointing to the communicative role of chemosensory anxiety cues in enhancing adjustment mechanisms in light of a distressing situation.

The functional specificity of brain areas is diminished with age and accompanied by the recruitment of additional brain regions in healthy older adults. This process has repeatedly been demonstrated within distinct functional domains, in particular the visual system. However, it is yet unclear, whether this phenomenon in healthy aging, i.e., a reduced activation of task-associated areas and increased activation of additional regions, is also present across different functional systems. In the present functional imaging study, comprising 102 healthy subjects, we therefore assessed two distinct tasks engaging the sensory-motor system and the visual attention system, respectively. We found a significant interaction between age and task in the parietal operculum bilaterally. This area as a part of the sensory-motor system showed an age-related decrease in its BOLD-response to the motor task and an age-related increase of neural activity in response to the visual attention task. The opposite response pattern, i.e., reduced visual attention activation and increased response to the motor task, was observed for regions associated with the visual task: the superior parietal area 7A and the dorsal pre-motor cortex. Importantly, task performance was not correlated with age in either task. This age-by-task interaction indicates that a reduction of functional specificity in the aging brain may be counteracted by the increased recruitment of additional regions not only within, but also across functional domains. Our results thus emphasize the need for comparisons across different functional domains to gain a better understanding of age-related effects on the specificity of functional systems.

Background: The influence of endoscopic video camera (VC) image quality on surgical performance has not been studied. Flexible endoscopes are used as substitutes for laparoscopes in natural orifice translumenal endoscopic surgery (NOTES), but their optics are originally designed for intralumenal use. Manipulable wired or wireless independent VCs might offer advantages for NOTES but are still under development., Objective: To measure the optical characteristics of 4 VC systems and to compare their impact on the performance of surgical suturing tasks., Methods: VC systems included a laparoscope (Storz 10 mm), a flexible endoscope (Olympus GIF 160), and 2 prototype deployable cameras (magnetic anchoring and guidance system [MAGS] Camera and PillCam). In a randomized fashion, the 4 systems were evaluated regarding standardized optical characteristics and surgical manipulations of previously validated ex vivo (fundamentals of laparoscopic surgery model) and in vivo (live porcine Nissen model) tasks; objective metrics (time and errors/precision) and combined surgeon (n = 2) performance were recorded., Results: Subtle differences were detected for color tests, and field of view was variable (65°-115°). Suitable resolution was detected up to 10 cm for the laparoscope and MAGS camera but only at closer distances for the endoscope and PillCam. Compared with the laparoscope, surgical suturing performances were modestly lower for the MAGS camera and significantly lower for the endoscope (ex vivo) and PillCam (ex vivo and in vivo)., Conclusions: This study documented distinct differences in VC systems that may be used for NOTES in terms of both optical characteristics and surgical performance. Additional work is warranted to optimize cameras for NOTES. Deployable systems may be especially well suited for this purpose.

Background: This study evaluated operative outcomes and ergonomics for a magnetic camera (MAGS) used in conjunction with percutaneous instruments [percutaneous surgical set (PSS)] compared with single-site laparoscopic (SSL) and conventional laparoscopic (LAP) cholecystectomy techniques., Methods: Four surgical trainees each performed three porcine cholecystectomies using three randomized techniques including MAGS/PSS, SSL, and LAP. The operative outcomes, procedure-specific ratings (1-5 scale; 1 = superior), workload (1-10 scale; 1 = superior), and global impressions (1-10 scale; 10 = superior) were recorded. Comparisons used analysis of variance (ANOVA) on ranks (Kruskal-Wallis), and p values lower than 0.05 were considered significant., Results: The operative outcomes were similar except for significantly higher blood loss with SSL (16.3 ± 10.3) versus LAP (2.8 ± 1.5; p < 0.05) but not with MAGS/PSS (4.8 ± 3.8). Several inadvertent tissue-damaging events occurred with SSL but not with MAGS/PSS or LAP. The incision was significantly shorter with MAGS/PSS (29.3 ± 2.8 mm) and SSL (29.3 ± 2.5 mm) than with LAP (48.0 ± 3.6 mm; p < 0.05). Compared with SSL (3.6 ± 0.5), the procedure-specific ratings significantly favored MAGS/PSS (2.8 ± 0.4) and LAP (1.7 ± 0.2; p < 0.05). Ergonomics and technical challenges both were rated significantly inferior with SSL (4.3 ± 1.0 and 3.8 ± 0.5, respectively) versus LAP (1.5 ± 0.6 and 2.0 ± 0.8, respectively; p < 0.05) but not with MAGS/PSS (2.5 ± 1.0 and 3.0 ± 0.8, respectively). Both MAGS/PSS (4.5 ± 0.5) and SSL (4.8 ± 1.0) were associated with a significantly greater workload than LAP (2.5 ± 0.6; p < 0.05). Global impression ratings were significantly higher for LAP (8.7 ± 1.3) versus SSL (5.8 ± 2.0; p < 0.05) but not for MAGS/PSS (7.1 ± 1.8). Cosmesis was significantly better with MAGS/PSS (9.5 ± 0.6) versus LAP (6.5 ± 2.4; p < 0.05) but not with SSL (8.8 ± 1.3)., Conclusion: The MAGS/PSS technique allows better triangulation and fewer technical difficulties than SSL and better cosmesis than LAP. Further development of these devices is warranted.

Introduction: This study evaluated operative outcomes and workload during single-site laparoscopy (SSL) using a magnetically anchored cautery dissector (MAGS) compared with a conventional laparoscopic hook cautery (LAP)., Methods: Each cautery was used to perform six SSL porcine cholecystectomies. For MAGS, the cautery device was inserted through the umbilical incision, magnetically coupled, and deployed; two graspers and a laparoscope were used. For LAP, two percutaneous retraction sutures, one grasper, a hook cautery dissector, and a laparoscope were used. Operative outcomes, surgeon ratings (scale, 1-5; 1 = superior), and workload (scale, 1-10; 1 = superior) were evaluated., Results: No significant differences were detected for operative outcomes and surgeon ratings, however, trends were detected favoring MAGS. Surgeon workload ratings were significantly better for MAGS (2.6 ± 0.2) vs. LAP (5.6 ± 1.1; p < 0.05). For MAGS, depth perception and triangulation were excellent and the safe handling protocol was followed with no complications. For LAP, the parallelism of instruments and lack of triangulation hindered depth perception, caused instrument conflicts, and resulted in two minor complications (one superficial liver laceration and one inadvertent burn to the diaphragm)., Conclusion: These data suggest that using the MAGS device for SSL cholecystectomy results in equivalent (or better) operative outcomes and less workload compared with LAP.

Background: This study aimed to evaluate the surgeon performance and workload of a next-generation magnetically anchored camera compared with laparoscopic and flexible endoscopic imaging systems for laparoscopic and single-site laparoscopy (SSL) settings., Methods: The cameras included a 5-mm 30° laparoscope (LAP), a magnetically anchored (MAGS) camera, and a flexible endoscope (ENDO). The three camera systems were evaluated using standardized optical characteristic tests. Each system was used in random order for visualization during performance of a standardized suturing task by four surgeons. Each participant performed three to five consecutive repetitions as a surgeon and also served as a camera driver for other surgeons. Ex vivo testing was conducted in a laparoscopic multiport and SSL layout using a box trainer. In vivo testing was performed only in the multiport configuration and used a previously validated live porcine Nissen model., Results: Optical testing showed superior resolution for MAGS at 5 and 10 cm compared with LAP or ENDO. The field of view ranged from 39 to 99°. The depth of focus was almost three times greater for MAGS (6-270 mm) than for LAP (2-88 mm) or ENDO (1-93 mm). Both ex vivo and in vivo multiport combined surgeon performance was significantly better for LAP than for ENDO, but no significant differences were detected for MAGS. For multiport testing, workload ratings were significantly less ex vivo for LAP and MAGS than for ENDO and less in vivo for LAP than for MAGS or ENDO. For ex vivo SSL, no significant performance differences were detected, but camera drivers rated the workload significantly less for MAGS than for LAP or ENDO., Conclusion: The data suggest that the improved imaging element of the next-generation MAGS camera has optical and performance characteristics that meet or exceed those of the LAP or ENDO systems and that the MAGS camera may be especially useful for SSL. Further refinements of the MAGS camera are encouraged.

Introduction: We report a redesigned magnetically anchored and guided systems (MAGS) camera with improved optics and a 30° downward viewing angle that facilitates solitary surgeon laparo-endoscopic single site (LESS) nephrectomy., Methods: The prototype consists of an external 2 by 6 cm cylinder containing magnets positioned such that the intra-abdominal camera is anchored on the peritoneal surface with a default 30° downward angle. It was inserted through a 3 cm LESS-port periumbilical incision in three pigs (mean 47 kg). The camera was coupled with the handheld magnetic device across the anterior abdominal wall and was steered into position to view the kidney. LESS nephrectomy was then performed., Results: Since a standard LESS laparoscope was not needed, only the two operative instruments were inserted through the single incision port, significantly decreasing instrument "clashing" compared with traditional LESS nephrectomy. Due to the favorable angle of view of the camera and its self-anchoring capability, no assistant was needed to drive the camera. Instead, the surgeon periodically made minor adjustments to optimize the view. The nephrectomy was completed without complication in an average of 35 minutes in these three nonsurvival animals., Conclusion: The MAGS camera provides good optics and easy maneuverability during LESS porcine nephrectomy. As with other MAGS instruments, by replacing a traditional transabdominal laparoscope that occupies access port space, use of this insertable camera may diminish some of the "collision challenge" of LESS surgery. Also, by being self-anchoring, this prototype may minimize the need for an assistant surgeon.

Introduction: The purpose of this study was to evaluate the histological effects of dynamic abdominal wall compression using the magnetic anchoring and guidance system (MAGS) platform., Methods: Cholecystectomy was performed in two nonsurvival and two survival pigs using a single-site laparoscopic (SSL) approach. A deployable MAGS cautery dissector was used to perform the entire dissection in conjunction with a laparoscope and other instruments. The abdominal wall areas corresponding to the region occupied by the MAGS platform were examined grossly and microscopically for signs of tissue damage. Gallbladder dissection time was 36 min with no complications. Compressed abdominal wall thickness was 1.4 cm., Results: In all four animals, a very mild skin erythema was noted immediately postprocedure but was nonvisible within 20 min. Mild peritoneal blanching was noted in two animals, and one animal exhibited a 5-mm area of petechiae. Necropsy demonstrated no adhesions. Light microscopy documented no evidence of tissue injury for all specimens., Discussion: This study demonstrated that the use of the MAGS cautery dissector for a SSL cholecystectomy was advantageous in providing triangulation and did not result in any significant gross or microscopic tissue damage despite the thin abdominal wall of the porcine model.

Objectives: To study the potential pathologic effect of prolonged compression of abdominal wall between the components. Magnetic Anchoring and Guidance System (MAGS) instruments ameliorate some of the challenges in triangulation created by laparo-endoscopic single-site and natural orifice translumenal endoscopic surgery. They consist of an intracorporeal magnetic device coupled to an external hand-held magnet used to anchor and "steer" it around the peritoneal cavity., Methods: Three pigs (45.5-48.6 kg) underwent laparoscopic placement of magnetic devices in 4 quadrants, with the devices left in place for 2 or 4 hours. Full-thickness abdominal wall sections (mean 2.1 cm thick) where each MAGS platform was placed plus a control were harvested at 0, 2, or 14 days after surgery. Histologic assessment was then performed., Results: Beyond mild blanching of the peritoneal surface with a few petechiae immediately after internal component removal, no gross tissue damage was seen. These changes were undetectable by 48 hours and no intra-abdominal adhesions were identified at necropsy. NADH stain for tissue viability in the 4 nonsurvival specimens showed no tissue damage. Hematoxylin and eosin stain showed no necrosis of either superficial or deep muscle, skin, or subcutaneous fat tissue in all 12 specimens when compared with the control., Conclusions: MAGS instruments do not appear to cause tissue damage or adverse clinical outcomes when coupled across thin porcine abdominal walls for up to 4 hours. Because the distance across the abdominal wall is generally greater in adult human beings, these findings support the further clinical development of magnetic instruments to be used in human patients., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: The Magnetic Anchoring and Guidance System (MAGS) includes an external magnet that controls intra-abdominal surgical instruments via magnetic attraction forces. We have performed NOTES (Natural Orifice Transluminal Endoscopic Surgery) and LESS (Laparoendoscopic Single Site) procedures using MAGS instruments in porcine models with up to 2.5-cm-thick abdominal walls, but this distance may not be sufficient in some humans. The purpose of this study was to determine the maximal abdominal wall thickness for which the current MAGS platform is suitable., Methods: Successive iterations of prototype instruments were developed; those evaluated in this study include external (134-583 g, 38-61 mm diameter) and internal (8-39 g, 10-22 mm diameter) components using various grades, diameters, thicknesses, and stacking/shielding/focusing configurations of permanent Neodymium-iron-boron (NdFeB) magnets. Nine configurations were tested for coupling strength across distances of 0.1-10 cm. The force-distance tests across an air medium were conducted at 0.5-mm increments using a robotic arm fitted with a force sensor. A minimum theoretical instrument drop-off (decoupling) threshold was defined as the separation distance at which force decreased below the weight of the heaviest internal component (39 g)., Results: Magnetic attraction forces decreased exponentially over distance. For the nine configurations tested, the average forces were 3,334 ± 1,239 gf at 0.1 cm, 158 ± 98 gf at 2.5 cm, and 8.7 ± 12 gf at 5 cm; the drop-off threshold was 3.64 ± 0.8 cm. The larger stacking configurations and magnets yielded up to a 592% increase in attraction force at 2.5 cm and extended the drop-off threshold distance by up to 107% over single-stack anchors. For the strongest configuration, coupling force ranged from 5,337 gf at 0.1 cm to 0 gf at 6.95 cm and yielded a drop-off threshold distance of 4.78 cm., Conclusions: This study suggests that the strongest configuration of currently available MAGS instruments is suitable for clinically relevant abdominal wall thicknesses. Further platform development and optimization are warranted.

Background: Magnetic anchoring guidance systems (MAGS) are composed of an internal surgical instrument controlled by an external handheld magnet and do not require a dedicated surgical port. Therefore, this system may help to reduce internal and external collision of instruments associated with laparoendoscopic single-site (LESS) surgery. Herein, we describe the initial clinical experience with a magnetically anchored camera system used during laparoscopic nephrectomy and appendectomy in two human patients., Methods: Two separate cases were performed using a single-incision working port with the addition of a magnetically anchored camera that was controlled externally with a magnet., Results: Surgery was successful in both cases. Nephrectomy was completed in 120 min with 150 ml estimated blood loss (EBL) and the patient was discharged home on postoperative day 2. Appendectomy was successfully completed in 55 min with EBL of 10 ml and the patient was discharged home the following morning., Conclusions: Use of a MAGS camera results in fewer instrument collisions, improves surgical working space, and provides an image comparable to that in standard laparoscopy.

Introduction: Natural orifice translumenal endoscopic surgery (NOTES) is an evolving field and suitable instruments are lacking. The purpose of this study was to perform transvaginal cholecystectomies using instruments incorporated into a magnetic anchoring and guidance system (MAGS)., Methods: Non-survival procedures were conducted in pigs (n = 4). Through a vaginotomy created under direct vision, a rigid access port was inserted into the peritoneal cavity and used to maintain a CO(2) pneumoperitoneum. MAGS instruments were deployed through the port and held in place on the peritoneal surface using magnetic coupling via an external handheld magnet which was optionally exchanged for an 18 ga percutaneous threaded needle anchor; instruments included a tissue retractor (a clip-fixated magnet or flexible graspers) and a cautery dissector. A gastroscope was used for visualization., Results: The first two procedures ended prematurely due to instrumentation shortcomings and inadvertent magnetic coupling between instruments; one case required a laparoscopic rescue. Three new forms of instrumentation were developed: (1) a longer access port (50 cm) which provided easier deployment of instruments and suitable reach, (2) a more robust cauterizer with a longer, more rigid, pneumatically deployed tip with better reach and sufficient torque to allow blunt dissection, and (3) a more versatile tissue retractor with bidirectional dual flexible graspers which provided excellent cephalad fundus retraction and inferiolateral infundibulum retraction. With these modifications, 100% of the cholecystectomy was completed in the third and fourth animals using only a NOTES/MAGS approach. Retrieval of the tissue retractor resulted in a rectal injury in the third animal but further procedural modifications resulted in a successful procedure in the fourth animal with no complications., Conclusions: While still under development with more refinements needed, completely transvaginal cholecystectomy using MAGS instruments is feasible. By offering triangulation and rigidity, MAGS may facilitate a NOTES approach while alleviating shortcomings of a flexible platform.

Purpose: We assessed the feasibility of single keyhole laparoscopic surgery using a novel transabdominal magnetic anchoring and guidance system platform in the porcine model., Materials and Methods: A collaborative research group was formed to build a prototype system of magnetically anchored instruments for trocar-free laparoscopy. The design mandate was that the developed technology should be able to deploy into the insufflated abdomen through an existing 12 mm diameter trocar and then be moved into position in the peritoneum by manipulating external magnets. The magnetic anchoring and guidance system concept was advanced to a working prototype with a system of external magnetic anchors, an internal camera system and a hook cautery supported by an intra-abdominal robotic arm. This prototype system was then evaluated in vivo in a porcine laparoscopic nephrectomy model., Results: Two nonsurvival porcine laparoscopic nephrectomies were successfully completed without complications via a single 15 mm transumbilical trocar using the prototype magnetic anchoring and guidance system camera and the magnetically anchored robotic arm cauterizer. A conventional laparoscopic grasper was used for retraction through the 15 mm trocar after magnetic anchoring and guidance system deployment. The renal artery and vein were transected with a conventional Endo-GIA stapler introduced through the 15 mm trocar. Procedure time was not recorded and blood loss was minimal., Conclusions: Single trocar laparoscopic nephrectomy using magnetically anchored instrumentation is technically feasible, demonstrating that intracorporeal instrument manipulation may overcome the limitations of current laparoscopic and robotic surgery by allowing unhindered intra-abdominal movement. This single access technique may be used with natural orifice surgery approaches and it has the potential to realize incision-free intra-abdominal surgery.

Background: Streptococcus pneumoniae is a major cause of community acquired infections in the United States, and rates of antibiotic resistance have increased dramatically in the past decade. Statewide rates of pneumococcal resistance to penicillin and other antibiotics have not been previously reported in Wisconsin. To determine these rates, we assessed invasive pneumococcal isolates for reduced susceptibility to nine different antibiotics., Methods: Pneumococcal isolates from blood, cerebrospinal fluid or other normally sterile body sites were submitted by 91% of laboratories that perform invasive bacterial cultures. Isolates were tested for susceptibility to penicillin, cefotaxime, ceftriaxone, levofloxacin, meropenem, erythromycin, vancomycin, sulfamethoxazole-trimethoprim and chloramphenicol., Results: There were 409 invasive pneumococcal isolates identified in 1999 among Wisconsin residents, including 385 (94%) isolates from blood. The mean patient age was 42.5 years (range, < 1 year to 96 years), and 213 (52%) were male. Of the pneumococcal isolates, 24% were not susceptible to penicillin, including 10% with high level resistance. Isolates with reduced penicillin susceptibility were also likely to have reduced susceptibility to other antibiotics. Patients with penicillin nonsusceptible (intermediate and fully resistant) pneumococcal isolates were significantly younger (mean, 37.0 years) than those with susceptible isolates (mean, 44.3 years) (p = .04). The proportion of patients with a penicillin nonsusceptible isolate varied by region, ranging from 12.8% in northeastern Wisconsin to 35.5% in northern Wisconsin., Conclusions: The proportion of invasive pneumococcal isolates with penicillin resistance in Wisconsin is similar to other regions of the United States. Inappropriate antibiotic use contributes to the emergence of resistant pneumococcal infections, and educational efforts are underway to promote judicious antibiotic use in Wisconsin.

A new, interdisciplinary research area has emerged known as bioorganometallic chemistry. It focuses on the introduction of organometallic fragments into biomolecules (see, for example, structure on the right). "Classical" α-amino acid and peptide ligands have proven particularly versatile, and provide access to compounds that display interesting stereochemistry. α-Amino acids and peptides can be synthesized, labeled, stabilized, or activated by organometallic fragments., (© 1998 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.)

Stress is laid on the importance of sports instruction in the process of educating the young generation. Illness and injuries have a bad effect and result in exemption from sports lessons at school. The extent of these factors in the district of Weissenfels is shown in analysis and a therapy schedule based on empirical data has been developed for the rehabilitation of children and young people exempted from obigatory sports at school.

Bronchial-pulmonary disease is of great importance during infancy. Additionnal to common methods the advantages of sport therapy are pointed to. Experience and hints for its application are explained. In pediatrics sport therapy should be used to a greater extend than before.