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Purpose: To evaluate and compare the clinical results of different single-use flexible ureteroscopes (su-fURS) used in retrograde intrarenal surgery (RIRS). Materials and methods: RIRS cases performed identically by an experienced surgeon between 2022 and 2023 in a single center were retrospectively analyzed. These surgeries were performed with three su-fURS (Redpine RP-U-C12, Hugemed HU30, and Pusen Uscope 3022 A). In the study, the age, gender, body mass index, and Charlson comorbidity index of the patients were compared, along with their clinical details, such as the stone size, volume, density, location, and history of hydronephrosis or a double J stent or SWL. Operation time, stone-free rates (SFR), perioperative and postoperative complications, and hospitalization times were also compared. Results: The study included 208 patients. Pusen had 63 cases, Hugemed had 62, and Redpine had 83. The comparison of the patient's demographic and clinical properties with stone-related variables was similar between the groups. The SFR was similar between the groups (p = 0.056). Perioperative, postoperative, and total complication rates and the need for a second intervention showed no significant differences among the three groups (p = 0.324, 0.088, 0.061, and 0.052, respectively). Conclusion: In the first study comparing the clinical results of cases in which different su-fURS were used, no difference was observed in surgical outcomes and complications, even though the technical features of these devices were different. Urologists should select su-fURS based on clinical requirements, financial constraints, and personal experiences. [ABSTRACT FROM AUTHOR]

The standard treatment procedures for managing renal calculi in the pediatric population are similar to those in adults. The application of flexible ureteroscopy has contributed to the increased popularity of retrograde intrarenal surgery (RIRS) as an alternative therapeutic modality that can be successfully applied in children. One of the most significant innovations of the last decade is the introduction of single-use flexible ureteroscopes (fURSs). In this case report, we present the case of a 2-year-old boy with multiple large calculi in his right kidney, which were successfully removed after a single session of RIRS using a 7.5 F single-use fURS and high-power laser settings. The total operative and lithotripsy times were estimated at 90 and 75 min, respectively. No complications were recorded. The hemoglobin loss was calculated at 0.3 mg/dL, while the creatinine level was decreased by 0.1 mg/dL. The urethral catheter was removed on the first postoperative day, and the patient was discharged. The management of multiple or large kidney stones is very challenging in the pediatric population under the age of three years. Convenient preoperative planning and the appropriate use of available equipment may lead to excellent outcomes accompanied by a reduced risk for complications. [ABSTRACT FROM AUTHOR]

The standard treatment procedures for managing renal calculi in the pediatric population are similar to those in adults. The application of flexible ureteroscopy has contributed to the increased popularity of retrograde intrarenal surgery (RIRS) as an alternative therapeutic modality that can be successfully applied in children. One of the most significant innovations of the last decade is the introduction of single-use flexible ureteroscopes (fURSs). In this case report, we present the case of a 2-year-old boy with multiple large calculi in his right kidney, which were successfully removed after a single session of RIRS using a 7.5 F single-use fURS and high-power laser settings. The total operative and lithotripsy times were estimated at 90 and 75 min, respectively. No complications were recorded. The hemoglobin loss was calculated at 0.3 mg/dL, while the creatinine level was decreased by 0.1 mg/dL. The urethral catheter was removed on the first postoperative day, and the patient was discharged. The management of multiple or large kidney stones is very challenging in the pediatric population under the age of three years. Convenient preoperative planning and the appropriate use of available equipment may lead to excellent outcomes accompanied by a reduced risk for complications.

Advances in manufacturing technology coupled with the increased potency of new biotherapeutic modalities have created an external environment where continuous manufacturing (CM) can address a growing need. Amgen has successfully implemented a hybrid CM process for a commercial lifecycle program. In this process, the bioreactor, harvest, capture column, and viral inactivation/depth filtration unit operations were integrated together in an automated, continuous module, while the remaining downstream unit operations took place in stand‐alone batch mode. CM operations are particularly suited for so‐called "high mix, low volume" manufacturing plants, where a variety of molecules are manufactured in relatively low volumes. The selected molecule fit this mold and was manufactured in a low‐capital micro‐footprint suite attached to an existing therapeutic production facility. Use of a hybrid process within an already operating facility required less capital and minimized complexity. To enable this hybrid CM process, an established fed‐batch process was converted to a perfusion process with continuous harvest. Development efforts included both process changes and the generation of a novel cell line adapted to long‐term perfusion. Chromatography resins were updated, and purification processes adapted to handle variable inputs due to the fluctuations in harvest titer from the lengthy production process. A novel automated single‐use (SU) viral inactivation (VI) skid was introduced, which entailed the development of a robust pH verification and alarm system, along with procedures for product isolation to allow discard of specific cycles. The CM process demonstrated consistent performance, meaning it met predefined performance criteria (including product quality attributes, or PQAs) when operated within established process parameters and manufactured according to applicable procedures. Using a 75% reduction in scale, it resulted in a five‐fold reduction in process media and buffer usage, a fifteen‐fold increase in mass per thaw, and an overall process productivity increase of 45‐fold (as measured by grams drug substance per liter per day.) The hybrid CM process also enabled increased material demand to be met with no change in cost of goods manufactured or plant capacity, due to the repurposing of existing facility space and the flexible duration of the hybrid CM harvest. Overall, the success of the hybrid CM platform represents an exciting opportunity to reduce costs and increase process efficiency in industry. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Patient or Public Contribution To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single‐use healthcare materials.A cross‐sectional multi‐centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials.A hospital survey was conducted to collect the procurement data for single‐use medical materials. Based on consumption and cost, five single‐use medical materials with sustainable alternatives were selected using different reuse strategies. Single‐use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency.A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single‐use options. First, an inventory of single‐use medical materials consumed was collected. Next, single‐use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single‐use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material.This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide.Patient care involves a large consumption of single‐use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single‐use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single‐use medical materials, thereby yielding positive outcomes for the entire population.No patient or public contribution. [ABSTRACT FROM AUTHOR]

BackgroundSingle use flexible ureteroscopes (su-fURS) have emerged as an alternative to reusable flexible ureteroscopes (r-fURS) for the management of upper urinary tract calculi. However, little is known about urologist usage and attitudes about this technology. Through a worldwide survey of endourologists, we assessed practice patterns and preferences for su-fURS.MethodsAn online questionnaire was sent to Endourology Society members in January 2021. The survey explored current su-fURS practice patterns, reasons for/against adoption, and preferences for next generation models including developments in imaging, intra-renal pressure, heat generation, and suction. Responses were collected through QualtricsXM over a 1-month period from surgeons in North America, Latin America, Europe, Asia, Africa, and Oceania. The study was conducted according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).Results208 (13.9%) members responded to the survey. Most respondents (53.8%) performed >100 ureteroscopies per year. 77.9% of all respondents used su-fURS for less than half of all procedures while only 2.4% used su-fURS for every procedure. 26.0% had never used a su-fURS. Overall, usage was not influenced by a surgeon's geographic region, practice environment, or years of experience. Top reasons for not adopting su-fURS were cost (59.1%) and environmental impact (12.5%). The most desired improvements in design were smaller outer shaft size (19.4%), improved optics and vision (15.9%), and wireless connectivity (13.6%). For next generation concepts, the functions most commonly described as essential or important by respondents was the ability to suction fragments (94.3%) while the function most commonly noted as not important or unnecessary was incorporation of a temperature sensor (40.4%).Conclusionssu-fURS are not commonly used, even among urologists who perform a high number of fURS. The primary concern for adoption is cost and environmental impact. Suction capability was considered the most important future development.

A thermally driven, micrometer-scale switch technology has been created that utilizes the ErH3/Er2O3 materials system. The technology is comprised of novel thin film switches, interconnects, on-board micro-scale heaters for passive thermal environment sensing, and on-board micro-scale heaters for individualized switch actuation. Switches undergo a thermodynamically stable reduction/oxidation reaction leading to a multi-decade (>11 orders) change in resistance. The resistance contrast remains after cooling to room temperature, making them suitable as thermal fuses. An activation energy of 290 kJ/mol was calculated for the switch reaction, and a thermos-kinetic model was employed to determine switch times of 120 ms at 560 °C with the potential to scale to 1 ms at 680 °C.

Single‐use bioreactors (SUBs, or disposable bioreactors) are extensively used for the clinical and commercial production of biologics. Despite widespread application, minimal results have been reported utilizing the turndown ratio; an operation mode where the working range of the bioreactor can be expanded to include low fluid volumes. In this work, a systematic investigation into free surface mass transfer and cell growth in high turndown single‐use bioreactors is presented. This approach, which combines experimental mass transfer measurements with numerical simulation, deconvolutes the combined effects of headspace mixing and the free surface convective mass transfer on cell growth. Under optimized conditions, mass transfer across the interface alone may be sufficient to satisfy oxygen demands of the cell culture. Within the context of high turndown bioreactors, this finding provides a counterpoint to traditional sparge‐based bioreactor operational philosophy. Multiple monoclonal antibody‐producing cell lines grown using this high turndown approach showed similar viable cell densities to those cells expanded using a traditional cell bag rocker. Furthermore, cells taken directly from the turndown expansion and placed into production showed identical growth characteristics to traditionally expanded cultures. Taken together, these results suggest that the Xcellerex SUB can be run at a 5:1 working volume as a seed to itself, with no need for system modifications, potentially simplifying preculture operations. [ABSTRACT FROM AUTHOR]

Purpose: Removal of zirconia restorations can be challenging and time consuming, requiring dental burs with optimal cutting efficiency to minimize iatrogenic complications. Yet, there are very few burs marketed for this purpose and little evidence of their comparative benefit. This study evaluated one specialized bur and compared its cutting efficiency with three general‐purpose burs (one single use and two multiple uses). Materials and methods: This study was designed to assess the cutting efficiency of 4 burs on a high‐strength zirconia substrate. One of these burs is a multiple‐use bur marketed for high‐strength ceramics (Komet 4ZR), another is a single‐use general‐purpose bur (Piranha 837.012 coarse), and two are multiple‐use general‐purpose burs (Brassler 6837.31.012C coarse and Komet 6837.314.012 coarse). The cutting efficiency of each bur was determined by measuring the time taken to perform serial 2 mm cuts into a block of zirconia. Ten burs in each group were tested with repeated cuts until the time taken for a 2 mm cut was twice that of the first 2 mm cut (50% loss of efficiency). This study was performed under reproducible conditions using a custom‐designed and fabricated rig assembly. Results: The results demonstrated a statistically significant difference in the cutting efficiency between bur types. The single‐use general‐purpose bur (Piranha 837.012) was the most efficient for all cut numbers p <2.2 × 10–16. The performance of all burs decreased with each cut, with cutting efficiency dependent on time point/cut number (p = 0.02). The rate of deterioration varied between burs, but this difference was not sufficient to be statistically significant. Conclusions: This study demonstrated that a single‐use bur is more efficient than 3 multiple‐use burs. The cutting efficiency of a single‐use general‐purpose bur (Piranha 837.012 coarse) on Cerec Zirconia Mono L was statistically superior to that of multiple patient use burs in this study, including one marketed for use on high‐strength ceramics. Because single‐use burs are comparatively inexpensive and require no sterilization, they should be strongly considered for the removal of zirconia restorations. [ABSTRACT FROM AUTHOR]

Government agencies around the world regulate food contact materials or articles. Understanding these regulations and keeping up with the new regulations are essential for maintaining market access for food contact products. My intent is to provide global plastics food contact regulation developments and updates relevant to plastic film and sheet for food packaging. [ABSTRACT FROM AUTHOR]

Objectives: To compare the clinical performance and surgical outcomes of the new digital single use flexible ureteroscope (WiScope®) with a reusable digital flexible ureteroscope. Patient and methods: Our prospective study includes patients with renal stones less than 2 cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. Patients were randomized into two groups: group A included patients who underwent laser lithotripsy using WiScope® Single use digital flexible ureteroscope and group B included patients who underwent laser lithotripsy using reusable flexible ureteroscope. Image quality, deflection, ease of insertion, maneuverability, and overall performance were assessed using either a visual analog or Likert scale. Operative outcomes and complications were collected and analyzed in both groups. Results: A total of 242 patients were included in our study. There were 121 patients in the WiScope® group and 121 patients in reusable ureteroscope group. The WiScope® had higher maneuverability (9.3 ± 0.7 vs. 7.2 ± 0.8, P < 0.001) and less limb fatigue but had lower image quality when compared to reusable digital flexible ureteroscope (7.6 ± 0.9 vs. 9.2 ± 0.6, P < 0.001). There were no differences in operative time, complication rates and rates of relook ureteroscopy. Conclusions: The WiScope® single use flexible ureteroscope has comparable outcomes to the reusable flexible ureteroscope with regard to maneuverability, limb fatigue, and deflection. However, it has a lower image quality. [ABSTRACT FROM AUTHOR]

The composition and abundance of solid waste and the effect of COVID-19 measures were studied in an inland water ecosystem in Turkey. Solid waste items were collected annually for 5 years from 2017 to 2021 from seven stations located in Borçka Dam Lake (B1–B4) and Murgul Stream (M1–M3) in the Artvin Province. The highest densities by number and weight were recorded at M3 in 2020 (5.72 items/m2) and M1 in 2020 (0.39 kg/m2), respectively. However, no significant difference in density was recorded (p < 0.05) between the years. Plastic was the most abundant waste material by number of items in all the stations with a percentage contribution varying between 25.47 and 88.89%. There was a considerable increase in medical items during the COVID-19 pandemic in 2020–2021. Nonmetric multidimensional scaling (NMDS) and ANOSIM results revealed visually and statistically significant differences in solid waste composition between the years and stations. The dissimilarity between the years was driven by plastic and medical waste. The main sources of solid waste were river transportation (22.93%), improper disposal (20.74%), aquaculture activities (16.42%), and recreational and tourism activities (14.72%). The results of our study can be a baseline for transportation models, local administrations, and non-governmental organizations. Besides, the current waste management measures in Turkey are not effective in preventing waste accumulation in inland aquatic systems such as the Borçka Dam Lake and Murgul Stream. Furthermore, these findings indicate that the COVID-19 pandemic influenced solid waste composition and increased its abundance in the study area. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether the introduction of single use flexibles ureteroscopes (su-fURS) at our high-volume centre had an advantageous impact on the turn-over and breakage rates of reusable fURS (re-fURS). Methods: We analysed re-fURS number of usages and breakages at our centre between February 2015 and December 2018. We recorded the number of usages for analysed scope between the first usage until a breakage requiring reconditioning. Usage count was restarted following each reconditioning episode. Since su-fURS (Lithovue, Boston Scientific, USA) were introduced at our center in September 2016, we had the chance to compare different re-fURS life cycles according to both su-fURS availability and usage intensity (i.e., number of su-fURS used during each re-fURS life cycle). We then explored the relationship between su-fURS usage intensity and reusable scope survival (i.e., number of utilizations before any breakage requiring reconditioning) using locally weighted scatterplot smoothing (LOWESS) approach. Results: Five different re-fURSs were employed at our centre, for a total of 1820 usages and 40 breakages requiring reconditioning. The overall mean (SD) number of usages before breaking was 40 (22). After su-fURS introduction, mean (SD) re-fURS number of usages increased from 35 (22) to 49 (20), (+ 40%, p = 0.02). The relationship between su-fURS usage intensity and reusable scopes survival showed a linear survival increase after 10 or more su-fURS scopes were used per life cycle. Conclusions: The life cycle of re-fURS increased by 40% after the introduction of su-fURS. Ten or more used su-fURS per life cycle were associated with increased re-fURS survival. [ABSTRACT FROM AUTHOR]

Background: Single use flexible ureteroscopes (su-fURS) have emerged as an alternative to reusable flexible ureteroscopes (r-fURS) for the management of upper urinary tract calculi. However, little is known about urologist usage and attitudes about this technology. Through a worldwide survey of endourologists, we assessed practice patterns and preferences for su-fURS., Methods: An online questionnaire was sent to Endourology Society members in January 2021. The survey explored current su-fURS practice patterns, reasons for/against adoption, and preferences for next generation models including developments in imaging, intra-renal pressure, heat generation, and suction. Responses were collected through QualtricsXM over a 1-month period from surgeons in North America, Latin America, Europe, Asia, Africa, and Oceania. The study was conducted according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES)., Results: 208 (13.9%) members responded to the survey. Most respondents (53.8%) performed >100 ureteroscopies per year. 77.9% of all respondents used su-fURS for less than half of all procedures while only 2.4% used su-fURS for every procedure. 26.0% had never used a su-fURS. Overall, usage was not influenced by a surgeon's geographic region, practice environment, or years of experience. Top reasons for not adopting su-fURS were cost (59.1%) and environmental impact (12.5%). The most desired improvements in design were smaller outer shaft size (19.4%), improved optics and vision (15.9%), and wireless connectivity (13.6%). For next generation concepts, the functions most commonly described as essential or important by respondents was the ability to suction fragments (94.3%) while the function most commonly noted as not important or unnecessary was incorporation of a temperature sensor (40.4%)., Conclusions: su-fURS are not commonly used, even among urologists who perform a high number of fURS. The primary concern for adoption is cost and environmental impact. Suction capability was considered the most important future development., Competing Interests: KG is a consultant for Boston Scientific, Olympus, Coloplast and Karl Storz, and Ambu. He has grant funding from Coloplast, Boston Scientific, Patient Centered Outcomes Institute and Blue Cross Blue Shield of Michigan. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Salka, Bahaee, DiBianco, Plott and Ghani.)

Over the past decade, single‐use tangential flow filtration (TFF) technologies have emerged to reduce system preparation time, promote fast and flexible product change over, and ultimately shorten process development and manufacturing time/cost. In this study, the performance of a recently developed Pellicon® single‐use TFF capsule was compared against traditional Pellicon® cassettes by assessing TFF process performance (such as flux, residuals clearance, and yield) and post‐purification product attributes (such as concentration and mass‐weighted average molecular weight). Good scaling was shown by comparing process performance and product attributes across different scales and formats. Additionally, similar TFF process performance and post‐purification product attributes were observed for the single‐use capsule compared to the reusable TFF cassettes. The capsule requires a smaller flush than the cassette, and it is easier to use since it does not require a compression holder or pre‐sanitization. The results provide insight into the application of the single‐use TFF capsule and scalability of TFF processes for the purification of conjugate vaccines. [ABSTRACT FROM AUTHOR]

Objective: Surgical site complications (SSCs) such as dehiscence and infection are a common issue within vascular surgeries and are a key concern to payers and clinicians. It is estimated that occurrence of complications in vascular surgery can increment length of stay by 9.72 days and costs by £3776 per episode. The objective of this research was to determine the clinical and economic impact of the prophylactic use of single use negative pressure wound therapy (sNWPT) in postoperative femoral endarterectomy incisions within a single centre in the Netherlands. Method: Data were extracted retrospectively from the medical notes of patients consecutively treated for femoral endarterectomy between January 2013 and December 2019 in a single centre in the Netherlands. Since August 2016, patients were treated with the sNPWT device and their data were compared with that of patients treated before the introduction of the device. Data were extracted on SSCs and associated healthcare resource use, with comparisons made between the two patient groups. Results: The study included a cohort of 108 patients. Data of patients treated by standard care (n=64) showed 32 (50%) patients developed complications. This reduced significantly in patients treated with the sNPWT device (n=44) of whom eight (18.2%) developed a postoperative complication (p=0.0011). Average postoperative costs per patient were €3119 for those in the standard care group and €2630 where the sNPWT device was used. Conclusion: sNPWT provided clinical and economic benefits over standard care in the treatment of femoral endarterectomy patients, significantly reducing rate of complication and their associated costs. [ABSTRACT FROM AUTHOR]

Bioartificial liver devices (BALs) are categorized as advanced therapy medicinal products (ATMPs) with the potential to provide temporary liver support for liver failure patients. However, to meet commercial demands, next-generation BAL manufacturing processes need to be designed that are scalable and financially feasible. The authors describe the development and application of a process economics decisional tool to determine the cost of goods (COG) of alternative BAL process flowsheets across a range of industrial scales. The decisional tool comprised an information database linked to a process economics engine, with equipment sizing, resource consumption, capital investment and COG calculations for the whole bioprocess, from cell expansion and encapsulation to fluidized bed bioreactor (FBB) culture to cryopreservation and cryorecovery. Four different flowsheet configurations were evaluated across demands, with cell factories or microcarriers in suspension culture for the cell expansion step and single-use or stainless steel technology for the FBB culture step. The tool outputs demonstrated that the lowest COG was achieved with microcarriers and stainless steel technology independent of the annual demand (1500–30 000 BALs/year). The analysis identified the key cost drivers were parameters impacting the medium volume and cost. The tool outputs can be used to identify cost-effective and scalable bioprocesses early in the development process and minimize the risk of failing to meet commercial demands due to technology choices. The tool predictions serve as a useful benchmark for manufacturing ATMPs. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The purpose of single-use flexible ureteroscopes (su-fURS) was to overcome the main limitations of conventional reusable ureteroscopes in terms of maneuverability and of the maintenance. We aimed to perform a systematic literature review on available su-fURS performance versus conventional reusable fURS with a focus on clinical data. Materials and Methods. A systematic research using electronic database Pubmed was performed for studies evaluating single-use fURS and reusable fURS in the setting of urinary tract stone disease. Prospective assessments and case series studies were included. The goal of this review was to provide an overview of these single use and disposable flexible ureteroscopes and to examine and compare their capabilities (deflection, irrigation, optical properties). Results. We found 11 studies which met our inclusion criteria, where it was compared the single use fURS with reusable fURS. The studies about single-use ureteroscopes included data on LithoVue (Boston Scientific), The Uscope UE3022 (Pusen, Zhuhai, China), NeoFlex-Flexible, (Neoscope Inc San Jose, CA), 23 YC-FR-A (Shaogang). Reusable ureteroscopes studies included data about three models, two digital (Karl Storz Flex-XC and Olympus URF-Vo) and one fiber optic (Wolf-Cobra). There were not significant statistical differences concerning stone-free rate, procedure duration, functional capabilities between single-use fURS and reusable fURS. Conclusions. Single-use fURS demonstrate a comparable efficacy with reusable fURS in resolving renal lithiasis. [ABSTRACT FROM AUTHOR]

Introduction: Acquisition costs and prohibitively expensive technical support for endoscope maintenance, repair, and reprocessing have deterred adoption of flexible cystoscopes by many urologists internationally. This study evaluated the performance of a novel single-use digital cystoscope that can directly connect to a laptop or computer monitor for visualization, obviating the need for a tower. Materials and Methods: The performance characteristics of flexible single-use cystoscopes (NeoScope) were prospectively evaluated vs a reusable flexible cystoscope (Olympus) in three clinical cases and two independent benchtop testing episodes in Canada. Cystoscope maneuverability, imaging, deflection, irrigation, and ease of use of instrumentation were investigated. Additional investigations were performed during clinical use in Zimbabwe (7 patients), Egypt (10 patients), and Dominica (5 patients). Results: Bench testing revealed smaller tip diameter (4.06 vs 6.09 mm) and shorter (35.4 vs 38 cm) single-use cystoscopes vs reusable cystoscopes. Deflection of the single-use scope was superior with an empty working channel (230 up/220 down) vs the reusable (195 up/95 down) but showed a more substantial decrease in deflection on placement of instruments including a grasper. Clinical use revealed satisfactory maneuverability, ease of use of instruments, deflection, and visualization. Conclusions: Benchtop testing performance of the single-use digital flexible cystoscopes was inferior compared with reusable digital cystoscopes. However, these single-use endoscopes offer adequate illumination, imaging, and maneuverability. Direct connection to any computer monitor allowed truly portable use, allowing for treatment of patients in a variety of clinical settings without the need for ancillary equipment. [ABSTRACT FROM AUTHOR]

Introduction and objective: The novel single-use digital flexible cystoscope Isiris™ has been developed to perform in-office JJ stent removal, without the need of special equipment nor limitations linked to the disinfection of a reusable device. The aim of our study was to perform a cost-effectiveness analysis of Isiris™ in our institution. Patients and methods: A total of 127 consecutive patients undergoing in-office stent removal with Isiris™ were prospectively included in study. After each procedure, the urologist filled a questionnaire specifically developed to evaluate the efficiency of the device and the invasiveness of the procedure. We performed a cost analysis of the main variables involved in JJ removal using Isiris™ versus the traditional Storz™ reusable flexible cystoscope used for all our previous patients. Results: The procedure was successful in all cases except for one, where the device did not work due to the failure of the grasper and had to be replaced. Overall, the performance of Isiris™ was judged by the physician "very good" and "good" in 90.6% of the cases. Both median pain and invasiveness felt by the patient were 0 (range = 0–8). The mean cost of procedure was estimated at €361 for in-office stent removal with Isiris™, and €1.126.8 for stent removal in operatory room with a reusable flexible cystoscope. Considering the 127 procedures performed in office, 64 h of operatory room time was saved. Conclusion: In institutions where JJ removal is performed in the operatory room, Isiris™ leads to a significant advantage in terms of money saved per procedure, operatory room time gained and patient satisfaction. [ABSTRACT FROM AUTHOR]

Clomiphene is a selective estrogen receptor modulator. It is indicated for the treatment of female infertility issues but in sport, it can be misused to stimulate endogenous testosterone secretion in men. Therefore, it has been prohibited at all times by the World Anti-doping Agency. The aim of this study was to get data to be able to interpret concentrations in athletes. A healthy volunteer (male, 62 years-old) ingested a single therapeutic dose of clomiphene (Clomid™, 50 mg). Strands of hair (blond, 4 cm) were collected one month after the ingestion. Body hair (beard, axillary, pubic and chest hair), and finger and toenails were collected over 4–5 months. A previous method was modified to identify and quantify clomiphene in keratinous matrices. 30 mg of specimen were sonicated and incubated in 1 mL of methanol, in presence of 200 pg of clomiphene-D 5 (internal standard). After centrifugation and evaporation of the organic phase, the samples were analyzed using LC-MS/MS. Linearity was verified in hair and nail clippings between 1 and 500 pg/mg. The limits of detection and quantification were determined at 0.3 and 1 pg/mg respectively. The study demonstrated that clomiphene tested positive in all the analyzed specimens at 9 pg/mg in head hair, from 28 to 486 pg/mg (body hair) and from 4 to 57 pg/mg (nails). Clomiphene was identified for the first time in multiple keratinous matrices. This study demonstrated that a single oral therapeutic dose is detectable in keratinous matrices over a long period of time. • A single dose of clomiphene (50 mg) is detectable in head hair, body hair and nail clippings. • A single therapeutic dose is detectable for a long period in keratinous matrices. • Higher concentrations of clomiphene are identified in body hair than in head hair. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to perform a cost minimisation analysis of reuse of single use devices used in the coronary angiography unit after sterilization. Methods: Thirty kinds of disposable devices used in the angiography unit and which were sent to the sterilization unit for reuse were determined. The cost of these materials was based on information provided by purchasing department of the hospital. Payments of staff, amounts and costs of water and electricity used, and expenditures during packaging and sterilization stages were calculated for a single sterilization procedure. Numbers of sterilization procedures projected and amounts of devices purchased were calculated according to the needs between 2014 and 2015 in angiography unit. Accordingly, hospital costs of single use and reuse of the devices was calculated separately. Results: The cost of buying 30 kinds of devices when one piece of each was purchased was 17 839.46 TL. Expenses of preparation stages for reuse was 255.75 TL. When the hospital's needs for one year was considered, the cost for single use was 4 787 710 TL. On the other hand, when a predicted number of sterilization process was considered, the calculated cost was 2 162 855 TL. The annual total of the expenses in the preparation stage for reuse was calculated as 164 050 TL. The sum of the costs for purchase of new devices and preparation for reuse was 2 162 855 + 164 050 = 2 336 905 TL. The savings of the hospital were calculated as 4 787 710 - 2 336 905 = 2 451 608 TL per year when calculated according to the predicted reuse number. When compared to single use, reuse reduced the costs by 51.2%. Conclusions: It is shown that reuse of disposable materials in coronary angiography unit is an effective method in terms of cost. In particular, reuse of electrophysiology catheters and pacemakers is cost-effective and a medically safe method. [ABSTRACT FROM AUTHOR]

Introduction: Retrograde intrarenal surgery (RIRS) represents a standard option for kidney stone removal. However, RIRS is considered a cost-intensive procedure. Single-use flexible ureterorenoscopes have been introduced to improve budget predictability in RIRS. We assessed differences in physical and optical properties of single-use devices compared to standard reusable endoscopes.Methods: In two single-use (LithoVue™, Boston Scientific; Pusen Uscope UE3011™), and one reusable ureterorenoscope (Flex-Xc™, Karl Storz), we investigated flow rates, deflection, illuminance, and intrapelvic pressure in a porcine kidney model. Subjective image quality was assessed using a standardized questionnaire. Common insertable devices were applied to investigate additional influence on physical properties.Results: Significant variability in maximum flow rates was observed (Flex-Xc™: 25.8 ml/min, LithoVue™: 30.3 ml/min, Pusen™: 33.4 ml/min, p < 0.05). Insertion of a guide wire resulted in the highest reduction of flow rates in all endoscopes. Flection led to a reduction of absolute flow rates up to 9.4% (Flex-Xc™). Light intensity at 20/50 mm distance was 9090 lx/1857 lx (Flex-Xc™) and 5733 lx/1032 lx (LithoVue™) and 2160 lx/428 lx (Pusen™), respectively (p < 0.05). Subjective image quality score was highest using the Flex-Xc™ endoscope. During manipulation, maximum intrarenal pressure up to 66 mmHg (Pusen™) was measured.Conclusions: Significant differences in physical and optical properties of single-use or reusable flexible ureterorenoscopes are present, with putative influence on surgical efficacy and complications. Further comparative evaluation of single-use and reusable endoscopes in a clinical scenario is useful. Moreover, utilization of ureteral access sheaths may be considered to avoid renal damage. [ABSTRACT FROM AUTHOR]