Center Experience In Treatment Research Articles

Triple therapy in pyridoxine-dependent epilepsy: A single center experience in treatment of 7 patients and evaluation of their outcomes

Triple therapy in pyridoxine-dependent epilepsy: A single center experience in treatment of 7 patients and evaluation of their outcomes

Outcomes and Genomic Landscape of Patients Treated with Re-Irradiation for Recurrent Head and Neck Cancer Using Pencil Beam Scanning Proton Therapy: The Maryland Proton Treatment Center Experience

Outcomes and Genomic Landscape of Patients Treated with Re-Irradiation for Recurrent Head and Neck Cancer Using Pencil Beam Scanning Proton Therapy: The Maryland Proton Treatment Center Experience

Pegylated liposomal doxorubicin (PLD) in daily practice-A single center experience of treatment with PLD in patients with comorbidities and older patients with metastatic breast cancer.

Real-world data about pegylated liposomal doxorubicin (PLD) in patients with metastatic breast cancer (MBC) are limited. We have aimed to highlight the role of PLD in daily practice focusing on older patients and patients with comorbidities with MBC. We analyzed electronic records of all patients with advanced/metastatic breast cancer treated with single-agent PLD at the University Hospital Basel between 2003 and 2021. Primary endpoint was time to next chemotherapy or death (TTNC). Secondary endpoints were overall survival (OS), progression-free survival (PFS), and overall response rate (ORR). We performed univariate and multivariate analysis for clinical variables. 112 patients with MBC having received single-agent PLD in any treatment line were analyzed, including 34 patient who were older than 70 years and 61 patients with relevant comorbidities. Median TTNC, OS, and PFS for treatment with PLD were 4.6, 11.9, and 4.4 months, respectively. ORR was 13.6%. Age >70 years predicted shorter OS (median 11.2 months) in multivariate analysis (hazard ratio [HR] 1.83, 95% CI 1.07-3.11, p = 0.026). Age and comorbidities did not significantly affect other endpoints. Unexpectedly, hypertension predicted longer TTNC (8.3 months, p = 0.04) in univariate analysis, maintained in multivariate analysis as a trend for both TTNC (HR 0.62, p = 0.07) and OS (HR 0.63, p = 0.1). Age predicted shorter OS significantly but median OS was not relevantly shorter in older patients. PLD remains a treatment option in patients with comorbidities and older patients with MBC. However, our real-world results of PLD appear underwhelming compared to relevant phase II trials through all age groups, pointing to an efficacy-effectiveness gap, possibly due to sampling bias.

SIOG2022-0076 - Pegylated liposomal doxorubicin (PLD) in daily practice – A single center experience of treatment with PLD in elderly and co-morbid patients with metastatic breast cancer

SIOG2022-0076 - Pegylated liposomal doxorubicin (PLD) in daily practice – A single center experience of treatment with PLD in elderly and co-morbid patients with metastatic breast cancer

Management and outcomes of mild hemophiliacs and hemophilia carriers during pregnancy and peripartum period: a hemophilia treatment center experience in the United States

Background Pregnancy, peripartum management, and outcomes of mild hemophiliacs and hemophilia carriers in the United States are not well established. Aim To describe the management and outcomes of mild hemophiliacs and hemophilia carriers during assisted conception, pregnancy, peripartum and post-partum period at our hemophilia treatment center (HTC). Methods Retrospective review of electronic medical records of pregnant women with mild hemophilia A or B (Factor VIII [FVIII] or Factor IX [FIX] level <0.4 IU/mL) and hemophilia A and B carriers followed at our HTC from January 2008 to October 2020. Demographics, the reason for diagnosis, FVIII and FIX levels at baseline and third trimester, bleeding phenotype and genotype were obtained. Method of conception, factor replacement, iron supplementation, mode of delivery, type of anesthesia, peripartum complications, and offspring outcomes was recorded. Results There was a total of 18 pregnancies in 12 women (2 with mild hemophilia A, 2 mild hemophilia B, 6 hemophilia A carriers, and 2 hemophilia B carriers). Eleven pregnancies (61%) were conceived naturally and 7 (39%) via in-vitro fertilization (IVF). Eight (44.4%) and 10 (55.6%) pregnancies were vaginal and C-section deliveries, respectively. Neuraxial anesthesia was administered in 17 (94.4%) deliveries without complications. Four pregnancies (22.2%) had bleeding complications, 2 of which were post-partum hemorrhages not requiring transfusion. Conclusion In our case series of pregnant hemophilia carriers and mild hemophiliacs, successful outcomes were achieved with a carefully detailed multidisciplinary-driven approach.

Multicentric Castleman disease: A single center experience of treatment with a focus on autologous stem cell transplantation.

Castleman disease (CD) is a rare lymphoproliferative disease characterized by diverse clinical and pathologic features. Due to its rarity, there are limited studies comparing currently available therapies. The role of autologous stem cell transplantation (ASCT) in CD has not yet been established. In this paper, we describe the clinical characteristics, treatment choices, and outcomes in 34 Mayo Clinic patients diagnosed with multicentric CD from July 1, 2003 to April 30, 2018. Eighteen patients (53%) also met the criteria for POEMS, including 14 with the osteosclerotic variant. The first-line treatments included: steroid monotherapy (4), cytotoxic chemotherapy (6), rituximab alone (8) or with chemotherapy (2), anti-IL6 treatment (3), and ASCT (10). The median follow-up was 4.8 (range: 0.1-15.2) years. The 5- and 10-year overall survival rates were 84% and 71%, respectively. Sixteen patients received high-dose chemotherapy followed by ASCT during their disease course. Among those, 14 had multicentric CD associated with POEMS. There were no transplant-related deaths. All patients had at least a partial response to ASCT, most of whom achieved a complete response. The favorable outcomes seen with ASCT in this cohort suggest that transplantation may have a role in multicentric CD, particularly for patients with multicentric CD associated with POEMS.

Impact of COVID 19 Pandemic on Health Care Utilization for Patients with Sickle Cell Disease - a Specialty Treatment Center Experience

Introduction:Starting in March 2020, the coronavirus 19 disease (COVID-19) pandemic affected the United States (US) health care system. Many individuals were afraid to seek medical care due to fear of obtaining COVID-19; therefore, there was a high frequency of adults forgoing medical care. Chronic conditions including diabetes, COPD, mental health, and HTN outcomes worsened due to decrease in routine care during the pandemic. Sickle cell disease (SCD) is a chronic blood disorder that causes numerous complications including but not limited to vaso-occlusive crisis, strokes, and chronic kidney disease. Individuals who have routine follow up with a hematologist have been shown to have decreased hospitalizations, ER visits, length of stay, and opiate usage. The Inland Empire region of Southern California is one of the densest hot spots for patient's living with sickle cell disease in terms of disease burden and health care utilization. Therefore, we evaluated how the COVID-19 pandemic affected health care utilizations with individuals with SCD in this area.Methods:A retrospective analysis of the health care utilization in the inpatient setting was performed at three time points in line with the C.D.C. COVID pandemic declaration (Pre COVID: September 2019 to February 2020, Intra COVID 1: March 2020 to Sept 2020, Intra COVID 2: October 2020 to February 2021). Primary endpoints included emergency room visits, inpatient admissions, and length of stay, blood product utilization, and opioid utilization. Secondary endpoints and analyses included pediatric vs. adult health care utilization disparity and outcomes. Descriptive analysis was done by calculating frequency and percentages for categorical variables and mean and standard deviation for continuous variables.Results:Shown in Result TABLE attached .Patients seeking inpatient care for scheduled procedure's/ transfusion were excluded from this analysis. Patients with SCD diagnoses of acute SCD crises (pan crisis /chest syndrome / COVID infection / Pneumonia) were included in assessment. Absolute number of patients per ED visit, patient per Inpatient admission frequency has been shown in more detail in the bar chart in Figure and will be presented in the oral presentation along with detailed data analysis box plots and charts.Discussion:Fewer patients' sought timely care for acute SCD event leading to fewer but prolonged hospitalizations, a trend seen in our adult and pediatric patient's across the board during intra COVID 1 and 2 time points, likely due to the fear of contracting COVID infection at an acute health care setting in a declared pandemic . Similarly, we found there were less unique sickle cell patients using the ER for both pediatric and adult patients during the pandemic. There was a decrease in the amount of hospital admission related to sickle cell disease, which was similar to results published in the United Kingdom. More sickle cell vaso-occlusive crisis were being managed at home, likely due to avoidance of COVID exposures at health care facilities, likely thus leading to certain individuals having more severe crisis as shown by increased LOS in our adult population. Additionally, only a few individuals with likely more severe crisis needed more RBC transfusions. The general trend for different patients requiring RBCs and IV opiates decreased during the pandemic. Due to more people foregoing medical care especially in the minority populations who had restrictions to access to healthcare, there was an overall decrease in inpatient healthcare utilization in sickle cell population during the pandemic. Additionally care disparities in outcome of pediatric and adult SCD patients were highlighted by our study. Pediatric patients commonly cared at a center of excellence by the dedicated team of sickle cell stakeholders, seemed to do well overall as compared to adult SCD patients who notoriously have has inequitable access to comprehensive Sickle Cell care globally.Infrastructure around better outpatient support, care optimization with sickle cell disease modifying agents and timely access to inpatient care even in a pandemic, that is ongoing could be strategies to reduce stress on the health care systems and better utilization of scarce resources in current times of surge from an International health care crisis such as the SAR CoV2 pandemic. [Display omitted] DisclosuresJain: GBT: Consultancy; CSL Behring: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Octapharma: Consultancy; Blue Bird Bio: Consultancy.

Clinical Analysis of Hospitalized Patients with Hemophilia A: Single-hemophilia Treatment Center Experience in Korea over 10 years.

BackgroundThere is lack of data on admitted hemophilia patients in Korea. For this reason, this study was intended to analyze the hospitalization data of hemophilia patients in a regional Hemophilia Treatment Center (HTC) for the first time in Korea.MethodsIn this retrospective study, we surveyed hospitalized patients with Hemophilia A (HA) in a HTC for 14 years. Medical records of these hemophiliacs were reviewed and data regarding demographic characteristics, cause of admissions and their outcomes in each patient were obtained. In addition, the data of admitted days, type and amount of Coagulation factor concentrate (CFC) used, treatments other than CFC infusion during the admission days were also obtained from the medical record of each patient.ResultsA total 107 patients with hemophilia A were admitted during 14 years. Annual rate of admission of patients with HA was 8%. Mean age on admission was 29.63±19.51 years old and mean admission days were 11.28±5.46 days. Most admissions were occurred in severe and moderate hemophilia patients. The most common cause of admission was bleed control followed by surgery and other reasons. With modified WFH CFC supplementation guideline, all the bleeds were successfully controlled and all surgeries were also successfully conducted with less total CFC consumption compared to the consumed dose of other reports.ConclusionThese results suggest that it is necessary to develop more specified regimens different from WFH guidelines of CFC supplementation for admitted Korean patients with hemophilia A.

Establishment of an effective nursing team against COVID-19-a COVID-19 treatment center experience.

Novel coronavirus disease 2019 (COVID-19) is a serious infectious respiratory disease widespread worldwide. Nurses are the front-line staff in contact with infected patients and play a key role in treating patients and controlling the epidemic. The purpose of this study was to share our nursing team's experience in the treatment of COVID-19 and provide clinical guidance. Detail nursing system arrangement was laid down: (I) reasonable division of ward channel was built; (II) effectively arranged human nursing resources and establishing special groups, including Training group, Critical patients nursing group, Quality control group, Epidemic preventive measures group, and Logistics support group; (III) optimize nursing workflow and establish various rules and regulations; (IV) scientific scheduling and humanized management; (V) pay attention to psychological support and adopt humanized management. The pre-job preparation, treatment results, and medical staff infection number were recorded. Fifty-four intensive care nurses all passed the training with an average score of 99.75±0.13. One patient was dead, and 22 patients were discharged smoothly. The average length of stay was 9.12 days. The medical staff was not infected. The treatment center was set up and functioning rapidly, safely, and orderly by implementing an emergency management strategy. The goal of a high rescue rate, low mortality, and no medical staff infection was achieved. This nursing system could be applied in COVID-19 patient treatment.

Association between treatment center experience and survival after diagnosis of stage I to III Merkel cell carcinoma treated with surgery with or without postoperative radiation therapy

Association between treatment center experience and survival after diagnosis of stage I to III Merkel cell carcinoma treated with surgery with or without postoperative radiation therapy

Management and Outcomes of Persons with Hemophilia Undergoing Endoscopies: A Single Hemophilia Treatment Center Experience

INTRODUCTION The need for factor concentrate (FC) prior to uncomplicated endoscopies in persons with hemophilia (PWH) is not well characterized. Infusion of FC is time consuming, costly, and increases risk of inhibitor development. There is no general consensus on management of PWH undergoing endoscopies and the incidence of bleeding is not well established. At our Hemophilia Treatment Center (HTC), our standard of care (SOC) for many years was to manage PWH with an infusion of FC prior to any endoscopy for any indication regardless of severity of hemophilia. In November 2017, we changed our SOC for persons with mild hemophilia (factor VIII or IX &amp;gt;5%) to use only antifibrinolytics pre-endoscopy for those in whom no procedural intervention was anticipated, followed by infusion of FC post-endoscopy if a biopsy or polypectomy was performed or if there was bleeding associated with the procedure. Persons with moderate or severe hemophilia (factor VIII or IX ≤5%) continued to receive infusion of FC prior to all endoscopies. We report our experience managing PWH of all severities undergoing EGD and colonoscopy between 2008 and 2019. We compare incidence of bleeding, cost of medical care, and outcomes before and after the change in SOC for persons with mild hemophilia. METHODS Subjects were identified from a database of patients treated at our HTC. Those with factor VIII inhibitors were excluded. Cost of FC and antifibrinolytics were determined from average wholesale pharmacy prices in 2019. Gastrointestinal (GI) bleeding was assessed by review of medical records within 30 days after endoscopy. Documentation of any patient or clinician reported hematemesis or rectal bleeding, requiring or not requiring medical attention or treatment, was recorded as GI bleeding. Adequacy of hemostasis, as assessed by review of medical records, was classified as poor if the subject had unexpected hypotension, required intensive or intermediate care, or transfusion; fair if unplanned doses of FC were required, but the event did not meet criteria for poor hemostasis; and excellent for events that did not meet any of the above criteria. RESULTS Sixty-seven subjects met eligibility criteria; 12 were excluded due to inadequate records of endoscopies. Data were collected on 110 endoscopies performed in 55 subjects, range 1 to 5 per subject. Subject demographics are noted in Table 1. Endoscopy characteristics and outcomes are shown in Table 2. GI bleeding occurred within 30 days after 10 endoscopies prior to the change in SOC. This included 7 endoscopies performed because of preexisting bleeding due to esophageal varices, or gastric, duodenal, or colonic ulcers. In addition, post endoscopy bleeding occurred in one patient after colonoscopy following the use of hot snare cautery resection of polyps, and in another after resection of a rectal polyp by cold snare following an EGD with colonoscopy. No GI bleeding occurred within 30 days of the endoscopies performed after we changed our SOC. FC was used prior to 97.1% of 68 endoscopies performed before we changed our SOC, compared to 73.8% of 42 endoscopies performed after. Hospital stay of 2 days was equivalent across all groups when subjects with preexisting bleeding were excluded. Hemostasis was excellent in 79.4% of endoscopies before we changed our SOC and 100% of endoscopies after. Endoscopy characteristics and outcomes in subjects with mild hemophilia before and after we changed our SOC are shown in Table 3. Reasons for using FC pre-endoscopy in these subjects included preexisting bleeding, planned intervention, or anticipated complex procedure. Treatment costs in subjects with mild hemophilia are noted in Table 4. CONCLUSION We describe our HTC's experience with endoscopies in PWH. In our cohort of persons with mild hemophilia, we demonstrate that the use of antifibrinolytics rather than FC pre-endoscopy did not result in any difference in adequacy of hemostasis or development of GI bleeding within 30 days post endoscopy. This practice was associated with significant cost-savings and no difference of hospitalization rate or length of stay. We conclude that persons with mild hemophilia, who are not actively bleeding or undergoing complex procedures, can be safely managed with antifibrinolytics alone pre-endoscopy. However, patient-specific and procedure-specific factors must be considered when determining the appropriate pre-endoscopy treatment for bleeding prophylaxis in PWH. Disclosures Eyster: Novo Nordisk: Research Funding; SPARK: Research Funding; Sanofi: Research Funding; Baxalta/Shire: Research Funding.

Effect of Treatment Center Experience on Survival after Diagnosis of Stage I-III Merkel Cell Carcinoma Treated with Surgery with or without Postoperative Radiation Therapy

Treatment center volume (TCV) is associated with improved outcomes across different cancers. Prior work suggested that TCV is associated with overall survival (OS) for Merkel cell carcinoma (MCC). This study characterizes the relationship between TCV and OS for stage I-III MCC treated with surgery with or without postoperative radiation therapy (RT). Retrospective large database study including 11, 119 patients diagnosed with stage I-III MCC from 2004-2015. Treatment at a high TCV center, defined as ³90th percentile (³5 cases/year) was associated with a statistically significant improvement in OS in stage I-III MCC (2-year OS 70.9% vs. 63.6%, p <0.0001). For every 9 patients treated per year, there was a 3% improvement in OS (adjusted hazard ratio [AHR], 0.974; 95% CI: 0.959 - 0.989, P < 0.0010). Treatment at high TCV centers was associated with improved 2-year OS (69.8% vs. 59.4%, p <0.0001) for patients treated with surgery alone, and for patients treated with postoperative RT (2yr OS 73.1% vs. 68.4%, p <0.0001). A sensitivity analysis identified a significant OS benefit for treatment at centers with TCV at the 75th percentile (3 patients/year) or above. Survival after curative-intent treatment of MCC is higher in high-volume facilities for stage I-III MCC treated with surgery-alone with or without postoperative RT. Due to the rarity of the condition, providers at cancer centers with low volume of MCC patients, should consider referring their patients to a high-volume center, where there also may be enhanced access to clinical trials and specialty expertise.

Single center experience in treatment of tibial shaft fractures using Ilizarov technique

Introduction/Objective. Since tibial shaft is a common location of opened and closed tibial fractures, it is very important to determine the best method of treating these fractures. Our objective was to assess whether the Ilizarov technique is appropriate in terms of complications, outcomes, and pain reduction in treatment of patients with tibial shaft fracture. Methods. Retrospective analysis included all consecutive patients with tibial shaft fracture treated with the Ilizarov technique in the period from January 2013 to June 2017 at the Banjica Institute for Orthopaedic Surgery, Belgrade, Serbia. Demographic and clinical data on patients were collected. Pain was assessed using visual analogue scale of pain. Two models of uni- and multi-variate linear regression analysis were performed. Results. The study showed that the overall rate of complications was low, and that hypertension, administration of antibiotics, and reoperation prolonged fixation. Also, severe fractures and longer procedure time delay mobilization. Significant reduction of pain was observed. Conclusion. The Ilizarov technique is a safe and reliable method in the treatment of patients with tibial shaft fractures and is followed by pain reduction, overall improvement of functioning, good outcomes, and is not commonly associated with complications.

Pediatric Nonceliac Gluten Sensitivity: A Gluten-related Disorder Treatment Center Experience.

The aim of the study was to identify the prevalence and clinical characteristics of children with nonceliac gluten sensitivity (NCGS) presenting to a tertiary care center specialized for evaluation of gluten-related disorders. The medical records of all patients aged 0 to 18 years who presented to our center over a 4-year period (July 2013-June 2018) and consented to participate in our research registry were reviewed. Patients meeting the clinical criteria for NCGS were reviewed in detail. Among 500 pediatric patients who volunteered to participate in the registry during the study period, we identified 26 (5.2%) with NCGS. Both gastrointestinal and extraintestinal symptoms associated with gluten ingestion were common with abdominal pain (57.7%), bloating (53.9%), rash (53.9%), diarrhea/loose stool (42.3%), and emotional/behavioral issues (42.3%) emerging as the predominant complaints. In addition, children with NCGS demonstrated a high personal history (61.5%) and family history (61.5%) of concomitant allergic/atopic disease. Even within our highly specialized population of patients with a suspected gluten-related disorder, pediatric NCGS is relatively uncommon. The estimated prevalence and clinical features mirror those previously reported in a similarly highly selective population of adults. In the absence of celiac disease, clinical suspicion for NCGS should arise in a child with gastrointestinal and/or extraintestinal complaints alleviated with gluten removal and considered in symptomatic patients with associated allergic/atopic disease. Proper and adequate exclusion of celiac disease and other potential causes of the clinical complaints is essential to justify adoption of the gluten-free diet according to an appropriate stringency and with dietitian supervision to avoid nutritional deficiencies.

Single Childhood Center Experience in Treatment of Pediatric Blastic Plasmacytoid Dendritic Cell Neoplasm

Single Childhood Center Experience in Treatment of Pediatric Blastic Plasmacytoid Dendritic Cell Neoplasm

Experience in Using Fetal Membranes: The Present and New Perspectives

IntroductionThe placenta is an accessible source of tissues for transplantation. Placental transplants have been used in wound treatment because of the basic function of the placenta and its nutritious properties and structure. Patients and methodsThe aim of this work is to present the clinical usage of fetal membranes, including human amnion, on the basis of the burn treatment center's experience. The clinical use of amnion and different types of placental transplants are described. The initial results of research work within the MEDPIG project are presented regarding the application of placenta from transgenic pigs as a source of tissues for transplantation. ResultsFrom August 2011 to March 2017, 252,592 cm2 of biostatic human amnion transplants were prepared in our tissue bank. During this period they were transplanted to 528 patients, including 10 patients with Lyell syndrome.Initial studies were conducted in which placentas were collected from 5 transgenic pigs and 27,426 cm2 of amniotic grafts were prepared from them. DiscussionThe authors' own experience as well as the literature confirm the extraordinary efficiency of transplants prepared from placental tissues, especially from the amniotic membrane. ConclusionsThe clinical effects confirm the effectiveness of using human amnion in wound treatment. Amniotic transplant is a new treatment standard in toxic epidermal necrolysis TEN (Lyell's syndrome), which has found confirmation in very good clinical outcomes.The collected placentas from transgenic animals enabled the preparation of significantly more grafts than in the case of human material, which is a great advantage of this source of placenta over human tissues.

The hyperthermic intraoperative intraperitoneal chemotherapy in the treatment of advanced abdominopelvic cancer. Personal experience on 103 procedures during a seventeen year period in a single Italian center.

Integration of different therapeutic strategies in cancer surgery in the last years has led from treating primary lesions to the surgical treatment of metastases. The purpose of this paper is to report a single Italian center experience of treatment of peritoneal carcinosis of the abdominopelvic malignancies. 103 HIPEC procedures were performed in 17 years on 94 selected patients affected by abdominopelvic cancer. The PCI score was calculated at laparotomy. The CC score was calculated before doing HIPEC. HIPEC was carried out according to the Coliseum technique. The surgical cytoreduction allowed 89 patients to be subjected to HIPEC treatment with a CC score 0; 9 patients with a CC 1; 3 patients with a CC 2 and 2 patients with a CC 3. In 22 patients postoperative complications were recorded. No operative mortality occurred. The median follow-up of 53 months shows a rate of survival equivalent to 49 %, with a relapse in 46 patients, 29 of them reached exitus. The surgical resection alone for patients affected by advanced cancer with peritoneal carcinomatosis cannot be considered a sufficient treatment any longer and HIPEC would help to prolong survival in these patients.

Survival Is Independent of Radiation Therapy Treatment Center Experience After Surgical Therapy

Survival Is Independent of Radiation Therapy Treatment Center Experience After Surgical Therapy

Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval

To evaluate a single treatment center's experience with autologous IVF using vitrified and warmed oocytes, including fertilization, embryonic development, pregnancy, and birth outcomes, and to estimate the likelihood of live birth of at least one, two, or three children according to the number of mature oocytes cryopreserved by elective fertility preservation patients. Retrospective cohort study. Private practice clinic. Women undergoing autologous IVF treatment using vitrified and warmed oocytes. Indications for oocyte vitrification included elective fertility preservation, desire to limit the number of oocytes inseminated and embryos created, and lack of available sperm on the day of oocyte retrieval. Oocyte vitrification, warming, and subsequent IVF treatment. Post-warming survival, fertilization, implantation, clinical pregnancy, and live birth rates. A total of 1,283 vitrified oocytes were warmed for 128 autologous IVF treatment cycles. Postthaw survival, fertilization, implantation, and birth rates were all comparable for the different oocyte cryopreservation indications; fertilization rates were also comparable to fresh autologous intracytoplasmic sperm injection cycles (70% vs. 72%). Implantation rates per embryo transferred (43% vs. 35%) and clinical pregnancy rates per transfer (57% vs. 44%) were significantly higher with vitrified-warmed compared with fresh oocytes. However, there was no statistically significant difference in live birth/ongoing pregnancy (39% vs. 35%). The overall vitrified-warmed oocyte to live born child efficiency was 6.4%. Treatment outcomes using autologous oocyte vitrification and warming are as good as cycles using fresh oocytes. These results are especially reassuring for infertile patients who must cryopreserve oocytes owing to unavailability of sperm or who wish to limit the number of oocytes inseminated. Age-associated estimates of oocyte to live-born child efficiencies are particularly useful in providing more explicit expectations regarding potential births for elective oocyte cryopreservation.

Review of a 10-year single center experience in treatment of thoracoabdominal aortic trauma

Objective To review the case data and treatment methods in a single center so as to search for rational treatments for thoracoabdominal aortic trauma. Methods This retrospective analysis was performed for 34 cases (28 males and 6 females) sustaining thoracoabdominal aortic trauma treated from October 2002 to February 2013. The mean age was 41 years (range, 11-60 years). Causes of injury included traffic crashes in 14 cases, high falls in 7, stab wound in 3, abdominal crash injury in 3, aorticoesophageal fistula caused by a fish bone in 3, interventional therapy-induced aortic dissection in 2, abdominal aortic injury caused by the dropped ventricular septal defect occluder in 1, and accidental aortic injury in spinal operation in 1. There were 23 cases of thoracic aortic trauma (6 sharp and 17 blunt) and 11 cases of abdominal aortic trauma (4 sharp and 7 blunt). Preoperative imaging findings, treatment methods and follow-up data were studied. Results Personal treatment was produced based on the mechanism of injury and imaging findings. Of sharp thoracic aortic trauma, 2 cases were treated non-operatively but both died, and four cases had endovascular repair (one progressed, two cured, and one died). All the four cases of sharp abdominal aortic trauma had open surgery (three cured and one severely complicated). Of thoracic aortic trauma, four cases were treated non-operatively (three cured and one died), twelve cases had endovascular repair (11 cured and one died), and one case had open surgery and cured. Six cases of blunt abdominal aortic trauma were treated non-operatively and one had open surgery. Conclusions Treatment of aortic trauma should be based on injury condition, injury site, and occurrence of aortic rupture or impending of aortic rupture. Endovascular repair has a high success rate and good clinical outcome in treatment of thoracoabdominal aortic trauma. Key words: Aorta; Wounds and injures; Endovascular repair