A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

Objective:Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter.The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the“ureter”during the ureteroscopic holmium laser lithotripsy in vitro.Methods:An in vitro lithotripsy was performed using a modified catheter(5 Fr)as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet.Different laser power settings(10 W,20 W,and 30 W)with various firing times(3 s,5 s,and 10 s)and rates of irrigation(15 mL/min,20 mL/min,and 30 mL/min)were applied in the experiment.Temperature changes in the“ureter”were recorded with a thermometer during and after the lithotripsy.Results:During the lithotripsy,the local highest mean temperature was 60.3℃ and the lowest mean temperature was 26.7℃.When the power was set to 10 w,the temperature was maintained below 43℃ regardless of laser firing time or irrigation flow.Regardless of the power or firing time selected,the temperature was below 43℃ at the rate of 30 mL/min.There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing(3 s,5 s,or 10 s)compared to with not drainage(p<0.05)except for two conditions of 0.5 J×20 Hz,30 mL/min,firing 5 s,and 1.0 J×10 Hz,30 mL/min,firing 5 s.Conclusion:Our modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect,especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

Therapeutic approach to emotional reactions accompanied with thermal skin injury–from basic to epidemiological research

In this editorial,we discuss the status of a therapeutic approach to emotional reactions accompanying thermal skin injuries.Burns are considered a major health problem,as well as an economic and social problem,with potentially devastating and life-changing consequences.They affect a wide range of patients with different damage mechanisms,varied depths,and localizations of the burns.The most common are thermal burns,with more than 11 million occurrences annually according to the World Health Organization data.Thermal skin injuries are among the most tragic and catastrophic injuries,almost unsurpassed in terms of severity,morbidity,and mortality,as well as functional,aesthetic,social,economic,and psychological consequences.Burn survivors face stress,anxiety,depression,low self-esteem,body deformity,social isolation,unemployment,financial burden,and family problems.The advances in acute burn care have allowed researchers and physicians to pay more attention to other effects of burns,focusing on psychological consequences in particular.Apart from the significant improvements in routine protocols,it seems useful to take care of psychological disturbances that occur simultaneously but may emerge as the most lasting outcome of those injuries.In that sense,various standards and additional approaches may be involved to achieve overall recovery.

Burns and frostbite in the Red Army during World War Ⅱ

The start of World War Ⅱ(WWⅡ) led to the deployment of combat troops in several continents. Destruction and many casualties among both the military and civilians became an inevitable consequence. A large amount of people injured were in need of life-saving treatment and a speedy return to duty. Intensive studies of the specific issues of diagnosis and treatment of thermal injury were conducted in the Soviet Union before the war. The first special units for patients with burn injuries were created, and the first specialists received their first clinical experience. The contributions of famous Soviet scientists in the development of the treatment of burns and frostbite in WWⅡ are studied in this article. The structure of thermal injuries among military personnel and the results of their treatment are shown. Treatment, classification and quantity frostbite in the structure of sanitary losses during the WWⅡ are studied in this article.

Modulated-Power Implantable Neuromodulation Devices and Their Impact on Surrounding Tissue Temperatures

This project was intended to determine whether the preprogrammed time-varying recharge protocol for a battery incased in a neuromodulation implant can give rise to tissue temperatures that surpass a safe level or are otherwise benign. The study included the development of a highly accurate model of all the thermal processes that are activated by the recharging of the battery contained within the neuromodulation implant. The model was implemented by numerical simulations performed for several realistic operating conditions. The computed spatial and temporal tissue temperature distributions were employed to estimate possible tissue damage by making use of two independent methodologies. Independent calorimeter-based experiments were performed to provide validation for the calculated rates of heat generation in the coils of the implant. Spatial and temporal tissue temperature distributions extracted from the numerical simulations revealed the thermal effects associated with several realistic operating protocols. None of the operating protocols gave rise to temperatures above 42℃. Numerical values of thermal tissue damage metrics were determined and compared with accepted values which correspond to the absence and the presence of tissue damage. The experimentally determined rate of heat generation in the implant coils validated that from electrical measurements to within 2%. Both the tissue temperature results and the thermal damage metrics found no evidence of tissue injury when time-varying preprogrammed protocols are used in the recharging of neuromodulation implant-encased batteries.

Cutting performance of surgical electrodes by constructing bionic microstriped structures

Surgical electrodes rely on thermal effect of high-frequency current and are a widely used medical tool for cutting and coagulating biological tissue.However,tissue adhesion on the electrode surface and thermal injury to adjacent tissue are serious problems in surgery that can affect cutting performance.A bionic microstriped structure mimicking a banana leaf was constructed on the electrode via nanosecond laser surface texturing,followed by silanization treatment,to enhance lyophobicity.The effect of initial,simple grid-textured,and bionic electrodes with different wettabilities on tissue adhesion and thermal injury were investigated using horizontal and vertical cutting modes.Results showed that the bionic electrode with high lyophobicity can effectively reduce tissue adhesion mass and thermal injury depth/area compared with the initial electrode.The formation mechanism of adhered tissue was discussed in terms of morphological features,and the potential mechanism for antiadhesion and heat dissipation of the bionic electrode was revealed.Furthermore,we evaluated the influence of groove depth on tissue adhesion and thermal injury and then verified the antiadhesion stability of the bionic electrode.This study demonstrates a promising approach for improving the cutting performance of surgical electrodes.