Improve Success Rates Research Articles

RACIAL DISPARITIES IN FROZEN EMBRYO TRANSFER SUCCESS

Racial and ethnic disparities in pregnancy outcomes have been reported after fresh in vitro fertilization (IVF) cycles, but there are limited data on disparities after frozen embryo transfers (FETs). The objective of this study was to compare pregnancy and live birth rates after FETs among women of different self-reported race/ethnicity groups and explore the effect of patient, protocol, and cycle characteristics on success. Retrospective cohort study Women undergoing an autologous FET between January 2013 and March 2020 were included. Co-maternity, surrogacy, donor oocyte/embryo cycles, or those not surviving the thaw were excluded. Demographics and clinical characteristics including self-reported race and ethnicity were abstracted from the medical record. Continuous variables were compared using the Student’s t-test or Mann–Whitney U test while the χ2 or Fisher’s exact tests were used to compare categorical variables. Multivariable logistic regression was used to examine the relationships between pregnancy, live birth, and race while adjusting for potential confounders. White, Black, and Asian women underwent a total of 1664 (73.7%), 257 (11.4%), and 336 (14.9%) frozen embryo cycles, respectively. Only 3.4% of the population self-identified as Hispanic/Latino. Programmed FETs were performed in 83.4% of all cycles (n=1975). Black women were significantly older at the time of egg retrieval, had a higher prevalence of fibroids, higher BMIs, were less likely to transfer PGT-tested blastocysts, and less likely to undergo a single embryo transfer when compared to non-Black women (p < 0.05). Overall, Black women were significantly less likely to achieve pregnancy after FET when adjusting for age, BMI, parity, and number of embryos transferred compared to non-Black women (AOR 0.68, 95% CI 0.51-0.92, p=0.01). Though there was no significant overall difference in live birth rates, endometrial preparation protocol modified the effect of race on live birth. Black women were significantly less likely to achieve a live birth after a natural cycle FET compared to non-Black women (37.1% vs 13.0%, p=0.02), a difference not observed with programmed FETs (42.2% vs 40.0%, p=0.5). A sub-analysis investigating lower implantation rates showed no racial differences in mean estradiol or progesterone within 24 hours of transfer or endometrial morphology in programmed FETs (n=1680). Results were unchanged when restricting the analysis to women without fibroids and non-PGT cycles. In this study using a diverse cohort of more than 2000 women, Black race was associated with a significantly lower rate of embryo implantation following FET independent of the effects of endometrial preparation protocol, PGT, and established predictors of treatment success. Our finding that racial differences in live birth after FET may depend on the endometrial preparation protocol is novel and requires further study. Disparities in success are not only important for patient counseling, but also warrant further investigation to develop strategies to improve success rates in Black women.

ASSOCIATION BETWEEN ESTRADIOL LEVELS AND OBSTETRIC OUTCOMES IN LETROZOLE-STIMULATED FROZEN EMBRYO TRANSFER CYCLES

Letrozole-stimulated frozen embryo transfer (LTZ-FET) cycles are increasingly utilized due to growing evidence of improved success rates in multiple populations, including patients with polycystic ovary syndrome, diminished ovarian reserve, tubal factor, or unexplained infertility. The degree of estrogen suppression is variable between patients, and the impact of low estradiol (E2) levels in the follicular phase is unknown. Thus, the goal of this study was to assess the impact of low estradiol on outcomes of LTZ- FET cycles.

Named Data Networking-Based Macrovehicular Cloud Framework

Named data networking (NDN) is a new data-centric paradigm where a consumer may communicate with multiple providers; therefore, it might be an ideal solution for constructing a macrovehicular cloud (aVC). Based on this observation, we are motivated to exploit the advantages of NDN to achieve aVC. However, NDN has a different architecture from vehicular networking, which might lead to considerable aVC-based data retrieval costs and frequent reverse-path disruptions. To overcome the problems, we propose an NDN-based aVC framework (NVCF) to achieve aVC, and aim to reduce aVC-based data retrieval costs and improve aVC-based data acquisition success rates. NVCF exploits NDN to achieve aVC so that vehicles can acquire aVC-based data via one data retrieval process. Moreover, NVCF stabilizes reverse paths by electing a small number of forwarders so that vehicles can employ unicast and stable reverse paths to retrieve data from the nearest provider or forwarder involved in reverse paths. Furthermore, NVCF can effectively fix broken reverse paths to guarantee successful receipt of aVC-based data. NVCF is analyzed and evaluated, and the experimental results demonstrate that NVCF effectively reduces data retrieval costs and improves success rates.

The variation of the posterior variance and Bayesian sample size determination

We consider Bayesian sample size determination using a criterion that utilizes the first two moments of the posterior variance. We study the resulting sample size in dependence on the chosen prior and explore the success rate for bounding the posterior variance below a prescribed limit under the true sampling distribution. Compared with sample size determination based on the average of the posterior variance the proposed criterion leads to an increase in sample size and significantly improved success rates. Generic asymptotic properties are proven, such as an asymptotic expression for the sample size and a sort of phase transition. Our study is illustrated using two real world datasets with Poisson and normally distributed data. Based on our results some recommendations are given.

An analysis of the demography and histology of patients presenting with oral cavity malignancy

In the modern world one of the most dreaded disease is cancer. Among all the cancers that occur, cancer within the oral cavity ranks as the eleventh most common cancer globally In view of the changing trends in oral cancer we did a study to evaluate the practices followed for oral cancer in our study.The present study was a non-randomized prospective observational study that was done on patients who visited hospital and were diagnosed by histopathology as having oral cancer. The study was done at the department of general surgery and surgical oncology at the Father Muller Medical College. Kankanady in the state of Karnataka South India. The study was done. During the study period that extended from March 2014 to February 2020 the following observations were done on a total of 202 cases.Those who met a predefined criteria and gave a written informed consent were enrolled in the study. They were explained regarding their disease, the treatment options that are available and the alternative treatments if any. Once the patients was optimized, based on the decision of the tumour board appropriate therapy was given and the complications of each was noted down. During the study period that extended from March 2014 to February 2020 the following observations were done on a total of 202 cases .In the present study between the age of 20 and 60 years we had 148 cases (73.26%), the most common decade involved was 41-50 years with 68 cases (33.66%). In the productive age group between the age of 21 years and 50 years we had 146 cases. The predominant population affected by oral cancer was male’s 164 cases (81.19%)On evaluation of the clinical presentation distribution in the study subjects all cases presented with ulcer .Lesions of the tongue were seen in 99.01% cases. In most cases wide excision and reconstruction was possible (54 cases) near glossectomy with MRND was done in 1patient hemi glossectomy with MRND was done in 16 patient partial glossectomy with MRND was done in 17 patient. All case were proved as Squamous cell carcinoma. The minimum follow up was for 13 months and at the last follow-up all cases were found to be tumour free . The mainstay of current. Exciting challenges include improving success rates of current therapy, reducing the morbidity of treatment, and to select the most appropriate treatment.

Abstract 802: Implementation of optimized research biopsy analyses for clinical pharmacodynamic (PD) studies

Abstract Research biopsies collected for evaluation of pharmacodynamic (PD) biomarkers present requirements beyond those obtained for diagnostic purposes. Despite establishing stringent post-collection handling and processing procedures, we have found that many biopsy pairs collected from the early phase trial patient population demonstrate significant tissue heterogeneity and viable tumor content too low to adequately assess biomarker response in the tumor cell population. A retrospective analysis of samples collected from NCI's Developmental Therapeutics Clinic (DTC) from 1/2010-9/2016 revealed an initial success rate for analysis of paired biopsies of only 53%; this was primarily due to a high incidence of biopsies with no or very low tumor content. Based on this initial high failure rate, several clinical and laboratory initiatives were undertaken to identify and mitigate factors which contribute to biopsy unsuitability. After consultation with other translational oncology teams to review best practices, we have published and implemented critical recommendations to improve research biopsy quality at the clinical project team level (PMID: 30285529). In addition to important updates to the clinical trial strategy, several actionable improvements have been identified and implemented at the laboratory level to significantly increase the success rate of research biopsy analyses. Improvements in the biopsy processing approach include use of multiple 18-gauge biopsy cores per timepoint as a standard approach for all PD trials, implementation of methods to prevent biopsy curling during fixation and processing to ensure full longitudinal facing of the tissue during sectioning, and deeper sectioning of the blocks with H&amp;E evaluation of flanking slides by an anatomic pathologist with subsequent release of nonadjacent slides from the most optimal slide range for the primary PD analyses. Development of advanced image analysis methods including the use of β-catenin as a tissue segmentation marker for multiplex immunofluorescence assays has allowed for successful analysis of biopsies with significant heterogeneity and low tumor content. Additionally, defining the minimum cell number required to reach significance for PD marker measurements and capturing additional image fields in low tumor content biopsies to reach the required threshold has led to the implementation of highly robust methods across multiple clinical trials and laboratories. An analysis of biopsies collected from 10/2016-9/2019, after which several clinical and laboratory improvements had been implemented, revealed a significantly improved success rate for paired biopsies of 83%. Funded by NCI Contract No HHSN261200800001E. Citation Format: Katherine V. Ferry-Galow, Deborah Wilsker, Robert J. Kinders, Hala R. Makhlouf, Angie Dull, Tony Navas, Rachel E. Andrews, Geraldine O'Sullivan Coyne, Alice P. Chen, James H. Doroshow, Ralph E. Parchment. Implementation of optimized research biopsy analyses for clinical pharmacodynamic (PD) studies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 802.

Outcomes of Pulmonary Vein Isolation in Athletes

The aims of this study were to assess outcomes of pulmonary vein isolation (PVI) performed on athletes at a tertiary care center and to characterize its efficacy and physiological effects. The incidence of atrial fibrillation (AF) is increased in highly trained athletes and poses unique management challenges. Athletes were identified through a database of patients undergoing PVI from January 2000 through October 2015. Outcomes of AF ablation were defined in accordance with published guidelines. Available electrocardiographic, echocardiographic, and exercise treadmill testing data were also analyzed. The study population included 144 athletes (93% men; mean age 50.4 ± 8.6 years; 97 paroxysmal, 38persistent, and 9 long-standing persistent) with median follow-up of 3 years. Single-procedure freedom from arrhythmia was 75%, 68%, and 33% at 1 year for paroxysmal, persistent, and long-standing persistent AF, respectively. Multiple-procedure freedom from arrhythmia off antiarrhythmic drugs was 86%, 76%, and 56% in respective groups at the end of follow-up (mean 1.4 ± 0.7 ablations per athlete). Compared with a matched cohort of nonathletes who underwent PVI, there was no difference in arrhythmia recurrence (log-rank p=0.23). Excluding long-standing persistent AF, longer diagnosis-to-ablation time was the only variable in Cox proportional hazards analyses associated with arrhythmia recurrence (adjusted heart rate per log increase: 1.92; 95% confidence interval: 1.40 to 2.73; p<0.0001), and PVI within 2 years of diagnosis was notably associated with successful outcomes (log-rank p=0.002). Sinus rate increased following the index ablation (mean 54 beats/min vs. 64 beats/min at >1 year; p<0.0001), but maximum metabolic equivalents on exercise treadmill testing were unchanged (13.1 ± 1.2 vs. 12.7 ± 1.4; p=0.44). PVI is an effective therapy in athletes with paroxysmal and persistent AF, and arrhythmia recurrence was no different from that among matched nonathletes. Early ablation was associated with improved success rates. Sustained cardioautonomic effects were observed following ablation, but exercise capacity was preserved.

Ketosynthase Domain Constrains the Design of Polyketide Synthases.

Modular polyketide synthases (PKSs) produce complex, bioactive secondary metabolites in assembly line-like multistep reactions. Longstanding efforts to produce novel, biologically active compounds by recombining intact modules to new modular PKSs have mostly resulted in poorly active chimeras and decreased product yields. Recent findings demonstrate that the low efficiencies of modular chimeric PKSs also result from rate limitations in the transfer of the growing polyketide chain across the noncognate module:module interface and further processing of the non-native polyketide substrate by the ketosynthase (KS) domain. In this study, we aim at disclosing and understanding the low efficiency of chimeric modular PKSs and at establishing guidelines for modular PKSs engineering. To do so, we work with a bimodular PKS testbed and systematically vary substrate specificity, substrate identity, and domain:domain interfaces of the KS involved reactions. We observe that KS domains employed in our chimeric bimodular PKSs are bottlenecks with regards to both substrate specificity as well as interaction with the acyl carrier protein (ACP). Overall, our systematic study can explain in quantitative terms why early oversimplified engineering strategies based on the plain shuffling of modules mostly failed and why more recent approaches show improved success rates. We moreover identify two mutations of the KS domain that significantly increased turnover rates in chimeric systems and interpret this finding in mechanistic detail.

GWOVina: A grey wolf optimization approach to rigid and flexible receptor docking.

Protein–ligand docking programs are indispensable tools for predicting the binding pose of a ligand to the receptor protein. In this paper, we introduce an efficient flexible docking method, gwovina, which is a variant of the Vina implementation using the grey wolf optimizer (GWO) and random walk for the global search, and the Dunbrack rotamer library for side‐chain sampling. The new method was validated for rigid and flexible‐receptor docking using four independent datasets. In rigid docking, gwovina showed comparable docking performance to Vina in terms of ligand pose RMSD, success rate, and affinity prediction. In flexible‐receptor docking, gwovina has improved success rate compared to Vina and AutoDockFR. It ran 2 to 7 times faster than Vina and 40 to 100 times faster than AutoDockFR. Therefore, gwovina can play a role in solving the complex flexible‐receptor docking cases and is suitable for virtual screening of compound libraries. gwovina is freely available at https://cbbio.cis.um.edu.mo/software/gwovina for testing.

Simulation Modeling as a Novel and Promising Strategy for Improving Success Rates With Research Funding Applications: A Constructive Thought Experiment.

Writing a successful grant or other funding applications is a requirement for continued employment, promotion, and tenure among nursing faculty and researchers. Writing successful applications is a challenging task, with often uncertain results. The inability to secure funding not only threatens the ability of nurse researchers to conduct relevant health care research but may also negatively impact their career trajectories. Many individuals and organizations have offered advice for improving success with funding applications. While helpful, those recommendations are common knowledge and simply form the basis of any well-considered, well-formulated, and well-written application. For nurse researchers interested in taking advantage of innovative computational methods and leading-edge analytical techniques, we propose adding the results from computer-based simulation modeling experiments to funding applications. By first conducting a research study in a virtual space, nurse researchers can refine their study design, test various assumptions, conduct experiments, and better determine which elements, variables, and parameters are necessary to answer their research question. In short, simulation modeling is a learning tool, and the modeling process helps nurse researchers gain additional insights that can be applied in their real-world research and used to strengthen funding applications. Simulation modeling is well-suited for answering quantitative research questions. Still, the design of these models can benefit significantly from the addition of qualitative data and can be helpful when simulating the results of mixed methods studies. We believe this is a promising strategy for improving success rates with funding applications, especially among nurse researchers interested in contributing new knowledge supporting the paradigm shift in nursing resulting from advances in computational science and information technology.

Study on drug related problems in tuberculosis patients undergoing treatment

Background: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It is one of the leading causes of mortality and morbidity around the world. The aim of this study to identify and document the drug related problems in tuberculosis patients under anti-tubercular treatment (ATT) in an attempt to promote adherence, reduce the drug related problems and improve success rate in TB treatment. The main objective of the study to identify the drug related problems in tuberculosis patients on ATT and second objective measure the medication adherence and counsel patients to improve medication adherence.Methods: A prospective observational study was conducted in Raja Muthiah Medical College Hospital for 6 months from November 2018 to April 2019. The study was approved by Institutional Human Ethics Committee (IHEC).Results: Total 101 drug related problems have been identified in 70 patients using pharmaceutical care network of Europe classification. Drug interactions 41.58% was the most common drug related problems found, which was clinically significant in tuberculosis patients with co- morbidities. Insufficient awareness of health and disease 21.75% was the second most common drug related problems found, 16.83% drug choice problems found. Nearly 64% of the enrolled patients were found to be non-adherence during pre-patient counselling. After the patient counselling the adherent rate was improved 74%.Conclusions: The study concludes that pharmacist provided patient counselling found to have significant influence on improvement in the patient’s knowledge towards their disease and medication, and adherence to prescribed therapy which helps to improve the clinical outcome of TB patients.

Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function

BackgroundManagement of lumbar canal stenosis should be started with conservative treatment and preferably with a multimodal approach, but in cases of severe pain with extensive neurogenic claudication symptoms, surgical intervention is indicated. This retrospective study targets to evaluate the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function.MethodsData of 184 patients of the study groups were divided into group A (data from patients who underwent laminectomy and foraminotomy only) and group B (data from patients who underwent laminectomy and foraminotomy with spinal fixation). Preoperative, operative, postoperative (PO), and follow-up data were extracted and analyzed from files of patients fulfilling the inclusion criteria.ResultsPrimary outcome was at least 50% improvement of pain severity regarding numeric rating scale (NRS) and Oswestry disability index (ODI) score at 6-months PO compared to preoperative scores. Operative time was significantly longer in group B than group A. Immediate PO data regarding PO analgesic requirement, amount of wound drainage, and PO hospital stay showed non-significant difference between both groups. There was a statically significant improvement of EHL muscle strength regarding Odom’s scoring in group B in which the success rate for pain improvement was 81.8% and for disability was 66.8%. There were insignificant differences in patient’s satisfaction to surgery with variable ages, a significant outcome in females and in patients with fewer levels of affection of both groups.ConclusionThe present study reported the efficacy and safety of the laminectomy, foraminotomy, discectomy, and medial facetectomy with spinal fixation using trans-pedicular screws for management of patients with spinal canal stenosis.

Interventions for non-tubal ectopic pregnancy.

Interventions for non-tubal ectopic pregnancy.

Isolation and Propagation of Laboratory Strains and a Novel Flea-Derived Field Strain of Wolbachia in Tick Cell Lines.

Wolbachia are intracellular endosymbionts of several invertebrate taxa, including insects and nematodes. Although Wolbachia DNA has been detected in ticks, its presence is generally associated with parasitism by insects. To determine whether or not Wolbachia can infect and grow in tick cells, cell lines from three tick species, Ixodes scapularis, Ixodes ricinus and Rhipicephalus microplus, were inoculated with Wolbachia strains wStri and wAlbB isolated from mosquito cell lines. Homogenates prepared from fleas collected from cats in Malaysia were inoculated into an I. scapularis cell line. Bacterial growth and identity were monitored by microscopy and PCR amplification and sequencing of fragments of Wolbachia genes. The wStri strain infected Ixodes spp. cells and was maintained through 29 passages. The wAlbB strain successfully infected Ixodes spp. and R. microplus cells and was maintained through 2–5 passages. A novel strain of Wolbachia belonging to the supergroup F, designated wCfeF, was isolated in I. scapularis cells from a pool of Ctenocephalides sp. cat fleas and maintained in vitro through two passages over nine months. This is the first confirmed isolation of a Wolbachia strain from a flea and the first isolation of any Wolbachia strain outside the “pandemic” A and B supergroups. The study demonstrates that tick cells can host multiple Wolbachia strains, and can be added to panels of insect cell lines to improve success rates in isolation of field strains of Wolbachia.

A New Therapeutic Framework for Atrial Fibrillation Drug Development

Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia and cause of significant morbidity and mortality. Its increasing prevalence in aging societies constitutes a growing challenge to global healthcare systems. Despite substantial unmet needs in AF prevention and treatment, drug developments hitherto have been challenging, and the current pharmaceutical pipeline is nearly empty. In this review, we argue that current drugs for AF are inadequate because of an oversimplified system for patient classification and the development of drugs that do not interdict underlying disease mechanisms. We posit that an improved understanding of AF molecular pathophysiology related to the continuous identification of novel disease-modifying drug targets and an increased appreciation of patient heterogeneity provide a new framework to personalize AF drug development. Together with recent innovations in diagnostics, remote rhythm monitoring, and big data capabilities, we anticipate that adoption of a new framework for patient subsegmentation based on pathophysiological, genetic, and molecular subsets will improve success rates of clinical trials and advance drugs that reduce the individual patient and public health burden of AF.

Protein Binding Pocket Optimization for Virtual High-Throughput Screening (vHTS) Drug Discovery.

The virtual high-throughput screening (vHTS) approach has been widely used for large database screening to identify potential lead compounds for drug discovery. Due to its high computational demands, docking that allows receptor flexibility has been a challenging problem for virtual screening. Therefore, the selection of protein target conformations is crucial to produce useful vHTS results. Since only a single protein structure is used to screen large databases in most vHTS studies, the main challenge is to reduce false negative rates in selecting compounds for in vitro tests. False negatives are most likely to occur when using apo structures or homology models of protein targets due to the small volume of the binding pocket formed by incorrect side-chain conformations. Even holo protein structures can exhibit high false negative rates due to ligand-induced fit effects, since the shape of the binding pocket highly depends on its bound ligand. To reduce false negative rates and improve success rates for vHTS in drug discovery, we have developed a new Monte Carlo-based approach that optimizes the binding pocket of protein targets. This newly developed Monte Carlo pocket optimization (MCPO) approach was assessed on several datasets showing promising results. The binding pocket optimization approach could be a useful tool for vHTS-based drug discovery, especially in cases when only apo structures or homology models are available.

Automated macula proximity diagnosis for early finding of diabetic macular edema

Diabetic retinopathy (DR) is non-recoverable in nature. One of the advanced sight threatening condition in diabetic patient is defined in terms of diabetic macular edema (DME), where the macula gets deposited with fluid rich in proteins called exudates. It is indisputably required to find and treat occurrence of exudates near macula in time, to avoid further complications of retina and vision loss at later stage. However, presence of various dark and bright lesions awakes the need of reliable macula and exudate detection process. Proposed work intends to present a robust, scale, and rotation invariant tool for early diagnosis of DME. Optic disc (OD) diameter is one of the important parameters; it is always proportional to the size of the retina; an adaptive method based on pixel count and histogram-based segmentation is used for optic disc detection. Center of macula is detected based on estimated optic disc radius calculations and anatomical priors. In order to reduce computational burden, two disc diameter (DD) region near macula is extracted. Hard exudates are extracted with unique combination of CLAHE and morphological operations, followed by Kirsch’s mask for sharp edge detection of hard exudates, and further morphological operations for noise removal. OD detection algorithm is evaluated on four different databases DiaretDB1, MESSIDOR, DRIONS-DB, and images from local hospital, overall sensitivity of 95.71% is achieved, highest sensitivity value is 98%, and is achieved on first 100 images from MESSIDOR database. Further DiaretDB1 and images from local hospital are processed further for macula detection and exudates finding in macular proximity, as DiaretDB1 is rich in variety of DR lesions and images from the local hospital to deal with real-time issues. Finding macula region is achieved with an overall success rate of 91.93% and overall sensitivity of 99% is reported on both the chosen databases. Proposed work provides an automated tool, for early diagnosis of diabetic macular edema. The method is straightforward, robust and computationally less complex and improved success rates for feature, and lesion detections are achieved as compared with state-of-the-art methods.

Anatomical features of the radial artery in the Xinjiang population in China and its impact on the transradial coronary intervention procedure.

The anatomical features of the radial artery (RA) influence the transradial coronary intervention. The aim of this study is to discuss the anatomical features of the RA in the Xinjiang population and to guide interventionists in decreasing complications and improving success rates. We enrolled 1731 patients in this study. All relevant basic information was recorded in detail, and the RA diameter was examined. Patients were divided into a RA variation group and a RA non-variation group; univariate and multivariate factor analyses were performed to evaluate the relevant factors for RA diameter and the predictive value of the variable factors in RA variations. The mean RA diameter for all patients was 3.01 ± 0.14 mm. The multi-factorial analysis showed that height, gender, and occupation are significantly associated with RA diameter (p < 0.05). The incidence of RA variation was 4.97% (86/1731). Multi-factorial analysis showed that: gender (OR 2.72, 95% CI 1.469-5.037, p < 0.01), occupation (OR 2.228, 95% CI 1.0.000-0.012, p < 0.001) and RA inner diameter (OR 0.002, 95% CI 0.000-0.012, p < 0.001) are significantly associated with the incidence of RA variation. The mean RA diameter in the Xinjiang population was 3.01 ± 0.14 mm, height, gender, occupation are associated with RA diameter, gender, farmer, RA diameter are associated with RA variation. These factors can guide the interventionists to choose the appropriate equipment before the operation then can increase the efficiency of operation and prevent from the complications.

Comparison of Intranasal Dexmedetomidine Versus Intranasal Ketamine as Premedication for Level of Sedation in Children Undergoing Radiation Therapy: A Prospective, Randomised, Double-Blind Study.

ObjectiveRadiation therapy is indicated in many solid tumours in children. Absolute immobility is required to precisely position children for optimal delivery of radiation energy to the target tissues, improve success rate and reduce the damage to nearby normal tissues. Intranasal (IN) administration of drugs is well tolerated, effective and fast acting. The primary aim of the present study was to evaluate the effectiveness of IN ketamine and dexmedetomidine for providing sedation in children before shifting to the radiotherapy suite. The secondary objective was to assess the requirement of propofol dosage in these patients.MethodsA total of 243 children aged between 1 and 5 years scheduled to undergo external beam radiotherapy were randomised to receive 5 mg kg−1 ketamine (group K, n=80), 2.5 μg kg−1 dexmedetomidine (group D, n=85) or 0.5 ml of saline (group S, n=78) in each nostril. After 45 min, sedation score was measured according to the modified Ramsay score (MRS) at the time of shifting for radiation. Time to awakening and time to discharge after the procedure were also noted.ResultsA significantly higher proportion of children in group D (84.7%) achieved an MRS score ≥3 as compared to group K (36.2%) and group S (3.84%). The total propofol dose (mg kg−1) required was significantly less in group D (p<0.01). The patients in group D required more time to awakening, but this difference was not clinically significant.ConclusionThe present study demonstrated that IN dexmedetomidine is superior to IN ketamine to provide procedural sedation for radiotherapy in children.

Role of Coronary Computed Tomography Angiography in Percutaneous Coronary Intervention of Chronic Total Occlusions

Despite significant advances in procedural techniques for revascularization of chronic total occlusions (CTO), comprehensive procedural planning and accurate prediction of procedural success remain the Achilles’ heels of CTO percutaneous coronary intervention (PCI). Understanding the unique anatomic characteristics of CTOs that may predict relative success and complication rates of revascularization is imperative. Coronary computed tomography angiography (CCTA) has evolved as an adjunct to invasive angiography to better characterize CTO lesions to improve success rates of CTO PCI. Invasive angiography may be inadequate to characterize CTOs due to its inability to fully visualize the occluded segment. CCTA has evolved as a valuable adjunct to angiography, as it permits imaging of the arterial wall in the absence of luminal contrast, and thereby provides additional information regarding both the vessel course and lesion characteristics. CCTA-derived data can also be used in either standalone or combined scoring systems to assess the difficulty level of CTO PCI and has been shown to predict procedural success in clinical trials. Real-time CT fusion with X-ray angiography provides intraprocedural guidance to help resolve proximal cap ambiguity and better determine vessel course. In this review, we discuss the role of CCTA in guiding and improving outcomes of CTO PCI, both pre-procedurally and in real time.