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Virtual Surgery: Mathematician Works To Make It A Reality Print E-mail
SciMed - Healthcare
TS-Si News Service   
Tuesday, 27 November 2007 19:00
practicing on a virtual you 
 
Virtual Surgery: Mathematician Works To Make It A RealityLos Angeles, CA, USA. A surgeon accidently kills a patient, undoes the error and starts over again. Can mathematics make such science fiction a reality?
 
The day is rapidly approaching when your surgeon can practice on your "digital double" — a virtual you — before performing an actual surgery, according to UCLA mathematician Joseph Teran, who is helping to make virtual surgery a viable technology. The advantages will save lives, he believes.
 
UCLA mathematician Joseph Teran"Surgical simulation is coming, there is no question about it," he said. "It's a cheaper alternative to cadavers and a safer alternative to patients."
 
"You can fail spectacularly with no consequences when you use a simulator and then learn from your mistakes," said Teran, 30. "If you make errors, you can undo them — just as if you're typing in a Word document and you make a mistake, you undo it. Starting over is a big benefit of the simulation.
 
How would virtual surgery work?
 
"The ideal situation would be when patients come in for a procedure, they get scanned and a three-dimensional digital double is generated; I mean a digital double — you on the computer, including your internal organs," Teran said. "The surgeon first does surgery on the virtual you. With a simulator, a surgeon can practice a procedure tens or hundreds of times. You could have a patient in a small town scanned while a surgeon hundreds or thousands of miles away practices the surgery. The patient then flies out for the surgery. We have to solve mathematical algorithms so what the surgeon does on the computer mimics real life."
 
How far off is this virtual surgery?
 
"A three-dimensional double of you can be made, but it would now take 20 people six to nine months," Teran said. "In the future, one person will be able to do it in minutes. It's going to happen, and it will allow surgeons to make fewer mistakes on actual patients. The only limiting factor is the complexity of the geometry involved. We're working on that. Our job as applied mathematicians is to make these technologies increasingly viable." The technology will be especially helpful with new kinds of surgeries, he said.
 
"A virtual surgery cannot be a cartoon," said Teran, who works with a surgeon. "It has to be biologically accurate. A virtual double needs to be really you." Teran is organizing a virtual surgery workshop (PDF) that will take place at UCLA from Jan. 7-11 2007 as part of UCLA's Institute for Pure and Applied Mathematics.
 
Making virtual surgery a reality will require solving mathematical equations, as well as making progress in computational geometry and computer science. An applied mathematician, Teran works in these fields; he develops algorithms to solve equations. Advances by Teran and other scientists in computational geometry, partial differential equations and large-scale computing are accelerating virtual surgery.
 
How human tissue responds to a surgeon, Teran said, is based on partial differential equations. Teran solves on a computer the mathematical equations that govern physical phenomena relevant to everyday life. He has studied the biomechanical simulation of soft tissues.
 
"Most of the behavior of everyday life can be described with mathematical equations," he said. "It's very difficult to reproduce natural phenomena without math."
 
Tissue, muscle and skin are elastic and behave like a spring, Teran said. Their behavior can be accounted for by a classical mathematical theory. Progress in his field is already rapid, Teran said, noting that "things in geometry that used to take days and days start to take hours and minutes." Teran believes medical schools will increasingly train physicians using computer surgical simulation.
 
Teran's applied mathematics can also be used to design more durable bridges, freeways, cars and aircraft.
 
"I would like people who design bridges to be able to use a virtual model — I'm interested in making that a reality and in creating numerical algorithmic tools that let people who design bridges have more computational machinery at their fingertips," he said.
 
As an undergraduate, Teran realized "you can use math problems to solve real problems and can help people in ways that seem totally unrelated to math." He earned his doctorate at Stanford University, where he took graduate classes in partial differential equations and worked on new ways of solving the governing equations of elastic biological tissues. He was a postdoctoral scholar at New York University before joining UCLA's faculty.
 
"I started with math because I like problem-solving, and I like how elegant math is," Teran said. "I like how much careful analysis is required, and that there's a right answer. Now I'm completely fascinated by what you get from a simulation, the kinds of complex behavior you can reproduce on a computer and the kinds of questions you can answer. Math will tell you how the world is. It will give you an answer, and it's intellectually stimulating and fun. It really pays off."
 
Teran, who is teaching a course on scientific computing for the visual effects industry, said he came to UCLA because it is one of the country's best universities for applied mathematics, because its medical school is among the country's best and because it is near Hollywood, where he helps to make movie special effects.
 
Teran, who works with UCLA's Center for Advanced Surgical and Interventional Technology, spoke this fall as part of Intel Chief Technology Officer Justin Rattner's keynote address at the Intel Developer Forum on the rise of the "3-D Internet." Teran demonstrated virtual surgery applications. The future 3-D Internet will include an "avatar" — a virtual representation of you — that could look "just like you, or better than you," Teran said. The graphics will be astonishingly realistic and three-dimensional, he said, but the simulation needs to be much more accurate, a goal Teran is working to achieve.
 
"As virtual words get more realistic, modern applied mathematics and scientific computing are required," he said.
 
 
Last Updated on Wednesday, 28 November 2007 02:51
 
Female Stress: Tendencies For Addiction, Depression, PTSD Print E-mail
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Tuesday, 13 November 2007 19:00
Manifold comparisons between male and female
 
Female Stress: Tendencies For Addiction, Depression, PTSDWashington, DC, USA. Human hormones regulate neuroendocrine activity. They can alter behavior and mood, and protect the brain from stress. They also contribute to brain aging and certain disease processes.
 
Understanding the underlying mechanisms involved, those that influence stress and the action of sex hormones, is an important activity in neuroscience. The neuroendocrine system links hormone secreton with behavior and experience.
 
"The comparisons between male and female responses to pain, depression, injury, and addiction are manifold," says Bruce McEwen, PhD, at Rockefeller University in New York City. 
 
Bruce McEwen, PhD, at Rockefeller University in New York City."Neuroscientific proof of these differences can have profound impacts on everything from over-the-counter pharmaceuticals to government reimbursements for health care."
 
Females seem to be unequally disposed to the harmful effects of stress and to addiction compared with males. Recent studies show that:
  • Mothers with post-traumatic stress disorder (PTSD) may uniquely pass on biological risk factors to their offspring, according to work with the descendents of Holocaust survivors.
     
  • Females appear to have a genetic predisposition toward reproducing the physiological reward produced by cocaine, suggesting sex chromosomes may influence habit formation.
     
  • Females without a growth-factor gene can become more depressed than males.
     
  • Estrogen can increase the possibility that females will start to take, and continue taking, cocaine.
     
  • Stress can damage an area of the brain with a controlling effect on mood.

 
Jill Becker, PhD, of the University of Michigan.In three experiments with rats, Jill Becker, PhD, of the University of Michigan, found in each case that females showed an increased vulnerability to cocaine addiction.
 
In the study, a pool of 150 male and female rats of various predetermined hormone levels (some males were castrated, some females had their ovaries removed) were exposed to various combinations of estrogen, progesterone, or a peanut oil control.
 
The rats were allowed to self-administer cocaine for a three-week period, during which time doses increased every seven days.
 
Becker found that female rats were more likely to use cocaine when circulating estrogen was high, but also that progesterone could counter the effects of estrogen. Further, she found that the administration of estrogen had no effects on self-administration in male rats.
 
"The factors that cause some people to try drugs despite all of society's warnings about their dangers are complex, but we know that among the factors are gender, personality type, and prior stress experiences," Becker says. "Women tend to try cocaine earlier in life, susceptible individuals become addicted faster, and, once addicted, they suffer worse damage to their brains, hearts, and livers as a result of their cocaine use, compared with men."
 
The study attributed this tendency to activity in the nucleus accumbens and the striatum — two areas in the brain where neurons producing the brain chemical dopamine transmit signals related to reward and motivation.
 
Estrogen's activation of this brain region appears to be critical in determining the brain's response to narcotics and why it might be different for men and women.
 
"Females acquire self-administration at lower doses of cocaine and escalate drug taking more rapidly than males, so they take more cocaine in relation to their body weight," Becker says. "They will also work harder for cocaine than males will."
 
Becker also found that stress in early life or even during the prenatal period can increase vulnerability to drug use and abuse. Preliminary findings indicate that the tendency to begin using cocaine is enhanced following prenatal stress, and that males and females are uniquely affected by stress in the womb. Further research will focus on the interaction of gender, stress response, hormonal fluctuations, and novelty-seeking. Such studies may help researchers understand women's susceptibility to cocaine use, abuse, and addiction.
 
In related work with rats, scientists found that females appear to have a genetic predisposition to reproduce the physiological reward produced by cocaine.
 

 
Jane Taylor, PhD, of Yale University.Jane Taylor, PhD, of Yale University, studied cocaine's effects on the signaling pathway for protein kinase A (PKA), the enzyme that helps transfer dopamine-transmitting signals inside cells.
 
In the experiment, rats were given access over a 24-hour period to either cocaine or a saline solution. Their degree of dependence was rated by counting the number of times rats would return to the dispenser when either the cocaine or saline had been removed. Taylor examined one group immediately after the 24-hour exposure period; she studied a second group after a 10-day delay. Taylor examined the rats' brains and measured levels of protein kinase A (PKA), which is a sign of the activation of pleasure circuits.
 
Compared to males, females had higher levels of markers for PKA in the striatum, indicating increased dopamine and therefore greater reinforcement of reward signals in the female rats' brains. Increased levels of markers for PKA were seen also in the pleasure-indicative nucleus accumbens of females more than males, particularly among controls and rats tested after the 10-day abstinence period. Cocaine also increased PKA marker levels when male rats, but not females, were tested immediately after exposure.
 
"Our data appear to be a unique demonstration of a role of gender in a complex behavior: habit formation. These habits do not appear to be hormone-dependent," says Taylor. "This has allowed us to make significant progress in understanding some of the distinct contributions of genetic and hormonal factors to behaviors that are argued to be associated with an increased vulnerability to addiction."
 
Further studies may follow the mice through different phases of the cycle of addiction, which could aid in the development of gender-specific treatments to prevent relapses in cocaine-dependent women.
 
Recent examination of risk factors associated with PTSD show that mothers may contribute uniquely to the possibility that their offspring will develop the disorder.
 

 
Rachel Yehuda, PhD, at Mount Sinai Medical Center in New York City.Working with the children of Holocaust survivors, Rachel Yehuda, PhD, at Mount Sinai Medical Center in New York City, studied biological risk factors by examining levels of the stress hormone cortisol.
 
The study assembled 49 subjects, none of whom had been diagnosed with PTSD. Twenty-three subjects had parents who were Holocaust survivors with PTSD. The parents of the remaining 26 subjects did not have PTSD, but in 10 cases, a parent had survived the Holocaust. The three groups were monitored for basal cortisol secretion over a 24-hour period, to account for any fluctuations in hormone release over the circadian cycle.
 
On average, the study team found lower cortisol levels in offspring who had at least one parent with PTSD. In previous research, low cortisol levels have been associated with an increased risk for developing PTSD; some researchers think it could serve as a marker for vulnerability to developing the disorder.
 
It also complements work showing that mothers with PTSD confer different risk on their offspring than fathers with PTSD.
 
In earlier research, Yehuda studied about 38 children whose mothers were pregnant and in New York's World Trade Center on the morning of Sept. 11, 2001. Half of these mothers developed PTSD and showed low levels of cortisol. Examining results from healthy-baby checks when the infants were a year old, she found a trimester effect: Babies of PTSD mothers born closest to the traumatic event had the lowest levels of cortisol, if mothers were in their third trimester on 9/11.
 
"The risk factor has something to do with effects that are uniquely maternally transmitted," says Yehuda. "Paternal PTSD contributes to other outcomes, but maybe not low cortisol." The maternal contribution to increased risk, she suggests, is "a real gender difference."
 
Other findings indicate that stress may damage a region of the brain that regulates mood, adding to previous findings that had indicated damage in the hippocampus, which can regulate levels of cortisol. By identifying the biological changes that result from stress, researchers hope to pin down the ways stress can trigger depression in some people, and, in particular, how this may affect women, who show increased sensitivity to stress.
 

 
Tracy Bale, PhD, of the University of Pennsylvania.Tracy Bale, PhD, of the University of Pennsylvania, studied the effects of stress on male mice that were 3 months old, the equivalent of human adults. In particular, she focused on the role of corticotrophin-releasing factor (CRF), an important element in the brain's stress-response pathway. In one group of mice, a gene aiding the transmission of CRF was knocked out.
 
Half of the mice in each group were then exposed to several different types of mild stress, in a random order, each day for three weeks. They were put in a cage with damp bedding overnight, for example, moved to several different cages in a short period of time, or restrained for 15 minutes.
 
When the responses of the mice were later tested when they were placed in a cage or on an elevated cross-shaped maze with no protective siding, Bale found that normal mice responded by becoming more active and alert, showing they had adapted to the chronic stress.
 
They started exploring the new environment and were curious to look over the edge of the maze. In contrast, the genetically altered, stress-sensitive mice showed no change in behavior in the new setting, "as though they had shut down or their brains hadn't dealt with the stress they had experienced," she says.
 
Detailed examination of the brains of the mice showed that the stress-sensitive mice exposed to stress, but not normal mice exposed to the same conditions, lost cells in the raphe nucleus, which releases serotonin, an important brain chemical that is associated with depression.
 
Biologically identifiable changes, such as cell loss in the raphe nucleus, ultimately could provide ways to look for susceptibility to depression in people before disorders develop and help researchers pinpoint different reactions to stress in males and females.
 
"Finding a significant loss of cells following a period of mild stress in a brain region that is critical for regulating serotonin and mood is essential to our understanding of how stress is related to the onset of affective disorders, such as depression," Bale says.
 
"We've shown that changes in gene expression in this area are probably vital to coping with stress, and the absence of such changes in the stress-sensitive mice may suggest potential sex differences linking heightened stress responsivity to disease."
 
The next step, Bale says, will be to repeat this study, examining differences between male and female mice.
 
Bale is a shareholder in Neurocrine Biosciences, which is developing drugs for treating insomnia, anxiety, depression, irritable bowel syndrome, pain, and CNS-related disorders.
 

 
Tara Perrot-Sinal, PhD, at Dalhousie University (Halifax, Canada).Previous work has shown that anxiety and depression are more often diagnosed in females and that stress is a predisposing factor in the development of these mood disorders. Tara Perrot-Sinal, PhD, at Dalhousie University (Halifax, Canada), studied differences in stress responding between male and female rats using a number of models, including reactions to the natural stress of predator odor.
 
In one experiment, Perrot-Sinal restrained rodents, resulting in the release of stress hormones. The process demonstrated that levels of a protein that is important for normal brain cell function, brain-derived neurotrophic factor (BDNF), was reduced after stress in both males and females.
 
However, she also found that BDNF levels in nonstressed males were different than in females in two areas of the hippocampus, a brain region important for responses to stress.
 
This indicates that males and females start out with differing levels of BDNF and therefore could be at differential risk of developing pathologies involving this brain region following exposure to stress. Previous work suggests that alterations in BDNF may contribute to depression-related behaviors, but also that they may be involved in the therapeutic effect of antidepressants.
 
"Most stress experienced by humans today is psychological in nature, and therefore we need to mimic that in our animal models," Perrot-Sinal said.
 
Psychological stress can be triggered in rats by exposing them to the smell of a cat. Perrot-Sinal's team used this scenario to highlight several gender differences in response to stress. Her findings included the tendency for females to show more caution than males when exposed to acute cat odor-whether the animals had been stressed previously or not. Female rats also failed to show stress hormone responses upon exposure to the smell of cats, unlike males.
 
Her most recent work shows differences between males and females in the serotonin system following cat odor stress. The serotonin system is targeted by many antidepressants. Further research will include assessing how these gender differences in stress responding are related to the development of depression-like behavior and related diseases in female subjects.
 
 
Last Updated on Wednesday, 28 November 2007 14:28
 
Surgeon's Gender Can Influence Choice Of Subspecialty Print E-mail
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Sunday, 11 November 2007 19:00
Women think about lifestyle more than men
 
Surgeon's Gender Can Influence Choice Of SubspecialtyChicago, IL, USA. Gender differences exist among surgeons who choose a surgical subspecialty, particularly when they evaluate the factors that may influence their career choice.
 
A survey indicated that a significantly higher percentage of women than men were influenced by lifestyle perceptions associated with their career choice. Findings suggest that general surgical residency programs might improve efforts to recruit women for subspecialty training.
 
The findings were published in the Journal of the American College of Surgeons. The results suggest that changes are needed in the perception of the lifestyle associated with choosing a subspecialty surgical career.
 

Motivation to Pursue Surgical Subspecialty Training: Is There a Gender Difference? Jaime H McCord, Robert McDonald, Glenn Leverson, David M Mahvi, Layton F Rikkers, Herbert C Chen, Sharon M Weber. J Am Coll Surg. Vol. 205, No. 5, November 2007. 698-703. doi:10.1016 / j.jamcollsurg.2007.06.014. ISSN 1072-7515/07.

 
Jaime H. McCord, MD, general surgery resident at the University of Wisconsin (Madison).“Typically, surgery has been viewed as having an uncontrollable lifestyle with higher work hour demands. However, it is becoming evident through similar types of surveys that both men and women are placing a higher priority on personal and family time and seeking ways to shape their careers to accommodate these desires." So said Jaime H. McCord, MD, general surgery resident at the University of Wisconsin (Madison).
 
Over the past 20 years, the number of women has increased across many medical fields, including general surgery. Yet despite these advances, of the approximately 26,300 practicing general surgeons in the US, only 12 percent are women.
 
“The field of surgery and the majority of surgical residencies have been implementing changes to improve the "lifestyles" of surgeons. That's why it is important for surgeons, both male and female, to model a balanced lifestyle to medical students and promote it in surgical residents if we are to continue to recruit high caliber women, as well as men, into surgery, and especially subspecialty fields," McCord added.
 
The University of Wisconsin general surgery residency program developed and distributed via email a 32-item Web based survey to 99 graduates (74 respondents) between the years 1985 and 2006. The survey contained matrix questions, contingency questions, scaled responses and open questions designed to evaluate the factors that most influenced a resident’s decision to pursue fellowship or subspecialty training. Of the 74 respondents, 58 were men and 16 were women. The mean age of the respondents was 40 years (range 31 to 52 years), and 95 percent were married or partnered, with an average of 1.9 children.
 
Chart: Women In Surgery.
 
There was a significant difference between genders in those practicing general surgery versus subspecialties, with 69 percent of women and 36 percent of men responding that general surgery was their current field (p=0.02) and the rest currently practicing in a specialized area of surgery.
 
More than 70 percent of respondents indicated that the following factors were either important or very important when choosing future subspecialty training:
  • interest in the field,
     
  • intellectual appeal of field,
     
  • an influential mentor, and
     
  • clinical opportunities in that field.
Among all possible factors queried, only lifestyle was significantly more important to women versus men graduates when choosing their future career (69 percent [11 of 16] versus 43 percent [25 of 58], respectively; p=0.03).
 
Other results for women and men respondents focused on
  • research exposure during residency (basic science, 38 percent versus 40 percent;
     
  • clinical, 56 percent versus 61 percent, respectively; p>0.05);
     
  • fellowship training (38 percent versus 69 percent, respectively; p=0.04); and
     
  • academic practice setting (27 percent versus 46 percent, respectively; p=0.2).
For the majority of factors there was no significant difference in the response rates for men and women.
 

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient.

 
Motivation to Pursue Surgical Subspecialty Training: Is There a Gender Difference? Jaime H McCord, Robert McDonald, Glenn Leverson, David M Mahvi, Layton F Rikkers, Herbert C Chen, Sharon M Weber. J Am Coll Surg. Vol. 205, No. 5, November 2007. 698-703. doi:10.1016/j.jamcollsurg.2007.06.014. ISSN 1072-7515/07.
 
Background. Few studies have examined whether women and men identify the same factors as important in choosing their specialty.We sought to evaluate whether the factors influencing residents’ choice of surgical specialty differed by gender.
 
Study Design. A 32-itemWeb survey, designed to elucidate which factors motivated residents to seek fellowship training, was sent to 99 graduates of a university general surgery program, all of whom matriculated between 1985 and 2006.
 
Results. A total of 74 (75%) respondents replied (16 women, 58 men). There was a higher proportion of men who pursued fellowship training than women (69% versus 38%, p  0.04), but there was no significant difference in those who were currently in academic practice (men, 46% versus women, 27%, p  0.2). Both genders were equally likely to respond that interest in and intellectual appeal of their field, clinical opportunities in that field, and having an influential mentor during residency were important in choosing their future specialty. But significantly more women listed lifestyle as an important factor in choosing their future careers (69% versus 43%, p  0.03). When respondents’ data from the most recent decade were analyzed, there was no difference between genders in completion of fellowship training or in those in academic practice. But lifestyle continued to be more important to women.
 
Conclusions. Both genders were influenced by many similar factors when deciding to pursue subspecialty training, but women were more likely than men to be influenced by their perception of the lifestyle associated with their career choice. These findings suggest that general surgical residency programs might improve efforts to recruit women by addressing the perception of the lifestyle associated with choosing a surgical career.
 
PDF  | 
 
 
Last Updated on Thursday, 27 December 2007 19:21
 
Johns Hopkins On Reconstruction For Inter-sex Females Print E-mail
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Monday, 29 October 2007 19:00
Study says vaginal reconstruction not needed in most cases
 
Johns Hopkins On Reconstruction For Inter-sex FemalesBaltimore, MD, USA. Attempting to dispell a common understanding, researchers from the Johns Hopkins Children’s Center say vaginal reconstruction should be a matter of preference for most teens or adult women born with a type of inter-sex condition marked by the presence of both female and male genitals.
 
In their study of 29 women born with the syndrome, researchers found that 38 percent chose to have vaginal surgery.
 
Comparing those who had surgery with those who did not, researchers found that both groups had similar rates of sexual activity. Eighty percent of those who chose not to have surgery were sexually active, compared to 70 percent of those who had surgery. The findings were scheduled for presentation at the American Academy of Pediatrics Conference in San Francisco (26–30 October 2007 ).
 
Women with complete androgen insensitivity are born with relatively shallow vaginas that may or may not require surgical repair and with undescended testes that do require removal.
 
The Hopkins authors say that vaginal surgery, if needed or wanted, should be done after puberty, when physical development is complete and a girl or a woman is mature enough to make a decision, researchers say.
 
“It is a common misconception in the general public — and quite often among doctors — that most girls born with this condition should have vaginal reconstruction in order to be sexually active,” says lead investigator Todd Purves, M.D. Ph.D., a urologist at Hopkins Children’s.
 
“Our findings show that, on the contrary, most young women choose not to have the surgery, have vaginal depths that are within normal parameters and can lead active sexual lives.”
 
“As surgeons, we need to make sure that the parents of babies with this disorder understand that their daughter may not even need vaginal surgery, and if she does, it is a decision that should wait until after adolescence,” Purves says.
 
According to the Hopkins investigators, gender identity in women born with this condition is almost always female.


Study co-investigators: Jennifer Miles-Thomas, M.D., Claude Midgeon, M.D., and John P. Gearhart, M.D., all of Hopkins.

 
Scheduled Conference Presentations:
 
Vaginal Reconstruction for Patients with Complete Androgen Insensitivity:
Challenging the Dogma.
Todd Purves, Jennifer Miles-Thomas, Claude Migeon, and John P Gearhart. American Academy of Pediatrics Conference (San Francisco, 26–30 October 2007 ).
 
Complete Androgen Insensitivity Syndrome: An Anatomic Evaluation and
Sexual Function Questionnaire.
Anne Arnhym, Jason M Wilson, Angie Hinds, Michelle Ebbers-Brophy, Fergus Coakley, and Laurence Baskin. American Academy of Pediatrics Conference (San Francisco, 26–30 October 2007 ). 
 
 
Last Updated on Monday, 29 October 2007 19:19
 
Lasers Gradually Replace Steel Scalpel For Many Procedures Print E-mail
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Sunday, 28 October 2007 19:00
UV lasers cut with less power than previously thought
 
Lasers Gradually Replace Steel Scalpel For Many ProceduresNashville, TN, USA. Intense beams of coherent light, called lasers, are increasingly popular for a variety of surgical procedures that can range from from cosmetic to brain surgery. However, there is a lot that scientists do not know about the ways in which laser light interacts with living tissue.
 
A first investigation answers some of these basic questions into how ultraviolet lasers — similar to those used in LASIK eye surgery — cut living tissues. The findings are published in the Physical Review Letters.
 
The effect that powerful lasers have on actual flesh varies both with the wavelength, or color, of the light and the duration of the pulses that they produce. The specific wavelengths of light that are absorbed by, reflected from or pass through different types of tissue can vary substantially. Therefore, different types of lasers work best in different medical procedures.
 
For lasers with pulse lengths of a millionth of a second or less, there are two basic cutting regimes:
  • Mid-infrared lasers with long wavelengths cut by burning. That is, they heat up the tissue to the point where the chemical bonds holding it together break down.

    Because they automatically cauterize the cuts that they make, infrared lasers are used frequently for surgery in areas where there is a lot of bleeding.
     
  • Shorter wavelength lasers in the near-infrared, visible and ultraviolet range cut by an entirely different mechanism. They create a series of micro-explosions that break the molecules apart. During each laser pulse, high-intensity light at the laser focus creates an electrically-charged gas known as a plasma. At the end of each laser pulse, the plasma collapses and the energy released produces the micro-explosions.

    As a result, these lasers – particularly the ultraviolet ones – can cut more precisely and produce less collateral damage than mid-infrared lasers. That is why they are being used for eye surgery, delicate brain surgery and microsurgery.
Shane Hutson, assistant professor of physics at Vanderbilt University who conducted the research with post-doctoral student Xiaoyan Ma.“This is the first study that looks at the plasma dynamics of ultraviolet lasers in living tissue,” says Shane Hutson, assistant professor of physics at Vanderbilt University who conducted the research with post-doctoral student Xiaoyan Ma.
 
Post-doctoral student Xiaoyan Ma.“The subject has been extensively studied in water and, because biological systems are overwhelmingly water by weight, you would expect it to behave in the same fashion. However, we found a surprising number of differences.”
 
One such difference involves the elasticity, or stretchiness, of tissue. By stretching and absorbing energy, the biological matrix constrains the growth of the micro-explosions. The resulting explosions tend to be considerably smaller than those in water. This reduces the damage that the laser beam causes while cutting flesh. This effect had been predicted, but the researchers found that it is considerably larger than expected.
Two sequences of confocal microscope images (the columns labeled a and b) show the effects of laser beams above the threshold energy level where they cut reliably and uniformly and at the threshold level where they cut erratically. The white circles are centered on micro-explosion sites and have radii equal to the explosion sizes. Credit: Shane Hutson.Two sequences of confocal microscope images (the columns labeled a and b) show the effects of laser beams above the threshold energy level where they cut reliably and uniformly and at the threshold level where they cut erratically. The white circles are centered on micro-explosion sites and have radii equal to the explosion sizes. Credit: Shane Hutson.
Another surprising difference involves the origination of the individual plasma “bubbles.” All it takes to seed such a bubble is a few free electrons.
 
These electrons pick up energy from the laser beam and start a cascade process that produces a bubble that grows until it contains millions of quadrillions of free electrons. Subsequent collapse of this plasma bubble causes a micro-explosion. In pure water, it is very difficult to get those first few electrons. Water molecules have to absorb several light photons at once before they will release any electrons. So a high-powered beam is required.
 
“But in a biological system there is a ubiquitous molecule, called NADH, that cells use to donate and absorb electrons. It turns out that this molecule absorbs photons at near ultraviolet wavelengths. So it produces seed electrons when exposed to ultraviolet laser light at very low intensities,” says Hutson.
 
This means that in tissue containing significant amounts of NADH, ultraviolet lasers don’t need as much power to cut effectively as people have thought.
 
The cornea in the eye is an example of tissue that has very little NADH. As a result, it responds to an ultraviolet laser beam more like water than skin or other kinds of tissue, according to the researcher.
 
“Now that we have a better sense of how tissue properties affect the laser ablation process, we can do a better job of predicting how the laser will work with new types of tissue,” says Hutson.
 

 
Plasma and Cavitation Dynamics during Pulsed Laser Microsurgery in vivo. M. Shane Hutson and Xiaoyan Ma. Phys. Rev. Lett. 99, 158104 (2007). doi:10.1103/PhysRevLett.99.158104.
 
Abstract. We compare the plasma and cavitation dynamics underlying pulsed laser microsurgery in water and in fruit fly embryos (in vivo)—specifically for nanosecond pulses at 355 and 532 nm. We find two key differences. First, the plasma-formation thresholds are lower in vivo —especially at 355 nm—due to the presence of endogenous chromophores that serve as additional sources for plasma seed electrons. Second, the biological matrix constrains the growth of laser-induced cavitation bubbles. Both effects reduce the disrupted region in vivo when compared to extrapolations from measurements in water.
 
 
Last Updated on Sunday, 11 November 2007 19:42
 
Study Finds Hysterectomy Increases Risk Of Urinary Incontinence Print E-mail
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Sunday, 28 October 2007 19:00
Highest likelihood noted within five years of removal
 
Study Finds Hysterectomy Increases Risk Of Urinary IncontinenceStockholm, Sweden. Hysterectomy — a common operation involving the removal of the uterus — is the most common gynaecological abdominal operation in the world. It is normally performed as a cure for benign medical problems in order to improve life quality for the patients. However, the long-term effects are largely unknown.
 
Medical researchers have long suspected that the operation increases the risk of developing urinary incontinence.
 
In many respects, incontinence is a very disabling condition that affects hundreds of thousands of women in Sweden and more elsewhere around the world.
A comment that accompanies the journal Article cited below shows how the findings contradict previous studies, and concludes there could be other reasons why the risk increases. — Ed.
Researchers at the Swedish medical university Karolinska Institutet have shown that the operation greatly increases the risk of urinary incontinence. Their nationwide study results show that women who have had a hysterectomy are more than twice as likely to undergo surgery for urinary incontinence as women with intact uteri.
 
Daniel Altman, gynaecologist and one of the researchers behind the study."It's important that gynaecologists take this into account ahead of a hysterectomy, and the patients should themselves be aware of the greater risk the operation entails, particularly if they belong to a high-risk group," says Daniel Altman, gynaecologist and one of the researchers behind the study.
 
According to the findings presented in The Lancet, the highest likelihood of incontinence surgery was noted within five years of the removal of the uterus, but the higher risk remains throughout the patients' lives. The risk increased most for women who had a hysterectomy before their menopause or after having undergone several deliveries.
 
The study was based on analyses of patient registers for the years 1973 to 2003, and incorporated over 165,000 women who have had hysterectomies and almost 479,000 women who have not.
 

 
Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Daniel Altman, Fredrik Granath, Sven Cnattingius and Christian Falconer. The Lancet 2007; 370:1494-1499. DOI:10.1016/S0140-6736(07)61635-3.
 
Summary
 
Background. Hysterectomy for benign indications has been associated with an increased risk for lower-urinary-tract sequela, but results have been inconclusive. We aimed to establish the risk for stress-urinary-incontinence surgery after hysterectomy for benign indications.
 
Methods. We did a nationwide, population-based, cohort study from 1973 to 2003 in Sweden. We identified our population from the Swedish Inpatient Registry. We selected 165 260 women who had undergone hysterectomy (exposed cohort) and a control group of 479 506 individuals who had not had this procedure (unexposed cohort), matched by year of birth and county of residence. In both cohorts, occurrence of stress-urinary-incontinence surgery was established from the Swedish Inpatient Registry. Hazard ratios with 95% CIs were calculated by Cox's proportional-hazards regression.
 
Findings. During the 30-year observational period, the rate of stress-urinary-incontinence surgery per 100 000 person-years was 179 (95% CI 173–186) in the exposed cohort versus 76 (73–79) in the unexposed cohort. Correspondingly, individuals in the exposed cohort were at increased risk for stress-urinary-incontinence surgery compared with those in the unexposed cohort (hazard ratio 2·4; 95% CI 2·3–2·5), irrespective of surgical technique. Risk for stress-urinary-incontinence surgery varied slightly with time of follow-up: the highest overall risk was recorded within 5 years of surgery (2·7; 2·5–2·9) and the lowest risk was seen after an observation period of 10 years or more (2·1, 1·9–2·2).
 
Interpretation. Hysterectomy for benign indications, irrespective of surgical technique, increases the risk for subsequent stress-urinary-incontinence surgery. Women should be counselled on associated risks related to hysterectomy, and other treatment options should be considered before surgery.
 
 
Last Updated on Tuesday, 04 December 2007 06:25
 
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