Low Success Rate Research Articles

Association between glottis screen location and intubation difficulty: a retrospective video laryngoscopy study

BackgroundIn emergency settings, difficult intubations often occur unexpectedly despite pre-intubation assessments. Traditional glottic view scoring systems for direct laryngoscope may not apply to video laryngoscopy. With video laryngoscopy, the vertical location of the glottis on the monitor can be clearly defined. If the glottis location is associated with intubation difficulty, it could serve as a simple indicator for anticipating intubation challenges. This study aimed to investigate the relationship between the glottis screen location during video laryngoscopy-guided intubation and the success and timing of the first-attempt intubation.MethodsWe retrospectively analyzed laryngoscopy recordings from adult intubations in the emergency department of a tertiary teaching hospital in Chiayi, Taiwan, using the C-MAC video laryngoscope between March 2020 and April 2023. The vertical screen location of the vocal cords, determined by the arytenoid cartilage position after laryngeal blade engagement, was categorized into upper and lower locations for analysis. The primary outcome was first-attempt intubation success within 90 s, analyzed using Kaplan-Meier survival curves and multivariable Cox proportional hazard analysis.ResultsAmong 209 laryngoscopy records, 113 had the arytenoid in the lower field of view and 96 in the upper field. Kaplan-Meier analysis showed a significantly lower cumulative success rate for intubations with a higher arytenoid location (log-rank test, P < 0.001). Multivariable Cox models, adjusted for factors like modified Cormack-Lehane grade, blade tip engagement, and other intubation findings, confirmed the arytenoid’s location as an independent predictor of successful intubation within 90 s, with an adjusted hazard ratio of 0.55 (95% confidence interval, 0.38–0.79) for the upper location group compared to the lower (P < 0.001).ConclusionsA higher screen location of the vocal cords after blade engagement is associated with reduced first-attempt intubation success. Assessing glottis location during video laryngoscopy intubation provides a quick method to anticipate intubation challenges.

One-Year Outcomes of Trabeculotomy with 120°, 180°, or 360° Schlemm’s Canal Incision for Primary Open-Angle Glaucoma: A Retrospective Study

Background/Objectives: Primary open-angle glaucoma (POAG), if caused by elevated intraocular pressure (IOP), may require a trabeculotomy (LOT), in which the trabecular meshwork (TM) and Schlemm’s canal (ISC) are incised. However, the association between the incision angle and outcomes remains unclear. Therefore, in this study, we investigated the surgical outcomes of a trabeculotomy combined with cataract surgery in patients with POAG over a 12-month follow-up period. Methods: We included 66 patients (corresponding to 83 eyes) with POAG who underwent trabeculotomy ab externo with a metal probe (M-LOT: 120° incision of the TM and ISC), ab interno with a Kahook Dual Blade® (K-LOT: 180° incision of the TM and ISC), or ab interno with a 5-0 nylon suture (S-LOT: 360° incision of the TM and ISC) between January 2015 and December 2022. We assessed IOP, the percentage reduction from preoperative IOP, the number of IOP-lowering medications taken, the incidence of postoperative complications, and the success rate using Kaplan–Meier survival analysis. Results: The median IOP was significantly lower than the baseline across all three groups. The number of IOP-lowering medications taken was significantly reduced only in the M-LOT group. The mean percentage reduction from the preoperative IOP in the K-LOT group was significantly lower than that in the M and S-LOT groups. Beween those subjected to an ab ineterno LOT, the S-LOT group demonstrated a significantly higher rate of IOP reduction 12 months after the operation compared to the K-LOT group. Kaplan–Meier cumulative survival analyses revealed a lower success rate for the K-LOT group than for the M and S-LOT groups. The M-LOT group had the lowest incidence of hyphema and IOP spikes, whereas the S-LOT group had the highest incidence of these complications. Conclusions: The M-, K-, and S-LOTs had different surgical outcomes during the 12 months of follow-up, with the M-LOT group showing the fewest complications. These results will help in selecting the most suitable trabeculotomy strategy for patients with POAG. Based on the postoperative outcomes of the ab interno K- and S-LOTs, a wider incision of the TM and ISC leads to effective IOP reduction.

Comparative Analysis of Face Recognition Algorithms for Facial Recognition in Diverse Environments

Facial recognition technology has evolved significantly over the last five decades and plays a central role in various applications such as biometrics, information security, access control, law enforcement and surveillance. In this study, the performance of two face recognition algorithms, Dlib and FaceNet, is evaluated using datasets obtained from video recordings in different environments. The Dlib algorithm uses the Histogram of Oriented Gradients (HOG) method for face detection, while FaceNet uses the Multi-Task Cascaded Convolutional Neural Network (MTCNN). The experimental results show that both algorithms achieve high accuracy in controlled environments, with Dlib showing greater robustness in complex scenarios. This study makes an important contribution to this topic by presenting a comparative analysis of the face recognition performance of the OpenFace, ArcFace, Exadel, and Dlib methods under different environmental conditions and scenarios. The results show that while the tested methods achieve high accuracy in controlled environments, their performance differs in more com-plex environments.In the results, OpenFace and ArcFace showed lower success rates than the other two algorithms. In particu-lar, Dlib proved superior in dynamic and challenging scenarios, achieving an overall accuracy of 96.1% compared to 94.6% for Exadel. Exadel, on the other hand, performed slightly better in certain controlled environments, highlighting its potential strength in certain applications. These results emphasize the importance of selecting the appropriate algorithm based on the specific environmental conditions and requirements of the application. This research not only improves our understanding of the performance characteristics of leading facial recognition technologies, but also provides practical insights into their use in real-world applications.

Long-term Outcomes of a Minimally Invasive Surgical Approach in Paediatric Patients with Congenital Dacryocystoceles.

Congenital dacryocystoceles are a rare condition caused by nasolacrimal duct obstruction. Symptoms include epiphora, nasal obstruction, and swelling in the medial canthus. Treatment usually entails probing Hasner's valve open and, if necessary, intubating the nasolacrimal duct. We present a minimally invasive, endoscopic procedure with marsupialisation of the endonasal portion of the cele. The operation avoids additional manipulation of the lacrimal duct to prevent iatrogenic injury. This retrospective analysis included a total of nineteen infants or young children (21 eyes) aged 3 days to 39 months. Two of the patients were suffering from acute respiratory distress, seven from recurrent infections with persistent epiphora, and twelve from acute dacryocystitis with orbital phlegmon. The endonasal portion of the dacryocele was detected in all cases and resected endonasally using an endoscope. Recurrences required revision surgery involving dacryocystorhinostomy after primary surgery in two patients aged of 22 and 39 months. All other seventeen patients were free of recurrence. Our results show endoscopic endonasal marsupialisation without additional intubation or probing of the lacrimal ducts to be a successful treatment strategy for congenital dacryocystoceles. This avoids iatrogenic scarring, false passages, or postoperative bacteraemia. The surgical technique presented here shows a lower success rate in older children with a history of inflammation.

Active primitive reflexes obstruct tactical and technical skills in football players

ABSTRACT Primitive reflexes (PRs) are involuntary motor responses present at birth, typically replaced by voluntary motor control during development. If PRs remain active beyond infancy, they can impair motor and cognitive abilities. This study investigated the correlation between active PRs and Tactical (TaS) and Technical Skills (TeS) in professional football matches. Fifty-eight male football players (17.5 ± 1.4 years) from a French academy were assessed for PR activity, categorized into inactive or active PR groups. Assessed PRs included asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR), tonic labyrinthine reflex (TLR), and Moro reflex (MR). Analysis of twenty matches showed players with active PRs had significantly lower success rates in TaS and TeS, including 15.5% and 31.8% lower pass success in imbalance and finishing zones (p < 0.01). Players with active PRs also performed worse in defensive actions and duels (p < 0.01). The findings highlight that active PRs hinder football performance, especially in challenging match situations like duels and crowded zones. This suggests the need for training programs to address PR effects and enhance player performance. Further research should refine methods for integrating these RPs.

UAV Cruise Strategies Based on Initial Attack

Forest fires not only cause severe damage to ecosystems and biodiversity but also directly threaten the safety of human societies. Given the significant increase in both the frequency and intensity of forest fires worldwide, especially under extreme climate conditions, efficient fire detection and initial attack (IA) are particularly critical. The initial attack is a key stage in forest fire control, and the time taken for fire detection is a crucial factor influencing the success of the initial attack. In response to the challenges of forest fire prevention and control, this study explores Unmanned Aerial Vehicle (UAV) cruising strategies, aiming to develop appropriate approaches based on regional characteristics and provide efficient periodic monitoring solutions for areas with high ecological value and challenging accessibility. By optimizing UAV patrol routes, this research seeks to maximize coverage in areas with lower initial attack success rates and significantly reduce fire detection time, thereby improving detection efficiency. We developed and applied four optimization strategies, random search, high-risk first (HRF), nearest high-risk first (NHRF), and a genetic algorithm-based (GA-based) strategy, to compare different UAV flight routes. To evaluate the deployment effectiveness of the four UAV cruise strategies, we introduced two evaluation metrics: Average Grid Risk (AGR) and Average Distance Risk (ADR). Experimental results showed that the NHRF and GA-based strategies performed better. Specifically, NHRF achieved the highest high-risk coverage, ranging from 51.5% to 71.3%, significantly outperforming the random search strategy (4–7%) and the HRF strategy (23.1–37.5%). The GA-based algorithm achieved the highest grid coverage, ranging from 30% to 59.8%, far surpassing the random search strategy (4–6.6%) and the HRF strategy (10.2–19.1%). Additionally, the NHRF and GA-based strategies delivered the best AGR and ADR performance, respectively. The application of these innovative strategies and evaluation metrics enhances forest fire prevention through periodic monitoring and supports more efficient firefighting efforts.

Development and invitro testing of an orthodontic miniscrew for use in the mandible.

Temporary anchorage devices (TADs) have been successfully used in the maxilla. However, in the mandible, lower success rates present achallenge in everyday clinical practice. Anew TAD design will be presented that is intended to demonstrate optimization of the coupling structure as well as in the thread area for use in the mandible. Three TADs were examined: (A)Aarhus® system (68.99.33 A, Medicon, Tuttlingen, Germany), (B)BENEfit® orthodontic screw (ST-33-54209; PSM Medical, Gunningen, Germany) and(C) anew design with atwo-part screw thread. The TADs were inserted into artificial bone blocks after predrilling to test primary stability. To test the fracture stability, the TADs were embedded in Technovit® 4004 (Heraeus Kulzer, Wehrheim, Germany) and torsional loaded at an angle of 90° until fracture. The threshold torque values occurring were recorded digitally. The statistical evaluation was carried out using the Kruskal-Wallis test with aposthoc test according to Bonferroni (p < 0.05). The following values were measured for the insertion torque: A: 33.7 ± 3.3 Ncm; B: 57.1 ± 8.4 Ncm; C: 34.2 ± 1.4 Ncm. There were significant differences between A-B andB-C. The measured values for the fracture strength were as follows: A: 46.7 ± 3.5 Ncm; B: 64.2 ± 5.1 Ncm; C: 55.4 ± 5.1 Ncm. Significant differences were found between all groups. The adapted screw design has no negative influence on primary and fracture stability. Whether the design has apositive effect on the success rates in the mandible must be clarified in further clinical studies.

Improved identification and tracking of three-dimensional eddies in the Southern Ocean utilizing 3D-U-Res-Net

Oceanic mesoscale eddies are prevalent throughout the global ocean, playing a critical role in material and energy transport while significantly influencing climate change. Accurate characterization of their three-dimensional structures and movement is essential for a quantitative analysis of their transport processes. Traditional eddy detection algorithms have lower successful detection rate and with more limitations, so they fall short in the complex and dynamic ocean environment. The rising trend of applying artificial intelligence (AI) algorithms, due to their efficiency, precision, and automation, addresses this challenge. This study employs the 3D-U-Res-Net algorithm to identify the three-dimensional structures of mesoscale eddies in the Southern Ocean using GLORYS12V1 data from 2011 to 2020. A vector geometry-based eddy detection algorithm (VG) initially identified 1587292 eddy snapshots in the Southern Ocean (2011–2019), which were used for training the 3D-U-Res-Net algorithm. Data from 2020 served as the ground truth and validation set. The successful detection rate of 3D-U-Res-Net algorithm is 100%, which means that it identified all 135734 eddy snapshots from the VG dataset in 2020. For eddy tracking, the VG algorithm counted 18168 eddy tracks, whereas the 3D-U-Res-Net counted 18559, reflecting a 2.15% bias. To reduce uncertainty, eddies with lifespans shorter than two weeks were excluded. The average lifespans and traveling distances for eddies detected by the 3D-U-Res-Net (VG) algorithm were 29.35 (29.61) days and 77.78 (37.60) km, respectively, with the 3D-U-Res-Net identifying eddies with longer traveling distances. The mean radius of eddies detected by the VG algorithm was 43.16 km, while the 3D-U-Res-Net detected eddies with a mean radius of 43.74 km, a 0.58 km increase. We categorized eddies into four three-dimensional structures: bowl-shaped, cone-shaped, lens-shaped, and cylindrical. The VG algorithm identified these structures in proportions of 32%, 31%, 25%, and 12%, respectively, whereas the 3D-U-Res-Net algorithm found 19.48%, 19.58%, 0.04%, and 60.9%, respectively. The 3D-U-Res-Net identified more cylindrical eddies and was approximately ten times faster than the VG algorithm. Overall, this algorithm has good performance and higher efficiency. It is an attempt of using AI for oceanic research, and more works can be carried out in the future.

Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center.

Mechanical thrombectomy (MT) is an established therapy for acute ischemic stroke (AIS), but recanalization is not always achieved. Common reasons are inadequate removal at the thrombus site and difficulties with the access route. In order to identify risk factors for MT failure we conducted a retrospective study on a high-volume comprehensive stroke center. Evaluation of 552 thrombectomies (2019-23; anterior and posterior circulation, direct aspiration +/- stent retriever [SR]). MT failures (= modified Thrombolysis in Cerebral Infarction score 0 or 1) were analyzed for age, sex, pre- and post-MT modified Rankin Scale, bridging intravenous thrombolysis (IVT), occlusion site (anterior / posterior circulation, proximal / distal), the Kaesmacher classification and time trend results. MT failure occurred in 56 patients (10.1%; median age 76; 53.6% female). Nineteen (33.9%) patients received IVT (p = 0.326). Logistic regression analysis did not show a significant association of age, sex or occlusion site with MT failure (p = 0.165, p = 0.738, p = 0.838). Distal MT generally demonstrated lower success rates (p < 0.01). According to the Kaesmacher classification SR failure was the most frequent cause of MT failure (category 2B: 48%, p < 0.001). Time trend analysis suggests improving recanalization rates in the further course (4 times in year-on-year comparison; p < 0.01). MT failure occurs in AIS treatment, even in high-volume centers and occurs more frequently in distal occlusions. Improvements in device technology, particularly SR, and ongoing refinements in access route selection offer the prospect of better outcomes in the future.

Outcome of video laryngoscopy versus direct laryngoscopy for emergency tracheal intubation in emergency department: a propensity score matching analysis

BackgroundThe high incidence of airway management failure in the emergency department (ED) necessitates a comparative analysis of laryngoscopy methods. This study aims to compare the success and complications associated with video-assisted laryngoscopy (VL) and direct laryngoscopy (DL) in emergency tracheal intubation in ED.MethodsThis retrospective cohort study was conducted at the ED of Thammasat University Hospital. It involved adult patients undergoing emergency tracheal intubation using either VL (GlideScope®) or DL (Macintosh®). The outcomes assessed were success rates of intubation and occurrence of peri-intubation adverse events. Propensity score matching and multivariable risk regression analysis were employed for statistical evaluation.ResultsThe study included 3,424 patients, with 342 in the VL group and 3,082 in the DL group. The initial analysis revealed no significant differences in the intubation success rates between the two methods. However, the VL group experienced fewer peri-intubation adverse events (33% compared to 40%). After propensity score matching, a higher first-attempt success rate was observed in the DL group (88.9% vs. 81.3%, risk difference: 7.6, 95% CI: 1.9 to 13.2, p=0.009), but there was no statistically significant difference in peri-intubation adverse events. VL had a lower first-attempt success rate among low-experience intubators. Subgroup analyses of intubators with moderate and high experience, as well as patients who received both induction agents and neuromuscular blocking agents, show results consistent with the analysis of the entire cohort.ConclusionBoth VL and DL have comparable first-attempt success rates and peri-intubation adverse events. VL is particularly beneficial when used by moderately or highly experienced intubator. The choice of intubation method, combined with clinical experience and technique plays a critical role in the success and safety of emergency intubations.

Left-sided portal hypertension: what an interventional radiologist can offer?

Left-sided portal hypertension (LPH) refers to increased splenic venous pressure caused by splenic vein stenosis or occlusion. Pancreatitis is the leading cause of LPH. Typically, LPH remains asymptomatic, but it can lead to life-threatening hemorrhage from ruptured fundal varices in about 10% of patients. Further, it may be complicated by hypersplenism. Interventional radiology plays an essential role in LPH patients with failed endoscopic treatment. Variceal embolization is an effective salvage measure in bleeding gastric varices, but it carries a risk of recurrence and worsening of hypersplenism. Considering the pathophysiology, splenic vein recanalization (SVR) appears to be the best treatment; nevertheless, its lower technical success rate limits its utility only to a subgroup of LPH patients. Partial splenic embolization (PSE), a non-surgical alternative to splenectomy, reduces the splenic volume and venous outflow, thereby lowering variceal pressure. PSE is technically easier, which may explain its widespread use. Nonetheless, PSE can be complicated by life-threatening sepsis and portal vein thrombosis. Despite all attempts, some LPH patients eventually require a splenectomy. Importantly, the choice of therapy requires multidisciplinary discussion and is often influenced by availability, expertise, and clinical context. This article discusses various interventional strategies for managing LPH with the available evidence. KEY POINTS: Question Pressure within the main portal vein is normal in left-sided portal hypertension; thus, transjugular intrahepatic portosystemic shunt is ineffective. Findings Splenic vein stent placement can restore hepatopetal splenic blood flow and decompress splenic venous pressure. Clinical relevance Partial splenic embolization (PSE) is the most widely used interventional approach to manage left-sided portal hypertension-related complications.

Biomedical research grant resubmission: rates and factors related to success – a scoping review

ObjectivesMost first-time biomedical research grant applications are not funded. In the challenging research funding climate, resubmitting a grant application is a necessary task for scientists. Identifying which factors influence their...

Air DNA forensics: Novel air collection method investigations for human DNA identification.

Modern techniques can generate highly discriminatory DNA profiles from minuscule biological samples, providing valuable information in criminal investigations and court proceedings. However, trace and touch DNA samples, due to their nature, often have lower success rates than other biological materials, such as blood. Further, forensically aware criminals can utilize gloves and meticulously clean the crime scene to remove DNA traces of themselves from contacted surfaces. Air sampling offers a novel approach to the collection of human DNA that has the potential to bypass some of these issues. This study reports on the results of research into the prevalence and persistence of human DNA in the air. The ability to collect human DNA from the air was investigated with the use of an AirPrep Cub Sampler ACD220 in different spaces, with and without the presence of individuals for various durations of sample collection. Results of this study demonstrate that level of occupation and sampling duration each have an influence on quantity and quality of DNA recovered from the air whereas the effects of orientation and distance of participants from the collection device as well as sequence of occupation remain unclear and require further investigation.

Performance of Chatgpt in ophthalmology exam; human versus AI.

This cross-sectional study focuses on evaluating the success rate of ChatGPT in answering questions from the 'Resident Training Development Exam' and comparing these results with the performance of the ophthalmology residents. The 75 exam questions, across nine sections and three difficulty levels, were presented to ChatGPT. The responses and explanations were recorded. The readability and complexity of the explanations were analyzed and The Flesch Reading Ease (FRE) score (0-100) was recorded using the program named Readable. Residents were categorized into four groups based on their seniority. The overall and seniority-specific success rates of the residents were compared separately with ChatGPT. Out of 69 questions, ChatGPT answered 37 correctly (53.62%). The highest success was in Lens and Cataract (77.77%), and the lowest in Pediatric Ophthalmology and Strabismus (0.00%). Of 789 residents, overall accuracy was 50.37%. Seniority-specific accuracy rates were 43.49%, 51.30%, 54.91%, and 60.05% for 1st to 4th-year residents. ChatGPT ranked 292nd among residents. Difficulty-wise, 11 questions were easy, 44 moderate, and 14 difficult. ChatGPT's accuracy for each level was 63.63%, 54.54%, and 42.85%, respectively. The average FRE score of responses generated by ChatGPT was found to be 27.56 ± 12.40. ChatGPT correctly answered 53.6% of questions in an exam for residents. ChatGPT has a lower success rate on average than a 3rd year resident. The readability of responses provided by ChatGPT is low, and they are difficult to understand. As difficulty increases, ChatGPT's success decreases. Predictably, these results will change with more information loaded into ChatGPT.

Gastric Per-Oral Endoscopy Myotomy (G-POEM): Tips, Tricks, and Pitfalls.

The number of hospitalizations for gastroparesis has risen over 300% in recent decades with increased physical, psychological, and healthcare burdens. Gastric per-oral endoscopic myotomy (G-POEM) is a promising therapy for patients with refractory gastroparesis. This article reviews important considerations for G-POEM. Predictive factors for clinical success after G-POEM include diabetic and idiopathic gastroparesis, shorter gastroparesis duration, symptoms predominant of nausea and emesis, and gastric emptying study showing gastric retention of > 20% at 4h. Mucosal closure is a critical step for G-POEM; both sutures and clips have high success rates, with clips having a trend to lower success rates but with significantly shorter procedure time and cheaper cost. G-POEMs have an overall 61% pooled success rate at one year with a yearly 13% symptom recurrence rate. A careful patient selection can yield higher clinical success rates. Further studies are needed on variant G-POEM techniques for more durable outcomes.

EUS-guided gastroenterostomy for malignant gastric outlet obstruction: impact of clinical and demographic factors on outcomes

EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to surgical gastrojejunostomy and endoluminal stenting for malignant gastric outlet obstruction (MGOO). Studies regarding factors associated with the EUS-GE outcomes are limited. A retrospective observational study was conducted with consecutive patients who underwent EUS-GE for MGOO from January 2016 to November 2023. Primary outcomes were technical success (establishing EUS-GE) and clinical success (low-residue diet tolerance without re-intervention at 90-day follow-up). Secondary outcomes were adverse events (AEs), reinterventions, and full regular diet tolerance. Technical success and clinical success rates were 92.70% (127 of 137) and 88.00%, respectively, with 42.86% of the patients tolerating a regular diet. Patients with peritoneal carcinomatosis had lower odds of technical success (odds ratio [OR], .19; 95% confidence interval [CI], .04-.93). Obstruction at the level of stomach, compared with duodenum, had lower odds of clinical success (OR, .06; 95% CI, .006-.56). AE and reintervention rates were 14.17% and 8.66%. Nasogastric tube decompression before EUS-GE was associated with lower AE rates in multivariable analysis (OR, .32; 95% CI, .11-.95). Prior GI surgery was associated with reintervention in multivariable analysis (OR, 4.09; 95% CI, 1.02-16.45; P= .047). EUS-GE has high technical and clinical success rates, with many patients tolerating a regular diet. Routine nasogastric tube decompression should be considered to minimize AEs. MGOO at the level of the stomach is associated with lower clinical success rates. Extra care should be taken while performing EUS-GE in patients with peritoneal carcinomatosis. Prior GI surgery is a likely risk factor for reintervention.

Doughnut-shaped amniotic membrane transplantation in pediatric simple limbal epithelial transplantation after ocular chemical injury

Abstract Children of any age are at high risk for ocular chemical injuries and the development of limbal stem cell deficiency with severe visual consequences. Surgical options for ocular surface reconstruction at the pediatric age tend to have lower success rates than their adult counterparts. Herein, we report the results of a novel modification of the simple limbal stem cell epithelial transplantation using a doughnut-shaped amniotic membrane graft to avoid further visual axis obstruction during re-epithelization. Since younger children are a highly susceptible population suffering from chemical burns, with nearly half of them being at preschool (first months of life to 5 years) ages, such a technique may be more appropriate to reduce the time of visual obstruction and obtain faster visual rehabilitation.

Maximum extension and regression rate of cutaneous sensory block obtained with the external oblique intercostal block or the modified thoracoabdominal nerves block through perichondrial approach in patients undergoing laparoscopic cholecystectomy.

Several studies demonstrate that both external oblique ıntercostal block (EOIB) and modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) contribute to analgesia in the anterior abdomen by targeting the thoracoabdominal nerves through distinct pathways. However, the sensory assessment and dermatomal analysis remain poorly understood. This prospective observational study aimed to determine the sensory assessment and dermatomal regression rate of EOIB and M-TAPA in patients undergoing laparoscopic cholecystectomy. The study included a total of 24 patients, with 12 patients in each group. Blocks were performed bilaterally, administering 25 mL of bupivacaine 0.25% for each side, resulting in a total volume of 50 mL. The anterior abdominal wall was vertically partitioned into the midabdomen, left-lateral abdomen, and right-lateral abdomen, and horizontally divided into the epigastric, umbilical, and hypogastric regions. Sensory block was assessed at the 45th minute with cold stimulus and pinprick. Subsequent evaluations were at intervals of 6, 10, 14, 18, 22, and 24 hours. The blocked area percentile with cold sensation in the anterior abdomen was 43.07% (36.67-55.74) with EOIB, 40.49% (34.05-43.67) with M-TAPA (P=0.3219). When the region above the intertubercular plane was examined with cold sensation, EOIB covered 55.92% (46.75-62.07), and M-TAPA covered 49.60% (40.39-54.03) of the epigastric and umbilical areas. Assessment of the midabdominal portion of the anterior abdomen revealed that the blocked area percentile was statistically significantly higher in the M-TAPA group with both cold sensation and pinprick. At 45 minutes, the percentage of blocked dermatomes was 100% between T7-T8 in the EOIB group and between T7-T10 in the M-TAPA group. Both groups exhibited lower success rates in dermatomes T5 and T12, with no sensory block within the L1 dermatome, and cutaneous dermatomal block status either absent or negligible after 24 hours. All trocar entries were located within the cutaneous sensory block for both blocks, except for trocar C, which was located most laterally. Bilateral EOIB and M-TAPA produce a comparable sensory cutaneous block in the anterior abdomen, particularly in the umbilical and epigastric regions. Additionally, the midabdominal cutaneous blocked area was greater in patients undergoing M-TAPA, suggesting a more consistent distribution along the anterior cutaneous branches of the thoracoabdominal nerves.

Analysis of influencing factors of residual dizziness after repositioning of horizontal semicircular canal benign paroxysmal positional vertigo

Background Horizontal semicircular canal benign paroxysmal positional vertigo(HSC-BPPV) is the second most common type of BPPV. It is difficult to diagnose and treat, which has a serious impact on the prognosis of patients. Objectives To study the clinical features of HSC-BPPV and the influencing factors of residual dizziness (RD). Materials and methods The clinical data of 358 patients with BPPV were retrospectively collected. The differences between HSC-BPPV and posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) were compared, and the influencing factors of RD after HSC-BPPV repositioning were analyzed. Results ① Compared with PSC-BPPV, HSC-BPPV had a lower success rate of first repositioning (64.7 vs. 75.0%), a higher incidence of RD (57.3 vs. 43.8%), and a higher DHI score (40.0 vs. 34.0), and the differences were statistically significant (p < .05). ② Logistic regression analysis showed that age ≥60 years, secondary, DHI score, successful first repositioning were the influencing factors for the development of RD after HSC-BPPV repositioning (p < .05). Conclusions and significance The diagnosis and treatment of HSC-BPPV is difficult, and RD is prone to occur. Clinicians need to strengthen the training of HSC-BPPV diagnosis and treatment to reduce the occurrence and progression of RD.

Identifying Predictors of Unfavorable Treatment Outcomes in Tuberculosis Patients.

In South Korea, there has been a continuous decrease in the incidence of tuberculosis (TB) attributable to a national TB elimination program; however, TB still poses a significant socioeconomic burden. This study aimed to analyze factors associated with successful TB treatment and to identify refractory patient groups with unfavorable outcomes. We analyzed anonymized data on 89,150 patients with TB provided by the Korea Disease Control and Prevention Agency. Specifically, we collected independent variables, which were categorized as individual, regional, and medical facility factors. Individual factors included age, sex, nationality, TB type, drug-resistant status, category of TB, housing type, underlying disease status, number of referrals, and smoking status. Regional factors referred to the region where the TB case was reported. Medical facility factors included the first visit to a medical facility, categorized by hospital type and the distinction between private-public mix (PPM) and non-PPM depending on the presence or absence of dedicated TB nurses. These factors were analyzed in relation to treatment success to identify refractory patient groups with unfavorable outcomes. Multivariable logistic regression analysis revealed the following significant factors associated with successful TB treatment: sex, nationality, status of drug-resistant TB, category of TB, number of referrals, region of TB registry, underlying diseases, and smoking status. Specifically, compared with their relevant counterparts, male patients had a lower rate of successful treatment (adjusted odds ratio [aOR]: 0.66, reference [Ref.]: women); Korean nationals had a higher rate of treatment success (aOR: 7.20, Ref. foreign residents in Korea); resistant TB was associated with a lower rate of treatment success (aOR: 0.35, Ref.: non-resistant TB status); newly treated patients had a higher rate of treatment success (aOR: 1.75, Ref.: retreatment patient); switching hospitals once (aOR: 1.78), never (aOR: 1.41), or twice (aOR: 1.37) was associated with increased treatment success (Ref.: three or more times); having zero (aOR: 1.45), one (aOR: 1.31), or two (aOR: 1.24) underlying diseases was associated with a higher rate of treatment success (Ref. three or more underlying diseases); and past smokers (aOR: 1.40) and non-smokers (aOR: 1.35) had a higher rate of treatment success (Ref.: current smokers). Our study identified several factors contributing to unfavorable treatment outcomes in tuberculosis patients, including male patients, foreign residents in Korea, drug-resistant TB, retreatment patients, frequent hospital switching, multiple underlying diseases, and current smoking status. These research findings could inform the development of efficient management strategies and policies for improving the treatment success rate among patients with TB.