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Background: Increased intrarenal pressure during endoscopic lithotripsy is associated with increased adverse outcomes. The objective of this study was to evaluate the effect of various devices on IRP during percutaneous intrarenal surgery in ex vivo porcine kidney models. Methods: Whole intact porcine urinary tracts were harvested. Intrarenal pressure was measured using cystometrometry software. Intrarenal pressure during PCNL was recorded using variations of percutaneous access sheath size, irrigation height of 100 cm and 60 cm, use of a ureteric catheter and use of suction. The primary outcome was absolute IRP measurements. Secondary outcomes were comparisons of IRP between techniques. Results: Using a 30 Fr vs 26 Fr access sheath and 26 Fr nephroscope the mean pressure at an irrigation height of 60 cm was significantly lower than 100 cm (p = 0.0013 vs p

To objectively and subjectively assess the performance and surgical outcomes of the new Innovex EU-scope™ single-use digital flexible ureteroscope (fURS). A prospective cohort study was carried out (August 2019 to May 2020). The new single-use fURS (Innovex Medical Devices Co. Shanghai, China) was analysed with regard to visibility, manoeuvrability, laser interference and overall performance using a validated Likert scale. Outcomes are compared to the LithoVue™ (Boston Scientific, Marlborough, MA). One hundred patients were included in this study. 50 cases underwent retrograde fURS using the Innovex EU-scope™ and 50 with the LithoVue™. There were no differences in the patient demographics data, or operative data between the two groups. The Innovex EU-scope™ scored higher visibility scores compared to the LithoVue™, median 4, interquartile range (IQR) (4–4), vs. 3.5, IQR (3–5), p = 0.5086. Both scopes had similar manoeuvrability scores. The Innovex EU-scope™ scored significantly lower with regard to comfort compared to the LithoVue, median 4 IQR (3–4) vs. 4.5 IQR (4–5), p = 0.0445. Whereas, laser interference, affected the Innovex much less than the LithoVue™. Both scopes scored well for overall performance. The median overall performance score for the Innovex was 4 IQR (4–4) vs. 4 IQR (4–5). This Innovex EU-scope™ has good objective and subjective visibility and manoeuvrability profiles. This single-use flexible ureteroscope may achieve similar clinical outcomes to an established single use instrument.

This paper examines the role of trade credit in a comprehensive panel of 290,301 SMEs across 15 European countries over the period 2003-2012. The results show that trade credit served as an important source of finance for credit constrained firms, and that the financial position of firms entering the crisis was the main determinant of trade credit use over the financial crisis period. Evidence supporting a significant redistribution effect is reported with cash rich firms extending up to 9 times more net trade credit than their less financially resourced counterparts. Country factors, including banking concentration and the strength of institutional and creditor rights are reported as significant determinants of trade credit use. Distinctively, the paper shows that trade credit significantly reduced the likelihood of firm financial distress and failure. The results are robust to several econometric concerns, including endogeneity arising from possible omitted variables.

Thermal injuries represent a significant and common mechanism of accidental injury within the paediatric population. Thermal injuries over 10% TBSA are often associated with poorer cosmetic, and psychological outcomes. Prolonged hospital stay, admission to an intensive care unit, as well as complex multidisciplinary approached to patient care are often required. With a greater TBSA, usually comes a greater burden of care. Here we present data from the National Paediatric Burns Unit at Our Lady’s Children’s Hospital in Crumlin, on admissions to the unit with burns >20% TBSA. We look at their mechanism of Injury (scald vs. flame), TBSA as a%, and length of hospital stay, as well as long term outcomes where available.

Introduction Testicular torsion is an acute surgical emergency, with an approximate 6 hour window from onset of symptoms, to irreversible damage to the testicle.1 Trauma associated testicular torsion is a well recognised complication of blunt scrotal trauma, accounting for 4–8% of all torsions.2,3 Delays in recognition of the condition, and subsequent delayed surgical exploration, may necessitate orchidectomy, and risks impairment of future fertility.4Patient factors associated with delay in presentation include embarrassment around pain in the genitals, and lack of awareness of the condition.5 Case description A 14 year old Irish boy, with a previous history of bilateral retractile testes, presented to the Emergency department with a three day history of severe left sided scrotal pain and swelling following a traumatic injury to the perineum. The patient was cycling off-road three days prior to presentation, and suffered a cross-bar related injury to the scrotum and perineum. He felt immediate left testicular pain, however believed this to be related to bruising of his testicle. The pain progressively worsened over the following three days, and presented to hospital once the pain had become unbearable. Examination demonstrated a tender, erythematous, and swollen left hemiscrotom with an absent cremasteric reflex on the left side. The right testicle was retractile, but present within the right hemiscrotom, with a positive cremasteric reflex. US of the scrotom demonstrated an enlarged, oedematous left testicle, with absent internal vasculature, and a normal appearing right testicle. At operation, the left testicle was found to be necrotic and non-viable, and so we proceeded with a left orchidectomy. After discussion with his parents, we decided to proceed with a right sided orchidopexy with three-point fixation of his remaining testicle. The patient was discharged home later that day on a course of oral antibiotics. Discussion Time is of utmost importance in cases of testicular torsion, with early presentation, and early surgical exploration the most important factors in testicular salvage.3 It is easy to attribute post-traumatic testicular pain and swelling to the initial insult, however, a high index of suspicion is required to out-rule trauma associated testicular torsion. Early education around testicular health, an understanding that scrotal pain requires swift medical evaluation, and that delays in evaluation may impair future fertility, are important messages to convey to paediatric populations, and should be included in sexual health education for males.

This article uses panel data to test the extent to which trade credit acted as a substitute for bank finance in Small and Medium-sized Enterprises (SMEs), in the aftermath of the financial crisis of 2008. It demonstrates that the reduction in the supply of funds to SMEs was compounded by the contraction of net trade credit within the sector. Nevertheless, trade credit played a vital role in the adjustment of the sector by easing the burden of the financial crisis for some SMEs. Thus, the relative importance of trade credit increased for financially “vulnerable” SMEs that were less liquid, highly dependent on short-term bank finance, and with greater levels of intangible assets, when entering the crisis. In terms of a redistribution effect, financially stronger firms extended relatively more trade credit, to financially vulnerable SMEs in the aftermath of the financial crisis. In addition, the analysis demonstrates that the financial position of SMEs entering the crisis was more important in determining the impact of the financial crisis on trade credit use than company characteristics of age and size. JEL Classification: L26, L14, G20, B41, C33