Current laser therapy options for endoscopic treatment of upper tract urothelial carcinoma.

Endoscopic management via retrograde ureteroscopic laser ablation of upper tract urothelial carcinoma (UTUC) has become the preferred treatment modality for low-risk tumors. The most popular ablative lasers over the past 15-20 years have been the holmium:yttrium-aluminum-garnet (Ho:YAG) and neodymium (Nd:YAG) lasers, but recently the thulium (Th:YAG) laser has emerged as a potential alternative. This review compares the mechanism of action, physiological properties and effects, and oncologic outcomes of Ho:YAG/Nd:YAG lasers versus the Th:YAG laser for UTUC treatment. Potential advantages of the Th:YAG laser over existing technologies are outlined, followed by a discussion of emerging laser technologies in UTUC management.

Psychosocial Burden of Verruca Vulgaris: A Cross-Sectional Survey.

Although medically benign, common warts, or verruca vulgaris, may negatively affect emotional wellbeing and quality of life (QoL). The various treatment options, such as liquid nitrogen cryotherapy or Candida antigen injection, can be painful, and repeat trials for wart resolution can be burdensome. Because the psychosocial burden of verruca is likely underestimated, we surveyed adult patients diagnosed and treated with warts at a single academic institution in an urban setting to assess the reported effects on QoL and satisfaction with the different treatment modalities. In domains such as anxiety, social activities, and interpersonal relationships, patients rated impact of warts on a scale of 1-100, with a score of 1 representing “minimal impact” and 100 representing “severe impact.” These numerical ratings were then converted to the validated Dermatology Life Quality Index (DLQI) parameters for consistency with other QoL studies. Our results indicate that patients are “A little” self-conscious or embarrassed by their warts and that their warts caused “A little” anxiety. Although patients reported more discomfort with Candida antigen than with cryotherapy, overall patient satisfaction for the two procedures was identical. Notably, 52% of respondents endorsed attempting home remedies before seeking clinical care, suggesting room for improvement in patient education for initiating dermatologic care. Future studies should examine patients with recalcitrant verruca and patient satisfaction with other management options. J Drugs Dermatol. 2022;21(6):614-617. doi:10.36849/JDD.6773.

DermIA: Machine Learning to Improve Skin Cancer Screening.

This manuscript reviews DermIA, an online platform geared towards improving skin cancer surveillance. This mobile application allows users to capture images of suspicious lesions and have them evaluated using artificial intelligence technology on their mobile device. Users simply snap a picture of their skin lesion, which then allows the DermIA technology to analyze the image. The system operates using neural network technology, which enables the program to adapt and analyze a user's lesion. Per the application, the analysis can reach an accuracy of 95% on their free version and an accuracy of up to 98.2% on their premium version. As artificial intelligence and machine learning become a more integral part of our society, this mobile application has the potential to revolutionize skin cancer surveillance.Application Specs Application name: DermIA Analyze Skin Cancer with your camera AIApplication developer: GeniaLabsApplication developer website: N/AApplication price: There is a free version of the application on the Google Play Store for Android devices. The application is $5.99 for the premium version.Category: Health and FitnessInstalls: 10,000 + Launch Date: May 2019Tags: N/AWorks offline: N/AFDA approval: N/AQuick Review (1 star, lowest; 5 stars, highest)Overall Rating (1-5): 5Content (1-5): 4Usability (1-5): 5.

Evaluation of Surgical Improvement of Clinical Knowledge Ops (SICKO), an Interactive Training Platform.

Over the past two decades, there have been numerous attempts at using surgical simulation software for training purposes. There has been extensive prior success at using digital laparoscopic tools and virtual and augmented reality in strengthening specific surgical techniques, but clinical decision-making simulation has been limited to multiple choice question banks. Surgical Improvement of Clinical Knowledge Ops (SICKO) is a web-based educational application that takes users through various aspects of clinical decision-making in the field of surgery.App SpecsApp name: Surgical Improvement of Clinical Knowledge Ops (SICKO)App developer: James Lau M.D., Dana Lin M.D., Julia Park M.D.App website/URL*: http://med.stanford.edu/sm/archive/sicko/game/SICKOTitle.html App price: The website is free to use and has no microtransactionsCategory: educational, surgery simulation, clinical decision makingTags: web-based app, surgical simulation, learning, healthcare, gamificationWorks offline: noBrowsers: Works on Google Chrome, Mozilla Firefox, Safari, and Microsoft EdgeFDA approval: N/A*It should be noted that although the URL leads to a website with a tab header that reads "SEPTRIS," an older iteration of the game, the interactive experience is actually SICKO, which the user can clearly see from the webpage itself.Quick Review (1 star, lowest; 5 stars, highest)Overall Rating (1-5): 4.5Content (1-5): 5Usability (1-5): 5Design (1-5): 4Ratings Disclosure: The SICKO application was reviewed by two independent medical student authors of this article, as well as a resident physician. The reviews were done anonymously through each reviewer's own input and were blinded to each other's ratings until completion of the simulation. Each reviewer completed full renditions of the game from beginning to end to experience a situation where the patient expired, as well as one where the patient was saved in order to observe the full user experience. Both authors felt that the game was remarkably useful, with the only criticism being the simple graphical design of the application. No reviewers or authors of this paper have any connection to the software content or development team of SICKO.

Use of the T-1470 LiteTouch™ Laser in the En Bloc Resection of an Upper Tract Urothelial Cancer.

BACKGROUND: Endoscopic laser-ablative therapy of upper tract urothelial carcinoma offers kidney-sparing treatment for well-selected low-risk tumors. The traditional technique consists of tumor biopsy with flexible forceps or nitinol basket for pathologic assessment of stage and grade, followed by laser ablation of the tumor. In this case, we present the use of the new T-1470 LiteTouch™ laser for intraoperative tumor en bloc resection, affording both tissue acquisition and tumor ablation. Case Presentation. An 81-year-old female with a past medical history significant for stage 4 chronic kidney disease, peripheral artery disease, coronary artery disease, type 2 diabetes mellitus, and gout was diagnosed with a 2 cm left upper tract high-grade papillary urothelial carcinoma confirmed by cytology with cell block preparation. Using a novel approach, the tumor was resected, en bloc, using the T-1470 LiteTouch™ laser which allowed for sufficient tissue resection for pathologic examination and strong hemostasis. This new technique is the first recorded example of tumor en bloc resection using the T-1470 LiteTouch™ laser of an upper tract urothelial carcinoma. CONCLUSION: The use of the T-1470 LiteTouch™ laser offers promise for its use as a novel laser for the endoscopic treatment of upper tract urothelial carcinoma. It shows potential for advantages over current techniques through its ability to achieve en bloc resection and superior hemostasis.