Stand-alone Cases Research Articles

Cryopreservation of testicular tissue in pre-pubertal and adolescent boys at risk for infertility: A low risk procedure

Cryopreservation of testicular tissue (TT) has become an increasingly attractive option for fertility preservation (FP), particularly for pre-pubertal boys at risk for gonadotoxicity from cancer therapy. At our institution, all at-risk families undergo counseling regarding infertility risk and available FP strategies, including this vulnerable patient population. As the technology required to use the acquired tissue is, as yet, unproven, it is paramount to document minimal morbidity and complications from this procedure. Herein, we report these outcomes for all pre-pubertal patients who have undergone TT biopsies for FP. We retrospectively reviewed consecutive patients who underwent unilateral open TT biopsies between January 2014 and December 2016. Patient diagnosis, age, concomitant procedures, anesthetic type, complications, procedure times, planned therapy, and bleeding were evaluated. Of a total of 34 patients, mean age at biopsy was 6.9±4.4years. Diagnoses included: leukemia/lymphoma (n=12), solid tumors (n=15) and non-neoplastic disorders (hemophagocytic lymphohistiocytosis, aplastic anemia; n=7). Twenty-two patients (64.7%) were scheduled for stem cell transplantation. Eleven (32.4%) patients had not received any chemotherapy prior to TT biopsy, while all others had exposure preceding the biopsy. Biopsies were performed in conjunction with other procedures (central line placement, bone marrow biopsy, lumbar puncture, lymph node biopsy) in 29 cases (85.3%), with stand-alone procedures performed in the remainder (n=5). In stand-alone cases, mean anesthetic time was 22±8.7min. Overall, two (5.9%) patients had complications after biopsy: 1) ipsilateral epididymo-orchitis (resolved with antibiotics) and 2) ipsilateral torsedappendix testis (managed conservatively) (Table). In this series, pre-pubertal TT biopsy for cryopreservation was safely performed, and was most often coordinated concomitantly with other medically necessary procedures. The safety profile reported herein supports performing this procedure while technological advances fulfill the requirements to make it a viable option for future fertility.

Compensation of Damages in Standalone Cases: Lessons to Be Learned from a Case Against a State-owned Telecommunication Company. Case Comment to the Judgment of the Lithuanian Court of Appeal of 3 March 2017 (Case No. e2A-27-464/2017)

Compensation of Damages in Standalone Cases: Lessons to Be Learned from a Case Against a State-owned Telecommunication Company. Case Comment to the Judgment of the Lithuanian Court of Appeal of 3 March 2017 (Case No. e2A-27-464/2017)

Scenario-based dynamic negotiation for the coordination of multi-enterprise supply chains under uncertainty

A novel scenario-based dynamic negotiation approach is proposed for the coordination of decentralized supply chains under uncertainty. The relations between the involved organizations (client, provider and third parties) and their respective conflicting objectives are captured through a non-zero-sum and non-symmetric roles SBDN negotiation. The client (leader) designs coordination agreements considering the uncertain reaction of the provider (follower) resulting from the uncertain nature of the third parties, which is modeled as a probability of acceptance function. Different negotiation scenarios are studied: (i) cooperative, and (ii) non-cooperative and (iii) standalone cases. The use of the resulting models is illustrated through a case study with different vendors around a “leader” (client) in a decentralized scenario. Although the usual cooperation hypothesis will allow higher overall profit expectations, using the proposed approach it is possible to identify non-cooperative scenarios with high individual profit expectations which are more likely to be accepted by all individual partners.

SARNET benchmark on Phébus FPT3 integral experiment on core degradation and fission product behaviour

The importance of computer simulations in the assessment of nuclear plant safety systems has increased dramatically during the last three decades. The systems of interest include existing or proposed systems that operate, for example, normal operation, in design basis accident conditions, and in severe accident scenario beyond the design basis. The role of computer simulations is especially critical if one is interested in the reliability, robustness, or safety of high consequence systems that cannot be physically tested in a fully representative environment. In the European 7th Framework SARNET project, European Commission (EC) co-funded from 2008 to 2013, the Phébus FPT3 experiment was chosen as a code benchmark exercise to assess the status of the various codes used for severe accident analyses in light water reactors.The aim of the benchmark was to assess the capability of computer codes to model in an integral way the physical processes taking place during a severe accident in a pressurised water reactor (PWR), starting from the initial stages of core degradation, fission product, actinide and structural material release, their transport through the primary circuit up to the behaviour of the released fission products in the containment.The FPT3 benchmark was well supported, with participation from 16 organisations in 11 countries, using 8 different codes. The temperature history of the fuel bundle and the total hydrogen production were well captured. No code was able to reproduce accurately the final bundle state, using as bulk fuel relocation temperature, the temperature of the first significant material relocation observed during the experiment. The total volatile fission product release was well simulated, but the kinetics were generally overestimated. Concerning the modelling of semi-volatile, low-volatile and structural material release, the models need improvement, notably for Mo and Ru for which a substantial difference between bundle and fuel release was experimentally observed, due to retention in the cooler upper part of the bundle. The retention in the primary circuit was not well predicted, this was due mainly the non-prototypic formation of a boron-rich blockage in the rising line of the FPT3 steam generator, simulated in the circuit as a single external cooled U tube. The deposition mechanism and the volatility of some elements (Te, Cs, I) could be better predicted.Containment vessel thermal hydraulics, designed in the experiment to be well-mixed, were well calculated. Concerning the containment aerosol depletion rate, only stand-alone cases (in which the input data were derived from experimental data) provided acceptable results, whilst the integral cases (in which the input data came from circuit calculations) tended to largely overestimate the total aerosol airborne mass entering the containment.The disagreement of the calculated total aerosol airborne mass in the containment vessel with the measured one is due to the combination of a general underestimation of the overall circuit retention and overestimation of fission product and structural material release.Calculation of iodine chemistry in the containment turned out to be a major challenge. Its quality strongly depends on the correct prediction of chemistry speciation in the integral codes. The major difficulties are related to the presence of high fraction of iodine in gaseous form in the primary circuit during the test, which is not correctly reproduced by the codes. This inability of the codes compromised simulation of the observed iodine behaviour in the containment.In the benchmark a significant user effect was detected (different results being obtained by different users of the same code) which had to be taken into account in analysing the results. This article reports the benchmark results comparing the main parameters calculated and observed, summarising the results achieved, and identifying the areas in which understanding needs to be improved. Relevant experimental and theoretical work is under way to resolve the issues raised.

The Interaction of Public and Private Enforcement of Competition Law Before and After the EU Directive – a Hungarian Perspective

The paper explores the changes the EU Directive on harmonizing certain rules governing actions for damages under national law for infringements of the competition law provisions will bring about in Hungary, with a special focus placed on damages liability rules, the interaction of public and private enforcement of these rules, and the importance of class actions. Amendments of the Competition Act introduced in 2005 and 2009 had created new rules to promote the idea of private enforcement even before the Directive was adopted. Some of these rules remain unique even now, notably the legal presumption of a 10% price increase for cartel cases. However, subsequent cases decided by Hungarian courts did not reflect the sophistication of existing substantive and procedural rules. There has only ever been one judgment awarding damages, while most stand-alone cases involved minor competition law issues relating to contractual disputes. The paper looks at the most important substantial rules of tort law (damage, causality, joint and several liability), the co-operation of competition authorities and civil courts, as well as at (the lack of) class action procedures from the perspective of the interaction of public and private enforcement of competition law.

Adhering to the principles of surgical ablation.

The surgical treatment of atrial fibrillation (AF) has evolved since Dr James Cox introduced the maze procedure in 1987. The advent of innovative technologies for endocardial and epicardial ablation endeavouring to replicate Cox-maze III surgical lesions has ushered in a new era of innovative operations to address AF. The current report by Fengsrud et al. [1] elegantly demonstrates the technique of right monolateral thoracoscopic creation of an isolated pulmonary vein encircling box lesion using the Cobra Adhere XL radiofrequency device (Estech, Inc., San Ramon, CA, USA). In their preliminary experience with 10 stand-alone cases for AF of varying type and duration, they had no mortality, 1 re operation for bleeding and an average length of stay of 5.6 days. They performed guideline-directed Holter monitoring in 8 patients. Though 7 of 10 were free of AF at 12 months, only 4 were free from antiarrhythmic medications. The development of this technique started nearly a decade ago with the introduction of microwave epicardial ablation [2], demonstrating excellent safety and short-term efficacy. However, late results revealed that these outcomes were not effective in sustaining curative intent [3]. The result was the abandonment of the ablation technology but not the approach. Several others have replicated and modified the epicardial thoracoscopic procedure by making this a monolateral right-sided procedure. Initial experience with the epicardial Cobra Adhere XL vacuum-assisted radiofrequency ablation (Estech, Inc.) revealed good outcomes [4]. Applying rigorous monitoring, this technique demonstrated respectable freedom from paroxysmal AF and helped establish a hybrid approach to ablation that includes a secondary percutaneous endocardial mapping and ablation with an electrophysiology partnership [5–7]. The challenge with right mono-lateral approaches is the inability to surgically address the left atrial appendage (LAA). Though the necessity of LAA exclusion or excision is debated by authors of the current report [1], many surgeons and cardiologists continue to feel that addressing the LAA is a fundamental principle in the surgical approach to AF [8]. As we innovate with different ablative technologies, can we adhere to the principles of surgical ablation? Though definitions may evolve over time, these include a low morbidity procedure that durably restores sinus rhythm documented by Holter or continuous monitoring over 1 year, one that enables freedom from antiarrhythmic medications and one that mitigates the occurrence of stroke and improves quality of life. This latter point often relates to patients safely stopping anticoagulation. This is often not possible for several months or longer when the LAA remains intact post-ablation. Non-sternotomy approaches to treat AF include monoor bilateral thoracosopic or mini-thoracotomy, on-pump endocardial or off-pump epicardial surgical ablation. Each approach has demonstrated clinical effectiveness in several excellent centres worldwide [7]. However, a recent comparison between mini-right thoracotomy open Cox-maze, epicardial ablation and epicardial hybrid ablation with percutaneous treatment revealed that operations most closely following the full Cox-maze procedure may afford the best long-term results [9]. Regardless of the surgical approach or institutional expertise, when innovating with surgical ablation, being dedicated to the rigours of monitoring, follow-up, drug-free morbidity reduction and complete ablation, should be among the principles we adhere to for our patients and our specialty.

Delivering Competition Damages in the UK

This paper examines the system for delivering compensation for breach of competition law that would apply to claims if the proposals contained in 2012 consultation by the U.K. government came into effect. It examines how the system would operate in practice, and how an individual or collective claim would be dealt with. The position involves incorporating various innovative techniques from the three pillars of public enforcement, and private enforcement and ADR, each of which individually constitutes a significant reform, into a sophisticated pre-existing system. The result is complex and untested, not least because the details of every one of the major individual techniques are yet to be defined. The paper examines crucial influence that the incentives and powers (carrots, nudges and sticks) that would apply in each situation would have on how a claim is processed, or which impede it. It finds that the ADR and regulatory techniques can offer transformative solutions in delivering compensation. Whilst a private class action could operate in follow-on mass cases, it would be unnecessarily slow and costly compared with intelligent use of the ADR and regulatory alternatives. Significant concerns are identified over whether a class action would be effective in stand-alone or mass consumer cases. Accordingly, it suggests that policymakers should re-examine priorities as between private enforcement and other options.

Synergies from combined pulp&paper and fuel production

In this paper, the prospect of integrating a combined paper&pulp mill with fuel production via biomass gasification was investigated. In the study, three different types of gasifiers (circulating fluidised bed, entrained flow and indirect gasification) and three fuel processes (dimethyl ether, methanol and Fischer-Tropsch wax synthesis) were investigated using computer simulations. The paper reports differences from the stand-alone cases and the integrated cases, using the electricity equivalence efficiency as a measure. Only 6 out of the 18 integrated cases studied displayed a positive result from integration and no obvious fuel selection that stand out as the most beneficial one, however the synthesis of dimethyl ether is, in combination with all gasifiers assessed a rather good choice, with an change in efficiency from integration ranging from −1% to 4%. Dimethyl ether is not the best choice if the electrical equivalence is to be maximised however. In this case the combination of circulating fluidised bed gasification and methanol synthesis should be pursued. The production of Fischer-Tropsch wax should according to the chosen measure not be produced; however there is an added value in the production of a non-oxygenated fuel which has not been taken into account in this particular study. All cases leads to a reduction of 0.4–0.9 kg CO 2 per kg of dry biomass used in the process for fuel synthesis and the possibility to export bark is a more significant factor in this respect than which type of fuel is synthesised. ► A system integration with three gasifier types used for synthesising three different synthetic fuels. ► Energy efficiencies and electrical equivalence efficiencies reported. ► Results differ and the benefit of integration is not given, only some of the investigated cases show synergies on integration.

Using an optimization model to evaluate the economic benefits of industrial symbiosis in the forest industry

In this work, a model comprising a pulp mill, a sawmill, a district heating network and a biofuel upgrading plant is used to demonstrate how the MIND method, an optimization method based on mixed integer linear programming, can be used to evaluate industrial symbiosis in the forest industry. Using this method, both energy and material flows on both the supply and the demand side can be studied simultaneously. The method can be used to find improvements in the structure of the modelled system, to find the optimal operational strategy of a given system, and to evaluate and compare different systems. The total system costs for stand-alone cases and integrated industrial symbiosis system configuration are compared, generating results that can be used as decision support when planning industrial symbiosis initiatives in the forest industry. The results of this study showed that there are financial benefits to industrial symbiosis compared to the same system operated in stand-alone mode, and that the industrial symbiosis configuration generates a more stable system. However, it is difficult to generalize the results from a case study, and the main conclusion drawn is that it is possible to show that industrial symbiosis has economical benefits, although the magnitude of these benefits needs to be evaluated from case to case.

A Straight-Line Extractable Non-malleable Commitment Scheme

Non-malleability is an important security property of commitment schemes. The property means security against the man-in-the-middle attack, and it is defined and proved in the simulation paradigm using the corresponding simulator. Many known non-malleable commitment schemes have the common drawback that their corresponding simulators do not work in a straight-line manner, requires rewinding of the adversary. Due to this fact, such schemes are proved non-malleable only in the stand-alone cases. In the multiple-instances setting, i.e., when the scheme is performed concurrently with many instances of itself, such schemes cannot be proved non-malleable. The paper shows an efficient commitment scheme proven to be non-malleable even in the multiple-instances setting, based on the KEA1 and DDH assumptions. Our scheme has a simulator that works in a straight-line manner by using the KEA1-extractor instead of the rewinding strategy.