Techniques In Terms Of Efficacy Research Articles

Power transmission system’s fault location, detection, and classification: Pay close attention to transmission nodes

For transmission systems to operate safely and reliably, fault identification and classification are essential. However, power network physical architecture and data information cannot be fully utilized by conventional intelligent approaches. This study,therefore,presents a fault localization, detection, and classification model for transmission systems that concentrate on the key distribution nodes. The model makes use of a deep graph neural network with multi-scale attention and multi-linear perceptron block which accounts for the power network's structural composition during learning. The model's capacity to manage unusual data input and unidentified application situations is improved by the inclusion of multi-scale attention. Furthermore, it enables the model to precisely pinpoint fault areas by identifying patterns and connections among system parts, concentrating on specific areas or nodes. In addition, a multi-linear perceptron block is designed to enhance the capturing of amplitude information and increase comprehension. The efficiency and generalizability of the proposed model are improved by the implementation of a multi-task training approach for locating faults and their type. With the use of two IEEE 13-Bus systems and the PSS/E 23-Bus system, the proposed fault diagnosis model is tested. Examining various setups for fault analysis allows for a more thorough evaluation of the model's ability to generalize and disturbance resilience. Experimental findings show that the proposed model outperforms existing cutting-edge techniques in terms of efficacy with a balanced accuracy of 0.8204 for classification, 0.556 for localization, and a Macro MAE of 38.780 for detection.

Percutaneous Balloon Compression for Trigeminal Neuralgia. A Comparative Study Between the Fluoroscope Guided and Neuronavigated Technique.

Percutaneous balloon compression (PBC) is a safe and effective procedure in the treatment of trigeminal neuralgia (TN) due to its simplicity, low cost and the possibility of being repeated in case of pain recurrence. Foramen ovale (FO) cannulation is accomplished with the assistance of intraoperative C-arm fluoroscopy. Recently, several authors have reported successful application of intraoperative CT navigation as well. The reported advantages of CT navigation are linked to better spatial orientation and the low rate of attempts for FO cannulation. However, these advantages should be considered in the face of concerns regarding increased radiation dose to the patient and its possible adverse effects. Here we compared the fluoroscopic guided and neuronavigated PBC techniques in terms of efficacy and radiological exposure. We retrospectively analyzed 37 patients suffering for TN and submitted to PBC. We observed a significant improvement of pain at 1month FU compared with the pre-operative in both groups (p<0.0001 and p<0.0001, respectively). A significant increase in radiation exposure was found in the neuronavigated group compared with the fluoroscopy group (p<0.0001). We suggest the use of neuronavigated PBC only in selected cases, such as patients with multiple previous operations, in whom a difficult access can be pre-operatively hypothesized.

A Stepwise Proposal for Low-Grade Hemorrhoidal Disease: Injection Sclerotherapy as a First-Line Treatment and Rubber Band Ligation for Persistent Relapses

Outpatient treatments are actually the techniques of choice in the management of low-grade hemorrhoidal disease. Among these, rubber band ligation (RBL) and injection sclerotherapy (IS) are the most frequently performed. Both techniques are used, without one having been determined to be superior over the other. We analyzed the studies that compare these two techniques in terms of efficacy and safety in order to offer a proposal for treatment choice. RBL seems to be most efficient in terms of symptom resolution for second-degree hemorrhoidal disease and equal or superior for treatment of third-degree disease. However, IS offers lower rates of severe post-operative pain and minor complications. Since outpatient treatments are offered to patients as painless options that allow a prompt recovery, we propose a stepwise protocol using 3% polidocanol or aluminum potassium sulfate and tannic acid IS as the first treatment option, as it has less complications, followed by RBL in cases of relapse.

Trabeculectomy versus Xen gel implant for the treatment of open-angle glaucoma: a 3-year retrospective analysis

ObjectiveTo compare the two surgical techniques in terms of efficacy, safety, and postoperative management over 36 months of follow-up.MethodsThis retrospective clinical cohort study compared the outcome of trabeculectomy surgery and...

Modified small-incision cataract surgery for combined extraction - A comparative study of two techniques.

To explore straight incision technique in terms of efficacy for intraocular pressure (IOP) lowering by small-incision cataract surgery (SICS) trab versus modified "frown" incision with triangular scleral flap technique. This study was done at a tertiary health center. It included 44 eyes diagnosed with cataract and coexisting primary glaucoma that underwent SICS with trabeculectomy using modified "frown" incision with triangular scleral flap technique and straight incision in group A (n = 22) and B (n = 22), respectively. Postoperative evaluation was done at first postoperative day, then at the end of first week, third week, and 6 weeks; at the end of third month and finally at the end of sixth months. Data were entered and analyzed via Microsoft Excel sheet and SPSS software using Mann-Whitney U test for averages and Chi-square test for categorical values. Mean preoperative IOP in groups A and B were 38.6 and 29.1 mm Hg respectively, by applanation tonometry. After 6-month follow-up, mean of difference in IOP (preoperative - postoperative) for group A was 20.8 ± 8.3 mm Hg and that for group B was 17.2 ± 13.5 mm Hg. Capacity of IOP reduction of both techniques was found to be comparable and did not show much difference up to the end of 6 months. Mastering technique of group A (modified "frown" incision with triangular scleral flap technique) requires more expertise; the simpler straight incision technique provided in group B may be effectively used by the novice and current era Ophthalmologists to combat glaucoma coexistant with cataract.

A Review of Techniques of Intercostal Nerve Blocks

Intercostal nerve blocks are indicated for multiple chronic pain and acute pain conditions including rib fractures, herpes zoster, post-thoracotomy pain syndrome, and intercostal neuralgia. Intercostal neuralgia is a type of neuropathic pain that is in the distribution of intercostal nerves. The purpose of this review is to evaluate the different techniques used to perform intercostal nerve blocks and review their efficacy and safety including blind technique using anatomical landmarks, and fluoroscopically guided and ultrasound-guided intercostal nerve blocks. Literature search was performed with the keywords including intercostal neuralgia, treatment, intercostal nerve blocks, and radiofrequency ablation on PubMed and Google Scholar. Three studies and one case report were identified. Literature review revealed that ultrasound-guided techniques and fluoroscopically guided techniques are superior to landmark-based technique in terms of efficacy. There was no difference in efficacy and complication rates between ultrasound and fluoroscopic guidance. Ultrasound-guided techniques and fluoroscopically guided techniques can both be performed safely and effectively for various chronic pain conditions. Ultrasound guidance has its advantages of direct visualization of nerves, vessels, muscles, and the lung. It is potentially a superior technique in terms of improving accuracy and decreasing complications. Further large population randomized control studies should be conducted to compare the efficacy of intercostal nerve blocks performed under ultrasound and fluoroscopy.

Trans-Radial Approach: technical and clinical outcomes in neurovascular procedures

BackgroundTo evaluate efficacy and safety of Trans-Radial Approach (TRA) in cerebral angiography for diagnostic and therapeutic purpose.MethodsWe retrospectively included consecutive patients eligible for TRA cerebral angiography at our Institution between September 2019 and January 2020. Cerebral DSA was classified in diagnostic (one-vessel imaging) or therapeutic (emergency/elective). Technical and clinical outcome were recorded for each group.ResultsA total of 61 TRA angiographies were evaluated. Right-sided TRA was obtained in 85,2% of all cases. Interventional procedures included 11 strokes, 2 ruptured aneurysms, 2 unrupted aneurysms, 1 DAVF and 3 symptomatic atheromatous intracranial stenosis. Successful TRA angiographies were obtained in 97,6% and 94,7% for diagnostic and therapeutic group, respectively. No major radial artery complications were recorded. Mean puncture-to-final angiogram was 11 and 62 min for diagnostic and therapeutic groups, respectively. Mean radial compression maintenance was 4 h, allowing patients discharge within 6 h in all cases undergone diagnostic angiography.ConclusionsTRA could be a valid technique in terms of efficacy and safety both for diagnostic and therapeutic cerebral angiographies, with low complication rate.

Endovascular Treatment Versus Surgery in Long Occlusions of the Superficial Femoral Artery about 50 Cases

Surgical treatment is considered the gold standard for the management of complex lesions in FSA and is currently in competition with the improvement of new endovascular techniques. The aim of this work is to compare the two revascularization techniques in terms of efficacy, morbidity and mortality, which is based on a retrospective study of 50 cases of long FSA occlusions treated either by surgical treatment or by endovascular, at the vascular surgery department of Avicenna military hospital in Marrakech during the period between January 2014 to December 2016. The mean age of our patients was higher in the endovascular treatment group compared to the surgical treatment group, (68.5 years versus 62.3) respectively, we noted a male predominance in both groups. Critical lower extremity ischaemia was the most common reason for consultation in both groups: 76.7% in the endovascular treatment group and 80% in the surgical treatment group. All the patients had received the necessary explorations to assess the lesion as well as the extension of the atherosclerotic disease. The technique was successful in 100% of cases, without any major postoperative complications or death, the average length of hospital stay was lower in the endovascular treatment group: one day compared to 4 days in the surgical treatment group. The primary and secondary patency at 12 months were similar in the two groups (73.3% versus 75%) and (83.3% versus 85%) respectively. Thanks to the improvement of endovascular techniques, the management of long occlusions of the superficial femoral artery therefore appears to be an attractive alternative to surgical treatment, more particularly for patients with high surgical risk and presenting numerous comorbidities.

Comparison of damping techniques for the soft‐stop of ultra‐fast linear actuators for HVDC breaker applications

This paper assesses the advantages, drawbacks, and overall suitability of different soft-stop techniques to provide smooth deceleration of ultra-fast linear actuators used in hybrid HVDC breaker designs, with the help of FEA simulations. The paper compares active and passive damping techniques in terms of efficacy, energy consumption, and interference with the ultra-fast operation needed from the actuator. The possibility of combining active and passive damping techniques is discussed.

Current surgical techniques of enucleation in holmium laser enucleation of the prostate.

Holmium laser enucleation of the prostate (HoLEP) has been accepted as the most efficient method of transurethral surgery for benign prostatic hyperplasia. The originally developed three-lobe technique has popularized this surgery; this method is based on three longitudinal incisions, by which the median lobe is removed, and subsequently, both lateral lobes are enucleated. To maintain a consistent surgical plane and to minimize sphincteric damage, the traditional three-lobe technique is continuously being refined and evolving. A few modifications of the original technique have been developed, and several en bloc enucleation methods have been introduced. However, more clinical evidence is required to show the superiority of newer techniques over the original three-lobe technique in terms of efficacy and long-term side effects. To date, none of the newer techniques have been accepted as a standard technique for HoLEP.

Clinical impact of regional citrate anticoagulation in continuous renal replacement therapy in critically ill patients.

Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.

Comparison of the Efficacy of Local Infiltration and Mandibular Block Anesthesia With Articaine for Harvesting Ramus Grafts

We compared the efficacy of local infiltrative anesthesia and regional mandibular block anesthesia using articaine to harvest ramus grafts and the postoperative sequelae. A total of 20 patients with alveolar bone deficiency participated in the present comparative, prospective, randomized study. The first group received regional anesthesia with the mandibular block technique (group A; n= 10), and those in the second group received local infiltration anesthesia (group B; n= 10). Intraoperative pain and bleeding were evaluated as the primary outcome variables. The visual analog scale (VAS) scores were compared at 0.5, 1, 2, and 4hours postoperatively. The maximal interincisal mouth opening (MIO) (on days 3 and 7) and VAS scores (at 6, 12, 24, and 48hours and on days 3 and 7) were compared as secondary outcome variables. The correlation between pain (VASscores) and trismus (MIO) were also compared. A painless procedure was performed in both groups. The VAS score, MIO, and intraoperative bleeding were not significantly different between the 2 groups. Paresthesia was not observed in either group postoperatively. No statistically significant correlations were found between the VAS scores andMIO. Local infiltrative anesthesia preserves almost the same depth of anesthesia as mandibular block anesthesia. No differences were found between these techniques in terms of efficacy and postoperative sequelae during and after ramus graft harvest. Thus, using articaine with a local infiltration technique is an alternative to mandibular block anesthesia during ramus graft harvesting and results in a reduced risk of inferior alveolar nerve damage.

The Role of Soft-Tissue Surgery of the Tongue in Obstructive Sleep Apnea

Obstructive sleep apnea is a common disease with high morbidity. Narrowing and collapse of the pharyngeal airway during sleep characterize the disease resulting in a decrease or a complete cessation of oronasal airflow. Continuous positive airway pressure is the gold standard and is proven to be very effective. However, due to its rather low adherence and acceptance, alternative treatment options for OSA are necessary. When obstruction of the upper airway (UA) is caused at the level of the tongue base, surgery of the soft tissue of the tongue may be an effective treatment option in OSA. In this review, the aim is to determine and compare the effect of glossectomy, transoral robotic surgery, radiofrequency, tongue suspension, and adjustable tongue advancement techniques in terms of efficacy based on changes in outcome parameters and in terms of complications. UA surgery significantly improves sleep outcomes as part of multi-level surgery in adult patients. Further research on the efficacy of standalone procedure of soft-tissue surgery techniques of the tongue is necessary, in order to gain more evidence of their effectiveness.

Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon

Background and purposeAssisted coiling with stents or balloons enables a higher percentage of complete occlusions of saccular unruptured intracranial aneurysms to be achieved with a reasonable complication rate. The aim...

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. PROSPERO number CRD42011001355. The National Institute for Health Research Health Technology Assessment programme.

Electrosurgery in urology: recent advances

Inadequate hemostasis is one of the most important causes of morbidity and mortality following urological surgery. Despite the long-term usage of coagulation, there is an ongoing development of new devices, including bipolar transurethral resection of the prostate or new vessel-sealing devices. A thorough understanding of the advantages and disadvantages of these new instruments can improve the operative experience for both the urologist and patient. The optimal coagulation system should be small, efficient, easy to handle and with low heat spread. In this article, we analyze different electrothermal coagulation systems and modern tissue-sealing devices in urological applications with the aim to substantiate the advantages and disadvantages of each technique in terms of efficacy and safety.

Therapeutic hypothermia after cardiac arrest: A retrospective comparison of surface and endovascular cooling techniques

Objectives Therapeutic hypothermia (32–34 °C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome. Design Retrospective cohort study. Setting Thirty-bed teaching hospital intensive care unit (ICU). Patients All patients ( n = 83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61 ± 16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia. Interventions Therapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface ( n = 41) or endovascular ( n = 42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32–34 °C for 12–24 h, followed by rewarming at a rate of 0.25 °C h −1. Measurements and main results Endovascular cooling provided a longer time within the target temperature range ( p = 0.02), less temperature fluctuation ( p = 0.003), better control during rewarming (0.04), and a lower 48-h temperature load ( p = 0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling ( p = 0.05) and failure to reach the target temperature ( p = 0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome. Conclusion Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial.

Efficacy and safety of TVT-O and TVT-Secur in the treatment of female stress urinary incontinence: 1-year follow-up

To reduce complications of transobturator tension-free vaginal tape, single-incision devices were introduced in the last years. We here report a comparison between the tension-free vaginal tape-obturator (TVT-O) and the TVT-Secur techniques in terms of efficacy and safety. Eighty-four patients with stress urinary incontinence (SUI) were scheduled to undergo TVT-O or TVT-Secur. Duration of the procedure, subjective estimate of blood loss, intraoperative and postoperative complications, postoperative postvoidal residue (PVR), time to first voiding, and pain level were recorded. Urodynamic tests, PVR, Incontinence Questionnaire Short Form (ICIQ-SF), King's Health Questionnaire, and a urinary diary were performed before and 12 months after procedure. No differences in terms of cure rate were observed between the two groups (81.6% vs. 83.8%). Complication rate in the TVT-Secur group was lower (8.1%) than in the TVT-O group (15.8%), but not significant. Both techniques seem to be effective and safe, with a low incidence of complications in both groups.

Local anesthesia for cataract surgery

Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.

A Comparative Study of Non-Chopping Rotation and Axial Rotation Versus Quick Chop Phacoemulsification Techniques

The authors describe the non-chopping rotation and axial rotation phacoemulsification techniques and compare them with the quick chop technique in terms of efficacy and safety. A prospective, randomized, comparative study of 654 eyes of patients with cataracts who underwent phacoemulsification and intraocular lens implantation was conducted. Patients were randomly assigned to three groups according to phacoemulsification technique and were subdivided into four groups according to nuclear density. For grade 1 and 2 nuclei, non-chopping rotation and axial rotation techniques outperformed the quick chop technique in ultrasound time, cumulative dissipated energy, best-corrected visual acuity, central corneal thickness, and endothelial cell loss. For grade 3 nuclei, the axial rotation technique did best according to the same terms. For grade 4 nuclei, the two rotation techniques were less efficient for lens removal. The non-chopping rotation and axial rotation phacoemulsification techniques are advisable for removal of soft to medium-hard nuclei. For hard nuclei, chopping techniques are more successful.