Predictive Factors For Success Research Articles

Efficacy of gastric per-oral endoscopic myotomy remains similar after failure of interventional techniques in refractory gastroparesis

Background and aimsGastric per-oral endoscopic myotomy (G-POEM) is a new therapeutic option for the treatment of refractory gastroparesis. However, the outcome of G-POEM after the failure of gastric electrical stimulation (GES) or other pylorus-targeting therapies has been poorly reported. MethodsData were collected from patients referred for G-POEM for refractory gastroparesis. The efficacy in patients with previous interventional techniques was compared to patients naïve to instrumental technique. The primary endpoint was the 6-month clinical success rate, defined as at least a 1-point decrease in the Gastroparesis Cardinal Symptom Index (GCSI). ResultsAmong 48 patients referred for G-POEM, 32 patients had had previous instrumental treatments (66%): 15 (31%) had had GES, and 17 (35%) had had pyloric endoscopic dilation or toxin injection. The technical success rate was 100%. At 6 months, clinical success was achieved in 25/48 patients (52%) and the GCSI decreased from 3.38 (2.94–3.95) to 2.25 (1.11–3.36) (p < 0.001). The 6-month success rate was similar in patients with or without previous instrumental treatment (50.0% vs 56.3%; p = 0.41). The complication rate was also similar in the two groups (6.3% vs 12.5%; p = 0.59), with only one severe adverse event. The only predictive factor for success at 6 months was a higher body mass index (OR = 1.14 [1.01–1.32]; p = 0.05). ConclusionG-POEM is safe and remains effective after GES or previous pyloric treatment failure, with 50% efficacy at 6 months. The therapeutic strategy in refractory gastroparesis remains to be defined.

Predicting thyroid cancer ablation success: Pre-ablative 99mTc-Pertechnetate and post-ablative 131I scan comparison

IntroductionThe purpose of this study was to evaluate the relationship between pre-ablative 99mTc-pertechnetate scintigraphy, and therapeutic iodine-131 (131I) whole-body scan (TxWBS), with ablation status and to investigate the possible predictive factors for successful ablation in differentiated thyroid carcinoma (DTC) patients. Materials and methodsA total of 330 DTC patients underwent 99mTc-pertechnetate scintigraphy after thyroidectomy. Uptake values were determined using the region-of-interest technique. All patients had neck ultrasonography and TxWBS. Both scintigraphic scans were interpreted visually and qualitatively. The ablation status was evaluated with a diagnostic 131I whole-body scan. ResultsThe success rate for residual thyroid ablation was 88.8%. The sensitivity, specificity, accuracy, PPV, and NPV of 99mTc-Pertechnetate scintigraphy were 82.4%, 87.5%, 82.7%, 99.2%, and 20.2%, respectively. Pre-ablative TG values and 99mTc uptake (%) were significantly lower in successfully ablated patients. The 99mTc uptake was determined as a significant predictive factor for ablation success (P=0.000). The optimal 99mTc uptake cut-off value of 0.75% was demonstrated for successful ablation. There were significant positive correlations between the visual and the calculated uptake (%) of residual tissues on both scintigraphic scans, Considering the number of remnant tissue foci, significant positive correlations were found between 99mTc-Pertechnetate scintigraphy, TxWBS, and USG. ConclusionPre-ablative 99mTc-Pertechnetate uptake (%) value of the remnant tissue can predict the ablation status in DTC patients. 99mTc-Pertechnetate scintigraphy, which is an easily applicable and accessible imaging method, has maintained its place in the postoperative and pre-ablative period in DTC patients over the years and has not lost any of its value.

Predictive factors for success of radioactive iodine treatment in graves' disease

Predictive factors for success of radioactive iodine treatment in graves' disease

Trial and error − Outcome of breech presentation depending on birth mode and root cause analysis of severe adverse events

ObjectivesThe debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management.Study design: We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB. ResultsOf 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003). ConclusionThe failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth.

Impact of hospital internships on success in university summative objective structured clinical examinations: Large-scale experience in a French medical school.

Objective structured clinical examinations (OSCEs) are extensively used in many medical schools worldwide with the stated objective to assess students' clinical skills acquired during internships. The objective of the present study was to assess the factors associated with success in university summative OSCEs, especially the impact of previous hospital internships in corresponding disciplines and supervision during internships. This was a cross-sectional study assessing the results in the summative OSCEs of 4th year medical students during the 2021-2022 academic year in a French medical school. The summative OSCEs included five stations for each student. Each student answered a survey at the end of summative OSCEs about previous internships, the supervision they had and perceived difficulty levels for each station. The scores in each station were assessed according to previous hospital internships in the corresponding discipline. Analysis of predictive factors of success in OSCEs, defined by a score ≥ 10/20 at each station, were performed using univariate and multivariate logistic regression. Out of the 220 students participating in the summative OSCEs, 182 (83%) answered the survey. One hundred and forty-four (79%) of these students had carried out hospital internships in at least one of the disciplines evaluated during the OSCEs. Students having completed an internship in the corresponding discipline had significantly higher OSCEs scores for interrogation, communication, therapeutic education and procedure stations compared to those who had not. Previous internship in corresponding disciplines was independently associated with success in OSCEs in interrogation (OR 9.45 [1.34-66.8] p = 0.02), clinical examination (OR 6.93 [1.88-25.57] p = 0.004, and therapeutic education (OR 3.09 [1.22-7.82] p = 0.02) stations. Previous hospital internships in the discipline evaluated by the OSCEs are associated with success in summative OSCEs. This reinforces the importance of student involvement during their hospital internships.

Success predictive factors of teeth subjected to autotransplant: An umbrella review

Abstract Introduction: A dental autotransplant is a controlled case of dental avulsion based on the transplantation of erupted teeth within the same individual, from one place to another, in sites where an extraction was performed or that were surgically prepared. Autotransplantation has become a viable method to replace lost teeth since transplanted teeth may operate as fully normal teeth. Objective: The objective of this study was to summarize the available scientific evidence regarding predictors of success in autotransplanted teeth. Materials and Methods: A systematic review of systematic reviews, known as an umbrella review, was performed. Two calibrated and standardized investigators independently analyzed the quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and evaluated the confidence level and bias review with the Amstar-2 guideline. The PubMed, Embase, and Scopus databases were used. The search was conducted in August 2022 and updated on March 22, 2023. Systematic reviews or meta-analyses carried out from publications on human beings, between 2017 and 2022, were included. Results: From 104 achieved, 4 systematic reviews and meta-analyses were assessed. The overall survival of autotransplanted teeth ranged from 81% to 98%, the prevalence of overall inflammatory root resorption ranged from 2.1% to 43%, and the prevalence of ankylosis ranged from 1.2% to 43%. Predictive factors for success identified in the literature included tooth type or root development and clinical intervention factors, including socket preparation, splinting, occlusion control, antibiotic regimen, treatment time of endodontics, and orthodontic treatment. Conclusions: The existing evidence on autotransplanted teeth in humans indicates that the survival rate of such teeth involves a series of presurgical and surgical variables. Analyses of factors associated with complications or failures still require primary studies where associations may be made to draw more solid conclusions.

Clinicopathological factors associated with sentinel lymph node detection in non-small-cell lung cancer

BackgroundMapping of the pulmonary lymphatic system by near-infrared (NIR) fluorescence imaging might not always identify the first lymph node relay. The aim of this study was to determine the clinicopathologic factors allowing the identification of sentinel lymph nodes (SLNs) by NIR fluorescence imaging in thoracic surgery for non-small-cell lung cancer (NSCLC).MethodsWe conducted a retrospective review of 92 patients treated for suspected or confirmed cN0 lung cancer with curative intent who underwent an intraoperative injection of indocyanine green (ICG) either by direct peritumoral injection or by endobronchial injection using electromagnetic navigational bronchoscopy (ENB). After exclusion of patients for technical failure, benign disease and metastasis, we analyzed the clinicopathologic findings of 65 patients treated for localized-stage NSCLC, comparing the group with identification of SLNs (SLN-positive group) with the group without identification of SLNs (SLN-negative group).ResultsForty-eight patients (73.8%) were SLN-positive. Patients with SLN positivity were more frequently female (50%) than the SLN-negative patients were (11.8%) (p = 0.006). The mean value of diffusing capacity for carbon monoxide (DLCO) was lower among the patients in the SLN-negative group (64.7% ± 16.7%) than the SLN-positive group (77.6% ± 17.2%, p < 0.01). The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FCV) was higher in the SLN-positive group (69.0% vs. 60.8%, p = 0.02). Patients who were SLN-negative were characterized by a severe degree of emphysema (p = 0.003). There was no significant difference in pathologic characteristics. On univariate analyses, age, female sex, DLCO, FEV1/FVC, degree of emphysema, and tumor size were significantly associated with SLN detection. On multivariate analysis, DLCO > 75% (HR = 4.92, 95% CI: 1.27–24.7; p = 0.03) and female sex (HR = 5.55, 95% CI: 1.25–39.33; p = 0.04) were independently associated with SLN detection.ConclusionsAt a time of resurgence in the use of the sentinel lymph node mapping technique in the field of thoracic surgery, this study enabled us to identify, using multivariate analysis, two predictive factors for success: DLCO > 75% and female sex. Larger datasets are needed to confirm our results.

Predictive factors of success in the first radioactive iodine treatment for Graves’ disease

Predictive factors of success in the first radioactive iodine treatment for Graves’ disease

Can we predict whether a man with acute or chronic urinary retention will void after bladder outflow resistance reduction surgery? ICI-RS 2023.

To address the predictive factors of a successful voiding after bladder outflow resistance reduction surgery (BORRS) in men presenting with acute or chronic urinary retention (UR). A think tank (TT) of ICI-RS was gathered in 2023, Bristol, UK, to discuss several aspects of the problem, such as the pathophysiology of UR, the clinical and urodynamic evaluation of men with UR and whether it is possible to predict which men will be able to successfully void after treatment with contemporary surgical options. The TT agreed that successful voiding after BORRS depends on several factors but that a strong recommendation cannot be made regarding preoperative evaluation and whether there are predictive factors of success because of the heterogeneity of patients and methodology in published trials. The diagnosis of obstruction in men with UR may be challenging when there is apparent reduced detrusor contraction during urodynamic studies. Even in the absence of bladder contractility there is documentation of such cases that have voided adequately after BORRS. Still, detrusor underactivity and inadequate relief of prostatic obstruction are the main causes of an unsuccessful voiding after BORRS. Conventional resection and enucleation methods remain the most successful surgeries in relieving UR in men, whereas the efficacy of minimally invasive surgical treatments needs to be assessed further. Research is needed to understand the pathophysiology of UR and the predictors of successful voiding after different types of BORRS in men with UR.

Retrospective cohort study comparing success of medical management of early pregnancy loss in pregnancies conceived with and without medical assistance

To compare the success rates of medical management using a combined mifepristone and misoprostol protocol in cases of early pregnancy loss (EPL) between women who conceived without medical assistance and those who conceived through invitro fertilization (IVF), after fresh or frozen embryo transfer, and evaluate for the predictive factors of success, time to first passage of tissue, and time to complete resolution of pregnancy. Retrospective cohort study. University hospital. Women who presented with EPL below 13 weeks of gestation between June 2013 and July 2021 who were managed medically with mifepristone 200 mg orally and misoprostol 800 mcg vaginally were included in the study. Medical management with mifepristone and misoprostol; conception without medical assistance vs. post-IVF, after fresh or frozen embryo transfer. We evaluated overall success and performed subgroup analysis according to the mode of conception and compared fresh vs. frozen-thawed embryo transfers for IVF pregnancies. In all groups, we also calculated success according to gestational age and compared the time to first passage of tissue. The potential predictive factors of treatment success were analyzed. The side effects and complications of treatment were recorded. A total of 930 women were included in the study, 99 (11%) of whom achieved pregnancy after IVF. The overall success of medical treatment was 89% with no statistically significant difference according to the mode of conception (89% vs. 89%) or type of transfer (fresh 89% vs. frozen 89%). Only lower gestational age by sonography was independently predictive of treatment success, showing a negative regression coefficient of β = -0.333 and an odds ratio of 0.717. The mean time to first passage of tissue was 5.0 ± 2.1 hours. Altogether, 666 women (72%) showed pregnancy resolution on the day of medication administration, an additional 110 women at 1-week follow-up, and a further 74 women after ≥4 weeks on ultrasound. Medical management of EPL with mifepristone and misoprostol is a highly successful treatment option that results in completed abortion in a timely fashion in both pregnancies conceived without medical assistance and those conceived after IVF.

Factors Influencing the Successful Treatment of Recurrent Trigger Finger With Repeated Corticosteroid Injections: A Prospective Cohort Study

The aim of this study was to determine the success rate, duration of disease control, and predictive factors of success of repeated corticosteroid injections for recurrent trigger finger. This prospective cohort study involved patients who had recurrent trigger finger and a history of corticosteroid injections. A total 114 patients were treated with repeated corticosteroid injections and followed for 12 months. Data on demographic characteristics, comorbid conditions, and possible predictive factors for successful treatment from medical chart reviews and direct patient interviews were compared. Patients were classified into success or failure groups at one, three, six, and 12 months after the initial injection. The relationship between hypothesized predictors and success or failure after repeated corticosteroid injection was analyzed with multivariable logistic regression. The overall success rates from repeated cortisone injections after one, three, six, and 12 months were 97.4%, 84.2%, 68.4%, and 49.1%, respectively. Multivariable logistic regression modeling revealed that a high grade of disease (grade III or IV based on the Quinnell system), a body mass index (BMI) ≥ 25 kg/m2, and a short symptom-free period (< six months) after a previous injection were strong predictors of symptom recurrence (odds ratio= 3.6 [95% CI 1.5-8.4], odds ratio= 2.5 [95% CI 1.1-5.9], and odds ratio= 1.8 [95% CI 1.1-3.0], respectively). The average success rates for patients at 1-year according to the number of risk factors were as follows: none of the three risk factors, 73.3%; one risk factor, 54.2% to 63.6% (54.2% for grade III-IV triggering, 63.6% for BMI ≥ 25 kg/m2 and 63.6% for < 6-month symptom-free period); two risk factors, 30% to 75% (30% for a combination of grade III-IV and BMI ≥ 25 kg/m2, 45.5% with grade II-IV and < 6-month period, and 75% with a combination of < 6-month period and BMI ≥ 25 kg/m2); and all three risk factors, 11.8%. Repeated corticosteroid injections for recurrent trigger finger should be considered in patients who prefer nonsurgical treatment, especially in those without factors predictive of failure. Prognostic II.

Office endometrial sampling: effectiveness and predictive factors of success in Novak versus Endosampler devices.

The study aimed to evaluate the rate of endometrial sampling (ES) failure, predictive factors of success, and reliability as diagnostic methods of Endosampler versus Novak. A retrospective single-center study was carried out with all patients who underwent ES via Endosampler or Novak in 2020 and 2021. Demographic data, personal background, and histopathologic results were evaluated. Eighty-six patients underwent ES by Novak and 90 by Endosampler. The failure rate of ES was 43.2% with lower values for Endosampler (33.3% vs. 53.5%, P<0.05). Age, biopsy device, menopausal status, indication for biopsy, and amount of sample collected were predictive factors of failure. Analyzing each device, Endosampler was only affected by menopausal status. Only 50% in Novak and 62.5% in the Endosampler group of endometrial neoplasia cases were detected by these methods. Analyzing the performance for endometrial neoplasia (EN), we obtained higher values of sensitivity and accuracy for Endosampler (62.5% vs. 50.0% and 83.3% vs. 72.7%), respectively. In our study, the failure rate obtained was in line with other previous studies. Menopausal status, age, type of biopsy device, indication for biopsy, and amount of sample collected affected ES performance. Analyzing diagnostic performance for EN, we found that these methods have better reliability for positive results than for negative ones, which may indicate the need for further evaluation in cases of high clinical suspicion. In short, we obtain a higher rate of success rate in Endosampler devices and better performance in diagnosing EN, which is the major objective of an ES.

Predictive factors of success and failure for intravenous ketamine therapy in patients suffering from chronic neuropathic pain.

Intravenous (IV) ketamine is used for chronic neuropathic pain refractory to other treatments. Administration of such a medication requires high-cost services while the result is not always satisfactory with a significant percentage of failure. Success and failure are related to some factors. In this study, we aim to point the most responsive disease category to IV ketamine and the predictive factors for successful and failed treatment. Two hundred and sixty-nine patients out of 371 were included. Demographic, clinical, and therapy-related variables were retrospectively collected and then statistically analyzed using various descriptive and inferential methods. A few descriptive statistics are obtained for the variables depending on their nature (e.g., percentages for qualitative variables and means for quantitative variables). Furthermore, several inferential methods are considered to address some statistical points of interest, including, but not limited to, odds ratio interpretations via logistic regression as well as association and correlation analyses. A significant association was found between the presence of intermittent pain pattern as well as the pain of chronic primary category and favorable response to IV ketamine while the history of previous analgesic interventions was significantly associated with a negative response. The identified factors can be used to prospectively study the efficacy of ketamine using selection criteria based on the observed results in our study to re-evaluate the percentage of responsiveness according to these new parameters.

P-411 Cumulative live-birth rate after oocyte vitrification for fertility preservation (FP) in oncologic or benign conditions: a retrospective comparative monocentric study

Abstract Study question Does cumulative livebirth-rate (CLBR) after reutilization of vitrified oocytes differ between patients having undergone fertility preservation (FP) for oncologic (onco-FP) reason or benign conditions (benign-FP)? Summary answer Although CLBR per woman was lower in the onco-FP group, there was no statistically significant association in multivariate analysis between onco-FP and CLBR. What is known already Recent ESHRE guidelines reported oocyte vitrification after controlled ovarian hyperstimulation (COH) as an established option for FP. Although age at the time of oocyte vitrification remains the main predictive factor of success, several lines of evidence suggest that the use of COH or in vitro maturation (IVM), as well as the indication of FP, in particular the type of disease, may influence outcomes after devitrification. The present investigation aimed at clarifying this issue. Study design, size, duration Observational comparative, monocentric retrospective study including all patients having reused, between January 2014 and December 2021, their oocytes vitrified for oncologic or benign conditions between 2013 and 2021. Women having undergone FP for non-medical indication were excluded. Participants/materials, setting, methods Among the 2201 patients having vitrified their oocytes, 94 (4.7%) returned for reutilization. The primary objective was the comparison of CLBR between onco-FP (n = 48) and benign-FP (n = 46) groups. A logistic model was performed. Factors associated with the CLBR in univariate analysis were included in a multivariate model. A secondary analysis was performed, comparing the benign-FP group and 2 groups of onco-FP according to the use of COH (Onco-COH, n = 25) or in-vitro maturation (Onco-IVM, n = 23). Main results and the role of chance Overall, in comparison with benign FP, women with malignant diseases were younger (median [IQR]: 34.0 y [31.0;37.0] vs. 36.5 y [33.2;38.0], p = 0.04) and had fewer oocytes vitrified (median [IQR]: 6.0 [3.0;9.2] vs.15.5 [6.2;18.0]), p &amp;lt; 0.001). The CLBR in onco-FP and benign-FP groups were 14.6% (7/48), and 32.6% (15/46), respectively. In univariate analysis, the CLBR was significantly lower in the onco-FP group when compared with the benign-FP group: (OR [95%CI]: 0.35 [0.12;0.94], p = 0.04). However, this difference in the CLBR did not reach significance after multivariate analysis (OR [95%CI]: 0.38 [0.09;1.51], p = 0.18). As expected, age at the time of oocyte vitrification was negatively associated with CLBR (OR [95%CI]: 0.80 [0.67;0.92], p = 0.005), while the number of oocytes inseminated was positively related to CLBR (OR [95%CI]: 1.22 [1.08;1.40], p = 0.002). Unlike onco-COH, onco-IVM was associated with a significant decrease in CLBR when compared to benign-FP (only COH), in univariate analysis: 8.7% (OR [95%CI]: 0.20 [0.03;0.80], p = 0.04), without significance after multivariate analysis (OR [95%CI]: 0.37 [0.04;2.16], p = 0.29).The livebirth rate (LBR) per oocyte was 2.1% in the onco-IVM subgroup (3 babies for 141 oocytes thawed), 2.7% in the onco-COH subgroup (7 babies for 260 oocytes thawed) and 3.7% (18 babies for 479 oocytes thawed) in the benign-FP group. Limitations, reasons for caution The small size of our population was probably responsible for a lack of statistical power. The retrospective and monocentric nature of our study may also be a weakness. Furthermore, LBR per oocyte was analyzed without age-adjustment. Wider implications of the findings This study provides actual data on chances of achieving a livebirth after oocyte vitrification, according to the use of a COH or IVM and the context of FP, oncologic or benign conditions. Trial registration number not applicable

Deep remission improves the quality of life of patients with Crohn's disease and anoperineal fistula treated with darvadstrocel: results of a French pilot study.

The injection of allogeneic adipose tissue-derived mesenchymal stem cells (MSC) into anal fistulas in patients with Crohn's disease has never been evaluated in "real-life" conditions in France. We prospectively studied the first patients receiving MSC injections at our center and undergoing 12months of follow-up. The primary endpoint was the clinical and radiological response rate. The secondary endpoints were symptomatic efficacy, safety, anal continence, quality of life (Crohn's anal fistula-quality of life scale, CAF-QoL), and predictive factors of success. We included 27 consecutive patients. The complete clinical and radiological response rates at M12 were 51.9% and 50%, respectively. The combined complete clinical-radiological response (deep remission) rate was 34.6%. No major adverse effects or changes in anal continence were reported. The perianal disease activity index decreased from 6.4 to 1.6 (p < 0.001) for all patients. The CAF-QoL score also decreased from 54.0 to 25.5 (p < 0.001). At the end of the study, M12, the CAF-QoL score was significantly lower only in patients with a complete combined clinical-radiological response relative to those without a complete clinical-radiological response (15.0 versus 32.8, p = 0.01). Having a multibranching fistula and infliximab treatment were associated with a combined complete clinical-radiological response. This study confirms reported efficacy data for the injection of MSC for complex anal fistulas in Crohn's disease. It also shows a positive impact on the quality of life of patients, particularly those for whom a combined clinical-radiological response was achieved.

Adalimumab in Biologic-naïve Patients With Crohn’s Disease After Resolution of an Intra-abdominal Abscess: A Prospective Study From the GETAID

The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n= 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n= 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P=0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P= .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P= .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P= .046) were significantly associated with ADA failure at W104. Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. gov, Number: NCT02856763.

Vasectomy Regret or Lack Thereof.

Vasectomy is a procedure that results in permanent yet reversible sterility and remains a great contraceptive option for many. Previous research studies have highlighted frequency of vasectomy utilization, defining characteristics of individuals who opt for this method, various surgical techniques, and the risks and benefits associated with the procedure. What remains to be defined is why or why not individuals may experience post-vasectomy regret and whether the previous characteristics correlate. The objective of this review is to synthesize information regarding reasons individuals may regret their vasectomy and seek reversal, what options exist for accomplishing the reversal, and patients' fertility prognosis post-vasovasostomy. This review utilized a combination of secondary and tertiary data analysis across a wide scope of academic databases pertaining to the topic of interest. Typically, most males who have sought a vasectomy are satisfied with their decision, however, approximately 6% of this population seeks reversal. Key factors influencing vasectomy regret include age at the time of vasectomy, parental status, pre- and post-operative relationship status, unresolved physical and psychosexual problems, and development of chronic scrotal pain following the procedure. Few options exist for vasectomy reversal including microsurgical reconstructive vasectomy reversal (VR) and sperm extraction for in vitro fertilization. There is no guarantee that fertility will be restored in any case but a major predictive factor for success is the time interval prior to reversal. Vasectomy is intended to be a permanent form of contraception; however, a minor chance remains that individuals may experience post-operative regret due to various factors. This warrants proper comprehensive counseling by the patient's provider regarding benefits and risks, procedural outcomes, opportunities for reversal, and fertility prognosis.

EP40.21: Medical management of early pregnancy failure with misoprostol: echographic predictive factors of success

EP40.21: Medical management of early pregnancy failure with misoprostol: echographic predictive factors of success

Rescue Cervical Cerclage for Protruding Amniotic Sac: A Retrospective Analysis of Clinical Efficacy

Background: Cervical insufficiency, or cervical incompetence, describes the condition in which the cervix dilates without painful uterine contractions in the second trimester of pregnancy. It often leads to loss of pregnancy or preterm delivery. Recommendations for the prophylactic placement of cervical sutures are well established, however rescue cervical cerclage for a prolapsing amniotic bag is more controversial due to higher technical demands, higher risk of iatrogenic rupture of membranes, and questionable long-term neonatal prognosis. This study aimed to answer two important questions: (1) Should rescue cerclage be performed for those with an evidently protruding amniotic bag? (2) Who would benefit the most from rescue cerclage? Materials: Eighteen pregnant women with cervical incompetence with a clinically evident prolapsing amniotic bag from January 2016 to February 2020 were included. Four received conservative treatment, i.e., without cerclage, and the other 14 patients opted to receive emergency rescue cervical cerclage. Results: We classified the patients into futile (n = 7) and successful (n = 7) cerclage groups at post-operative day 21. Pregnancy and neonatal outcomes were obviously better in the success group, however no significant pre-operative predictive factors for success could be identified. The results of the women who did not receive cerclage and those with futile cerclage were comparable. Rescue cerclage was especially beneficial for those at 22 weeks to 26 weeks of gestation. Conclusions: The maternal and fetal outcomes of the patients with futile rescue cerclage were comparable to those who did not receive cerclage. Therefore, rescue cerclage for advanced cervical insufficiency could be considered, especially for those at 22 weeks to 26 weeks of gestation.

Implantation du dispositif XEN 45® dans la chirurgie du glaucome : étude bicentrique bispective s’intéressant au glaucome cortisonique par rapport au glaucome primitif à angle ouvert

XEN 45® gel stent is an ab interno aqueous humor drainage device indicated for moderate glaucoma refractory to medical management. Its efficacy has been demonstrated in primary open-angle glaucoma (POAG). However, there are few studies on secondary glaucoma, including steroid-induced glaucoma (CG), defined as optic neuropathy induced by using local or systemic corticosteroids without increased flare. We conducted a dual-center comparative cohort study between April 2019 and January 2021. 66 operated eyes were included, divided into two groups: POAG (56 eyes) and GC (10 eyes). The primary endpoint was the relative reduction in intraocular pressure (IOP) at three months postoperatively in the GC group. Three outcomes were defined: total success, partial success and failure. The total success rate was 100% in the GC group and 42.6% in the POAG group. Preoperative IOP was 36.1±9.1mmHg and 19.0±7.3mmHg respectively. IOP reduction was 69.1±11.7% in the GC group and 21.8±30.3% in the POAG group. Patients were younger in the GC group (49.3±21.2 versus 71.1±8.4 years), and preoperative conjunctival preparation was longer in this group (12 versus 5 weeks). The needling rate was 17.9% in the POAG group and 10% in the GC group. The XEN 45® gel stent is effective in the treatment of steroid-induced glaucoma. Further studies will be required to identify predictive factors for success and to establish criteria for good candidacy.