Subsequent Success Rates Research Articles

A Cross-Sectional Study Evaluating the GuardianCPVTM Supraglottic Airway Device in a Clinical Setting

Objective: The GuardianCPVTM is a new second-generation supraglottic airway device (SAD), for which there is currently limited information on efficacy or safety. Our aim is to clarify further the efficacy of the Guardian, and to assess any potential predictors for success or failure of insertion. Methods: We conducted a cross-sectional pilot study over a two-month period, recruiting 67 operative cases (33 males; 34 females; weight 81.1 ± 23.0 kg) at the Northern Hospital (TNH), Victoria, Australia, that used the Guardian airway in an elective setting. For each case, the operator of the airway reported, via a voluntary questionnaire, several factors of interest: (1) the overall success rate (primary outcome); (2) ease of insertion; (3) cuff seal pressure (CSP); (4) need for repositioning of the SAD; and (5) patient, airway, operator and technique-related predictors, including past experience with the Guardian (as determined by number of times previously used) and insertion technique. Results: The overall success rate was 78%. There was a positive association between prior experience with the Guardian and subsequent success rates (p=0.049). Successful insertion was associated with greater ease with insertion (p=0.012), and greater CSPs (p<0.0001). The most popular insertion technique was sideways-and-rotate. No other patient, airway or technique-related factors had any significant impact on success rates with the Guardian. Conclusion: The Guardian SAD demonstrated similar efficacy to other SADs as reported in the literature. Prior familiarization with a new airway device is a key determinant in its successful use.

Defining competence in obstetric epidural anaesthesia for inexperienced trainees

Cumulative sum (CUSUM) analysis has been used for assessing competence of trainees learning new technical skills. One of its disadvantages is the required definition of acceptable and unacceptable success rates. We therefore monitored the development of competence amongst trainees new to obstetric epidural anaesthesia in a large public hospital. Obstetric epidural data were collected prospectively between January 1996 and December 2011. Success rates for inexperienced trainees were calculated retrospectively for (1) the whole database, (2) for each consecutive attempt and (3) each trainee's individual overall success rate. Acceptable and unacceptable success rates were defined and CUSUM graphs generated for each trainee. Competence was assessed for each trainee and the number of attempts to reach competence recorded. Mean (sd) success rate for all inexperienced trainees was 76.8 (0.1%), range 63-90%. Consecutive attempt success rate produced a learning curve with a mean success rate commencing at 58% on attempt 1. After attempt 10 the attempt number had no effect on subsequent success rates. From these results, the acceptable and unacceptable success rates were set at 65 and 55% respectively. CUSUM graphs demonstrated 76 out of 81 trainees competent after a mean of 46 (22) attempts. CUSUM is useful for assessing trainee epidural competence. Trainees require approximately 50 attempts, as defined by CUSUM, to reach competence.

Event recorder monitoring to compare the efficacy of a left versus biatrial lesion set in patients undergoing concomitant surgical ablation for atrial fibrillation

Various lesion sets and subsequent success rates have been reported in patients receiving concomitant surgical ablation for atrial fibrillation. However, most of these results have been obtained by discontinuous monitoring. We report results using continuous event recorder rhythm monitoring to compare more accurately the efficacy of a left versus biatrial lesion set to treat patients with persistent atrial fibrillation. Between July 2008 and December 2011, 66 patients with persistent or long-standing persistent atrial fibrillation underwent concomitant surgical atrial fibrillation ablation with a biatrial lesion set and subcutaneous event recorder implantation. The results and outcomes were compared with a propensity score-matched cohort of 66 patients with a left atrial lesion set and event recorder implantation. Event recorder interrogation was performed at 3, 6, and 12 months follow-up. The mean patient age was 70.2±7.4 years, and 70.3% were male. No major ablation-related complications occurred. One-year survival was 94.8% with no statistically significant differences between the 2 groups. The overall rate of freedom from atrial fibrillation was 57.3% and 64.4% after 3 and 12 months follow-up, respectively. Three months postoperatively, patients in the biatrial group had a slightly higher rate of freedom from atrial fibrillation (63.6% vs 52.3% P=.22), but it did not reach statistical significance. At 12 months follow-up, a statistically significant higher rate of freedom from atrial fibrillation was observed in patients with a biatrial lesion set (74.4% vs 55.8%; P=.026). The mean atrial fibrillation burden in all patients was 15.1%±12.5% in the biatrial group and 21.2%±14.4% in the left atrial group 12 months postoperatively (P=.03). Continuous rhythm monitoring by subcutaneous event recorder implantation was safe and feasible. In patients undergoing biatrial ablation, a statistically significant higher rate of freedom from atrial fibrillation was observed at 12 months follow-up.

The Role of Initial Success Rates and Other Factors in Determining Reliability of Outcomes of Phosphodiesterase Inhibitor Therapy for Erectile Dysfunction: A Pooled Analysis of 17 Placebo-Controlled Trials of Tadalafil for Use as Needed

Reliability of successful outcomes in men with erectile dysfunction (ED) on phosphodiesterase type 5 inhibitors is an important aspect of patient management. We examined reliability of successful outcomes in a large integrated dataset of randomized tadalafil trials. Success rates, time to success, subsequent success after first success, and probability of success were analyzed based on Sexual Encounter Profile questions 2 and 3. Data from 3,254 ED patients treated with tadalafil 10 mg (N = 510), 20 mg (N = 1,772), or placebo (N = 972) were pooled from 17 placebo-controlled studies. Tadalafil patients had significantly higher first-attempt success rates vs. placebo. This effect was consistent across most subgroups; however, patients with severe ED experienced a greater response to tadalafil than patients with mild-moderate ED. Approximately 80% of patients achieved successful penile insertion within two attempts with either tadalafil dose and successful intercourse within eight attempts for tadalafil 10 mg and four attempts for tadalafil 20 mg. However, approximately 70% of tadalafil-treated patients achieved successful intercourse even by the second attempt. Subsequent success rates were higher for patients with first-attempt success (81.5% for 10 mg and 86.1% for 20 mg vs. 66.2% for placebo, P < 0.001) vs. patients with later initial success (53.2% for 10 mg and 56.4% for 20 mg vs. 39.9% for placebo, P < 0.001). Among patients treated with tadalafil, intercourse success rates at early attempts were similar to rates at later attempts (i.e., attempts 5 and 10 vs. 25), although insertion success rates were significantly lower earlier in treatment. The findings affirm the reliability of successful outcomes with tadalafil treatment and that first-attempt success is a critical factor affecting subsequent outcomes. The results further show that even among men who did not succeed on first attempt, a substantial proportion will have successful outcomes if treatment is maintained.

Die‐Off Ratio Correlates with IncreasedTNF‐α:IL‐10 Ratio and DecreasedIVFSuccess Rates Correctable withHumira

Human embryos develop at varying rates in culture, with only a fraction of the eggs retrieved developing to 'transfer quality' embryos. We investigated whether the ratios between the number of eggs retrieved or the number of pro-nucleate embryos formed and the number of Day 3 embryos with ≥5 cells [oocyte 'die-off ratios' (DOR)] were correlated with the chance of IVF success, independent of other factors such as embryo grade score and patient's age. We also investigated what factors may be correlated with this ratio. 608 IVF fresh cycles in subfertile women were retrospectively evaluated. For each cycle, an oocyte DOR number was calculated as follows: Number of eggs retrieved divided by the number of Day 3 embryos with ≥5 cells. This number was correlated with the subsequent success rates for the index cycles. A 'post-fertilization' or 'embryo' die-off ratio (EDOR; the number of pro-nucleate embryos/the number of day 3 embryos ≥5 cells) was also calculated. The oocyte DOR showed a reverse linear correlation with IVF live birth rate. Live birth rate = (-5.75; DOR) +71.6 (with DOR > 1; P ≤ 0.005; R = -0.87). In addition, the oocyte DOR continued to show an inverse correlation with success rates even when embryo quality and patient's age were held constant. The post-fertilization or EDOR also continued to show a statistically significant negative correlation with live birth rate (R = -0.91; P ≤ 0.01). The preconception TNF-α:IL-10 ratio, an immmunologic marker (drawn 3.3 ± 2.6 months preconception), was more strongly correlated with high oocyte DOR than either age or number of eggs retrieved (P = 0.04, 0.14, 0.72, respectively). When anti-TNF-α therapy (Humira) was given preconception, the oocyte DOR's negative effect on live birth rate was nearly eliminated (correlation coefficient between oocyte DOR and live birth rate: cycles using no Humira, R = -0.90, P ≤ 0.006; cycles using Humira, R = 0.25, P ≤ 0.55). In subfertile women undergoing IVF, the oocyte DOR may help predict IVF success rates. This factor may offer an additional tool to help improve implantation rate, clinical pregnancy rate, live birth rate, and live birth rate per embryo transferred for an upcoming IVF cycle. Although many mechanisms may contribute to the oocyte DOR's negative effect on IVF success rates, its correlation with elevated preconception TNF-α:IL-10 ratio and correction with Humira suggests a strong immunologic component that may be treatable.

A prospective trial on ureteral stenting combined with secondary ureteroscopy after an initial failed procedure

The aim of this study is to investigate the impact of the intentional ureteral stenting on the success rate of calculus extraction by second ureteroscopy, when the initial ureteroscopy failed. We prospectively enrolled 512 patients with ureteral calculi who underwent ureteroscopies from April 2005 to May 2011. The patients with failed initial ureteroscopies were classified into two groups depending on the stent type: the Double-J stent and the ureteral catheter group. The secondary ureteroscopies were performed in a short period (3-22 days). Data were abstracted on stone size, location, patient demographics, outcome and complications. A total of 453 patients had success after the initial ureteroscopy and the success rate was 88.5%. Of the 59 failed patients, 40 were managed by reureteroscopy with Double-J stent placement and 19 with ureteral catheters. There were no statistically significant differences between patients in Double-J stent and ureteral catheter group in the aspects of age, primary stone size, gender, stone location and stone-free rate [39/40 (97.5%) versus 19/19 (100%), p > 0.05]. Moreover, the mean stents retaining period before the second ureteroscopy was significantly shorter in the ureteral catheter group, when compared with the Double-J stent group (3.9 versus 16.9 days, p < 0.01). The complications were moderate and not significantly different between the two groups (p > 0.05). Indwelling a ureteral stent leads to a high subsequent success rate for second ureteroscopy following an initial failed procedure. In addition to Double-J stent, the ureteral catheter stent was an effective alternative with shorter retaining period, especially for impacted stones.

Subsequent pregnancy outcomes in recurrent miscarriage patients with a paternal or maternal carrier of a structural chromosome rearrangement

Information concerning the prognosis of subsequent pregnancies in patients with reciprocal translocations is limited. This study was performed to determine the percentage success rate with first pregnancies after ascertainment of a carrier status. A total of 2,382 couples with a history of two or more consecutive miscarriages were studied in multicenters. The prevalence of an abnormal chromosome in either partner was examined, and subsequent success rates were compared between cases with and without an abnormal karyotype in either partner. A total of 129 couples (5.4%) had an abnormal karyotype in one partner excluding inversion 9 in 44 men and in 85 women. Thus, 2,253 couples had a normal karyotype in both partner. Eighty-five (3.6%) had translocations, 13 being Robertsonian translocations. Twenty-nine of the 46 cases (63.0%) who became pregnant with reciprocal translocations in either partner experienced a live birth with natural conception. In contrast, 950 of 1,207 cases (78.7%) with normal chromosomes had successful live births, the difference being significant (P = 0.019). No infant with an unbalanced translocation was found in 29 cases of successful pregnancy following recurrent miscarriage. Pregnancy prognosis was worsened with either maternal or paternal reciprocal translocations. Explanation of the success rate with natural conception should be provided before the subsequent pregnancy after ascertainment of carrier status.

Vardenafil provides reliable efficacy over time in men with erectile dysfunction

Objectives To evaluate the reliability of vardenafil efficacy and tolerability within 12 weeks in a broad population of men with erectile dysfunction (ED). Methods In a retrospective analysis of two pivotal, Phase III, randomized, double-blind, placebo-controlled trials conducted in 107 centers, 1650 men aged 18 years or older with ED received vardenafil 5 mg, 10 mg, or 20 mg on demand for 12 to 26 weeks. Outcome measures included the first-time and subsequent overall success rate until week 12 for diary entries regarding vaginal penetration (Sexual Encounter Profile [SEP]-2), erection maintenance (SEP-3), satisfaction with erection hardness, and overall satisfaction with the sexual experience. Mean efficacy was calculated for each patient during 12 weeks and then averaged for all patients within each treatment group. Results At baseline, the intention-to-treat population had moderate ED (International Index of Erectile Function-Erectile Function domain score of 13). For SEP-2 (penetration), the first-attempt and subsequent success rate was 44% and 74% for placebo, 71% and 81% for vardenafil 5 mg, 76% and 86% for vardenafil 10 mg, and 76% and 91% for vardenafil 20 mg, respectively. For SEP-3 (maintenance), first-attempt and subsequent success rate was 25% and 56% for placebo, 51% and 76% for vardenafil 5 mg, 65% and 76% for vardenafil 10 mg, and 59% and 84% for vardenafil 20 mg, respectively. For overall satisfaction with the sexual experience, the first-attempt and subsequent success rate was 19% and 48% for placebo, 48% and 68% for vardenafil 5 mg, 57% and 72% for vardenafil 10 mg, and 56% and 79% for vardenafil 20 mg, respectively. The reliability of vardenafil was similar or slightly greater in sildenafil-naive subjects compared with prior sildenafil responders. The most common adverse events were mild-to-moderate headache, flushing, and rhinitis. Conclusions Vardenafil provides reliable efficacy for key erectile function parameters important to patients when continuing oral treatment for ED.

Integrated analysis examining first-dose success, success by dose, and maintenance of success among men taking tadalafil for erectile dysfunction

Objectives To examine, in a post-hoc, integrated analysis, the first-dose success, cumulative success by dose, and maintenance of success among men taking tadalafil. Early treatment success is important to men with erectile dysfunction. Methods In five double-blind, placebo-controlled, 12-week studies, men were randomized to placebo (n = 308), tadalafil 10 mg (n = 321), or tadalafil 20 mg (n = 258) as a fixed dose. The Sexual Encounter Profile (SEP) diary questions assessed success from three perspectives: (a) first-dose success; (b) cumulative proportion of men with first success by dose; and (c) maintenance of success among men with first-dose success. Results With the first dose, significantly greater proportions of men taking tadalafil 10 and 20 mg versus placebo achieved successful erection (SEP-Q1: 85% and 90% versus 66%, respectively), successful penetration (SEP-Q2: 74% and 79% versus 47%, respectively), successful intercourse (SEP-Q3: 56% and 67% versus 31%, respectively), and were satisfied overall with their sexual experience (SEP-Q5: 36% and 47% versus 15%, respectively; all P <0.001). The proportion of men achieving first success increased with continued dosing, reaching a plateau between doses 4 and 8 at approximately 95% (SEP-Q2), 90% (SEP-Q3), and 81% (SEP-Q5). For men with first-dose success, the subsequent success rate during the 12-week period was significantly greater for men taking tadalafil 10 and 20 mg versus placebo (all P <0.001; SEP-Q2: 85% and 91% versus 75%; and SEP-Q3: 81% and 88% versus 64%, respectively). Conclusions Most men taking tadalafil achieved successful erection, penetration, and intercourse after one dose and maintained the success over time. Because success increased with continued use, men who do not respond initially should continue treatment to increase the likelihood of treatment success.

Endometrial integrin expression in women undergoing in vitro fertilization and the association with subsequent treatment outcome

Objective To study the endometrial expression of three integrins (αvβ3, α4β1, and α1β1) in women undergoing IVF–intracytoplasmic sperm injection (ICSI) treatment and assess whether they could be used to predict subsequent treatment success. Design Prospective observational study. Setting Healthy volunteers in a large teaching hospital. Patient(s) Sixty-six patients attending for IVF-ICSI treatment. Intervention(s) Timed endometrial biopsies were taken, during the implantation window at LH + 7–9 days, from women before IVF-ICSI treatment. Main outcome measure(s) Histological dating of endometrium and immunohistochemical staining intensity of α4β1, αvβ3, and α1β1 integrins. The integrin levels were correlated with subsequent success rates. Result(s) There was a statistically significantly greater expression of αvβ3 in the luminal epithelium of those patients who had successful treatment. However, treatment was successful in some patients with negative expression. Conclusion(s) Integrins are important markers of endometrial receptivity. There is an association between an in-phase endometrial biopsy, with positive luminal αvβ3 integrin expression, and subsequent treatment success. However, the clinical value of assessing the endometrium before treatment has drawbacks, and further work needs to be done before this can be considered a clinically useful test.

Enhancement of acrosome reaction and subzonal insemination of a single spermatozoon in mouse eggs

The acrosome reaction in mouse spermatozoa was induced by various means. These were 1) varying incubation time in T6 medium, 2) incubation in T6 medium with added A23187, 3) incubation in T6 medium with added dbcGMP and imidazole, 4) exposure to an electric field, and 5) a combination of incubation in a medium with dbcGMP and imidazole and electroporation. The mean percentages of acrosome-free spermatozoa obtained by these various methods and assessed on the basis of both Bryan's stain and immunolocalization by FITC-labeled monoclonal antibodies increased by steps from 36% to 67%, 73%, 86%, and 92%. Individual spermatozoa from the various treatments were afterwards microinjected under the zona pellucida of a mouse oocyte. The fertilization rate for eggs microinjected with a spermatozoon treated with A23187, dbcGMP, and imidazole, by electroporation and by a combination of the last two methods also increased by steps from 17% to 34%, 36%, and 70%, respectively. Ninety-five percent of the fertilized oocytes reached the early blastocyst stage, thirty-eight percent of these blastocysts implanted in pseudopregnant mice, and twenty-eight percent developed to term. These results indicated the varying degrees of success of different ways of inducing acrosomal loss in spermatozoa and their subsequent success rates in fertilization and further in vitro and in vivo development.

Use of the Double Pigtail Stent in Stone Retrieval following Unsuccessful Ureteroscopy

Insertion of a double pigtail stent is known to cause ureteric dilatation. We analysed the effect of an indwelling double pigtail stent on the success rate of calculus extraction by second ureteroscopy when the initial ureteroscopy fails. Over a 12-month period, a first ureteroscopy failed in 42 patients; 30 were then treated by ureteroscopy combined with a ureteric stent and 12 were treated without a ureteric stent. The group with an indwelling stent had a successful second ureteroscopy or spontaneously passed the calculus in 24 cases (84%) compared with 5 unstented cases (45%). Ureterolithotomy was necessary in 2 patients with a stent and 3 with no stent. It was concluded that following failed ureteroscopic manipulation of calculi, insertion of a double pigtail stent was associated with a higher subsequent success rate for removal of stone by ureteroscopy and a consequent lower rate of ureterolithotomy.

Changing Concepts of Crime and Its Treatment

organized, they at no point develop into political broadsheets urging reform. The essays, themselves, cover a wide range of topics illustrating the diversity of the modern criminological perspective. Several of them also make significant, if necessarily limited, contributions in their respective fields. Professor Wolfgang brings to the study of Negro criminality in the United States, the same thoroughness and capacity for handling inadequate statistics that distinguished 'The Measurement of Delinqency', of which he was co-author. Besides casting substantial doubt on some of the popular misconceptions surrounding this subject, his discussion offers a convenient summary of previous findings and goes some way towards drawing the criminal behaviour of the Negro into the ambit of modern aetiological theory. Dr. Charlotte Banks reports on a large-scale survey of boys detained in Prisons, Borstals and Detention Centres. Her report compares some of the characteristics differentiating the young offenders currently being sent to these three types of institution, and examines the possible effect on subsequent success-rates of the redistribution occasioned by the Criminal Justice Act of 1961. This survey can clearly supply some important information about the operation of the present system for deal ng with this age-group, and possibly merits publication at greater length than the space limitations of a symposium permit. The same might also pply to Paul de Berker's contribution on the sociological aspects of change in penal institutions. While his discussion adds little to the body of theory already accumulated, particularly by American scholars, it does provide a useful outline of the several