Resolution Rate Research Articles

Meta-Analysis of Surgical Treatment versus Sclerotherapy for Management Of Branchial Arch Lesions

Abstract Background Branchial arch lesions (BALS) are uncommon congenital malformations presenting mainly in first 2 decades with neck cysts, sinuses, fistulas, recurrent infections and have low potential to turn malignant. Surgical management of these lesions can be associated with significant risk of complications and recurrence. Sclerotherapy has been described as effective and less invasive alternative option. Aim of the Study is to summarize current available evidence regarding effectiveness and safety of surgery and sclerotherapy as two modalities of treatment for BALS. Methods A systematic review for all interventional studies on management of (BALS) was conducted in multiple medical databases from its inception till March 2021 with inclusion of all studies reporting on either surgical management or sclerotherapy for BALS in humans and reported effectiveness or safety outcomes. Diagnostic and review articles, single case reports and non-human studies were excluded. Proportional meta-analyses were utilized where there is only uncontrolled studies available reporting on outcomes. Assessment of quality was done with use of validated tool relevant to design of primary studies included and risk of bias of studies was assessed statistically. PRISMA Guidelines were followed in reporting of the study. Results A total of 525 studies were retrieved of which only 25 were eligible for inclusion. All included studies were uncontrolled case series; 18 reported on surgery and 7 reported on sclerotherapy The overall quality of included studies were fair to good according to NIH validated tool. Meta-analyses of surgical studies for BALS showed success rate of complete excision of 90%,96%,96% and 98% for first, second, third and fourth branchial arch lesions respectively with complications rates of 19.7%,5%,24% for first, second and third arch lesions. The rates of recurrence were 11.2%,2%,5%,1% for first to fourth arch lesions in order. The corresponding success rates of completed resolution for sclerotherapy were 86% with complications rates of 8% all of which were minor complications. There were no recurrences but recognized incomplete resolution. Conclusion Both surgery and sclerotherapy have satisfactory success in terms of complete excision/resolution of BALS. The risks of complications howeverseem to be more significant with surgical management however no controlled studies were available to allow for definitive conclusions. Further studies with standardized diagnostic criteria and treatment techniquesare needed to allow for prioritizing treatment lines based on conclusive evidence.

Efficacy of Three Different Injection Techniques for the Endoscopic Treatment of Vesicoureteral Reflux (VUR) in Children: A Review of 10 Years of Experience.

To review our 10 years of experience with the endoscopic treatment of vesicoureteral reflux (VUR) in children, emphasizing the long-term efficacy of the "combined STING-HIT" technique. A retrospective study was performed including all children with symptomatic VUR undergoing the cystoscopic injection of bulking agents from January 2013 to December 2022 in our pediatric tertiary referral center. Three different endoscopic techniques were adopted: the "combined STING-HIT" technique, the STING technique, and the HIT technique. Treatment success was defined as symptom remission and VUR resolution on the voiding cystourethrogram (VCUG) performed at the 3-month follow-up. In the study period, 140 (F:M = 64:76) patients and 228 ureters were treated at a median patient age of 3 (2.0-6.0) years. After a single endoscopic treatment, VUR resolved in 203 (88%) ureters. The VUR resolution rate after a single endoscopic treatment was 95% (n=70/74) in case of I-II VUR, 88% (n=87/99) in case of III VUR; 83% (n=38/46) in case of IV VUR; 89% (n=8/9) in case of V VUR (p-value: 0.174). Overall, one or two endoscopic treatments succeeded in 219 (96%) ureters. The overall VUR resolution rate following one or two endoscopic treatments was 100% (74/74) in case of I-II VUR, 93% (n=92/99) in case of III VUR; 96% (n=44/46) in case of IV VUR; 100% (n=9/9) in case of V VUR (p-value: 0.083). Despite not being statistically significant, the VUR resolution rate was higher for the "combined STING-HIT" technique, both after one (92%: n=110/119; versus 85%; n=62/73 versus 86%; n=31/36; p-value: 0.225) or two (98%: n=116/119; versus 95%; n=69/73 versus 94%; n=34/36; p-value: 0.469) endoscopic treatments. The endoscopic approaches were highly successful for the treatment of VUR in children. The "combined STING-HIT" technique was a safe and effective procedure, being associated with the higher resolution rate.

Acceptance Tests of more than 10 000 Photomultiplier Tubes for the multi-PMT Digital Optical Modules of the IceCube Upgrade

More than 10000 photomultiplier tubes (PMTs) with a diameter of 80 mm will be installed in multi-PMT Digital Optical Modules (mDOMs) of the IceCube Upgrade. These have been tested and pre-calibrated at two sites. A throughput of more than 1000 PMTs per week with both sites was achieved with a modular design of the testing facilities and highly automated testing procedures. The testing facilities can easily be adapted to other PMTs, such that they can, e.g., be re-used for testing the PMTs for IceCube-Gen2. Single photoelectron response, high voltage dependence, time resolution, prepulse, late pulse, afterpulse probabilities, and dark rates were measured for each PMT. We describe the design of the testing facilities, the testing procedures, and the results of the acceptance tests.

Systematic Review and Critical Appraisal of Cauda Equina Syndrome Management During Pregnancy.

Cauda equina during pregnancy represents a rare entity, with data regarding optimal treatment being very scarce in the pertinent literature. Given the scarcity of current evidence on the topic, this study conducts a systematic review and analysis of existing literature concerning cauda equina syndrome (CES) management in pregnant women. A comprehensive search was performed across multiple databases, yielding 26 level IV peer-reviewed articles that met the inclusion criteria. These studies collectively encompassed 30 pregnant patients with CES, with a mean age of 31.2 years and an average gestational age of 26 weeks. Disc herniation emerged as the primary cause in 73% of cases. Regarding surgical interventions, the prone position was utilised in 70% of cases, with 73% receiving general anaesthesia. Notably, third-trimester spinal surgeries exhibited a higher complete recovery rate compared to earlier trimesters. Minimally invasive spinal surgery demonstrated superior outcomes in terms of complete recovery and reduced risk of persistent post-operative symptoms when compared to open approaches. Moreover, patients undergoing caesarean section (CS) after spinal surgery reported higher rates of symptom resolution and lower symptom persistence compared to those with CS before spinal surgery or vaginal delivery post-spinal surgery. Despite these study's findings, the overall evidence base remains limited, precluding definitive conclusions. Consequently, the study underscores the importance of multidisciplinary team discussions to formulate optimal treatment strategies for pregnant individuals presenting with CES. This highlights a critical need for further research to expand the knowledge base and improve the guidance available for managing CES in pregnant populations.

Optimizing the Detective's Burden: A Data-Driven Approach to Enhancing Investigative Productivity

This study examines the critical issue of detective workload and its impact on investigative effectiveness. While detectives play a vital role in solving crimes and upholding justice, they often face overwhelming workloads that can hinder their ability to focus on core investigative activities. The overall aim of this study is to utilize workload analysis to gain a comprehensive understanding of detective work and identify evidence-based strategies to increase their productivity in criminal investigations. This research analyzes detective workload through a data-driven lens, exploring the challenges and opportunities for improvement. Main topics the impact of heavy workloads on detective productivity and well-being. Current workload distribution and its limitations Innovative strategies for workload management (e.g., data-driven case prioritization, workload sharing). The role of technology adoption (e.g., digital forensics tools, data analysis platforms) in streamlining investigations. The importance of work-life balance for detective well- being and performance. Key Arguments traditional investigative practices and an imbalance between administrative and investigative tasks significantly impede detective productivity. Implementing data- driven workload management strategies can optimize detective time allocation and improve case resolution rates. Utilizing advanced investigative technologies equips detectives with efficient tools to analyze evidence and identify leads. Promoting a healthy work-life balance for detectives reduces stress and burnout, ultimately contributing to investigative effectiveness. Methodology this research employs a comprehensive approach, drawing on. Literature Review analyzing existing research on detective workload, productivity, and innovative investigative techniques. Policy Review: Examining existing policies and practices related to detective workload management and technology adoption within police departments. Significance this research has significant implications for policymakers, police leadership, and detectives themselves. Policymakers can leverage the findings to develop evidence-based strategies for optimizing detective workload and improving investigative efficiency. Police leadership can utilize the recommendations to implement data-driven workload management practices and equip detectives with the necessary technology and training. Detectives can gain valuable insights into workload management strategies and advocate for initiatives that promote well-being and enhance their investigative capabilities. Audience this research is targeted towards a broad audience, including: Policymakers involved in criminal justice reform and police department funding. Police leadership seeking to enhance detective productivity and improve investigative outcomes. Detectives and law enforcement professionals seeking to optimize their workload and improve investigative efficiency. Academic researchers interested in the field of criminal justice and police work.

Investigation of the fission gas release and grain boundary percolation in oxide fuels: A COMSOL multiphysics-based study

In this study, we explore fission gas release (FGR) behaviour in oxide fuels using the COMSOL Multiphysics framework. Building upon the conventional Booth model, our model incorporates the influence of grain boundary network percolation on FGR. The microstructure of the fuel pellet is represented by a 2D axi-symmetric geometry. We investigate various factors affecting FGR, mainly includes bubble contact angle, resolution rate, radial position. This study aims to capture the physical phenomena observed in FGR experiments and assess the sensitivity of FGR to these parameters at both microscopic and macroscopic scales. Moreover, our model accounts for long-range percolation on the networked grain boundaries, a factor overlooked by the Booth model. The gas resolution of grain boundaries is also considered. Finally, we compare and analyze the results obtained from our model with those from the Booth model and other relevant models, aiming at enhancing our understanding of FGR behavior in oxide fuels.

Vaulting further: cranial vault expansion for craniocerebral disproportion without primary craniosynostosis.

Treatment of subjects with refractory idiopathic intracranial hypertension (IIH) or shunted hydrocephalus with chronic shunt complications is challenging. What is the role for cranial vault expansion, particularly utilizing posterior vault distraction osteogenesis (PVDO), in these cases? This study assesses medium-term efficacy of cranial vault expansion in this unique patient population. A retrospective review was conducted of patients who underwent cranial vault expansion from 2008 to 2023 at the Children's Hospital of Philadelphia. Subjects who did not have a diagnosis of primary craniosynostosis were included in the study. Demographic information, medical history, and perioperative details were collected from medical records. Primary outcomes were the rate of CSF diversion procedures and resolution of presenting signs and symptoms. Secondary outcomes were perioperative and 90-day complications and reoperation requirement. Among 13 included subjects, nine (69.2%) patients had a primary diagnosis of shunted hydrocephalus and 4 (30.8%) patients had IIH. Twelve (92.3%) subjects underwent posterior vault distraction osteogenesis (PVDO) and one (7.7%) underwent posterior vault remodeling (PVR). All 4 patients with IIH demonstrated symptomatic improvement following PVDO, including resolution of headaches, vomiting, and/or papilledema. Among 9 patients with shunted hydrocephalus, CSF diversion requirement decreased from 2.7 ± 1.6 procedures per year preoperatively to 1.2 ± 1.8 per year following cranial vault expansion (p = 0.030). The mean postoperative follow-up was 4.1 ± 2.1years and four (30.8%) patients experienced complications within 90days of surgery, including infection (n = 2), CSF leak (n = 1), and elevated ICP requiring lumbar puncture (n = 1). Four (30.8%) patients underwent repeat cranial vault expansion for recurrence of ICP-related symptoms. At most recent follow-up, 7 of 9 patients with shunted hydrocephalus demonstrated symptomatic improvement. Cranial vault expansion reduced intracranial hypertension-related symptomology as well as the rate of CSF diversion-related procedures in patients with refractory IIH and shunted hydrocephalus without craniosynostosis, and should be considered in those who have significant shunt morbidity.

Store-and-forward teledermatology in a Spanish health area significantly increases access to dermatology expertise

IntroductionTeledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years.MethodsCross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality. Main measures: referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation.ResultsThe annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p < 0.001). The resolution rate for non-face-to-face consultations was 44%. Diagnostic concordance, assessed by the kappa index, was 0.527 for face-to-face consultations and 0.564 for non-face-to-face consultations. Greater compliance with the quality criteria in the non-attendance consultations.ConclusionsTeledermatology appears to be an efficient tool in the resolution of dermatological problems, with a rapid, effective, and higher quality response for attention to skin pathologies.RegistryClinicalTrials.gov Identifier: NCT05625295. Registered on 21 November 2022 (https://clinicaltrials.gov/ct2/show/ NCT05625295).

Accurate extrinsic calibration for the invisible-light 1D laser rangefinder and camera

Abstract A combined sensor, comprising a camera and a one-dimensional laser rangefinder (1D LRF), has wide application across engineering sectors, notably in aerospace. This combined sensor is pivotal for earth observation and deep space exploration. To achieve precise and stable external parameters for this combined sensor, an accurate external calibration method is proposed. Initially, a technique for localized registration of laser spots is introduced to ensure precise determination of their positions, addressing the challenge of laser invisibility in a 1D LRF. Subsequently, a data evaluation criterion known as the data synthesis criterion is presented, addressing the issue of limited constraints in traditional calibration methods. This criterion evaluates relative errors encompassing 1D LRF ranging values, camera external parameters, and laser spot positions. Finally, based on the proposed criteria, a robust extrinsic calibration method is introduced that automatically filters observation data with significant errors and utilizes the growth rate of camera spatial resolution as the termination condition. The efficacy of the proposed method is confirmed through simulation experiments and real-world data experiments.

Statins for neuroprotection in spontaneous intracerebral haemorrhage (STATIC): protocol for a multicentre, prospective and randomised controlled trial

IntroductionIntracerebral haemorrhage (ICH) is a neurological emergency with high morbidity and mortality, and current treatment is limited. Emerging evidence has reported that statins can exert neuroprotective effects in cerebrovascular diseases....

Comparative clinical feasibility of antireflux mucosectomy and antireflux mucosal ablation in the management of gastroesophageal reflux disease: Retrospective cohort study.

No definitive treatment has been established for refractory gastroesophageal reflux disease (GERD). Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) using argon plasma coagulation are promising methods. However, no study has compared these two. This study compared the efficacy and safety of the two procedures. This multicenter, retrospective, observational study included 274 patients; 96 and 178 patients underwent ARMA and ARMS, respectively. The primary outcome was subjective symptom improvement based on GERD questionnaire (GERDQ) scores. The secondary outcomes included changes in the presence of Barrett's esophagus, Los Angeles grade for reflux esophagitis, flap valve grade, and proton pump inhibitor withdrawal rates. The ARMS group had higher baseline GERDQ scores (10.0 vs. 8.0, P < 0.001) and a greater median postprocedure improvement than the ARMA group (4.0 vs. 2.0, P = 0.002), and even after propensity score matching adjustment, these findings remained. ARMS significantly improved reflux esophagitis compared with ARMA, with notable changes in Los Angeles grade (P < 0.001) and flap valve grade scores (P < 0.001). Improvement in Barrett's esophagus was comparable between the groups (P = 0.337), with resolution rates of 94.7% and 77.8% in the ARMS and ARMA groups, respectively. Compared with the ARMA group, the ARMS group experienced higher bleeding rates (P = 0.034), comparable stricture rates (P = 0.957), and more proton pump inhibitor withdrawals (P = 0.008). Both ARMS and ARMA showed improvements in GERDQ scores, endoscopic esophagitis, flap valve grade, and the presence of Barrett's esophagus after the procedures. However, ARMS demonstrated better outcomes than ARMA in terms of both subjective and objective indicators.

Study of high-precision time transfer method enhanced by PPP-AR/PPP-RTK

Abstract With the continuous development and improvement of Global Navigation Satellite Systems (GNSS), the use of GNSS for high-precision time transfer has become increasingly mature. To delve into the contribution of information-enhanced GNSS PPP to time transfer performance, this paper focuses on the comprehensive evaluation and analysis of the time transfer performance of PPP-AR and PPP-RTK. Using GPS as a case study, experimental results demonstrate that the average success fixing rate of PPP integer ambiguity resolution across five stations is 93.57%, with initial fixing times consistently below 20 minutes. The stability of the station clock offset sequence of PPP-AR is better than that of PPP floating solution. Compared with the PPP floating solution, the average improvement of PPP-AR stability is 16.54%. Furthermore, using PPP-AR for time transfer not only enhances the stability of the time transfer link clock offset sequence, but also improves its noise level. The stability is increased by 14.41% on average, and the noise level is improved by 9.11% on average. PPP-RTK also improves the stability and noise level of time transfer even better than PPP-AR. However, as the reference network scale increases, the accuracy of the interpolated atmospheric delay correction decreases, impacting the performance of PPP-RTK.&amp;#xD;

Uremic Stomatitis: A Latin American Case Series and Literature Review.

Uremic stomatitis is often unfamiliar to healthcare professionals. This study presents five cases of uremic stomatitis, providing a comprehensive analysis of their demographic distribution, clinicopathological features, and management strategies based on existing literature. Data were collected from centers across Brazil, Argentina, Venezuela, and Mexico. Electronic searches were conducted in five databases supplemented by manual scrutiny and gray literature. The series consisted of three men and two women with a mean age of 40.2 years. Lesions mostly appeared as white plaques, particularly on the tongue (100%). The median blood urea level was 129mg/dL. Histopathological analysis revealed epithelial changes, including acanthosis and parakeratosis, with ballooned keratinocytes in the suprabasal region. Oral lesions resolved subsequent to hemodialysis in three cases (75%). Thirty-seven studies comprising 52 cases of uremic stomatitis have been described hitherto. Most patients were male (65.4%) with a mean age of 43.6 years. Clinically, grayish-white plaques (37.3%) and ulcers/ulcerations (28.9%) were common, particularly on the tongue (30.9%). Hemodialysis was performed on 27 individuals. The resolution rate of oral lesions was 53.3%. Earlier recognition of uremic stomatitis, possibly associated with long-term uremia, holds the potential to improve outcomes for patients with undiagnosed chronic kidney disease.

Retrospective Analysis of Effective Management Strategies for Primary Amenorrhea of Reproductive Age in Saudi Arabia.

Primary amenorrhea, the absence of menstruation by age 15, can have significant implications for reproductive health and overall well-being. This retrospective study aimed to evaluate the effectiveness of various management strategies for primary amenorrhea among women of reproductive age in Saudi Arabia. Medical records of 63 eligible patients from 2018 to 2023 were analyzed, assessing diagnostic methods, treatment modalities, and associated outcomes. The findings revealed that hormonal therapy was the most commonly employed management strategy (50.0%) and demonstrated the highest rate of achieving menstrual regularity (62.5%). Surgical interventions were utilized in 28.1% of cases, with a 50.0% rate of symptom resolution. Lifestyle modifications were less frequent (21.9%) but showed a moderate rate of symptom resolution (35.7%). Logistic regression analysis identified age, underlying etiology, and management strategy as significant predictors of treatment success. Subgroup analyses highlighted the efficacy of hormonal therapy and lifestyle modifications for genetic etiologies, while surgical interventions were more effective for anatomical causes. The study underscores the importance of a comprehensive diagnostic approach and personalized treatment plans tailored to individual patient characteristics. Despite limitations, the findings contribute to the understanding of optimal management strategies for primary amenorrhea and emphasize the need for multidisciplinary collaboration in addressing this complex condition.

Applying the Rupture Resolution Rating System to emotion-focused couple therapy.

Alliance ruptures and their repair are robustly associated with outcomes in individual therapy. Little is known about these processes in couple therapy, despite the acknowledged challenges of nurturing the alliance when working with two parties in conflict. One factor contributing to this gap in the literature is the lack of an instrument to capture ruptures and repair in couple therapy. We adapted the Rupture Resolution Rating System (3RS)to identify ruptures and repairs in couple therapy at the within-system (between the two partners) and the between-system (between each partner and the therapist) levels. Sessions from one couple with good outcome and one couple with poor outcome were coded. Couples were in therapy to deal with emotional injury. Rupture-repair events in both the within-system and between-system were common. The couple with the poor outcome showed greater levels of rupture with the therapist. The injured partners (vs. injurer partners) demonstrated higher frequencies of ruptures.

Evaluation of the safety, biodistribution, dosimetry of [18F]AlF-NOTA-LM3 and head-to-head comparison with [68Ga]Ga-DOTATATE in patients with well-differentiated neuroendocrine tumors: an interim analysis of a prospective trial.

18F-labelled somatostatin receptor (SSTR) analogs offer several advantages over 68Ga in terms of yield, cost, spatial resolution and detection rate. This study presents an interim analysis of a prospective trial designed to assess the safety, biodistribution and dosimetry of [18F]AlF-NOTA-LM3, and compare its diagnostic efficacy and clinical management outcomes with [68Ga]Ga-DOTATATE or [68Ga]Ga-NODAGA-LM3 in patients with well-differentiated NETs. Twenty-one patients with histologically confirmed well-differentiated neuroendocrine tumors (G1 and G2) were prospectively recruited. The first eight patients underwent serial PET scans at 5, 15, 30, 45, 60, and 120min after [18F]AlF-NOTA-LM3 injection to assess biodistribution and dosimetry. The remaining patients underwent whole-body PET/CT scans. [18F]AlF-NOTA-LM3 and [68Ga]Ga-DOTATATE PET/CT were done within a week, with a minimum 24-hour interval between the two scans. Focal uptake above the surrounding background activity and could not be explained by physiologic uptake was considered lesions of NETs. Lesion number, tumor uptake, and tumor-to-background ratio (TBR) were compared. In patients with discrepant findings, the size of the smallest lesions (measured on coregistered CT) detected on [68Ga]Ga-DOTATATE and [18F]AlF-NOTA-LM3 was compared. [18F]AlF-NOTA-LM3 was safe and well-tolerated. Physiological uptake of [18F]AlF-NOTA-LM3 was significantly lower than that of [68Ga]Ga-DOTATATE in abdominal organs and bone marrow, but higher in blood pool and lung. The mean effective dose was 0.024 ± 0.014 mSv/MBq. [18F]AlF-NOTA-LM3 detected significantly more liver lesions (457 vs. 291, P = 0.006) and lymph node lesions (30 vs. 22, P = 0.011) compared to [68Ga]Ga-DOTATATE. The tumor uptake was comparable, but TBR was significantly higher with [18F]AlF-NOTA-LM3 for lesions from all sites except for the duodenum. The size of the minimum liver lesions (0.54 ± 0.15 vs. 1.01 ± 0.49, P<0.001) and lymph node lesions (0.50 ± 0.19 vs. 1.26 ± 0.86, P = 0.024) detected on [18F]ALF-NOTA-LM3 were significantly smaller than those detected on [68Ga]Ga-DOTATATE. [18F]AlF-NOTA-LM3 shows favorable biodistribution, higher spatial resolution and superior performance than [68Ga]Ga-DOTATATE in detecting liver and lymph node metastases, with higher TBR. Notably, it is the first SSTR analog to show superiority in detecting lymph node lesions when compared to [68Ga]Ga-DOTATATE. ClinicalTrials.gov identifier NCT06056362.

Scanning-assisted focal plane-detection system for a sector-field mass spectrometer - Part-I: Simulation and data processing

In this paper, a novel detection system, the Scanning-Assisted Focal Plane-Detection System (SAFPDS), is proposed as a focal plane detector for sector-field mass spectrometers. The principle of SAFPDS is to decouple the spatial resolution and local count rate of the microchannel plate (MCP) focal plane-detection system in order to enhance the local count rate and dynamic range limited by the MCP. This decoupling is achieved by deflecting ions along the vertical direction of the focal plane detector using an ion deflector during acquisition. Simulations of the SAFPDS are reported for optimal geometrical design, operation, and performance. Additionally, a dedicated novel data processing protocol for deriving a representative mass spectrum from the 3D-recorded data obtained with SAFPDS is developed in combination with the SAFPDS hardware. Our study shows that this protocol effectively enhances the spectrometer's Figure of Merit (FOM), defined as the integral of the mass resolution (m/Δm) over the relevant mass range, by a factor of 2.4. Furthermore, the evaluation of the spectrometer equipped with SAFPDS highlights its capability to enhance the local count rate and dynamic range of sector field mass spectrometers with an MCP-based detector by at least one order of magnitude. Importantly, this enhancement is achieved with a deterioration in mass resolving power that remains below 30%, which we consider acceptable given the significant improvements in local count rate and dynamic range.

Comparative evaluation of endoscopic anti-reflux mucosectomy and stretta radiofrequency ablation in the management of gastroesophageal reflux disease: insights from a retrospective multicenter cohort study.

Treatment options for gastroesophageal reflux disease (GERD) that is unresponsive to proton pump inhibitors (PPIs) remain limited. Therefore, we compared the therapeutic effects of anti-reflux mucosectomy (ARMS) and Stretta radiofrequency (SRF) for intractable GERD in over 400 individuals who underwent either procedure. We conducted a retrospective study between 2016 and 2023 to evaluate the effectiveness of SRF and ARMS treatments for refractory GERD. The primary measure of success was the change in the GERD questionnaire (GERDQ) score. The secondary outcomes were various GERD-related indicators, including endoscopic Los Angeles (LA) classification, Hill's type-based flap valve grade (FVG), EndoFLIP™ distensibility index (DI), rate of PPI discontinuation, resolution rate of Barrett's esophagus, and incidence of adverse events. The ARMS group included patients with high GERDQ scores, FVG, LA grade, and Barrett's esophagus. Both groups had similar rates of improvements in GERDQ score (P = 0.884) and PPI withdrawal (P = 0.866); however, the ARMS group had significantly more side effects and improvements in the median change in GERDQ score (P = 0.011), FVG (P < 0.001), LA grade (P < 0.001), EndoFLIP™ DI (P < 0.001), and resolution of Barrett's esophagus (P < 0.001). The ARMS group had a greater GERDQ score improvement than the SRF group but had symptom relief and PPI discontinuation rates similar to those of the SRF group. However, objective measures, including EndoFLIP™ DI and endoscopic evaluations, were better in the ARMS group than in the SRF group.

Impact of Embolisate Penetration, Type, and Technique on Results After Standalone Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

BACKGROUND AND OBJECTIVES: Middle meningeal artery embolization (MMAE) has emerged as a promising modality for chronic/subacute subdural hematoma treatment; however, consensus regarding embolization technique and embolisate has not been achieved. We thus sought to compare the efficacy of distinct MMAE techniques and embolisate. METHODS: An institutional registry was reviewed to identify patients undergoing standalone MMAE for symptomatic chronic/subacute subdural hematoma. Surgical rescue rate and time preceding 50% hematoma resolution were evaluated across 3 technical groups: aggressive penetration (AP), nonaggressive penetration with proximal coil embolization (NP-PC), and nonaggressive penetration alone (NP). Effect sizes were adjusted for demographic, neurological and radiological features through multivariable logistic and Cox regression. RESULTS: Among 117 procedures, 33.3% achieved AP, 36.8% had NP-PC, and 29.9% had NP. The rate of surgical rescue was 2.6% after AP, 9.3% for NP-PC, and 11.4% for NP. In patients not undergoing rescue surgery, 82.4% achieved hematoma resolution ≥50% at a median imaging follow-up of 56 days; AP or NP-PC were each statistically significantly associated with enhanced hematoma resolution as compared with NP (P = .02). Similarly, sensitivity analysis within medium-size hematoma and antiplatelet/anticoagulation-at-admission subgroups revealed a superiority of resolution after AP or NP-PC. A unique, comparative secondary analysis of liquid embolisate (Onyx vs n-butyl cyanoacrylate) revealed no impact on rate of surgical rescue or hematoma resolution. CONCLUSION: AP was associated with the lowest rate of surgical rescue, while both AP and NP-PC were associated with improved rates of hematoma resolution.

Tolerability of the niraparib individualized starting dose in the PRIMA/ENGOT-OV26/GOG-3012 trial of niraparib first-line maintenance therapy

PurposeTo explore safety and tolerability parameters for the niraparib individualized starting dose (ISD) in patients with newly diagnosed advanced ovarian cancer that responded to platinum-based chemotherapy who participated in the phase 3 PRIMA/ENGOT-OV26/GOG-3012 trial (NCT02655016). MethodsThe PRIMA protocol was amended so newly enrolled patients received an ISD based on baseline body weight/platelet count. In this ad hoc analysis, the timing, duration, and resolution of the first occurrence of common any-grade hematologic (thrombocytopenia, anemia, neutropenia) and nonhematologic (nausea, asthenia/fatigue, constipation, insomnia, hypertension) treatment-emergent adverse events (TEAEs) were evaluated by treatment arm in the ISD safety population (data cutoff, November 17, 2021; median follow-up, 3.5 years). ResultsOf 733 randomized patients, 255 were enrolled after the ISD protocol amendment and received ≥ 1 dose of study treatment (niraparib, 169; placebo, 86). In the niraparib arm, median times to first events were 22.0–35.0 days for hematologic TEAEs and 7.0–56.0 days for nonhematologic TEAEs. First events resolved in ≥ 89.8% of patients for hematologic TEAEs; for nonhematologic TEAEs, resolution rates ranged from 55.3% (insomnia) to 86.0% (nausea). Median durations of first hematologic TEAEs were ≤ 16.0 days, but for first nonhematologic TEAEs ranged from 18.0 days (nausea) to 134.0 days (insomnia). ConclusionThe niraparib ISD was generally well tolerated and TEAEs were manageable. Common hematologic and nonhematologic TEAEs occurred early and first events of hematologic TEAEs had a short duration (≈ 2 weeks) and a high resolution rate. These findings support close monitoring immediately following niraparib initiation and may help inform patient expectations for niraparib safety.