Improve Success Rates Research Articles

Computational prediction of the metabolites of agrochemicals formed in rats

Today, computational tools for the prediction of the metabolite structures of xenobiotics are widely available and employed in small-molecule research. Reflecting the availability of measured data, these in silico tools are trained and validated primarily on drug metabolism data.In this work, we assessed the capacity of five leading metabolite structure predictors to represent the metabolism of agrochemicals observed in rats. More specifically, we tested the ability of SyGMa, GLORY, GLORYx, BioTransformer 3.0, and MetaTrans to correctly predict and rank the experimentally observed metabolites of a set of 85 parent compounds. We found that the models were able to recover about one to two-thirds of the experimentally observed first-generation, second-generation and third-generation metabolites, confirming their value in applications such as metabolite identification. However, precision was low for all investigated tools and did not exceed approximately 18 % for the pool of first-generation metabolites and 2 % for the pool of compounds representing the first three generations of metabolites. The variance in prediction success rates was high across the individual metabolic maps, meaning that outcomes depend strongly on the specific compound under investigation. We also found that the predictions for individual parent compounds differed strongly between the tools, particularly between those built on orthogonal technologies (e.g., rule-based and end-to-end machine learning approaches). This renders ensemble model strategies promising for improving success rates. Overall, the results of this benchmark study show that there is still considerable room for the improvement of metabolite structure predictors left. Our discussion points out several avenues to progress. The bottleneck in method development certainly has been, and will remain, for the foreseeable future, the limited quantity and quality of available measured data on small-molecule metabolism.

Save the Meniscus: The Meniscal Mantra Remains Durable: Commentary on an article by Rick W. Wright, MD, et al.: "Ten-Year Outcomes of Second-Generation, All-Inside Meniscal Repair in the Setting of ACL Reconstruction".

Commentary Save the meniscus. Save the meniscus. Save the meniscus. This is a subconscious orthopaedic mantra that we have all heard and repeated numerous times. Ever since Fairbank’s landmark study in 1948, “Knee Joint Changes After Meniscectomy,” and numerous later studies, we have learned to respect the importance of preserving the meniscus and, in turn, preventing degenerative changes1. In 2023, we may continue to debate over the best repair technique and the best repair augmentation and/or biologics, but we can all agree that we should do what we can to preserve and repair the meniscus. This has been demonstrated to be even more certain in the setting of a concomitant anterior cruciate ligament reconstruction (ACLR). Literature has demonstrated that meniscal tears heal better in the environment of an ACLR and, therefore, we should attempt to repair and preserve the meniscus as much as possible in this setting2,3. Historically, inside-out meniscal repair techniques were considered the gold standard, but as all-inside techniques have become more reliable, user-friendly, and able to mimic the traditional technique, they are more popularly used4. There are few 10-year outcome studies, and not many that examine all-inside meniscal suture devices; therefore, I commend Wright et al. on their current study. The authors performed a Level-IV retrospective review of 81 patients with a meniscal repair and concomitant primary ACLR using the second-generation, all-inside FAST-FIX Meniscal Repair System (Smith & Nephew). Some of these patients were included in their previous study evaluating outcomes of all-inside, second-generation repair at a 5-year follow-up4. In this current study, 69 of the 81 patients had a 10-year follow-up and 9 (13%) of the 69 patients had a failed meniscal repair, which was defined as a repeat surgical intervention involving resection or revision repair. The authors demonstrated that 84% to 88% of patients had a successful repair and all patients, regardless of failure, had favorable patient-reported outcome measures, which included the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) score, and the Marx Activity Rating Scale score, at 10 years. There were 59 medial repairs and 22 lateral repairs, and, of all the repaired tears, there were 13 bucket-handle tears, and the remaining tears were vertical longitudinal tears in the red-red or red-white vascular region. The study did not include radial tears, root tears, or ramp lesions. The mean number of sutures used for repair was only 2. Concerns with regard to the study include the lack of a comparison group, the use of older devices, and the shorter postoperative rehabilitation protocol. There are now third-generation, all-inside repair devices available, and the postoperative rehabilitation after a meniscal repair and ACLR is now ≥8 months. Perhaps this longer rehabilitation time can influence meniscal repair success or failure rates. The authors have demonstrated that the success rate of meniscal repair is 84% to 88% using an all-inside, second-generation technique with a concomitant ACLR. Although this is considered successful, what else can we do to optimize our success rates even more? Should we use better techniques and devices, or orthobiologics? How will this change as we repair different types of tears, including root and ramp tears? Also, how will longer rehabilitation affect meniscal healing and retear rates? If our mantra, save the meniscus, remains true, then I look forward to future data demonstrating what else we can do to improve success rates with all tears (bucket-handle, longitudinal, root, and ramp) with newer techniques and biologics.

Surgical Tips for Improving Success Rate of Deep Anterior Lamellar Keratoplasty in Keratoconus

This article aims to provide some personal surgical tips to increase the success rate of deep anterior lamellar keratoplasty (DALK), a very advantageous yet complex procedure for treating keratoconus. The most troublesome surgical step is obtaining a successful pneumatic dissection of the deep stromal tissue, allowing the exposure of a deep cleavage plane. The following tips may aid the trainee surgeon in mastering this step, among others: performing a deep trephination, using intraoperative anterior segment optical coherence tomography and/or femtosecond laser, exploiting the red reflex after pupil dilation, using the ophthalmic viscoelastic device in case of bubble formation failure. Approaches for reducing postoperative astigmatism are employing large-diameter grafts and using intraoperative keratoscopy with digital ring analysis. In conclusion, different tips can shorten the DALK learning curve and help to obtain better results from this surgery. Standardizing this surgical technique is paramount to reduce "human errors" and broaden its range of applicability.

EFFECTIVENESS OF COUGH ASSIST IN THE EXTUBATION OF ADULT PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS

In Intensive Care Unit (ICU), failure of extubation, resulting in the need for reintubation, mayoccur in 2-25% of Patients undergoing extubation[1].
 The purpose of this review and meta-analysiswas to determine the effectiveness of cough assist in improving success rates of extubation compared with standard treatment.
 Inclusion criteria were; Randomized Control Trials, which compared cough assist and conventional therapy in adult population in intensive care unit whith conventional therapy only. Outcomes representing the efficacy of the cough assist were: quantity and quality of secretions (weight, volume, and density), number of reintubation, indices of thoraco-pulmonary function.
 The search string produced 764 studies, and only 5 studies eligible for review. Overall, a total of 331 participants were enrolled in the five studies selected.
 Of the meta-analyzed outcomes, the calculation of the effect size for the weight of secretions is the one that gave the best results, while no statistical difference was found in the other outcomes. In none of the meta-analysis studies were observed adverse effects in the use of in-exsufflator.
 Our systematically review edsuggest sthatcough assist might be feasible and effective in patients intubated in ICU, but studies with larger sample sizes and well-defined outcomes are still required to obtain conclusive evidence.

Improving success rates by applying interventions in clinical practice and measuring their impact: A multicenter retrospective analysis of more than 240,000 cycles

BackgroundSystematic monitoring of key performance indicators (KPI) is an important component of quality management within the IVF laboratory and, as success of assisted reproduction depends on many variables, it is important to examine how each variable can be optimized to achieve the best possible outcome for patients. ObjectiveTo analyze how the design of a QMS impacts homogenization, safety, and efficacy in multiple fertility centers.Study Design Multicenter, retrospective cohort study with 188,251 patients who underwent 246,988 assisted reproductive treatments at 14 private centers belonging to IVI-RMA clinics between January 2005 and December 2019. Data were stratified by year, clinic, and patient group (standard patient cycles with no PGT-A, standard patients with PGT-A, and oocyte donation patients). Unadjusted and adjusted logistic regression models with other known predictors were made to analyze the impact and the interactions of policies. Main outcomes were determined per clinic and summarized per year as the median of the rates of the clinics; each clinic had the same weight independent of the number of cycles. ResultsUp to 188,251 patients were treated, for a total of 246,988 IVF cycles and 356,433 procedures. The introduction of standard operating procedures, trophectoderm biopsies, and blastocyst-stage transfers, coupled with an increased proportion of PGT-A cycles, led to improved outcomes while maximizing the number of single embryo transfers, driving a significant decrease in the number of multiple pregnancies while improving live birth rates. In terms of the live-birth rate per transfer, the interventions with greater impact over time in logistic regression analysis were 24-chromosome analysis and the introduction of benchtop incubators (odds ratio 1.92 [95% confidence interval 1.81 to 2.05]; p < 0.001). The odd ratios of the policies remained significant and very similar in the unadjusted and adjusted models. ConclusionsThe greatest impact on live-birth rate per cycle was obtained with a cumulative effect of all policies, especially in egg donation patients. In patients without PGT-A changing embryo culture conditions and blastocyst stage transfer had the greatest impact; in patients with PGT-A, trophectoderm biopsy. Standardizing procedures was essential in reducing variability among clinics and implementing changes.

Contextual Representation in NLP to Improve Success in Accident Classification of Mine Safety Narratives

Contextual representation has taken center stage in Natural Language Processing (NLP) in the recent past. Models such as Bidirectional Encoder Representations from Transformers (BERT) have found tremendous success in the arena. As a first attempt in the mining industry, in the current work, BERT architecture is adapted in developing the MineBERT model to accomplish the classification of accident narratives from the US Mine Safety and Health Administration (MSHA) data set. In the past multi-year research, several machine learning (ML) methods were used by authors to improve classification success rates in nine significant MSHA accident categories. Out of nine, for four major categories (“Type Groups”) and five “narrow groups”, Random Forests (RF) registered 75% and 42% classification success rates, respectively, on average, while keeping the false positives under 5%. Feature-based innovative NLP methods such as accident-specific expert choice vocabulary (ASECV) and similarity score (SS) methods were developed to improve upon the RF success rates. A combination of all these methods (“Stacked” approach) is able to slightly improve success over RF (71%) to 73.28% for the major category “Caught-in”. Homographs in narratives are identified as the major problem that was preventing further success. Their presence was creating ambiguity problems for classification algorithms. Adaptation of BERT effectively solved the problem. When compared to RF, MineBERT implementation improved success rates among major and narrow groups by 13% and 32%, respectively, while keeping the false positives under 1%, which is very significant. However, BERT implementation in the mining industry, which has unique technical aspects and jargon, brought a set of challenges in terms of preparation of data, selection of hyperparameters, and fine-tuning the model to achieve the best performance, which was met in the current research.

(359) Validation of Peripheral Endothelial Assessment and Central Arterial Tonometry as Tools in Arteriogenic Erectile Dysfunction and Can These Tools Aid in Better Selection of Patients for LI-ESWT Treatment Improving Success Rates?

Abstract Introduction An important mechanism of ED is vascular endothelial function injury or disorder and low-intensity extracorporeal shock wave therapy (LI-ESWT) can stimulate and promote vascular regeneration, especially in failed PDE5i. The present selection criteria used for EDSWT are subjective in the form of IIEF, EHS or SEP with no objective definition of the extent of vascular involvement. There is a need to comprehensively evaluate ED including the extent of local and systemic involvement. Objective To develop objective parameters of validated assessment of endothelium in men with organic erectile dysfunction and to evaluate if they could be used to plan accurate PDE5i, non-invasive modalities of treatment. Methods In a prospective study, patients who were earlier evaluated and had vasculogenic ED and failed PDE5i treatment were clinically re-evaluated with questionnaires and CDDU. Additionally endothelial function and large arterial stiffness was assessed with the Vendys (reactive hyperaemia) &amp; Sphygmocor (central arterial pressure waveform analysis). Categories identified were, endothelial dysfunction by Vendys, Aortic augmentation index abnormality by Sphygmocor (age corrected), combined abnormality with poor scores with or without metabolic comorbidity. All three groups underwent LI-ESWT with low dose PDE5 inhibitors with a revised protocol. Results Validation of diagnostic tools was done in thirty five patients aged 48.24 ± 4.6 years (mean ± SD) with a mean IIEF score of 8.4 were evaluated by the three techniques. Positive predictive value (PPV) of the three techniques was similar, in the range 89-91% and a negative predictive value (NPV) around 41-45%. CDDU had highest sensitivity at 85%, but low specificity of 55%, followed by Sphygmocor® at 77% and Vendys at 75% and the latter techniques had better specificity of 70%. Parameter Penile Doppler SphygmoCor® Vendys® Value 95% CI Value 95% CI Value 95% CI Sensitivity 85 % 70.1-94.3 77.5 % 61.5-89.1 75 % 58.8-87.3 Specificity 55.6 % 21.2-86.3 70.0 % 34.7-93.3 70 % 34.7-93.3 Positive likelihood Ratio 1.91 0.91-4.02 2.58 0.99-6.76 2.50 0.95-6.55 Negative likelihood Ratio 0.27 0.11-0.69 0.32 0.16-0.65 0.36 0.18-0.70 PSV (N) IIEF Class (N) % &amp;lt; 25 (22) Severe (18) 81.82 44.00 Mod (3) 13.64 Mild (1) 4.55 25-30 (17) Severe (0) 0.00 34.00 Mod (14) 82.35 Mild (3) 17.65 CDDU Vs IIEF score The patients were grouped into three arms Vendys abnormality, Sphygmocor and combined; for Li-ESWT treatment (15 each). Pre and Post questionnaire based assessment was done and maximum improvement of IIEF was in the Alx abnormality arm with poor results in combined abnormality. Conclusions The aortic strain index and distensibility index were impaired in patients with ED. Vendys® SphygmoCor® are new tools in diagnosis of ED and superior to penile Doppler or questionnaire assessment. Li-ESWT is most beneficial in patients with Aortic elastic abnormality probably due shock wave effect on sheer stress of vessels by altering vessel wall pulsatality and resistivity index. Disclosure No

What's New in Musculoskeletal Infection.

What's New in Musculoskeletal Infection.

Challenge in modern intensive care: chronic critical illness - pathophysiology and therapeutic options

The recent developments in intensive care have resulted in improved survival rates of patients treated with acute organ deficiency. As a consequence, the rate of those who survive the acute phase and subsequently require protracted organ support due to persisting organ dysfunction has been growing. Several survivors display chronic health status deterioration leading to prolonged rehabilitation or nursing, and repeated hospitalizations. The condition developed following the survival of the acute phase and requiring long-lasting intensive care is frequently termed as chronic critical illness (CCI). Several definitions exist, most of these are based on the number of ventilator days, or days of stay at the intensive care unit. Nevertheless, in spite of the initially heterogenous etiology of the acute illness, the complications associated with CCI, as well as the pathophysiological processes underlying these, are relatively uniform. This causes CCI to be a unique clinical syndrome characterized by the development of secondary infections, myopathy, central and peripheral neuropathy, and typical alterations of the hormonal and immune system functions. The outcome is heavily influenced by the frailty and comorbidities of the patient, in addition to the severity of the acute illness. The treatment of CCI patients presents a complicated task requiring multidisciplinary view and individualized therapeutic measures. Since the aging of the population and the continuously improving success rates in overcoming acute conditions also facilitate the development of CCI, the systematic overview of the underlying pathophysiological processes is pivotal for the optimization of the medical, nursing, social and economical burden presented by this syndrome. Orv Hetil. 2023; 164(18): 702-712.

PO-05-232 SAFETY AND EFFICACY OF ATRIOVENTRICULAR NODAL REENTRY TACHYCARDIA ABLATION USING AN IRRIGATED CONTACT FORCE CATHETER

Atrioventricular Nodal Reentry Tachycardia (AVNRT) ablation is a common procedure in contemporary electrophysiology practice. Traditionally ablation for AVNRT has been performed with non-irrigated catheters, guided by fluoroscopy and intracardiac electrograms. Increasingly electroanatomic mapping systems are utilized to allow for low or zero fluoroscopy procedures. Contact force catheters can provide information on tissue contact and stability that can be helpful in patients with challenging anatomy. Available contact force catheters are irrigated and concern has existed for using irrigated tip ablation catheters for AVNRT ablation due to the potential to create lesions that are too deep and could increase the risk for AV block. To describe the safety and efficacy for the use of irrigated contact force catheters for ablation of AVNRT Review of procedural data from patients undergoing radiofrequency ablation for AVNRT using electroanatomical mapping combined with irrigated contact force catheter. Fifty patients from 4 regions across Australia were included. Procedures were performed by 9 experienced electrophysiologists. No periprocedural complications occurred. Procedural success was achieved in 96%. Median lesion contact force (25-75 centile) was 4.0(2-6)g. Peak power was set at 50W, median baseline irrigation was at 2ml/min and 6ml/min during ablation. Median number of lesions was 9(4.5-17.5); with total ablation time of 203(95-366) seconds. 60% of the cases were performed without fluoroscopy. Ablation of AVNRT using an irrigated contact force catheter on low irrigation setting is safe and effective. Contact force catheters using low irrigation settings may safely improve success rates in AVNRT with challenging anatomy or ablation of other substrate in close proximity to vital structures.

PO-02-036 THE POSTERIOR WALL ISOLATION FOR PERSISTENT ATRIAL FIBRILLATION HIGH POWER SHORT DURATION (PEF-HOT) TRIAL

Treatment of persistent atrial fibrillation (PeF) remains a procedural challenge with high recurrence rate after catheter ablation. Posterior wall isolation (PWI) has emerged as a potential concomitant treatment strategy for PAF with conflicting outcomes. PWI introduces a left atrial (LA) roof and low posterior line through a series of radiofrequency (RF) applications to achieve entrance and exit block of the LA posterior wall. It remains unclear whether PWI with pulmonary vein isolation (PVI) during initial catheter ablation improves success rate over PVI alone. This study investigated whether PWI with PVI reduced recurrence rates compared to PVI alone in patients with PeF undergoing first-time radiofrequency ablation utilizing high-power-short-duration (HPSD) ablation. In this prospective, multicenter, randomized controlled trial, we randomized 67 patients with symptomatic PeF undergoing initial ablation to either PVI+PWI (n = 39) or PVI (n = 28) alone. The primary endpoint was freedom from atrial arrhythmias after a single procedure. Of the 67 study participants, the median duration of PeF was 0.67 (interquartile range, 0.25 - 2) years. The mean CHADS-VASc score was 2.7±1.6. No significant difference was found in the baseline characteristics between the two groups (Table 1). PWI was successfully achieved in all 39 patients in PVI+PWI group. Mean procedural times were 83.4±23.4 minutes for the PVI group, and 111.7±41.0 minutes for the PVI+PWI group. There was one complication of tamponade in the PVI+PWI group. At a median follow up of 12.4±3.0 months, the atrial arrhythmia recurrence rate did not significantly differ (P=0.9275) between PVI+PWI (20.5%) and PVI alone (21.4%). Kaplan-Meier analysis showed no significant difference in the overall AF recurrence (log-rank, P=0.9485). Additionally, the Cox univariate regression and multivariate Cox regression for all notable comorbidities revealed no significant association with procedural outcomes. In patients with PeF undergoing initial RF ablation, adjunctive PWI with PVI using HPSD did not significantly reduce recurrence rate of atrial arrhythmias.Tabled 1Table 1: Baseline Clinical CharacteristicsOverall (N = 67)Arm 1(N=28)Arm 2 (N=39)P-valueAge, mean (±SD)68.4 (±7.9)68.5 (±8.4)68.4 (±7.7)0.968Men, n (%)51 (76.1)20 (29.9)31 (46.3)0.445AF Duration, median (IQR)0.67 (0.25-2)1 (0.29-2)0.5 (0.25-2)0.440Comorbidities, n (%)Heart failure21 (31.3)10 (35.71)11 (28.21)0.513Hypertension49 (73.1)22 (78.6)27 (69.2)0.395Diabetes mellitus14 (20.9)8 (28.6)6 (15.4)0.190Stroke6 (9.0)3 (10.7)3 (7.7)0.669Vascular disease6 (9.0)2 (7.1)4 (10.3)0.660CHA2DS2-VASc score, mean (±SD)2.7 (±1.6)2.9 (±1.7)2.5 (±1.4)0.230Echocardiographic parameters, mean (±SD)LA dimension, cm4.7 (±0.6)4.6 (±0.6)4.8 (±0.6)0.206LA volume index, mL/m252.5 (±35.4)54.1 (±33.5)51.4 (±38.1)0.975LV ejection fraction, %52.1 (11.2)53.5 (±10.3)51.0 (±11.9)0.385 Open table in a new tab

The performance of dipole charge density mapping integrated with robotic magnetic navigation in the treatment of atrial tachycardias

BackgroundCatheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure.MethodsAll patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups.ResultsA total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21).ConclusionsAcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.

Fluoroscopically guided repositioning of peripherally inserted central catheter in patients failing ultrasound-guided-only placement: a retrospective five-year study.

Ultrasound (US)-guided-only insertion at the bedside is safe and improves the success rates of peripherally inserted central catheter (PICC). However, PICC insertion procedures remain challenging for special cases. To show that fluoroscopically guided tip repositioning, for failed US-guided PICC placement, safely led to satisfactory positioning in difficult cases and, importantly, improved success rates of PICC placements. A retrospective study of 1560 patients who underwent US-guided PICC placement were performed. Patients who failed US-guided PICC placement were transferred to the interventional radiology department for fluoroscopically guided tip repositioning. Baseline characteristics as well as insertion-related factors were collected. All data were analyzed using SPSS software. In total, 37 (2.4%) patients who failed US-guided PICC placement accepted fluoroscopically guided adjustment or re-insertion. Of these 37 patients, 32 were enrolled. We observed no significant differences between right and left arm PICC access (P > 0.05), even though a higher percentage of PICCs were inserted into left arms (56.3%). The basilic vein (65.6%) was the most common insertion site. Only four patients experienced slight angiospasm (3.1%) and venous thrombosis (9.4%). US-guided PICC insertion failures were primarily due to line tip malposition (84.4%). All patients successfully underwent fluoroscopically guided tip repositioning, which resulted in optimal catheter tip positioning. PICC lines were adjusted in most patients (n=28, 87.5%). Malposition was the primary issue causing US-guided PICC insertion failure. Fluoroscopically guided tip repositioning safely and efficaciously led to satisfactory positioning in difficult cases; thus, we recommend this method for patients failing US-guided PICC placement.

PD18-10 A MARKOV MODEL FOR FERTILITY TREATMENT: SUBFERTILE COUPLES WITH A VARICOCELE SAVE TIME AND MONEY BY PURSUING MALE-FIRST EVALUATION PRIOR TO TREATMENT

You have accessJournal of UrologyCME1 Apr 2023PD18-10 A MARKOV MODEL FOR FERTILITY TREATMENT: SUBFERTILE COUPLES WITH A VARICOCELE SAVE TIME AND MONEY BY PURSUING MALE-FIRST EVALUATION PRIOR TO TREATMENT George Wayne, Albert Ha, Anthony Bui, and Joseph Alukal George WayneGeorge Wayne More articles by this author , Albert HaAlbert Ha More articles by this author , Anthony BuiAnthony Bui More articles by this author , and Joseph AlukalJoseph Alukal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical practice presents a variety of obstacles to prompt male evaluation in a subfertile couple. Varicocele repair improves sperm parameters in most patients and has been suggested to improve pregnancy rates in both natural conception and assisted reproductive technologies (ART). The course of an infertile couple’s work-up, however, is often non-linear and hard to predict. We constructed a discrete-time Markov model to simulate various evaluation and treatment strategies and thereby estimate success rates and costs for a couple with a clinically significant varicocele. METHODS: A discrete-time Markov chain was constructed to represent the various treatment and evaluation states for a couple with a clinically significant varicocele. Transition probabilities, treatment success rates, and discontinuation rates were estimated from the literature. Treatment strategies included Current Practice (CP), Male-First Evaluation (MF), IUI-First (IUI), and IVF-First (IVF). A sensitivity analysis predicted total cost and time-to-pregnancy for 50%, 75%, and 99% of couples at different treatment-cost levels and different expected success rates following varicocelectomy. RESULTS: At 1% increased pregnancy rate following varicocele diagnosis and treatment, 75% of couples pursuing CP treatment were pregnant at 20.1 months at a cost of $35,550, compared to those pursuing MF (21.2 months, $38,892), IUI (16.8 months, $41,324.51), or IVF (12.3 months, $49,537.29). At 5% improved success rate, there was an inflection – 75% of couples were pregnant via MF at 19.2 months at a cost of $33,976.81, compared to CP (19.9 months, $34,172.18), IUI (16.6 months, $39,757.48), or IVF (12.2 months, $48,589.41). CONCLUSIONS: For couples that harbor a clinically significant varicocele, strict adherence to MF treatment with even a modest benefit (5% increase in pregnancy rate), varicocele ligation leads to significant cost- and time-savings over CP. Moreover, transitioning directly to ART too soon achieves limited gains in time (2-5 months), at 40-80% increased costs when compared to MF. Adherence to an MF approach, in addition to these benefits, offers couples valuable opportunities to screen for other pathologies and ensure male health. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e506 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Wayne More articles by this author Albert Ha More articles by this author Anthony Bui More articles by this author Joseph Alukal More articles by this author Expand All Advertisement PDF downloadLoading ...

MP65-14 EFFICACY OF POLYACRYLAMIDE GEL (BULKAMID ® ) INJECTION IN PATIENTS WITH MITROFANOFF LEAKAGE AFTER CONTINENT DIVERSION SURGERY: A COMPARISON WITH MACROPLASTIQUE®

You have accessJournal of UrologyCME1 Apr 2023MP65-14 EFFICACY OF POLYACRYLAMIDE GEL (BULKAMID®) INJECTION IN PATIENTS WITH MITROFANOFF LEAKAGE AFTER CONTINENT DIVERSION SURGERY: A COMPARISON WITH MACROPLASTIQUE® Ioannis Loufopoulos, Kapriniotis Konstantinos, Mahreen Pakzad, Anthony Noah, Helena Gresty, Tamsin Greenwell, and Jeremy Ockrim Ioannis LoufopoulosIoannis Loufopoulos More articles by this author , Kapriniotis KonstantinosKapriniotis Konstantinos More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Anthony NoahAnthony Noah More articles by this author , Helena GrestyHelena Gresty More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have previously published outcomes of polydimethylsiloxane (Macroplastique®) in patients with leakage from their Mitrofanoff channels. Macroplastique® has now been replaced by Bulkamid® hydrogel. We present the outcomes of Bulkamid® injection in the last 5 years and compare it to the previous usage of silicone. METHODS: We retrospectively analysed data 2016-2021 for patients who had previously undergone Mitrofanoff channel formation who received Bulkamid® injections for incontinence. Effectiveness was assessed by the number of pads used before and after injection. Outcomes were classified as complete success (dry), partial success (>50% reduction incontinence pads) and failure. We also calculated success by channel type, type of reservoir and for number and volume of injections per treatment. RESULTS: Results are shown on Table. 11 female patients had Bulkamid® injection to their Mitrofanoff channels due to urinary leakage. Mean age was 45.9 (range 21-67) and median follow-up 16 weeks (range 1-44). 9 patients received Bulkamid® injections once, whilst 2 patients received injections twice. Initial injection was partially successful in 4/10 patients (40%) and a second injection in 1 patient (cumulative success rate 45%), but only 1 patient was completely dry (9%).Of the 5 failures, 2 had revision of their Mitrofanoff channels with success. The 5 successful injections were given to 4 patients with Monti channels and 1 with appendiceal channel (3 patients ileocystoplasty and 1 with ileal neobladder). None of the injections given to native bladders were successful. The mean volume of the injected Bulkamid® gel was 1.9mls (range 0.5-4mls). Greater volumes did not improve success rates, as 3/4 successful injections had a volume less than 1.9 ml. Comparison to Macroplastique® showed no statistical difference in the success rates between the two injectable bulking agents. CONCLUSIONS: Bulkamid® injection to Mitrofanoff® channel had a partial response (45%) in the management of incontinence through a Mitrofanoff channel, but was curative in only 9%. Success rates for Bulkamid® seem to be comparable to the ones previously reported for Macroplastique®. Bulking may, at least, defer the necessity for major surgical revision. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e896 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ioannis Loufopoulos More articles by this author Kapriniotis Konstantinos More articles by this author Mahreen Pakzad More articles by this author Anthony Noah More articles by this author Helena Gresty More articles by this author Tamsin Greenwell More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement PDF downloadLoading ...

Anticipative measurements in hybrid quantum-classical computation

Before the availability of large scale fault-tolerant quantum devices, one has to find ways to make the most of current noisy intermediate-scale quantum devices. One possibility is to seek smaller repetitive hybrid quantum-classical tasks with higher fidelity, rather than directly pursuing large complex tasks. We present an approach in this direction where the quantum computation is supplemented by a classical result. While the presence of the supplementary classical information helps alone, taking advantage of its anticipation also leads to a new type of quantum measurements, which we call anticipative. Anticipative quantum measurements lead to improved success rate over cases where we would use quantum measurements optimized without assuming the later arriving supplementing information. Importantly, in an anticipative quantum measurement the combination of the results from classical and quantum computations happens only in the end, without the need for feedback from the one to the other computation, a feature which hence allows for running both computations in parallel. We demonstrate the method with an experiment using an IBMQ device and show that it leads to an improved success rate even in a real noisy setting.

Comparing the Efficacy and Success Rate of Radial Artery Approach under Ultrasound Guidance and Palpation Technique for Coronary Intervention at Central Chest Institute of Thailand

Background: Previous studies of ultrasound guidance for transradial artery access during coronary angiography or interventional procedures demonstrate improving success rate, number of attempts, and short-time access in radial artery cannulation. Objective: To compare the benefit of ultrasound guidance radial artery access during coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpation technique in experienced and inexperienced operators. Materials and Methods: A randomized prospective study was performed between October 2021 and April 2022. One hundred sixty-four patients were randomized into three groups. The first group, group I (55 cases), underwent radial artery puncture with ultrasound guidance by an experienced interventionist. The second group, group II (56 cases), underwent radial artery puncture using the palpation technique by another experienced interventionist. The third group, group III (53 cases), was also assigned to radial artery puncture with the palpation technique, however, performed by three interventional cardiology fellows. Results: The success rate of radial cannulation was 55 (100%) in group I, 52 (92.9%) in group II, and 48 (90.6%) in group III (p=0.060). Firstattempt success rates in the three groups were 83.6%, 75%, and 69.8%, respectively (p=0.233). The median number of attempts was not significantly different (p=0.208). Time to access the radial artery in group I was reduced significantly compared to the palpation technique in group II and group III (p&lt;0.001). There were no significant differences in complications such as difficult access, access site crossover, radial spasm, and hematoma/ bleeding complication (p=0.135, 0.367, 0.132, and 0.700, respectively). Conclusion: In experienced operators, an ultrasound-guided technique has been shown to have beneficial advantages in reducing the time to access radial artery cannulation compared to experienced and inexperienced operators using the palpation technique. Keywords: Transradial catheterization; Ultrasound guide

Biplanar versus conventional two-dimensional ultrasound guidance for radial artery catheterisation.

Ultrasound guidance increases first-pass success rates and decreases the number of cannulation attempts and complications during radial artery catheterisation but it is debatable whether short-, long-, or oblique-axis imaging is superior for obtaining access. Three-dimensional (3D) biplanar ultrasound combines both short- and long-axis views with their respective benefits. This study aimed to determine whether biplanar imaging would improve the accuracy of radial artery catheterisation compared with conventional 2D imaging. This before-and-after trial included adult patients who required radial artery catheterisation for elective cardiothoracic surgery. The participating anaesthesiologists were experienced in 2D and biplanar ultrasound-guided vascular access. The primary endpoint was successful catheterisation in one skin break without withdrawals. Secondary endpoints were the numbers of punctures and withdrawals, scanning and procedure times, needle visibility, perceived mental effort of the operator, and posterior wall puncture or other mechanical complications. From November 2021 until April 2022, 158 patients were included and analysed (2D=75, biplanar=83), with two failures to catheterise in each group. First-pass success without needle redirections was 58.7% in the 2D group and 60.2% in the biplanar group (difference=1.6%; 95% confidence interval [CI], -14.0%-17.1%; P=0.84), and first-pass success within one skin break was 77.3% in the 2D group vs 81.9% in the biplanar group (difference=4.6%; 95% CI, 8.1%-17.3%; P=0.473). None of the secondary endpoints differed significantly. Biplanar ultrasound guidance did not improve success rates nor other performance measures of radial artery catheterisation. The additional visual information acquired with biplanar imaging did not offer any benefit. N9687 (Dutch Trial Register).

Signature peptide selection workflow for biomarker quantification using LC-MS-based targeted proteomics.

In contrast to quantification of biotherapeutics, endogenous protein biomarker and target quantification using LC-MSbased targeted proteomics can require a much more stringent and time-consuming tryptic signature peptide selection for each specific application. While some general criteria exist, there are no tools currently available in the public domain to predict the ionization efficiency for a given signature peptide candidate. Lack of knowledge of the ionization efficiencies forces investigators to choose peptides blindly, thus hindering method development for lowabundantprotein quantification. Here, the authors propose a tryptic signature peptide selection workflow to achieve a more efficient method development and to improve success rates in signature peptide selection for lowabundantendogenous target and protein biomarker quantification.

Numerical Investigation on Reduction of Power Consumption and Improvement of Success Rate for Consensus in Multi‐Agent Systems over a Wireless Network Considering the Number of Agents

AbstractIn this paper, we investigate power adjustment for multi‐agent systems in a wireless network where communication range is limited. The approach in which communication range is dynamically changed is utilized so as to save power consumption. However, since drawback of this approach is that agents cannot expand their communication range, it causes that communication between agents tends to be disconnected. To overcome this problem, we propose two power adjustment methods. In the first method, communication range is temporarily expanded in accordance with the number of neighboring agents. In the second method, agents change their communication range by using information on the total number of agents and relative distance between an agent and the farthest neighboring agent. Through numerical simulation, we show that the proposed power adjustment methods reduce power consumption and improve success rate for consensus. © 2023 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC.