Creating the BELgian COngenital heart disease database combining administrative and clinical data (BELCODAC) : rationale, design and methodology

Background: Congenital heart disease (CHD) entails a broad spectrum of malformations with various degrees of severity and prognosis. Consequently, new and specific healthcare needs are emerging, requiring responsive healthcare provision. Research on this matter is predominantly performed on population-based databases, to inform clinicians, researchers and policy-makers on health outcomes and economic burden of CHD. Most databases contain data either from administrative sources or from clinical systems. We describe the methodological design of the BELgian COngenital Heart Disease Database combining Administrative and Clinical data (BELCODAC), to investigate patients with CHD. Methods: Data on clinical characteristics from three university hospitals in Belgium (Leuven, Ghent and Brussels) were merged with mortality and socio-economic data from the official Belgian statistical office (StatBel), and with healthcare use data from the InterMutualistic Agency, an overarching national organization that collects data from the seven sickness funds for all Belgian citizens. Over 60 variables with multiple entries over time are included in the database. Results: BELCODAC contains data on 18,510 patients, of which 8926 patients (48%) have a mild, 7490 (41%) a moderately complex and 2094 (11%) a complex anatomical heart defect. The most prevalent diagnosis is Ventricular Septal Defect in 3879 patients (21%), followed by Atrial Septal Defect in 2565 patients (14%). Conclusions: BELCODAC comprises longitudinal data on patients with CHD in Belgium. This will help build evidence-based provision of care to the changing CHD population

Single-setting robot-assisted kidney transplantation consecutive to single-port laparoscopic nephrectomy in a child and robot-assisted living-related donor nephrectomy : initial Ghent experience

Introduction Kidney transplantation (KT) is the gold-standard treatment for end-stage renal disease (ESRD) in children. Robot-assisted kidney transplantation (RAKT) in adults is becoming increasingly common with potentially improved morbidity compared with open KT. The study objective was to evaluate feasibility and outcomes of RAKT in children. Patients & methods An 8-years-old boy with ESRD received a kidney transplant from his mother. Simultaneously in two operation theatres, the boy underwent single-port (GeIPOINT (R)) right laparoscopic nephroureterectomy (LNU), and his mother underwent robot-assisted left donor nephrectomy (RADN).Two full surgical teams were operating at the same time. Subsequently, the boy underwent RAKT, introducing the graft through the GeIPOINT (R). Results Total operative time for LNU, RADN, and RAKT was 180, 140, and 195 min, respectively, with warm, cold, and rewarming ischemia times 1.5, 200, and 47 min, respectively. Blood loss was 300, 20, and 50 cc, respectively. No intraoperative complications were noted. Convalescence of both donor and recipient was uneventful, with good kidney function at 1-year follow-up. Conclusion RAKT in children is technically feasible and safe, resulting in excellent graft function. Concomitant nephrectomy can be done laparoscopically through the single-site GeIPOINT (R). An experienced RAKT team with the full support of pediatric nephrologists is mandatory

Precision measurement of the magnetic octupole moment in 45Sc as a test for state-of-the-art atomic-and nuclear-structure theory

We report on measurements of the hyperfine A, Band C-constants of the 3d4s22D5/2and 3d4s22D3/2 atomic states in 45Sc. High-precision atomic calculations of the hyperfine fields of these states and second-order corrections are performed, and are used to extract C5/2=−0.06(6)kHz and C3/2=+0.04(3)kHz from the data. These results are one order of magnitude more precise than the available literature. From the combined analysis of both atomic states, we infer the nuclear magnetic octupole moment Omega =−0.07(53)μNb, including experimental and atomic structure-related uncertainties. With a single valence proton outside of a magic calcium core, scandium is ideally suited to test a variety of nuclear models, and to investigate in-depth the many intriguing nuclear structure phenomena observed within the neighbouring isotopes of calcium. We perform nuclear shell-model calculations of Omega, and furthermore explore the use of Density Functional Theory for evaluating Omega. From this, mutually consistent theoretical values of Omega are obtained, which are in agreement with the experimental value. This confirms atomic structure calculations possess the accuracy and precision required for magnetic octupole moment measurements, and shows that modern nuclear theory is capable of providing meaningful insight into this largely unexplored observable

Robot-geassisteerde nefro-ureterectomie voor urotheelCa van de hogere urinewegen : resultaten van 3 high-volume robot centra

Doelstelling: Robot-geassisteerde nefro-ureterectomie (RANU) vormt een minimaal invasief alternatief voor open nefro-ureterectomie in de behandeling van urotheelcelcarcinoom van de hogere urinewegen (UTUC). Het doel van deze studie is om de perioperatieve en oncologische uitkomst na RANU te onderzoeken. Materiaal en Methoden: Tussen 2008 en 2017 ondergingen 78 patiënten RANU voor UTUC in 3 high-volume robot centra. Retrospectieve analyse met beschrijvende statistiek en Kaplan-Meier curves gebeurde om de intra- en postoperatieve complicaties te beschrijven, en de oncologische uitkomst (algeheel en gestratifieerd volgens hervaltype en pathologisch tumorstadium) te onderzoeken. Resultaten: De mediane leeftijd bij diagnose was 72jaar (IQR 65-78) met een mediane Charlson comorbidity index van 3 (IQR 1-6). Man-vrouw ratio was 2:1. De tumor bevond zich ter hoogte van het renaal/pyelo-calicieel systeem (52%), de proximale ureter (6%), midureteraal (19%), de distale ureter (2%) of multifocaal (21%). Het mediane geschatte bloedverlies was 75ml (IQR 35-180) en de mediane verblijfsduur 4dagen (IQR 4-6). Bloedtransfusies gebeurden bij 3% van de patiënten. Intraoperatieve complicaties traden op in 5% en postoperatieve complicaties in 25% van de gevallen. Clavien-Dindo graad ≥ III complicaties traden op bij 3%. Pathologisch tumorstadium betrof pTa (27%), pTis (3%), pT1 (21%), pT2 (17%), pT3 (24%), pT4 (5%) of pT0 (3%). Lymfeklierdissectie gebeurde bij 31 patiënten (40%) waarvan er bij 29% lymfeklieren waren betrokken. Bij een mediane opvolgingstijd van 15 maanden, is de geschatte algehele 2jaarsoverleving 79%. Gestratifieerd volgens hervaltype is dit respectievelijk 100% voor blaasherval en 16% voor patiënten met herval op afstand (p<0.001). Gestratifieerd volgens pT-stadium is dit 95%, 90% en 41% voor respectievelijk pTa-1, pT2 en pT3-4 tumoren (p=0.01). Peritoneale metastasering werd gezien bij 1 patiënt met pT4N2R1 UTUC. Conclusie: RANU is een veilige en doenbare chirurgische strategie als minimaal invasieve behandeling voor patiënten met UTUC. Postoperatieve morbiditeit is accepteerbaar en het aantal zware complicaties is zeer laag. Op korte termijn lijkt de oncologische uitkomst zeker aanvaardbaar zonder dat er aanwijzingen zijn op een verhoogd risico op peritoneale metastasering

Voltage scanning and technical upgrades at the Collinear Resonance Ionization Spectroscopy experiment

To optimize the performance of the Collinear Resonance Ionization Spectroscopy (CRIS) experiment at CERN-ISOLDE, technical upgrades are continuously introduced, aiming to enhance its sensitivity, precision, stability, and efficiency. Recently, a voltage-scanning setup was developed and commissioned at CRIS, which improved the scanning speed by a factor of three as compared to the current laser-frequency scanning approach. This leads to faster measurements of the hyperfine structure for systems with high yields (more than a few thousand ions per second). Additionally, several beamline sections have been redesigned and manufactured, including a new field-ionization unit, a sharper electrostatic bend, and improved ion optics. The beamline upgrades are expected to yield an improvement of at least a factor of 5 in the signal-to-noise ratio by suppressing the non-resonant laser ions and providing time-of-flight separation between the resonant ions and the collisional background. Overall, the presented developments will further improve the selectivity, sensitivity, and efficiency of the CRIS technique.Comment: 10 pages. Under review at NIM B as part of the proceedings of EMIS 2022 at RAON, South Kore

Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique

ABSTRACT Introduction: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5–7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). Surgical Technique: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane – virtually until the seminal vesicles – prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. Conclusions: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention

Discrimination, Reliability, Sensitivity, and Specificity of Robotic Surgical Proficiency Assessment With Global Evaluative Assessment of Robotic Skills and Binary Scoring Metrics: Results From a Randomized Controlled Trial

Objective: To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity. Background: GEARS–Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations. Methods: In a prospective, randomized, and blinded study, we compared conventional with PBP training for a robotic suturing, knot-tying anastomosis task. Thirty-six surgical residents from 16 Belgium residency programs were randomized. In the skills laboratory, the PBP group trained until they demonstrated a quantitatively defined proficiency benchmark. The conventional group were yoked to the same training time but without the proficiency requirement. The final trial was video recorded and assessed with binary metrics and GEARS by robotic surgeons blinded to individual, group, and residency program. Sensitivity and specificity of the two assessment methods were evaluated with area under the curve (AUC) and receiver operating characteristics (ROC) curves. Results: The PBP group made 42% fewer objectively assessed performance errors than the conventional group (P &lt; 0.001) and scored 15% better on the GEARS assessment (P = 0.033). The mean interrater reliability for binary metrics and GEARS was 0.87 and 0.38, respectively. Binary total error metrics AUC was 97% and for GEARS 85%. With a sensitivity threshold of 0.8, false positives rates were 3% and 25% for, respectively, the binary and GEARS assessments. Conclusions: Binary metrics for scoring a robotic VUA task demonstrated better psychometric properties than the GEARS assessment. </jats:sec