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Purpose. Urinary tract infections (UTIs) are the most common infections among hospitalized patients. Cystoscopy is a minimally invasive procedure to check bladder disease, among the patients receiving procedure, approximately 10% of patients may experience UTI. In this study, a neural network model with high accuracy, sensitivity, and specificity was developed to predict the probability of UTIs caused by cystoscopic procedures. To reduce antibiotic overuse during cystoscopic procedures, the model can provide clinicians with a rapid assessment of whether patients require prophylactic antibiotics. Materials and Methods. Patients who underwent cystoscopic procedures at China Medical University Beigang Hospital from 2016 to 2019 were retrospectively reviewed. A total of 1647 patients were enrolled, and 147 cases of urinary tract infection occurred. An artificial neural network (ANN) and logistic regression analysis were used to develop the prediction models, and the two models were compared. Results. The logistic regression analysis model had an accuracy of 91%, sensitivity of 2%, and specificity of 99%, indicating that the logistic regression model predicted that most patients had a low risk of infection. The neural network model had a high accuracy of 85%, sensitivity of 80%, and specificity of 88%. Conclusions. Because the logistic regression model had low sensitivity and missed most cases of UTI, the logistic regression model is inappropriate for clinical application. The neural network model has superior predictive ability and can be considered a tool in clinical practice.

Ultrasound (US) imaging system is widely used in robotic systems for precision positioning in clinical applications. The US calibration is critical to minimize the difference of spatial coordinates between instruments, for minimally invasive surgery (MIS) in navigation systems. In this study, we propose a dual robotic arm system that combines US imaging with one arm for path planning and monitoring and accurate positioning with the other arm for instrument placement via the preplanning procedures. A phantom with N-wire and N-wedge was designed for US calibration. The US calibration showed a mean error of 0.76 mm; the mean dual-arm calibration error is 0.31 mm. The positioning error of the system was verified with a mean error of 1.48 mm. In addition, we used two abdominal phantoms with computed tomography scan validation, with an averaged position error of 1.867 ± 0.436 mm and an orientation error of 2.190 ± 0.764°. The proposed system is aimed to perform clinical operations, such as abdominal MIS, with real-time image monitoring of the organ tissues and instrument positions, which meet the requirements for medical application.

The usage of machine vision technologies for image-based analysis and inspection is increasing. With the advent of the ability to process high-dimension data instantly, the possibilities of machine vision multiply exponentially. Robots now use this technology to assist in surgery.The aim of this study is to explore the efficacy of Surgical Navigation Robot NaoTrac (Brain Navi Biotechnology Co., Ltd.), which utilizes machine vision-inspired technology for patient registration and stereotactic external ventricular drainage (EVD) by the robotic arm.Preoperative and postoperative computed tomography (CT) scans were acquired for each case. The surgeons planned the targets and trajectories with the preoperative CT images. The postoperative CT images were utilized in the accuracy measurements.All 14 cases had cerebrospinal fluid drained through the catheter. The NaoTrac placed the catheter into the frontal horn in one attempt in 13 cases and was able to drain CSF in 12 cases. Not a single case had any bleeding or intraoperative complications. The average time spent on the patient registration was 142.8 s. The mean target deviation was 1.68 mm, and the mean angular deviation was 1.99°, all within the accepted tolerance for minimal tissue damage.The results of this report demonstrate that machine vision-inspired patient registration is feasible and fast. NaoTrac has demonstrated its accuracy and safety in performing frameless catheter placement in 13 clinical cases. Other stereotactic neurosurgical operations such as stereotactic biopsy, depth electrode placement, deep brain stimulation electrode positioning, and neuroendoscopy may also be benefited from the assistance of NaoTrac.

Hyperlipidemia, excessive amounts of fat and fatty substances in the blood, is a major risk factor for cardiovascular disease. The measuring of fat or fatty substance in blood is usually obtained through a blood lipid test which includes total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). In the Medical Device industry, Point-of-care (POC) methods provide fast, portable and easy to use devices suitable for rapid determination of Lipid levels. Here, we evaluated the analytical performance of PixoTest POCT Lipid System (iXensor Co., Ltd.), a newly developed POC lipid panel analyzer. PixoTest POCT Analyzer accuracy evaluation with the Cobas c111 Analyzer (Roche Diagnostics Ltd.) as a reference method was carried out according to CLSI EP 09-A3 guidelines. This study enrolled one hundred and twenty (120) subjects and conducted over three (3) clinical sites (40 subjects each), administered through nine (9) trained operators (total) performed under manufacturer’s protocol using three (3) reagent lots per blood sample (capillary & venous). Linear regression, bias plot and other statistical analyses were extrapolated from the test data in this study. Passing-Bablok regression analysis of the data between PixoTest POCT System and Roche Cobas c111 Analyzer with the venous blood showed a slope of 1.03, an intercept of − 0.1 and correlation coefficient of 0.99. The results for capillary blood showed a slope of 1.01, an intercept of − 0.04 and correlation coefficient of 0.99. Passing-Bablok regression analysis of the data (n = 120) from the comparison between the PixoTest POCT System and Roche Cobas c111 Analyzer with the TC venous blood of total 3 lots at 3 sites showed a slope of 0.99, an intercept of − 0.337 and correlation coefficient of 0.995 and the TC capillary blood showed a slope of 0.99, an intercept of − 0.105 and correlation coefficient of 0.984. TG venous blood of total 3 lots at 3 sites showed a slope of 0.99, an intercept of 0.0246 and correlation coefficient of 0.998 and TG capillary blood showed a slope of 0.99, an intercept of − 0.329 and correlation coefficient of 0.998. HDL venous blood showed a slope of 0.99, an intercept of − 0.0297 and correlation coefficient of 0.987 and the HDL capillary blood showed a slope of 0.99, an intercept of − 0.0403 and correlation coefficient of 0.989. The evaluation results of PixoTest POCT system’s accuracy, linearity, and correlation with Roche Cobas c111 Analyzer, the PixoTest POCT System displayed great performance results for all evaluated data points. Thus, the PixoTest POCT System is capable of providing accurate and reliable lipid measurements in the POC setting.

Glycated hemoglobin (HbA1c) has been recommended as a standard indicator of long-term glycemic control for diabetic and non-diabetic patients, within the in vitro diagnostic (IVD) industry that is focused on the development of point-of-care (POC) methods with improved operational convenience and shorter measurement time. In this study, we evaluated the measurement accuracy performance of a recently commercialized POC HbA1c analyzer, PixoTest POCT System (iXensor Co., Ltd.) that is portable, intuitive and wireless data transmission enabled. For PixoTest POCT accuracy evaluation, TOSOH G7 Analyzer (TOSOH Bioscience GmbH) was used as a reference method and performed in accordance with CLSI EP 09-A3 guidelines. This study enrolled one hundred and twenty (120) subjects from three clinical sites (40 subjects each), administered through nine (9) trained operators (total) performed under manufacturer’s protocol using three reagent lots per blood sample (capillary & venous). Linear regression, bias plot and other statistical analyses were extrapolated from the test data. Passing-Bablok regression analysis of the data between PixoTest POCT System and TOSOH G7 Analyzer with the venous blood showed a slope of 1.03 and an intercept of − 0.1 and a correlation coefficient of 0.99. The results for capillary blood showed a slope of 1.01 and an intercept of − 0.04 and a correlation coefficient of 0.99. The PixoTest POCT System’s performance is similar to TOSOH G7 Analyzer in accuracy and linearity. Therefore, the system’s HbA1c test capability is ideal for the management of chronic disease, as a user convenient and efficient POC solution.

An ultrasonic examination is a clinically universal and safe examination method, and with the development of telemedicine and precision medicine, the robotic ultrasound system (RUS) integrated with a robotic arm and ultrasound imaging system receives increasing attention. As the RUS requires precision and reproducibility, it is important to monitor the real-time calibration of the RUS during examination, especially the angle of the probe for image detection and its force on the surface. Additionally, to speed up the integration of the RUS and the current medical ultrasound system (US), the current RUSs mostly use a self-designed fixture to connect the probe to the arm. If the fixture has inconsistencies, it may cause an operating error. In order to improve its resilience, this study proposed an improved sensing method for real-time force and angle calibration. Based on multichannel pressure sensors, an inertial measurement unit (IMU), and a novel sensing structure, the ultrasonic probe and robotic arm could be simply and rapidly combined, which rendered real-time force and angle calibration at a low cost. The experimental results show that the average success rate of the downforce position identification achieved was 88.2%. The phantom experiment indicated that the method could assist the RUS in the real-time calibration of both force and angle during an examination.

Blood glucose measurements help to guide insulin therapy, thus reducing disease severities, secondary complications, and related mortalities. Efforts are underway to allow diabetes patients to experience a more convenient way to measure blood glucose and consequently increase their adherence to regular self-monitoring of blood glucose (SMBG). This study demonstrated a new SMBG system that integrated all components of a glucometer via a smartphone’s optical sensing module to detect the colorimetric blood strip and obtains the blood glucose concentration with calculations performed by an application install in the smartphone. To validate the accuracy and applicability of the new SMBG system regarding the ISO15197:2013 accuracy criteria and patient requirements, a clinical trial and usability survey involving participants from different age groups were conducted in collaboration with the China Medical University, where enrolled 120 diabetic patients were asked to operate the new SMBG system to measure their blood glucose concentration, and feedback was obtained from their user experience. The results showed that three different reagent system lots fulfilled the accuracy requirements with values of 97.4–97.5% , and all of the data were within zones A and B of the consensus error grid, which satisfies the ISO 15197:2013 requirement. The usability survey showed that 97.5% of the participants found the operations convenient, and 100% found the design easy for carrying. This new system could lead to improvements in blood glucose monitoring by people with diabetes, and thus, better management of the disease.

Maintaining appropriate insulin levels is very important for diabetes patients. Effective monitoring of blood glucose can aid in maintaining the body’s insulin level, and thus reduce disease severities, secondary complications, and related mortalities. However, existing blood glucose measurement devices are inconvenient to carry and involve complex procedures, reducing the willingness of diabetes patients to regularly measure blood glucose. We aim to provide a rapid, convenient, and portable meter for diabetes patients. We introduce an integrated blood glucose detection device (IBGDD) that has no electronic component and uses the optical sensing module of a smartphone to inspect colorimetric blood strips. To demonstrate accuracy conformance of the developed device to the ISO 15197:2013 standard for blood glucose measurement, 20 diabetes mellitus patients used the IBGDD with smartphones to measure their blood glucose level. The measurement results revealed an accuracy of 100%, completely satisfying the requirements of the ISO 15197:2013 standard. Overall, our specially designed IBGDD with a smartphone could achieve high accuracy and convenient usage for the measurement of blood glucose concentration. Furthermore, the device is highly portable and simple to operate. This contributes toward achieving self-monitoring of blood glucose by diabetes patients and improved mobile health in the future.

Biomimetic materials are used for creating microsystems to control cell growth spatially and elicit specific cellular responses by combining complex biomolecules with nanostructured surfaces. Intercellular cell-to-cell and cell-to-extracellular matrix (ECM) interactions in biomimetic materials have demonstrated potential in the development of drug discovery platforms and regeneration medicine. In this study, we developed a biomimetic nanostructured matrix by using various ECM molecular layers to create a biomimetic and biocompatible environment for realizing neuronal guidance in neural regeneration medicine. Silicon-based substrates possessing nanostructures were modified using different ECM proteins and peptides to develop a biomimetic and biocompatible environment for studying neural behaviors in adhesion, proliferation, and differentiation. The substrates were flat glass, flat silicon wafers (FWs), and nanorod-structured wafers prepared using wet etching. The three substrates were then functionalized using laminin-1 peptide, PA22-2-contained active isoleucine-lysine-valine-alanine-valine (IKVAV) peptide, and poly-d-lysine (PDL), separately. When PC12 cells were cultured and differentiated on the modified substrates, the cells were able to elongate the neurites on the glass and FW, which was coated with three types of peptide. More differentiated neurons were observed on the nanorod-structured wafers coated with laminin than on those coated with IKVAV or PDL. For achieving directional guidance of neurite outgrowth, substrates exhibiting a grating pattern of nanorods were partially collapsed by the pulling force of water, leaving few nanorods, which support the net form of laminin on the surface. Furthermore, we fabricated the topological nanostructure-patterned wafer coated with laminin and successfully manipulated the extension and direction of neurites by using more than 80 μm of a single soma. This approach demonstrates potential as a facile and efficient method for guiding the direction of single axons and for enhancing neurite outgrowth in studies on nerve regenerative medicine.

Objective. To kill urothelial cancer cells while preserving healthy cells, this study used photothermal therapy (PTT). PTT techniques target urothelial cancer cells using gold nanoparticles (GNPs) and a green light laser.Materials and Methods. The GNPs were conjugated with anti-Mucin 7 antibodies, which acted as a probe for targeting tumor cells. Conjugated GNPs were exposed to a green light laser (532 nm) with sufficient thermal energy to kill the transitional cell carcinomas (TCCs).Results. According to our results, nanoparticles conjugated with Mucin 7 antibodies damaged all types of cancer cells (MBT2, T24, 9202, and 8301) at relatively low energy levels (i.e., 500 laser shots at 10 W/cm2in power, 1.6 Hz in frequency, and 300 ms in duration). Nonconjugated nanoparticles required 30 W/cm2or more to achieve the same effect. Cell damage was directly related to irradiation time and applied laser energy.Conclusions. The minimally invasive PTT procedure combined with Mucin 7 targeted GNPs is able to kill cancer cells and preserve healthy cells. The success of this treatment technique can likely be attributed to the lower amount of energy required to kill targeted cancer cells compared with that required to kill nontargeted cancer cells. Our in vitro pilot study yielded promising results; however, additional animal studies are required to confirm these findings.

Treating forgotten indwelling ureteral stents is difficult because forgotten stents become encrusted and fragmented. Therefore, we developed a silk loop with which to loop the lower end of a forgotten ureteral stent during ureterorenoscopy to supply a counterforce, which fixed the stent while separating encrusted stones from the forgotten stent. We evaluated the success of the silk loop method.Nine patients were enrolled in this study from 1997 to 2003. Each patient had a forgotten ureteral stent with renal stones on the tip of the proximal end. All consented to the procedure of silk loop assisted ureterorenoscopic lithotripsy (URSL) with a Lithoclast (Microvasive, Natick, Massachusetts) lithotriptor.We successfully removed the forgotten indwelling stent from all 9 patients with the silk loop assisted URSL method.Silk loop assisted URSL makes the removal of forgotten stents easier. While percutaneous nephrostolithotomy and open surgery produce successful results, the silk loop method is less invasive and expensive, and it minimizes hospital recovery time.

The aim of this project is to utilize photothermal therapy (PPT) to treat urothelial cancer by gold nanoparticles and the exposure of green light laser. According to our study, tumor cells will be killed at laser power more than 10W/ cm2, 1.6Hz, 300ms duration for 500 shots. However, the control group required more than 30 W/ cm2 under the same condition.

Objectives To report our experience with hand-assisted laparoscopic nephroureterectomy (HALNU) to treat upper urinary tract transitional cell carcinoma (TCC). In addition, we report the treatment of 4 patients with upper urinary tract TCC and synchronous superficial urinary bladder TCC by HALNU and simultaneous transurethral resection of bladder tumor (TURBT). Methods We retrospectively reviewed 33 patients who had undergone HALNU. Recovery was evaluated according to the Eastern Cooperative Oncology Group performance status. Four patients had concomitant superficial urinary bladder cancer and underwent simultaneous TURBT at the beginning of surgery. We compared our data with those of our open surgery group and previously published data. Results Partial recovery had occurred by 1 week and complete recovery by 4 weeks postoperatively. Conversion to open surgery was required in 2 (6%) of the 33 patients. The complication rate was 24% (8 of 33) without any mortality. The recurrence rate of urinary bladder TCC was 6% (2 of 33). Both patients with recurrent tumor were treated successfully by TURBT and bacille Calmette-Guerin instillation. All 4 patients with synchronous superficial urinary bladder TCC had undergone simultaneous transurethral resection of bladder tumor, and all 4 were disease free at the last follow-up visit. Conclusions Hand-assisted procedures are appropriate for surgeons with limited experience with laparoscopic surgery. In our study, the convalescence of patients was excellent, and the postoperative results were compatible with those of previous studies. To treat upper urinary tract TCC with synchronous urinary bladder TCC, HALNU and TURBT together seems to be a safe and efficient technique.

Carcinosarcoma is a malignancy that occurs very rarely in the renal pelvis[1-3]; thus, only a very limited number of cases has been documented.[2,3] These tumors are composed of both carcinomatous and sarcomatous elements.[1] We report here a case of a carcinosarcoma composed of well-differentiated, keratinizing, squamous carcinoma cells and high-grade sarcoma cells. Differently from the cases described so far, this carcinosarcoma of the renal pelvis was characterized by the quick recurrence, following complete surgical resection, as a highly disseminated high-grade sarcoma.

Thromboembolism is one of the common paraneoplastic syndromes. Approximately 15 percent of patients with thromboembolism have a diagnosis of malignancy, including pulmonary, pancreatic, gastrointes

Bladder cancer is a common malignancy of the urinary tract, which generally develops in the epithelial lining of the urinary bladder. The specific course of treatment depends on the stage of bladder cancer; however, therapeutic strategies typically involve intravesical drug delivery to reduce toxicity and increase therapeutic effects. Recently, metallic, polymeric, lipid, and protein nanoparticles have been introduced to aid in the treatment of bladder cancer. Nanoparticles are also commonly used as pharmaceutical carriers to improve interactions between drugs and the urothelium. In this review, we classify the characteristics of bladder cancer and discuss the types of nanoparticles used in various treatment modalities. Finally we summarize the potential applications and benefits of various nanoparticles in intravesical therapy.