Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause

Abstract not availableFariba Behnia-Willison, Sara Sarraf, Joseph Miller,*, Behrang Mohamadi, Alison S. Care, Alan Lam, Nadia Willison, Leila Behnia, Stefano Salvator

Fractional CO2 laser for treatment of stress urinary incontinence.

Objectives: To evaluate the impact of trans-vaginal fractional CO2 laser treatment on symptoms of stress urinary incontinence (SUI) in women. Study design: Women clinically diagnosed with SUI preferring non-surgical treatment were recruited to the study. Fractional CO2 laser system (MonaLisa T, DEKA) treatments were administered trans-vaginally every 4-6 weeks for a total of three treatments. Response to treatment was assessed at baseline (T1), at 3 months after treatment completion (T2) and at 12-24-month follow-up (T3) using the Australian Pelvic Floor Questionnaire (APFQ). The primary outcome was changes in reported symptoms of SUI. Secondary outcomes assessed included bladder function, urgency, urge urinary incontinence (UUI), pad usage, impact of urinary incontinence on quality of life (QOL) and degree of bothersome bladder. Results: Fifty-eight women were recruited and received the study treatment protocol. Eighty-two percent of participants reported an improvement in symptoms of SUI at completion of treatment (mild to no SUI) (p = <0.01). Treatment effect waned slightly when assessed at follow-up. Nevertheless, 71% of participants reported ongoing improvement in SUI symptoms at 12-24 months (p < 0.01). All secondary outcome measures were improved after treatment compared to baseline. Conclusions: This study suggests that fractional CO2 laser is a safe, feasible, and beneficial treatment for SUI and may have a role as a minimally-invasive alternative to surgical management

Parsing with GETARUN

GETARUNS, the system for text and reference understanding which is currently used for summarization and text generation has a highly linguistically sophisticated parser which implements a number of strategies to cope with ambiguity ensuing from PP attachment and other similar problems(see Delmonte & Dolci, 1997). In this paper we present the parser from a linguistic point of view and as such implementing LFG theoretical framework within a DCG, using Xtraposition Grammars to cope with Long Distance Dependencies. The parser is multilingual and contains a lookahead mechanism, which is then used by the Well-Formed-Substring-Table to recover wrongly parser attachment

Double-command feedforward-feedback control of a nonlinear plant

In this paper, a design approach is proposed for feedforward-feedback control systems. As the basis of the proposed design approach, steady state control command is defined as the control command which maintains the desired situation of the system. Steady state control law is derived form system's mathematical model and employed as feedforward controller. Using such a feedforward controller, for a wide class of systems, the stability of system is proved if the feedback controller is a gain with an arbitrarily high value. That is, the only limit for the feedback (transient) control command is the actuator's practical limit; moreover, there will be no overshoot and control system is capable to damp sever disturbances. In this article, the proposed method has been applied on a Catalytic Stirred Tank Reactor (CSTR) with two control inputs leading to an excellent control response.Morteza Mohammadzaheri, Lei Chen, Fariba Behnia-Willison, Samin Askaria

A design approach for feedback-feedforward control systems

In this paper, a general design approach is proposed to derive the feedforward control law in feedback-feedforward control systems. This design approach is based on the concept of `control equilibrium point'. In this design approach, the feedback controller generates the transient control command and the feedforward controller generates the steady state one. Using the proposed feedforward controller, for a wide class of process plants, the stability of system is guaranteed if the feedback controller is a gain with an arbitrarily high value. That is, the only limit for the feedback (transient) control command is the actuator's practical limit; however, in this approach, a mathematical model of the system is needed to derive the feedforward control law. In order to remove this drawback, in case of having significant uncertainties, an artificial neural network, independent of mathematical model of the system, is designed to play the role of feedforward (steady state) control law.Morteza Mohammadzaheri, Lei Chen, Fariba Behnia-Willison and Pouria Arya

Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women's views on a new technique

Background: Laparoscopic and minimally invasive surgery has changed the surgical landscape irrevocably. Natural orifice translumenal endoscopic surgery (NOTES) offers the possibility of surgery without visible scars. Transvaginal entry offers potential benefits because it gains access to the peritoneal cavity without the need to open an abdominal viscus. Much of the discussion pertaining to NOTES focuses on technical and training issues, with little attention to date paid to the opinions of women. The perceptions of female health care workers and patients were sought in relation to their views on transvaginal NOTES. Methods: This study surveyed 300 women using a 12-point questionnaire devised by a multidisciplinary group of surgeons interested in minimally invasive surgery. The questionnaire was designed to establish the opinions of women with respect to NOTES surgery versus standard laparoscopic procedures. Responses were de-identified. Results: Three-fourths of the women surveyed were neutral or unhappy about the prospect of a NOTES procedure, and this remained constant even when it was stipulated that laparoscopic cholecystectomy and NOTES had equivalent safety and efficacy. Younger nulliparous women were most concerned about the potential negative effect of NOTES on sexual function. A minority were concerned about the cosmetic effect of surgery, although surgical scars were perceived as more important to younger respondents. Conclusions: Potentially, NOTES surgery offers women a scarless operation with the possibility of less pain than experienced in standard laparoscopic surgery. Few women, however, were troubled about the cosmetic effect of surgery. The effect of NOTES on sexual function was expressed as a particular concern by younger women. In all groups and across all ages, peritoneal access using the transvaginal route was met by significant scepticism. In Australia, women remain to be convinced about the potential advantages of the emerging NOTES technology.Andrew D. Strickland, Michael G. A. Norwood, Fariba Behnia-Willison, Santosh A. Olakkengil and Peter J. Hewet

Perspectives of laparoscopic donors toward a new procedure: Transvaginal donor nephrectomy

Background: Interest in natural orifice transluminal endoscopic surgery (NOTES) is increasing. Transvaginal NOTES (TVNOTES) donor nephrectomy with subsequent removal of the kidney via the vagina is technically possible. This approach may minimize the surgical insult to the donor and allow improved cosmesis. The acceptability to patients of such a technique is, however, unknown. The aim of this article is to explore the attitudes of women who have previously undergone laparoscopic donor nephrectomy (LDN). Methods: A 15-point questionnaire was designed by a multidisciplinary group of surgeons interested in minimally invasive surgery to obtain the views of women who had previously undergone LDN at the Queen Elizabeth Hospital, Adelaide. It was sent to 150 female donors, and their views with regard to the acceptability of a TV approach to the peritoneal cavity for donor nephrectomy were recorded. Results: Forty-nine patients returned the completed questionnaire. The majority (90%) of these women did not have adverse feelings toward scars. Thirty-seven percent of women would consider a TVNOTES donor nephrectomy; however, this was increased to 51% if they could be reassured that TVNOTES was as safe as LDN. Concerns regarding a negative impact on sexual function after this procedure were raised by 33% of patients. The majority (88%) did not cite surgeon gender as an important factor when deciding for or against this procedure. Conclusions: This study demonstrates that less postoperative pain, better cosmesis, and safety are factors that may influence a patient's decision to choose TVNOTES donor nephrectomy. The majority, however, would still prefer LDN.Santosh Antony Olakkengil, Michael G.A. Norwood, Andrew D. Strickland, Fariba Behnia-Willison, Manchala Mohan Rao, Peter J. Hewet