Mean Number Of Applications Research Articles

Ablation outcome in patients with atrial fibrillation undergoing ICE-guided pulsed-field ablation

Abstract Background Prior experiences from preclinical studies indicate the critical need of catheter-tissue- contact for creation of consistent transmural lesions in pulsed-field ablation (PFA). Intracardiac echocardiography (ICE) not only provide real-time visualization of cardiac structures, but also ensure adequate contact with the tissue. Objective We evaluated ablation outcome and reconnection rate following ICE-guided PFA procedure in patients with atrial fibrillation (AF). Methods Consecutive patients receiving ICE-guided PFA procedure were included in this multi-center analysis. All patients received isolation of PVs (PVI). Additional ablation of left atrial posterior wall (LAPW) was decided based on operator’s discretion. Concentric overlapping lesions were placed in the LAPW. Number of applications were determined on a case-by-case basis. ICE and fluoroscopy were used to optimize contact between the PFA catheter and the targeted tissue. All procedures were performed under uninterrupted anticoagulation. Mapping was done before and after ablation to confirm electrical isolation. Arrhythmia-monitoring was done for 1-year with periodic clinic visits, event recorders and 7-day Holter monitoring. Results A total of 372 patients [age: 62.69 ± 10.41 years, male: 201 (71.3%), paroxysmal AF: 67 (18%)] were included in this analysis of which 48 (12.9%) underwent PVI-only and the remaining subjects received additional ablation of LAPW. Mean number of applications were 34.67 ± 8.88 and 73.65 ± 37.21 for PVI-only and PVI+LAPWI cohorts respectively (p<0.001). No major procedural complications such as esophageal injury, atrio-esophageal fistula, pericardial effusion requiring drainage or cerebrovascular accidents were reported. During 1-year follow-up, 38 (10.2%) patients underwent repeat procedure for recurrence. Reconnection of PV and LAPW were found in only 2 (5.2%) patients. In all 38 patients, new triggers initiating AF were detected to be originating from interatrial septum: 25 (65.8%), superior vena cava: 9 (23.7%), coronary sinus: 7 (18.4%) and left atrial appendage: 6 (15.8%). Conclusion ICE-guided PFA procedures are safe and produce durable lesions leading to very low reconnection rate. The recurrence was mostly due to new triggers initiating AF.

The golden tickets: impact of preference signaling on obstetrics and gynecology residency applicants

With the residency selection process becoming more competitive and programs receiving unprecedented numbers of applications, some specialties have introduced preference signaling in an attempt to help applicants target programs of interest. In the 2022-2023 application cycle, obstetrics and gynecology also introduced a 2-tiered system with a limited number of gold signals (n=3) and silver signals (n=15). Given the novelty of preference signaling in the obstetrics and gynecology residency application process, this study aimed to (1) assess the effect of signals on interview offers and match and (2) discuss applicant attitudes toward this preference signaling system. This was a voluntary cross-sectional survey study conducted in April 2023 that was open to all fourth-year medical students who applied to an obstetrics and gynecology residency in the United States. Self-reported demographics, signaling, interview, and match data were collected. In addition, students were asked about attitudes toward signaling on a 5-point Likert scale. Of the 1507 applicants who entered an obstetrics and gynecology residency via match or Supplemental Offer and Acceptance Program process, 969 (64.3%) completed the survey. Moreover, an additional 22 applicants who did not match responded to the survey. More respondents used all 3 gold tokens (98.3%) and all 15 silver tokens (94.3%). The mean number of applications sent was 74.3±35.1, and the mean number of interviews received per applicant was 12.8±6.6. The interviews or token yields were 64.0%±31.5% for gold tokens, 43.8%±23.1% for silver tokens, and 9.8%±10.0% for no token. Of the survey respondents, 340/951 (35.8%) matched to a gold token program, 338/951 (35.5%) matched to a silver token program, and 244/951 (25.7%) matched to a nontoken program. Furthermore, 499/951 applicants (52.5%) reported feeling slightly positive or very positive about signaling. Most obstetrics and gynecology applicants in this survey participated in preference signaling. Gold and silver tokens were associated with high ratios of interview invitations compared with no token. However, the overall number of applications did not decrease in the 2022-2023 cycle, and only half of survey respondents reported feeling positive about the signaling process. These results can inform program directors and students about application number and strategy in upcoming cycles.

Initial experience with pulsed field ablation for atrial fibrillation.

Pulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI) and describe procedural findings and peri-procedural safety of the first 100 patients. We investigated 100 patients treated for symptomatic AF using the FARAWAVE PFA catheter (Farapulse, Menlo Park, CA, USA) between July 2021 and March 2022. Procedure workflow and electrophysiological findings at the time of ablation, peri-procedural complications, and operator learning curves are described. The mean age of patients was 62.9 ± 9.4 years, 62% were male subjects and 80% had paroxysmal AF. The median CHA2DS2-VASc score was 1.5 (IQR: 1.0-2.0) and the mean left atrial volume index was 35.7 ± 9.6 ml/m2. In 88 (88%) patients, PVI alone was performed and in 12 (12%) patients additional ablation of the posterior wall was performed. 3D-electroanatomic mapping was performed in 18 (18%) patients. Procedures without mapping lasted for 52.3 ± 16.6 min. The mean number of applications per pulmonary vein (PV) was 8.1 ± 0.6. In all patients (100%), all PVs were confirmed to be isolated. The learning curves of the two operators who performed > 20 procedures showed a negligible variation of performance over time and practice did not significantly predict procedure time [Operator 1 (senior): R 2 = 0.034, p = 0.35; Operator 2 (junior): R 2 = 0.004, p = 0.73]. There was no difference between the procedure times between senior and junior operators (Operator 1: 46.9 ± 9.7 min vs. Operator 2: 45.9 ± 9.9 min; p = 0.73). The only complications observed were two cases of bleeding at the site of percutaneous access. Our initial experience shows that use of the PFA catheter for pulmonary vein isolation (PVI) is safe, fast, and easy to learn.

Regional variations in patient selection and procedural characteristics for cryoballoon ablation of atrial fibrillation

Abstract Background Cryoballoon ablation is a well-established anatomical approach for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Although widely adopted, regional variations in standards of care have not been well characterized. Purpose To evaluate regional variations in patient selection and procedural characteristics for PVI with cryoablation in the Cryo Global Registry (NCT02752737). Methods Patients with AF were enrolled from May 2016 to October 2021 at 128 sites in 37 countries. Patients were treated with cryoballoon ablation according to local clinical practice. Baseline subject and procedural characteristics were summarized for 8 regions (Central Asia and Russia, East Asia, Europe, Middle East, North America, South Africa, South America, and Southeast Asia). Procedure-related serious adverse events (SAEs) were evaluated in a subset of patients with ≥7 days of follow-up. Results A total of 3680 patients undergoing initial PVI for AF were included. Cryoballoon ablation was more commonly performed in patients with paroxysmal vs. persistent AF in all regions, and in males vs. females in all regions except Central Asia and Russia. Mean age ranged from 47±12 in the Middle East to 64±11 in East Asia. Regional variations were observed in the proportion of patients with common AF comorbidities undergoing cryoablation (Table 1). Median procedure time ranged from 61 (49–68) minutes in Central Asia and Russia to 95 (76–120) minutes in Southeast Asia. Median fluoroscopy time was ≤20 minutes in all regions. The use of 3D mapping was relatively uncommon except in North America (63.3%). Large variation was observed in the use of esophageal monitoring, whereas phrenic nerve monitoring was used in ≥97.7% of cases in all regions (Table 2). Same-day discharge was uncommon except in North and South America (37.8% and 26.5% of cases, respectively). Average freeze duration ranged from 153±41 seconds in Southeast Asia to 230±29 seconds in Central Asia and Russia. Mean number of applications per vein ranged from 1.2±0.4 in Central Asia and Russia to 2.1±1.0 in North America. Acute procedural success was ≥94.7% in all geographies and focal radiofrequency touch-up was required in ≤13.0% of cases. In 3126 subjects with ≥7 days of follow-up, 122 procedure-related SAEs were reported in 111 patients (3.6%), and 1 procedure-related death was reported during data collection. Conclusion(s) Despite regional variations in patient selection and procedural characteristics, PVI using cryoballoon ablation is performed with high acute success and short procedural times around the world. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.

Initial experience with a novel pulsed field ablation catheter for ablation of atrial fibrillation: procedural findings and acute safety

Abstract Funding Acknowledgements Type of funding sources: None. Background Currently employed catheters for treatment of symptomatic atrial fibrillation (AF) leverage thermal energy to ablate the myocardium. Despite excellent acute success rates, the non-selective nature of thermal injury has been associated with frequent AF recurrences and complications such as pulmonary vein stenosis and thermal damage to adjacent structures. Recently, a novel, non-thermal ablative modality has been introduced for the treatment of AF: pulsed field ablation (PFA). The selective nature of PFA translates in the ability to perform full transmural lesions whilst sparing adjacent tissues and structures, making PFA an attractive solution to limitations faced with thermal energy sources. Although several pre-clinical studies investigated the safety and feasibility of PFA, limited reports have been published so far describing the clinical application of this novel catheter technology. Purpose In this study we present our initial experience with a pulsed field ablation catheter and describe procedural findings and acute safety of the first 68 patients treated at our center. Methods We investigated the first 68 patients treated for symptomatic AF at our center using pulsed field ablation between July 2021 and January 2022. Procedural findings at the time of ablation are presented. Procedure-related complications are reported. Qualitative analysis of electrograms and electrophysiological maps before and after ablation are also provided. Lastly, learning curves of operators who performed more than 10 procedures are described. Results Mean age of patients was 63.1±9.2 years, and most were men (57.4%). Most patients suffered from paroxysmal AF (79.4%). The median CHA2DS2-VASc score was 2.0 (1.0; 3.0) and mean left-atrium (LA) volume index was 33.0±8.3 ml/m2. All procedures were performed using conscious sedation. In 63/68 patients ablation of the PVI was performed and in 5/68 patients additional ablation of the left atrial posterior wall was performed. 3D electroanatomic mapping was performed during 10/68 procedures which lasted on average 107.3±15.5 min. Procedures where no mapping was performed lasted on average 48.5±20.7 min. Mean LA time was 39.9±19.0 min. Mean number of applications per pulmonary vein (PV) were 8.6±1.1. In all patients (100%) PVs were confirmed to be isolated. Four different operators performed the ablations: operator 1 performed 25/58 procedures (36.8%), operator 2 28/58 (41.2%), operator 3 9/58 (13.2%), and operator 4 6/58 (8.8%). The learning curves of both operator 1 and operator 2 showed negligible variation of performance over time (R2: Operator 1 = 0.181; Operator 2 = 0.078). The only complications reported were two cases of bleeding at the percutaneous access site of the femoral vein. Conclusions Our initial experience with a PFA catheter in 68 patients shows that PFA is a safe, quick, easy-to-learn, and effective ablation technique for the treatment of symptomatic AF.

Optimal catheter-tissue contact value for ablation of ventricular arrythmias originating from the left ventricular papillary muscles

Abstract Funding Acknowledgements Type of funding sources: None. Background Good catheter-tissue contact is mandatory to create effective ablation lesions. The minimal contact force (CF) value for successful ablation of arrhythmias originating from the left ventricle (LV) was reported at the 8-10 g level, however, optimal CF values for ablation of arrhythmias arising from papillary muscles (PM) are not known. Purpose To determine optimal CF value for ablation of arrhythmias from LV PM. Methods Twenty-four consecutive patients (mean age 57,9 ± 11,9 years, 16 males) who from May 2017 to June 2020 underwent ablation of premature ventricular complexes (PVC) originating from LV PM were included. The primary endpoints were an acute procedural success (total elimination of PVC) and long-term success (median 27 months). Ablation was performed with the use of the CARTO electro-anatomical system and intracardiac echocardiography (ICE). Results Acute success – complete abolition of PVC, was obtained in 23 (96%) patients. The fluoroscopy time was 3,9 ± 3,5 min and the procedure duration was 114,8 ± 38 min. The mean number of applications was 8,74 ± 6,78 and the mean application time - 518,5 ± 437,25 sec. The mean CF during successful ablations was 3,1 ± 1,5 g, with 3 ± 1,1 g and 3,18 ± 1,8 g for anterolateral and posteromedial PM, respectively (p= 0,809975). The mean CF during one unsuccessful ablation was 3 g. At control Holter ECG, the mean PVC burden in all patients was reduced from 28,36 ± 14,48 % to 2,42 ± 2 %: in the anterolateral PM group from 18 ± 8 % to 2,6 ± 2 % (p= 0,005415) and in the posteromedial PM group - from 34,8 ± 13,7 % to 1,7 ± 1,3 % (p= 0,012694). During long-term follow-up (median 27, IQR 17-34) there was one recurrence among 23 patients who had acutely successful procedures. Conclusion The values of CF for successful ablation of PVC originating from LV PM are lower than those for ablation in other parts of LV. The values slightly exceeding 3 g seem to be sufficient to achieve ablation success.

Initial clinical experience of pulmonary vein isolation using the ultra-low temperature cryoablation catheter for patients with atrial fibrillation.

The iCLAS ultra-low temperature cryoablation (ULTC) system has recently been brought to the market. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation in atrial fibrillation (AF) ablation. The use of an esophageal warming balloon is recommended when using the system to reduce the potential for collateral esophageal injury. To describe the initial clinical experience when using ULTC in the AF treatment without general anesthesia (GA). Consecutive patients undergoing AF ablation using ULTC under deep sedation without GA were enrolled. We assessed the procedural data focusing on "single-shot isolation" defined as successful pulmonary vein (PV) isolation after the first application. Esophagogastroduodenoscopy was systematically performed the day after ablation. A total of 27 AF patients (67% paroxysmal AF) were analyzed. Onehundredfour out of 106 PVs (98.1%) were isolated solely using ULTC. The mean procedure time was 79 ± 30 min. The mean number of applications per PV was 2.6 ± 1.0. Single-shot isolation was achieved in 57 PVs (54%) varying across PVs from left superiorto inferior PVs (40%-64%). The single procedure 6-month recurrence-free rate was 84%. No major complication (cerebrovascular event, pericardial effusion/tamponade, esophageal damage on esophagogastroduodenoscopy) occurred. A single transient phrenic nerve palsy occurred during the right superior PV ablation, which had recovered by the 3-month follow-up appointment. AF ablation using the novel ULTC system seemed feasible without GA and enabled a >50% single-shot isolation rate. The promising safety profile has to be confirmed in large-scalestudies.

Treatment of Advanced Coats' Disease With Combination Therapy of Laser Photocoagulation, Intravitreal Ranibizumab, and Sub-Tenon Methylprednisolone Acetate.

To investigate the efficacy of combination therapy with laser photocoagulation, intravitreal ranibizumab, and sub-Tenon methylprednisolone acetate in patients presenting with advanced Coats' disease. This was a retrospective analysis of 16 patients who underwent laser photocoagulation combined with intravitreal ranibizumab and sub-Tenon methylprednisolone acetate between 2008 and 2017. The primary outcome was anatomic success and the secondary outcomes were globe preservation and final visual acuity. The average age at surgery was 5.12 ± 2.7 years (range: 3 to 10 years). The mean follow-up time was 45.43 ± 29.01 months (range: 12 to 108 months). Of the 16 patients (16 eyes) reviewed, 6 patients had stage 3A and 10 patients had stage 3B Coats' disease. The mean number of applications was 10 (range: 4 to 18). Globe preservation was achieved in all patients. Final visual acuity outcomes were satisfactory: 20/20 to 20/50 in 2 patients, 20/60 to 20/100 in 1 patient, and 20/200 or worse in 13 patients. Intravitreal ranibizumab used in combination with laser photocoagulation and sub-Tenon methylprednisolone acetate could be an effective treatment option for patients with advanced Coats' disease. The combined therapy achieved anatomical success, globe preservation, and reasonable visual acuity outcomes. [J Pediatr Ophthalmol Strabismus. 2022;59(3):187-191.].

Initial clinical experience of pulmonary vein isolation using the novel ultra-low temperature cryoablation catheter for patients with atrial fibrillation

Abstract Background The high cooling power and ultra-low temperature cryoablation (ULTC) catheter called “Adagio” has been recently launched. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation applicable not only for atrial fibrillation (AF) but also for other tachyarrhythmia by optimizing catheter shape. The exclusive esophageal warming balloon in order to preserve esophageal temperature is encouraged to prevent the potential risk of esophageal complication during procedure. Aim To assess the initial clinical data on pulmonary vein (PV) isolation for patients with AF using the novel ULTC catheter. Methods Consecutive patients who underwent AF ablation using ULTC in our center were enrolled. We assessed the acute procedural data focusing on procedural feasibility and safety comprising “first-pass isolation” defined as successful PV isolation after the initial application. Results A total of 16 AF patients (53% male, age 67 years, 59% paroxysmal AF) were analyzed. Sixty-six out of 67 PVs (98.5%) were isolated with ULTC. The mean number of applications per PV was 2.3 1.1. Touch-up catheter was needed in one case at left inferior PV. The mean total procedure and fluoroscopy times were 79±30 and 14±7 mins, respectively. First-pass isolation was achieved in 34 PVs (50.7%) varying across PVs from left superior PV (43.8%) to right superior PV (58.8%). In none of the patients an acute thromboembolic event (stroke or transient ischemic attack), a pericardial effusion/tamponade and postprocedural esophageal complication occurred. A single transient phrenic nerve weakening was observed at right superior PV. Conclusion Sequential PV isolation using the novel ULTC catheter was achieved feasibly without compromising safety. First-pass isolation was accomplished about in a half of PVs. Funding Acknowledgement Type of funding sources: None.

Percutaneous alcohol-based sclerotherapy in aneurysmal bone cyst in children and adolescents

IntroductionAneurysmal bone cyst (ABC) is a benign bone lesion of childhood and adolescence. It can be locally aggressive, with risk of fracture. Management is controversial. The aim of the present study was to assess the efficacy, simplicity and tolerance of percutaneous alcohol-bases sclerotherapy in ABC. HypothesisAlcohol-based sclerotherapy for ABC under radiographic control is safe and effective. Material and MethodsA single-center retrospective study for the period 2008–2016 included all of the 55 ABCs, in 54 patients, confirmed on pathology and treated by alcohol-based sclerotherapy under radiographic control. Mean age at diagnosis was 9.6 years. ABC involved the humerus in 30 cases (54%), tibia in 7 (13%) and femur in 5 (9%). Mean follow-up was 50.9 months (range, 16–117 months). Mean number of applications was 1.7 (range, 1–4). Results were assessed clinically (pain, return to sport, limb length and alignment, revision surgery) and radiologically. The main endpoint was lesion volume reduction. The secondary endpoint was failure, defined by open revision surgery or pain preventing return to a sports activity. ResultsClinical progression was favorable in 36 patients (67%), and radiological progression in 45 (85%). Only 1 cyst required secondary resection. One patient experienced spontaneously resolving intraoperative bradycardia. Male gender and young age emerged as factors for poorer response. DiscussionABC management in children can be made difficult by lesion size, aggressiveness, location, proximity to the growth plate and small bone stock. Alcohol-based sclerotherapy is simple, reliable and effective in childhood ABC, and may be a first-line attitude, avoiding recourse to invasive surgery. Level of evidenceIV, retrospective study.

A novel simple, fast, and safe approach for effective superior vena cava isolation using the third-generation cryoballoon.

Superior vena cava (SVC) isolation with radiofrequency energy remains a challenge due to potential side effects, especially phrenic nerve (PN) or sinus node injury. The purpose of this study was to evaluate the feasibility of a novel SVC isolation technique using the third-generation cryoballoon (CB3). Patients undergoing atrial fibrillation (AF) ablation were prospectively included. The procedure was performed with the CB3, beginning with the pulmonary veins and ending with SVC isolation. During applications in the SVC, continuous PN capture and sinus rate were monitored. Once reached SVC isolation during the application, 60 s more was applied, with no bonus application. If after 90 s the SVC was not isolated, application was stopped. A maximum number of four applications were permitted. Thirty patients (62 ± 9 years; 74% male, 78% paroxysmal AF) were included. No SVC activity was observed in two patients. Success rate for SVC isolation was 89%. Mean number of applications per patient was 2.3±1. Mean time to SVC isolation was 37±20 s. Mean duration of application was 92 ± 15 s. Mean total time of procedure for SVC isolation was 218 ± 43s. We recorded only two complications: one transient PN palsy and one short and transient sinus arrest. After a mean follow-up of 5 ± 2 months, 89% are free from arrhythmia recurrence. We present a promising simple SVC-isolation technique using CB3, featuring a high success rate and very low incidence of complications.

A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

BackgroundThe optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol.MethodsA total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 s each) (the Cryo-AFConventional group n = 84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of − 40 °C within 60 s (the Cryo-AFDosing group n = 80)ResultsWe treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7 ± 0.8, with no difference between groups (Cryo-AFConventional, 8.7 ± 0.8 versus Cryo-AFDosing,8.6 ± 0.8; P = 0.359). The Cryo-AFDosing group required significantly less total cryotherapy application time (990.60 ± 137.77versus 1501.58 ± 89.60 s; P < 0.001) and left atrial dwell time (69.91 ± 6.91 versus 86.48 ± 7.03 min; P < 0.001) than the Cryo-AFConventional group. Additionally, the Cryo-AFDosing group required significantly less total procedure time (95.03 ± 6.50 versus 112.43 ± 7.11 min; P < 0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 min. The reconnection rates between the Cryo-AFConventional and Cryo-AFDosing groups were similar in that 2.98 and 0.94% of the initially isolated veins were reconnected, respectively, (P = 0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AFDosing group versus 78.57% in the Cryo-AFConventional group (P = 0.978).ConclusionA novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

Sık Hastane Başvurusu Ev içi Şiddetin Habercisi mi?

Amaç:Eş şiddeti toplumun her kesiminde değişik oranlarda görülmektedir ve orta-uzun vadede çok farklı sağlık sorunlarına neden olabilmektedir. Bu çalışmada, Adli Tıp Polikliniğine eşinden/partnerinden şiddet görme nedeniyle başvuran olguların son bir yıl içindeki hastane başvurularını değerlendirerek; şiddet mağdurlarının sağlık sorunlarını ortaya koymak ve şiddet ile ilişkisini belirlemek amaçlanmıştır. Yöntem: 01 Haziran 2014-31 Mayıs 2017 tarihleri arasında Muğla Sıtkı Koçman Üniversitesi Eğitim ve Araştırma Hastanesi Adli Tıp Polikliniğine eş/partner şiddeti nedeniyle başvuran olguların demografik verileri yanı sıra, hastanemiz hasta kayıt sisteminden; her bir olgunun adli tıp polikliniğine başvurusundan önceki son bir yılda diğer poliklinik/klinik başvuruları geriye doğru incelenmiştir. Bulgular:Belirtilen tarihlerde polikliniğimize başvuran toplam 3966 olgu arasından 198 olgu (%5) eşi tarafından fiziksel şiddete maruz kalmıştı. Olguların 177’si (%89.4) kadın, 21’i (%10.6) erkekti. Yaş ortalaması 35.2±10.5 (aralık 17-76) olup, en fazla olgu %37.4 oranıyla 30-39 yaş grubundaydı. Rapor talep eden birim 115 olgu ile en fazla savcılık adına polis merkezleri idi. Olguların son bir yıl içinde hastanemizin değişik birimlerine başvuru sayısının ortalaması 7.5 ± 8.5 bulundu. Olguların yıllık başvurusunda; tek bir poliklinikten 10 farklı polikliniğe kadar farklı başvuruları olabildiği, 1 ile 10 farklı semptom/yakınma ile başvurdukları tespit edildi. Yakınma ve semptomların en sık kas iskelet sistemi, gastrointestinal sistem ve psikiyatrik yakınma ve semptomlar olduğu görüldü. 39 yaş ve altındaki genç grubun başvuru sayısının istatistiksel olarak daha fazla olduğu görüldü. Tartışma ve Sonuç: Eş şiddetine maruz kalanların büyük çoğunluğunu kadınlar oluşturmaktadır. Şiddet mağdurlarının psikosomatik semptom ve yakınmalarla yıllık hastane başvuruları 10’un üzerinde olabilmektedir. 39 yaş ve altı olguların görece fazlalığı; şiddetin bedenselleştirilerek ifade edilmesi...

Where are we in cosmetics and esthetics practices in educational clinics in Turkey?

Objective: Cosmetic dermatology has recently gained importance with the recent increase in demand. The aim of this study is to identify cosmetic dermatology training in Turkey and to assess instructors' attitudes toward cosmetic dermatology training during residency and current cosmetic dermatology practices. Methods: This is a cross-sectional questionnaire study conducted with instructors to investigate the practice of cosmetics dermatology, the technical equipments, number of patients, and their ideas in the clinics that provide dermatology specialty education in Turkey. Results: At least one cosmetic procedure was found to be performed in 69% of the clinics that participated in the study (n = 55), and no cosmetic procedure was performed in 31% of the clinics. The mean number of application was 13.2 ± 12.3 weekly in the clinics that performed cosmetics procedure. The most common procedures were botulinum toxin injection with 63.6% (n = 35), chemical peeling with 60% (n = 33), and platelet-rich plasma with 60% (n = 33), respectively. The most common laser application was neodymium-doped yttrium aluminum garnet (28/55). The mean time spent for cosmetic procedures was 1–5 h weekly in the clinics which performed cosmetic procedures. Seventy-six percent (n = 42) of the participants felt inadequate for performing cosmetics procedures, and 95% (n = 52) reported that cosmetic dermatology education was required. Conclusions: Both theoretical and practical education must be given in educational clinics, and the infrastructure must be created, and the educational schedule must be standardized.

Trends in the Orthopaedic Surgery Fellowship Match 2013 to 2017.

Introduction:This study describes trends in the postgraduate orthopaedic surgery fellowship match from 2013 to 2017.Methods:We determined the numbers of applicants and positions in Adult Reconstruction/Oncology, Foot and Ankle, Pediatrics, Shoulder and Elbow, Spine, Sports Medicine, and Trauma. We also defined the odds of matching in each subspecialty. We determined the applicant's odds of matching in their first or second choice by year and specialty. We also determined the number of applications made by applicants in each subspecialty. Data were obtained from the San Francisco Match.Results:In 2017, Adult Reconstruction/Oncology was the most selective, with a 68% match rate in 2017, whereas Pediatric Orthopaedic Surgery had a 93% chance of matching. The odds of matching in one's first (14% to 41%) or second (8% to 16%) choice was low in the study period. The average range of applications made by applicants varied from 18 to 28 applications, depending on year and specialty. Sports applicants made significantly more mean number of applications than all specialties (range +5 to 9.8 applications; P < 7.59 × 10−7 to 0.011).Discussion:The numbers of positions and odds of matching in postgraduate orthopaedic surgery fellowships are variable by year and subspecialty. Applicants need to consider their entire match list carefully due to low odds of matching in their first or second choice. These trends are valuable to applicants and training programs when selecting the numbers of applications and interviews for a successful match.

Abstract QS60: The Plastic Surgery Prisoner’s Dilemma: The Relationship Between Applications and Match Rate

PURPOSE: Plastic surgery is one of the most competitive residency matches. The mean number of applications per applicant is correspondingly high, creating significant time and financial strains. With the increasing cost of the application process in time and money, limiting the number of applications per applicant may offer a potential solution. In this study we examine whether an increased number of applications confers a benefit to applicants. METHODS: The authors analyzed annual data from NRMP and ERAS for integrated plastic surgery programs between 2010 and 2017. The number of U.S. seniors that matched in each year, and the number of applicant U.S. seniors that year, was obtained from NRMP’s Main Residency Match Results and Data report and used to calculate the match rate for that year. The average number of applications per year reported by ERAS was used for our calculations. RESULTS: Presents a summary of our findings. The number of integrated Plastic Surgery programs has increased from 31 in 2010 to 73 in 2017. The average number of applications per US senior in 2017 was 58.36, which corresponds to 80% of programs. In 2010 the average number of applications was 22.75, or 73% of programs. Two programs went unfilled in 2017, one in 2016 and three in 2015. The number of positions offered has increased from 69 in 2010 to 159 in 2017. However, the number of applicant has increased at a slower rate from 168 in 2010 to 200 in 2017. Accordingly, there has been an increase in the match rate from 36% in 2010 to 74% in 2017. Overall, since 2010, there is a statistically significant correlation between the mean number of applications and the match rate (p=0.005). However, if the increased number of positions available each year is taken into account by using the percentage of programs applied to instead of the mean number of applications, there is no statistically significant relationship between percentage of programs applied to and match rate (p=0.78). CONCLUSIONS: Our study suggests that there is no benefit to students applying to a greater number of programs as the percentage of programs applied to does not correlate with a higher match rate. Additionally, even though integrated plastic surgery programs are extremely competitive there have been unfilled positions every year since 2015. This could be explained by the Prisoner’s Dilemma in Game theory. The economic theory that all parties are worse off when individuals act in their own self interest. In other words, while a student may increase their own chances by applying to as many programs as possible while other students do not, if every student applies to most programs, all students have a reduced chance of matching. F. Molina Burbano: None. A. Yao: None. J. Stock: None. P. Taub: None.

Smartphone use in Paediatric Practice: a national survey

Results: From a total of 78 randomly selected eligible participants, 75 (96%) paediatricians agreed to participate in the study. The majority of physicians reported that they owned a smartphone (n53, 71%) and the rest (n22, 29%) used a Symbian phone as their primary device. Of those who owned a smartphone, 40% (n21) reported using at least one app related to their clinical work. The mean number of applications used by these users was 3.5. The majority (44/53, 83%) responded that they did not use their smartphone as a tool for managing patient appointments, while 9 out of the 53 (17%) responded positively. Over 80% of participants used their smartphone to take or receive a picture or a video from their patients for professional purposes. Conclusion: This study found a high level of smartphone ownership and usage among medical Cypriot paediatricians, corroborating with previous literature for other specialties in other countries. Despite the benefits they offer, more rigorous validation practices regarding mobile medical apps need to be established to ensure they are used safely and appropriately.

Is Electroconvulsive Therapy Improving Executive Functions in Unipolar Depression Patients?

In an acute episode of unipolar depression, patients show lower performance on the tests which make substantial demands on executive functions. Several studies documented that the impairment sometimes remains even in remitted patient, partially due to the antidepressant side effects or ECT. The aim of the present study was to evaluate executive functions in subjects who underwent ECT for therapy-resistant depression. Methods A course of bilateral ECT (mean number of applications 8.8+/-3.2) was applied to 22 patients (age 46.3±9.8; males 45.8%;IQ 97.2±11.6) with baseline HAMD 28.5±3.6, DASS 95±15, MMSE 29.1±1,1, who were tested by Sockings of Cambridge (SOC) tests (Cambridge Automated Neuropsychological Test Battery)at baseline (T0), immediately after ECT (T1) and one month later (T2). ECT was delivered with a modern square-wave machine with EEG and ECG monitoring. Modified treatment was performed in all cases. Results The intensity of depressive symptoms (HAMD and DASS) was significantly reduced at T1 and T2in comparison to baseline (p Conclusion ECT reduced depression without impairing executive function. As it is less likely that improvement in mean thinking time on SOC is directly associated with ECT, we suggest that improved execution is rather due to the decreased individual sensitivity to negative feedback during performing the task.

Non-Operative Management of Pilonidal Sinuses Located Around Anus

Aim: Pilonidal disease is generally located at sacrococcygeal region whereas it is rarely located near anus. The aim of this study is to discuss the results of crystallized phenol application that we performed for patients with sinus pilonidalis located near anus with 95% success rate. Patients and Methods: Patients admitted between 2005 to 2011 with sinuses located in 2 cm range of anus or were primarily located up to 2 cm to the anal verge were enrolled in the study. Patients’ demographic features, Body Mass Index (BMI), family history, skin color, hair thickness, number of sinus openings, and the status of the sinus (acute vs. chronic) were recorded. Crystallized phenol was applied into the sinus. The pa tients were followed-up after recovery during the first 6 months and annually afterwards. Results: A total of 25 sinus pilonidalis cases located near anus were encountered. All patients were male; crystallized phenol application was per formed on all patients a total of 115 times. The mean number of applications was 5.6 (between 4 and 8 times). The mean recovery period was 74.5 days (range: 31 - 154) and the mean follow-up period was 36.16 months (range: 18 - 48). No surgical intervention was required. Conclusion: Sinus pilonidalis cases located in perianal region can be successfully treated with the crystallized phenol application which is a simple and inexpensive method, that can easily be performed in an outpatient setting.

Initial Results of Efficacy of Left Linear Ablation Using a Novel Simultaneous Multielectrode Ablation Catheter

Creating complete linear block with point-by-point ablation is challenging in the left atrium (LA). The purpose of this study was to evaluate the efficacy of LA linear ablation using a hexapolar linear multielectrode mapping/ablation catheter. Seventeen patients (age 57 ± 10, 14 male, 6 paroxysmal AF (PAF)) were studied and underwent linear ablation at the mitral isthmus (MI) and LA roof. Ablation was performed with 90 second, 60 °C applications of duty-cycled bipolar/unipolar radiofrequency in a 1:1 ratio simultaneously at all selected electrode pairs. The result could not be evaluated in 2 patients because AF persisted despite cardioversion. Roof line block was confirmed in 9 of 15 (60%) patients. The mean number of applications and the procedural time with and without block was 5.4 ± 2.4 and 4.5 ± 2.2 applications, and 15 ± 8 and 13 ± 7 minutes. MI block was confirmed in 4 of 15 (27%) patients. The mean number of RF applications with and without block was 5.3 ± 2.2 and 9.9 ± 4.4 applications, and the procedural time was 20 ± 9 and 27 ± 10 minutes, respectively. For patients with underlying persistent AF, power was lower than those with PAF but improved when ablation was performed in sinus rhythm. Char was observed in 2 cases; however, no procedure-related complications were observed. In our initial experience, a linear multielectrode catheter using duty-cycled bipolar and unipolar RF energy was inferior to conventional single point irrigated ablation in achieving LA linear block. However, successful linear block was obtained within a short period of time, when it was achieved.