Kelayakan Finansial Pengembangan Perumahan Bumi Kanjuruhan Kabupaten Malang

Pertambahan penduduk di Kabupaten Malang harus diikuti dengan sarana dan prasarana yang memadai, khususnya Perumahan.Salah satu Perumahan yang sedang berkembang adalah Perumahan Bumi Kanjuruhan yang mana Perumahan ini diutamakan untuk pegawai negeri sipil (PNS). PT Kharisma selaku pengembang bekerjasama dengan Pemerintah Kabupaten Malang membangun Perumahan Bumi Kanjuruhan, Kabupaten Malang, dimanaperumahan ini perlu dikaji kelayakan secara finansial untuk mengetahui apakah Perumahan ini layak dibangun atau tidak. Metode yang digunakan dalam studi kelayakan ini adalah dengan menggunakan parameter Net Present Value (NPV), Internal Rate of Return (IRR), Benefit Cost Ratio (BCR) danPayback Period (PP). Perhitungan kelayakan didasarkan pada 3 alternatif yaitu 100 modal sendiri, 70% modal sendiri dan 30% modal pinjaman, serta 50% modal sendiri dan 50% modal pinjaman. Suku bunga dihitung dengan menggunakan weighted average cost of capital (WACC). Hasil NPV untuk alternatif 1 sebesar Rp 9.000.436.026 alternatif 2 sebesar - Rp 7.610.997.065, dan alternatif 3 sebesar - Rp 8.434.739.436. Alternatif yang layak untuk dijalankan ialah alternatif 1 karena NPVbernilai positif, sedangkan alternatif 2 dan alternatif 3 tidak layak karena NPV bernilai negatif.Batas suku bunga yang ditawarkan sehingga memenuhi kelayakan dengan metode IRR adalah alternatif 1 sebesar 16,36%, alternatif 2 sebesar 1,42%, dan alternatif 3 sebesar 0%. Alternatif yang layak untuk dijalankan ialah alternatif 1 karena suku bunga yang ditawarkan lebih dari faktor diskon, sedangkan alternatif 2 dan alternatif 3 tidak layak karena suku bunga yang ditawarkan kurang dari faktor diskon. Perbandingan nilai yang ditawarkan menurut kelayakan finansial dengan metode BCR adalah alternatif 1 bernilai 1,34, alternatif 2 bernilai 0,72, dan alternatif 3 bernilai 0,32. Alternatif yang layak untuk dijalankan ialah alternatif 1 karenaIRR > 1 sedangkan alternatif 2 dan alternative 3 tidak layak karena IRR < 1. Jangka waktu pengembalian yang diperlukan sehingga pengembang memperoleh keuntungan adalah alternatif 1 berjumlah 4 tahun 5 bulan, alternatif 2 berjumlah 10 tahun 1 bulan, dan alternatif 3 jumlahnya melebihi periode yang ditentukan. Alternatif yang layak untuk dijalankan ialah alternatif 1 karena pengembalian modalnya lebih cepat dari alternatif lainnya

Postoperative evaluation of chronic pain in patients with Mayer – Rokitansky – Küster – Hauser (MRKH) syndrome and uterine horn remnant: Experience of a tertiary referring gynaecological department

International audienceIntroduction: Patients with Mayer - Rokitansky - Küster - Hauser (MRKH) syndrome often experience chronic pelvic pain negatively impacting their life's quality. Our understanding of the factors involved in this symptom remains poor. The aim of our study was to further investigate the different components of this pelvic pain in patients with MRKH undergoing pelvic surgery. Our second objective was to assess the evolution of this pain in patients undergoing surgical removal of their uterine horn remnant.Material and methods: We conducted a retrospective analysis of a cohort of patients treated in our tertiary referring gynaecological department. Patients included had a MRKH syndrome with at least one uterine horn remnant and all underwent at least one surgical procedure in our centre. Descriptive analysis of the main characteristics and of the management of these patients was conducted. Postoperative pain was evaluated using simple words and / or analgesic consumption evaluation.Results: Between 1991 and 2013, twenty-one patients were included in our centre. Out of them, 20 (95 %) had chronic pelvic pain, mostly cyclic pain lasting 2-3 days. Fourteen patients had surgical removal of their uterine horns remnant and only 3 patients (21 %) had persistent pain at their postoperative visit. Surgical findings included peritoneal endometriosis in 8 patients (38 %) and other unexpected findings in 6. At pathological analysis, secretary endometrium in the uterine horn remnant was found in 11 patients (79 %).Conclusion: The origin of chronic pain in MRKH is combining several factors such as endometriosis or secretary endometrium. Surgical removal of uterine horn remnant improved most of our patients' pelvic chronic pain. Further studies should help improve our understanding of this specific entity

O-RADS MRI classification of indeterminate adnexal lesions: time-intensity curve analysis is better than visual assessment.

Background The MRI Ovarian-Adnexal Reporting and Data System (O-RADS) enables risk stratification of sonographically indeterminate adnexal lesions, partly based on time-intensity curve (TIC) analysis, which may not be universally available. Purpose To compare the diagnostic accuracy of visual assessment with that of TIC assessment of dynamic contrast-enhanced MRI scans to categorize adnexal lesions as benign or malignant and to evaluate the influence on the O-RADS MRI score. Materials and Methods The European Adnex MR Study Group, or EURAD, database, a prospective multicenter study of women undergoing MRI for indeterminate adnexal lesions between March 2013 and March 2018, was queried retrospectively. Women undergoing surgery for an adnexal lesion with solid tissue were included. Solid tissue enhancement relative to outer myometrium was assessed visually and with TIC. Contrast material washout was recorded. Lesions were categorized according to the O-RADS MRI score with visual and TIC assessment. Per-lesion diagnostic accuracy was calculated. Results A total of 320 lesions (207 malignant, 113 benign) in 244 women (mean age, 55.3 years ± 15.8 [standard deviation]) were analyzed. Sensitivity for malignancy was 96% (198 of 207) and 76% (157 of 207) for TIC and visual assessment, respectively. TIC was more accurate than visual assessment (86% [95% CI: 81, 90] vs 78% [95% CI: 73, 82]; P < .001) for benign lesions, predominantly because of higher specificity (95% [95% CI: 92, 98] vs 76% [95% CI: 68, 81]). A total of 21% (38 of 177) of invasive lesions were rated as low risk visually. Contrast material washout and high-risk enhancement (defined as earlier enhancement than in the myometrium) were highly specific for malignancy for both TIC (97% [95% CI: 91, 99] and 94% [95% CI: 90, 97], respectively) and visual assessment (97% [95% CI: 92, 99] and 93% [95% CI: 88, 97], respectively). O-RADS MRI score was more accurate with TIC than with visual assessment (area under the receiver operating characteristic curve, 0.87 [95% CI: 0.83, 0.90] vs 0.73 [95% CI: 0.68, 0.78]; P < .001). Conclusion Time-intensity curve analysis was more accurate than visual assessment for achieving optimal diagnostic accuracy with the Ovarian-Adnexal Reporting and Data System MRI score. Clinical trial registration no. NCT01738789 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Vargas and Woo in this issue

Surgical management of patients with advanced ovarian cancer: results of a French National Survey.

Desire to homogenize advanced stage ovarian cancer management has led to a debate on the need to centralize cares. The aim was to assess current practices to compare them with centralization motivation and to overview possible perspectives of evolution. An anonymous questionnaire of 57 questions has been submitted from August 2021 to October 2021 to members of French gynecological oncological surgical societies. Questions encompassed all aspects of ovarian cancer surgical management, including institutions, technics, indications, and outcomes. Of the 40 responses, 77.5% managed less than 20 cases by themselves, but 67.5% practiced in institution managing more than 30 cases annually. Since the LION trial results' publication, 95% of practitioners have evolved their lymphadenectomy indications. More than 10% of surgery needed digestive resection for 90% of practitioners. Digestive resections rate was significantly higher for practitioners managing more than 20 cases (p&lt;0.01), but it was not for institutions managing more than 30 cases annually (p=0,07). Surgeons performing more than 20 ovarian cancers annually reported less severe complications (p=0.04) compared to low-volume surgeons independently of institution volume. For more than a quarter of the practitioners, less than half of the patients can benefit from the enhanced recovery after surgery program despite benefits of such care. Our survey provides an overview of French practices in ovarian cancer management. This survey seems to confirm that minimum volume thresholds could lead to better outcomes. It also underlines that individual performances are as valuable as center volume

How to predict para-aortic node involvement in advanced cervical cancer? Development of a predictive score. A FRANCOGYN study

International audienceINTRODUCTION: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation

Fuzzy Approach for Bibliometric Analysis of Publication Trends on Intragastric Balloon as a Minimally Invasive Procedure for Weight Loss in Obese Individuals

Part 12: FuzzyInternational audienceIn this paper, we perform Bibliometric assessment of research output that has been carried out pertaining to the literature on intragastric balloon (IGBs) as a treatment modality of morbid obesity. To do this, we conducted a bibliometric analysis on this topic using the growth of publications, publication trends over time, annual research productivity and authors’ activity as main outcome points. Furthermore, we validate the comparable applicability of Lotka’s law among authors with a single publication and those with multiple ones using a fuzzy approach. The analysis shows that publication trend follows Price’s law. The extracted trend is exponential and in accordance with what is found in other studies. Lotka’s formula using one and two publications, is found to hold but for mean $$x = 3.025$$x=3.025

Impact of COVID-19 on surgical emergencies: nationwide analysis

International audienceBackground The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. Methods This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. Results During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). ConclusionA marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population

Management of patients with advanced epithelial ovarian cancer: a European survey.

The aim of this study was to assess current European practices in the management of patients with advanced epithelial ovarian cancer in 2021. A 58-question electronic survey was distributed anonymously to the members of six European learned societies. Initial diagnostic workup and staging, pathological data, surgical data, treatments and follow-up strategies were assessed. A total of 171 participants from 17 European countries responded to emailed surveys. Most participants were experienced practitioners (superior than 15 years of experience) specializing in gynecology-obstetrics (29.8%), surgical oncology (25.1%), and oncogynecology (21.6%). According to most (64.8%) participants, less than 50% of patients were eligible for primary debulking surgery. Variations in the rate of primary debulking surgery depending on the country of origin of the practitioners were observed in this study. The LION study criteria were applied in 70.4% of cases during PDS and 27.1% after chemotherapy. In cases of BRCA1-2 mutations, olaparib was given by 75.0-84.8% of respondents, whereas niraparib was given in cases of BRCA wild-type diseases. This study sheds light on current practices and attitudes regarding the management of patients with advanced epithelial ovarian cancer in Europe in 2021