Flexible Scope Research Articles

Chest Tube Placement of Secondary Tracheoesophageal Voice Prosthesis: Overcoming Challenging Anatomy in the Laryngectomy Patient.

Introduction: Total laryngectomy is used to cure advanced larynx cancer in many patients. The removal of the larynx requires the rehabilitation of the patient's ability to communicate, and one common method is to place a tracheoesophageal voice prosthesis (TEP) as a secondary procedure after the patient has completed cancer treatment. The traditional technique utilizes a rigid esophagoscope for access, but this can prove difficult in many patients who have kyphosis, scarring of the neck, or trismus. We describe a technique to allow TEP placement in these challenging patients that does not utilize rigid esophagoscopy to access the tracheoesophageal puncture site. Methods: For more than 15 years, the senior authors of this study have used this technique in patients in whom traditional methods of TEP with rigid esophagoscope were unsuccessful or not attempted due to the anticipated high probability of failure. The ease of this technique has prompted its use for all patients undergoing secondary TEP placement in their practice. The technique is described in detail in the Methods section below. Results: The described method has been successfully utilized to place TEPs in many patients with challenging anatomy. There have been no failed placements, including a patient with severe trismus who was able to have a TEP placed by placing the chest tube and flexible endoscope transnasally. Further, because of precise visualization and ease of the technique, there have been no observed complications of injury to the pharyngoesophageal lumen or creation of a false passage. Conclusion: The use of a chest tube and flexible scope allows for the protection of the pharyngoesophageal lumen, precise visualization and placement of the puncture, and avoidance of a false tracheoesophageal passage, all while minimizing the need for extension of the patient's neck. This has proven ideal for patients suffering the consequences of cancer treatment such as cervical scarring, fibrosis, kyphosis, and trismus.

Comparison of Clinical Performance of I-gel and Fastrach Laryngeal Mask Airway as an Intubating Device in Adults: A Systematic Review and Meta-Analysis.

The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. PubMed, EMBASE, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing I-gel and Fastrach SGD in adult patients undergoing intubation. The primary outcome was the first-pass success rate for tracheal intubation. Secondary outcomes were tracheal intubation time, SGD insertion time and success, and complications. We computed risk ratios (RRs) to assess binary end points and weighted mean differences (WMDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs) for the primary outcome and its subgroup analysis (P < .05 was considered statistically significant) and 99% CI after Bonferroni correction for the secondary outcomes (P < .01 was considered statistically significant). This study included a total of 14 RCTs encompassing 1340 patients. The results indicated a significant difference in the first-pass success rate favoring Fastrach (RR, 0.81; 95% CI, 0.67-0.98; P = .03; I² = 91%). In the subgroup analysis, when a flexible scope was utilized through I-gel, providers achieved a better tracheal intubation first-pass success rate (RR, 1.05; 95% CI, 1.01-1.11; P = .03; I² = 0%), compared with the Fastrach. Overall intubation success rates (RR, 0.92; 99% CI, 0.82-1.04; P = .08, I² = 92%) and time (WMD - 1.03 seconds; 99% CI, -4.75 to 2.69; P = .48; I² = 84%) showed no significant difference irrespective of the device used. There was no significant difference regarding device insertion time by the providers (WMD -6.48 seconds; 99% CI, -13.23 to 0.27; P = .01; I2 = 98%). Success rates of the providers' initial SGD insertion and complications such as sore throat (RR, 1.01; 99% CI, 0.65-1.57; P = .95, I² = 33%) and blood presence post-SGD removal (RR, 0.89; 99% CI, 0.42-1.86; P = .68, I² = 0%) showed no significant difference. Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used.

The single port robotic surgical "toolbox": a primer for beginners.

The aim of this study is to provide a comprehensive overview of the da Vinci Single Port robotic platform, including instruments and tools that can aid in implementing the use of this novel platform. Footage recorded during various Single port robotic urologic procedures and dry labs performed at two US institutions was used as video material. A step-by-step guide illustrating key points on OR set-up, platform, instruments, trocar configurations, intraoperative suctioning, bedside assistance were discussed and highlighted. The Single port surgeon console resembles the Xi console but includes upgraded software. The 6-mm biarticulated instruments incorporate an elbow and a wrist flexible joint. These instruments are deployed through the Access port. Access port kit includes the Access port, and a 25-mm multichannel trocar accommodating an 8-mm flexible scope, and three 6-mm robotic instruments. The 0° endoscope has two sets of articulation: a fixed one, and a distal one, allowing for three movements, selected with a hand command, the "Camera Adjust", the "Camera Control" and the "Relocation." The "Cobra mode," is an extra setting that allows the camera to wing out and move laterally relative to the working instruments. Suction is preferably performed with the Remotely Operated Suction Irrigation system. Herein we provide a detailed guide to the main technical nuances of the Single port platform and a practical overview of the instrumentation that is used during Single port robotic procedures. Knowledge of the toolbox that is used during Single port robotic surgery is key for those approaching for the first time this novel technology.

The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation.

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies obstructing airway access are at risk of airway management failure once they lose spontaneous respiration. Awake flexible scope intubation is considered the gold standard for controlling the airway in such patients. Following a feasibility trial involving 25 patients with challenging airways, this article presents a step-by-step protocol for awake nasotracheal intubation using a flexible video rhino-laryngoscope, which is significantly shorter than conventional intubating flexible scopes. The flexible video laryngoscope only exceeds the intubating tube length by a few centimeters, allowing the tube to closely follow the flexible scope during the procedure. Once the scope reaches the pharynx, it can be easily manipulated with one hand, enabling the operator to focus on the safe advancement of the scope-intubating tube assembly through the glottis. Based on previous results and experience gained, this article highlights the potential benefits of the technique: the opportunity for a minimally invasive "quick look" preoperatively to establish a final management plan, a more convenient and safer tool for navigating distorted anatomy with a lower chance of intubating tube impingement and airway injury, and a fast and smooth procedure resulting in improved patient satisfaction.

The Cerebral Aqueduct Compliance: A Simple Morphometric Model.

This work aimed to identify different configurations of the adytum of the cerebral aqueduct suggesting its safe neuroendoscopic navigation. This concept is intimately connected to the physiological aqueductal dilatability or compliance, which is relatively ignored in the literature. A better knowledge of the extent of physiological aqueductal dilatability might better define the ideal diameter and safer features of dedicated flexible endoscopes. The study includes 45 patients operated on using a flexible scope with a 3.9-mm diameter, where the structural elements of the adytum of the cerebral aqueduct are clearly visible. Patients were grouped according to the pathology (colloid cyst/normal anatomy, intraventricular hemorrhage, tetraventricular obstructive hydrocephalus, normal pressure hydrocephalus, and distal membranous aqueductal stenosis). A simple geometrical scheme was applied to the endoscopic anatomy of the aqueductal adytum in relation to the posterior commissure to measure its pathologic deformations. Eventual damages to the aqueduct walls caused by the endoscope were also reported. Proceeding from normal anatomy to hydrocephalic condition, the ratio between the commissure and the aqueductal access area progressively decreases, while the vertex angle increases. Interestingly, the entity of the ependymal damages due to the passage of the endoscope correlates with such measures. The cerebral aqueduct, excluding atrophic processes, is provided with a certain degree of dilatability, which we estimate to be around a diameter of 4 mm. This represents the maximum size for a flexible neuroendoscope for a safe aqueductal neuronavigation. The schematic model of the aqueductal adytum as a triangle defines 3 different aqueductal patterns and can be helpful when an intraoperative decision on whether to navigate the aqueduct must be taken.

National survey on the current status of airway management in China

Apparently, understanding airway management status may help to reduce risk and improve clinical practice. Given these facts, our team conducted a second survey on the current status of airway management for mainland China following our 2016 national airway survey. The national survey was conducted from November 7 to November 28, 2022. An electronic survey was sent to the New Youth Anesthesia Forum, where Chinese anesthesiologists completed the questionnaire via WeChat. A total of 3783 respondents completed the survey, with a response rate of 72.14%. So far, in 2022, 34.84% of anesthesiologists canceled or delayed surgery at least once due to difficult airway. For the anticipated difficult airway management, 66.11% of physicians would choose awake intubation under sedation and topical anesthesia, while the percentage seeking help has decreased compared to the 2016 survey. When encountering an emergency, 74.20% of respondents prefer to use the needle cricothyrotomy, albeit less than a quarter have actually performed it. Anesthesiologists with difficult airway training experience reached 72.96%, with a significant difference in participation between participants in Tier 3 hospitals and those in other levels of hospitals (P < 0.001). The videolaryngoscope, laryngeal mask, and flexible intubation scope were equipped at 97.18%, 95.96%, and 62.89%, respectively. Additionally, the percentage of brain damage or death caused by difficult airways was significantly decreased. The study may be the best reference for understanding the current status of airway management in China, revealing the current advancements and deficiencies. The future focus of airway management remains on training and education.

System Dynamics for Local Supply Chain Management: A Literature Review

Nowadays, logistics activities are growing annually by 4.4%, reaching annual valuations of up to 10 billion dollars. This area is key for manufacturing companies and commerce in general, which is why the central question arises in this area of knowledge about how to approach proposals or improvement actions in a sustainable way. On the other hand, technological tools such as simulation are an important element to evaluate sustainability alternatives and operational strategies due to their flexibility and high scope. This article addresses a systematic literature review about the use of system dynamics within the management of current supply chains, covering 144 articles in databases such as Scopus and ScienceDirect, for the period between 2000 and 2022 to generate an overview for new sustainability proposals in México.

The Impact of Scenario Planning in Managing Complexity Strategy: The Mediating Role of Strategic Flexibility: An Applied Study of the Opinions of a Sample of Managers of the General Company for Construction Contracting in Baghdad

The aim of this study was to examine the impact of scenario planning on managing complexity strategy and investigate whether strategic flexibility acts as a mediator between scenario planning and complexity strategy. The study was conducted on a sample of 75 employees from the General Company for Construction Contracting in Baghdad out of a study population of 400 employees. The data was collected through a questionnaire that was distributed to various department managers in the company. The study aimed to test several hypotheses and sub-hypotheses related to the relationship between the study variables. The study results indicate that there is a positive relationship between scenario planning and complexity strategy, although it is only partial. The study also found that strategic flexibility partially mediates the relationship between scenario planning and complexity strategy. Therefore, scenario planning can enhance complexity strategy, but strategic flexibility plays a crucial role in mediating this relationship. The study recommends that cognitive skills of the scenario drafting team should be developed, particularly in the areas of induction and deduction, to facilitate the identification of pre-determined factors and the formulation of flexible assumptions for scenarios. Additionally, the study suggests expanding the scope of competitive flexibility and productivity in the face of intense betting, globalization and openness, as well as achieving a competitive position aligned with the company's objectives based on the structure of complexity theory.

Flexible Fiber-Optic Scope Use in Retrieval Medicine: A Case Series

ObjectiveThe use of flexible fiber-optic scopes is increasing across critical care specialities, but there is limited literature on their use in retrieval medicine. This study aims to describe a case series in which flexible fiber-optic scopes were used by New South Wales Ambulance Aeromedical Operations critical care teams. MethodsA retrospective case series was performed in our service from January 1, 2019, to December 31, 2021. We searched our electronic medical retrieval database for the terms “aScope,” “Awake Fibreoptic Intubation (AFOI),” “Fibreoptic Intubation (FOI),” and “Nasal Endotracheal Tube (ETT)” to identify when a flexible fiber-optic scope was used. ResultsThere were 16 uses of flexible fiber-optic scopes during the study period. The most common procedure was awake nasal fiber-optic intubation, which was performed during 9 cases, 7 of which were successful. Other procedures performed included 4 cases of intubation through a supraglottic airway, 1 case of an asleep fiber-optic intubation, 1 case of flexible nasoendoscopy for upper airway assessment, and 1 case of fiber-optic bronchoscopy via tracheostomy. These procedures were performed by anesthetic, emergency and intensive care doctors. This case series describes 4 of these cases in more detail. ConclusionThis case series demonstrates a variety of procedural and diagnostic uses for flexible fiber-optic scopes in retrieval medicine. These procedures can have an important bearing on decision making and patient management. The training and clinical governance provided by our service in this skill appears to be safe and robust with high success rates of awake fiber-optic intubations.

Cash holding by consumers: The role of the perceived characteristics of money

AbstractThis study examined why consumers who typically pay electronically at points of sale still carry cash and explained the inertia of demand for cash by considering the additional (perceived by consumers) characteristics of cash. The research was motivated by the growing discussion on why cash, despite the increasing importance of e‐payments, remains a significant part of the demand for money. The study focused on psychological factors and consumers' perceptions of certain features of cash, which make it an attractive additional option for precautionary reasons, and therefore, explored beyond the typical discussion of money as a means of payment. The structural equation modeling based on data collected as part of a survey of Polish consumers was used to verify the hypotheses. It was revealed that cash becomes a reserve solution for consumers, which is kept “just in case” to expand the scope of personal freedom and flexibility in making payments and protect against various potential restrictions and threats related to e‐payments. Consumers' holding of cash as an additional option depends on three key factors: attitude toward cash, particularly the flexibility it offers, unusual purchasing situations, and perceived card or mobile payment risk, considered as a moderator. In the debate on the future of cash, the study supports the position that cash has a place in the modern payment system, although it plays a different role. Cash is a supportive backup solution. Eliminating cash significantly reduces consumer welfare.

The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit.

A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.

CRITICAL REVIEW OF ASSESSMENT APPROACHES OPERATIVE AT SCHOOL LEVEL- A JOURNEY FROM MINIMUM LEVELS OF LEARNING TO LEARNING OUTCOMES

Assessment being an inextricable part of any learning process has gone through many ups and downs since independence in India. Transformations have seen from the introduction of Minimum Levels of Learning: to measure a list of competencies as an end product, to the introduction of theoretically sound Continuous and Comprehensive Evaluation (CCE)to guide the overall learning process of student. With time, many pitfalls and implementation failures have been observed in these approaches of assessment. Thus, the inception of learning outcomes approach after CCEs unexpected implementation failure opens a scope for critical discourse in the field of school education in India. The term learning outcomes reflects a conceptual tension and far less scope of flexibility as propounded by many educationists globally. Thus, the paper attempts to show the post-independence journey of assessment procedures at primary and elementarylevel in India and critically reflects upon the current learning outcomes approach from national and international perspective to predict its futurefeasibility and upshots.

Verification of the analytical performance of the serum magnesium assay on Abbott Architect ci8200

Magnesium is recognized as the fourth most important cation in the body and the second most abundant intracellular cation, following potassium. Its physiological significance lies in its capacity to form complexes with crucial intracellular anionic ligands, notably ATP, and its ability to compete with calcium for specific binding sites on proteins and cell membranes. Over 300 enzyme reactions rely on magnesium. The concentration of free magnesium within cells determines the magnesium content of these enzymes. Magnesium influences myocardial contraction and the electrical activity of myocardial cells, as well as the specialized conduction systems of the fetus, by modulating the transmembrane movements of ions like sodium, potassium, and calcium. Furthermore, magnesium can affect the contractility of vascular smooth muscle, and alterations in intracellular magnesium levels may impact cell proliferation or contraction. Magnesium is involved in nucleic acid and protein metabolism, intermediary metabolism, energy production, and consumption reactions, and it plays specific roles in various physiological systems such as the neuromuscular and cardiovascular systems. Our research aims to assess the analytical accuracy of the serum magnesium assay method utilizing an Abbott kit on the Architect ci8200 automated system in the biochemistry laboratory of Mohammed VI University Hospital of Oujda. The evaluation of the kit's analytical accuracy was conducted within the flexible scope A by conducting a performance analysis on the Architect ci8200. We examined repeatability, reproducibility, measurement imprecision, and compared results between two Architect ci8200 instruments. All findings align with the acceptability criteria recommended by the supplier and the Valtec protocol of the Société Française de Biologie Clinique (SFBC), indicating overall satisfactory outcomes for the study. The Architect ci8200 automated system demonstrated satisfactory analytical performance for reliably determining serum magnesium levels. Method verification in medical laboratories is essential to guarantee the accuracy, precision, and reliability of test results. Verification entails confirming that the test method used is suitable for its intended purpose, yields result consistent with the claimed performance characteristics, and meets the laboratory's quality control and quality assurance standards.

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath.

The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.

Exploring the implications of ‘no net land take’ policy for spatial planning: the case of the Netherlands

The European Union’s ‘no net land take’ (NNLT) target, which seeks to halt greenfield development by 2050, is very pertinent for planners. The present article investigates its potential impact with special attention for the Netherlands. Given that no single definition or methodology had been established at the EU level, land take was calculated over the 2000–2018 period for alternative definitions. A result is that qualitative approaches oriented to soil quality provide more scope for flexibility than quantitative approaches oriented towards land use. In addition, successful implementation of NNLT will depend on engaging with planners and planning practice.

Enhancing prime editor flexibility with coiled-coil heterodimers

BackgroundPrime editing enables precise base substitutions, insertions, and deletions at targeted sites without the involvement of double-strand DNA breaks or exogenous donor DNA templates. However, the large size of prime editors (PEs) hampers their delivery in vivo via adeno-associated virus (AAV) due to the viral packaging limit. Previously reported split PE versions provide a size reduction, but they require intricate engineering and potentially compromise editing efficiency.ResultsHerein, we present a simplified split PE named as CC-PE, created through non-covalent recruitment of reverse transcriptase to the Cas9 nickase via coiled-coil heterodimers, which are widely used in protein design due to their modularity and well-understood sequence-structure relationship. We demonstrate that the CC-PE maintains or even surpasses the efficiency of unsplit PE in installing intended edits, with no increase in the levels of undesired byproducts within tested loci amongst a variety of cell types (HEK293T, A549, HCT116, and U2OS). Furthermore, coiled-coil heterodimers are used to engineer SpCas9-NG-PE and SpRY-PE, two Cas9 variants with more flexible editing scope. Similarly, the resulting NG-CC-PE and SpRY-CC-PE also achieve equivalent or enhanced efficiency of precise editing compared to the intact PE. When the dual AAV vectors carrying CC-PE are delivered into mice to target the Pcsk9 gene in the liver, CC-PE enables highly efficient precise editing, resulting in a significant reduction of plasma low-density lipoprotein cholesterol and total cholesterol.ConclusionsOur innovative, modular system enhances flexibility, thus potentially facilitating the in vivo applicability of prime editing.

Financial system dynamics model for multidimensional flexibility in toll road PPPs: a life-cycle analysis

Although scholars have developed simulation models and analyzed bankability criteria in numerous papers to enhance the financial outcomes of Public-Private Partnerships (PPPs), the intersection between both fields considering alternatives to assess the financial impact of flexibility in both scope and financing, remains underdeveloped. To address this gap, this paper introduces a financial model that assesses the financial impact of suitable life-cycle flexibility alternatives while coexisting with revenue performance alterations in each project phase within toll road PPPs. This model serves as a tool to gain insight into the planning of strategic actions to implement flexibility in both scope and financing. Based on system dynamics and validated using financial data from two toll road PPPs in India and East Europe, simulation results suggest that two key drivers (capital expenditures and debt repayment period) have the greatest influence on financial performance. Findings support the implementation of flexible scopes to effectively address the most influential exogenous factor impacting the financial performance of PPPs, namely traffic shortfalls. This model provides a suitable tool for assessing the life-cycle economic sustainability of PPPs in uncertain and complex environments.

Abstract LB105: Sensitive urothelial cancer detection via high volume urine DNA analysis

Abstract Background: The detection of cancer-associated DNA in urine samples has significant potential in urothelial cancer (UC) detection and surveillance. Every year millions of patients with urinary symptoms undergo cystoscopy, an examination of the bladder using a flexible scope. Only 10% of these invasive examinations result in a cancer diagnosis. Cystoscopy is also used in post-operative surveillance, with many UC patients requiring life-long cystoscopies. Methods: We developed a high-volume urine DNA collection kit and laboratory platform and prospectively analyzed 433 urine samples collected from diagnostic and post-operative timepoints from 167 UC patients and 95 negative controls from January 2021 to September 2023. We used a hybridization capture assay targeting the coding regions of 21 commonly mutated genes in urothelial tumors, as well as 8 frequently copy number altered loci. Samples were sequenced using Illumina NovaSeq instruments. Mutations, copy number alterations, and chromosomal rearrangements were computationally identified. Key Findings: In the diagnostic settings our assay achieved a sensitivity of 100% for pT1+ bladder cancer, 97% for pTa bladder cancer, and 91% for upper tract urothelial cancer (UTUC) (100% for pT1+ or high grade) in an all-comers UC cohort, at a specificity of 93%. Post-operative urine DNA surveillance informed by preoperative urine mutations detected 28/30 (93%) residual cancer cases found in cystoscopy or surgery, with two pTa low grade recurrences missed. Using a secondary, highly stringent urine tumor DNA detection threshold (100% specificity for UC), we show that urine DNA testing in the diagnostic setting may allow up to 68% of UC patients to be scheduled directly to operating room procedures, reducing hospital workload and expediting care. In addition, we demonstrate the feasibility of urine DNA for detecting underlying Lynch syndrome in UC patients by identifying three UTUC patients who carried germline defects in mismatch repair genes MSH2 or MSH6, indicative of Lynch syndrome. In two of these patients our assay also found a somatic second hit and high mutation load. Conclusions and Clinical Implications: These results show promise in urine DNA based cancer diagnostics even in patients with low grade tumors. The assay is designed to offer a non-invasive and cost-effective alternative for cystoscopies. Citation Format: Jussi Nikkola, Lauri Ryyppö, Juuso Vuorinen, Heini Kallio, Hanna Selin, Pyry Jämsä, Jonne Åkerla, Tarmo Pekkarinen, Antti Kaipia, Matti Nykter, Thea Veitonmäki, Matti Annala. Sensitive urothelial cancer detection via high volume urine DNA analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB105.

A class of computational methods to reduce selection bias when designing Phase 3 clinical trials.

When designing confirmatory Phase 3 studies, one usually evaluates one or more efficacious and safe treatment option(s) based on data from previous studies. However, several retrospective research articles reported the phenomenon of "diminished treatment effect in Phase 3" based on many case studies. Even under basic assumptions, it was shown that the commonly used estimator could substantially overestimate the efficacy of selected group(s). As alternatives, we propose a class of computational methods to reduce estimation bias and mean squared error with a broader scope of multiple treatment groups and flexibility to accommodate summary results by group as input. Based on simulation studies and a real data example, we provide practical implementation guidance for this class of methods under different scenarios. For more complicated problems, our framework can serve as a starting point with additional layers built in. Proposed methods can also be widely applied to other selection problems.

Renal caliculi: Types, mechanism, therapeutic approaches encompassing role of GAGS, MGP, Hormones, UPTF1, CAI, Osteopontin

Kidney stones are deposits in the renal pelvis, calyces, and ureters and reside in urine. Kidney stones undergo biomineralization pathogenesis via nucleation, aggregation, and growth of caliculi. The greater prevalence of kidney stones in men than in women may be due to the link between sex hormones. Kidney equilibrium is maintained with glycosaminoglycans inhibiting growth and aggregation. Sialylated glycoforms of urinary prothrombin fragment 1 prevent calcium stone development. Crystal adherence to tubules is inhibited by CAI, and osteopontin inhibits calculi formation. Medical treatments involve the use of alpha blocker, potassium citrate, thiazide, NSAIDS, opioids, antiemetics and other drugs used in treatment of kidney stone, Alpha adrenoceptor blockers, calcium channel blockers and corticosteroids help to expel renal stones, chemolytic treatment and it could be necessary to remove stones surgically if they are affecting kidney function with the use of techniques. Use of catheter, ultrasound, using a flexible scope equipped with a laser, HDAC inhibitors and many are recent advances in treatment lithiasis.