Cases Of Failure Research Articles

P-603 Combined oral contraceptive pill (COCP) before controlled ovarian hyperstimulation (COH) in donors could negatively affect egg donation outcomes in recipients: a multicentre retrospective study

Abstract Study question Could COCP use before COH with a progestin primed ovarian stimulation protocol (PPOS) in donors also negatively influence the egg donation outcomes in recipients? Summary answer Synchronization with a combined oral contraceptive pill (COCP) before controlled ovarian hyperstimulation (COH) involving progestin for pituitary suppression shows worst outcomes in egg donation treatments. What is known already It is well known that COCP leads to a long-lasting pituitary suppression, a reversible reduction in AMH and antral follicle count with higher risk of inappropriate response to COH and GnRH-agonist trigger, potentially reducing number and quality of retrieved oocytes. This is supported by the latest international guidelines on COH that strongly discourage COCP use before GnRH antagonist protocols because of a reduced efficacy of such cycles, also, in terms of ongoing pregnancy rate (OPR). They also underlie that interactions between COCP pretreatment and PPOS protocols remain inadequately explored and more research are needed to clarify discrepancies persisting in literature. Study design, size, duration Multicentre retrospective cohort study evaluating egg donation outcomes, depending on the use or not of COCP pre-treatment in donors, in terms of OPR, Live Birth Rate (LBR), and secondly of fertilization rate (FR), blastulation rate (BR), implantation rate (IR) and miscarriage rate (MR). The treatments were realized in a Private Fertility Clinic (where donors also underwent COH with PPOS protocol) and a public hospital (transnational egg donation program) between January 2022 and September 2023. Participants/materials, setting, methods 216 egg donation cycles were studied. Excluding cases of fertilization and/or embryo development failure and cases for which embryo transfer outcomes were not available at the time of data collection, the study analysed the outcomes of 90 embryo transfers (ETs). After the first analysis on total cycles, a stratification was made to evaluate whether COCP could have a different influence depending on the oocytes type used: fresh or vitrified. Main results and the role of chance COCP-No and COCP-Yes groups show similar FR and BR, after donation of same oocytes number (6,4 ± 1,1 vs 6,5± 1). Interestingly, vitrified oocytes from COCP-Yes donors produced a statistically lower yield of viable blastocysts (22,2% versus 37,9%; p = 0,007). IR was higher in the COCP-No group, (46,4% vs. 28,6%), data confirmed also in the two subgroups (fresh: 42,9% vs. 14,3%; vitrified: 48,8% vs. 35,7%). Higher MR was observed in the COCP-Yes group, achieving statistical significance both for total oocytes (66,7% vs. 9,4%; p = 0,006) and vitrified ones (60% vs. 5%; p = 0,016). Pregnancy rate was higher in the COCP-No group (46,4% vs. 28,6%), the same trend was found regardless of the type of oocytes used (fresh: 42,9% vs. 14,3%; vitrified: 48,8% vs. 35,7%). The greatest discrepancies were observed in OPR and LBR subcategories. In fact, a statistically higher OPR was obtained in the COCP-No group (42% vs. 9,5%, p = 0,008), which leads to a statistically higher LBR (30,4% vs. 0%; p = 0,004). Notably, the LBR after using both fresh and vitrified oocytes was markedly higher in the COCP-No group (fresh: 28,6% vs. 0%, p = 0,385; vitrified: 31,7% vs. 0%, p = 0,041), presenting a significant difference when vitrified oocytes were used with potential clinical relevance. Limitations, reasons for caution The main limitation lies in the retrospective nature of the study and the small sample size, but the multicentre design gives greater reliability. Further research is needed to confirm these findings and better understand the specific circumstances in which COCP may or may not be beneficial. Wider implications of the findings COCP pretreatment in egg donors undergoing PPOS protocol may negatively impact embryo development and pregnancy outcomes in recipients, with increased MR, and reduced OPR, and LBR. Particularly, the worst outcomes involve vitrified oocytes, providing valuable insights to reconsider COCP use in transnational egg donation programs, but also fertility preservation ones. Trial registration number Not Applicable

P-406 Late paternal effect rooted in sperm DNA double-strand breaks (DSBs) correlates with the likelihood of miscarriage in patients with poor ovarian response

Abstract Study question Can paternal risk factors be minimized and prevented in ICSI procedure? Summary answer The influence of DSBs can be prevented in ICSI cases with normal ovarian response, whereas DSB is exclusively associated with miscarriage in poor ovarian reserve. What is known already Sperm DNA fragmentation (SDF) is intricately linked to male fertility capacity, with a high prevalence affecting 20% of men with unexplained infertility and up to 50% of those with idiopathic infertility. Despite these statistics, the association between paternal DNA damages and clinical outcomes is controversial. Variations in SDF effects may be influenced by female factors associated with maternal DNA repair activity. To elucidate this interrelationship, we assessed SDF effects on diverse ovarian responses using POSEIDON stratification. The goal was to identify potential paternal risk factors for ART as a preventative solution and devising preventative strategies. Study design, size, duration This retrospective study included 323 couples who underwent ICSI cycles at Lee Women’s Hospital. Normal responders (n = 89) were identified based on female age (<35 years) and AMH levels (≥1.2 ng/mL). Patients (n = 234) fulfilling POSEIDON group 1–4 criteria were categorized as poor ovarian response (POR). Clinical outcomes assessed included clinical pregnancy, miscarriage, and live birth rates. Participants/materials, setting, methods Paternal risk factors include male age, semen parameters (CEROS II CASA, Hamilton-Thorne), and two types of SDF evaluation. LensHooke® R10 kit (Bonraybio, Taiwan) was used to detect total SDF (tSDF), which includes single-strand breaks and double-strand breaks (DSBs). LensHooke® R11 kit was specifically used for DSB detection. Kruskal-Wallis test was conducted to compare controls and cases of ART failure. Univariate and multivariate logistic regression analyses were employed to identify potential factors. Main results and the role of chance We sought to evaluate paternal effects during the early gestation stage by comparing parental characteristics in groups with clinical pregnancy and those without pregnancy. No significant differences in paternal indications were observed between the groups. Notably, significantly lower AMH levels and advanced maternal age were prevalent in pregnancy failures across both normal responders and POR cases, highlighting maternal factors’ dominance in these outcomes. When dissecting paternal effects during the later gestation stage, male factors did not show a significant difference between the group with live birth and the group with miscarriage among normal responders. Nevertheless, several paternal pathogenic indications were identified between the groups in POR. Miscarriages were associated with compromised sperm total motility (68% vs. 54.5%, p = 0.01), reduced normal morphology rate (5.5% vs. 2.5%, p = 0.03), and elevated DSB levels (7.5% vs. 18.8%, p = 0.01). Furthermore, multivariate regression analysis identified high DSBs as an exclusive paternal factor in miscarriage risk (Odds ratio: 1.19, 95% confidence interval 1.04–1.36, p = 0.01). In the ROC curve, a DSBs threshold of 19%, based on the R11 technique, offers significant value in predicting miscarriage with an accuracy of 81%. Limitations, reasons for caution The limitations of the current study are single-center trial, and relatively small sample size. Further clinical trials are needed to robustly establish the relationship between DSB and miscarriage. Wider implications of the findings The impact of DSBs is overlooked in normal responders but not in POR due to different levels of maternal DNA repair activity. These results advocates for (1) the necessity of DSBs (R11) assessment for POR, and (2) egg donation as a potential strategy for couples facing high DSBs and POR. Trial registration number CS2-20012

P-334 Hysterosalpingo-Contrast-Sonography: a key step in the female infertility workup?

Abstract Study question The main objective of this study is to estimate the possibility of offering Hystero-Salpingo-Contrast-Sonography (HyCoSy) as a first-line diagnosis test in the female infertility exploration Summary answer HyCoSy represents a key step in decision-making regarding subsequent steps in infertility diagnosis and treatment What is known already In this age of rising rates of infertility; the evaluation of the fallopian tubes and the endometrial cavity in an essential part of the infertility investigation. Traditionally hysterosalpingography has been used to evaluate tubal patency; but it has many disadvantages; laparoscopy and hysteroscopy are at present considered as the gold standard techniques for tubal and endometrial cavity assessment, respectively. Hysterosalpingo- Contrast –Sonography or HyCoSy was introduced over 20 years ago since 1981; it allows to gynecologist to evaluate the fallopian tubes the uterus and the ovaries with only one ultrasound in the office. Study design, size, duration During two years, one hundred and sixty-seven patients with a context of female infertility with normal spermogram were included in our prospective and descriptive study, Participants/materials, setting, methods Our patients underwent: a Hysterosalpingography (HSG), a Hysteroscopy, a Laparoscopy and as part of our study: a Hystero-Salpingo-Contrast-Sonography (HyCoSy), a comparison was made between the tubal and uterine parameters found by the HyCoSy with those of the HSG after comparison with the data shown by the Gold Standard techniques: Laparoscopy and Hysteroscopy, also we evaluated the failure rate, its duration, its tolerability, its cost, its complications, its limitations and the rate of post-HyCoSy pregnancies. Main results and the role of chance The technique was impossible in 4 patients, so a failure rate of 2.4%, the average duration of the procedure was 17+/-1 min (10-30 min), generally well tolerated, pain assessment found an average of 3 on the VAS (2-4), the rate of all minor complications was 8.85% at 5 min and 3.06% at 15 min, no case of allergy to the contrast product was noted. Following the 4 cases of failures the comparison was only possible in 163 patients, after comparing the data with the GOLD STANDARDS For the tubal permeability we noted almost perfect concordances between the three techniques HyCoSy, HSG and laparoscopy, with a concordance of 0.87 between HyCoSy versus laparoscopy (p value at 0.34) and 0.85 between HSG versus laparoscopy (p value at 0.18), For the uterine cavity evaluation the comparison of hydrosonography(step one of our technique) to hysteroscopy finds an almost perfect agreement at 0.88 (p value at 0.71) in contrast to a low agreement at 0.27 between the HSG and the gold standard (p value <0.02). Our technique also allows us to carry out a morphological and functional assessment of the ovaries as well as a study of the peritoneal cavity. Limitations, reasons for caution A disadvantage of this technique is the rate of false results, regardless of the contrast product used. However, it is important to note that these errors also occur when using an HSG, or during a Laparoscopy.A review of the literature allows us to identify the causes and identify solutions. Wider implications of the findings It is important to work more on improving exploration techniques by working to ensure that they are as precise, tolerable, of certain safety and as economical as possible and why not with a therapeutic effect. Trial registration number not applicable

P-435 Superiority of modified natural cycle vs hormonal replacement therapy in non-menopausal egg recipients of advanced maternal age: clinical outcomes from 1273 single blastocyst transfer cycles

Abstract Study question Is the modified natural cycle (mNC) better than hormonal replacement therapy (HRT) for endometrial preparation in non-menopausal egg recipients of advanced maternal age? Summary answer In women above 40 years, mNC shows better reproductive and obstetrical outcomes compared to hormonal replacement therapy, especially in the subgroup 45-50 years old. What is known already There is extensive evidence showing the superiority of mNC over HRT in terms of live birth rates, miscarriages, and even obstetric complications. Apparently, the presence of the corpus luteum plays a major role in endometrial receptivity and embryo implantation, probably allowing for better placentation. Nevertheless, there is a general belief that the ovulatory cycle of older women is not the best choice for endometrial preparation, although paradoxically they are the group of patients who could benefit most from the reduction of obstetric complications. An increase in cancellation rates for mNC is claimed, without consistent data available. Study design, size, duration Retrospective single-centre comparative clinical study, including 1273 endometrial preparation cycles for frozen single-blastocyst transfer between January 2020 and December 2022: 892 (70,2%) on HRT protocol and 381 (29,8%) on mNC protocol. The two groups were homogeneous for donor’s age (25,7 years HRT vs 25,3 years mNC), recipient’s age (42,2 years HRT vs 42,1 years mNC), severe male factor (6% HRT vs 5% mNC), and the need for a sperm donor (28% HRT vs 26% mNC). Participants/materials, setting, methods Among 1273 started non-menopausal recipient’s cycles, we compared cancellation rates between HRT and mNC due to either medical reasons (inadequate endometrium, bleeding, premature ovulation) or other issues (no embryo survival, COVID-19, etc). We studied the outcomes of the 1096 elective frozen single-blastocyst transfers performed, comparing HRT and mNC cycles for: pregnancy, clinical pregnancy, miscarriage, live birth and <35weeks preterm birth rates. We stratified the results by age and used Chi-square test to compare groups (p < 0,05). Main results and the role of chance The overall cancellation rate was 13.9%. No significant differences in cancellation for medical reasons were found between HRT (7%) and mNC (6.8%), p = 0.93. When we analyse results stratified by age, patients aged 39 or less (270 cycles: HRT 75.9%, mNC 24.1%) showed no statistically significant differences in pregnancy (58% vs 64.6%, p = 0.35), clinical pregnancy (50.7% vs 56.9%, p = 0.34), miscarriage (18.3% vs 18.9%, p = 0.93), and live birth rates (41.5% vs 46.2%, p = 0.5). In the 40-44 age group (494 cycles: HRT 64.2%, mNC 35.8%), no statistically significant differences were found between HRT and mNC in pregnancy (58.2% vs 61.5%, p = 0.47), clinical pregnancy (50.8% vs 51.1%, p = 0.96), and live birth rates (40.4% vs 45.8%, p = 0.25). The HRT group had a significantly higher miscarriage rate (21%) compared to mNC (10%), p = 0.03. For patients aged 45-50 years (332 cycles: HRT 72%, mNC 28%), no statistically significant differences were observed in pregnancy (56.5% vs 62.4%, p = 0.33) and miscarriage rates (24.3% vs 15.1%, p = 0.18). Clinical pregnancy (44.8% Vs 57%, p = 0.04) and live birth rates (33.9% vs 48.4%, p = 0.01) were significantly higher in the mNC group compared to HRT. No significant differences were found between HRT and mNC in preterm birth rates <35 weeks (3.6% vs 4.6%, p = 0.75). Limitations, reasons for caution This study is a single-centre retrospective comparative trial. Our homogeneity study included several confounding variables, however other bias such as severe uterine factor, embryo quality or repeated implantation failure cases were not taken into account. Wider implications of the findings Modified natural cycle should be encouraged as the first option for endometrial preparation in non-menopausal egg recipients of advanced maternal age, having shown superiority over hormonal replacement therapy in patients aged 45-50 years. Moreover, modified natural cycles are more patient friendly and cost-effective, with no increase in the cancellation rates. Trial registration number not applicable

Intravaginal probiotics before embryo transfer do not improve pregnancy rates in recurrent implantation failure cases: An RCT.

Considering the considerable influence of the vaginal microbiome on endometrial receptivity and embryo implantation, we hypothesized that cases of recurrent implantation failure (RIF) might benefit from the intravaginal probiotic administration. Evaluation of the effects of intravaginal probiotic administration before frozen embryo transfer (FET) on the rates of pregnancy and the status of vaginal lactobacillary flora in cases of RIF. This was a randomized, parallel-group, clinical trial conducted at an infertility clinic in Tehran, Iran between January 2021 and September 2022. A total of 166 reproductive-aged women with a history of unexplained RIF were randomly assigned to either the probiotic group or the control group (n = 83/each group). The probiotic group received intravaginal probiotics (LactoVagⓇ) daily for 2 wk from the second day of the menstrual cycle along with the routine treatment of FET. The control group received only the routine treatment of FET. The primary outcome was the chemical pregnancy rate, and the secondary outcomes were the clinical pregnancy rate and the status of vaginal lactobacillary flora. A total of 163 participants were included in the final analysis. The probiotic group had a slightly higher chemical pregnancy rate than the control group (39.02% vs. 33.33%), but the difference was not statistically significant (risk ratio: 1.71, 95% CI: 0.77-1.76; p = 0.449). The clinical pregnancy rate was also non-significantly higher in the probiotic group than the control group (37.80% vs. 33.33%; RR: 1.14, 95% CI: 0.76-1.74; p = 0.623). Intravaginal probiotic administration did not significantly improve the pregnancy rates in RIF cases undergoing FET. Further studies are needed to explore the optimal dose, duration, and timing of probiotic administration, as well as the mechanisms of action and the potential adverse effects of probiotics on the vaginal microbiome and the implantation process.

Drug-induced Liver Injury Caused by Levetiracetam

Levetiracetam, known as Keppra, is an antiepileptic drug that is commonly used due to its rare side effects, particularly on the liver. It is mainly excreted by the kidneys with minimal hepatic metabolism. Drug-induced liver injury associated with Levetiracetam is extremely rare. Few cases of Levetiracetam-induced liver toxicity and failure were declared. Until now, there are no previously reported cases of mixed pattern liver injury related to this drug. We report a case of a patient taking Levetiracetam, that was found to have mixed pattern liver injury. Our patient experienced important rapid improvement of hepatocellular injury and a delayed improvement of cholestatic pattern after Levetiracetam discontinuation, suggesting the mentioned association. This case report is the first to establish both hepatocellular and cholestatic injury associated with Levetiracetam. We would like to highlight this side effect, though rare, of this frequently used drug in medical practice.

Fingertip amputations in children: Atasoy flap’s indications and limitations

IntroductionThe Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications. HypothesisThe Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children. Materials and methodsFifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed. ResultsForty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3). ConclusionThe Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk. Level of evidenceIV; retrospective study.

Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older

PurposeThe purpose of this study was to compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports. MethodsBetween 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients with concomitant meniscus, cartilage and MCL injury were also included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or ipsilateral osteoarthritis (Ahlback stage 2 or higher) were excluded. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. Mann-Whitney test was used for unpaired samples, whereas the Friedman test was used for analyzing variables over time. The chi-square statistic test was used to determine differences in categorical data between groups ResultsThe number of patients in the QT and HT groups was 85 and 143 respectively. The mean age was 54.4 [50-65] and 56.4 [50-65] for the QT and HT groups respectively, 49% and 51% were males in the QT and HT groups respectively. The two groups did not differ significantly in terms of age, gender, time from injury to surgery and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). At the 2-year follow-up, Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores between the two groups (p>0.05).Furthermore, at the 2-year follow-up, Lysholm score, and VAS didn't show significant differences between QT and HT groups. (p=.390; p= .131). Similarly, no differences have been reported in Tegner activity level scores between HT and QT groups at 2 years of follow-up. No significant differences in terms of minimal clinically important difference (MCID) have been detected between the two groups for Lysholm and Tegner activity scores (p = 0.410 and p = 0.420 for Lysholm score and Tegner activity level score respectively).The two groups did not differ in terms of patient’s percentage of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease (p=0.01) in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline [116 (81%) vs 98 (69%)]. No case of graft failures and quadriceps tendon rupture was reported in either of the groups. ConclusionArthroscopic ACL reconstruction by using HT or QT autograft in athletically active older than 50 years patients provide satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity.

Tryptophan and Its Derived Metabolites as Biomarkers for Tuberculosis Disease: A Systematic Review

Feasible diagnostic assays are required to detect new tuberculosis (TB) cases and monitor treatment. This study aimed to evaluate evidence on tryptophan (Trp) and its metabolites as proposed biomarkers for TB. Through specific keyword searches, we identified 170 relevant literature sources and included seven publications (from 2013 to 2023). The biomarker used in these studies were indoleamine 2, 3-dioxygenase (IDO) activity, IDO-1 gene expression, and plasma IDO protein, measured using ELISA, liquid chromatography-mass spectrometry, ultraperformance liquid chromatography mass spectrometry, and transcriptional profiling. The studies encompassed a pediatric case-control and six studies involving adults, pregnant women with TB-HIV, and individuals with multidrug-resistant tuberculosis, active TB, and latent TB. The assessment of IDO activity and IDO protein level demonstrated promising performance in distinguishing active TB from controls and in evaluating treatment failure and recurrent cases to controls. Trp and its metabolites fulfilled nearly all of target product profile criteria for detecting active TB. This study highlights the potential of utilizing host Trp and its metabolites as non-sputum-based biomarker for TB infection.

Autogenic Molar Transplantation of Third Molar with Complete Root Formation Versus Incomplete Root Formation: A Prospective Clinical Study.

The aim of the study was to assess and compare the efficacy of autotransplantation of molars with complete and incomplete root formation, by checking the viability of the procedure to replace non-restorable molar teeth in the extraction sockets. Twenty patients with non-restorable molars were included in this study. They were divided into two groups with complete and incomplete root-formed third molars, which needed to be transplanted in place of non-restorable molars. A routine surgical procedure was performed to remove infected molars. Atraumatic removal of the third molar was performed and reimplanted in the socket of previously extracted infected molars. Results were evaluated based on clinical observation and radiographic analysis of the transplanted tooth. Out of 20 transplants, one transplant, despite good initial stability, was extracted after one month because of abnormal horizontal and axial mobility; this was the single failure case (5%). Of the rest, 19/20 (95%) transplants were followed up for 6 months and showed no failure. This study clearly indicated that the benefits of autotransplantation over other treatment options are numerous, and the results are not affected by whether the root of the transplanted tooth is complete or incompletely formed.

Failure analysis and structural optimization of abnormal cracking of through-channel support seats of digital rail vehicles

In this paper, the failure analysis and structural optimization of a new type of digital rail vehicle throughway support bracket with abnormal cracking are investigated. This paper addresses the failure case of a new digital rail vehicle throughway bracket. From the simulation point of view and the vibration test point of view of the service line, it verifies and reproduces the reasons for the fatigue fracture failure of the original through-channel bracket structure. The fatigue fracture failure of the throughway bracket is caused by external excitation. The shortcomings of the optimized structure of the through-channel support filled with steel plates are explained from the simulation point of view and the fracture mechanics damage tolerance theory. The feasibility of the vibration decoupling optimized structure is completely evaluated from the service line perspective and simulation perspective, and the results show that the service environment load of the vehicle meets the life requirements, and the research method can provide guidance for the service safety and fatigue life assessment of other components of the new type of digital rail vehicles.

THE EFFECTIVENESS OF EMPIRIC TRANSARTERIAL GLUE EMBOLIZATION (TAGE) OF GASTRODUODENAL ARTERY (GDA) FOR BLEEDING DUODENAL ULCER - A RETROSPECTIVE STUDY

ABSTRACT: Purpose To conduct a clinical audit on clinical outcome of empiric transarterial glue embolization (TAGE) of gastroduodenal artery (GDA) for bleeding duodenal ulcers to evaluate treatment efficacy. Materials and Methods All patients treated for bleeding duodenal ulcers between June 2019 and June 2023, in a single tertiary center (Penang General Hospital) were identified based on intervention radiological reports. Patients with bleeding duodenal ulcers underwent empiric transarterial glue embolization (TAGE) of gastroduodenal artery (GDA) following endoscopic hemostasis were included. Information was extracted from patients' medical records, endoscopic and radiological reports. Data was computed and analyzed using Statistical Package for Social Sciences (SPSS). Results During the study period, a total of 26 patients were planned for empiric transarterial glue embolisation (TAGE) of gastroduodenal artery (GDA) for bleeding duodenal ulcer. The median age was 68 with 68% male (n=18) and 32% female (n=8). A total of 25 patients with duodenal ulcers of Forrest 1a (n=5), 1b (n=12), 2a (n=4), 2b (n=3) and 2c (n=1) who successfully underwent prophylactic TAGE of GDA were included in this study. It has a high technical success rate of 96.2% (n=25) with only one case of failure in cannulation due to tortuous arterial anatomy. Clinical success rate amongst the 25 patients who successfully underwent empiric TAGE of GDA was 84% (n=21) with only four patients developed rebleeding and required repeated endoscopic clipping. One of the four patients succumbed secondary to refractory bleeding. Conclusion Empiric transarterial glue embolisation (TAGE) of gastroduodenal artery (GDA) can be a useful adjunct treatment option in high risk bleeding duodenal ulcer with high technical and clinical success.

Comparison between Total Hip Arthroplasty for Avascular Osteonecrosis of Femoral Head and That for Fixation Failure of Femoral Neck Fracture

Objective: To compare the clinical and radiologic results between primary total hip replacement arthroplasty (THRA) in patients with avascular necrosis of femoral head (AVN) and secondary THRA in patients with fixation failure of femoral neck fracture.Methods: From March 2014 to February 2021, we retrospectively evaluated a total of 53 patients who underwent either THRA for AVN (33 cases) or THRA for fixation failure of femoral neck fracture (20 cases). Clinical performances and Hemodynamic scales were evaluated. Radiologic analyses were conducted to assess stem alignment, stem stability, the appearance of heterotrophic ossification, stress shielding, and any signs of osteolysis or loosening.Results: THRA for AVN showed a mean blood loss of 881 mL and a 2.1 g/dL preoperative–postoperative (preop–postop) hemoglobin (Hb) difference. Meanwhile, THRA for fixation failure of femoral neck fracture showed a mean blood loss of 1,072 mL and a 3.2 g/dL preop–postop Hb difference (P= 0.017 and P= 0.034, respectively). The mean operation time was 70 minutes in THRA for AVN and 91 minutes in THRA for fixation failure of femoral neck fracture (P= 0.035). Stem alignment was varus 1.50° in AVN and varus 3.50° in fixation failure of femoral neck fracture. There was one case of a varus femoral stem in AVN and six such cases in the fixation failure of femoral neck fractures. This was a statistically significant difference (P= 0.010 and P= 0.020, respectively).Conclusion: Secondary THRA in patients with fixation failure of femoral neck fracture showed longer operation time, larger bleeding, and more varus stem alignment than primary THRA in patients with AVN.

Consumer Protection Agency’s crisis management for children’s kidney failure cases in Indonesia

Background: The Badan Perlindungan Konsumen Nasional Republik Indonesia (BPKN RI) is a government institution dedicated to protect consumer rights nationwide. In August 2022, instances of kidney disorders affecting children emerged in various regions of Indonesia, necessitating BPKN’s involvement in addressing these cases. Purpose: This study examines how crisis communication factored into BPKN RI’s crisis management strategy during the 2022 outbreak of atypical progressive acute kidney injury (APAKI) in children. Methods: The theoretical framework guiding this research encompasses organizational theory, corporate communication theory, crisis communication theory, and crisis management theory. Employing a descriptive qualitative approach, data collection involves interviews, internet observations, and document analysis. Interviews were conducted with key figures, including the secretary of BPKN RI, the Public Relations and Education Division of BPKN RI, and the Investigation Team for APAKI cases in children. Results: The research findings reveal that BPKN RI’s crisis management process involves identifying the crisis, analyzing its implications, isolating the crisis, formulating a strategy, and implementing a crisis control program, with crisis communication as the fundamental element of the crisis management strategy. Conclusion: BPKN RI’s crisis management strategy prioritizes public welfare, ensuring easy public access, and maintaining transparency and honesty. Implications: BPKN RI disseminates regular and periodic information to the public, designates the Chairman of BPKN RI as the spokesperson, monitors community sentiments and media coverage, and establishes a public information center.

Extracorporeal Membrane Oxygenation for Respiratory Failure: A Narrative Review.

Extracorporeal membrane oxygenation support for respiratory failure in the intensive care unit continues to have an expanded role in select patients. While acute respiratory distress syndrome remains the most common indication, extracorporeal membrane oxygenation may be used in other causes of refractory hypoxemia and/or hypercapnia. The most common configuration is veno-venous extracorporeal membrane oxygenation; however, in specific cases of refractory hypoxemia or right ventricular failure, some patients may benefit from veno-pulmonary extracorporeal membrane oxygenation or veno-venoarterial extracorporeal membrane oxygenation. Patient selection and extracorporeal circuit management are essential to successful outcomes. This narrative review explores the physiology of extracorporeal membrane oxygenation, indications and contraindications, ventilator management, extracorporeal circuit management, troubleshooting hypoxemia, complications, and extracorporeal membrane oxygenation weaning in patients with respiratory failure. As the footprint of extracorporeal membrane oxygenation continues to expand, it is essential that clinicians understand the underlying physiology and management of these complex patients.

Field test on thermal control for bridge piers on plateau through energy pile

This study presents a sustainable thermal control method (energy pile technology) for bridge piers in high-altitude regions, addressing the challenges posed by temperature variations in mass concrete structures. The proposed method involves integrating various heat exchange tubes within the pile foundation, pile cap, and bridge pier concrete to harness shallow geothermal energy. This paper summarizes failure cases of bridge structures due to the impact of thermal loads. Through three field tests on a plateau, the feasibility and practicality of the energy pile technology are verified. The system exhibits promising results, achieving a maximum temperature difference reduction of 3.9°C and a reduction of 53.4%. Furthermore, the method has effectively reduced the expansion strain on the sunny side of the bridge piers, with a maximum reduction of up to 44.4%. Importantly, the energy pile technology has minimal impact on the pile foundation, with negligible constrained stress variation. The study evaluates the heat exchange efficiency and energy efficiency of the energy pile-based system, reporting stable heat exchange rates and a comprehensive Coefficient of Performance (COP) reaching up to 4.0. The findings highlight the potential of this sustainable temperature control methodology to enhance the resilience and longevity of critical infrastructure in challenging climates.

Service Performance in Banks: The Effects of Customer Relationship Management Systems Extended Usage

With the rapid development of information technology, customer relationship management systems (CRMS) have been widely adopted by banks and play a crucial role in customer development and retention. However, there are also numerous cases of CRMS implementation failures. Further, employees are enabled by CRMS to make service decisions with the support of leaders. The role of leaders in employees’ CRMS usage is understudied. Thus, based on the information systems diffusion model and the theory of leader substitutes, a research model is proposed and empirically tested. The results show that employee CRMS explorative usage has a positive impact on their service performance, while employee CRMS exploitative usage has a significant negative impact on service performance. Besides, significant leadership substitution effects are discussed in CRMS usage.

Wireless Data Acquisition System with Feedback Function

When operating solar–wind power plants (SWPPs) located in populated areas, cases of premature failure of expensive batteries and other power equipment often occur. The purpose of this study is to develop a wireless data acquisition system (DAS) for the operation of an SWPP with a feedback function to prevent material damage from the failure of power equipment and to increase the efficiency of natural energy use. The principles of constructing a DAS, free from some of the disadvantages of analogues, are described in this paper. Intelligent wireless current and voltage sensors and a device for receiving and recording data with an additional feedback function have been developed, providing real-time feedback when the measured parameters go outside the norm. Measurement data are displayed on the laptop screen and alphanumeric display and stored on the hard drive along with timestamps and current event messages. An example of using a reverse communication channel to implement the functions of backup battery protection and to switch SWPP loads is described. The principles and methods proposed in this article are suitable for constructing systems for remote measurements of any physical quantities; therefore, the scope of application of the described system can be significantly expanded.

Relationship between N-terminal pro-brain natriuretic peptide concentration and heart-type fatty acid-binding protein in postmortem urine

The clinical use of N-terminal pro-brain natriuretic peptide (NT-proBNP) and blood concentrations of heart-type fatty acid-binding protein (HFABP) is well-established in diagnosing heart conditions. However, their applicability in forensics is controversial due to postmortem changes. NT-proBNP and HFABP are excreted in the urine due to their small molecular weights and may be found in postmortem urine samples; however, their correlation has not been evaluated. In this study, we compared the concentrations of urinary NT-proBNP and HFABP in 386 forensic autopsy cases. The urinary NT-proBNP levels were significantly higher in acute myocardial infarction (AMI), congestive heart failure (CHF), sepsis, and hyperthermia cases, with the highest levels in CHF cases. Similarly, HFABP concentration was significantly higher in CHF, sepsis, and hyperthermia cases, with the highest level observed in hyperthermia cases. However, the difference in urinary HFABP levels between the AMI and control cases was not significant. Our analysis revealed a correlation between postmortem urine NT-proBNP and HFABP levels, and the NT-proBNP/HFABP ratio was high in patients with CHF and sepsis cases and low in those with hyperthermia. The difference between the ratios was possibly due to the combined release of ventricular myocardial cells in response to ventricular wall stress and myocardial injury for NT-proBNP, as well as myocardial and skeletal muscle injuries for HFABP. This study, for the first time, demonstrates the utility of postmortem measurements of urinary NT-proBNP and HFABP levels, offering valuable insights for improving the accuracy of postmortem diagnosis in forensic medicine.

Identification of pediatric activated T-cell hepatitis using clinical immune studies

Background and aimsThe majority of indeterminate pediatric acute liver failure (PALF) cases are secondary to immune dysregulation, labeled activated T-cell hepatitis (TCHep). We aimed to describe a cohort of children with acute severe hepatitis and PALF and define how clinical immune labs may help identify the TCHep group. MethodsRetrospective review of children with acute hepatitis and PALF between March 2020 and August 2022. Patients were classified as known diagnosis, indeterminate hepatitis (IND-Hep), or TCHep (defined by liver biopsy with predominant CD8 T-cell inflammation or development of aplastic anemia). Results124 patients were identified: 83 with known diagnoses, 16 with TCHep, and 25 with IND-Hep. Patients with TCHep had significantly increased median total bilirubin levels (7.5 mg/dL (IQR 6.8–8.9) vs 1.5 mg/dL (IQR 1.0–3.6), p < 0.0001), soluble interleukin-2 receptor levels (4512 IU/mL (IQR 4073–5771) vs 2997 IU/mL (IQR 1957–3237), p = 0.02), and percent of CD8+ T-cells expressing perforin (14.5 % (IQR 8.0–20.0) vs 1.0 % (IQR 0.8–1.0), p = 0.004) and granzyme (37.5 % (IQR 15.8–54.8) vs 4.0 % (IQR 2.5–5.5), p = 0.004) compared to IND-Hep patients. Clinical flow cytometry showed that TCHep patients had significantly increased percent CD8+ T cells (29.0 % (IQR 24.5–33.5) vs 23.6 % (IQR 19.8–25.8), p = 0.04) and HLA-DR+ (16.0 % (IQR 14.5–24.5) vs 2.7 (1.8–5.3), p < 0.001) compared to IND-Hep patients indicative of increase in CD8+ T cells that are activated. ConclusionsPeripheral blood clinical immune studies demonstrate increased markers of CD8 T-cell activation, proliferation, and cytotoxic function for TCHep patients. These readily available immune function labs can be used to help distinguish patients with TCHep from those with other causes. This provides a non-invasive tool for early detection of potential TCHep before progression to liver failure.