Similar Success Rates Research Articles

Combined EUS and ERCP in patients with malignant distal biliary obstruction is associated with reduced time to oncological therapy compared to ERCP and sampling alone.

Standard ERCP sampling techniques for pancreaticobiliary malignancy have modest yields that could lead to delays in treatment. We aimed to evaluate whether combining EUS guided tissue acquisition (EUS-TA) with ERCP versus ERCP alone at the time of index procedure improved time to first outpatient evaluation and oncological treatment. All patients without a prior pathological diagnosis who underwent index ERCP at Leeds Teaching Hospitals NHS Trust, United Kingdom, for malignant distal biliary obstruction from 2015 to 2020 were considered. A total of 292 patients were included, of whom 74.7% (n = 202) underwent EUS-TA/ERCP. A combined approach was more likely to establish a positive diagnosis (96.5% (n = 195) vs 57.8% (n = 52), p < 0.01) and less likely to require further sampling procedures (2.0% (n = 4) vs 17.8% (n = 16), p < 0.01). Mean times to first outpatient evaluation (16.9 vs 24.5 days (p = 0.01)) and oncological treatment (55.1 vs 79.3 days (p = 0.03)) were significantly shorter in the EUS-TA/ERCP group. A third (n = 86) of patients with a positive diagnosis did not receive oncological/surgical treatment. In our cohort of patients, a combined approach was associated with improved diagnostic yield, reduced need for repeat sampling procedures and reduced time to evaluation and treatment, with similar therapeutic success and adverse event rates. Careful multidisciplinary discussion is recommended to avoid performing unnecessary EUS procedures on patients who will not benefit from further treatment.

Efficacy of Antibiotic Regimens for Sepsis or Possible Serious Bacterial Infection in Young Infants Aged 0 to 59 Days: A Systematic Review and Meta-analysis.

Sepsis is a leading cause of young infant mortality. To evaluate the efficacy of different antibiotic regimens to treat young infant sepsis or possible serious bacterial infection (PSBI) on clinical outcomes. MEDLINE, Embase, CINAHL, World Health Organization Global Index Medicus, Cochrane Central Registry of Trials. We included randomized controlled trials (RCTs) of young infants 0 to 59 days with sepsis or PBSI (population) comparing the efficacy of antibiotic regimens (intervention) with alternate regimens or management (control) on clinical outcomes. We extracted data and assessed risk of bias in duplicate. We performed random-effects meta-analysis, and used Grading of Recommendations, Assessment, Development, and Evaluation to assess certainty of evidence. Of 2390 publications, we included 41 RCTs (n = 18 054). Thirty-five trials were hospital-based and 6 were nonhospital-based. Meta-analysis of 4 trials demonstrated similar rates of treatment success with intramuscular/intravenous third generation cephalosporins versus intramuscular/intravenous penicillin or ampicillin + gentamicin (RR 1.03, 95% CI 0.93-1.13]; n = 1083; moderate certainty of evidence). Meta-analysis of 3 trials demonstrated similar rates of treatment failure with oral amoxicillin + intramuscular gentamicin versus intramuscular penicillin + gentamicin for nonhospital treatment of clinical severe illness (RR 0.86, 95% CI 0.72-1.02]; n = 5054; low certainty of evidence). Other studies were heterogeneous. RCTs evaluated heterogeneous regimens, limiting our ability to pool data. We found limited evidence to support any single antibiotic regimen as superior to alternate regimens to treat young infant sepsis or PSBI.

Efficacy of Antibiotic Regimens for Pneumonia in Young Infants Aged 0-59 Days: A Systematic Review.

Pneumonia is a leading cause of death in young infants. To evaluate the efficacy of different antibiotic regimens to treat young infant pneumonia on critical clinical outcomes. MEDLINE, Embase, CINAHL, World Health Organization (WHO) Global Index Medicus, Cochrane Central Registry of Trials. We included randomized controlled trials of young infants aged 0 to 59 days with pneumonia (population) comparing the efficacy of antibiotic regimens (intervention) with alternate regimens or management (control) on clinical outcomes. We extracted data and assessed risk of bias in duplicate. We used Grading of Recommendations, Assessment, Development, and Evaluation to assess certainty of evidence. Trials were heterogeneous, which precluded data pooling. Of 2601 publications screened, 10 randomized controlled trials were included. Seven trials were hospital-based (n = 869) and 3 were nonhospital-based (n = 4329). No hospital-based trials evaluated WHO-recommended first-choice regimens. One trial found the WHO-recommended second-choice antibiotic, cefotaxime, to have similar rates of treatment success as non-WHO-recommended regimens of either amoxicillin-clavulanate (RR 0.99, 95% confidence interval 0.82-1.10) or amoxicillin-clavulanate/cefotaxime (RR 1.02, 95% confidence interval 0.86-1.12). Among 3 nonhospital-based trials comparing oral amoxicillin to alternate regimens to treat isolated tachypnea among infants aged 7-59 days, there were no differences in treatment failure between amoxicillin and alternate regimens. Certainty of evidence was low or very low for all primary outcomes. We found limited evidence to support the superiority of any single antibiotic regimen over alternate regimens to treat young infant pneumonia.

Endoscopic diagnostic and therapeutic management of branchial cleft fistula type III & IV: a single tertiary centre experience.

To date, recurrent neck abscesses associated with branchial anomalies are treated using a variety of techniques. Management strategies may include various imaging modalities and surgical methods. Endoscopic assessment and electrocauterization are the preferred diagnostic modalities and treatment strategies that have recently gained widespread acceptance and popularity. This was a retrospective review on patients' medical record from 2016 to 2023. Seven patients underwent endoscopic cauterization at our centre, a tertiary academic institution. Five of the patients (71.5%) achieved complete remission. Two patients experienced recurrence within 6 months that necessitated re-cauterization once but subsequently recovered completely. Currently, endoscopic management is the preferred approach compared to the typical open neck excision surgery as it is significantly less invasive, resulting in lesser morbidity and similar success rates. At presentation, all of them had ultrasound neck that suggestive of neck abscess. Computed tomography or magnetic resonance imaging unable to provide adequate information about the side of internal opening of fistula where only 3 out of 7 patients demonstrated tract up to the ipsilateral region of pyriform fossa. Management outcomes of this limited case series showed the potential benefits of endoscopic cauterization as the minimally invasive therapeutic method for recurrent neck abscesses caused by third and fourth branchial cleft fistulas but also to suggest the possibility as the first diagnostic tool prior to imaging studies.

Epley's Manoeuvre vs. Semont's Maneuver in Post-Canal Benign Paroxysmal Positional Vertigo: A Comparative Study in a Tertiary Centre.

This was a prospective, comparative study conducted at a tertiary care hospital. One hundred patients diagnosed with post-canal BPPV were randomized into two groups: Group A (n = 50) underwent the Epley's manoeuvre, and Group B (n = 50) underwent the Semont's manoeuvre. The patients were assessed for the resolution of vertigo and nystagmus immediately after the manoeuvre and at a follow-up visit one week later. The resolution of symptoms was confirmed through Dix-Hallpike test. In Group A, 46 patients (92%) reported complete resolution of vertigo immediately after Epley's manoeuvre, and 47 patients (94%) had no nystagmus on the Dix-Hallpike test at the one-week follow-up. In Group B, 42 patients (84%) reported complete resolution of vertigo immediately after Semont's manoeuvre, and 44 patients (88%) had no nystagmus on the DH test at the one-week follow-up. The difference in effectiveness between the two manoeuvres was not statistically significant (p > 0.05). Both Epley's manoeuvre and Semont's manoeuvre are effective in treating post-canal BPPV, with similar success rates. The choice of manoeuvre may depend on patient preference, clinician expertise, and other individual factors. Further studies with larger sample sizes are warranted to validate these findings and explore other potential factors influencing the outcomes of canalith repositioning manoeuvres in BPPV.

Vitrectomy versus scleral buckle for retinal detachment without posterior vitreous detachment

To compare the effectiveness and safety of scleral buckling and pars plana vitrectomy in treating retinal detachment without posterior vitreous detachment. A total of 88 eyes of 83 patients with retinal detachment without prior posterior vitreous detachment were investigated retrospectively. Group A comprised patients who underwent scleral buckling (n = 47) and Group B (n = 36) patients who were treated with pars plana vitrectomy. Anatomical success, postoperative visual acuity, and ocular adverse events were evaluated. The primary and final anatomical success rate showed a nonsignificant difference (p = 0.465 and p = 0.37 respectively). No significant difference was observed in the reoperation rate or development of epiretinal membrane between the groups (p = 0.254 and p = 0.254 respectively). However, scleral buckling resulted in significantly better visual acuity at the last follow-up (0.12 ± 0.23) compared to pars plana vitrectomy (0.37 ± 0.46, p = 0.001). The incidence of cataract progression was also significantly higher in the pars plana vitrectomy group (46%) compared to the scleral buckling group (10%, p < 0.001). Scleral buckling and pars plana vitrectomy show similar success rates in treating retinal detachment without vitreous detachment. However, due to less cataract progression and better visual acuity outcomes, scleral buckling is recommended for these cases. Determining vitreous status before surgery is crucial for optimal outcomes.

Renal Access in Pediatric Supine Miniaturized Percutaneous Nephrolithotomy: Comparative Evaluation of Ultrasound-Fluoroscopy Combined and Biplanar (0°-90°) Fluoroscopic Techniques.

Introduction: Ultrasound (US)-guided puncture has the benefits of avoiding radiation and limiting the risk of visceral injury. We aimed to evaluate the results of two different renal access techniques during pediatric supine mini percutaneous nephrolithotomy (smPCNL) in a comparative manner. Patients and Methods: Data obtained from pediatric patients undergoing smPCNL by single surgeon between September 2021 and 2023 were reviewed retrospectively. Children were divided into two groups namely; biplanar 0°-90° fluoroscopy (Group-F) and US-fluoroscopy combined (Group-C). In all cases, preoperative, operative, and postoperative findings were recorded. Success was defined as the determination of either no (complete stone-free status) or < 4 mm residual fragments (CIRF) on US and X-ray (postoperative 3rd month) images. Complications were evaluated according to modified Clavien-Dindo classification. Results: Data of 54 patients with a mean age of 8.6 years (Group-F = 30, Group-C = 24) are reviewed. In addition to the similar success rates in both groups (Group-F = 86.7% Group-C = 87.5% p = 0.928), similar minor complications were noted in the majority of the cases. No child required transfusion and/or angioembolization. Although the fluoroscopy and operation time were lower in Group-C, the difference was not statistically significant. Conclusion: US-fluoroscopy combined access technique can be applied with similar success and complication rates in pediatric smPCNL. Ultimately, as experience is gained, this technique may lower radiation exposure, although this was not observed in the current study.

Unbiased analysis of spatial learning strategies in a modified Barnes maze using convolutional neural networks

Assessment of spatial learning abilities is central to behavioral neuroscience and a useful tool for animal model validation and drug development. However, biases introduced by the apparatus, environment, or experimentalist represent a critical challenge to the test validity. We have recently developed the Modified Barnes Maze (MBM) task, a spatial learning paradigm that overcomes inherent behavioral biases of animals in the classical Barnes maze. The specific combination of spatial strategies employed by mice is often considered representative of the level of cognitive resources used. Herein, we have developed a convolutional neural network-based classifier of exploration strategies in the MBM that can effectively provide researchers with enhanced insights into cognitive traits in mice. Following validation, we compared the learning performance of female and male C57BL/6J mice, as well as that of Ts65Dn mice, a model of Down syndrome, and 5xFAD mice, a model of Alzheimer’s disease. Male mice exhibited more effective navigation abilities than female mice, reflected in higher utilization of effective spatial search strategies. Compared to wildtype controls, Ts65Dn mice exhibited delayed usage of spatial strategies despite similar success rates in completing this spatial task. 5xFAD mice showed increased usage of non-spatial strategies such as Circling that corresponded to higher latency to reach the target and lower success rate. These data exemplify the need for deeper strategy classification tools in dissecting complex cognitive traits. In sum, we provide a machine-learning-based strategy classifier that extends our understanding of mice’s spatial learning capabilities while enabling a more accurate cognitive assessment.

Impact of previously failed extracorporeal shock wave lithotripsy on ureterorenoscopy outcomes in upper urinary tract stones: a prospective comparative study.

We sought to prospectively evaluate the impact of previously failed SWL on subsequent URS outcomes in the treatment of upper urinary tract stones. Between May 2021 and May 2023, one hundred thirty-six patients with proximal ureteral stones < 1.5cm and renal stones < 2.5cm who were candidates for URS were prospectively assigned to a non-SWL group, which included patients without a history of failed SWL before URS, and a post-SWL group, which included patients with a history of failed SWL before URS. The success rate was the primary outcome. The perioperative data of the two groups were compared. The stone-free rate was 83.3% in the post-SWL group versus 81.3% in the non-SWL group, and 8.3% in the post-SWL group versus 9.4% in the non-SWL group had clinically insignificant residual fragments. There was no significant difference in the stone-free rate or success rate between the groups. No significant differences in intraoperative fluoroscopy time, operative time, intraoperative stone appearance, perioperative complications, or the presence of embedded fragments in the ureteral mucosa were detected between the two groups. Compared with patients who underwent primary URS, patients who underwent salvage URS for upper urinary tract stones had similar stone-free rates, success rates, operative times, fluoroscopy times, and complication rates without any significant differences.

The Feasibility, Safety and Middle Term Clinical Outcome Study of Chronic Total Occlusion Percutaneous Coronary Intervention among Elderly Aged &lt;75 Years versus ≥75 Years in a High Intravascular Imaging Usage Centre

Background: Chronic total occlusion (CTO) is common among elderly patients, yet data on their outcomes with CTO percutaneous coronary intervention (PCI) remain limited. Understanding the feasibility, safety and clinical outcomes of CTO-PCI in this population is crucial for optimal care. The present study aimed to evaluate these aspects in elderly patients aged &lt;75 versus ≥75 years. Methods: Two hundred and fifty-eight patients who underwent CTO-PCI at a single Japanese centre, categorised into two groups: &lt;75 and ≥75 years old, were retrospectively analysed. Demographics, clinical factors, angiography and procedure data were collected. Follow-up data were obtained from electronic health records. The primary outcome measure was target lesion failure (TLF) at 1-year follow-up. Kaplan-Meier curve analysis and multivariable Cox-regression analysis were performed to identify predictors of TLF. Results: 68.6% were &lt;75 years old and 31.4% were ≥75 years old. Similar procedural success rates were observed. There were no significant differences in 1-year TLF, death, non-fatal MI or target-lesion revascularisation. The older group had a higher rate of intraprocedural complications. Mechanical circulatory support and emergency PCI negatively impacted target-lesion revascularisation-free survival in older patients, while hypertension appeared protective. Conclusion: The present study demonstrates the feasibility, safety and good mid-term outcomes of CTO-PCI in elderly patients. These findings suggest its potential as a treatment option for appropriate elderly patients. Additionally, possible risk factors for adverse events were identified, potentially guiding future management strategies. Therefore, elderly patients with CTO should not be deprived of invasive PCI strategies when appropriate.

Needle aspiration versus tube thoracostomy in patients with symptomatic primary spontaneous pneumothorax: an updated meta-analysis of randomized controlled trials.

Primary spontaneous pneumothorax (PSP) is an important disease commonly seen in young males. While incidentally diagnosed cases can be managed conservatively, symptomatic patients often necessitate intervention. Chest tube placement (tube thoracostomy) is commonly used, at least in the USA as a primary treatment modality, which requires hospitalization. On the other hand, needle aspiration (NA) has been widely adopted due to simplicity and reported efficacy and safety. No consensus is reached regarding superiority and/or preferred modality, with a lack of guidelines agreement. Therefore, we conducted an updated meta-analysis of randomized controlled trials comparing NA to tube thoracostomy in patients with symptomatic PSP. Prespecified outcomes were immediate success rate, 12-month recurrence rate, post intervention complications rate, and hospital length of stay. We identified and pooled data from six randomized trials, with a total of 759 patients and a median follow up of 12 months. Our analysis showed that NA and tube thoracostomy have similar immediate success rate and 12-month recurrence rate. We also found that NA has less complication rate, need for surgical intervention, and less hospital stays. In conclusion, our review showed that in symptomatic patients with PSP, NA is as effective as tube thoracostomy regarding immediate success rate and 12-month recurrence rate, with the added benefit of less complications rate and need for surgical intervention.

Comparative Efficacy of Fecal Microbiota Transplantation in Treating Refractory or Recurrent Clostridioides difficile Infection among Patients with and without Inflammatory Bowel Disease: A Retrospective Cohort Study.

Clostridioides difficile infection (CDI) worsens inflammatory bowel disease (IBD) prognosis. While fecal microbiota transplantation (FMT) is effective for refractory or recurrent CDI (rrCDI), comparative success rates between IBD and non-IBD patients are scarce. This study addresses this gap. A retrospective cohort study was conducted at Chang Gung Memorial Hospital from April 2019 to October 2023. Patients receiving FMT for rrCDI were categorized into IBD and non-IBD groups. Baseline characteristics and outcomes were compared at one month and one year, with successful FMT defined as the resolution of diarrhea without CDI recurrence. The study included 88 patients: 30 with IBD and 58 without IBD. The IBD group was younger, with fewer comorbidities. Success rates at one month were similar between groups (IBD: 80.0% vs. non-IBD: 78.9%, p = 0.908), as were negative toxin tests (IBD: 83.3% vs. non-IBD: 63.8%, p = 0.174). One-year success rates (IBD: 70.0% vs. non-IBD: 67.6%, p = 0.857) and eradication rates (IBD: 94.4% vs. non-IBD: 73.9%, p = 0.112) were also similar. Poor bowel preparation predicted FMT failure at one month (OR = 0.23, p = 0.019). No safety issues were reported. FMT is a safe, effective treatment for rrCDI, demonstrating similar success rates in patients with and without IBD.

No mess with mesh; vaginal natural orifice transluminal endoscopic surgery (vNOTES) autologous posterior rectus fascia mesh for vaginal urinary incontinence procedures

Urinary incontinence affects 25–45 % of women with the gold standard surgical approach being placement of mid-urethral synthetic slings; tension-free vaginal tape (TVT) and trans-obturator tape (TOT). Due to the controversies regarding vaginal mesh the last decade, an increasing demand has evolved for incontinence treatment without vaginal synthetic mesh. The short term results of autologous rectus fascia sling for TOT surgery have shown similar success rates compared to those after the use of synthetic mesh, but the harvesting of the mesh is less minimally invasive and is associated with longer surgical time.vNOTES is a combination of a vaginal entrance to the abdomen and endoscopy via the vagina.The aim with the video is to show a new surgical technique with a fully vaginal, scarless vNOTES approach for harvesting the posterior rectus fascia for TVT and TOT procedures.

The Clinical Usability Evaluation of an Attachable Video Laryngoscope in the Simulated Tracheal Intubation Scenario: A Manikin Study.

The aim of this study was to assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and a monitor to a conventional Macintosh laryngoscope (CML). Normal and tongue edema airway scenarios were simulated using a manikin. Twenty physicians performed tracheal intubations using CML, AVL, Pentax Airwayscope® (AWS), and McGrath MAC® (MAC) in each scenario. Ten physicians who had clinical experience in using tracheal intubation were designated as the skilled group, and another ten physicians who were affiliated with other departments and had little clinical experience using tracheal intubation were designated as the unskilled group. The time required for intubation and the success rate were recorded. The degree of difficulty of use and glottic view assessment were scored by participants. All 20 participants successfully completed the study. There was no difference in tracheal intubation success rate and intubation time in the normal airway scenario in both skilled and unskilled groups. In the experienced group, AWS had the highest success rate (100%) in the tongue edema airway scenario, followed by AVL (60%), MAC (60%), and CML (10%) (p = 0.001). The time required to intubate using AWS was significantly shorter than that with AVL (10.2 s vs. 19.2 s) or MAC (10.2 s vs. 20.4 s, p = 0.007). The difficulty of using AVL was significantly lower than that of CML (7.8 vs. 2.8; p < 0.001). For the experienced group, AVL was interpreted as being inferior to AWS but better than MAC. Similarly, in the unskilled group, AVL had a similar success rate and tracheal intubation time as MAC in the tongue edema scenario, but this was not statistically significant. The difficulty of using AVL was significantly lower than that of CML (8.8 vs. 3.3; p < 0.001). AVL may be an alternative for VL.

Low-dose immune tolerance induction for severe hemophilia A inhibitor patients: Immunosuppressants are generally not necessary for inhibitor-titer below 200 BU/mL.

It remained unclear that the efficacy comparison between low-dose immune tolerance induction (LD-ITI) incorporating immunosuppressants (IS) when severe hemophilia A (SHA) patients had inhibitor-titer ≥200 Bethesda Units (BU)/mL (LD-ITI-IS200 regimen) and LD-ITI combining with IS when SHA patients had inhibitor-titer ≥40 BU/mL (LD-ITI-IS40 regimen). To compare the efficacy of the LD-ITI-IS200 regimen with that of the LD-ITI-IS40 regimen for SHA patients with high-titer inhibitors. A prospective cohort study on patients receiving LD-ITI-IS200 compared to those receiving LD-ITI-IS40 from January 2021 to December 2023. Both received LD-ITI [FVIII 50 IU/kg every other day]. IS (rituximab + prednisone) was added when peak inhibitor tier ≥200 BU/mL in the LD-ITI-IS200 regimen and ≥40 BU/mL in the LD-ITI-IS40 regimen. Success is defined as a negative inhibitor plus FVIII recovery ≥66% of the expected. We enrolled 30 patients on LD-ITI-IS200 and 64 patients on LD-ITI-IS40, with similar baseline clinical characteristics. A lower IS-use rate was discovered in the LD-ITI-IS200 regimen compared to the LD-ITI-IS40 regimen (30.0% vs. 62.5%). The two regimens (LD-ITI-IS200 vs. LD-ITI-IS40) had similar success rate (70.0% vs. 79.7%), median time to success (9.4 vs. 10.6 months), and annualized bleeding rate during ITI (3.7 vs. 2.8). The cost to success was lower for LD-ITI-IS200 than for LD-ITI-IS40 (2107 vs. 3256 US Dollar/kg). Among patients with peak inhibitor-titer 40-199 BU/mL, 10 non-IS-using (on LD-ITI-IS200 regimen) and 28 IS-using (on LD-ITI-IS40 regimen) had similar success rates (70.0% vs. 78.6%) and time to success (9.0 vs. 8.8 months). In LD-ITI, IS are not necessary for inhibitor titer <200 BU/mL.

Evaluating the Performance of ChatGPT in Urology: A Comparative Study of Knowledge Interpretation and Patient Guidance.

Background/Aim: To evaluate the performance of Chat Generative Pre-trained Transformer (ChatGPT), a large language model trained by Open artificial intelligence. Materials and Methods: This study has three main steps to evaluate the effectiveness of ChatGPT in the urologic field. The first step involved 35 questions from our institution's experts, who have at least 10 years of experience in their fields. The responses of ChatGPT versions were qualitatively compared with the responses of urology residents to the same questions. The second step assesses the reliability of ChatGPT versions in answering current debate topics. The third step was to assess the reliability of ChatGPT versions in providing medical recommendations and directives to patients' commonly asked questions during the outpatient and inpatient clinic. Results: In the first step, version 4 provided correct answers to 25 questions out of 35 while version 3.5 provided only 19 (71.4% vs 54%). It was observed that residents in their last year of education in our clinic also provided a mean of 25 correct answers, and 4th year residents provided a mean of 19.3 correct responses. The second step involved evaluating the response of both versions to debate situations in urology, and it was found that both versions provided variable and inappropriate results. In the last step, both versions had a similar success rate in providing recommendations and guidance to patients based on expert ratings. Conclusion: The difference between the two versions of the 35 questions in the first step of the study was thought to be due to the improvement of ChatGPT's literature and data synthesis abilities. It may be a logical approach to use ChatGPT versions to inform the nonhealth care providers' questions with quick and safe answers but should not be used to as a diagnostic tool or make a choice among different treatment modalities.

Safety and feasibility of zero-fluoroscopy technique in ablation-index guided pulmonary vein isolation: a prospective, single center trial

Abstract Introduction Pulmonary vein isolation (PVI) represents the cornerstone of catheter ablation procedures in patients with symptomatic paroxysmal/persistent atrial fibrillation (AF). Conventionally, PVI is performed using fluoroscopy, but it can also be performed using the zero-fluoroscopy (ZF) technique with the assistance of electroanatomical mapping systems and intracardiac ultrasound, achieving fluoroscopy-free procedures. Purpose Our study aimed to compare procedural data of ablation-index guided point-by-point radiofrequency (RF) PVI performed with non-zero-fluoroscopy (NZF) vs. ZF approaches. Methods We enrolled 100 consecutive patients undergoing PVI for antiarrhythmic drug- refractory AF in our prospective observational study. In the first 50 cases, PVI was performed using the NZF technique, and in the other 50 cases, the ZF technique was applied. Procedural time, fluoroscopy exposure, ablation parameters, and the occurrence of complications were compared between the two groups. Results Compared to the NZF group, procedural time (59.6±10.7 min vs. 74.6±13.2 min, p&amp;lt;0.0001) was significantly shorter in the ZF group. This difference was mainly driven by the time from puncture to the beginning of left atrial mapping, which was significantly longer in the NZF group (17 [16; 20] min vs. 31 [23; 34.5] min, p&amp;lt;0.001). No differences were found between the two approaches in the number of RF applications (81 [73; 103] vs. 83 [71; 91], p=0.67), total ablation energy (54986 ± 13093 Ws vs. 55500 ± 11907 Ws, p=0.48), and the left atrial dwelling time (41.5 [36; 52.5] min vs. 40.5 [35; 46], p=0.14). No complications occurred in either group. In the ZF group, complete elimination of fluoroscopy was achieved in all cases, resulting in significant differences in fluoroscopy time (0 [0; 0] sec vs. 132 [100; 160] sec, p&amp;lt;0.0001] and dose (0 [0; 0] mGy vs. 4.8 [4.1; 8.2] mGy, p&amp;lt;0.0001) compared to the NZF technique. The acute success rate was 100% in the study population, and no complications occurred during the study period. Conclusion Ablation-index guided ZF PVI is feasible and safe. Using this technique, the procedure time can be shortened besides achieving a similar acute success rate without increasing complications.

Use of a novel, mode-switching electroanatomic mapping function and its effect on procedure and fluoroscopy duration in de novo AF procedures

Abstract Background Electroanatomical mapping systems utilize either an impedance-primary (IP) or magnetic-primary (MP) coordinate system for navigation. IP systems allow visualization of metal within the impedance field and can be scaled with supplemental magnetic information. MP systems collect information from catheters with a magnetic sensor, and supplementary impedance information is used to visualize catheters without a sensor. One commercially available mapping system offers both IP and MP navigation modes; however, operators must select a mode at procedure start. A novel software function allowing for near-instant transition between modes was recently introduced; its impact on procedural metrics has not yet been quantified. Objective Assess the impact of a mode-switching software function (MS) on acute procedural metrics in de novo paroxysmal atrial fibrillation (PAF) cases in which both the IP and MP modes were used, compared to procedures in which IP or MP was used alone. Methods Observational data was collected from 309 de novo PAF cases performed at 63 centers in Europe, the US, and Australia. Ablation technology used, procedure duration, fluoroscopy time, and acute outcomes were collected. Results Of 309 cases analyzed, 157 (50.8%) used MS, 97 (31.4%) used MP alone, and 55 (17.8%) used IP alone. Radiofrequency ablation (RFA) was used in 291 (94.2%) cases, while the remaining 18 (5.8%) used cryoablation. Irrigated, contact force sensing RFA catheters were used in 153 (97.4%) MS, 89 (91.8%) MP, and 29 (52.7%) IP cases. Mean procedure durations for MS and MP cases were similar: 106.2±51.6 min and 106.8±53.0 min, respectively (p=0.93). However, IP cases were significantly longer than both MS and MP cases, 134.2±53.8 min (p=0.002). Fluoroscopy time was significantly less in the MS group compared to MP and IP groups: 3.9±5.5, 6.1±5.2, and 7.8±6.4 min, respectively (p&amp;lt;0.001). No fluoroscopy was used in significantly more MS compared to MP or IP cases: 72 (45.9%) MS, 10 (10.3%) MP, and 8 (14.5%) IP cases (p&amp;lt;0.001). When these 90 cases were excluded, mean fluoroscopy times were similar between MS, MP, and IP cases (7.1±5.6, 6.8±5.0, and 9.2±5.9 min, respectively (p=0.05)). Acute success rates were not significantly different between modes: 98.6% MS, 100% MP, and 100% IP (p=0.49). Conclusions In this analysis of international usage of a novel software function, cases utilizing MS had significantly shorter fluoroscopy durations with similar acute success rates and procedure durations than those using MP or IP. When zero fluoroscopy cases were excluded, there was no significant difference in fluoroscopy times; however, there were significantly more zero fluoroscopy cases in the MS group, indicating that, while MS supports and may encourage low-fluoroscopy workflows, differences in procedural metrics seen may be biased by operator preference. Future analyses are warranted to provide insight into operator-specific metrics when using MS.Fluoroscopy Duration Comparison

Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial

ObjectiveThis randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. MethodsInclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). ResultsThe follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03). ConclusionThis study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. Clinical significanceSCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Clinical outcomes of peroral endoscopic myotomy with and without septotomy for management of epiphrenic diverticula: an international multicenter experience (with video)

There are few data favoring the need for septotomy at the time of peroral endoscopic myotomy (POEM) or if POEM alone is sufficient. Our aim was to compare POEM outcomes with and without septotomy (POEM+S or POEM-S) in patients with symptomatic epiphrenic diverticula (ED) and an underlying motility disorder. This was an international, multicenter retrospective study involving 21 centers between January 2014 and January 2023. Patients with ED and an underlying motility disorder who underwent POEM were included. The primary outcome was clinical success (Eckardt score [ES]≤3 or a 1-point drop in ES for patients with baseline ES<3) without the need for repeat surgical/endoscopic interventions during follow-up. A total of 85 patients (mean age, 64.29 ± 17.1 years; 32 [37.6%] female) with ED and underlying motility disorder underwent POEM+S (n= 47) or POEM-S (n= 38). Patients in the POEM+S group had a significantly higher mean pre-POEM ES (7.3 ± 2.1 vs 5.8 ± 2; P= .002). The most common indication for POEM was achalasia (51% in the POEM+S cohort and 51.8% in the POEM-S cohort; P= .7). A posterior approach was favored in the POEM+S group (76.6% vs 52.6%; P= .02). A similar rate of technical success was seen in both groups (97.9% vs 100%; P= .1). The rate of adverse events was similar between the 2 cohorts (4.2% vs 8.1%; P= .6). The median length of hospital stay after POEM-S was significantly longer compared with POEM+S (2 days [interquartile range (IQR), 1-4 days] vs 1 day [IQR, 1-2 days]; P= .005). Clinical success was equivalent between the 2 groups (83% vs 86.8%; P= .6) at a median follow-up duration of 8 months (IQR, 3-19 months). In patients with ED and an underlying motility disorder, both POEM+S and POEM-S are equally safe and effective, with similar procedure duration and a low recurrence rate at short-term follow-up. Future comparative prospective studies with long-term follow-up are required to validate these findings.