Efficacy and safety of the implantable, magnetic resonance imaging-compatible StimRouter neuromodulation system in the treatment of refractory lower urinary tract symptoms in multiple sclerosis patients.

BACKGROUND AND PURPOSE: Lower urinary tract symptoms (LUTS) significantly affect quality of life (QoL) of multiple sclerosis (MS) patients, and pharmacotherapy has limited efficacy. We investigated efficacy and safety of the implantable StimRouter neuromodulation system for treating refractory LUTS in MS. METHODS: This prospective, single-center, clinical trial was conducted at the Multiple Sclerosis Center of Lugano, Switzerland, involving MS patients treated with self-administered percutaneous tibial nerve stimulation delivered by StimRouter over 24 weeks. Changes in video-urodynamic parameters as well as LUTS severity were measured by Overactive Bladder Questionnaire (OAB-q), QoL using the Multiple Sclerosis Quality of Life (MSQoL-54), and treatment satisfaction using a 1-10 visual analogue scale. Adverse events were also recorded. RESULTS: Of 23 MS patients recruited, six had neurogenic detrusor overactivity (NDO), five had detrusor sphincter dyssynergia (DSD), and 12 had both NDO and DSD. Of patients with NDO, median bladder volume at first uninhibited contraction significantly increased from baseline to week 24 (median = 136 mL, interquartile range [IQR] = 101-244 mL vs. 343 mL, IQR = 237-391 mL; ß = 138.2, p = 0.001). No significant changes of urodynamic parameters were found in patients with DSD. OAB-q symptom scores progressively decreased, and OAB-q quality of life scores increased (ß = -0.50, p < 0.001 and ß = 0.47, p < 0.001, respectively), whereas MSQoL-54 scores did not significantly change (ß = 0.24, p = 0.084) in the overall population. Treatment satisfaction was overall high (median = 8, IQR = 6-9). No serious adverse events were recorded. CONCLUSIONS: StimRouter represents a minimally invasive, magnetic resonance imaging-compatible, self-administered neuromodulation device leading to objective and subjective improvements of OAB symptoms and related QoL in MS patients with refractory LUTS.

[Urology: what's new in 2022]. / Urologie : ce qui a changé en 2022.

Over the last year, urologic progress remains driven by evolutions in oncological and functionnal urology. Prostate cancer imaging modalities are improving, as well as treatment options for advanced stages. Kidney and bladder cancer are benefiting from new treatment modalities including immunotherapy, whose role in the peri-operative setting is still unclear. Surveillance startegies for testicular cancer has been greatly simplified, for the benefit of the patients. In functional urology, a new therapeutic class in now available for the treatment of overactive bladder. Mutliples alternatives to transurethral resection are emerging in the surgical treatment of benign prostatic hypertrophy, whose expected benefits will need to be validated by long-term studies.

Les progrès de cette année sont marqués par des avancées en uro-oncologie et urologie fonctionnelle. La prise en charge du cancer de la prostate s'améliore tant dans la qualité de son diagnostic que dans le traitement des stades avancés. Les cancers du rein et de la vessie bénéficient de nouvelles options de traitement incluant l'immunothérapie, qui cherche encore sa place en périopératoire. Quant au cancer des testicules, il a vu sa surveillance grandement simplifiée au bénéfice des patients. En urologie fonctionnelle, une nouvelle classe thérapeutique est désormais disponible pour le traitement de l'hyperactivité vésicale et de multiples alternatives à la résection endoscopique de la prostate émergent dans le traitement chirurgical de l'hypertrophie bénigne de la prostate. Il faudra toutefois valider les avantages espérés par des études à long terme.

Exciton-Exciton Interaction beyond the Hydrogenic Picture in a MoSe_{2} Monolayer in the Strong Light-Matter Coupling Regime.

In transition metal dichalcogenides' layers of atomic-scale thickness, the electron-hole Coulomb interaction potential is strongly influenced by the sharp discontinuity of the dielectric function across the layer plane. This feature results in peculiar nonhydrogenic excitonic states in which exciton-mediated optical nonlinearities are predicted to be enhanced compared to their hydrogenic counterparts. To demonstrate this enhancement, we perform optical transmission spectroscopy of a MoSe_{2} monolayer placed in the strong coupling regime with the mode of an optical microcavity and analyze the results quantitatively with a nonlinear input-output theory. We find an enhancement of both the exciton-exciton interaction and of the excitonic fermionic saturation with respect to realistic values expected in the hydrogenic picture. Such results demonstrate that unconventional excitons in MoSe_{2} are highly favorable for the implementation of large exciton-mediated optical nonlinearities, potentially working up to room temperature.

Effectiveness of percutaneous posterior tibial nerve stimulation for the management of bowel dysfunction in multiple sclerosis patients.

BACKGROUND: Neurogenic bowel dysfunctions (NBDs) in the form of both fecal incontinence (FI) and functional constipation (FC) are frequent in multiple sclerosis (MS) patients and significantly affect their quality of life. Therapeutic options are limited. OBJECTIVE: To investigate effectiveness of percutaneous posterior tibial nerve stimulation (PTNS) in MS patients suffering from FI and FC. METHODS: Prevalence and severity of FI and FC were prospectively collected among MS patients undergoing 12 weeks of PTNS for neurogenic bladder. The Cleveland Clinic Fecal Incontinence Score (CCFIS) and the Rome III criteria were used to define FI and FC, respectively. Subjective treatment satisfaction was estimated using the Benefit Satisfaction and Willingness to Continue (BSWC) questionnaire. RESULTS: A total of 60 patients undergoing PTNS suffered from NBDs (25 FI+/FC+, 5 FI+/FC-, 30 FI-/FC+). Median CCFIS decreased after PTNS from 12.0 (11.0-13.0) to 8.5 (7.0-11.0, p < 0.001), with particular improvements in liquid and flatal incontinence, pads' need, and lifestyle restrictions. Seven patients became FC free after PTNS and no patients developed FC during the study (p = 0.023). More than 50% of the patients were satisfied and willing to continue PTNS at study end. CONCLUSION: PTNS represents a valid minimally invasive alternative treatment for MS patients suffering from NBDs.

[Living donor nephrectomy]. / Prélèvement de rein chez le donneur vivant.

Kidney living donor is the best treatment of terminal kidney failure. Donors are remarkably altruistic. The first concern of the medical team is not to harm the donor and respect their will to give their kidney. The technological evolution towards mini-invasive approaches has largely contributed to a better post-operative recovery. The evolution of this trend has led us to use laparoscopic robot-assisted kidney harvesting as the optimal standard. This work describes our pathway to this option.

Recevoir un rein par un donneur vivant est à ce jour le meilleur traitement de l'insuffisance rénale terminale. Les donneurs font un geste remarquablement altruiste. Le but primaire de l'équipe médicale est de pouvoir soigner un patient insuffisant rénal grâce au don d'organe sans nuire au donneur. Les avancées technologiques vers des approches mini-invasives ont contribué à l'amélioration de la prise en charge des donneurs en augmentant considérablement leur confort postopératoire et en réduisant drastiquement les durées moyennes d'hospitalisation. La procédure standard aux HUG à ce jour est la laparoscopie robot-assistée. Cet article retrace l'évolution mini-invasive du don de rein dans le service.

Extra-cardiac stimulators: what do cardiologists need to know?

For several decades, treating patients with pacemakers has been the privilege of cardiologists. However, in the last 30 years, researchers have found new targets for electrical stimulation in different clinical subspecialities, such as deep brain stimulation (for the treatment of Parkinson's disease, essential tremor, dystonia, and some psychiatric illnesses); spinal cord stimulation (for refractory angina, chronic pain, and peripheral artery disease); and sacral (for diverse urologic and proctologic conditions), vagal (for epilepsy), and phrenic nerve stimulation (for sleep apnoea). The purpose of this article is to familiarize cardiologists with these 'extra-cardiac pacemakers' and to discuss potential issues that must be addressed when these patients undergo cardiac procedures.

[Non infectious pollakiura of women : diagnosis and treatment]. / Pollakiurie non infectieuse de la femme : bilan et traitement.

Overactive bladder is a frequent condition, often underdiagnosed, which affects deeply the quality of life of patients. The main burden linked to this syndrome is the limitation of every day life activities and the emotional impact which can even lead to depression.This impact on quality of life makes it a public health problem due to the high costs which stem from its management. In this context, a prompt and correct diagnosis, excluding all differential diagnosis, is essential before considering treatment options.

L'hyperactivité vésicale est un trouble fréquent, souvent sousdiagnostiqué, affectant la qualité de vie des patients atteints : limitation des activités quotidiennes, impact émotionnel profond, voire dépression. Les conséquences sur la qualité de vie en font un problème de santé publique aux coûts élevés pour le patient et la société. Dans ce contexte, le diagnostic doit être rapide et efficace. Les diagnostics différentiels doivent être soigneusement exclus avant d'envisager tout traitement.

Few-electron edge-state quantum dots in a silicon nanowire field-effect transistor.

We investigate the gate-induced onset of few-electron regime through the undoped channel of a silicon nanowire field-effect transistor. By combining low-temperature transport measurements and self-consistent calculations, we reveal the formation of one-dimensional conduction modes localized at the two upper edges of the channel. Charge traps in the gate dielectric cause electron localization along these edge modes, creating elongated quantum dots with characteristic lengths of ∼10 nm. We observe single-electron tunneling across two such dots in parallel, specifically one in each channel edge. We identify the filling of these quantum dots with the first few electrons, measuring addition energies of a few tens of millielectron volts and level spacings of the order of 1 meV, which we ascribe to the valley orbit splitting. The total removal of valley degeneracy leaves only a 2-fold spin degeneracy, making edge quantum dots potentially promising candidates for silicon spin qubits.

Origins of nonlocality near the neutrality point in graphene.

We present an experimental study of nonlocal electrical signals near the Dirac point in graphene. The in-plane magnetic field dependence of the nonlocal signal confirms the role of spin in this effect, as expected from recent predictions of the Zeeman spin Hall effect in graphene, but our experiments show that thermo-magneto-electric effects also contribute to nonlocality, and the effect is sometimes stronger than that due to spin. Thermal effects are seen to be very sensitive to sample details that do not influence other transport parameters.

[Initial management of female urinary incontinence by the general practitioner]. / Prise en charge initiale de l'incontinence urinaire chez la femme par l'interniste generalist.

Urinary incontinence is a frequent urological burden for women. It is subdivided in 3 etiological subcategories, each of them bearing specific symptoms, causes and treatment options. Due to its possible hybrid clinical presentation, diagnosis may seem complex, which often leads the general practitioner to refer immediately patients to the specialist. However, a simple, rigourous initial investigation procedure helps in identifying the best management options and finding the most suitable treatment in most of cases without requiring a specialized consult.

Controlled Coherent Coupling in a Quantum Dot Molecule Revealed by Ultrafast Four-Wave Mixing Spectroscopy.

Semiconductor quantum dot molecules are considered promising candidates for quantum technological applications due to their wide tunability of optical properties and coverage of different energy scales associated with charge and spin physics. While previous works have studied the tunnel-coupling of the different excitonic charge complexes shared by the two quantum dots by conventional optical spectroscopy, we here report on the first demonstration of a coherently controlled interdot tunnel-coupling focusing on the quantum coherence of the optically active trion transitions. We employ ultrafast four-wave mixing spectroscopy to resonantly generate a quantum coherence in one trion complex, transfer it to and probe it in another trion configuration. With the help of theoretical modeling on different levels of complexity, we give an instructive explanation of the underlying coupling mechanism and dynamical processes.

[Transurethral bladder catheterization in male patients: prevention and treatment of iatrogenic lesions]. / Sondage transurétral chez le sujet masculin: prévention et traitement de l'iatrogénie.

Transurethral catheterization represents a common and frequent procedure performed on hospitalized patients. Although consequences can be disastrous, most of these procedures are performed by nurses or young medical doctors in training who are unfortunately not all specifically taught. In fact 45% of urethral strictures are from iatrogenic origin and expose patients tedious investigations and treatments with a relative high risk of recurrence. It is therefore fundamental to ensure the maximum education to health professionals in terms of transurethral catheterization techniques, indications and signs of complications to reduce the rate of iatrogenic lesions.

A gate-tunable graphene Josephson parametric amplifier.

With a large portfolio of elemental quantum components, superconducting quantum circuits have contributed to advances in microwave quantum optics1. Of these elements, quantum-limited parametric amplifiers2-4 are essential for low noise readout of quantum systems whose energy range is intrinsically low (tens of µeV)5,6. They are also used to generate non-classical states of light that can be a resource for quantum enhanced detection7. Superconducting parametric amplifiers, such as quantum bits, typically use a Josephson junction as a source of magnetically tunable and dissipation-free non-linearity. In recent years, efforts have been made to introduce semiconductor weak links as electrically tunable non-linear elements, with demonstrations of microwave resonators and quantum bits using semiconductor nanowires8,9, a two-dimensional electron gas10, carbon nanotubes11 and graphene12,13. However, given the challenge of balancing non-linearity, dissipation, participation and energy scale, parametric amplifiers have not yet been implemented with a semiconductor weak link. Here, we demonstrate a parametric amplifier leveraging a graphene Josephson junction and show that its working frequency is widely tunable with a gate voltage. We report gain exceeding 20 dB and noise performance close to the standard quantum limit. Our results expand the toolset for electrically tunable superconducting quantum circuits. They also offer opportunities for the development of quantum technologies such as quantum computing, quantum sensing and for fundamental science14.

High-power potassium-titanyl-phosphate laser fibres for endovaporization of benign prostatic hyperplasia: how much do they deteriorate during the procedure?

OBJECTIVE: • To assess the residual power delivered at the tip of a high-power (80 W) potassium-titanyl-phosphate (KTP) laser (80 W Green Light PV(TM), Laserscope(®); American Medical Systems, Minnetonka, MN, USA) at the end of a photoselective vaporization of the prostate (PVP) procedure, as well as the deflection angle of the laser beam. MATERIALS AND METHODS: • In total, 65 laser fibres were collected at the end of PVP procedures indicated for symptomatic benign prostatic hyperplasia over a period of 17 months. PVP was performed by two senior urologists. • The power of laser beam at tip exit was measured for each fibre at the end of the procedures using a photodiode whose signal was amplified, and then quantified by a volt multimeter. • The deflection angle was measured using a graduated sphere. RESULTS: • Approximately 70% of fibres delivered less than 40 W at the end of the procedure, which is less than the vaporization threshold. • Some 9% of fibres had lost their diffraction capacity with a significant alteration of laser beam angulation. These values were not operator dependent. CONCLUSIONS: • The data show that a large proportion of laser fibers deliver a significantly underpowered beam at the end of the procedures. • This seems to be caused by peroperative destruction of the fibers, which results in a progressive loss of efficacy of PVP during procedures.

Percutaneous biopsy of small renal mass: can diagnostic accuracy be affected by hospital volume?

INTRODUCTION: High diagnostic performance and low morbidity for renal tumor biopsy (RTB) have been described in highly experienced centers. Here we present the five-year experience of our institute in performing RTB. The protocol used, the safety profile and the diagnostic accuracy obtained were analyzed. MATERIAL AND METHODS: The study is a retrospective single-institution clinical data review of 84 consecutive RTB of small renal masses. Post-biopsy complications were reported using the Clavien-Dindo system. To measure the concordance between biopsy and nephrectomy specimens regarding histological subtype and International Society of Urological Pathology/World Health Organization (ISUP/WHO) renal cell carcinoma grade, the kappa coefficient of Cohen was used. RESULTS: Median (IQR) follow-up time was 44 (29-58) months. In total, 94% of RTB procedures were free of complications; when complications did occur, 80% were grade I and 20% were grade II. No cases of tumor seeding were observed. Combining the first and repeated biopsies the overall diagnostic rate was 85.8%. Overall, 79.1% of diagnostic RTB were malignant. In 42 surgically treated patients, the concordance between the histological results of biopsies and surgical specimens was very good for histological subtypes (k = 0.87) and moderate for tumor grade (k = 0.51). CONCLUSIONS: RTB resulted in a high safety profile. The overall diagnostic rate was 85% and an unnecessary intervention was avoided in 21% of patients. RTB showed a very good accuracy in determining the histological subtype of renal cancer while it was moderate for the tumor grade. These results are similar to those reported in larger series and support feasibility of this procedure in low-volume centers.

Current evidence between hospital volume and perioperative outcome: Prospective assessment of robotic radical prostatectomy safety profile in a regional center of medium annual caseload.

INTRODUCTION: We aimed to present the safety profile of robotic radical prostatectomy (RARP) performed in a single center of medium surgical volume since its introduction and identify predictors of postoperative complications. METHODS: We prospectively collected clinical data from 317 consecutive patients undergoing RARP between August 2011 and November 2019 in a medium-volume center. Surgical procedures were performed by a single experienced surgeon. Complications were collected according to the Martin criteria for reporting and the Clavien-Dindo classification for rating. Preoperative, intraoperative, and postoperative data were analyzed and compared with available literature. RESULTS: A total of 102 complications were observed in 96 (30.3%) patients and were minor in 84.4% of cases (Clavien grade 1 and 2). Transfusion rate was 1.3%. Complications of grade 4b or 5 did not occur. The most frequent complications were urinary retention (7.3%) and anastomotic leak (5.9%). At multivariate analysis, the nerve-sparing technique was an independent predictor of complications (odds ratio [OR] 0.55, p=0.02). CONCLUSIONS: The study shows that a high safety profile may be achieved in a medium-volume hospital. The nerve-sparing technique was a predictor of complications. Further studies are needed to define the current relationship between surgical volume and perioperative outcome for RARP.

In-Plane Magnetic Domains and Néel-like Domain Walls in Thin Flakes of the Room Temperature CrTe2 Van der Waals Ferromagnet.

The recent discovery of magnetic van der Waals (vdW) materials triggered a wealth of investigations in materials science and now offers genuinely new prospects for both fundamental and applied research. Although the catalog of vdW ferromagnets is rapidly expanding, most of them have a Curie temperature below 300 K, a notable disadvantage for potential applications. Combining element-selective X-ray magnetic imaging and magnetic force microscopy, we resolve at room temperature the magnetic domains and domain walls in micron-sized flakes of the CrTe2 vdW ferromagnet. Flux-closure magnetic patterns suggesting an in-plane six-fold symmetry are observed. Upon annealing the material above its Curie point (315 K), the magnetic domains disappear. By cooling back the sample, a different magnetic domain distribution is obtained, indicating material stability and lack of magnetic memory upon thermal cycling. The domain walls presumably have Néel texture, are preferentially oriented along directions separated by 120°, and have a width of several tens of nanometers. Besides microscopic mapping of magnetic domains and domain walls, the coercivity of the material is found to be of a few millitesla only, showing that the CrTe2 compound is magnetically soft. The coercivity is found to increase as the volume of the material decreases.

Retroperitoneal decortication of simple renal cysts vs decortication with wadding using perirenal fat tissue: results of a prospective randomized trial.

OBJECTIVES To evaluate, in a pilot prospective randomized trial, the safety, effectiveness and radiological recurrence of retroperitoneal renal cyst decortication compared with retroperitoneal decortication with wadding using perirenal pedicled fat tissue. PATIENTS AND METHODS From March 2004 to December 2007, 40 patients with simple renal cysts were enrolled and randomized; 22 (group A) had a simple retroperitoneal decortication (SRD) and 18 (group B) a decortication with wadding of the cyst using perirenal fat tissue (RDCW). The following variables were recorded: age, gender, side, size on ultrasonography/computed tomography (CT), location, operative duration, blood loss, complications, pathology, presence or absence of flank pain, hypertension, urinary tract compression or urinary infection. The primary endpoint of this trial was to evaluate and compare the efficacy of both treatments. Secondary endpoints were safety and pain, hypertension and the resolution of urinary tract obstruction. RESULTS In all, 40 cysts were treated; there were no bilateral cysts. The mean (sd) size on CT was 11.9 (1.84) cm in group A and 12.8 (1.25) cm in group B (P = 0.1). All the procedures were completed laparoscopically and no conversion was necessary. There were no intraoperative complications. The mean (range) hospital stay was 3.4 (3-6) days. There was no statistically significant difference between the groups for all variables assessed. There was a radiological recurrence in three patients (14%) in group A, but none in group B (all successful). CONCLUSION To be completely successful, with maximum safety and to prevent recurrences in the treatment of renal cysts, RCDW is recommended when a retroperitoneal approach is chosen, especially if the cyst is located anteriorly. When symptom relief is considered, RCDW duplicates the results obtained with SRD.

Evolution of inter-layer coupling in artificially stacked bilayer MoS2.

In this paper, we show experimentally that for van der Waals heterostructures (vdWh) of atomically-thin materials, the hybridization of bands of adjacent layers is possible only for ultra-clean interfaces. This we achieve through a detailed experimental study of the effect of interfacial separation and adsorbate content on the photoluminescence emission and Raman spectra of ultra-thin vdWh. For vdWh with atomically-clean interfaces, we find the emergence of novel vibrational Raman-active modes whose optical signatures differ significantly from that of the constituent layers. Additionally, we find for such systems a significant modification of the photoluminescence emission spectra with the appearance of peaks whose strength and intensity directly correlate with the inter-layer coupling strength. Our ability to control the intensity of the photoluminescence emission led to the observation of detailed optical features like indirect-band peaks. Our study establishes that it is possible to engineer atomically-thin van der Waals heterostructures with desired optical properties by controlling the inter-layer spacing, and consequently the inter-layer coupling between the constituent layers.