Robotic-assisted versus manual Uro Dyna-CT-guided puncture in an ex-vivo kidney phantom.

INTRODUCTION AND OBJECTIVES: Challenging percutaneous renal punctures to gain access to the kidney requiring guidance by cross-sectional imaging. To test the feasibility of robotic-assisted CT-guided punctures (RP) and compare them with manual laser-guided punctures (MP) with Uro Dyna-CT (Siemens Healthcare Solutions, Erlangen, Germany). MATERIAL AND METHODS: The silicon kidney phantom contained target lesions of three sizes. RP were performed using a robotic assistance system (guidoo, BEC GmbH, Pfullingen, Germany) with a robotic arm (LBR med R800, KUKA AG, Augsburg, Germany) and a navigation software with a cone-beam-CT Artis zeego (Siemens Healthcare GmbH, Erlangen, Germany). MP were performed using the syngo iGuide Uro-Dyna Artis Zee Ceiling CT (Siemens Healthcare Solutions). Three urologists with varying experience performed 20 punctures each. Success rate, puncture accuracy, puncture planning time (PPT), and needle placement time (NPT) were measured and compared with ANOVA and Chi-Square Test. RESULTS: One hundred eighteen punctures with a success rate of 100% for RP and 78% for MP were included. Puncture accuracy was significantly higher for RP. PPT (RP: 238 ± 90s, MP: 104 ± 21s) and NPT (RP: 128 ± 40s, MP: 81 ± 18s) were significantly longer for RP. The outcome variables did not differ significantly with regard to levels of investigators' experience. CONCLUSION: The accuracy of RP was superior to that of MP. This study paves the way for first in-human application of this robotic puncture system.

Graphology in German psychiatry (1870-1930).

This article discusses both the use of graphology in German psychiatry (1870-1930) and the use of handwriting in psychiatric experiments. The examination of handwriting was part of an ensemble of diagnostic tools. Although disorders of handwriting seemed to indicate psychic diseases, graphology did not seem the right method to produce valid observations. Nevertheless, psychiatrists began to incorporate the process of writing into research and diagnosis and to make the process of handwriting an experimental field. Emil Kraepelin invented an apparatus - the so-called Writing-Scale - with which he could measure the dynamics of writing in various dimensions and, in particular, the pressure of movements. The experiments produced a huge amount of data, but the psychiatrists were unable to interpret them in a comprehensible way. Although psychiatrists failed to grasp the psychopathology in handwriting, they discovered a systemic behaviour of the organism controlled by feedback.

Concept and evaluation of an endaurally insertable middle-ear implant.

A concept for a partially implantable hearing device, for which the power supply and signal transmission are provided by an optical transmission path, is evaluated. The actuator is designed to fit into the round-window niche and to couple directly to the round-window membrane. Implantable hearing aids can be a suitable solution in the case of severe hearing loss, where conventional hearing aids often fail. However, the surgical effort for an implantation is comparatively high. Therefore, the objective of our work was to provide a hearing system which combines reliable coupling to the auditory system with an easy implantation technique. The actuator was designed as a piezoelectric thin-film cantilever. The optical transmission path was realised using an infrared light-emitting diode combined with an active receiver circuit. For a voltage of 1V, the unloaded actuator presents displacement amplitudes of 1µm up to a stimulus frequency of 25kHz and forces up to 0.2mN. Proportionally larger forces can be achieved by stacking single actuators. The overall transmission loss from the electrical input of the light-emitting diode driver to the mechanical output of the unloaded actuator was less than 25dB at 1kHz and maximum output.

[Exhausted literature. The emergence of the new in Samuel Beckett's novels and plays]. / Erschöpfte Literatur. Uber das Neue bei Samuel Beckett.

The article investigates literary subjectivity in some texts by Samuel Beckett. The article proceeds by relating the ways of how narration and speech acts constitute literary subjectivity to the problems of subjectivity that scientific investigations deal with. While successful self-regulation of the organism nourishes the roots of subjectivity, i.e., the habits, subjectivity decomposes in states of exhaustion, when self-regulation breaks down. As soon as a certain threshold is transgressed, fatigue sets in, alters the personality and eventually leads to exhaustion--a state, which psychiatrists compare to mental illness. Notwithstanding the different explanations given, scientists agreed about the effects of exhaustion. According to their investigations, the decomposition of personality by exhaustion generally does not involve apathy, withdrawal from activity or termination of movements, but rather mere action. Similarly, in Beckett's novels and plays exhaustion is much more than tiredness, as French philosopher Gilles Deleuze observed. For Beckett, exhaustion is rather the model for both literary innovation and a new concept of subjectivity, which he explores on the basis of a detailed knowledge of physiology, psychology, and psychiatry, but using his own literary means. The exhausted subject is beyond any calculus of activity. It will perform an activity even if he or she makes mistakes or loses control, and will thus act in an unpredictable way. This unpredictable action is not an exception in the continuation of the habits, but rather points to the moment when a new subjectivity emerges. Such new subjectivity suraces in Beckett's novels and plays in forms of literary innovation.