Assisted Approach Research Articles

Screening Referable Diabetic Retinopathy Using a Semi-automated Deep Learning Algorithm Assisted Approach.

Purpose: To assess the accuracy and efficacy of a semi-automated deep learning algorithm (DLA) assisted approach to detect vision-threatening diabetic retinopathy (DR).Methods: We developed a two-step semi-automated DLA-assisted approach to grade fundus photographs for vision-threatening referable DR. Study images were obtained from the Lingtou Cohort Study, and captured at participant enrollment in 2009–2010 (“baseline images”) and annual follow-up between 2011 and 2017. To begin, a validated DLA automatically graded baseline images for referable DR and classified them as positive, negative, or ungradable. Following, each positive image, all other available images from patients who had a positive image, and a 5% random sample of all negative images were selected and regraded by trained human graders. A reference standard diagnosis was assigned once all graders achieved consistent grading outcomes or with a senior ophthalmologist's final diagnosis. The semi-automated DLA assisted approach combined initial DLA screening and subsequent human grading for images identified as high-risk. This approach was further validated within the follow-up image datasets and its time and economic costs evaluated against fully human grading.Results: For evaluation of baseline images, a total of 33,115 images were included and automatically graded by the DLA. 2,604 images (480 positive results, 624 available other images from participants with a positive result, and 1500 random negative samples) were selected and regraded by graders. The DLA achieved an area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy of 0.953, 0.970, 0.879, and 88.6%, respectively. In further validation within the follow-up image datasets, a total of 88,363 images were graded using this semi-automated approach and human grading was performed on 8975 selected images. The DLA achieved an AUC, sensitivity, and specificity of 0.914, 0.852, 0.853, respectively. Compared against fully human grading, the semi-automated DLA-assisted approach achieved an estimated 75.6% time and 90.1% economic cost saving.Conclusions: The DLA described in this study was able to achieve high accuracy, sensitivity, and specificity in grading fundus images for referable DR. Validated against long-term follow-up datasets, a semi-automated DLA-assisted approach was able to accurately identify suspect cases, and minimize misdiagnosis whilst balancing safety, time, and economic cost.

Transition from open to robotically assisted approach on radical prostatectomies in Iceland. A nationwide, population-based study

Objectives In January 2015, radical prostatectomies (RPs) in Iceland changed almost entirely from being performed as open (ORP) to robotically assisted (RARP). This study assesses early surgical and short-term oncological outcome after ORP and RARP and evaluates the safety of transition between the two surgical techniques. Methods The study population involved 160/163 (98%) of all radical prostatectomies performed in Iceland between January 2013 and April 2016. Data on patients was collected retrospectively from medical records. Early surgical and short-term oncological outcomes were compared between the two surgical techniques. Results The ORP and RARP cohorts were comparable with respect to all clinical and pathological variables, except for median prostate volume, which was 45 mL in the ORP cohort and 37 mL in the RARP cohort (p = 0.03). Intraoperative blood loss was higher, hospital stay longer, catheterization time longer, and risk of complications within 30 days of surgery higher after ORP than RARP (p < 0.01). The operative time, positive surgical margin rate and recurrence free survival, within two years, was comparable between the two surgical techniques. Conclusions The transition from ORP to RARP in Iceland was safe and resulted in improved early surgical outcome. However, no conclusion can be drawn from this study regarding oncological outcome, due to short follow up and a small sample size.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Feb 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002330AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Safety and Efficacy of Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair in Infants under 1 Year of Age Even as robotic pediatric urological procedures proliferated, open pyeloplasty continued to be standard of care in infants. The robotic assisted laparoscopic approach was ideal for older children, allowing for meticulous anastomotic repair of the ureteropelvic junction while decreasing recovery times and postoperative pain levels. For open infant pyeloplasty, multiple sites had already demonstrated short length of stay and pain management without opioids. Additionally, because of concerns of the decreased instrument working space in small infants, initial published studies on pediatric robotic pyeloplasty were limited to children weighing more than 10 kg. Increasingly, pediatric centers are offering a robot-assisted laparoscopic approach for these smaller infants as well. In this issue of The Journal, Rague et al (page 432) from Chicago compare outcomes from robotic assisted laparoscopic to open pyeloplasty in infants younger than 1 year of age and less than 10 kg.1 In this retrospective study, pyeloplasty was performed by robotic assisted laparoscopic approach in 83 infants and open approach in 121. Infants in the robotic group tended to be older and to weigh more. The authors did not demonstrate a significant difference in length of stay, postoperative radiographic improvement, 30-day complication rate or need for reoperative pyeloplasty. Currently, the robotic procedures required more hospital resources. The robotic procedures had longer operative times, and approximately a third of the robotic procedures had 2 attending co-surgeons. The dissemination of robotics has changed pediatric urology fellowship training much like it has changed general urology residency. The authors report that the robot-assisted laparoscopic approach has been the preferred method for correction of ureteropelvic junction obstruction in infants at their institution since 2017—so much so that no open infant pyeloplasty was performed from January to June 2020. Certainly, the needs of urology learners are ever changing, and pediatric urology educators should be vigilant. This study highlights that trainees may have limited exposure to open infant pyeloplasty in the near future unless it remains an educational priority. Reference 1. : Safety and efficacy of robot-assisted laparoscopic pyeloplasty compared to open repair in infants under 1 year of age. J Urol 2022; 207: 432. Link, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue 2February 2022Page: 261-261 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stacy T. Tanaka More articles by this author Expand All Advertisement Advertisement Loading ...

Interprofessional education in medical and physiotherapy studies for future collaboration

BackgroundInterprofessional education (IPE) for medical and healthcare professions is highly relevant. It increases knowledge and skills, but also helps to foster the development of collaboration, which is essential for optimal patient care. One important aspect of IPE is to better understand profession’s individual attitudes and perceptions towards interprofessionalism and the expected roles and skills for future collaboration in the context of patient care. MethodsWe offered IPE workshops using a peer assisted learning approach, with the focus on anatomy in the area of the lower back and hip. The workshops were attended by medical and physiotherapy students and consisted of three consecutive training sessions with the topics anatomical prosections, anatomy in vivo and orthopedics testing. We focused on student’s attitudes and perceptions regarding the relevance of IPE and their expected skills in interprofessionalism. An established questionnaire was used as an instrument for self-assessment before and after the interprofessional experience. To evaluate for significance, analysis was carried out for all groups on pre- and post-course item mean differences. ResultsPre-post score comparison for all groups combined demonstrated significant increase in terms of perceptions and attitudes for several items related to interprofessionalism and interprofessional skills. Medical and physiotherapy students rated themselves significantly higher for different questionnaire items. Students, who had obtained a professional qualification prior to their current studies, rated themselves significantly higher on certain items compared to those who had not. ConclusionsThe results from this brief interprofessional anatomy experience are encouraging. The course led to meaningful improvements in competencies that are highly relevant for effective interprofessional collaboration in the future. Furthermore, identification of differences in professional group perceptions can be useful for development of future IPE workshops.

PKM virtual: Model dan strategi gerakan sosial pandemi Covid 19 masyarakat Jatimulyo Kabupaten Tulungagung

The COVID-19 pandemic that has hit Indonesia for approximately 2 years has had an impact on the community's economy, education, and religion. The purpose of this research is to help food consumption security for people affected by the COVID-19 pandemic. The method used in this research is virtual service by using the social assistance and social services approach virtually. The results of this study are the first to distribute aid in the form of food to people affected by the COVID-19 pandemic, especially to the elderly. As well as social services in the form of spraying disinfectants in the community through the head of the RT, distributing masks and hand sanitizers to the community as an effort to prevent the transmission of COVID-19. Second, efforts to create a healthy environment as an effort to minimize the transmission of COVID-19. Third, many people still think that the transmission of COVID-19 can be avoided simply by staying away from infected people, even though this virus can be transmitted through particles attached to objects around us, sneezing, and coughing.

Development and Validation of an Artificial Intelligence–Powered Platform for Prostate Cancer Grading and Quantification

The Gleason grading system has been the most reliable tool for the prognosis of prostate cancer since its development. However, its clinical application remains limited by interobserver variability in grading and quantification, which has negative consequences for risk assessment and clinical management of prostate cancer. To examine the impact of an artificial intelligence (AI)-assisted approach to prostate cancer grading and quantification. This diagnostic study was conducted at the University of Wisconsin-Madison from August 2, 2017, to December 30, 2019. The study chronologically selected 589 men with biopsy-confirmed prostate cancer who received care in the University of Wisconsin Health System between January 1, 2005, and February 28, 2017. A total of 1000 biopsy slides (1 or 2 slides per patient) were selected and scanned to create digital whole-slide images, which were used to develop and validate a deep convolutional neural network-based AI-powered platform. The whole-slide images were divided into a training set (n = 838) and validation set (n = 162). Three experienced academic urological pathologists (W.H., K.A.I., and R.H., hereinafter referred to as pathologists 1, 2, and 3, respectively) were involved in the validation. Data were collected between December 29, 2018, and December 20, 2019, and analyzed from January 4, 2020, to March 1, 2021. Accuracy of prostate cancer detection by the AI-powered platform and comparison of prostate cancer grading and quantification performed by the 3 pathologists using manual vs AI-assisted methods. Among 589 men with biopsy slides, the mean (SD) age was 63.8 (8.2) years, the mean (SD) prebiopsy prostate-specific antigen level was 10.2 (16.2) ng/mL, and the mean (SD) total cancer volume was 15.4% (20.1%). The AI system was able to distinguish prostate cancer from benign prostatic epithelium and stroma with high accuracy at the patch-pixel level, with an area under the receiver operating characteristic curve of 0.92 (95% CI, 0.88-0.95). The AI system achieved almost perfect agreement with the training pathologist (pathologist 1) in detecting prostate cancer at the patch-pixel level (weighted κ = 0.97; asymptotic 95% CI, 0.96-0.98) and in grading prostate cancer at the slide level (weighted κ = 0.98; asymptotic 95% CI, 0.96-1.00). Use of the AI-assisted method was associated with significant improvements in the concordance of prostate cancer grading and quantification between the 3 pathologists (eg, pathologists 1 and 2: 90.1% agreement using AI-assisted method vs 84.0% agreement using manual method; P < .001) and significantly higher weighted κ values for all pathologists (eg, pathologists 2 and 3: weighted κ = 0.92 [asymptotic 95% CI, 0.90-0.94] for AI-assisted method vs 0.76 [asymptotic 95% CI, 0.71-0.80] for manual method; P < .001) compared with the manual method. In this diagnostic study, an AI-powered platform was able to detect, grade, and quantify prostate cancer with high accuracy and efficiency and was associated with significant reductions in interobserver variability. These results suggest that an AI-powered platform could potentially transform histopathological evaluation and improve risk stratification and clinical management of prostate cancer.

Does catheter material affect functional performance of intravenous ports via the superior vena cava?

IntroductionThe catheter is the only intravascular portion of an implanted port and plays a crucial role in catheter related complications. Both polyurethane and silicone are biocompatible materials which are utilized for catheter manufacturing, but their correlation to complications remains controversial. The aim of this study was to try to analyze the relationship between catheter materials and complications.Materials and methodsA total of 3144 patients who underwent intravenous port implantation between March 2012 and December 2018 at Chang Gung Memorial Hospital, Linkou, Taiwan were recruited. Of these, 1226 patients received silicone catheter port implantation and 1679 received polyurethane catheter ports. Case matching was done prior to analysis and catheter related complications and cumulative complication incidence for each group were compared.ResultsIntergroup differences were identified in entry vessel (p = 0.0441), operation year (p < 0.0001), operation method (p = 0.0095), functional period (p < 0.0001), patient follow up status (p < 0.0001), operating time for vessel cutdown (p < 0.0001) and wire assisted approach (p = 0.0008). Stratified by specific entry vessel, no statistical difference was found in complication rate or incidence between the silicone and polyurethane groups. We further compared the cumulative complication incidence of the silicone and polyurethane groups, and also found no statistical difference (p = 0.4451).ConclusionAs long as external stress forces generated by surrounding structures and focused on potential weak points are avoided, both silicone and polyurethane materials provide sufficient structural stability to serve as reliable vascular access for patients.

Suprapubic-Assisted Transurethral Excision of Eroded Transvaginal Cerclage Suture

<h3>Study Objective</h3> To demonstrate our minimally invasive technique for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa using a suprapubic-assisted transurethral approach. <h3>Design</h3> A narrated, stepwise video demonstration of our suprapubic-assisted transurethral technique. <h3>Setting</h3> Transvaginal cervical cerclage is a common treatment for cervical insufficiency. Complications such as erosion are rare as the duration of treatment is typically several months, with cerclage placement in the second trimester and complete removal prior to the onset of labor. Retained suture can lead to erosion through the vaginal epithelium and into other organs as seen in our case. Our technique offers a minimally invasive approach for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa. <h3>Patients or Participants</h3> A single patient was included as part of this case. <h3>Interventions</h3> Suprapubic-assisted transurethral approach for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa with key strategies for successful outcome. 1. A Carter-Thomason device can be used as a minimally invasive approach for suprapubic assistance in lieu of suprapubic trocar or suprapubic incision. 2. Rigid biopsy forceps can be used for improved traction at the time of eroded suture removal from the bladder mucosa. 3. For efficient excision, utilize countertraction on the suture with both suprapubic assistance and the biopsy forceps. 4. A Methylene Blue test should be performed to evaluate for a vesicovaginal fistula after excision of suture. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> A suprapubic-assisted transurethral approach can be used as a minimally invasive technique for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa.

Robotic Assisted Laparoscopic Wedge Resection of a Large Cornual Ectopic Pregnancy

<h3>Study Objective</h3> To demonstrate the steps of a wedge resection of a large cornual ectopic pregnancy using a robotic assisted approach. <h3>Design</h3> A guided explanation of the surgery using video. <h3>Setting</h3> The surgery was completed at a university hospital using the Da Vinci Xi Robot. <h3>Patients or Participants</h3> A 38-yo G7P1051 with a history of chronic hypertension who was incidentally found to have a cornual ectopic pregnancy measuring 11 weeks 4 days on her initial prenatal ultrasound. <h3>Interventions</h3> Robotic Assisted Laparoscopic Cornual Wedge Resection. <h3>Measurements and Main Results</h3> On initial prenatal ultrasound, the patient was found to have a cornual ectopic pregnancy on the right. Crown rump length measured 47mm corresponding with a gestational age of 11 weeks and 4 days. She was asymptomatic. She presented immediately to the hospital and underwent an urgent robotic assisted laparoscopic cornual wedge resection that evening. Estimated blood loss was 100cc. She did well postoperatively and went home the same day. <h3>Conclusion</h3> We present a case of a robot assisted wedge resection of a large cornual ectopic pregnancy as an alternative to straight stick laparoscopy or laparotomy. Although robotic assisted cases are known to have longer operating times, as with myomectomy, a robot approach can potentially help to decrease blood loss when managing large cornual ectopic pregnancies.

Country perspectives on improving technical assistance in the health sector

Background: This paper presents learnings from the Re-Imagining Technical Assistance for Maternal, Neonatal, and Child Health and Health Systems Strengthening (RTA) project implemented in the Democratic Republic of the Congo and Nigeria from April 2018 to September 2020 by JSI Research & Training Institute, Inc. and Sonder Collective and managed by the Child Health Task Force. The first of RTA’s two phases involved multiple design research activities, such as human-centered design and co-creation, while the second phase focused on secondary analysis of interviews and reports from the design research. This paper explores the limitations of current technical assistance (TA) approaches and maps opportunities to improve how TA is planned and delivered in the health sector. Methods: We analyzed project reports and 68 interviews with TA funders, providers, and consumers to explore in greater detail their perspectives on TA, its characteristics and drawbacks as well as opportunities for improvement. We used qualitative content analysis techniques for this study. Results: The issues surrounding TA included the focus on donor-driven agendas over country priorities, poor accountability between and within TA actors, inadequate skill transfer from TA providers to government TA consumers, an emphasis on quick fixes and short-term thinking, and inadequate governance mechanisms to oversee and manage TA. Consequently, health systems do not achieve the highest levels of resilience and autonomy. Conclusions: Participants in project workshops and interviews called for a transformation in TA centered on a redistribution of power enabling governments to establish their health agendas in keeping with the issues that are of greatest importance to them, followed by collaboration with donors to develop TA interventions. Recommended improvements to the TA landscape in this paper include nine critical shifts, four domains of change, and 20 new guiding principles.

249 Laparoscopic Assisted Enterolithotomy: A Viable Option in The Management of Gallstone Ileus

Abstract Introduction Gallstone ileus (GSI) is a rare cause of small bowel obstruction in patients over the age of 65 years. We report a case of GSI treated successfully with a laparoscopic assisted enterolithotomy. Case report A 75-year-old female presented with two days of abdominal distension and vomiting with a non-peritonitic abdomen on examination. A computerised tomography scan demonstrated small bowel obstruction due to an obstructing stone in the distal ileum. Three port laparoscopy and small bowel assessment confirmed a solitary enterolith (4cms) in the distal ileum with upstream dilated loops. An infra-umbilical 6 cm midline incision was made and the localised bowel loop was delivered. An enterotomy was made proximal to the point of obstruction, stone retrieved, and a single layer interrupted closure was performed. Ten weeks post-operatively, patient had a virtual follow-up consultation and is doing well. Conclusions GSI often presents in elderly patients with multiple co-morbidities. A laparotomy with enterolithotomy is the initial treatment of choice with biliary intervention as a second operation, if needed, at a later date. Clearly, a conventional exploratory laparotomy in this cohort of patients carries a high risk and therefore the use of less morbid and less invasive procedure like laparoscopy should be considered. Although a total laparoscopic approach would require advanced laparoscopic skills particularly due to dilated bowel loops limiting the intra-abdominal space for suturing, a laparoscopic assisted approach as described above should be considered as a reasonable option within the remits of an emergency general surgeon.

727 Robotic Assisted Versus Fluoroscopic Guided Approach in Pedicle Screw Insertion: A Systematic Review and Meta-Analysis

Abstract Aim The robotic assisted surgery has become prevalent in most of the surgical subspecialty. The adaption of such technique in spine surgery has resulted in minimising several issues encountered with fluoroscopic guided approach. The aim of this study is to compare the outcomes of robotic assisted approach and fluoroscopic guided approach in pedicle screw insertion. Method PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All the studies comparing robotic assisted surgery and fluoroscopic guided approach in pedicle screw insertion were included for quantitative and qualitative analysis. Results Twenty-eight studies enrolling 2105 patients (robotic group: 1027, fluoroscopic: 1078) and total screws of 8668 screws (robotic group: 4217, fluoroscopic group: 4451) were eligible for inclusion, these studies consisted of 19 observational studies, 7 randomised controlled trials (RCTs) and 2 cadaveric study. Robotic assisted approach was associated with significantly higher accuracy (Grade A+B) (OR = 2.34; P &amp;lt; 0.0001) and distance between pedicle and screw (MD: 1.69; P = 0.001), lower incident of facet joint violation (OR = 0.22; P &amp;lt; 0.00001), screw revision (OR = 0.38; P = 0.009), intraoperative blood loss (MD: -116.95; P = 0.0006), shorter pedicle screw placement time (MD: -4.66; P &amp;lt; 0.00001), radiation exposure time (MD:-5.27; P = 0.0001), radiation dose (MD:-22.30; P = 0.0002) and postoperative hospital stay (MD: -0.79; P = 0.02) compared to fluoroscopic guided approach. There was no significant difference in operative time and wound infection. Conclusions In this meta-analysis, robotic assisted approach is more effective in achieving better clinical outcomes compared to fluoroscopic guided technique in pedicle screw insertion. However, future adequately powered RCTs are warranted to generate standardised outcomes.

Understanding Missing Patterns in Standardized Patient Functional Data at Inpatient Rehabilitation Facilities

<h3>Research Objectives</h3> The Improving Medicare Post-Acute Care Transformation Act of 2014 adopts standardized functional assessment, known as Section GG, across post-acute settings. Section GG has multiple options for missing and much higher percentages of missing values compared to Functional independent Measure ® (R) (FIM) at the inpatient rehabilitation facilities (IRFs). This study examines missing patterns of Section GG in stroke to enhance our understanding of how to interpret and use Section GG scores. <h3>Design</h3> We analyzed 2018 Medicare data. Each individual was assessed by both Section GG and FIM at admission and discharge. We categorized patients with any Section GG missing into one of five missing patterns: refuse, no attempt, not applicable, no value and tie (patients had the same highest frequency for more than two types of missing). We compared FIM scores across five missing patterns. Multiple imputation was applied to calculate missing GG scores. We compared correlations and agreements between Section GG and FIM before and after multiple imputation. <h3>Setting</h3> IRFs. <h3>Participants</h3> Patients with stroke older than 66 years (N=42,789). <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Section GG and FIM. <h3>Results</h3> The mean age of the patients was 78.7 (7.44), with the majority as male (52.3%), non-Hispanic White (80.3%), overweight (34.7%) and married (49.4%). Patients in the missing categories of ‘refused' and ‘not applicable' had higher FIM scores compared to other missing types (e.g. FIM self-care scores at discharge: refuse [25.4], not applicable [23.7], no value [20.6], not attempt [18.8] and tie [18.4]). Correlations and agreements between Section GG and FIM were improved after multiple imputation (correlations at discharge: 084 vs. 0.90, before and after imputation). <h3>Conclusions</h3> Patients had different functional levels when missing Section GG items, indicating different levels of assistance, resources and treatment approaches may be needed. Multiple imputation may be a potential solution to calculate missing Section GG values. Future study needs to examine how to adequately report variations of missing Section GG items, to ensure using standardized functional assessment can provide accurate patient assessment outcomes. <h3>Author(s) Disclosures</h3> No conflicts or interest declared by the authors.

A Digital Twin Approach for Contextual Assistance for Surgeons During Surgical Robotics Training.

Minimally invasive robotic surgery copes with some disadvantages for the surgeon of minimally invasive surgery while preserving the advantages for the patient. Most commercially available robotic systems are telemanipulated with haptic input devices. The exploitation of the haptics channel, e.g., by means of Virtual Fixtures, would allow for an individualized enhancement of surgical performance with contextual assistance. However, it remains an open field of research as it is non-trivial to estimate the task context itself during a surgery. In contrast, surgical training allows to abstract away from a real operation and thus makes it possible to model the task accurately. The presented approach exploits this fact to parameterize Virtual Fixtures during surgical training, proposing a Shared Control Parametrization Engine that retrieves procedural context information from a Digital Twin. This approach accelerates a proficient use of the robotic system for novice surgeons by augmenting the surgeon’s performance through haptic assistance. With this our aim is to reduce the required skill level and cognitive load of a surgeon performing minimally invasive robotic surgery. A pilot study is performed on the DLR MiroSurge system to evaluate the presented approach. The participants are tasked with two benchmark scenarios of surgical training. The execution of the benchmark scenarios requires basic skills as pick, place and path following. The evaluation of the pilot study shows the promising trend that novel users profit from the haptic augmentation during training of certain tasks.

753 SCARLESS APPROACH FOR KILLIAN JAMIESON DIVERTICULUM: TRANSORAL ENDOSCOPIC ASSISTED ESOPHAGODIVERTICULOSTOMY

Abstract Killian-Jamieson Diverticulum (KJD) is a rare variant of proximal esophageal diverticulum that arises from the Killian-Jamieson area (antero-lateral). It differs from the more common Zenkers diverticulum which usually arise from the posterior aspect of the proximal esophagus. The choice of surgical intervention for symptomatic KJD is still unclear due its rare incidence and surgeons still prefer the transcutaneous cervical approach. Here we present the transoral endoscopic assisted esophagodiverticulostomy approach and the relevant literature. Methods 26 year old male presented with progressive dysphagia for the past two years. A Killian-Jamieson Diverticulum was diagnosed after an Oesophagogastroduodenoscopy and Barium swallow. Patient underwent a transoral endoscopic assisted esophagodiverticulostomy. Results The surgery was uneventful and no complications were observed post-operatively. A year after the surgery patient is asymptomatic and no sign of recurrence. Conclusion Transoral endoscopic assisted esophagodiverticulostomy is a safe approach for treatment of symptomatic KJD. In this era of minimally invasive surgery it should be considered when formulating a treatment approach based on its obvious advantages.

Magnetic beads-assisted fluorescence aptasensing approach based on dual DNA tweezers for detection of ochratoxin A and fumonisin B1 in wine and corn.

A magnetic beads (MBs)-assisted fluorescence aptasensing approach based on dual DNA tweezers and magnetic separation was established for the detection of ochratoxin A (OTA) and fumonisin B1 (FB1). A dual DNA tweezers structure with four ends linked with fluorophores (FAM, ROX) and quenchers (BHQ1, BHQ2) was designed, and produced the high initial fluorescence signals because of the long spatial distance between FAM and BHQ1, ROX, and BHQ2. Bio-aptamer/anti-aptamer of OTA and bio-aptamer/anti-aptamer of FB1 were respectively annealed to form dsDNA, and immobilized to MBs coated with streptavidin (SA). With the existence of OTA and FB1, OTA and FB1 preferentially bound with their respective bio-aptamers, which made anti-aptamers dissociate from dsDNA coupled on MBs. After magnetic separation, the dissociated anti-aptamers reacted with dual DNA tweezers, respectively, which made DNA tweezers close and the fluorescence was quenched. The linear ranges of approach for OTA and FB1 detection were 0.05-20ng/mL and 0.1-40ng/mL, respectively. The limit of detection for OTA and FB1 was 0.029ng/mL and 0.061ng/mL. The prepared MBs-assisted fluorescence aptasensing approach was applied to detect OTA and FB1 in spiked red wine and corn samples, which showed good recoveries between 92 and 106%.

What Mutual Assistance Is, and What It Could Be in the Contemporary World.

This paper explores the implications of a Civil Economy approach to consumer ethics, by addressing the idea that Antonio Genovesi’s (1713–1769) notion of mutual assistance can be understood in terms of collective intentionality or team reasoning. I try to give reasons for this idea by a careful examination of Genovesi’s conception of social life and human agency and by reading it through the lens of team reasoning. I argue that this understanding of mutual assistance may imply broad constraints over agents’ choices whenever they conflict with the good of society. Then I explore the implications of a mutual assistance approach to market ethics in a global society, where conflicting views of good and different group affiliations are possible.

Green Synthesis of NiO Nanoparticle Using Ziziphus Spina-Christi Leaves Extract for Photocatalytic Methylene Blue Dye Degradation

In this presented work, ziziphus spina-christi leaves extract assisted green synthesise approach was used to prepare the NiO nanoparticle for UV light driven photocatalytic methylene blue (MB) dye degradation. Various analytical characterizations were used to understand the crystalline, structural, optical and morphological nature of the prepared nanoparticle. The prepared NiO nanoparticle have wide bandgap of 3.35 eV with average particle size of around 10–15 nm in range. Various environmental conditions and elemental trapping experiments were conducted to understand the factors affecting the MB degradation and main active species for the redox reaction. Hence, we hope that this green synthesise NiO would pave a new way for photocatalytic preparation and their environmental remediation application.

V01-06 ROBOTIC ASSISTED REPAIR OF A PERINEAL BLADDER HERNIA

You have accessJournal of UrologyIncontinence & Female Pelvic Medicine/Reconstructive Surgery (V01)1 Sep 2021V01-06 ROBOTIC ASSISTED REPAIR OF A PERINEAL BLADDER HERNIA Dmitry Volkin, and Christopher Tarnay Dmitry VolkinDmitry Volkin More articles by this author , and Christopher TarnayChristopher Tarnay More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001970.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perineal hernias are relatively uncommon but certainly may be encountered by the urologist or pelvic reconstructive surgeon. Diagnosis and management of these unusual hernias is limited to case reports in the literature. Our aim was to provide a video guide demonstrating our technique of how to successfully repair such a hernia. METHODS: This is a video presentation of a 70 year old female patient who developed lower urinary tract symptoms and a palpable mass in her right buttocks. Imaging confirmed a bladder hernia in the right ischiorectal fossa. She underwent repair of her hernia via a robotic assisted abdominal approach, which confirmed a large defect in the levator muscle bordered medially by the vagina and bladder. We also perform a brief review of the literature on perineal hernias and review possible sites of herniation of the bladder. RESULTS: The patient underwent a patch repair of the hernia with soft polypropylene mesh cut to approximately the size of the defect but she recurred 6 weeks later. Repeat operation revealed a medial detachment of her mesh patch. A second repair was performed utilizing a larger piece of mesh, anchoring it more broadly to the levator musculature laterally and pubic bone anteriorly. The patient’s immediate post-operative course was complicated by a retroperitoneal hematoma that was managed conservatively. She was free of hernia recurrence 1 year after her second operation. CONCLUSIONS: Perineal hernias are within the scope of practice of the urologist and pelvic reconstructive surgeon. They can successfully be repaired with reduction of the hernia and application of a broad mesh patch. Source of Funding: Not applicable © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e63-e63 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Volkin More articles by this author Christopher Tarnay More articles by this author Expand All Advertisement Loading ...

Treatment of duodenal lipoma with robotic-assisted transverse duodenotomy: A case report of novel approach.

Introduction and importanceLipomas are the third most common benign tumor of the gastrointestinal (GI) tract, typically occurring in the colon or small intestine. Less than 100 cases of symptomatic duodenal lipomas have been reported. Symptoms include non-specific upper GI complaints of heartburn, fullness, or abdominal pain. This report highlights the rarity of symptomatic duodenal lipomas, lack of specific treatment guidelines, and adds to surgical literature a new treatment approach.Case presentationA 53-year-old Caucasian woman presented with 2-year history with main concerns for early satiety and constipation. CT scan with contrast of the abdomen and pelvis demonstrated a duodenal mass. Differential diagnosis included duodenal lipoma versus stricture, and IBS. Subsequent EGD revealed a 4 cm transverse duodenal submucosal mass. Endoscopic removal was deemed too great a risk of bleeding. Pre-operatively, the patient expressed frustration as the patient was tolerating only a liquid diet with one bowel movement weekly. Treatment with robotic assisted transverse duodenotomy was performed, with final pathology of benign lipomatous tissue. Post-operatively the patient had immediate relief of symptoms which persisted at 2-week and 4-month follow-ups.Clinical discussionThis case demonstrates 3 primary learning points. First, duodenal lipomas should be included in the differential of vague upper GI symptoms. Second, we propose that surgeons consider treatment of duodenal lipomas utilizing robotic assisted approach. Third, we document the first robotic-assisted transverse duodenotomy for duodenal lipomas.ConclusionClinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy.