Rate Of Placement Research Articles

Impact of Oropharyngeal Stimulation during Laryngeal Mask Insertion on Cardiovascular Response in adult patients. A Double-blind Clinical Trial Study.

Laryngeal mask airway (LMA) insertion has been found to reduce cardiovascular responses when compared to laryngoscopy and intubation. This research aimed to examine the impact of various techniques employed for LMA insertion on cardiovascular response. This randomized, double-blind clinical trial included 90 elective surgery candidates divided into three groups of 30. All patients underwent similar anesthesia. The LMA was inserted using the classical technique, 180° rotation technique, and face-to-face triple maneuver technique (FFTMT). The cardiovascular responses, the success rate of LMA placement, and other outcomes were documented and compared among the three methods. The study revealed that the blood pressure of patients 10 minutes after LMA insertion using the rotational technique was higher than the standard technique (p=0.019). The pulse rate in the third (p=0.044, p=0.024) and fifth minutes (p=0.028, p=0.048) following the insertion of LMA demonstrated higher values when utilizing the FFTMT than the standard and rotational technique groups, respectively. Moreover, the incidence of sore throat following surgery in the FTFTM group was slightly greater than that observed with the standard and rotation techniques (p=0.389 and p=0.688, respectively). The findings of the present investigation indicated that implementing the classic technique for LMA placement resulted in a more consistent blood pressure (BP) and pulse rate (PR) response than the 180° rotation and FFTMT. Furthermore, the classical method exhibited a marginally lower success rate in terms of LMA insertion than the alternative methods.

Impact of well placement and flow rate on production efficiency and stress field in the fractured geothermal reservoirs

AbstractGeothermal energy has gained wide attention as a renewable alternative for mitigating greenhouse gas emissions. The advancements in enhanced geothermal system technology have enabled the exploitation of previously inaccessible geothermal resources. However, the extraction of geothermal energy from deep reservoirs poses many challenges due to high‐temperature and high‐geostress conditions. These factors can significantly impact the surrounding rock and its fracture formation. A comprehensive understanding of the thermal–hydraulic–mechanical (THM) coupling effect is crucial to the safe and efficient exploitation of geothermal resources. This study presented a THM coupling numerical model for the geothermal reservoir of the Yangbajing geothermal system. This proposed model investigated the geothermal exploitation performance and the stress distribution within the reservoir under various combinations of geothermal wells and mass flow rates. The geothermal system performance was evaluated by the criteria of outlet temperature and geothermal productivity. The results indicate that the longer distance between wells can increase the outlet temperature of production wells and improve extraction efficiency in the short term. In contrast, the shorter distance between wells can reduce the heat exchange area and thus mitigate the impact on the reservoir stress. A larger mass flow rate is conducive to the production capacity enhancement of the geothermal system and, in turn causes a wider range of stress disturbance. These findings provide valuable insights into the optimization of geothermal energy extraction while considering reservoir safety and long‐term sustainability. This study deepens the understanding of the THM coupling effects in geothermal systems and provides an efficient and environmentally friendly strategy for a geothermal energy system.

Uncovering Risk Factors and Outcomes of Pulmonary Embolism in a Nationwide Cohort of Hospitalized Children.

The incidence of pulmonary embolism (PE) in hospitalized children has increased in recent years. This study sought to characterize factors and outcomes associated with PE using a national pediatric cohort. The Nationwide Readmissions Database was queried (2016-2018) for patients (<18years) with a diagnosis of PE. Index and prior hospitalizations (PHs) within 1year were analyzed. A binary logistic regression utilizing 37 covariates (demographics, procedures, comorbidities, etc.) was constructed to examine a primary outcome of in-hospital mortality. 3440 patients were identified (57% female) with the majority >12years old (77%). One-third had a known deep vein thrombosis (69% lower and 31% upper extremity). Nineteen percent underwent central venous catheter (CVC) placement. Twenty-one percent had a PH within 1year. Nine percent underwent an operation with the majority being cardiothoracic (5%). Overall mortality was 5%. Neurocranial surgery, cardiothoracic surgery, and CVC placement were associated with the highest odds of inpatient mortality after logistic regression. Pediatric patients with PE have a high rate of PHs, CVC placement, and inpatient operations, which may be associated with higher mortality. This information can be utilized to improve screening measures and clinical suspicion for PE in hospitalized children.

Establishment of Peripherally Inserted Central Catheter Line Clinic at a Tertiary Care Hospital: Review of First 100 Cases

Abstract Objectives: Peripherally inserted central catheter (PICC) lines are increasingly being used as a reliable central venous access in the management of patients on long-term intravenous medications. These are usually placed by different specialists; however, an intensivist-driven PICC line program with a dedicated clinic covering outpatient chemotherapy patients is an added avenue to our subspecialty. We share our experience of starting a PICC line clinic in our hospital and developing the team for insertion, maintenance, and troubleshooting of PICC lines, so to make this procedure smooth and complication free. Materials and Methods: We conducted a retrospective cross-sectional study of the first 100 consecutively placed PICC lines by intensivists at our hospital with our experience of starting a PICC line clinic. We analyze the success rates of PICC line placement under ultrasound guidance, also reporting complications encountered. Results: The initial 100 PICC lines placed in 92 patients during the 2-year study period having catheter days of 8674 days were analyzed. All the PICC lines were successfully placed (100%), the majority on chemotherapy patients (84%). A total of 39 complications were found in 16 patients, at a rate of 4.49/1000 catheter days; out of which only 2 (2%) cases had infection with septicemia. None of the 12 patients in the intensive care unit with catheter days of 164 days had any catheter-induced infection. Conclusions: Ultrasound-guided PICC line placement by an intensivist is a safe method in patients requiring prolonged intravenous medication. PICC line clinic increases awareness among such patients and makes the procedure with afterward care more standardized.

Twenty-five years of child welfare data in Ontario, Canada: Examining the response of child welfare to reports of children's exposure to intimate partner violence (IPV)

BackgroundIncreases in child welfare investigations involving children's exposure to intimate partner violence (IPV) in Ontario are likely the result of three factors: 1) changes to legislation, policy, and assessment instruments; 2) increased awareness of the risks of exposure to IPV for children, and 3) referrals from professionals (e.g., police). ObjectivesUsing data from 6 cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993, 1998, 2003, 2008, 2013, and 2018), this paper will examine the changes of the incidence rates of IPV exposure, providing important context for a type of investigation that is not well understood in Ontario. MethodsThe incidence of investigations where the primary concern of the investigating worker is IPV was derived and compared across OIS cycles. Investigation were compared across cycles using incidence counts. ResultsAfter the nearly 2-fold increase of investigations for all maltreatment types in Ontario between 1998 and 2003, IPV investigations are the only type that continue to increase. There is a growing gap between these investigations and substantiating child maltreatment. Rates of placement have not changed over time, remaining low. Rates of transfers and referrals have increased but not significantly. ConclusionsThe continued growth in the rate of child welfare investigations involving exposure to IPV as well as the overwhelming endorsement of substantiated exposure to IPV, while maintaining the same proportion of transfers to ongoing child welfare services and low placement rates, is a significant concern for Ontario.

Minimally invasive pyeloplasty versus open pyeloplasty for ureteropelvic junction obstruction in infants: a systematic review and meta-analysis.

To compare the perioperative outcomes and success rates of minimally invasive pyeloplasty (MIP), including laparoscopic and robotic-assisted laparoscopic pyeloplasty, with open pyeloplasty (OP) in infants. In September 2022, a systematic search of PubMed, EMBASE, and the Cochrane Library databases was undertaken. The systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with the study registered prospectively in the PROSPERO database (CRD42022359475). Eleven studies were included. Dichotomous and continuous variables were presented as odds ratios (OR) and standard mean differences (SMD), respectively, with their 95% confidence intervals (CI). Compared to OP, a longer operation time and shorter length of stay were associated with MIP (SMD: 0.96,95% CI: 0.30 to 1.62, p=0.004, and SMD: -1.12, 95% CI: -1.82 to -0.43, p=0.002, respectively). No significant differences were found between the MIP and OP in terms of overall postoperative complications (OR:0.84, 95% CI: 0.52 to 1.35, p=0.47), minor complications (OR: 0.76, 95% CI: 0.40 to 1.42, p=0.39), or major complications (OR: 1.10, 95% CI: 0.49 to 2.50, p=0.81). In addition, a lower stent placement rate was related to MIP (OR: 0.09, 95% CI: 0.02 to 0.47, p=0.004). There was no statistical difference for success rate between the MIP and OP (OR: 1.35, 95% CI: 0.59 to 3.07, p=0.47). Finally, the results of subgroup analysis were consistent with the above. Our meta-analysis demonstrates that MIP is a feasible and safe alternative to OP for infants, presenting comparable perioperative outcomes and similar success rates, albeit requiring longer operation times. However, it is essential to consider the limitations of our study, including the inclusion of studies with small sample sizes and the combination of both prospective and retrospective research designs.

Latin American children in Ontario child welfare: An examination of investigation disparities

Despite literature indicating that children and families of certain racial and ethnic backgrounds are more likely to experience child welfare involvement than white children and families, there is limited research on Latin American children’s child welfare involvement within the Canadian context. This study provides the first investigation of potential differences and disparities in child welfare involvement for Latin American children in Ontario, Canada, by conducting a secondary analysis of data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018). The OIS-2018 collected data on child protection investigations from investigating workers, including characteristics of the investigated child, their caregivers, and their household, as well as characteristics of the investigation and short-term investigative dispositions. Incidence rates and disparity indices were calculated, and descriptive and bivariate analyses compared investigations involving Latin American children to those involving white children across key characteristics. While comprising a relatively small proportion of the investigation population, Latin American children were more than twice as likely to be investigated as white children. Consistent with this investigation disparity, significant differences were also observed in rates of substantiation and placement in out-of-home care. Investigations involving Latin American families more frequently involved concerns about family violence and were more likely to be initiated by police, but they were less likely to involve concerns about child or caregiver risks. These findings underscore a need to focus on Latin American experiences in the child welfare system, their service trajectories, and practice and policy considerations that can adequately respond to this community’s unique needs.

Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Patients with Pancreatic Cancer.

Accurate delivery of stereotactic body radiotherapy (SBRT) to pancreatic tumors relies on successful EUS-guided placement of fiducial markers. The aim of this study is to report the technical feasibility and safety of EUS-guided fiducial placement and to evaluate the characteristics and technical benefit of SBRT in a cohort of patients with pancreatic cancer (PC). A retrospective chart review was performed for all (n = 82) PC patients referred for EUS-guided fiducial placement by a single endosonographer at a tertiary cancer center. Data regarding EUS-related technical details, SBRT characteristics, adverse events, and continuous visibility of fiducials were recorded and analyzed. Most patients included in the study had either locally advanced disease (32 patients, 39%) or borderline resectable disease (29 patients, 35%). Eighty-two PC patients underwent the placement of 230 fiducial markers under EUS guidance. The technical success rate of the fiducial placement was 98%. No immediate EUS-related adverse events were reported. The average time to the simulation CT after fiducial placement was 3.1 days. Of the 216 fiducial markers used for the SBRT delivery, 202 fiducial markers were visible on both the simulation CT and the cone beam CT scan. A median dose of 40cGY was given to all the patients in five fractions. Of these, 41% of the patients reported no SBRT-related toxicities during the follow-up. Fatigue and nausea were the most reported SBRT-related toxicities, which were seen in 35% of the patients post-SBRT. Our results demonstrate that EUS-guided fiducial placement is safe and effective in target volume delineation, facilitating SBRT delivery in PC patients. Further clinical trials are needed to determine the SBRT-related survival benefits in patients with pancreatic cancer.

Epidural Interlay Graft for Pituitary Surgery: A 4-Year Institutional Experience.

Objective Sellar repair techniques with varying complexity and effectiveness have been employed to reduce the incidence of postoperative cerebrospinal fluid (CSF) leaks following endoscopic transsphenoidal pituitary surgery. This study describes our institutional experience with a minimalistic, highly effective approach to sellar repair. Methods The authors performed a retrospective review of consecutive cases of transsphenoidal pituitary surgery performed at our institution. All included subjects underwent sellar repair with an epidural interlay graft. Relationships between patient and tumor characteristics, incidence of CSF leak, adjunct repair techniques, and endocrine outcomes were examined. Results Three hundred and thirty-four (334) cases were included. Intraoperative CSF leak was encountered in 116 cases (34.7%), and postoperative CSF leak occurred only once (0.3%) early in the series. Seventy intraoperative CSF leaks were successfully repaired with an epidural interlay alone, including 13 high-flow leaks. Our rate of fat graft use (1.2%), nasoseptal flap (3.0%), and lumbar drain placement (6.6%) in the second half of the series showed a significant decline compared with the first half, indicating increased reliance on the interlay graft over time. Our 65% functional macroadenoma remission rate compares favorably with large historical series. Conclusion Simple sellar repair using an epidural interlay graft is highly effective in preventing postoperative CSF leaks, including cases of high-flow intraoperative leaks. More complex repair techniques are reserved for select high-risk cases or those with inadequate sellar bony ledges. With this technique, there has been no postoperative CSF leak at our institution in over 300 consecutive transsphenoidal pituitary surgeries.

Abstract 13661: In-Hospital Outcomes, Rates of Development of Complete Heart Block and Rates of Pacemaker Placement in TAVR and SAVR Cases: A 5-year Nationwide Inpatient Sample Analysis

Introduction: Complete Heart Block (CHB) is a commonly observed post-procedural complication associated with Transcatheter aortic valve replacement (TAVR) and Surgical aortic valve replacement (SAVR). Since 2016, limited data exists on In-hospital outcomes of TAVR and SAVR cases and rates of development of CHB. Methods: National Inpatient Sample 2016-2020 was used to identify and group TAVR and SAVR cases using appropriate ICD codes. Logistic regression was used to compare baseline characteristics and in-hospital outcomes. Results: 590,615 patients underwent aortic valve replacement (AVR) from 2016-2020, of which 49.6% were TAVR and 50.4% were SAVR. The most common diagnosis for AVR in both groups was nonrheumatic trileaflet aortic stenosis (AS) (86.6% in TAVR group and 53.5% in SAVR group, p&lt;0.001). In TAVR cases, development of CHB was more common (8.9%-vs-7.2%, p=0.235) along with increased need for transvenous pacing (16.6%-vs-8.7%, p=0.010) and permanent pacemaker placement (9.4%-vs-6.4%, p&lt;0.001). An upward trend in CHB occurrence and pacemaker placement (PPM) was noted in the TAVR group as shown in Image 1. TAVR group was observed to have higher rates of acute myocardial infarction (MI) (14.5%-vs-12.8%, p=0.074). SAVR group had higher rates of cardiogenic shock (8.10%-vs-2.20, p&lt;0.001) and in-hospital mortality (3.6%-vs-1.30%, p=0.02). Conclusions: Over the past few years, CHB has been more commonly observed with TAVR as compared to SAVR, necessitating increasing use for PPM placement. Despite these trends, in-hospital mortality and complications are lower with TAVR procedure.

Abstract 15832: Racial Differences in the Utilization and Outcomes of Transcatheter Aortic Valve Replacement

Introduction: The use of transcatheter aortic valvular replacement (TAVR) improves outcomes in patients with aortic stenosis (AS). However, there is limited data describing racial disparities in TAVR use. Our aim was to evaluate outcomes according to racial groups and TAVR use in the national inpatient sample (NIS). Methods: We identified all patients undergoing TAVR between 2016 - 2020 from the NIS of the Health Care Utilization Project database. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians. Outcomes included TAVR utilization by ethnic group, mortality, respiratory failure rates, cardiogenic shock, cardiac arrest, and hospital length of stay (H-LOS). Multivariate analysis was performed adjusting for age, sex, cardiovascular comorbidities, and socioeconomic status. Results: From 296,740 patients who underwent TAVR, 89.5% were white, 4.24% were black, 4.9% were Hispanic, and 1.39% were Asian. Blacks had higher rates of CHF, chronic kidney disease, peripheral vascular disease, obesity, and anemia but lower rates of myocardial infarction, CABG, pacemaker placement and PCI. Hispanic patients showed higher rates of AKI, while Asian patients had higher rates of DM. Blacks had lower adjusted mortality rates compared to whites (aOR: 0.56; CI 0.35 - 0.88 p=0.014). Respiratory failure rates (aOR: 0.82; CI 0.68 - 0.98, p=0.031) and H-LOS (5.2 days vs 3.7 days) were higher in black patients. Whites had a steeper increase in TAVR use compared to other groups during the study period. Patients with AS undergoing TAVR had significant lower adjusted mortality (aOR: 0.95; CI 0.92 - 0.98 p=0.005). Conclusion: White patients are most likely to receive TAVR compared to other ethnic groups. Such differences in TAVR utilization by ethnic group should be studied further to decrease healthcare disparities

Abstract 15223: Clinical and Economic Impact of Patient Loss-to-Follow-Up After Short-Term Cardiac Monitor Usage in Cryptogenic Stroke

Introduction: Short-term cardiac monitors (STMs) are increasingly used in the work-up of cryptogenic stroke patients before proceeding to long-term continuous monitoring for atrial fibrillation (AF) with insertable cardiac monitors (ICM). However, the rate of ICM placement after STM is only 4-5% based on large real-world studies. The impact of patient fall-out after STM on clinical/economic outcomes is unknown. Research Question: The objective of this analysis was to project the risk of additional ischemic strokes and stroke-related costs with varying rates of patient loss to follow-up (LTFU) after 48-hour, 14-day or 30-day monitors, compared to an approach of continuous ICM monitoring post-stroke. Methods: A previously published Markov model based on the CRYSTAL-AF trial was utilized to project lifetime ischemic strokes after various monitoring strategies, from a US payer perspective. Patient characteristics and AF detection rates were based on CRYSTAL-AF: diagnostic yield with the initial STMs were 0.8% for 48-hr, 3.1% for 14-day and 6.8% for 30-day monitors. AF detection resulted in a change from aspirin to DOAC, with subsequent risks of ischemic strokes and associated costs (including acute + post-acute care) modeled based on published literature. Results: Increasing rates of patient LTFU after STM were associated with higher projected additional secondary strokes compared to an immediate ICM approach, across all 3 STM types (figure). In the scenario based on real-world data (95% LTFU), a range of 62-68 additional strokes are projected per 1,000 patients, with associated stroke costs of $4,928-$5,449/patient when averaged across the population. Conclusions: Loss of patient follow-up after STM in real-world CS patients is projected to lead to substantial secondary stroke burden due to undetected AF, compared to continuous monitoring with ICM. Future work could focus on optimizing stroke pathways to ensure timely and continued access to monitoring.

Abstract 17466: Impact of the Covid-19 Pandemic on Pediatric Cholesterol Screening Rates

Introduction: Universal cholesterol screening during childhood has been recommended by the American Academy of Pediatrics since 2011, but most children remain unscreened. We hypothesized that the COVID-19 pandemic and subsequent disruptions in routine healthcare impacted pediatric cholesterol screening rates and may have disproportionately affected children based on race, ethnicity, socioeconomic status (SES), or rural/urban status. Hypothesis: The COVID-19 pandemic impacted pediatric lipid screening rates based on race, ethnicity, SES, and rural/urban status. Methods: The provider order placement rate (OPR) for a screening cholesterol panel was calculated for established patients 9-21 years old at a single institution pre-pandemic (3/18/2019-3/17/2020), mid-pandemic (3/18/2020-3/17/2021), late-pandemic (3/18/2021-3/17/2022), and post-pandemic (3/18/2022-12/31/2022). OPR was analyzed, including a chi-squared test, based on race, ethnicity, SES, rural/urban status, and the department of the visit. Results: Overall OPR fell over time and in both pediatric and family medicine specialties. There was a decrease in OPR across all race and ethnicity groups, though most did not reach statistical significance. Urban advantaged, urban, and rural underserved had a disproportionately larger decrease in OPR, though all groups had a lower OPR at the end of the study. Conclusions: The OPR decrease in late- and post-pandemic stages may be due to the pandemic. Though OPR differences existed between some rural/urban statuses and the ordering department pre-pandemic, these factors may have worsened these gaps. Future studies are needed to identify and address barriers to pediatric cholesterol screening.

Effect of proppant distribution in hydraulic fractures on coalbed methane extraction

Fracturing with proppants is often used to improve the permeability of coalbed methane (CBM) reservoir. The fracture is easy to close under the closure stress and the proppant distribution in fractures greatly influences the extraction efficiency of CBM. The past research mainly considered the impact of fracturing damage on the coalbed methane extraction but rarely investigated the influence of the proppant distribution forms on CBM extraction. Therefore, based on the theory of dual-porous media, this paper establishes a theoretical model of CBM extraction with different proppant distribution forms, which considers the proppant compaction, embedment, and fracture aperture change. The model is implemented numerically and is validated against field results of CBM production. The research results show that the extraction efficiency of CBM from high to low is the pulse proppant injection, continuous proppant injection, no proppant injection, no fracturing. The continuous proppant injection should ensure that the proppant placement rate is more than 60 %. The CBM extraction efficiency is the highest when the proppant column length is 0.2 m–0.3 m and the void area length is 0.5 m. The research results provide a theoretical basis for improving the extraction efficiency of coalbed methane using fracturing with sand injection.

A radiological analysis of pelvic fixation trajectories: patient series.

Three well-defined methods for pelvic fixation are used for biomechanical support in spine fusion constructs: iliac, recessed iliac, and S2-alar-iliac (S2AI) screws. The authors compared the maximum screw sizes that could be placed with these techniques by using image-guidance software and high-resolution computed tomography scans from 20 randomly selected patients. Six trajectories were plotted per side, beginning at recognized starting points (standard or recessed posterior superior iliac spine [PSIS] or S2AI screw) and ending at the anterior inferior iliac spine (AIIS) or supra-acetabular notch (SAN). The mean maximum screw length and width ranged from 80.0 ± 32.2 mm to 140.8 ± 22.6 mm and from 8.25 ± 1.2 mm to 13.0 ± 2.7 mm, respectively, depending on the trajectory. Statistically significant differences in length were found between the standard and recessed PSIS trajectories to the AIIS (p < 0.001) and between the standard PSIS-to-AIIS trajectory and the S2AI-to-AIIS (p = 0.007) or S2AI-to-SAN (p < 0.001) trajectories. The most successful trajectory was the PSIS to SAN (95%, 38/40). The traditional iliac screw trajectory enabled the longest and widest screw trajectories and highest rate of successful screw placement with the fewest theoretical breaches more reliably than recessed and S2AI trajectories. These findings may help surgeons plan for maximum screw purchase for pelvic fixation.

How often is prophylactic parastomal mesh placement performed after rectal resection without sphincter preservation? An analysis of German nationwide hospital discharge data among 41,697 patients

PurposeThe European Hernia Society guidelines of parastomal hernias, published in 2017, strongly recommend prophylactic synthetic non-absorbable mesh upon the construction of a permanent end colostomy to reduce the incidence of parastomal hernias. This study aims to evaluate the implementation of the guidelines in Germany.MethodsThis is a retrospective multicentric analysis conducted in December 2022 at the University Hospital Brandenburg an der Havel. Anonymous data on rectal resection without sphincter preservation in the period 2010–2020 were extracted from the German nationwide hospital discharge data set. Individuals with a hernia and < 18 years old were excluded. Another exclusion criterion was a performed colectomy or proctocolectomy with an ileoanal pouch and placement of an absorbable mesh. The primary endpoint was the annual rate of prophylactic parastomal mesh placement following rectal resection without sphincter preservation in Germany. Cases reporting both non-absorbable mesh placement and rectal resection without sphincter preservation were considered prophylactic mesh insertions.ResultsA total of 41,697 patients received a rectal resection without sphincter preservation and without non-absorbable mesh placement. Among these individuals, 27,089 were male and 14,608 were female. The rate of reoperations (3.1%) and the length of hospital stay (25.3 days ± 19.32) remained almost constant during these 10 years. The rate of prophylactic mesh placement was increasing from 0.2% (n = 8) in 2010 to 6.4% (n = 198) in 2020.ConclusionsCurrently, only the minority of patients who have undergone rectal resection without sphincter preservation receive prophylactic mesh insertion.

Tricuspid surgery at time of mitral surgery improves survival free from severe tricuspid regurgitation but not quality of life

ObjectiveThe choice to operate on moderate tricuspid regurgitation (TR) during mitral surgery is challenging owing to limited mid-term data. We assess whether concomitant tricuspid operations improve mid-term quality of life, morbidity, or mortality. MethodsAn institutional database identified mitral surgery recipients with moderate TR at the time of surgery from 2010 to 2019. Patients were stratified by the presence of a concomitant tricuspid operation. Quality of life at the last follow-up was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Morbidity was compared using the χ2 test, Mann-Whitney U test, and Student t test. Survival was analyzed with Kaplan-Meier estimation. ResultsOf 210 mitral surgery recipients, 67 (31.9%) underwent concomitant tricuspid surgery. The concomitant tricuspid surgery cohort had greater preoperative dialysis use (10.5% vs 3.5%; P = .043) but similar age, New York Heart Association class, and cardiac surgery history relative to the nonconcomitant cohort (P > .05 for all). The concomitant tricuspid surgery cohort had a longer cardiopulmonary bypass time (144 minutes vs 122 minutes; P = .005) but a similar rate of mitral repair (P = .220). Postoperative KCCQ-12 scores reflected high quality of life in both cohorts (95.1 vs 89.1; P = .167). The concomitant tricuspid surgery cohort trended toward a higher perioperative pacemaker placement rate (22.8% vs 12.7%; P = .088) but were less likely to develop severe TR (0.0% vs 13.0%; P = .004). Overall survival was comparable between the 2 cohorts at 1 year (84.9% vs 81.6%; P = .628) and 5 years (73.5% vs 57.9%; P = .078). Five-year survival free from severe TR was higher in the concomitant cohort (73.5% vs 54.3%; P = .032). ConclusionsConcomitant tricuspid surgery for moderate TR is associated with increased 5-year survival free from severe TR but not with increased quality of life.

A time-bounded approach for reducing runtime of well placement optimization using PSO and PSOGA algorithms

Determining the optimal drilling locations and well production/injection rates is a highly complex decision in reservoir development. The present study aims to optimize well placement and production/injection rates through the application of intelligent search algorithms. The Particle Swarm Optimization (PSO) and combined Particle Swarm Optimization-Genetic Algorithm (PSOGA) have been chosen as the optimal means to achieve this objective. The Net Present Value (NPV) of the project serves as the objective function, with decision variables including the location of wells, perforation, and flow rates. To evaluate the performance of the algorithms in optimizing well placement and flow rates, a heterogeneous reservoir model has been used. In order to reduce optimization runtime, a novel method has been presented. This method involves changing the termination condition, such that the entire optimization time is considered rather than the maximum iterations. The population size can be added to enhance algorithm convergence. Thus, modified algorithms, namely TPSO and TPSO-GA, have been introduced. The results of determining the termination condition on the TPSO-GA algorithm are quite promising. By setting a 24-h termination condition or a 70% reduction in the basic runtime, and with a population size of 30 agents, the same values of the objective function can be obtained. Furthermore, the impact of two parameters within the objective function, namely the oil price and discount rate, has also been explored.

Metal ureteral stents for ureteral stricture: 2 years of experience with 246 cases.

Metal ureteral stents (MUS) has gained popularity as an endoscopic treatment alternative for the management of ureteral strictures. The aim of this study was to evaluate the safety, efficacy, and tolerability of MUS for treating ureteral strictures and to identify any factors that could influence the success of this intervention. This study is a prospective analysis of the efficacy and safety of MUS for treating ureteral strictures in a single-center setting. The study enrolled 246 patients who had been diagnosed with ureteral strictures and had undergone MUS placement between January 2019 and July 2021. The patients were followed up for a duration of 2 years. The overall success rate of MUS placement was 71.7%. Furthermore, the success rate of ureteral strictures after kidney transplantation (78.2%) was significantly higher than common ureteral strictures (73.0%) or recurrent ureteral strictures (67.6%). Additionally, post-surgery, there was a considerable reduction in hydronephrosis volume (68.9±96.1 vs. 32.1±48.8cm3), blood creatinine level (103.7±49.8 vs. 94.4±47.5mol/L) and urea nitrogen level (6.7±7.2 vs. 5.1±2.4mmol/L). The study also reported that the rate of adverse events associated with MUS was relatively low, included hematuria (7.9%), pain (6.8%), urinary tract infection (6.4%) and lower urinary tract symptoms (5.3%). MUS appear to be a safe and effective treatment option for ureteral strictures, with a high success rate and low complication rate. These results have important implications for the management of ureteral strictures and can help guide clinical decision-making in the selection of treatment options.

Electromagnetically Navigated Tube Placement Device for Bedside Placement of Small Bowel Feeding Tube on Patients with Acute Severe Pancreatitis: Comparative Study.

A developing approach for the bedside installation of feeding tubes is the Electromagnetic Navigation-assisted Tube Placement Device (ENTPD). The ENTPD monitors the tip position of feeding tubes when they are inserted into the digestive tract. It aids in the avoidance of airway misalignment and allows placing into the small bowel. Several recent exploratory studies have shown that ENTPD for nasojejunal feeding tube installation can improve success rates, lower costs, and allow for a more rapid beginning of enteral nutrition. The aim of this study was to compare the effect of using an ENTPD for bedside placement of small bowel feeding tubes with blind placement on patients with acute severe pancreatitis and to see how well the electromagnetic navigation trajectory image (ENTI) and X-ray agreed on the location of the tube tip after placement. The study was done prospectively using randomized and single-blind methods. The 65 cases used electromagnetic navigation-assisted placement, and 58 cases were blind placement. For judging the tube tip location, we compared the success rate, median time, number of repeat placements, complications, and agreement of ENTI vs. X-ray. The blind placement group's success rate was 86.21% compared to the ENTPD's 95.38%, P = 0.075. The median time was significantly longer in the blind placement group (116.55 ± 68.62 min vs. 25.37 ±12.63 min, P=0.000); the average number of repeating placements was 3.02 ± 1.21 vs. 1.16 ± 0.31 (Blind placement vs. ENTPD, P = 0.002). It provided a high degree of agreement between ENTI and X-ray after contrast, κ=0.752 [95% confidence interval, 0.67-0.84]. No complications occurred in the two groups. ENTPD was used safely and effectively at the bedside to help patients with acute severe pancreatitis get feeding tubes. It not only improved the high successful rate of placement, decreased the time and reduced the exposure to X-ray, but it was also very convenient for bedside placement because of the portable equipment.