Cumulative Success Rate Research Articles

To evaluate the effect of anodized dental implant surface on cumulative implant survival and success. A systematic review and meta-analysis.

There have been certain apprehensions regarding the use of surface-modified dental implants due to peri-implant infection and crestal bone loss over the years. Thus, this review aims to evaluate the long-term effect of anodized implant surface on cumulative implant survival (CSR) and success rates in relation to marginal bone loss (MBL). Systematic electronic search was done using two databases, PubMed and Embase to assess the potentially relevant records from January 2008 to October 2019. Publications reporting cumulative survival and success rates with anodized dental implants were identified. Screening for duplicate articles and extraction of data was carried out to formulate evidence tables. Meta-analysis was conducted following PRISMA guidelines. Out of 217 observational clinical studies, 8 studies were selected based on predefined selection criteria. The summary estimate for the included studies for CSR was reported as 0.98 (95% confidence interval [CI]: 0.96; 0.99). The heterogeneity (I2 = 37.3%) among these studies was found to be statistically nonsignificant (P = 0.1314). The mean values of MBL after the implant insertion were 0.84 mm at 0-1 year and 1.05mm by the end of follow-up period. This data were provided by five studies only. The mean difference of the analyzed studies came out to be 0.49 mm with a 95% CI (-0.22; 1.19). The heterogeneity (I 2 = 97%) for these studies was statistically significant with P < 0.01. The anodized dental implants have demonstrated long-term survival and success rates in terms of clinical outcomes.

Risk Factors for Progression of Keratoconus and Failure Rate After Corneal Cross-linking.

To assess the occurrence of risk factors for progression of keratoconus and failure rate after corneal cross-linking (CXL) in patients with progressive keratoconus. This retrospective study observed 230 eyes of 173 patients with a minimum follow-up of 36 months after CXL. A total of 185 eyes underwent CXL once (80%) (control) and 45 (20%) underwent this treatment more than once (Re-CXL-group). Subgroup analysis included standard CXL with the Dresden protocol (S-CXL group, n = 120) and accelerated CXL with a reduced radiation time of 10 minutes and a higher radiation power of 9 mW/cm2 (A-CXL group, n = 110). Risk factors of interest were age, maximum keratometry (Kmax), minimum corneal thickness (MCT), sex, and atopy (including allergic bronchial asthma, food allergy, allergic rhinitis, and neurodermatitis). Follow-up for the control group was 76.0 ± 33.2 months. Re-CXL was performed after 46.2 ± 34.1 months overall and after 62.6 ± 41.9 months in the S-CXL subgroup and 29.2 ± 19.2 months in the A-CXL subgroup (P = .02). Kaplan-Meier analysis revealed a cumulative prediction rate of success after CXL of 92.5% (S-CXL) and 86.4% (A-CXL) after 36 months (P = .103). A high preoperative Kmax value (odds ratio = 1.056, P = .003 and odds ratio = 1.067, P = .028) in both subgroups and the presence of neurodermatitis combined with other atopic diseases in the A-CXL group (odds ratio = 11.662, P = .003) were significant risk factors for new progression of keratoconus after CXL. Risk factors for progression of keratoconus after CXL are both high preoperative Kmax values and the presence of neurodermatitis combined with other atopic diseases. Patients with severe atopy should receive the S-CXL procedure. [J Refract Surg. 2021;37(12):816-823.].

Safety and Efficacy of Graded Gradual Pneumatic Balloon Dilation in Idiopathic Achalasia Patients: A 24-Year Single-Center Experience.

Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up. We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. 216 patients did not undergo PBD due to comorbid diseases. Ultimately, 1092 achalasia patients were enrolled. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Response to treatment was evaluated by Vantrappen scoring system. Of 1092 achalasia patients, 937 patients were treated by PBD and 155 patients were treated by combined therapy (PBD 1 month after Botulinum toxin injection). In short-term follow-up, 728 of 1092 patients underwent one PBD and 77.3% of them had excellent or good response (responders), 163 patients (58.6%) who underwent two PBDs were responders, and 44 (51.2%) patients who underwent three PBDs were responders. Overall, 2193 balloon dilations were performed on 1092 patients (mean 2 PBDs/patient). Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. The responders with two, three, and four or more dilations were 149, 67, and 67, respectively. The overall response rate was 69%. No any serious complications were noted by using the graded gradual method. Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.

A randomized, phase II trial of adjuvant immunotherapy with durable TKI-free survival in patients with chronic phase CML

PurposeChronic myeloid leukemia (CP-CML) patients can achieve undetectable minimal residual disease (UMRD) and discontinue tyrosine kinase inhibitors (TKIs). Cellular immunity plays an important role in CML disease control. We conducted a randomized, non-blinded phase II trial of adjuvant immunotherapy with TKIs to facilitate TKI discontinuation. MethodsTKI-treated patients with CP-CML were randomized to receive the K562/GM-CSF vaccine (vaccine) OR Interferon-α + Sargramostim (IFN). If UMRD was achieved, then all treatment was stopped. Patients who did not achieve UMRD within one year, had a molecular relapse, or discontinued therapy for toxicity could crossover. ResultsThirty-four patients were randomized to IFN (n = 18) or vaccine (n = 16), and 21 patients crossed over (IFN⟶vaccine: n = 9, vaccine⟶IFN, n = 12). TKIs at enrollment included imatinib (n = 31), nilotinib (n = 2), and dasatinib (n = 1). No patients discontinued vaccine due to side effects, while 33 % of IFN-treated patients discontinued treatment. More patients randomized to IFN (47.4 %, 95 % CI: 16.7–66.7 %) versus vaccine (25.0 %, 95 % CI: 0.5–43.5 %) achieved UMRD within one year. Seven patients randomized to IFN discontinued treatment with 28.6 % (95 % CI: 8.9–92.2 %) sustaining treatment-free remission (TFR) at 1 year, while three patients randomized to vaccine discontinued treatment with none sustaining TFR. Including crossover, there was a cumulative discontinuation success rate of 36.4 % (95 % CI: 16.6 %–79.5 %) after adjuvant IFN. Patients who sustained TFR received a median of 29 months of imatinib prior to discontinuation. ConclusionAdjuvant IFN led to durable TFRs with limited prior TKI exposure with comparable success to prior discontinuation trials, but many patients stopped IFN early.

Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract

BackgroundThe relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract.MethodsConsecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored.ResultsOne hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038).ConclusionsThe presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.

Utility of Collagen Matrix Insertion during Ahmed Valve Implantation with Adjunctive Mitomycin-C: Outcomes at One-year

Purpose: To compare the surgical outcomes of adjunctive mitomycin-C (MMC) Ahmed valve implantation with and without collagen matrix insertion.Methods: We retrospectively reviewed 108 eyes of 108 patients who underwent Ahmed valve implant surgery with adjunctive MMC. Collagen matrix insertion/Ahmed valve implant surgery (CM-AGV) was performed on 55 eyes, while conventional Ahmed valve implant surgery (AGV) was performed on 53 eyes. We defined surgical failure as an intraocular pressure (IOP) &gt; 18 mmHg or &lt;5 mmHg on two or more consecutive visits, regardless of medication status.Results: After surgery, the IOP and number of topical medications required fell significantly (compared with the preoperative period) in both groups (both p &lt; 0.001); these findings did not significantly differ between groups. The cumulative surgical success rates at 1 year did not significantly differ between groups (78.2% vs. 79.2%, p = 0.54). The only risk factor significantly associated with surgical failure was a postoperative hypertensive phase. Anterior chamber (compared with sulcus) tube placement was significantly associated with visual acuity loss at 1 year postoperatively, but this did not significantly differ between groups.Conclusions: At the 1-year follow-up after Ahmed implant surgery with adjunctive MMC, the success rates of surgery with and without collagen matrix insertion were similar.

A novel application of dynamic guided navigation system in immediate implant placement

Background/purposeImmediate placement in the esthetic zone has been a predictable treatment option. However, it requires the clinician to be experienced and knowledgeable about esthetic diagnosis, accurate 3-dimensional (3D) implant placement, and restoratively driven planning/placement. Therefore, this study aimed to investigate a novel workflow integrating dynamic navigation to immediate single-implant placement in the aesthetic zone. Materials and methodsWe included ten patients who required at least one implant in the esthetic area and were treated with post-extraction socket implant placement. Osteotomy and implant placement followed computer-assisted implant positioning and image-guided dynamic navigation. Treatment outcomes were implant success rates, surgical and prosthetic complications, marginal bone level (MBL), modified pink esthetic score, and white score. ResultsIn the consecutive clinical cases, patients were satisfied with implant therapy's function and esthetic outcome in the esthetic zone. No other surgical or biological complications occurred, which accounts for the 100% cumulative success rate. The mean MBL was −0.76 ± 0.15 mm assessed using standardized intraoral digital periapical radiographs. ConclusionThe novel application of a dynamic guided navigation system is a dependable clinical protocol to obtain optimal implant position/angulation and esthetics on immediate implant placement.

A prospective cohort study evaluating the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions.

To evaluate the impact of various predictors on the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions after a minimum of 2years. One hundred and twenty previously root canal treated symptomatic mandibular first molars with periapical lesions which were diagnosed as symptomatic apical periodontitis or acute apical abscess with localized intraoral swelling were included. Root canal retreatment was performed by an experienced endodontist using a standardized treatment protocol. The teeth were followed up clinically and radiographically and the radiographic outcome was assessed using a modified periapical index scale (PAI). The cumulative success proportion and the influence of predictors on the outcome of the root canal retreatment were analysed using Kaplan-Meier analyses and log-rank tests, and the hazard ratios for the predictors were also investigated using Univariate Cox Proportional Hazard regression analysis at a significance level of 5%. Of the 120 teeth, 103 teeth were re-examined with an 85% recall rate. The cumulative success rate was 88% in which 64% were healed and 24% were healing, and failure rate was recorded as 12%. None of the preoperative predictors, including age, gender, soft tissue tenderness, intraoral swelling, size of the lesion, PAI score, apical level and density of root canal filling before root canal retreatment, nor intraoperative predictors, such as active exudate drainage, density of root canal filling after root canal retreatment and restoration type had an influence on the outcome of root canal retreatment (p>.05). The only factor that significantly reduced the success rate of root canal retreatment was the apical level of the root canal filling; when it was more than 2mm short of the radiographic apex in teeth where apical patency was not established, the success was significantly lower (p = .023). Root canal retreatment in symptomatic mandibular first molars with periapical lesions resulted in a success rate of 88%. None of the predictors had a significant influence on the outcome, except for the apical level of the root canal filling after root canal retreatment with short root fillings being associated with significantly more post-treatment endodontic disease.

Short-term Outcomes and Prognostic Factors of Cataract-combined Surgery with iStent versus iStent Inject

Purpose: To analyze the therapeutic effects, prognostic factors, and complications that occurred after iStent&lt;sup&gt;®&lt;/sup&gt; or iStent inject&lt;sup&gt;®&lt;/sup&gt; implantation in South Korean glaucoma patients. Methods: We retrospectively analyzed 42 eyes of South Korean glaucoma patients, who were followed-up for more than 6 months after iStent&lt;sup&gt;®&lt;/sup&gt; or iStent inject&lt;sup&gt;®&lt;/sup&gt; implantation alone or combined with cataract surgery. Surgical success was defined as an intraocular pressure (IOP) ≤21 mmHg and an IOP reduction ≥20% from preoperative IOP levels. Results: The cumulative success rate at 6 months after surgery was 45.3 ± 8.1% for iStent inject&lt;sup&gt;®&lt;/sup&gt; alone (group A), 28.6 ± 13.1% for iStent&lt;sup&gt;®&lt;/sup&gt; alone (group B), 81.2 ± 6.8% for iStent inject&lt;sup&gt;®&lt;/sup&gt; combined with cataract surgery (group A-1), and 27.3 ± 21.8% for iStent&lt;sup&gt;®&lt;/sup&gt; combined with cataract surgery (group B-1). Group A-1 showed a higher success rate than group B-1 (&lt;i&gt;p&lt;/i&gt; = 0.007); the difference in success rates between groups A and B was not statistically significant (&lt;i&gt;p&lt;/i&gt; = 0.579). When the success prognostic factors were analyzed by Cox regression analysis, the results showed that a higher preoperative IOP was associated with a higher surgical success rate (hazard ratio 0.80, &lt;i&gt;p&lt;/i&gt; = 0.02). Conclusions: In our patient group, iStent inject&lt;sup&gt;®&lt;/sup&gt; was more effective than iStent&lt;sup&gt;®&lt;/sup&gt; in combination with cataract surgery. The higher the preoperative IOP, the higher the surgical success rate; the results were significant.

Clinical and radiological outcomes of novel digital workflow and dynamic navigation for single-implant immediate loading in aesthetic zone: 1-year prospective case series.

ObjectivesTo evaluate clinical, radiological performance of novel digital workflow integrating dynamic navigation to streamline in one‐visit single‐implant immediate loading in aesthetic zone.Material and methodsConsecutive patients requiring one single‐implant in aesthetic zone of both jaws were treated between May and September 2017. Primary outcomes were implant and prosthetic success rates, surgical and prosthetic complications, marginal bone loss (MBL), final pink aesthetic score (PES‐f), and implant stability quotient (ISQ‐f). Secondary outcomes were ISQ‐0 and PES‐0 at implant positioning and PES‐p at definitive prosthesis placement. Potential effect of jaw (maxilla vs mandible), biotype (thin vs thick), type of incision (flap vs flapless), and implant site (healed vs. post‐extractive) on the primary outcomes (MBL, PES‐f, and ISQ‐f) was evaluated through a multivariable analysis.ResultsFifty‐two implants were placed (follow‐up 18.6, 15–20 months). One post‐extractive implant failed. No other surgical, biological complications occurred, accounting for 98.10% cumulative success rate (CSR). No definitive prostheses failed. Mean MBL was −0.63 ± 0.25 mm (−1.69 to −0.06). PES‐f was 12.34 ± 1.41 (9–14). ISQ‐f was 78.1 ± 3.2 (70–84). Age had significantly negative effect on MBL and PES‐f (p = .0058 and p = .0052). No other variables significantly affected primary outcomes.ConclusionsWithin study limitations, investigated digital workflow integrating dynamic navigation was reliable for single‐implant immediate loading in aesthetic zone in one visit. No statistically significant difference was found for MBL, PES‐f, and ISQ‐f, considering type of incision (flap vs. flapless), implant site (healed vs post‐extractive), jaw (maxilla vs. mandible), and biotype (thick vs. thin). Live‐tracked dynamic navigation may have contributed to improve operator clinical performance regardless of implant site characteristics. Further investigations are needed to confirm positive outcomes.

Flapless Localised Management of Sinus Floor (LMSF) for trans-crestal sinus floor augmentation and simultaneous implant placement. A retrospective non-randomized study: 5-year of follow-up

BackgroundTrans-crestal sinus lift procedures are well established. Purposeto retrospectively analyse the efficacy of a flapless trans-crestal maxillary sinus floor elevation and simultaneous dental implant placement based on the Localised Management of Sinus Floor (LMSF) technique suitable for cases with sufficient width of keratinized tissue and of crestal bone but insufficient vertical dimensions of the bone below the sinus. Materials and methods71 sinus elevations with simultaneous implant placement were performed on 52 consecutive patients. Following an initial pilot bur transmucosal perforation, the Magnetic Mallet was used with progressively larger osteotomes. The mallet osteotomes are initially directed palatally, towards the cortex of the medial wall of the sinus, below the palato-nasal recess (PNR) and then redirected in a more vertical direction to create the final osteotomy for implant placement. ResultsNo significant complications were reported in the post-operative phase. The cumulative success rate during the observation period was 95%. All successful implants were successfully loaded with metal-ceramic or monolithic zirconia crowns and bridges and remained in function during the observation period. ConclusionsFlapless Localised Management of Sinus Floor (LMSF) is a safe and effective surgical technique with minimal risks and with the advantage of low morbidity. Also, only native bone is used for augmentation and there is no need for additional grafting.

Zygomatic Implants Placed in Immediate Function through Extra-Maxillary Surgical Technique and 45 to 60 Degrees Angulated Abutments for Full-Arch Rehabilitation of Extremely Atrophic Maxillae: Short-Term Outcome of a Retrospective Cohort.

The use of new devices for the rehabilitation of the severely atrophic maxillae needs validation. We aimed to report the short-term outcome of severely atrophic jaws rehabilitated with zygomatic implants with no implant head angulation placed extramaxillary in conjunction with standard implants. Forty-four patients were consecutively included with 77 zygomatic implants (31 abutments of 45 degrees and 46 abutments of 60 degrees) and 115 standard implants. Outcome measures were prosthetic survival, implant/abutment success, complications, modified plaque index (mPLI), modified bleeding index (mBI), mucosal seal efficacy evaluation (MSEE) >4 mm, and Zygomatic implants classification level (ZICL). Two patients (4.5%) were lost to follow-up. No prosthesis was lost; one patient lost one zygomatic implant; two angulated abutments of 60 degrees needed to be replaced in one patient due to an aesthetic complaint; rendering a cumulative success rate at 2-years of 95.3% and 95.9% using patient and implant/abutment as unit of analysis, respectively. Mechanical and biological complications occurred in 13 and six patients, respectively; all resolved. The median mPLI and mBI was 1; MSEE > 4 mm occurred in 17% and 21% of patients at 1- and 2-years, respectively; ZICL1 was registered in 80% of patients. The current protocol enabled good short-term outcomes.

O-156 Fertilization rate as a novel indicator for cumulative live birth rate: multicenter retrospective cohort study of 9,394 complete IVF cycles

Abstract Study question Does fertilization rate (FR) affect cumulative success rates in assisted reproduction cycles? Summary answer These data indicate a positive association between FR with CLBR suggesting the predictive clinical relevance of this parameter and its adoption as Key Performance Indicator(KPI). What is known already Numerous studies have aimed at characterizing outcome predictors. Maternal age is historically and correctly recognized as the single most important factor impacting on the clinical outcome of ART. More recently ovarian response has also gained interest in this respect. However, the quest for novel, more comprehensive predictive factors is not over; new relevant evidence is starting to emerge. FR is a noteworthy parameter because expressing a fundamental aspect of both oocyte and sperm developmental competence. In fact it has been adopted as a key performance indicator of the IVF laboratory, to assess laboratory, operator, and gamete competence. Study design, size, duration Reported data concern a retrospective cohort study carried out between 2015 to 2017 involving 7,968 couples undergoing 9,394 complete ICSI cycles, i.e. whose all embryos were transferred or disposed.All women aged between 18-42 years were included.We excluded from analysis: surgical sperm retrieval cases, cycles resulting in neither fresh or frozen–thawed embryo transfers,cycles in which live birth were not achieved, but with remaining cryopreserved embryos,cycles of PGT, cycle with fertilization failure and standard IVF cycles. Participants/materials, setting, methods The cohort was groupped according to fertilization rate intervals based on recommendations of the Vienna Consensus (&amp;lt;65% - Group 1; 65%-80% - Group 2; &amp;gt;80% - Group 3). Harnessing the large size of the original dataset, further cycle stratifications were carried out based on female age (&amp;lt;34, 35-38, 39-42 years) and number of oocytes retrieved (5-7, 8-10, &amp;gt;10 oocytes). Main results and the role of chance No significant difference in female age was observed between fertilization rate groups (p = 0.640). CLBR was progressively higher in relation fertilization rate in Groups 1, 2 and 3 (20.1%, 34.7%, 41.3%, P &amp;lt; 0.001, respectively). Number of recovered oocytes, embryo number per cycle, cumulative pregnancy rate followed the same trend (p &amp;lt; 0.001). The decrease in CLBR with increasing female age was significantly correlated with fertilization rate and CLBR in all three female age groups (P &amp;lt; 0.001). Finally, to further control for possible patient-specific confounding factors, maternal age, number of retrieved oocytes, percent of inseminated oocytes and fertilization rate were evaluated in a multivariate logistic regression analysis. From this assessment, fertilization rate emerged as a factor independently associated with cumulative live birth rate, to a degree equivalent or higher compared with the number or retrieved oocytes. Limitations, reasons for caution The study design is retrospective and requires further refinement to control for factors that may impact clinical outcome. Wider implications of the findings These data indicate a positive association of FR with CLBR, thereby suggesting that fertilization, in addition to representing an assay for gamete quality and laboratory performance,has an independent clinical significance.Irrespective of the number of retrieved oocytes and female age, we observed that, rates of FR are positively associated with CLBR. Trial registration number None

One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

PurposeTo compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group).MethodsThis retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery.ResultsSchlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198).ConclusionS and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

Flexible endoscopy versus direct laryngoscopy for localising impacted pharyngeal foreign bodies in emergency department: A randomised cross-over manikin pilot study

Background: Direct laryngoscopy is often poorly tolerated in patients with foreign body ingestion. The use of flexible endoscopes, which are reported to be better tolerated, was described. However, studies on endoscopy usage by emergency physicians are lacking. Objective: This study evaluates whether using a bronchoscope is as effective as the direct laryngoscopy for localising pharyngeal foreign bodies by emergency physicians. Methods: This was a randomised cross-over manikin study conducted on 32 emergency physicians. Four foreign bodies were placed at the oropharynx, vallecula, arytenoid and post-cricoid area of a manikin. Participants, being randomised into two groups, examined the pharynx with a bronchoscope and a direct laryngoscope in designated orders. The primary outcome was the complete visualisation rate defined as visualising all the four foreign bodies within the time limit. Secondary outcomes included participants-rated difficulty scores, device preferences, the time needed for complete visualisation and cumulative success rates. Results: Complete visualisation rate was significantly higher using the bronchoscope (93.8%) than the direct laryngoscope (62.5%) p = 0.02. The overall difficulty score was lower using the bronchoscope (median 4, interquartile range: 3–5) than the direct laryngoscope (median 6, interquartile range: 5–8), p &lt; 0.001. The bronchoscope was the preferred method for overall examination (71.9%) over the direct laryngoscope (28.1%), p = 0.001. There were no significant differences in times needed for complete examination for the bronchoscope (median 73.6 s, interquartile range: 54.7–97.7 s) and the direct laryngoscope (median 82.2 s, interquartile range: 40.1–120 s), p = 0.9, and cumulative success rates, p = 0.081. Conclusion: The bronchoscope was associated with an increased complete visualisation rate and was the easier and preferred method for pharyngeal examination.

Fluoroscopy-free minimally invasive ureteral stricture balloon dilatation: a retrospective safety and efficacy cohort study.

BackgroundTraditional ureteral stricture balloon dilation was performed with fluoroscopic assistance. The use of a C-arm X-ray machine delivered hazardous radiation to both surgeons and patients. In attempt to eliminate the radiation hazard, we developed a F4.5/6.5 ureteroscope assisted intraoperative X-ray free balloon dilation surgical approach to treat ureteral stricture and to verify its safety and efficacy. Specifically, this method had not been previously reported in the literature.MethodsWe demonstrated an intraoperative X-ray free balloon dilation with detailed step-by-step procedures description and video illustration. Clinical data of patients undergoing minimally invasive endourological treatment for ureteral stricture between February 2015 and November 2019 were retrospectively analyzed. All steps of X-ray free balloon dilation were carried out under direct vision of a ureteroscope, and two indwelling F7 ureteral stents were used for 3 months postoperatively. Preoperative, intraoperative, and postoperative clinical data were evaluated, and follow-up results were reported. Successful outcome was defined as disappearance of preoperative symptoms, relief of hydronephrosis and stable of renal function. Univariate and multivariate prognostic analyses were performed.ResultsWe identified 109 patients who received endourological treatment for ureteral stricture in our hospital’s medical database. After excluding patients undergone simple catheter dilation, endoureterotomy and other treatment method, 76 patients received balloon dilation without intraoperative fluoroscopic guidance were included in our study. 4/76 patients report a grade II complication (urinary tract infections, UTIs) according to Clavien Dindo classification. In the 22.5 months median follow-up time, the one-year cumulative success rate and two-year cumulative success rate were 85.9% and 80.2% (61/76), respectively, and the majority (13/15, 86.7%) recurrence of ureteral stricture or hydronephrosis deterioration were found within two years after surgery. The longer stenotic lesion length (>5 mm) or multiple ureter stenosis and compromised blood supply of ureter were significantly associated with postoperative stenosis recurrence.ConclusionsX-ray free endoscopic balloon dilation is a safe and effective procedure that could be performed on patients with ureteral stenosis.

Long-term survival and success of zirconia screw-retained implant-supported prostheses for up to 12 years: A retrospective multicenter study

Statement of problemDespite the broad clinical application of zirconia for fixed implant-supported prostheses, evidence of long-term performance is sparse. PurposeThe purpose of this retrospective study was to evaluate the long-term clinical and radiographic outcomes of zirconia-based partial and complete screw-retained implant-supported zirconia fixed dental prostheses (ISZFDPs). Material and methodsRecords of patients treated with dental implants and ISZFDPs between December 2004 and June 2017 were screened. Eligible study participants, according to inclusion criteria, were contacted and invited to undergo clinical and radiographic examinations. Outcomes were evaluated as implant and prosthetic survival rates, prosthetic success rate, complications, marginal bone level (MBL) change, and soft tissue condition. Along with the effects of zirconia prosthesis type and level, the effects of implant type and connection, type of loading, and follow-up on MBL were tested with a generalized linear effects model (GLEM) (α=.05). ResultsA total of 118 patients were identified, of whom 20 (16.9%) were not available for clinical examination for various reasons. Ninety-eight participants (mean age 60.7 ±11.7 years) with 337 implants were included, of which 176 (52.2%) had been immediately loaded. A total of 111 ISZFDPs (96 zirconia connection and 15 titanium base) were investigated: 24 complete ISZFDPs with a zirconia connection (12.9 ±0.97 dental units, minimum 12, maximum 14), 72 partial with a zirconia connection (3.11 ±1.12, minimum 2, maximum 7), 15 partial with a titanium base (3.62 ±1.02, minimum 2, maximum 5). Forty ISZFDPs had been in function for ≥10 years (36%), 38 for 5 to 9 years (34.2%), and 33 for 2 to 4 years (22.8%). The mean follow-up time was 7.2 ±3.4 years. No zirconia fractures were identified. Two implants and 2 ISZFDPs failed, with chipping being the most common complication (13.5%). The implant survival rate was 99.4%, and the prosthetic survival rate was 98.2%. The cumulative prosthetic success rate was 91.9%. MBL change was -0.18 ±0.59 mm. Thirteen implants were treated for peri-implantitis (3.8%), and 9 for mucositis (2.7%), but presented healthy peri-implant soft tissues at the follow-up examination. A significant difference was found between the implant-level and abutment-level prostheses (P=.013), with less marginal bone loss observed in ISZFDPs delivered at the implant level. ConclusionsZirconia-based screw-retained implant-supported prosthesis can be considered a reliable long-term treatment option for partial and complete edentulism. No zirconia fractures were experienced. Stable bone levels and low peri-implantitis rates were reported regardless of the ISZFDP type and level, implant type and connection, and type of loading.

Surgical outcomes after primary Baerveldt glaucoma implant surgery with vitrectomy for neovascular glaucoma.

This study aimed to evaluate the 3-year long-term outcomes of primary Baerveldt glaucoma implant (BGI) surgery for neovascular glaucoma (NVG). We retrospectively evaluated 27 consecutive patients with NVG between November 2013 and November 2017. All the patients were treated with panretinal photocoagulation and pars plana vitrectomy before BGI surgery without anti-vascular endothelial growth factor treatment. The surgical success of the BGI was defined as an IOP of <22 mmHg and <5 mmHg with or without antiglaucoma medication. The outcomes were assessed on the basis of intraocular pressure (IOP), visual acuity, postoperative complications, and cumulative success rate. Except for 2 mortality cases, 25 eyes (92.6%) were followed up for 3 years. The mean IOPs (mmHg)/numbers of glaucoma medications ± standard error of the mean before and 12 and 36 months after BGI surgery were 41.6/4.6 ± 1.9/0.2, 14.8/2.2 ± 0.8/0.4 and 16.9/2.6 ± 1.1/0.3, respectively. In all of the follow-up time points, the postoperative mean IOP and number of glaucoma medications were statistically significantly lower than the preoperative values (analysis of variance, P < 0.001). At 3 years after surgery, the rates of visual acuity improvement (logMAR ≤ -0.3), invariance (-0.3 < logMAR < 0.3), and worsening (logMAR ≥ 0.3) were 56.0% (14/25 eyes), 24.0% (6/25 eyes), and 20.0% (5/25 eyes), respectively. The most common postoperative complications were hyphema (4 eyes, 14.8%) and vitreous hemorrhage (5 eyes, 18.5%), and serious complications such as expulsive hemorrhage, endophthalmitis, and tube/plate exposure did not occur. The cumulative probabilities of surgical success after the operation were 100% at 1 year, 85.2% at 2 years, and 77.4% at 3 years. In conclusion, combined non-valved pars plana tube placement in conjunction with vitrectomy was successful at lowering IOP with relatively low complication rates.

A142 TRENDS IN HELICOBACTER PYLORI TREATMENT AND CURE IN EDMONTON: 2015–2020

Abstract Background Therapies for Helicobacter pylori infection have changed significantly over time due to changes in resistance patterns. In 2016, the Toronto H. pylori consensus guidelines recommended treatment for 14 days. First-line therapies are concomitant therapy with a proton-pump inhibitor (PPI) and clarithromycin-amoxicillin-metronidazole (CLAMET) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT). Second and/or third line therapies are PBMT or PPI-amoxicillin-levofloxacin (PAL) and the fourth line PPI-amoxicillin-rifabutin (PAR) for 10 days. Aims To describe and compare the efficacy of current treatment regimens for H. pylori infection in Edmonton. Methods This retrospective study reviewed records of patients treated for H. pylori infection at the University of Alberta Hospital (UAH) in Edmonton, Alberta from January 1, 2015 - November 1, 2020. Diagnosis of H. pylori infection and test-of-cure were documented with a positive urea breath test, stool antigen test, histology on endoscopy, or positive culture. Patients who had no post-treatment testing were excluded. The per protocol efficacy of different regimens was calculated as well as cumulative success rates when given as 2nd, 3rd or 4th line therapy. Results Overall, 170 of 237 (71.7 %) confirmed H. pylori cases achieved cure. The majority were female (64%) and 113 (48%) were born outside of Canada. CLAMET initiated at UAH had the highest success rate 41/45 (91%), and in referred patients who were previously treated was successful as first-line therapy in 45/70 (64%). Overall success rate of regimens were as follows (Table 1): CLAMET 49/98 (50%), PBMT 45/114 (40%), PAL 33/99 (33%), and PAR 16/31 (51%). Alternative regimens were not successful 27/223 (12%). Cultures and resistance profiles were available for 53 cases that failed initial treatment. Resistance to clarithromycin (84%), metronidazole (48%), and levofloxacin (41%) was highly prevalent (Figure 1). Conclusions Test-of-cure is important to verify H. pylori eradication as antibiotic resistance is common to clarithromycin, metronidazole, and levofloxacin when prior treatments failed. These results support the H. pylori treatment regimens recommended by the Toronto consensus guidelines. Funding Agencies None

Long-term durability of uterine artery embolisation for treatment of symptomatic adenomyosis.

BackgroundFailing conservative therapies, uterine artery embolisation (UAE) has been proposed as a uterine‐sparing option for treatment of symptomatic adenomyosis. UAE appears effective at short‐term; however long‐term durability is less well established.AimsTo evaluate the long‐term clinical efficacy of UAE for treatment of adenomyosis.Materials and MethodsOne hundred and four women with initial clinical success following UAE for adenomyosis (results previously published) were further followed with a two‐part online survey. Part one inquired about menopause, symptom recurrence, need for further intervention and overall satisfaction. Part two comprised the Uterine Fibroid Symptom and health‐related Quality of Life (UFS‐QOL) questionnaire. Maintenance of clinical success was defined as remaining ‘happy’ or ‘very happy’ with overall outcome, no recurrence of symptoms, or need for further intervention.ResultsOf those women with initial success, 91/104 (88%) participated in this long‐term study at mean 52 months following UAE. Maintenance of clinical success was demonstrated in 82/91 (90%) women. For the remaining 9/91 (10%) women, mean time to failure was 31 months. There were 53/91 (58%) women who reached menopause at mean age of 51.5 years, occurring at mean 30 months post‐UAE. UFS‐QOL demonstrated significant decrease in symptom severity from 58.9 to 20.0 (P < 0.001); and significant increase in QOL from 40.3 to 86.3 (P < 0.001).ConclusionsLong‐term durability of UAE for treatment of adenomyosis was demonstrated, with cumulative success rate of 80% at mean 52 months. UAE did not appear to bring forward menopause. UAE should be considered as an alternative to hysterectomy to treat adenomyosis.