Separation Procedure Research Articles

타인의 선거범죄에 의한 당선무효제도에 관한 헌법적 검토

Trials for election crimes function to punish criminal acts that infringe on the freedom of elections and undermine the fairness of elections. Indirectly, it restores the fairness of elections disturbed by election crimes. However, there are far more cases in which the result of an election is changed by punishment for election crimes than in cases where the result of an election is corrected through an election lawsuit. In particular, there are many constitutional problems with a system that uniformly invalidates elections only by sentences of imprisonment or fines of 3 million won or more for other people's election crimes, not their own. The invalidation of the election due to election crimes by others violates the constitutional principle of responsibility or self-responsibility, as well as due process of law, thereby violating the candidate's right to hold public office. Above all, it can impose a burden on judges to simultaneously consider the policy judgment on the invalidation of the elected candidate in sentencing for other people's election crimes, thereby damaging the unique function of the judiciary. Comparatively, the UK and Japan also recognize the invalidity of elections due to election crimes by others. However, apart from the criminal trial for election crimes, whether to invalidate the election due to election crimes is decided through the judgment of the election court or the court in charge of election litigation. These comparative legislative examples can support the argument that the election invalidation system under Articles 263 and 265 of the Public Official Election Act violates the due process of law and violates the candidate's right to hold public office. In order to overcome the unconstitutionality of the invalidation of elections due to election crimes by others, it is necessary to think about guaranteeing a separate procedure for invalidation of elections. Therefore, legislative improvement should be made in the direction of organizing a due process that can determine whether or not an election is invalid, separate from criminal trials for other people's election crimes.

Outcome of Single Stage Anterior and Posterior Surgery for Tuberculous Paraplegia.

Morbidity and mortality from tuberculosis, a significant infectious illness, are expected to rise worldwide. The projected number of new cases rose from 7.5 million in 1990 to 11.9 million in 2005, a 58.6% increase in 2011. The widespread belief that TB is no longer a public health concern is unfounded; on the contrary, the link between HIV/AIDS and antibiotic resistance has further exacerbated the crisis that already existed. Similar to the nations in sub-Saharan Africa, India is now considered a Group IV country, with an annual risk of infection between 1% and 2.5%. 2. Although 60% of TB cases occur in people who are HIV-positive, only 3-5% of cases in HIV-negative individuals are skeletal. The most frequent type of articuloskeletal tuberculosis is spinal tuberculosis. 1. The goal of this study is to evaluate the neurological outcome of anterior debridement, fusion, posterior instrumentation, and early rehabilitation in individuals with spinal cord injuries. 2. The goal of this study is to determine the prevalence of pressure ulcers, hypostatic pneumonia, and urinary tract infections urinary tract infections (UTIs) among these individuals. 3. The goal of this study is to determine the frequency of graft-related problems. 4. See how well these individuals are able to keep their corrected deformities from returning. Patients who had simultaneous anterior (anterior debridement and bone grafting) and posterior (posterior instrumentation and fusion) procedures were followed prospectively. Thirty patients' films were examined. In addition, cord edema was suggested in 13 of the patients based on the presence of strong signal intensities there. Myelomalacia signs were seen in one patient, but he or she went on to make a complete neurological recovery. The average duration of operation was 355 minutes, and this included the time needed to position the patient for the two separate procedures. There was an 89.5% rate of neurological recovery with an average corrected loss of 6.98 degrees (0.20 degrees to 35.90 degrees), and the complication rate was acceptable in the group analyzed.

Attenuated Total Reflection Fourier Transform Infrared Mapping for the Identification of the Prescribed and Abnormal Ingredients of Herbal Powder Preparations.

Herbal powder preparations (HPPs) are common forms of traditional medicine made by blending the powder of two or more ingredients. The first step to ensure the safety and efficacy of HPPs is to confirm the prescribed ingredients and screen the abnormal ingredients. With the help of attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR) imaging or mapping, the particles of different ingredients in an HPP sample can be measured individually. In this way, the overlapped absorption signals of different ingredients in the ATR FT-IR spectrum of the bulk sample can be isolated in the ATR FT-IR spectra of the microscopic particles, which leads to the substantial increase of the specificity and sensitivity of the infrared spectral identification method. The characteristic particles of each ingredient can be identified by the objective comparison of the microscopic ATR FT-IR spectra against the reference spectra based on the correlation coefficients. Since the ATR FT-IR imaging or mapping tests of HPPs are free of the separation preprocess, multiple organic and inorganic ingredients are able to be recognized by a single identification procedure simultaneously rather than by different separation and identification procedures. As an example, the ATR FT-IR mapping method was used in this research to successfully identify three prescribed ingredients and two abnormal ingredients in oral ulcer pulvis, which is a classic HPP for oral ulcer in traditional Chinese medicine. The results show the feasibility of the ATR FT-IR microspectroscopic identification method for the objective and simultaneous identification of the prescribed and abnormal ingredients of HPPs.

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Optimized Schwarz Methods for the Cahn–Hilliard Equation

The Cahn–Hilliard equation was originally proposed to describe the phase separation phenomenon for a binary alloy in the quenching process and now has been widely applied in many other scientific fields. To investigate its solution behavior, one mainly depends on the numerical simulations because of the nonlinearity. However, it would require very small time steps to describe the phase separation procedure since it evolves very quickly in time, which implies that an efficient solver for the spatial problem at each time level is very important. In this paper, we investigate a coupled second order elliptic system of constant coefficients, which occurs in many different unconditionally energy stable time discretization schemes for the Cahn–Hilliard equation. For a min-max problem of convergence factor that is obtained via Fourier analysis in the case of two-subdomain domain decomposition, by using an asymptotic analysis we obtain the optimized transmission parameters in explicit form applied in the Robin and the two-sided Robin transmission conditions for both the overlapping and the nonoverlapping Schwarz domain decomposition algorithms, and we obtain as well the corresponding asymptotic convergence rates. Particularly, we also explore and analyze the many-subdomain cases directly and find that the algorithms are scalable until a certain number of subdomains is reached for small time steps, even if there is no coarse grid correction. We finally use numerical examples to illustrate our theoretical findings.

Institutional Experience With Surgical and Injectable Procedures at a Department Resident Aesthetic Plastic Surgery Clinic

Abstract Goals/Purpose Over the past several decades, the number of aesthetic procedures in plastic surgery has risen drastically in the United States. To meet this public demand, it is important to ensure plastic surgery residents are well-equipped to incorporate aesthetics into their future practice. Given the elective nature of aesthetic surgery, many patients opt to personally select their surgeon from qualified private practitioners. Patients’ tendency to avoid academic institutions, coupled with relatively high postoperative expectations, has historically led to limited hands-on experience for residents. Recent literature has documented graduating plastic surgery residents have felt deficient in performing aesthetic procedures, particularly those of the face. In a recent survey, 30% of department chairs/division chiefs acknowledged difficulties with and inadequacies of aesthetic surgery training at their institutions and recommending the need for more effective training models. The objective was to review the volume and outcomes of our resident aesthetic clinic. Methods/Technique The Resident Aesthetic Surgery Clinic at the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health sees patients 5 days per week and provides a total of 6 months of training experience for residents. Patients presenting to the clinic are first evaluated by senior residents, who perform the entire consultation. Patients are staffed with the attending present that day who provides feedback, oversight, and supervision and helps the residents refine their clinical skills of indicating a patient for surgery, pre-operative planning, and post-surgical follow-up visits. Dedicated clinic front office staff streamline the process by assisting with surgical quotes, preoperative clearance, and operating room scheduling. The resident aesthetic clinic does not engage in any formal advertising, but rather relies on word-of-mouth and direct referrals for patient recruitment. Patients are billed on a fee-for-service basis and insurance is not accepted. The revenue generated is used to offset operational costs of the clinic and operating rooms, as well as contribute to the salary of staff supporting the clinic. The remaining operational costs of the clinic are subsidized by the department. We conducted a retrospective review of all surgical and injectable procedures completed by the NYU Resident Aesthetic Surgery Clinic in 2021. Patients were excluded from the study if outcome information was missing. Participating residents were surveyed before and after their rotation in the clinic to assess their confidence performing aesthetic procedures which was rated on a scale of 1 to 5. Procedures were defined similar to how procedures are recorded for resident case logs for the Accreditation Council for Graduate Medical Education (ACGME).1 Bilateral procedures (e.g., bilateral breast augmentation) were counted as two separate procedures (left and right). Blepharoplasty was not only separated by laterality, but also by upper and lower lids. In contrast, an operation was defined as a single trip to the operating room or office visit in which the patient received at least one procedure. Complications were categorized as either minor, moderate, or major. Minor complications were treated with non-operative management. Moderate complications required a small intervention such as seroma aspiration, while major complications necessitated return to the operating room. Complication and revision rates were calculated by summing the number of complications and revisions, respectively, and dividing by the total number of procedures. Data analyzed using IBM SPSS software and the ggplot2 package in R. A chi-squared test assessed for significant deviation in frequencies of procedures across yearly quarters. Mann-Whitney tests evaluated significance between pre- and post-rotation confidence ratings among residents. A p-value of less than 0.05 was considered statistically significant. Complication and revision rates were calculated with respect to the total number of procedures. The complication rate, revision rate, and surgeon fees were compared to data from other institutions available in the literature. Surgeon fees were also compared to national averages according to the 2020 ASPS Plastic Surgery Statistics Report and 2021 Aesthetic Plastic Surgery National Databank Statistics. Results/Complications In 2021, 144/379 consultations led to an operation (38.0% conversion rate), resulting in 420 distinct surgical procedures. The majority (53.3%) of procedures involved the head and neck. Complication and revision rates were 5.5% and 1.0%, respectively, with surgeon fees consistently below national average. Residents reported being significantly more confident performing face lifts, rhinoplasties, and aesthetic surgery in general following their clinic rotation. Analyzing our injectable experience, 223/233 consultations led to an injection (95.7% conversion rate) for 142 patients. Neurotoxin was most commonly injected into the upper face, while fillers were most commonly injected into the midface. Only 2 complications from fillers (0.9% complication rate) and one touch-up (0.4% touch-up rate) occurred. Procedural fees were substantially less than national averages and comparable to other academic settings. Conclusion These data represent the largest annual reported study of plastic surgery resident aesthetic surgical and injectable procedures and outcomes, demonstrating the high volume and productivity of the NYU Resident Aesthetic Surgery Clinic. These results further support resident aesthetic clinics as a robust training modality.

Development of a New and Facile Carrier Element-Free Coprecipitation Procedure for Separation, Preconcentration and Sensitive Determination of Cu(II) and Cd(II) Ions in Water and Vegetable Samples

A facile and sensitive method predicated on carrier element free coprecipitation (CEFC) using 2-(2-(2-(4-bromobenzyl)-1H-benzo[d]imidazole-1-yl)acetyl)-N-ethylhydrazine-1-carbothioamide (BIMANEC) is reported for trace determination of Cu(II) and Cd(II) in vegetables and water. BIMANEC was used for the first time for the quantitative determination of these trace heavy metals. Flame atomic absorption spectrometer (FAAS) was used for quantitation. The preconcentration conditions were optimized with respect to pH (8.0), BIMANEC mass (4.0 mg), volume of sample (100 mL), standing time (5 min), and centrifugation time and rate (3 min and 2500 rpm). The influence of potentially interfering ions was scrutinized for the recovery of analyte ions. Under the optimum conditions, the limits of detection (LODs) were 0.51 and 2.28 µg L−1 for Cu(II) and Cd(II), respectively. The relative standard deviations were < 5% for both. The recoveries from the spiked vegetable samples were from 94.9 to 102.8% and from the spiked water samples between 93.2 and 101.6%. Consequently the developed new, facile, rapid, and highly efficient CEFC process was employed for the trace determination of Cu(II) and Cd(II).

Forensic characterization and differentiation of automotive lubricating greases using Fourier Transform Infrared spectroscopy and Scanning Electron Microscopy-Energy Dispersive X-Ray Spectroscopy

Automotive lubricating greases may be recovered as stains on the ground at vehicular accident scenes or on the garments of persons of interest (i.e., suspects or victims) allegedly involved in events under investigation. Numerous studies have been performed differentiating automotive motor oil for forensic applications, however little research has been conducted to characterize and differentiate automotive greases for forensic purposes. This study aims to determine physical and chemical properties of greases to help with their characterization and differentiation in a forensic setting. Thirty-five commercially available grease samples were obtained from major US hardware stores and were initially characterized using light microscopy methods; then they were subsequently examined using attenuated total reflection (ATR)-Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). The initial microscopical assessment showed the presence of microscopic particles that were part of the original formulation of the grease samples. In terms of shapes, sizes, colors, optical properties, and concentration, these particles differed considerably between the grease samples. Three classes of particles were identified and consequently labelled as opaque, isotropic, and anisotropic. ATR-FTIR spectroscopy enabled obtaining a common infrared profile characteristic of all for grease samples. Close inspection of the spectra also highlighted the presence of minor infrared absorption bands that were useful to the differentiation of different grease samples. Because of the high interference of the lubricating medium of the grease samples during SEM-EDS analyses, an oil-solid separation procedure to extract the observed microscopic particles from the grease medium was developed based on the investigation of three solvents – two petroleum solvents, hexane, and pentane, and one green solvent, D-limonene – which led to the selection of D-limonene. The developed extraction method enabled the successful isolation of the detected particles for conducting SEM-EDS analyses. The opaque particles were identified as solid lubricant additives, containing various amounts of molybdenum and niobium. Grease samples that did not contain opaque particles were missing these heavy elements. These differences in composition offered increased discriminating capabilities for the differentiation of automotive greases, also considering that such particles are not present in other automotive lubricating fluids like motor oils or brake fluids.

Thymine-mediated electrochemical aptasensor for sensitive and simultaneous detection of Hg2+ and CH3Hg+ in fish samples

In this study, a thymine-mediated electrochemical aptasensor was constructed for instantaneous detection of Hg2+ and CH3Hg+ in fish muscle using ferrocene (Fc) and methylene blue (MB) as electrochemical tags. In the presence of Hg2+, a HP-Fc (ferrocene and thiol-labeled hairpin DNA) was opened and hybridized with a complementary S1 (single-stranded DNA) to form a stable thymine-Hg2+-thymine (T-Hg2+-T) structure. Then, the Fc tag got far away from the gold electrode surface, inducing a distinct decrease of its electrochemical signal. Meanwhile, SA−MB (methylene blue labeled single-stranded DNA) was designed to complement with S2 (thiol-labeled single-stranded DNA). When CH3Hg+ was present, the double-stranded DNA was dissociated, and a more stable CH3Hg+-T structure was generated by binding of screened S2 and CH3Hg+. Thus, the SA−MB was away from electrode surface and the significantly reduced current of MB was observed. As a result, Hg2+ and CH3Hg+ were differentiated through the thymine-mediating, realizing the simultaneous detection of Hg2+ and CH3Hg+ without extra separation procedure. Such a sensing strategy allowed sensitive and selective detection of Hg2+ and CH3Hg+ down to the picomolar level, with limits of detection (LOD, S/N = 3) of 0.06 pM and 0.13 pM, respectively. The sensor was finally successfully applied for the detection of Hg2+ and CH3Hg+ in fish samples, and the results were in good agreement with those obtained by liquid chromatography-inductively coupled plasma mass spectrometry (LC-ICP-MS). This technology provides a sensitive and simple method for speciation analysis and monitoring of Hg2+ as well as CH3Hg+ in biological samples.

Effect of chemically activated natural vermiculite nanosheets on the performance of mixed matrix polyethersulfone membranes

In this study, natural raw vermiculite (RVMT) nanosheets, as an accessible and economic mineral, were chemically activated and used to modify polyethersulfone (PES) membranes. In this way, RVMT was modified with acid (AVMT) and cetyltrimethyl ammonium bromide (CTAB, OVMT) to increase its hydrophilic functional groups and dispersion properties. Various characterization methods, such as XRD and FTIR, verified the successful preparation of AVMT and OVMT. PES polymeric membranes’ properties were improved by the utilization of these additives. The fabrication of AVMT and OVMT/PES mixed matrix membranes with different quantities (0–1 wt.%) was carried out by a non-solvent-induced phase separation procedure. The asymmetric structure of the membranes was confirmed by SEM images. By modifying the matrix of the PES membranes, the porosity of the obtained membranes was improved from 60.50 to 84.92 and 85.09% in the presence of AVMT and OVMT, respectively. Furthermore, the flux of the PES mixed matrix membranes containing 0.5 wt.% AVMT and OVMT were enhanced from 201.76 to 315.89 and 272.07 L/m2 h with an improved flux recovery ratio of 51.81 and 49.15%, respectively.

Ultrasensitive Determination of L-Cysteine with g-C3N4@CdS-Based Photoelectrochemical Platform

L-cysteine, a component of the symmetric L-cystine, is essential in numerous biological activities. Thus, detecting cysteine rapidly, selectively, and sensitively is of tremendous interest. Herein, g-C3N4@CdS composites were employed as sensing elements in a photoelectrochemical platform for L-cysteine sensing. In this system, g-C3N4@CdS composites provided much better optoelectronic function than bare CdS materials owing to their high photon-to-current conversion efficiency and excellent anti-photocorrosion properties. The innovative photoelectrochemical sensor has a wide determination range of 5 to 190 µM, a very low detection limit of 1.56 µM, a fast response time, and good long-term stability (ca. 1 month). Without applying any separation procedures, a low concentration of CySH was successfully detected in human urine samples, which is compatible with the results of chemiluminescence.

A COMPARISON STUDY OF HUSBAND AND WIFE SEPARATION

A legal separation is a court-supervised arrangement that allows couples to live separate lives. This is usually by living apart. The court directs financial obligations, child visitation, and child support.Islamic countries, such as Brunei, prefer divorce to separation. Divorce is frowned upon by the religious system. Separation procedures are often similar to separation procedures.In Korea, the law focuses on separation. The law governing separation is a minor version of the separation law. In Japan, separation is not allowed. However, nullifying marriage is provided for in law. Couples who want to separate must navigate the law to establish grounds for separation. This paper compares some aspects of separation between husband and wife in Korea, Japan, and Brunei. It provides instances of how couples in the mentioned countries have been able to use the law to separate. In an Islamic country such as Brunei, separation is preferred to divorce because divorce is frowned upon by the religious system. Separation destroys the normal flow of finance and financial management among families and may tamper with the everyday life of the affected.Separation is mainly treated as a step before the divorce. Therefore, most legal procedures attached to separation involve property division, financial obligations, child visitation, and child support. Consequently, separation procedures are often similar to separation procedures. In Korea, the law focuses on divorce. However, couples should create an agreement that outlines how they will support their children and how they will access them.The complexities and dynamics of marital relationships and families established through institutional marriage pose a significant challenge to family law. Despite the reforms in Korean Family Law, there still exist legal limitations and controversies which the law has not been able to address effectively.

Shape-Controlled synthesis of conjugated microporous polymer nanotubes and their implementation in continuous flow polymerization

Flow reactors have materialized as a reliable and sustainable approach toward polymer production and processing to promote efficient and uniform irradiation pathways. However, the disadvantages of existing homogeneous photocatalysts including noxiousness, restricted photocatalytic activity and stability, and difficult separation and purification, still pose a great challenge to the advancement of this technique. Herein, conjugated microporous polymer nanotubes (hPorBDP NTs) were fabricated through Sonogashira-Hagihara cross-coupling polycondensation with silica nanorods as sacrificial templates, followed by etching of the inner cores. The hPorBDP NTs with a hollow nanostructure and a highly porous texture were demonstrated to facilitate the separation procedure and provide more accessible active sites for photocatalytic reactions. The hPorBDP NTs were employed as heterogeneous catalysts to activate photoinduced electron/energy transfer-reversible addition-fragmentation chain transfer (PET-RAFT) polymerization in batch and in continuous flow system. Screening of the initial monomer concentrations and pump flow rates, high monomer conversions (ɑ > 80%) and narrow dispersities (Đ < 1.15) were achieved in continuous flow system for upscaled production of polymers. Separation and reutilization of the catalyst-bound NTs were realized through facile centrifugation, which resulted in negligible leaching and maintenance of catalytic performance over multiple polymerization cycles. As such, the development of photosynthesis system using hPorBDP NTs as heterogeneous photocatalysts should broaden the application scope of these fascinating catalysts while benefiting synthetic upscaling by continuous flow polymerization.

Cyclic NH3 adsorption-desorption characteristics of Cu-based metal halides as Ammonia Separation and Storage Procedure

The efficient recycling of Ammonia (NH3) separation and storage technology is important for economic development and the realization of the “two-carbon” strategy. Some metal chlorides can combine with NH3 to form metal-ammonia complexes, thus achieving effective NH3 separation and stable storage. On this basis, we focused on the NH3 adsorption-desorption performance of three metal halides: CuCl2, CuBr2 and CuI, and investigated the effects of adsorption/desorption temperature and cycle number on the NH3 adsorption performance, and analyzed the NH3 adsorption mechanism from the perspective of pore structure. The results showed that CuCl2 had the highest NH3 adsorption capacity, up to 0.66 g NH3/g adsorbent in the first cycle. The NH3 adsorption capacity of CuI was very poor and could hardly bind to ammonia. Due to the high temperature of complete desorption of the metal-ammonia complexes, the NH3 adsorption capacity of the 2nd cycle of the metal halides was much lower than that of the first cycle and then decreases slowly. The porosity of the adsorbent is the main factor affecting the NH3 adsorption capacity. After 10 cycles, a large number of mesopores in CuCl2 still provided pore channels for the diffusion of NH3.

LBA01-17 AI-POWERED REAL-TIME ANNOTATIONS DURING UROLOGIC SURGERY: THE FUTURE OF TRAINING AND QUALITY METRICS

You have accessJournal of UrologyCME1 Apr 2023LBA01-17 AI-POWERED REAL-TIME ANNOTATIONS DURING UROLOGIC SURGERY: THE FUTURE OF TRAINING AND QUALITY METRICS Laura Zuluaga, Jordan M. Rich, Raghav Gupta, Adriana Pedraza, Burak Ucpinar, Kennedy E. Okhawere, Indu Saini, Mani Menon, Ashutosh Tewari, and Ketan K Badani Laura ZuluagaLaura Zuluaga More articles by this author , Jordan M. RichJordan M. Rich More articles by this author , Raghav GuptaRaghav Gupta More articles by this author , Adriana PedrazaAdriana Pedraza More articles by this author , Burak UcpinarBurak Ucpinar More articles by this author , Kennedy E. OkhawereKennedy E. Okhawere More articles by this author , Indu SainiIndu Saini More articles by this author , Mani MenonMani Menon More articles by this author , Ashutosh TewariAshutosh Tewari More articles by this author , and Ketan K BadaniKetan K Badani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Real-time artificial intelligence (AI) annotation of the surgical field has the potential to automatically extract information from surgical videos, helping to create a robust surgical atlas. This content can be used for surgical education and qualitative initiatives. We demonstrate the first use of AI in urologic robotic surgery to capture live surgical video and annotate key surgical steps and safety milestones in real-time. METHODS: We conducted an educational symposium, which broadcasted two live procedures, a robotic-assisted radical prostatectomy (RARP) and robotic-assisted partial nephrectomy (RAPN). A surgical AI platform system (Theator, Palo Alto, CA) generated real-time annotations and identified operative safety milestones (Image 1). This was achieved through trained algorithms, conventional video recognition, and novel technology called Video Transfer Network which captures clips in full context, enabling automatic recognition and surgical mapping in real-time. RESULTS: Real-time AI annotations for procedure #1, RARP, are found in Table 1. Safety milestone annotations included the apical safety maneuver and structures identification such as the external iliac vessels and the obturator nerve. Real-time AI annotations for procedure #2, RAPN, are found in Table 1. Safety milestones included deliberate views of structures such as the gonadal vessels and the ureter. AI annotated surgical events included intraoperative ultrasound and notable hemorrhage among others. CONCLUSIONS: Surgical intelligence successfully showcased real-time AI annotations of two separate urologic robotic procedures during live telecast for the first time. These annotations may provide the technological framework to send automatic notifications to clinical or operational stakeholders. This technology is a first step in real-time intraoperative decision support; leveraging big data to improve the quality of surgical care, potentially improve surgical outcomes and, support training and education. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1183 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Zuluaga More articles by this author Jordan M. Rich More articles by this author Raghav Gupta More articles by this author Adriana Pedraza More articles by this author Burak Ucpinar More articles by this author Kennedy E. Okhawere More articles by this author Indu Saini More articles by this author Mani Menon More articles by this author Ashutosh Tewari More articles by this author Ketan K Badani More articles by this author Expand All Advertisement PDF downloadLoading ...

MP39-10 SIMULTANEOUS BILATERAL PCNL: IS IT COST-EFFECTIVE?

You have accessJournal of UrologyCME1 Apr 2023MP39-10 SIMULTANEOUS BILATERAL PCNL: IS IT COST-EFFECTIVE? Kevin Wymer, Ben Johnson, Austen Slade, Daniel Heidenberg, Mitchell Humphreys, Karen Stern, and Marcelino Rivera Kevin WymerKevin Wymer More articles by this author , Ben JohnsonBen Johnson More articles by this author , Austen SladeAusten Slade More articles by this author , Daniel HeidenbergDaniel Heidenberg More articles by this author , Mitchell HumphreysMitchell Humphreys More articles by this author , Karen SternKaren Stern More articles by this author , and Marcelino RiveraMarcelino Rivera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Large, bilateral stone burden can present a unique challenge for both the urologist and patient. When bilateral PCNL is warranted, surgical timing can lead to differences in stone free rate (SFR), complications, and costs. This study compares the cost-effectiveness of simultaneous versus staged PCNL. METHODS: A decision-analytic Markov model was used to assess the cost-effectiveness of simultaneous (bilateral PCNL during a single operative episode for the index procedure) and staged (unilateral PCNL for the index procedure followed by a separate procedure for a contralateral PCNL) PCNL for the management of large, bilateral stone burden. Model probabilities and outcomes for index procedures, including SFR, complications, operative time, and hospital length of stay (LOS), were drawn from a large-volume, single-center cohort. Outcomes for secondary procedures and utility values were obtained from the literature. Primary outcomes included costs from a Medicare standpoint with the addition of operative time and LOS costs, effectiveness (quality adjusted life years, QALYs), and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to evaluate the robustness of the model. RESULTS: At 1 year following the index procedure, costs (inclusive of index procedure, secondary procedures, and complications) per patient were $52,585 and $61,687 for simultaneous and staged PCNL, respectively. In addition to being less costly, simultaneous PCNL also resulted in slightly higher QALYs (.982) compared to staged PCNL (.977). On one-way sensitivity analyses (Figure), staged PCNL became cost-effective if the SFR increased from 56% to 88% (40% greater per renal unit relative to simultaneous PCNL) or the cost of unilateral PCNL decreased approximately 50% to $4,699 ($16,266 less than simultaneous PCNL). CONCLUSIONS: Even when assuming a modest reduction in SFR (62% vs. 44% per renal unit), longer index procedure OR time (177 vs. 116 minutes) and LOS (3.2 vs. 2.3 days) and slightly higher major (6.2% vs. 5.5%) and minor (27.2% vs. 21.3%) complication rates at index procedure, simultaneous bilateral PCNL was both less costly and more effective at 1 year follow up relative to staged bilateral PCNL. This offers further support of simultaneous bilateral PCNL in the proper clinical setting. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e538 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Wymer More articles by this author Ben Johnson More articles by this author Austen Slade More articles by this author Daniel Heidenberg More articles by this author Mitchell Humphreys More articles by this author Karen Stern More articles by this author Marcelino Rivera More articles by this author Expand All Advertisement PDF downloadLoading ...

A visual method of establishing preperitoneal space for totally visceral sac separation in ventral hernia repair

ObjectiveTo explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated. MethodsA retrospective style was adopted. The clinical data of 33 patients who accepted the total visceral sac separation (TVS) procedure from December 2019 to November 2021 were collected. Observation indices included location and area of abdominal defect; surgical method and duration of operation to establish preperitoneal space and any postoperative complications; developments during follow-up. Follow-up was performed up to December 2021 using outpatient examination and telephone interview to detect any complications of incision or recurrence of ventral hernia. ResultsFor operative indices, all patients underwent the TVS procedure successfully except for one who had to be converted to laparoscopic intraperitoneal onlay mesh (IPOM) due to failure to establish preperitoneal space. The time required to establish preperitoneal space was 185.75 ± 44.37 s and the duration of hospital stay was 8.27 ± 1.42 days. No complications, such as abdominal bleeding or digestive tract injury, occurred during hospitalization. No complications of incision were observed during follow up, which lasted 2–24 months with an average of 7 months. ConclusionsPreliminary results of the novel attempt to establish the preperitoneal space visually confirmed this to be a safe and feasible method. However, the sample size used here was small, with a short follow up. The details and notes need to be further discussed.

Multiple Compression Syndromes of the Same Upper Extremity: Prevalence, Risk Factors, and Treatment Outcomes of Concomitant Treatment

Multiple nerve compression syndromes can co-occur. Little is known about this coexistence, especially about risk factors and surgical outcomes. Therefore, this study aimed to describe the prevalence of multiple nerve compression syndromes in the same arm in a surgical cohort and determine risk factors. Additionally, the surgical outcomes of concomitant treatment were studied. The prevalence of surgically treated multiple nerve compression syndromes within one year was assessed using a review of patients' electronic records. Patient characteristics, comorbidities, and baseline scores of the Boston Carpal Tunnel Questionnaire were considered as risk factors. To determine the treatment outcomes of simultaneous treatment, patients who underwent concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) were selected. The treatment outcomes were Boston Carpal Tunnel Questionnaire scores at intake and at 3 and 6 months after the surgery, satisfaction 6 months after the surgery, and return to work within the first year. A total of 7,867 patients underwent at least one nerve decompression between 2011and 2021. Of these patients, 2.9% underwent multiple decompressions for the same upper extremity within one year. The risk factors for this were severe symptoms, younger age, and smoking. Furthermore, the treatment outcomes of concomitant CTR and CubTR did notdiffer from those of CubTR alone. The median time to return to work after concomitant treatment was 6 weeks. Patients who underwent CTR or CubTR alone returned to work after4 weeks. Approximately 3% of the patients who underwent surgical treatment for nerve compression syndrome underwent decompression for another nerve within 1 year. Patients who report severe symptoms at intake, are younger, or smoke are at a greater risk. Patients with carpal and cubital tunnel syndrome may benefit from simultaneous decompression. The time to return to work may be less than if they underwent decompressions in separate procedures, whereas their surgical outcomes are comparable with those of CubTR alone. Therapeutic IV.

일본의 공유수면 경계 확정과 분쟁 해결 방안에 관한 연구

The article 9-3 of ｢Local Autonomy Act｣ was introduced in japan to prevent disputes by determining a boundary of public water in advance before reclamation. It can be seen that public water is included in jurisdictions under the ｢Local Autonomy Act｣and the reason why the decision of prefectural governor to determine on the boundary of public waters was stipulated is emphasize the local autonomy. Furthermore, separate procedure called consent was introduced to quickly set the boundary of public water. Although there aren’t stipulation about criteria for setting boundary of public water, it is based on equidistance principle in the process of judicial judgment. However, in light of all circumstances such as past history or jurisdiction of each local government, equidistance principle has been modified and applied. Administrative and judicial system, meanwhile, are proposed to resolve disputes caused when determining the boundaries of the public water. Among these, administrative systems are made up of mediation and determination of prefectural governor. There are two types of judicial systems: a lawsuit against the determination of prefectural governor, and a lawsuit to determine the boundaries filed by the relevant local government in the absence of mediation and administrative action. There are various views on the nature of these lawsuits, but it is appropriate to understand the former as an appeal suit, and the latter as a party suit.

Human Uterine Lavage: First Live Births from In Vivo Conceived Genetically Screened Blastocysts.

We wish to report the first live births from genetically screened human euploid blastocysts obtained by uterine lavage. The embryos transferred to infertile women were previously obtained using a novel fully automated uterine lavage catheter and fluid recovery device developed for this indication. The objective of this portion of the research was to confirm embryo implantation and live births with these unique in vivo conceived blastocysts obtained by uterine lavage. In vivo conceived embryos recovered by uterine lavage 5days after intrauterine insemination were available for embryo donation. In vivo embryos were the result of prior controlled ovarian stimulation cycles in oocyte donors and intrauterine insemination with donor sperm. An observational case series of nine embryo transfer procedures was performed at an outpatient fertility center. One to two embryos were transferred to eight infertile women since one woman had two separate embryo transfer procedures. Nine embryo transfer procedures were performed with 14 blastocysts in eight women resulting in a blastocyst implantation rate of 36% (5/14) and live birth rate of 44% (4/9). Five infants have been born from the four delivered pregnancies with one set of twins. This is the first report of live births from genetically screened human euploid blastocysts obtained by uterine lavage. The nonsurgical uterine lavage office procedure represents the only current approach to obtain in vivo conceived embryos and can provide a benchmark for comparison to standard in vitro cultured blastocysts. Live births of in vivo conceived blastocysts represent the validation that the nonsurgical uterine lavage procedure allows simplified access to naturally conceived embryos without performing the surgical procedure of an oocyte aspiration. Owing to its simplicity, uterine lavage may be useful in screening embryos for preimplantation genetic testing for aneuploidy in fertile and infertile couples. ClinicalTrials.gov (Identifier NCT03426007).