Independent Predictors Of Success Research Articles

Predictive variables for successful retrograde intrarenal surgery outcomes in pediatric patients: Development of nomograms.

Pediatric stone disease is characterized by its increasing prevalence and high recurrence rate. Consequently, the use of minimally invasive procedures with high stone-free rates (SFR) is essential. This study aims to identify risk factors associated with the failure of retrograde intrarenal surgery (RIRS) for renal stones smaller than 20mm in pediatric patients and to develop predictive nomograms for preoperative patient selection. A retrospective analysis of 62 RIRS identified five key factors affecting SFR: stone volume, stone diameter, stone density, the presence of multiple stones, and lower calyx location. Among these variables, independent predictors of success were identified and incorporated into logistic regression models, which were subsequently translated into two nomograms. These represent the first tools specifically designed to predict preoperative SFR in pediatric patients undergoing RIRS. The predictive models developed in this study demonstrated high accuracy in predicting surgical success, providing urologists with reliable tools to individualize treatment planning based on preoperative imaging. Despite these promising results, external validation by high-volume pediatric urology centers is crucial to confirm the generalizability and robustness of these models. These findings represent a significant advancement in the personalized management of pediatric stone disease.

Predictors of Success in Obtaining Postgraduate Residency or Fellowship

ObjectiveAs more pharmacy students are pursuing postgraduate training, colleges of pharmacy are investigating ways to predict success in matching for residency or fellowship. While data have been published about characteristics predictive of matching, we sought to study student scores, rotation types, and rotation evaluations as predictors of success. MethodsData were collected from students in the graduating classes of 2021, 2022, and 2023. Students were surveyed on participation in mock interviews, numbers of programs to which they applied, and number of interviews received. In addition, data were collected on impostor phenomenon, grit, perceived stress, anxiety, grade point average (GPA), types of patient care rotations, and preceptor evaluations. ResultsOverall, 295 students were included, with 69 unsuccessful and 226 successful students. Successful students were more likely to have lower Perceived Stress Scale-10 scores in the final 3 semesters of school, a higher GPA, more elective patient care rotations, and more preceptors who answered “Yes” to “Would you hire this student?” after graduation. In the multivariate logistic regression analysis, final GPA and preceptors answering affirmatively to “Would you hire this student?” were independent predictors of success in obtaining a postgraduate position. ConclusionAs colleges of pharmacy prepare students for postgraduate residencies or fellowships, in addition to GPA, stress levels during the final 3 semesters of pharmacy school may be areas on which to focus. Given that willingness of a preceptor to hire a student after graduation was a predictor of success in securing a postgraduate position, this should be explored in future research.

Patient preferences for long-term follow-up after hip replacement

Background Reports of surgical training and experiences vary across the 16 UK foundation schools. Little is known about whether foundation school choice is associated with later performance in surgical training. We investigated choice of school in relation to performance in the MRCS Part A. Materials and methods A retrospective cohort study of foundation programme trainees who attempted MRCS Part A between 2017 and 2020 (n = 553). Chi-square tests examined associations between foundation programme school and first–attempt MRCS Part A performance. Multinomial regression models identified the likelihood of MRCS part A success depending on foundation school. Results A statistically significant association was found between MRCS Part A first attempt pass rates and foundation school (P < 0.001). Mean Part A pass rates ranged from 23.8% to 81.8% between schools. Two foundation schools – Thames Valley and North, Central and East London – were found to be independent predictors of success at MRCS Part A at first attempt after adjusting for age, gender and ethnicity (P < 0.05). There was no significant correlation between MRCS Part A performance and subjective reports of training quality (the National Training Survey training satisfaction scores; P =0.256). Conclusions MRCS success is associated with foundation school but not subjective reports of training quality. Given that more competitive foundation schools attract the highest-achieving applicants, Occam's razor suggests this pattern is most likely due to individual differences such as innate academic ability rather than foundation school training experiences.

A cross-sectional study examining associations between foundation school and MRCS performance

Background Reports of surgical training and experiences vary across the 16 UK foundation schools. Little is known about whether foundation school choice is associated with later performance in surgical training. We investigated choice of school in relation to performance in the MRCS Part A. Materials and methods A retrospective cohort study of foundation programme trainees who attempted MRCS Part A between 2017 and 2020 (n = 553). Chi-square tests examined associations between foundation programme school and first–attempt MRCS Part A performance. Multinomial regression models identified the likelihood of MRCS part A success depending on foundation school. Results A statistically significant association was found between MRCS Part A first attempt pass rates and foundation school (P < 0.001). Mean Part A pass rates ranged from 23.8% to 81.8% between schools. Two foundation schools – Thames Valley and North, Central and East London – were found to be independent predictors of success at MRCS Part A at first attempt after adjusting for age, gender and ethnicity (P < 0.05). There was no significant correlation between MRCS Part A performance and subjective reports of training quality (the National Training Survey training satisfaction scores; P = 0.256). Conclusions MRCS success is associated with foundation school but not subjective reports of training quality. Given that more competitive foundation schools attract the highest-achieving applicants, Occam's razor suggests this pattern is most likely due to individual differences such as innate academic ability rather than foundation school training experiences.

Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

PurposeTo identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding.MethodsThis was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables—serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space—were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior–posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression.ResultsVariables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment.ConclusionsComplete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.

Effect of the introduction of C-MAC videolaryngoscopy on first-pass intubation success rates for emergency medicine registrars.

The present study investigated the impact of introducing C-MAC videolaryngoscopy as the standard method of visualising glottic structures on first-pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand. In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C-MAC videolaryngoscopy were compared. The primary outcome was first-pass intubation success rates by EM registrars. Secondary outcomes were first-pass success rates by all intubators, and incidence of any complication of intubation. There were 163 intubations by EM registrars from June 2015 to August 2017. There was a clinically important and statistically significant improvement in first-pass success from 59.2% (95% confidence interval [CI] 44.1-68.8%) to 85.1% (95% CI 76.0-91.2%, P < 0.001) after the introduction of C-MAC. In multivariate analysis, the independent predictors of success were: Airway Not Predicted Difficult, odds ratio (OR) 2.49 (95% CI 1.06-5.85, P = 0.037); and use of videolaryngoscope, OR 4.49 (95% CI 1.85-10.91, P = 0.001). Overall, complications of intubation improved significantly after introduction of C-MAC (28.9%, 95% CI 19.9-40.0% prior to C-MAC introduction; 16.1%, 95% CI 9.7-25.3% after; P = 0.048). This is the first published study specifically addressing EM registrar intubation success rates in New Zealand, adding to the existing body of data suggesting that videolaryngoscopy may improve success rates for novice intubators.

Mandibular advancement device therapy for obstructive sleep apnea: a prospective study on predictors of treatment success

ObjectiveTo survey potential predictors of success of mandibular advancement device (MAD) therapy in patients with obstructive sleep apnea (OSA), and in particular, to examine anatomical narrowings and sleep-related collapse levels in the upper airway. MethodsThis was a prospective study of 62 OSA patients (median apnea–hypopnea index [AHI] of 34), who were treated with a custom-made, monobloc MAD. The upper airway was examined by inspection, nasopharyngoscopy, overnight acoustic reflectometry recording collapses, and cephalometry of soft tissue dimensions (in addition to skeletal parameters). MAD treatment was controlled by polysomnograpy before and after at least five weeks from the beginning of treatment. Independent predictors of actual reduction in AHI and treatment success (reduction in AHI ≥ 50% with residual AHI < 10) were determined, using multivariable linear and logistic regression. ResultsPositional OSA (POSA) and nonsupine AHI (adjusted for upper airway narrowness and collapses, together with gender, age, body mass index, neck circumference, and baseline AHI) were the only independent predictors: POSA indicative for success, and nonsupine AHI inversely related to success. Cephalometry was not predictive. Two predictive models were proposed, one based on POSA having a specificity of 70% and sensitivity of 69%, and the other based on nonsupine AHI, generating a receiver operating characteristic (ROC) curve (area under ROC = 0.78). Using the ROC model, specificity could be increased to 80% without lowering sensitivity. ConclusionsOnly variables related to sleep position proved to be independent predictors of success with MAD therapy. The results could be explained by the MAD counteracting the mandible from moving backwards when sleeping supine.

Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non-cephalic presentation using logistic regression and classification tree analyses.

Among women with a fetus with a non-cephalic presentation, external cephalic version (ECV) has been shown to reduce the rate of breech presentation at birth and cesarean birth. Compared with ECV at term, beginning ECV prior to 37weeks' gestation decreases the number of infants in a non-cephalic presentation at birth. The purpose of this secondary analysis was to investigate factors associated with a successful ECV procedure and to present this in a clinically useful format. Data were collected as part of the Early ECV Pilot and Early ECV2 Trials, which randomized 1776 women with a fetus in breech presentation to either early ECV (34-36weeks' gestation) or delayed ECV (at or after 37weeks). The outcome of interest was successful ECV, defined as the fetus being in a cephalic presentation immediately following the procedure, as well as at the time of birth. The importance of several factors in predicting successful ECV was investigated using two statistical methods: logistic regression and classification and regression tree (CART) analyses. Among nulliparas, non-engagement of the presenting part and an easily palpable fetal head were independently associated with success. Among multiparas, non-engagement of the presenting part, gestation less than 37weeks and an easily palpable fetal head were found to be independent predictors of success. These findings were consistent with results of the CART analyses. Regardless of parity, descent of the presenting part was the most discriminating factor in predicting successful ECV and cephalic presentation at birth.

The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study.

Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

Predictors of Success with Single-dose Methotrexate Regimen for the Treatment of Ectopic Pregnancy in Chonburi Hospital

Objective : To determine the factors that effect the success in management of tubal pregnancy with single–dose methotrexate regimen in Chonburi hospital. Research design : Retrospective descriptive study Material and method : Out-Patient Department (OPD) and In-Patient Department (IPD) charts of the patients who were diagnosed ectopic pregnancy and treated with methotrexate from January 2010 to December 2014 were reviewed from Chonburi hospital database. The successful treatment was defined in case of disease resolution without surgery. Result : For all 70 patients were enrolled in this study. The overall success rate was 88.57% (62/70). The baseline characteristics of patients were not different between success and failure group and included age, BMI, parity gestational age, pretreatment serum β-hCG and average sized of adnexal mass. The absent fetal heart activity (OR 23.12, 95%CI 1.46-366.12, p 0.02) and size of adnexal mass less than 3.5 cms (OR 37.56, 95%CI 2.49-567.62, p 0.01) were independent predictors for successful treatment of ectopic pregnancy after analyzed with logistic regression model. Conclusion: The independent predictors of success in treatment of tubal pregnancy with single dose methotrexate regimen were absence of fetal heart activity and adnexal mass less than 3.5 cms.

Cryoablation of typical AVNRT: Younger age and administration of bonus ablation favor long-term success

Cryoablation (CA) is an emerging tool for the treatment of supraventricular tachyarrhythmias. Determinants of long-term success still need clarification. The purpose of this study was to assess which patients' and procedural features affect the long-term efficacy of CA for typical atrioventricular nodal reentrant tachycardia (AVNRT). Eighty-five consecutive patients undergoing CA for typical AVNRT were divided into 3 groups of age: group A, ≤20 years, n = 20 (23.5%); group B, 21-50 years, n = 30 (35.3%); group C, ≥51 years, n = 35 (41.2%). CA was performed for 5 minutes at -75°C in all; 4-minute bonus CA was delivered if not contraindicated (ie, transient PR interval lengthening during the first application and narrow triangle of Koch). The efficacy end point was the absence of recurrences at 12-month follow-up. CA was acutely successful in all 85 patients (100%). Bonus ablation was performed in 69 (81.2%). No permanent complications were observed. At follow-up, AVNRT recurrences occurred in 9 patients (10.6%): group A, 0 (0%); group B, 2 (6.7%), group C, 7 (20%). Incidence of recurrences was significantly different between age groups (P = .047) and between patients receiving (7.2%) and not receiving (25.0%) bonus CA (P = .038). In multivariable analysis, age groups (odds ratio [OR] 5.917; 95% confidence interval [CI] 1.372-25.518; P = .017) and bonus CA (OR 0.115; 95% CI 0.018-0.724; P = .021) were the only independent predictors of recurrences. Furthermore, age as a continuous variable remained statistically associated with recurrences (OR 1.046; 95% CI 1.002-1.091; P = .038). CA is effective and safe for typical AVNRT ablation. Younger age and bonus CA administration are independent predictors of success at 12 months. Incidence of recurrences is low in patients younger than 21 years.

Patient-posture and Ileal-intubation during colonoscopy (PIC): a randomized controlled open-label trial.

Background and aims: Patient’s posture change is commonly employed by a colonoscopist to achieve complete examination. We studied whether patient’s posture (left-lateral decubitus vs supine) influenced the success rate of ileal intubation. Patients and methods: In this prospective open-label randomized study performed in the Endoscopy Suite of a tertiary-care center, all adult outpatients referred for colonoscopy, in whom cecal intubation was achieved and who satisfied predefined inclusion criteria, were randomized to undergo ileal intubation in either of the above two postures. Colonoscopy (EC-201 WL, Fujinon) was performed after overnight poly-ethylene-glycol preparation, under conscious sedation and continuous pulse-oxymetry monitoring. After confirming cecal intubation, patients were randomized for ileal intubation. Success was defined by visualization of ileal mucosa or villi (confirmed by digital photography) and was attempted until limited by pain and/or time of ≥ 6 min. Results: Of 320 eligible patients, 217 patients (150 males) were randomized, 106 to left-lateral decubitus and 111 to supine posture. At baseline, the two groups were evenly matched. Successful ileal intubation was achieved in 145 (66.8 %) patients overall, significantly higher in the supine posture (74.8 % versus 58.5 %; P = 0.014). On multivariate analysis, supine posture (P = 0.02), average/good right-colon preparation (P < 0.01), non-thin-lipped ileocecal (IC) valve (P < 0.001) and younger age (P = 0.02) were independent predictors of success. Positive ileal findings were recorded in 13 (9 %) patients. Conclusion: Ileoscopy is more successful in supine than in left-lateral decubitus posture. Age, bowel preparation and type of IC valve also determine success.

Performance Assessment in Airway Management Training for Nonanesthesiology Trainees

Although the use of an anesthesiology "airway" rotation to train the nonanesthesiologist is commonly employed, little data exist on the utility, clinical exposure, and outcomes of these programs. A prospectively collected observational dataset of airway procedures completed by trainees in a 4-week, anesthesiology-based, airway rotation at an academic, level-1 trauma center from July 2010 to September 2012 was reviewed. Prospectively defined data points were collected through an online data tool and included patient demographics, location, date, best laryngoscopic view, and attempt details. At the authors' institution, an attending trauma anesthesiologist is present for all intubation attempts. The primary outcome was first-attempt success. A total of 4,282 self-reported, airway procedures were identified. The median number of procedures performed was 50.4 ± 13.2 (range, 20 to 93; 25th quartile = 41; 75th quartile = 57). Multivariate logistic regression analysis modeling of first-attempt success rate identified two independent predictors of success: rotation week (odds ratio, 1.42; 95% CI, 1.32 to 1.61; P < 0.0001) and number of previous intubation attempts before rotation (odds ratio, 1.23; 95% CI, 1.03 to 1.46; P = 0.02. In addition, the percentage of cases with a self-reported laryngoscopic grade 1 view increased significantly from 61 to 74% (P = 0.015) from week 1 to week 4 of the rotation. An anesthesiology-based program for airway training of nonanesthesiologists demonstrates improved self-reported, perceived first-attempt success over the course of training with improved ability to visualize glottic structures.

Preoperative opioid use and the outcome of thoracoscopic splanchnicectomy in chronic pancreatitis: a systematic review

Thoracoscopic splanchnicectomy (TS) is a minimally invasive intervention to relieve pain in patients with chronic pancreatitis (CP) with equivocal results. Preoperative opioid use seems to impair TS outcome but this has not been investigated in a systematic matter. We searched PubMed, EMBASE, and The Cochrane Library for studies on the outcome of TS in CP patients. Studies with ≥5 patients and a follow-up of ≥12months were included. Success was defined as the proportion of patients free of opioids or who had a reduction of ≥4 points on a pain scale. The effect of opioid use on the success rate of TS was analyzed by uni- and multivariate regression. Sixteen studies with 484 patients were included in our review. The mean (±SD) age of the patients was 44±4.3years and 66% were male. Median follow-up period was 21months (IQR 14-35). Median preoperative opioid use was 85% (IQR 54-100%). After TS, a median of 49% (IQR 22-75%) of patients were free of opioids at end of follow-up. The median success rate was 62% (IQR 48-86%). Mean success rate in studies in which ≤50% of the patients used opioids preoperatively was 81% (SD±21) compared to 60% (SD±15) for other studies (p=0.049). Higher age, male gender, and lower rates of preoperative opioid use were associated with a higher success rate (p=0.003, 0.047, and 0.017, respectively). Multivariate regression, including age, gender, preoperative opioid use, and duration of follow-up, identified age and preoperative opioid use as independent predictors of success after TS (both p=0.002). Preoperative opioid use is associated with a worse outcome after TS in CP patients. To optimize outcome, use of TS may be considered at an earlier stage in the treatment of patients with CP before prolonged opioid therapy.

Five Hundred Cases of Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Predictors of Success and Safety

Robotic technology has enabled totally endoscopic coronary artery bypass (TECAB) grafting. Little information is available on factors associated with successful and safe performance of TECAB. We report a 10-year multicenter experience with 500 cases, elucidating on predictors of success and safety in TECAB procedures. Between 2001 and 2011, 500 patients (364 [73%] men; 136 [27%] women; median age [minimum-maximum] 60 years [31-90 years], median EuroSCORE 2 [0-13]), underwent TECAB. Single, double, triple, and quadruple TECAB was performed in 334, 150, 15, and 1 patient, respectively. Univariate analysis and binary regression models were used to identify predictors of success and safety. Success was defined as freedom from any adverse event and conversion procedure, safety was defined as freedom from major adverse cardiac and cerebral events, major vascular injury, and long-term ventilation. Success and safety rates were 80% (400 cases) and 95% (474 cases), respectively. Intraoperative conversions to larger thoracic incisions were required in 49 (10%) patients. The median operative time was 305 minutes (112-1,050 minutes), and the mean lengths of stay in the intensive unit (ICU) and in hospital were 23 hours (11-1,048 hours) and 6 days (2-4 days), respectively. Independent predictors of success were single-vessel TECAB (p = 0.004), arrested-heart (AH)-TECAB (p = 0.027), non-learning curve case (p = 0.049), and transthoracic assistance (p = 0.035). The only independent predictor of safety was EuroSCORE (p = 0.002). Single-vessel and multivessel TECAB procedures can be safely performed with good reproducible results. Predictors of success include procedure simplicity and non-learning curve cases, whereas predictors of safety are mainly associated with patient selection.

Selection of students for admission to a medical school in Sri Lanka

To assess the extent to which selected entry point factors predicted success in a Sri Lankan medical school. The study sample consisted of all students in two consecutive entry cohorts. Marks obtained at the national university entrance examination in physics, chemistry, botany and zoology; the aggregate marks of these four subjects (the only academic criterion used in selection); the district of entry (the other, non-academic criterion); and gender, were identified as entry point variables. Success in a medical school was measured in five ways, including whether a student had passed all examinations in the medical faculty at first attempt or not. Multiple logistic regression was used to assess the extent to which the selected entry point factors could predict variability in outcome measures. Of 331 students, 6.6% were merit quota admissions, and 19.4% were from 'underprivileged' districts; 46.8% were women. Of the entry point factors, being female and obtaining an aggregate of > or =280 (of a possible 400) were the only independent predictors of success in all outcome measures. Obtaining at least grade B in zoology was also an independent predictor of passing all examinations at first attempt. The aggregate score alone accounted for only 2-5% of variance in a medical school performance. There was no association between admission from an underprivileged district and any of the outcome measures. The one and only measure of academic performance used for selection of students admitted to our medical schools, is a very weak predictor of success in a medical school.

Predictors of Short-Term Success in Smoking Cessation in Relation to Attendance at a Smoking Cessation Program

The identification of individual characteristics that predict success in smoking cessation is necessary to improve the effectiveness of smoking cessation efforts. The aim of this study was to identify the factors that predict success in smoking cessation in people who attended 2, 3, 4, or 5 sessions of a smoking cessation program. The participants comprised 2,471 people who attended at least 2 consultations during a 5-week smoking cessation program. Success in smoking cessation was defined as self-reported abstinence and having an exhaled carbon monoxide level ≤10 parts per million at the final consultation. Baseline characteristics were compared using univariate analysis of variance and the chi-square test. A stepwise multivariate logistic regression model was used to analyze the effect of baseline characteristics and the slopes of the withdrawal symptoms on the success in smoking cessation. Participating in a higher number of sessions gradually increased the chance of smoking cessation from 12.1% to 61.2% (p < .0001). Logistic regression analysis revealed that the independent predictors of success in smoking cessation were being male; low nicotine dependence; smoking few cigarettes per day at baseline; having no history of depression; having low values for craving for cigarettes, irritability, frustration, anger, or nocturnal awakening at baseline; decreased craving for cigarettes and restlessness with time; and use of nicotine replacement therapy (NRT). People who attended more sessions tended to be older. Attending more sessions of a smoking cessation program, NRT, and coping with withdrawal and psychosocial symptoms increases the chance of short-term success in smoking cessation.

Evaluation of Bioimpedance as Novel Predictor of Extracorporeal Shockwave Lithotripsy Success

Obesity has been identified as a limitation of extracorporeal shockwave lithotripsy (SWL). The obesity metrics of body mass index (BMI) and skin-to-stone distance (SSD) have been evaluated as predictors of SWL success. While SSD has demonstrated a strong correlation with success, BMI has not. Bioimpedance analysis (BIA) is an accurate way of determining body adiposity. We evaluated fat mass percentage (FMP) as measured by BIA as a predictor of SWL success. We prospectively collected body composition data using the Imp-DF50 Body Impedance Analyzer on consecutive patients undergoing SWL. All generated variables, including FMP, along with demographics, BMI, stone size, and stone composition, were analyzed. Patients were evaluated for success, defined as no evidence of stones on radiography of the kidneys, ureters, and bladder at follow-up. Fifty-two consecutive patients were enrolled in the study, of which 37 had the necessary metrics to be included in the analysis. Twenty-three (62.2%) patients were stone free while 14 (37.8%) were found to have residual stone at follow-up. There was no difference in sex, stone laterality, mean age, and stone size between the groups. For the success and failure groups, the mean BMI was 25.8 kg/m(2) and 29.8 kg/m(2) (P=0.0091), and mean FMP 24.6% and 32.2% (P=0.0034). On mirrored multivariable analysis, both BMI (OR=0.735, P=0.026) and FMP (OR=0.806, P=0.010) were associated with success. Patients with a FMP ≥35% had a reduced success rate compared with those with a FMP <35% (14% vs 73%, respectively, P=0.0028). Both BMI and FMP both appear to be independent predictors of success. Based on these findings, a large study examining the relationship between BMI, FMP, SSD, and SWL success is warranted. A preoperative FMP ≥35% is associated with a 14% success rate, and alternative treatment strategies for urolithiasis should be considered.

Surgical Management of Chronic Sinusitis in Children

The objective was to compare three common surgical modalities in children for the treatment of chronic sinusitis that is refractory to medical management. Prospective nonrandomized study in a pediatric otolaryngology tertiary service. Two hundred two children who satisfied criteria for surgery and were referred over a 10-year period were studied. Children were divided into three surgical groups. Group 1 had both endoscopic sinus surgery and adenoidectomy, group 2 had endoscopic sinus surgery alone, and group 3 had adenoidectomy. After a follow-up period of 12 months, improvement of symptoms was assessed. One hundred eighty-three children had adequate follow-up. Eighty seven percent of children in group 1 had improved symptoms, compared with 75% in group 2 and 52% in group 3 (P < .0001). Multivariate analysis showed that surgical procedure was a predictor of success. Asthma, smoke exposure, and age were independent predictors of success. Children who fail medical therapy benefit from surgery. Following certain criteria, one can chose between adenoidectomy alone or endoscopic sinus surgery with adenoidectomy to optimize surgical treatment of these children.

Immediate and long-term outcome of recanalization of chronic total coronary occlusions.

Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was < 30 days (subacute total occlusion [STO]: 25 patients; range 1-30 days) or > 30 days (chronic total occlusion [CTO]: 58 patients; range 3-144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complications, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 +/- 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success.