Prognostic Factors For Success Research Articles

The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success.

This study aimed to determine whether a trial of labor after two cesarean deliveries (TOLAC2) increases the risk of adverse maternal and neonatal outcomes and identify prognostic factors for TOLAC2 success. A retrospective cohort study was conducted at a single medical center. The study group was comprised of women with a history of TOLAC2. Outcomes were compared with women undergoing trial of labor after one previous cesarean delivery (TOLAC1). The primary outcome was trial of labor after cesarean delivery (TOLAC) success. Secondary outcomes included mode of delivery, uterine rupture, and combined adverse outcome (CAO; uterine rupture, postpartum hemorrhage, 5-minute Apgar score < 7, pH < 7.1). Logistic regression was used for the multivariate analysis to identify prognostic factors for TOLAC2 success. A total of 381 women who underwent TOLAC2 were compared with 3,635 women who underwent TOLAC1. Women attempting TOLAC2 were less likely to achieve vaginal births after cesarean delivery (VBAC; 80.8 and 92.5%; odds ratio [OR]: 0.35; 95% confidence interval [CI]: 0.26-0.47; p < 0.001) and more likely to experience uterine rupture (0.8 vs. 0.2%; OR: 4.1; 95% CI: 1.1-15.9; p = 0.02) but not CAO (4.2 vs. 4.8%; OR: 0.88; 95% CI: 0.5-1.5; p = 0.3). TOLAC2 women with no previous vaginal deliveries had a lower chance of VBAC and a higher risk of uterine rupture compared with TOLAC1 women without a prior vaginal delivery (45.2 vs. 86.3%; OR: 0.13; 95% CI: 0.07-0.25; p < 0.001; 2.3 vs. 0%) and TOLAC2 women with a prior vaginal delivery (45.2 vs. 85.3%; OR: 0.14; 95% CI: 0.1-0.3; p < 0.0001; 2.4 vs. 0.6%; OR: 4.1; 95% CI: 0.4-46.3; p = 0.3). Multivariate analysis revealed that a history of vaginal delivery is an independent predictor of TOLAC2 success. Women attempting TOLAC2 are less likely to achieve VBAC and are at greater risk of uterine rupture compared with those attempting TOLAC1. Despite these risks, the overall success rates remain very high, and the absolute risk of adverse outcomes is still very low. Prior vaginal delivery seems to have a protective effect on TOLAC outcomes. These data should be used to counsel women and assist in decision-making when considering the mode of delivery in women with two previous cesarean sections. · TOLAC2 has a lower chance of success and higher rate of uterine rupture compared with TOLAC1.. · Previous vaginal delivery is an independent predictor of TOLAC2 success.. · Overall TOLAC2 outcomes are associated with high chances of success and low risk of uterine rupture..

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review.

To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. 3B.

Prognostic factors for successful outcome in sialendoscopy for sialolithiasis

ZusammenfassungHintergrund Der Erfolg der Sialendoskopie hängt von mehreren Faktoren ab. Im Jahr 2008 wurde die Lithiasis-Stenosis-Dilatation (LSD) -Klassifikation zur genaueren Beschreibung des Stein-Gang-Verhältnisses eingeführt. Neben dem Nutzen der LSD-Klassifikation untersuchten wir weitere prä- und intraoperativ erhobene Einflussfaktoren auf den Erfolg der Sialendoskopie bei Sialolithiasis. Methode PatientInnen mit Sialolithiasis der Glandula submandibularis und Glandula parotis, die zwischen September 2018 und März 2020 eine primäre Sialendoskopie erhielten, wurden retrospektiv untersucht. Die Steingröße, Steinlokalisation und LSD-Klassifikation wurden unter anderem als prognostische Einflussfaktoren untersucht. Ergebnisse Insgesamt wurden 37 PatientInnen retrospektiv untersucht. Eine erfolgreiche Steinextraktion wurde bei 12/37 (32 %) PatientInnen durchgeführt. Bei Erfolg betrug die mediane Steingröße 3,7 mm, verglichen mit 10 mm bei Misserfolg (Mann-Whitney-Test; p < 0,0001). Bei Erfolg waren 11/12 Steine distal lokalisiert, verglichen mit 13/25 proximal lokalisierten Steinen bei Misserfolg (Pearson-Chi-Quadrat-Test; p = 0,010). Bei Erfolg wurden 10/12 Steine als L1S0D0 klassifiziert, während 15/25 bei Misserfolg als L3aS0D0-Steine klassifiziert wurden (Pearson-Chi-Quadrat-Test; p = 0,001). Für distal lokalisierte Steine, die kleiner als 5 mm waren, lag die Erfolgsrate bei 100 %. Für proximal lokalisierte Steine, die größer als 4 mm waren, lag die Erfolgsrate bei 0 %. Für die als L1S0D0 klassifizierten Steine betrug die Erfolgsrate 60–100 %. Schlussfolgerung Distal lokalisierte Steine und Steine kleiner als 5 mm in einem ansonsten unauffälligen Gangsystem können als prognostisch günstige Faktoren angesehen werden. Zukünftige Studien sollten anhand größerer Datenmengen die LSD-Klassifikation, das Volumen der Steine und deren Gangorientierung bzw. deren Abstand von der Papille untersuchen.

MP48-20 OUTCOMES OF PATIENTS WITH REFRACTORY OAB UNDERGOING PERCUTANEOUS TIBIAL NERVE STIMULATION IN REAL LIFE PRACTICE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-20 OUTCOMES OF PATIENTS WITH REFRACTORY OAB UNDERGOING PERCUTANEOUS TIBIAL NERVE STIMULATION IN REAL LIFE PRACTICE Wesley J. Smith*, B.S Dayron Rodriguez, M.D Alana L. Christie, B.S, M.S Lauren Sudheimer, PA Maude E. Carmel, M.D Gary E. Lemack, andM.D Philippe E. ZimmernM.D. Wesley J. Smith*Wesley J. Smith* More articles by this author , Dayron RodriguezDayron Rodriguez More articles by this author , Alana L. ChristieAlana L. Christie More articles by this author , Lauren SudheimerLauren Sudheimer More articles by this author , Maude E. CarmelMaude E. Carmel More articles by this author , Gary E. LemackGary E. Lemack More articles by this author , and Philippe E. ZimmernPhilippe E. Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous tibial nerve stimulation (PTNS) has variable success, ranging from 35%-86%. There is a paucity of data in the literature regarding long-term outcomes after PTNS and prognostic factors for success. We report on a single institution’s experience with PTNS treatments for refractory overactive bladder (OAB). METHODS: Following IRB approval, a retrospective chart review of patients who underwent PTNS treatments for refractory OAB was performed as part of a quality improvement project. Data collected included patient demographics, medical history, surgical history, obstetric history, urinary tract symptoms, OAB treatment, pad usage, number of PTNS treatments, and follow-up evolution. Patients were stratified by their completion of 12 PTNS sessions. PTNS was performed by FPMRS-trained specialists. PTNS success was defined as continuation of maintenance PTNS with no other medical/surgical treatments required for symptom relief. RESULTS: From 2012 to 2019, 80/100 patients completed at least 12 sessions, with 58 females (median age: 73 (range 64-79)) and 22 males (median age: 67 (range 58-77)). Females had a median of 5 years on OAB drugs (range 3-10) and failed a median of 2 drugs (range 2-3), while males had median of 4 years on OAB drugs (range 3-7) and failed a median of 3 drugs (range 2-4). PTNS success was 67% in females and 55% among men. Twenty did not want to continue to 12 sessions due to lack of benefits. Six of 26 were satisfied after 12 sessions without pursuing maintenance (see Table). Of those on maintenance PTNS, 39% decided for another therapy ultimately. On univariate analysis, diabetes was found to be a predictor of PTNS failure among female patients (p=0.023). All other prognostic factors were not significant. Regardless of PTNS ‘success’, there was overall decreased daytime frequency (15 to 8, p<0.001), decreased nocturia (3 to 2, p<0.001), and decreased pad usage (3 to 0, p<0.001). CONCLUSIONS: PTNS has a role in the armamentarium of OAB therapy in both men and women. However, the long-term success rate in real life practice requires maintenance therapy in the subgroup of satisfied patients who have done well with the first 12 PTNS sessions. Despite symptomatic improvement in the majority, alternative therapies are often sought out beyond PTNS. Source of Funding: UT Southwestern Urology Department © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e702-e703 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley J. Smith* More articles by this author Dayron Rodriguez More articles by this author Alana L. Christie More articles by this author Lauren Sudheimer More articles by this author Maude E. Carmel More articles by this author Gary E. Lemack More articles by this author Philippe E. Zimmern More articles by this author Expand All Advertisement PDF downloadLoading ...

Twenty-one year experience with intrauterine inseminations after controlled ovarian stimulation with gonadotropins: maternal age is the only prognostic factor for success.

To report our experience on homologous intrauterine insemination (IUI) with gonadotropin controlled ovarian stimulation (COS) cycles and to examine different variables which could predict IUI success. This is a retrospective analysis of IUIs performed between January 1997 and December 2017. A total of 7359 COS IUI's procedures (2901 couples) were reviewed. Clinical pregnancy, live birth rate and age, body mass index (BMI), smoking habit, duration of infertility, sperm characteristics before and after treatment (total motile count, morphology, and vitality), day 3 FSH, total gonadotropin dose, and number of follicles were assessed by multivariate logistic regression analysis, and data were expressed as odds ratio (OR). The mean female age at the time of COS was 35.10 ± 3.93years. The most common single infertility diagnoses were unexplained infertility (53.55%), mild male factor (19.69%), and anovulation (10.95%). The total progressive motile sperm count (TPMC) was > 1 × 106/ml (mean 1.34 ± 1.08 × 106/ml). The clinical pregnancy rate was 9.38%, and the live birth rate was 7.19% per cycle. Twin pregnancies were 12.17%. Cumulative pregnancy was 21.89% and cumulative live birth rate was 17.58% per couple. Clinical pregnancy and live birth rates were significantly associated with female age [OR 0.97 (95% CI 0.95-0.99) and 0.95 (95% CI 0.93-0.97), respectively] and day 3 FSH [OR 0.91 (95% CI 0.87-0.94) e 0.90 (95% CI 0.87-0.94), respectively]. Clinical pregnancy rate and live birth rates after COS-IUIs were significantly influenced by female age and FSH levels. Clinical trial registration number: NCT03836118.

2278 Spontaneous vs. Assisted Reproductive Technology-related Ectopic Pregnancy – Are There Any Differences?

Study Objective Extrauterine pregnancy (EUP) is a complication of assisted reproductive technology (ART). Data regarding specific clinical characteristics and treatment success rate of ART-related EUP are scant. This study assessed differences in clinical presentation, management and treatment success rate between spontaneous and ART-related EUP. Design A retrospective cohort study that included EUP diagnosed between 2007-2017. Setting Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Patients or Participants 412 EUP diagnosed between 2007-2017. Interventions Electronic medical record data of 278 spontaneous EUP were compared to 125 ART-related EUP (36 after ovulation induction and 89 after in vitro fertilization (IVF)). Symptoms, laboratory tests, ultrasound findings and treatment modalities were compared between groups. Measurements and Main Results Women with spontaneous EUP were more likely to be symptomatic than those who conceived after IVF (81.8% vs. 68.5%, p=0.022). Surgery was used as first-line treatment in 21.9% of spontaneous pregnancies, as compared to 37.1% of IVF pregnancies (p=0.004). IVF cases required additional methotrexate following conservative treatment failure less often than did those with spontaneous EUP (33.3% vs. 55.2%, p=0.019). Conclusion Women with IVF-related EUP were less symptomatic upon presentation and underwent surgery for first-line treatment more often than those with spontaneous EUP did. The type of conception was not a prognostic factor for success of first-line conservative treatment. Observation alone was more successful among IVF pregnancies.

Prognostic Factors for Success After Irrigation and Debridement With Modular Component Exchange for Infected Total Knee Arthroplasty

BackgroundIrrigation and debridement with modular component exchange (IDMCE) can treat prosthetic joint infection (PJI) after total knee arthroplasty (TKA). Compared to 2-stage revision, IDMCE is associated with lower morbidity but may carry higher infection recurrence rates. We aimed to identify prognostic factors associated with successful IDMCE in patients with PJI. MethodsWe identified 99 consecutive patients who underwent IDMCE following TKA PJI at a tertiary academic medical center from November 2009 through January 2016. Examined variables included age, gender, symptom duration, body mass index, Charlson comorbidity index, total protein, albumin, hemoglobin A1c, erythrocyte sedimentation rate (ESR), C-reactive protein, white blood cell count, gram stain results, final cultures, and use of long-term antibiotic suppression. Success was defined as no further operation on the ipsilateral knee. We used t tests and chi-square analyses to determine whether each preoperative factor was associated with IDMCE reoperation. ResultsAt mean follow-up of 2.6 years, 64 patients who underwent IDMCE were defined as successful. Thirty-five patients required one or more additional procedures for recurrent infection; of these, 20 patients underwent 2-stage revision. Patients with symptom duration of less than 2 days avoided additional surgery in 88% of cases. Elevated ESR >47 mm/h was the only variable associated with reoperation (P = .005). There were no associations among the other examined variables. ConclusionUsing IDMCE for PJI after TKA required reoperation in 35% of cases. Elevated preoperative ESR laboratory values and duration of symptoms >2 days were associated with reoperation.

Combined 23-G Pars Plana Vitrectomy and Lensectomy in the Management of Glaucoma Associated with Nanophthalmos

Purpose: To investigate the surgical results of 23-G pars plana vitrectomy (PPV) combined with lensectomy (PPL) in nanophthalmic patients with angle closure glaucoma. Methods: This prospective nonrandomized study included consecutive patients with nanophthalmic glaucoma recruited for 23-G PPV combined with PPL. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucoma medications, and surgery-associated complications were recorded. Surgical success rates were evaluated at each follow-up. Prognostic factors for success were also assessed using logistic regression analysis. Results: This study enrolled 21 eyes of 21 patients. The mean follow-up was 18.6 ± 7.0 months. At the final follow-up visit, the mean IOP was significantly reduced (from 47.4 ± 5.7 to 18.6 ± 3.6 mm Hg). The mean number of antiglaucoma medications dropped from 5 to 0. BCVA improved in 3 (14.3%) eyes. The complete success rate (IOP >6 and <21 mm Hg without antiglaucoma medication) was 71.4, 66.7, and 71.4% at the 6-month, 12-month, and final follow-up visit, respectively. Conclusions: Nanophthalmic glaucoma can be effectively managed with the combined surgery of 23-G PPV and PPL. IOP control was achieved with elimination of pupillary block and deepening of the anterior chamber. This surgical procedure proved to be safe in eyes with a potential risk of vision-threatening complications.

Clinical Outcomes of Patellofemoral Osteochondral Allograft Transplantation: A Prospective Analysis

Objectives:The use of osteochondral allograft transplantation (OAG) for chondral defects of the knee is increasing, particularly for defects involving the femoral condyles. The purpose of this study was to prospectively evaluate the clinical outcomes for patients undergoing patellofemoral OAG for symptomatic chondral lesions.Methods:Consecutive patients undergoing OAG for full-thickness patella and trochlear lesions between 2007 and 2014 by two senior surgeons were analyzed. Pre- and post-operative patient reported outcomes scores were collected, with a minimum 21-month follow-up. Patient demographics, preoperative clinical data including information on prior ipsilateral knee surgeries, and intraoperative details were analyzed for all patients. Complications, reoperations, and conversion to total knee or patellofemoral arthroplasty were recorded. Statistical analysis was conducted with student’s T-tests, with P<0.05 considered significant.Results:A total of 14 patients (10 females, 4 males) with an average age of 32.8±7.5 years (range, 20-48) were identified for inclusion with an average follow-up of 3.6±1.8 years (range, 1.8-7.8) (Table 1). The average body mass index was 27.5±6.9 kg/m2. Patients experienced an average 5.4±4.2 years of symptoms prior to OAG and 100% of patients had undergone previous ipsilateral knee surgery with an average 4.1±3.5 prior procedures before undergoing patellofemoral OAG. The average defect size on the patella was 855mm2 while that on the trochlea was 322mm2. At the time of OAG, 6 (43%) patients received trochlear grafts, 6 (43%) received patellar grafts, and 2 (14%) received bipolar grafts. Nine patients (64%) received a single allograft, 3 (21%) received 2 allografts to 2 separate lesions, and 2 (14%) received grafts to 4 separate lesions. At final follow-up, there were significant improvements in Lysholm, IKDC, KOOS, WOMAC, and SF-12 Physical outcomes scores; no significant improvements were found in the SF-12 Mental subscale (Figure 1). Two patients (both female, ages 27 and 41) were considered failures as they had converted to knee arthroplasty at an average 2.7 years following OAG. Both of these patients had received allografts to the patella with lesion sizes of 506mm2 and 1800mm2, respectively.Conclusion:Osteochondral allograft transplantation of the patellofemoral joint can be considered a viable restoration procedure for patients with symptomatic chondral lesions to the trochlea and patella. At an average follow-up of 3.6 years, the majority of patients will experience significant improvements in nearly all outcomes scores, with an arthroplasty conversion rate of 14%. Additional information on this difficult-to-treat patient population, including a better understanding of risk factors for failure, prognostic factors for success, and long-term outcomes, is needed.Table 1Patient informationCaseBody Mass Index (kg/m2)Symptom Duration(yrs.)History of Failed Prior Articular Cartilage ProcedureType of Previous Cartilage Procedure# OA GraftsLocation of GraftsLesion Area (mm)Failed to TKA/PFATime to Failure (Yrs.)1 (36yo M)33.225NoN/A2Trochlea, MFC400, 225NoN/A2 (27yo M)27.123YesACI1Patella324NoN/A3 (48yo F)23.402No1Trochlea400, 225NoN/A4 (24yo M)27.609No4Trochlea, MFC (x2), LFC625, 324, 225, 625NoN/A5 (34yo M)28.322YesMFX1Trochlea/MFC Junction225NoN/A6 (24yo F)19.583.5Yes1Trochlea225NoN/A7 (30yo F)26.623No2Trochlea, MFC324, 225NoN/A8 (34yo F)33.61YesMFX4patella, trochlea, MFC x21500,254, 254, 201NoN/A9 (41yo F)20.810No1Patella506Yes2.910 (27yo F)42.62.5YesTruFit Plug, DeNovo1Patella1800Yes2.411 (37yo F)35.72YesDeNovo1Patella988NoN/A12 (33yo F)17.311YesOA Graft2Patella, Trochlea375, 300NoN/A13 (20yo F)25.16YesDeNovo, ACI1Patella975NoN/A14 (38yo F)24.415No1Patella375NoN/A

Prognostic factors for success in the Kangaroo Mother Care method for low birth weight babies

Background Low birth weight (LBW) is closely related to neonatal morbidity and mortality. Management of LBW infants in developing countries remains limited, due to the low availability of incubators. The Kangaroo Mother Care (KMC) method has been shown to be effective for newborns, especially LBW infants, in which skin-to-skin contact may be conducive for infants’ weight gain, thermoregulation, and heart rate stability.Objective To determine the prognostic factors for KMC success in LBW babies.Methods This cohort study included LBW infants at Dr. Kariadi General Government Hospital, Semarang, by a consecutive sampling method. Success of KMC was assessed by infant weight gain, as well as stabilization of temperature, heart rate, and respiration. Prognostic factors for KMC success that we assessed were birth weight, gestational age, KMC duration, age at KMC onset and maternal education level. Statistical analyses used were Chi-square and relative risk (RR) tests.Results Of 40 LBW infants, 24 were successful in KMC. Birth weight ≥ 1500 grams (RR 0.4; 95%CI 0.23 to 0.73; P=0.001)], gestational age ≥ 34 weeks (RR 0.94; 95%CI 0.46 to 1.89; P=1.00), KMC duration ≥ 65 minutes (RR 1.44; 95%CI 0.76 to 2.75; P= 0.215), high maternal education level (RR 1.25; 95%CI 0.76 to 2.04; P=0.408), and age at KMC onset &gt;10 days (RR 2.69; 95%CI 1.14 to 6.32; P=0.003), were factors that related to the successful of KMC.Conclusion Age at KMC onset &gt; 10 days was a prognostic factor for KMC success in low birth weight babies.

Prognostic factors for success in the Kangaroo Mother Care method for low birth weight babies

Background Low birth weight (LBW) is closely related to neonatal morbidity and mortality. Management of LBW infants in developing countries remains limited, due to the low availability of incubators. The Kangaroo Mother Care (KMC) method has been shown to be effective for newborns, especially LBW infants, in which skin-to-skin contact may be conducive for infants’ weight gain, thermoregulation, and heart rate stability.Objective To determine the prognostic factors for KMC success in LBW babies.Methods This cohort study included LBW infants at Dr. Kariadi General Government Hospital, Semarang, by a consecutive sampling method. Success of KMC was assessed by infant weight gain, as well as stabilization of temperature, heart rate, and respiration. Prognostic factors for KMC success that we assessed were birth weight, gestational age, KMC duration, age at KMC onset and maternal education level. Statistical analyses used were Chi-square and relative risk (RR) tests.Results Of 40 LBW infants, 24 were successful in KMC. Birth weight ≥ 1500 grams (RR 0.4; 95%CI 0.23 to 0.73; P=0.001)], gestational age ≥ 34 weeks (RR 0.94; 95%CI 0.46 to 1.89; P=1.00), KMC duration ≥ 65 minutes (RR 1.44; 95%CI 0.76 to 2.75; P= 0.215), high maternal education level (RR 1.25; 95%CI 0.76 to 2.04; P=0.408), and age at KMC onset >10 days (RR 2.69; 95%CI 1.14 to 6.32; P=0.003), were factors that related to the successful of KMC.Conclusion Age at KMC onset > 10 days was a prognostic factor for KMC success in low birth weight babies.

Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success.

In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination. A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007-2009). A total of 493 patients were included (Holter ECGs ≥ every 6 months). Mean follow-up was 59 ± 16 months with 2.1 ± 1.1 procedures per patient. Single and multiple procedure success rates were 20.1% and 55.9%, respectively (80% off antiarrhythmic drug). Antiarrhythmic drug-free multiple procedure success was 46%. Long-term recurrences (n=171) were paroxysmal AF in 48 patients (28%) and persistent AF/atrial tachycardia in 123 patients (72%). Multivariable recurrent event analysis revealed the following factors favoring arrhythmia recurrence: failure to terminate AF during index procedure (hazard ratio [HR], 1.279; 95% confidence interval [CI], 1.093-1.497; P = 0.002), number of procedures (HR, 1.154; 95% CI, 1.051-1.267; P = 0.003), female sex (HR, 1.263; 95% CI, 1.027-1.553; P = 0.027), and the presence of structural heart disease (HR, 1.236; 95% CI, 1.003-1.524; P = 0.047). AF termination was correlated with a higher rate of consecutive procedures because of atrial tachycardia recurrences (P = 0.003; HR, 1.71; 95% CI, 1.20-2.43). Catheter ablation of persistent AF using the stepwise approach provides limited long-term freedom of arrhythmias often requiring multiple procedures. AF termination, the number of procedures, sex, and the presence of structural heart disease correlate with outcome success. AF termination is associated with consecutive atrial tachycardia procedures.

Previous abortion is a positive predictor for ongoing pregnancy in the next cycle in women with repeated IVF failures

Early pregnancy loss is common among women treated with assisted reproduction treatment, but whether it is a prognostic factor for success in subsequent IVF cycles is not well established. The aim of this study was to determine whether a biochemical pregnancy (BP) or spontaneous abortion (SA) affects the pregnancy rates in the following cycle. A retrospective study of 2687 women undergoing 6678 cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate (PR) per cycle was compared between patients with a pregnancy loss versus a negative β-HCG in their previous cycles. Multivariate analysis of factors affecting ongoing pregnancy rate was performed. BP and/or SA in the first three cycles did not significantly alter the chances to conceive (16.9% patients with BP and/or SA in the previous cycle versus 16.5% patients with no previous pregnancy). From cycle 4 onwards, the presence of a previous abortion (either BP or SA) was associated with better ongoing PR (23.0% versus 11.2%, P<0.001). In conclusion, BP and/or SA in a previous cycle appears to be a positive marker for success in subsequent cycles in patients with repeated IVF failures. These results should be further investigated in this challenging group of patients.Pregnancy loss in the first trimester is common among women treated with assisted reproduction treatment, but its significance regarding chances of future ongoing pregnancies is not well established. The aim of this study was to determine whether an early pregnancy loss during an IVF cycle, affects the ongoing pregnancy rates in following IVF cycles. A retrospective study of 2687 women undergoing 6678 IVF cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate was compared between patients with a pregnancy loss in their previous IVF cycle versus patients who failed to conceive (negative-human chorionic gonadotrophin blood test) in their previous IVF cycle. A multivariate analysis of factors affecting ongoing pregnancy rate including age, number of embryos transferred and aetiology of infertility was performed. We found that early pregnancy loss during the first three IVF cycles did not significantly alter the chances to conceive (pregnancy rates: 16.9% for patients with early pregnancy loss in the previous cycle compared to 16.5% in patients who didn’t conceive in the previous cycle). From cycle 4 onwards, the presence of a previous early pregnancy loss was associated with better ongoing pregnancy rate (23.0% compared to 11.2%, P<0.001). In conclusion, early pregnancy loss in the previous cycle appears to be a positive marker for success in subsequent cycles in patients with repeated IVF failures.

Interval Between Injury and Lingual Nerve Repair as a Prognostic Factor for Success Using Type I Collagen Conduit

The purpose of the present study was to investigate the role of a type I collagen nerve conduit in the repair of lingual nerve injuries compared with those lingual nerve repairs performed without a collagen membrane and to identify the prognostic factors for functional sensory recovery (FSR). This was a retrospective cohort study evaluating a sample derived from the population of patients who had undergone lingual nerve microsurgery from March 17, 2000, to February 23, 2010 by the same surgeon (V.B.Z.) with complete records available, including follow-up assessments. The primary outcome variable was the interval to successful FSR according to the British Medical Research Council criteria for FSR. The predictor variables were categorized into demographic, surgical, and clinical sensory testing. Appropriate descriptive statistics and univariate and multivariate Cox proportional hazards survival statistics were computed in analyzing the patient age at lingual nerve injury repair (in years), gender, timing of surgical intervention, mechanism of injury, specific surgical procedures, and application of a type I collagen conduit. The study cohort included 41 patients with 42 lingual nerve injuries who underwent surgical repair. Their mean age was 28.3 ± 8.3 years (range 13 to 44), with 88% females (n = 32). In the multivariate model, the injury to surgery interval per 1-month increase (hazard ratio 1.23, 95% confidence interval 1.02 to 1.48, P = .029) and injury to surgery interval of 9 months or longer (hazard ratio 4.67, 95% confidence interval 1.04 to 20.87, P = .04) remained significantly associated statistically with successful FSR. The results of the present study have demonstrated that the injury to surgery interval is the most significant prognostic factor in the repair of lingual nerve injuries. The use of the collagen membrane demonstrated a greater level of FSR compared with those treated without the use of the membrane. However, the results from the collagen conduit were not statistically significant.

The return to work after a neuropsychological programme and prognostic factors for success

Introduction: Several factors influence the return to work (RTW) after brain injury (BI). The aims of the study were to follow-up the RTW after a vocational neuropsychological programme for individuals with a brain injury and to explore factors predicting RTW. The hypothesis was that as self-awareness was already addressed in the programme, severity of injury would have a greater impact on RTW.Method: Sixty-five of 72 persons (median age 27) who had attended the programme 1998–2003 were interviewed about their occupation at 1, 2, 3 and 5 years after the programme. A logistic regression was made with the variables concerning process skill, somatic problems and irritability, the digit symbol coding and pre-morbid occupation to explore predictors of RTW.Results: The main cause was TBI (44.6%). Before injury 77% were employed or studied and after the injury 80% did not have any occupation. After 5 years 40% had returned to work. The only significant variable in the regression was the pre-morbid occupation.Discussion: The study stresses the difficulty to know the key elements involved in RTW which confirms the need for rehabilitation to focus on several factors in different contexts in order to affect the outcome.

Vaccine immunotherapy and prognostic factors of success: where we are today?

Vaccine immunotherapy and prognostic factors of success: where we are today?

A 13-year experience and predictors for success in transnasal endoscopic repair of congenital choanal obliteration

Objective To express a 13-year experience in transnasal endoscopic repair of congenital choanal obliteration and to analyze the different predictors that may affect the surgical outcome. Design Retrospective clinical study. Setting Otolaryngology Department, Tanta University Hospital, Egypt. Patients and methods Over a 13-year period (from January 1996 to December 2008), 54 children aged between 7 day and 14 year old at the time of surgery underwent transnasal endoscopic repair of an unilateral (32 cases) and bilateral (22 cases) congenital choanal obliteration using conventional instruments and microdebrider/drill to remove the atretic plate, bony boundaries, and vomer. A laterally based mucosal flap was routinely used to resurface most of the raw areas of the lateral and superior borders of the created choana followed by shortened period stenting (5–7 days). Patients were then clinically and endoscopically monitored for nasal obstruction and healing for a mean follow-up of 46 ± 6 months. Demographic characteristics of these patients, associated anomalies, surgical technique, postoperative stenting, complications, postoperative care, and surgeons’ learning curve were discussed in the light of the findings of the surgical outcomes. Results There were 33 females (61.1%) and 21 males (38.9%). A total of 12 patients (22.2%) presented with associated anomalies. There were no major intra-operative or postoperative complications. The success rate for bilateral choanal obliteration was 86.4% and for unilateral choanal obliteration 96.9% with an overall success rate 92.3%. Revision surgery of the relapsed cases using the same technique without mucosal flap was successful 100%. Conclusion Transnasal endoscopic repair of congenital choanal obliteration is an easy and evolving technique with adequate safety and high success rate. Early diagnosis and good preparation of the patients for surgery, adequate resection of the bony boundaries of the obliterated choana and vomer, shortened period nasal stenting, strict early and late follow-up, and the growing experience of the surgeons, all were prognostic factors for success. Associated anomalies and use of mucosal flap did not seem to affect the prognosis. Inadequate bone resection, bilaterality, pure bony obliteration, the younger the age of the patient, and early developing experience of the surgeons, all were possible predictive factors for relapse.

Endoscopic Incision of Short (&lt;3 cm) Urethral Strictures After Phallic Reconstruction

Urethral stricture formation is a frequent complication after phallic reconstruction, but little is known about the treatment. Endoscopic cold-knife incision has long been applied for short urethral strictures. Can this treatment be used for strictures in the phalloplasty patients as well? Thirty-two endoscopic urethrotomies were done in 22 patients with a phalloplasty. Only noncomplicated strictures shorter than 3 cm were considered appropriate for endoscopic incision. The stricture was treated by a cold-knife incision. The urethral catheter was maintained for at least 2 weeks. Follow-up was done every 3 months during the first year and annually thereafter. Comparing failures with successful cases, prognostic factors for success are assessed. Median follow-up is 51 months (range, 8-95 months). In 14 patients, no previous intervention was done. Mean stricture length is 1 cm (range, 0.5-2.5 cm). Endoscopic incision was successful in 14/32 cases (43.8%). First incision was successful in 10/22 cases (45.5%), a second incision was successful in 4/7 cases (57.1%), but three or more incisions were never successful (0/3). The only significant difference between failures and successful cases is the interval between phalloplasty and endoscopic incision (32 vs. 9.9 months; p = 0.00008). Endoscopic incision for short (<3 cm) urethral strictures after phallic reconstruction can solve the problem in about half of the cases. Three or more incisions seem to be useless. Endoscopic incision is significantly better when performed with a long-term interval after phalloplasty, indicating that a well-healed phallic urethra is more prone to a successful endoscopic incision.

P20.08: Power Doppler ultrasound assessment of follicular vascularization: prospective clinical interest evaluation for IVF management—preliminary results

Average live birth rate in Europe remains ∼28% per transfer despite advances in in-vitro fertilization (IVF). Factors such as maternal age, ovarian reserve, serum estradiol concentrations, follicular number and size are being investigated as possible prognostic factors of success. In regard to the oocyte quality at the time of retrieval, a relationship between follicular vascularization and the IVF outcome has been established. Conventional pulsatility indices of intra-ovarian arteries are very difficult to use routinely. The aim of this study was to investigate the accuracy of power Doppler ultrasonography for assessment of follicular vascularization during IVF attempts, as well as a prognostic factor of IVF outcome. 35 patients undergoing IVF treatment were prospectively recruited. Using power Doppler ultrasound, we assessed individual follicular vascularization of about three follicules in each ovary, by a subjective graduation, at the time of oocyte collection. Using a validated system, follicles were determined to be at high or low grade on regard with the extension of vascularization. Subsequent follicular and oocyte quality parameters were collected: mean follicular diameter, presence and maturity of the corresponding oocyte, quality of zygotes and cleaved embryos whether transferred or not. A total of 187 follicles were studied. The assessment of perifollicular vascularization, although highly subjective, was feasible in 92.51% of cases. Vascularization grade was not dependent on follicular size. There was no significant difference in any of the analysed follicular and oocyte quality parameters between high and low grade follicles. Power Doppler assessment of perifollicular vascularization does not seem to be a useful procedure to evaluate follicular and oocyte quality.

Percutaneous Embolization for Erectile Dysfunction due to Venous Leakage: Prognostic Factors for a Good Therapeutic Result

Objectives: To identify prognostic parameters for patient outcome after embolization for erectile dysfunction (ED) due to venous leakage (VL). Methods: 23 patients presenting with ED due to pure venous leakage were selected. Intracavernous pharmacological testing, Doppler ultrasound, dynamic cavernosography–cavernosometry and cavernous oxygen tension were done. All patients underwent embolization of the leakage areas visualized. The results were assessed in terms of the response: good, partial or absent. Mean values were calculated for diastolic flow, oxygen tension, maintenance flow and pressure decay, and were compared between the group of patients who responded and the group which did not respond using Student’s t test. Results: 26% had a good response, with a mean follow–up of 22 months, if we include partial response and adjuvant therapy this rate rises to 44%. A statistically significant relationship was found between the intracavernous oxygen tension and maintenance flow with a good response to treatment; patients with cavernosography types I and II showed a better response to treatment than those with cavernosography type III. Conclusions: Maintenance flow, intracavernous oxygen tension, and cavernosography types can be prognostic factors of success in the treatment of ED due to pure VL with embolization.