Failed Attempt Research Articles

Abstract 9954: Single Operator Experience, Learning Curve, and Outcomes With Conduction System Pacing

Introduction: Conduction system pacing (CSP) is an increasingly used physiologic pacing modality by either His-bundle pacing (HBP) or left-bundle area pacing (LBAP). However, operators new to this technique may hesitate to implement CSP. We describe a single operator's experience (learning curve, clinical outcomes) with CSP from 07/2016-05/2022. Methods: Retrospective analysis of all 3830 Medtronic SelectSecure leads implanted by one operator at an academic institution. Patient characteristics, procedure times, ECG findings, pacing parameters, and clinical outcomes were analyzed. Results: A total of 140 CSP cases (Medtronic 3830 lead) were attempted over 70 months (78 HBP, 62 LBAP). Implant frequency (year → # of cases): 2016 → 3; 2017 → 5; 2018 → 24; 2019 → 25; 2020 → 36; 2021 → 35; 2022 → 12. The last HBP lead was implanted in March 2021; the 1st LBAP lead was implanted in December 2019. There were 23 unsuccessful attempts to achieve CSP at initial implantation (18 in the 1st 34%, mainly HBP cases; 5 in the last 92 cases) and 5 revisions (all HBP, see figure ). Procedure times shortened after the 1st 25 procedures for both HBP (158 to 132 mins, P=0.028) and LBAP (174 to 133 mins, P=0.002). Mean follow-up: HBP=558.2 days and LBAP=109 days. Ten patients (4 HBP, 6 LBAP) were lost to follow up. LBAP leads showed significantly better capture thresholds compared to HBP at implant and follow-up, although QRS narrowing, LV activation times, and improvement in LV function were not significantly different (see table). Conclusion: LBAP is easier to learn and has fewer failure rates as compared to HBP. Procedure times improve with experience within 25 cases. Majority of failed attempts were in the first third of cases, and all but one were in the HBP group. Operators new to CSP should forego HBP and employ LBAP. LBAP provides similar reductions in QRS duration, LV activation times, and LVEF improvement as compared to HBP, but with lower failure/revision rates and superior long-term pacing thresholds.

Protocol from a randomized clinical trial of multiple pharmacotherapy adaptations based on treatment response in African Americans who smoke

BackgroundThe standard of care in tobacco treatment is to continue individuals who smoke on the same cessation medication, even when they do not stop smoking. An alternative strategy is to adapt pharmacotherapy based on non-response. A handful of studies have examined this approach, but they have adapted pharmacotherapy only once and/or focused on adaptation distal rather than proximal to a failed quit attempt. Few studies have included racial/ethnic minorities who have less success in quitting and bear a disproportionate share of tobacco-related morbidity and mortality. MethodsThe current study is comparing the efficacy of optimized (OPT) versus enhanced usual care (UC) for smoking cessation in African Americans (AA) who smoke cigarettes. AAs who smoke (n = 392) are randomized 1:1 to OPT or UC. Participants in both groups receive 7 sessions of smoking cessation counseling and18-weeks of pharmacotherapy with long-term follow-up through Week 26. OPT participants receive nicotine patch and up to two pharmacotherapy adaptations to varenicline and bupropion plus patch based on carbon monoxide verified smoking status (≥6 ppm) at Weeks 2 and 6. UC participants receive patch throughout the duration of treatment. We hypothesize that OPT will be more effective than UC on the primary outcome of biochemically verified abstinence at Week 12. DiscussionIf effective, findings could broaden the scope of tobacco dependence treatment and move the field toward optimization strategies that impro ve abstinence for AA who smoke. Trial registrationNCT03897439.

8189 “Failed CS-BS” a Role for vNOTES in Patient with 4 Prior Cesarean Sections and Severe Adhesive Disease Desiring Sterilization

Study Objective To demonstrate the utility of vNOTES for opportunistic bilateral salpingectomy for permanent sterilization after failed attempt at bilateral tubal ligation at the time of previous Cesarean section. Design Stepwise demonstration with narrated video footage. Setting vNOTES opportunistic bilateral salpingectomy for permanent sterilization after failed bilateral tubal ligation during previous Cesarean section. Patients or Participants 31-yo G4P3013 with 4 prior Cesarean sections desiring permanent sterilization, BMI 38. Interventions During previous Cesarean section, bilateral adnexa unable to be accessed due to dense adhesions from previous surgeries. Patient to have vNOTES instead of conventional laparoscopy. Measurements and Main Results Patient underwent a successful vNOTES bilateral salpingectomy, with pathology confirming bilateral fallopian tubes. Conclusion vNOTES bilateral salpingectomy is a reasonable alternative to conventional laparoscopy in patients with severe adhesive disease. To demonstrate the utility of vNOTES for opportunistic bilateral salpingectomy for permanent sterilization after failed attempt at bilateral tubal ligation at the time of previous Cesarean section. Stepwise demonstration with narrated video footage. vNOTES opportunistic bilateral salpingectomy for permanent sterilization after failed bilateral tubal ligation during previous Cesarean section. 31-yo G4P3013 with 4 prior Cesarean sections desiring permanent sterilization, BMI 38. During previous Cesarean section, bilateral adnexa unable to be accessed due to dense adhesions from previous surgeries. Patient to have vNOTES instead of conventional laparoscopy. Patient underwent a successful vNOTES bilateral salpingectomy, with pathology confirming bilateral fallopian tubes. vNOTES bilateral salpingectomy is a reasonable alternative to conventional laparoscopy in patients with severe adhesive disease.

ODP586 Analysis of Adrenal Vein Sampling (AVS) Success: A Retrospective Study of Primary Aldosteronism Patients at the National University of Malaysia (UKM) Medical Center

Abstract Currently, the gold standard for identifying a unilateral Primary Aldosteronism (PA) is adrenal vein sampling (AVS), an invasive and technically challenging procedure. In this study, we aim to identify the clinical-laboratory characteristics associated with successful AVS, and clinical parameters associated with PA patients that had successful AVS (on 1st, 2nd, or 3rd attempt), or had rejected further attempts after a failed AVS attempt.100 records of AVS from eighty-three AVS patients conducted between 2015 and 2020 at the National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia were analysed retrospectively. Of the 83 PA patients studied, 47 were performed on men and 36 were on women. Variables significantly associated with patients who booked for a further attempt of AVS was having a serum aldosterone of <300pg/ml compared to those who rejected further attempts. There was also a trend for those who rejected further attempts to have a shorter duration of hypertension. Over one third of patient's have a failed AVS on 1st attempt and more than half do not wish to reattempt this invasive procedure. A biomarker for those that achieve complete cure should be identified to give incentives to the PA patients to proceed with AVS. Presentation: No date and time listed

Gaslighting: ALS, anti‐Blackness, and medicine

AbstractGaslighting has become a popular term to describe experiences of doubt and manipulation that make individuals or groups feel like their lived realities are not valid. Much of the theoretical work utilizing gaslighting as an analytic can be found in psychology literature or feminist domestic violence discussions. More recently, political scientists, philosophers, and sociologists have noted the structural, political, economic, and social processes that enable gaslighting to move beyond an interpersonal dynamic between women and their abusers. This essay extends these arguments through a Black feminist anthropological lens to examine how anti‐Black medical gaslighting functions structurally within medical systems, individually through implicit biases held by healthcare workers, and collectively through cultural norms. Despite Black patients’ learned mistrust of the medical system and often after multiple failed attempts to receive care or answers, ethnographic vignettes reveal that Black people with amyotrophic lateral sclerosis (ALS) and their caregivers continue to fight to be heard by the medical establishment despite being gaslit.

“Liberty or Death!”

“Liberty or Death!”

Combined use of the GlideScope and flexible fiberoptic bronchoscope after several failed intubation attempts for a retrosternal thyroid mass: a case report

A GlideScope® and a flexible fiberoptic bronchoscope (FOB) were successfully used in combination, to intubate a 73-year-old female patient in which repeated previous intubation attempts with conventional laryngoscope had failed. GlideScope®, and FOB were used sequentially. She had been scheduled for an elective total thyroidectomy to remove a huge retrosternal goiter. A computed tomography (CT) scan revealed a large necrotic mass (measuring 10 x 16 cm) with heterogeneous enhancement involving the thyroid gland and extending to the anterior mediastinum, causing significant tracheal compression and left deviation. Endotracheal intubation was successfully performed while she was awake using a combination of GlideScope and FOB. The operation lasted for two hours and was uneventful. The patient was then transferred to the intensive care unit (ICU) and kept intubated, sedated, and mechanically ventilated overnight. She was awakened and extubated the following day with no airway complications.
 Key words: Adult; Failed intubation; Female; Fiberoptic bronchoscope; GlideScope; Humans; Intubation, Intratracheal; Retrosternal thyroid mass
 Citation: Abaalkhayl MS. Combined use of the GlideScope and flexible fiberoptic bronchoscope after several failed intubation attempts for a retrosternal thyroid mass: a case report. Anaesth. pain intensive care 2022;26(4):554-558; DOI: 10.35975/apic.v26i4.1965
 Received: July 05, 2022; Reviewed: July 14, 2022; Accepted: July 16, 2022

Synthesis, Structure, and Bonding of a XeIV Transition‐Metal Coordination Complex, F3XeFb‐ ‐ ‐WOF4

AbstractThe coordination complex, F3XeFb‐ ‐ ‐WOF4, was synthesized in CFCl3 solvent by reaction of the weak fluoride‐ion donor and strong oxidative fluorinating agent, XeF4, with the moderate‐strength fluoride‐ion acceptor, WOF4. The compound is the only transition‐metal coordination complex of XeIV and was characterized at low temperatures by single‐crystal X‐ray diffraction and Raman spectroscopy. Xenon tetrafluoride and WOF4 coordinate trans to the W=O bond through a W‐ ‐ ‐Fb bond. The XeF3 moiety of F3XeFb‐ ‐ ‐WOF4 acquires a degree of [XeF3]+ character upon coordination that is reflected by its Xe−F stretching frequencies which are intermediate with respect to those of XeF4 and [XeF3]+. Calculations show W‐ ‐ ‐Fb is predominantly an electrostatic, σ‐hole bond with a significant orbital contribution that accounts for the bent Xe−Fb‐ ‐ ‐W angle. The calculations show F3XeFb‐ ‐ ‐MOF4 (M=Cr, Mo) are less stable than their W analogue, consistent with failed attempts to synthesize F3XeFb‐ ‐ ‐MoOF4.

Synthesis, Structure, and Bonding of a XeIV Transition-Metal Coordination Complex, F3 XeFb - - -WOF4.

The coordination complex, F3 XeFb - - -WOF4 , was synthesized in CFCl3 solvent by reaction of the weak fluoride-ion donor and strong oxidative fluorinating agent, XeF4 , with the moderate-strength fluoride-ion acceptor, WOF4 . The compound is the only transition-metal coordination complex of XeIV and was characterized at low temperatures by single-crystal X-ray diffraction and Raman spectroscopy. Xenon tetrafluoride and WOF4 coordinate trans to the W=O bond through a W- - -Fb bond. The XeF3 moiety of F3 XeFb - - -WOF4 acquires a degree of [XeF3 ]+ character upon coordination that is reflected by its Xe-F stretching frequencies which are intermediate with respect to those of XeF4 and [XeF3 ]+ . Calculations show W- - -Fb is predominantly an electrostatic, σ-hole bond with a significant orbital contribution that accounts for the bent Xe-Fb - - -W angle. The calculations show F3 XeFb - - -MOF4 (M=Cr, Mo) are less stable than their W analogue, consistent with failed attempts to synthesize F3 XeFb - - -MoOF4 .

Intimate bordering: Intimacy, anti-blackness and gender violence in the making of the Dominican border

This article proposes the term Intimate Bordering to explain the role of intimacy and social reproduction in the active process of border-making and statecraft. The concept contributes to understanding daily experiences of bordering among subaltern subjects who make and contest the border every day and yet are often unaccounted for. The concept sheds light on how racialized and gendered relations of power intrinsic to antiblackness and cis-hetero-patriarchy interweave and condition spatial politics and belonging. These arguments are developed by bridging border studies and black and feminist geographies, and by centering the experiences of Haitian women who work as domestic workers in Dominican border towns. The article is based on fieldwork carried out in four Dominican and Haitian border towns, including interviews, focus groups and participant observation focused on the everyday commutes of Haitian domestic workers who live in Haiti and work in the Dominican Republic (DR). It analyzes two sets of intimate border practices that take place at two official border crossings: the first set includes normalized forms of intimate violence and humiliation at the border; the second examines the failed attempt at institutionalizing the transborder mobilities of domestic workers based on colonial entitlements of control over the bodies of black Haitian women. Centering intimacy in bordering brings transnational livelihoods, social reproduction and racialization into the heart of the analysis of statecraft projects in the space of the Afro-Caribbean.

Transcatheter arterial embolization for bleeding from the pancreaticoduodenal artery in patients with celiac artery stenosis: A technical report

BackgroundTranscatheter arterial embolization (TAE) is widely accepted as a treatment for bleeding from the pancreaticodoudenal artery (PDA) in patients with celiac artery stenosis. However, the technical aspect of TAE has not received much attention.PurposeTo report the technical details and success rate of TAE for bleeding from the PDA in patients with CA stenosis.Material and MethodsBetween 2015 and 2021, nine TAE procedures were performed in eight patients (five women, three men; one woman underwent TAE twice). The cause of CA stenosis was compression by the median arcuate ligament in eight cases and CA dissection in one case. The cause of bleeding was flow-related aneurysm rupture in six cases. Pre-TAE CT showed a pseudoaneurysm in all cases. The technical details of TAE were recorded, and the success rate was evaluated.ResultsThe technical and clinical success rates were 100%. In six cases, both the CA and superior mesenteric artery (SMA) were cannulated using two parent catheters: a microcatheter advancing to the pseudoaneurysm from the CA (the CA approach) to achieve embolization and another catheter for angiography advancing from the SMA to map the vascular anatomy. In five cases, the CA approach was successfully performed after failed attempts of advancing a microcatheter from the SMA.ConclusionTAE is an effective treatment for bleeding from the PDA in patients with CA stenosis. Using two parent catheters, one for CA cannulation and microcatheter advancement and another for SMA cannulation and vascular mapping, may be a useful technique.

COVID-19-INDUCED EVANS SYNDROME: UNUSUAL COMPLICATION OF THE NEW USUAL

COVID-19-INDUCED EVANS SYNDROME: UNUSUAL COMPLICATION OF THE NEW USUAL

A Case of Zenker’s Diverticulum Who Underwent Secondary Open Diverticulectomy After Failed Rigid Transoral Endoscopic Diverticulotomy

The traditional approach to diagnosis and management of Zenker’s diverticulum is open surgical treatment. More recently, however, endoscopic technique is also frequently used for Zenker’s diverticulum because it has advantages of shortening operation time, postoperative hospitalization and reducing the complication such as recurrent laryngeal nerve injury. A 75-year-old male, who was diagnosed with Zenker’s diverticulum, underwent a secondary open diverticulectomy after failed attempt at rigid transoral endoscopic diverticulotomy. Here we report this case with a review of literature.

Evolving liver transplantation in Pakistan: Future challenges.

Liver transplantation is a life-saving procedure that started in the early 60s. Initially, it struggled with multiple failed attempts but later it progressed and emerged as a gold standard procedure for liver failure secondary to various etiologies. In the first two decades, it faced various challenges like peri and post-operative care management, the quality of graft, optimal immunosuppressant use, and recipient selection criteria. Because of these challenges, the 1-year survival remained below 30% initially. Liver transplantation flourished tremendously over time due to advancements in organ preservation techniques, immunosuppressive therapies, and a better understanding of immunology. The invention of calcineurin inhibitors changed the dynamics of immunosuppressive therapies altogether. The donor organ shortage remains the leading challenge, Deceased donor transplantation activities have not yet started here due to various socio-cultural, and religious resistance. The majority population of the country is underprivileged and faces financial issues to afford the costly liver transplant procedure. The other challenges include the emerging NASH and obesity epidemics. The prevalence of viral hepatitis has not decreased in the country despite advancements in antiviral therapies and vaccine availability against hepatitis B. The local transplant community needs to overcome the limitation of organ supply through various donor expansion approaches. Although it may seem difficult to address all these challenges, still, the transplant community and health authorities need to find an effective way to sort out all these challenges.

Use of the endometrial receptivity array to guide personalized embryo transfer after a failed transfer attempt was associated with a lower cumulative and per transfer live birth rate during donor and autologous cycles

To determine whether personalized embryo transfer (pET) guided by endometrial receptivity array (ERA) test improves reproductive outcomes for fresh embryo transfers (fsETs) or frozen embryo transfers (FETs) during autologous and donor cycles. A retrospective, observational, multicenter cohort study. University-affiliated invitro fertilization center. The study included patients with a single previous failed transfer and yielded 3,239 autologous transfers and 2,133 donor transfers. Among autologous transfers, 255 were pET guided by ERA; among unguided autologous transfers, 1,122 and 1,862 transfers involved fresh or previously frozen embryos, respectively. Among donor transfers, 319 were ERA-guided; among unguided donor transfers, 1,175 and 639 involved fsETs or FETs, respectively. None. Primary outcomes were live birth rate per embryo transfer and cumulative live birth rate on consecutive transfers until live birth or cessation of pregnancy. Secondary outcomes were implantation, pregnancy rate, clinical pregnancy rates per embryo transfer, and miscarriage rate per pregnancy. During both autologous or donor transfers, live birth rate and cumulative live birth rate were higher in FET and fsET than in pET groups, even with euploid transfers. Logistic regression analysis, considering possible confounders, indicated patients receiving pET had poorer outcomes than those undergoing FET and fsET in autologous and donor cycles. Implantation, pregnancy, and clinical pregnancy rates were lower in patients undergoing pET. Using ERA to guide pET during either autologous or donor cycles after a failed transfer attempt did not improve reproductive outcomes. Conversely, worse outcomes were detected when ERA was used.

Shapeshifting in the Venus flytrap (Dionaea muscipula): Morphological and biomechanical adaptations and the potential costs of a failed hunting cycle

The evolutionary roots of carnivory in the Venus flytrap (Dionaea muscipula) stem from a defense response to plant injury caused by, e.g., herbivores. Dionaea muscipula aka. Darwin’s most wonderful plant underwent extensive modification of leaves into snap-traps specialized for prey capture. Even the tiny seedlings of the Venus flytrap already produce fully functional, millimeter-sized traps. The trap size increases as the plant matures, enabling capture of larger prey. The movement of snap-traps is very fast (~100–300 ms) and is actuated by a combination of changes in the hydrostatic pressure of the leaf tissue with the release of prestress (embedded energy), triggering a snap-through of the trap lobes. This instability phenomenon is facilitated by the double curvature of the trap lobes. In contrast, trap reopening is a slower process dependent on trap size and morphology, heavily reliant on turgor and/or cell growth. Once a prey item is caught, the trap reconfigures its shape, seals itself off and forms a digestive cavity allowing the plant to release an enzymatic cocktail to draw nutrition from its captive. Interestingly, a failed attempt to capture prey can come at a heavy cost: the trap can break during reopening, thus losing its functionality. In this mini-review, we provide a detailed account of morphological adaptations and biomechanical processes involved in the trap movement during D. muscipula hunting cycle, and discuss possible reasons for and consequences of trap breakage. We also provide a brief introduction to the biological aspects underlying plant motion and their evolutionary background.

Female small business owners in China: Discouraged, not discriminated

Using a unique small business loan application dataset from a peer-to-peer (P2P) digital loan platform in China, we show that female entrepreneurs are more likely to be discouraged from applying for funds after a failed attempt compared to their male counterparts. Female discouragement persists at different regional development levels and is prominent among those who need finance for working capital. Although digitization of financial markets has made external funding more accessible to small business owners, disclosing more information during the application process would help those discouraged from posting a new funding application.

P06-13 Movida.Cronos – eHealth app at primary care to fight sedentary behavior

BackgroundHealth systems play a fundamental and recognized role in promoting physical activity, particularly in the context of primary health care. eHealth is a broad concept that incorporates any area that combines healthcare and technology. This concept is often associated with improvements in process efficiency and cost reduction. Still, high occurrence of physical inactivity demonstrate the importance of developing new eHealth approaches for a more effective actuation. The aim of this work was to develop a new methodology to increase physical activity level, at primary health care.MethodsA mobile application with web platform was developed to: physical activity prescription and monitoring; registration of biomedical variables, sending messages to users, managing physical activity events at the initiative of users (social network). The application was explained to the medical doctors and data from a case-study was accessed (56 years-old male, Caucasian, single, nuclear family, upper middle class). History of physical inactivity, obesity, hypertension, dyslipidemia and depressive disorder (sertraline 50mg and mexazolam 1mg therapy), body composition, physical and CRP fitness were assessed. International physical activity and Self-perceived quality of life assessment questionnaires were also used.ResultsIt was possible to understand that just by talking was not enough to engage the patient on a more active lifestyle. After several failed attempts on counseling for lifestyle changing, patient was referred for using the developed app. Physical exercise tailored plan was prescribed using the Movida.cronos. This tool opened the possibility of assessing patient performance and adherence to the prescribed program (>90%). It allowed a narrow informative channel between the patient and the medical doctor. In three months, the patient reduced form obesity to overweight (-3.4%), decrease his waist circumference (-6.3%), fat mass (-1.8%) and arterial mean pressure (-5.1%); with an associated increase on step test performance.ConclusionsThis case study demonstrate the potential use of eHealth technology, particularly in primary care. Movida.Cronos allowed the prescription and monitoring of performance and adherence levels to the prescribed exercise program. It brings novel perspectives on prescription and remote monitoring of physical exercise, leading to an increased adherence.

Unrootedness: a New Surface in the Lacanian Black Split Subject

How is the split black subject symbolized? The article attempts this question with its Lacanian-styled gap-filling (or -opening) method, using two clues — one from The Big Bang Theory sitcom, and the other from Achebe’s Things Fall Apart. The split subject comes before the imaginary, the mirror stage, which begins with the child’s experience of the Parental Other. Colonization and civil rights then become a later stage in the growth process of the black race, where the white acted as a Parental or Significant Other. Amy Farrell Fowler and Sheldon Cooper from CBS’ The Big Bang Theory (Season 6, Episode 21, first aired on April 25, 2013) both symbolically portray the colonial condition of Africa. After several failed attempts to attain gratification from his Significant Other, Cooper’s revolutionary attention to his “split subject’s needs” without Amy offers a new lens to theorize colonization as a “halfway error” to be corrected and transcended to reach where Okonkwo, in Things Fall Apart, fails. The unrootedness of being black would then polish the new surface to which the entire black race globally can behold and do something not done before.

Post-Soviet settlement of the Sino-Soviet border: a failed attempt at a three-level game, 1991–2012

ABSTRACT After the fall of the USSR, the newly established republics had to finish negotiating the bilateral border issue with China. These states chose to have the talks as a joint delegation of post-Soviet states. They also each experienced pressure from domestic constituencies. Viewing the entire negotiation process as a three-level game, the paper argues that in all four post-Soviet states the national governments believed the cost of ‘no agreement’ with China on the border issue to be so high that they chose to risk dealing with complex issues at home over passing up the opportunity to settle the border with their strongest neighbour. They did so with little regard for domestic opposition or the restrictions posed by the previous commitments on the supranational level.