Advances in Lasers for the Treatment of Stones-a Systematic Review

PURPOSE OF REVIEW: Laser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year. RECENT FINDINGS: Variable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and "cleaving only" fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology. Laser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.info:eu-repo/semantics/publishedVersio

The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review

The Holmium:yttrium-aluminum-garnet (Ho:YAG) laser has been the gold-standard for laser lithotripsy over the last 20 years. However, recent reports about a new prototype thulium fiber laser (TFL) lithotripter have revealed impressive levels of performance. We therefore decided to systematically review the reality and expectations for this new TFL technology. This review was registered in the PROSPERO registry (CRD42019128695). A PubMed search was performed for papers including specific terms relevant to this systematic review published between the years 2015 and 2019, including already accepted but not yet published papers. Additionally, the medical sections of ScienceDirect, Wiley, SpringerLink, Mary Ann Liebert publishers, and Google Scholar were also searched for peer-reviewed abstract presentations. All relevant studies and data identified in the bibliographic search were selected, categorized, and summarized. The authors adhered to PRISMA guidelines for this review. The TFL emits laser radiation at a wavelength of 1,940 nm, and has an optical penetration depth in water about four-times shorter than the Ho:YAG laser. This results in four-times lower stone ablation thresholds, as well as lower tissue ablation thresholds. As the TFL uses electronically-modulated laser diodes, it offers the most comprehensive and flexible range of laser parameters among laser lithotripters, with pulse frequencies up to 2,200 Hz, very low to very high pulse energies (0.005-6 J), short to very long-pulse durations (200 µs up to 12 ms), and a total power level up to 55 W. The stone ablation efficiency is up to four-times that of the Ho:YAG laser for similar laser parameters, with associated implications for speed and operating time. When using dusting settings, the TFL outperforms the Ho:YAG laser in dust quantity and quality, producing much finer particles. Retropulsion is also significantly reduced and sometimes even absent with the TFL. The TFL can use small laser fibers (as small as 50 µm core), with resulting advantages in irrigation, scope deflection, retropulsion reduction, and (in)direct effects on accessibility, visibility, efficiency, and surgical time, as well as offering future miniaturization possibilities. Similar to the Ho:YAG laser, the TFL can also be used for soft tissue applications such as prostate enucleation (ThuFLEP). The TFL machine itself is seven times smaller and eight times lighter than a high-power Ho:YAG laser system, and consumes nine times less energy. Maintenance is expected to be very low due to the durability of its components. The safety profile is also better in many aspects, i.e., for patients, instruments, and surgeons. The advantages of the TFL over the Ho:YAG laser are simply too extensive to be ignored. The TFL appears to be a real alternative to the Ho:YAG laser and become a true game-changer in laser lithotripsy. Due to its novelty, further studies are needed to broaden our understanding of the TFL, and comprehend the full implications and benefits of this new technology, as well its limitations.info:eu-repo/semantics/publishedVersio

Evaluation of Ocean Color Scanner (OCS) photographic and digital data: Santa Barbara Channel test site, 29 October 1975 overflight

A summary of Ocean Color Scanner data was examined to evaluate detection and discrimination capabilities of the system for marine resources, oil pollution and man-made sea surface targets of opportunity in the Santa Barbara Channel. Assessment of the utility of OCS for the determination of sediment transport patterns along the coastal zone was a secondary goal. Data products provided 1975 overflight were in digital and analog formats. In evaluating the OCS data, automated and manual procedures were employed. A total of four channels of data in digital format were analyzed, as well as three channels of color combined imagery, and four channels of black and white imagery. In addition, 1:120,000 scale color infrared imagery acquired simultaneously with the OCS data were provided for comparative analysis purposes

Companion planting to attract pollinators increases the yield and quality of strawberry fruit in gardens and allotments

1. Global pollinator declines have led to concern that crop yields might fall as a result of a pollination deficit. Companion planting is a traditional practice thought to increase yield of insect pollinated crops by planting a co-flowering species next to the crop. 2. Using a combination of conventional researcher-led experiments and observational citizen scientist data, we tested the effectiveness of bee-friendly borage (Borago officinalis) as a companion plant to strawberry (Fragaria x ananassa). Insect visitors to the ‘Test’ (strawberry + borage) versus ‘Control’ (strawberry only) plants were observed, and strawberry fruit collected. Strawberries collected during the researcher-led experiment were also subject to fruit measurements and assessments of market quality. 3. Companion plants were found to significantly increase both yield and market quality of strawberries, suggesting an increase in insect pollination per plant. Test strawberries companion planted with borage produced an average of 35% more fruits, and 32% increased yield by weight. Test strawberry plants produced significantly more fruit of higher aesthetic quality when assessed by Marketing Standards for Strawberries. 4. Although there was no significant difference in the overall insect visits, when broken down by broad insect group there were significantly more flies visiting the test strawberries than controls. 5. These results could have implications for both gardeners and commercial growers. As consumers prefer a cosmetically perfect fruit, the production of fruit with increased aesthetics aids food waste reduction

In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters

OBJECTIVE: To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high- with low-frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias. MATERIALS AND METHODS: An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2-1.2 J pulse energies, 5-40 Hz frequencies, 4-20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made. RESULTS: Low frequency-high pulse energy (LoFr-HiPE) settings were (up to six times) more ablative than high frequency-low pulse energy (HiFr-LoPE) at the same power levels (P < 0.001), as they produced deeper (P < 0.01) and wider (P < 0.001) fissures. There were linear correlations between pulse energy and fragmentation volume, fissure width, and fissure depth (all P < 0.001). Total power did not correlate with fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015). CONCLUSIONS: At the same total power level, LoFr-HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time-consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability