Total Success Rate Research Articles

Factors affecting transtemporal window quality in transcranial sonography.

ObjectiveTo assess the influencing factors of transtemporal window quality and identify patients suitable for transcranial sonography (TCS) examination in two‐dimensional imaging.MethodsIn this cross‐sectional study, TCS was performed in 161 consecutive patients through the temporal bone window (TBW) in the neurology or neurosurgery department. Each patient's sex, age, height, weight, and temporal bone thickness (TBT) were collected. After examination, the patients were divided into two groups: TBW success and TBW failure. The data were statistically compared between the two groups.ResultsAmong the studied population, the total TBW success rate was 80.1% (95% confidence interval [CI]: 74–86). The TBW success rate was 91.4% (95% CI: 85–98) in males and 70.9% (95% CI: 61–81) in females (p = .001). Sex (p = .001), age (p = .002), height (p = .047), and TBT (p < .001) showed significant differences between the TBW success and failure groups. In males, only TBT (p = .001) showed a significant difference; in females, age (p < .001) and TBT (p = .003) showed a significant difference. The area under the receiver operating characteristic curve (AUC) of sex, age, and TBT and their combination was 0.686, 0.659, 0.842, and 0.922 (p < .001), respectively. The AUC of the combination of parameters was significantly greater than that of age and sex alone (p = .007; p = .0002) but not greater than that of TBT (p = .090).ConclusionsThe TBW success rate varied with sex, age, height, and TBT. Males, younger patients, taller patients, and patients with a thinner temporal bone tended to be more suitable for the examination by TCS.

A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation.

BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.

Ultrasound-guided short-axis out-of-plane vs. long-axis in-plane technique for radial artery catheterization: an updated meta-analysis of randomized controlled trials.

Short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) are the two major approaches used in ultrasound (US)-guided radial arterial catheterization. Nevertheless, their efficacy and safety remain controversial. Therefore, this meta-analysis aimed at comparing the two approaches for radial arterial catheterization. The PubMed, Embase, and Cochrane Library databases were searched for relevant articles published from database inception until December 2020. We selected randomized controlled trials comparing the short- and long-axis methods for US-guided radial artery catheterization. The results were analyzed using RevMan software to determine the adequacy and conclusiveness of the available evidence. Six studies (725 patients) ultimately met the inclusion criteria. No significant difference was observed between the SA-OOP and LA-IP approaches for US-guided radial artery catheterization (relative risk [RR], 0.99; 95% confidence interval [CI], 0.96-1.03; p =0.61; I2=0%). The first-attempt success rate was similar between the two groups (relative risk [RR], 1.02; 95% CI, 0.79-1.32; p =0.90; I2=87%). The incidence of hematoma formation was similar between the two groups (RR, 1.91; 95% CI, 0.66-5.56; p =0.24; I2=77%). The SA-OOP approach does not increase the total or first-attempt success rate of radial artery catheterization using the LA-IP approach. More highly powered well-designed trials are needed to evaluate additional outcomes.

Application of posterior canal skin flap for the repair of large tympanic membrane perforations.

ObjectiveMany methods have been described for the repair of the tympanic membrane, but there is no general consensus as to the standard method. The aim of this study was to evaluate the effect of the inferior base posterior canal skin flap on the graft success rate in large tympanic membrane perforations.MethodsAfter the post‐auricular incision, the posterior canal skin flap with inferior pedicle was created by two vertical and one horizontal incisions. Then the flap was rotated over the temporalis fascia graft. The graft success rate and postoperation hearing test results were evaluated in 52 patients who suffered from large tympanic membrane perforations.ResultsWe achieved a 92.3% total graft success rate with about 9 dB improvement in speech reception threshold (SRT).ConclusionThe rotational inferior base posterior canal skin flap tympanoplasty technique is simple, fast, safe, and effective for the repair of subtotal tympanic membrane perforations.

Effects of stroke etiology on angiographic success in patients undergoing mechanical thrombectomy.

In this study, we investigated the relationship between stroke etiology and recanalization success with endovascular treatment in patients with acute ischemic stroke. A total of 109 patients with anterior circulation stroke who underwent mechanical thrombectomy between August 2017 and June 2019 were included in the study retrospectively. Stroke etiologies of the patients were determined according to the TOAST criteria (Trial of Org 10,172 acute stroke treatment), and the relationship between stroke etiology and successful first-pass recanalization rate with endovascular treatment, total successful recanalization rate, and procedure time was evaluated. The data of 109 patients who presented with anterior circulation stroke and underwent mechanical thrombectomy were retrospectively analyzed. Fifty-five (50.5%) of the patients were female and 54 (49.5%) were male, and mean age was 67.3 ± 12.9. When the stroke etiologies of the patients were evaluated, it was found that 47 (43.1%) were due to large vessel ateherosclerotic disease (LVAD), and 62 (56.9%) were cardioembolic-related. Recanalization success and clinical outcomes did not differ significantly in patients with LVAD and those with cardioembolic etiology (p > 0.05). In addition, the number of patients with modified Rankin score (mRS) 6 in the atherosclerotic group was significantly higher than in the cardioembolic group (p = 0.022). Recanalization success and clinical outcomes did not differ significantly in patients with LVAD and those with cardioembolic etiology. However, mortality rate was higher in patients with atherosclerotic etiology, due to the complexity of the procedure and the high rate of reocclusion.

The role of peroral endoscopic myotomy for Zenker's diverticulum: a systematic review and meta-analysis.

Zenker's peroral endoscopic myotomy (Z-POEM) has revolutionized the therapeutic strategyfor Zenker's diverticulum (ZD) with promising results. We conducted this meta-analysis to estimate the safety and efficacy of Z-POEM for ZD and compare the feasibility and effectiveness of Z-POEM with that of flexible endoscopic septotomy (FES). A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases to query for studies that assessed the safety and efficacy of Z-POEM for ZD. All articles published from inception to July 31, 2021 were included. The primary outcomes were the overall technical success rate, clinical success rate, incidence of adverse events, and clinical recurrence rate. Eleven studies involving 357 patients undergone Z-POEM were included. Overall, the quality of included studies was above average, with five studies rated as high quality and six ranked as moderate quality. The overall pooled technical success rate for Z-POEM was 96.3% (95% confidence interval [CI] 93.6-97.9%; I2 = 0%). The total pooled clinical success rate for Z-POEM was 93.0% (95% CI 89.4-95.4%; I2 = 0%). The pooled incidence of adverse events for Z-POEM was 12.4% (95% CI 9.1-16.7%; I2 = 0%). The pooled clinical recurrence rate for Z-POEM was 11.2% (95% CI 7.6-16.2%; I2 = 0%). The clinical success for Z-POEM was significantly better than that of FES (relative risk [RR]: 1.11; CI 95% 1.03-1.18; p = 0.004, I2 = 0%), while there were no significant differences in technical success, adverse events, and clinical recurrence between Z-POEM and FES. Z-POEM could be an effective and safe therapeutic modality for ZD, and even has a slightly higher clinical success rate than FES. However, comparative studies with long-term follow-up will be needed to further confirm our finding.

Preliminary evaluation of SaCoVLM\u2122 video laryngeal mask airway in airway management for general anesthesia

BackgroundTo preliminary evaluate the application of SaCoVLM™ video laryngeal mask airway in airway management of general anesthesia.MethodsWe recruited 100 adult patients (ages 18–78 years, male 19, female 81, weight 48–90 kg) with normal predicted airway (Mallampati I ~ II, unrestricted mouth opening, normal head and neck mobility) and ASA I-II who required general anaesthesia. The SaCoVLM™ was inserted after anesthesia induction and connected with the anesthesia machine for ventilation. Our primary outcome was glottic visualization grades. Secondary outcomes included seal pressure, success rate of insertion, intraoperative findings (gastric reflux and contraposition), gastric drainage and 24-h complications after operation.ResultsThe laryngeal inlet was exposed in all the patients and shown on the video after SaCoVLM™ insertion. The status of glottic visualization was classified: grade 1 in 55 cases, grade 2 in 23 cases, grade 3 in 14 cases and grade 4 in 8 cases. The first-time success rate of SaCoVLM™ insertion was 95% (95% CI = 0.887 to 0.984), and the total success rate was 96% (95% CI = 0.901 to 0.989). The sealing pressure of SaCoVLM™ was 34.1 ± 6.2 cmH2O and the gastric drainage were smooth. Only a small number of patients developed mild complications after SaCoVLM™ was removed (such as blood stains on SaCoVLM™ and sore throat).ConclusionsThe SaCoVLM™ can visualize partial or whole laryngeal inlets during the surgery, with a high success rate, a high sealing pressure and smooth gastroesophageal drainage. SaCoVLM™ could be a promise new effective supraglottic device to airway management during general anesthesia.Trial registrationChiCTR,ChiCTR2000028802.Registered 4 January 2020.

Comparing the efficacy of endoscopic balloon dilation alone and combined with endoscopic sphincterotomy for common bile duct stone: a systematic review and meta-analysis

Several comparative studies have shown that endoscopic balloon dilation (EPBD) combined with endoscopic sphincterotomy (EST) may be a better choice than EPBD alone for the treatment of common bile duct stones (CBDS). However, there are limited data that can be used to compare this combination method with EST or EPBD alone in the treatment of choledocholithiasis. Therefore, this study aimed to systematically evaluate the efficacy of EPBD alone and EPBD combined with EST in the treatment of CBDS. We performed a literature search of the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases using the following search terms: endoscopic balloon dilation, endoscopic sphincterotomy, sphincterotomy, balloon dilation, gallstones, bile duct stones, and common bile duct stones. The Cochrane risk of bias tool was used to evaluate the quality of the included studies, and the network meta-analysis was performed using RevMan 5.20. A total of nine articles satisfied the inclusion criteria, involving 497 patients who received EST + EPBD and 548 patients who underwent EPBD alone. The results of the meta-analysis showed that compared with the EPBD group, the EST + EPBD group had significant differences in the stone removal time [mean difference (MD) is -1.83; 95% confidence interval (CI): (-3.57, -0.10)] and the initial stone removal rate [relative risk (RR) is 1.11; 95% CI: (1.04, 1.19)]. There were no significant differences in the rate of mechanical vibration stone crushing [RR is 0.74; 95% CI: (0.55, 1.00)], total rate of stone removal [RR is 1.01; 95% CI: (0.98, 1.04)], and complication rate [RR is 0.87; 95% CI: (0.66, 1.13)]. The stone removal time and initial stone removal rate of patients in the EST + EPBD group were superior to those of patients in the EPBD group, and the two groups were similar in terms of total stone removal success rate, mechanical lithotripsy (ML) rate, and complication rate. Therefore, large-scale, multi-center prospective studies are needed to clarify whether EST + EPBD is superior to EPBD alone in the treatment of choledocholithiasis.

Efficacy of nicotine-replacement therapy, bupropion, and a combination of both for treating nicotine addiction

Background Most of the studies about the efficacy of smoking-cessation medication and its side effects were conducted in developed countries on participants who differ from Arab population in sociocultural and genetic factors. Patients and methods A randomized controlled trial was conducted on a convenient sample of 100 smokers at the smoking-cessation clinic. The participants were allocated into four groups: nicotine-replacement therapy (NRT), bupropion (BPP), combination of NRT+BPP, and placebo. Counseling was offered to all participants. Outcomes: self-reported smoking status with biochemical verification (success to stop smoking, lapse, relapse, or failure to stop smoking) at 3 and 6 months from starting treatment. Results The total success rate in four studied groups was 14% at 3 months and 8% at 6 months. There was no evidence of any statistically significant difference between any of the interventional groups (NRT, BPP, or their combination) and placebo group at 3 and 6 months as regards success rate (8, 12, 8, and 28%, respectively, at 3 months and 8, 12, 0, and 12%, respectively, at 6 months). There were no serious adverse events in the studied groups. Headache was more significantly reported by placebo group compared with all other groups (P=0.01), and urgency was more significantly reported by placebo group compared with NRT group (P=0.001). Conclusion The study found no evidence of the superior effect of NRT, BPP, or their combination over placebo in helping smokers quit smoking at 3 and 6 months. However, more withdrawal symptoms were reported by the placebo group.

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma.

Purpose: To report the safety and efficiency of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with primary open-angle glaucoma (POAG) and the management of unexpected postoperative intraocular pressure (IOP) elevation.Methods: This was a prospective case series study. A total of 23 eyes from 23 patients with POAG who underwent CLASS were involved and followed-up for 12 months. The primary outcomes included the changes in best corrected visual acuity (BCVA), IOP, and medications before and after CLASS. The secondary outcomes were success rate and postoperative laser interventions.Results: The mean age of the patient was 42.6 ± 16.0 years. There was no significant change in BCVA and visual field at baseline and 12 months after CLASS. The number of medications was significantly reduced after CLASS. The IOP was also significantly decreased and remained well controlled during the follow-up period, except for a transient elevation at 1 month postoperatively, due to the occurrence of peripheral anterior synechiae (PAS). Generally, 17 patients (73.9%) were treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser synechiolysis to remove iris obstruction in the filtration site and seven patients (30.4%) underwent Nd:YAG laser goniopuncture to deal with scleral reservoir reduction. Only one patient (4.3%) received surgical repositioning due to iris incarceration. The complete success rate and total success rate at 12 months were 69.6 and 95.7%, respectively.Conclusion: CLASS was a safe and effective approach for Chinese patients with POAG. Peripheral anterior synechiae (PAS), iris incarceration, and scleral reservoir reduction were common causes of unexpected postoperative IOP elevation. Individualized Nd:YAG laser intervention helps to improve the long-term outcomes after CLASS.

Predicting Protein-Peptide Complex Structures by Accounting for Peptide Flexibility and the Physicochemical Environment.

Predicting protein-peptide complex structures is crucial to the understanding of a vast variety of peptide-mediated cellular processes and to peptide-based drug development. Peptide flexibility and binding mode ranking are the two major challenges for protein-peptide complex structure prediction. Peptides are highly flexible molecules, and therefore, brute-force modeling of peptide conformations of interest in protein-peptide docking is beyond current computing power. Inspired by the fact that the protein-peptide binding process is like protein folding, we developed a novel strategy, named MDockPeP2, which tries to address these challenges using physicochemical information embedded in abundant monomeric proteins with an exhaustive search strategy, in combination with an integrated global search and a local flexible minimization method. Only the peptide sequence and the protein crystal structure are required. The method was systemically assessed using a newly constructed structural database of 89 nonredundant protein-peptide complexes with the peptide sequence length ranging from 5 to 29 in which about half of the peptides are longer than 15 residues. MDockPeP2 yielded a total success rate of 58.4% (70.8, 79.8%) for the bound docking (i.e., with the bound receptor and fully flexible peptides) and 19.0% (44.8, 70.7%) for the challenging unbound docking when top 10 (100, 1000) models were considered for each prediction. MDockPeP2 achieved significantly higher success rates on two other datasets, peptiDB and LEADS-PEP, which contain only short- and medium-size peptides (≤ 15 residues). For peptiDB, our method obtained a success rate of 62.0% for the bound docking and 35.9% for the unbound docking when the top 10 models were considered. For LEADS-PEP, MDockPeP2 achieved a success rate of 69.8% when the top 10 models were considered. The program is available at https://zougrouptoolkit.missouri.edu/mdockpep2/download.html.

Liquefaction Evaluation Based on Shear Wave Velocity Using Random Forest

Liquefaction evaluation on the sands induced by earthquake is of significance for engineers in seismic design. In this study, the random forest (RF) method is introduced and adopted to evaluate the seismic liquefaction potential of soils based on the shear wave velocity. The RF model was developed using the Andrus database as a training dataset comprising 225 sets of liquefaction performance and shear wave velocity measurements. Five training parameters are selected for RF model including seismic magnitude ( M w ), peak horizontal ground surface acceleration ( a max ), stress-corrected shear wave velocity of soil ( V s 1 ), sandy-layer buried depth (ds), and a new introduced parameter, stress ratio (k). In addition, the optimal hyperparameters for the random forest model are determined based on the minimum error rate for the out-of-bag dataset (ERROOB) such as the number of classification trees, maximum depth of trees, and maximum number of features. The established random forest model was validated using the Kayen database as testing dataset and compared with the Chinese code and the Andrus methods. The results indicated that the random forest method established based on the training dataset was credible. The random forest method gave a success rate for liquefied sites and even a total success rate for all cases higher than 80%, which is completely acceptable. By contrast, the Chinese code method and the Andrus methods gave a high success rate for liquefaction but very low for nonliquefaction which led to the increase of engineering cost. The developed RF model can provide references for engineers to evaluate liquefaction potential.

Modified long-axis in-plane ultrasound-guided radial artery cannulation in adult patients: A randomized controlled trial

IntroductionFor adults with small radial arteries, ultrasound-guided radial artery cannulation remains challenging and the relevant data is currently lacking. The study aimed to test the hypothesis that modified long-axis in-plane ultrasound guidance (M-LAIP) would improve success rates of radial artery cannulation in this population. Patients and methodsThis was a prospective, randomised, and controlled clinical study that enrolled 201 adult patients with diameters of the radial artery less than 2.2 mm. Patients were randomised to M-LAIP, short-axis out-of-plane (SAOP), or conventional palpation (C-P) group according to different approaches of radial artery cannulation (M-LAIP, SAOP, and C-P). Outcome measurements included the success rate, cannulation time, and cannulation-related adverse events. ResultsThe cannulation success rate was significantly higher in the M-LAIP group than in the SAOP or C-P groups (first success rate: 80.3% vs. 53.8% or 33.8%; P < 0.001; total success rate: 93.9% vs. 78.5% or 50.8%; P < 0.001). Total cannulation time in the M-LAIP group was shorter than that in the SAOP group (P = 0.002) or the C-P group (P < 0.001). The rates of posterior wall puncture and haematoma in the M-LAIP group were lower than that in the SAOP group or C-P group (P < 0.008). ConclusionThe use of the M-LAIP approach significantly improved the success rate of radial artery cannulation, shortened procedure time, and lowered the rates of posterior wall puncture and haematoma in adults with radial artery diameters less than 2.2 mm, compared with that achieved by the SAOP or C-P approach.

Real-Time Multiple-Workflow Scheduling in Cloud Environments

With the development of cloud computing, an increasing number of applications in different fields have been deployed to the cloud. In this process, the real-time scheduling of multiple workflows composed of tasks from these different applications must consider various influencing factors that strongly affect scheduling performance. This paper proposes a real-time multiple-workflow scheduling (RMWS) scheme to schedule workflows dynamically with minimum cost under different deadline constraints. Due to the uncertainty of workflow arrival time and specification, RMWS dynamically allocates tasks and divides the scheduling process into three stages. First, when a new workflow arrives, the latest start time and the latest finish time of each task are calculated according to the deadline, and the subdeadline of each task is obtained by probabilistic upward ranking. Then, each ready task is allocated according to its subdeadline and the increased cost of the virtual machine (VM). Meanwhile, only one waiting task can be assigned to each VM to reduce delay fluctuations. Finally, when the task is completed on the assigned VM, all the parameters of the relevant tasks are updated before allocating them to appropriate VMs. The experimental results based on four real-world workflow traces show that the proposed algorithm is superior to two state-of-the-art algorithms in terms of total rental cost, resource utilization, success rate and deadline deviation under different conditions.

Hypospadias treatment by tubulated pedicled preputial island flap according to the DUCKETT technique: single-center experience in sub-Saharan Africa

BackgroundHypospadias is the second most frequent congenital condition in boys after cryptorchidism, with an incidence of 0.3–0.7% compared to 2–4% for cryptorchidism. Since the 1980s, single-stage operations, such as the one described by Duckett, have been adopted by some authors. To assess the results of hypospadias surgery by tubed pedicled preputial island flap (DUCKETT’s procedure) in a West African reference hospital.MethodsThis is a retrospective and descriptive study that includes 41 patients with hypospadias who underwent DUCKETT procedure by a tubed pedicled preputial island flap during a period of 12 years. After penile degloving, the curvature has been corrected by skin bridging with or without Nesbit’s plication. The urethroplasty was done according to the DUCKETT procedure.ResultsThe patients mean age was 11 ± 8.5 years. All of them had posterior foreskin and a ventral curvature of the penis. The urethral meatus was posterior in 37%. Six of them had a previous hypospadias repair. The complication rate was 58.5%. Wound infection and meatal stenosis occurred in 14.6% and 19.6% of cases, respectively. After a mean follow-up of 20 ± 9 months, total success, relative success and failure rates were 63%, 27% and 10%, respectively.ConclusionThe DUCKETT procedure is associated with a high complication rate in our daily practice.

Clinical Efficacy of Sealer-based Obturation Using Calcium Silicate Sealers: A Randomized Clinical Trial

IntroductionThis randomized controlled clinical trial compared the clinical efficacy and outcome of a sealer-based obturation technique (SBO) with calcium silicate sealers and a continuous wave of condensation technique (CWC) with a resin-based sealer. MethodsRoot canals were prepared using rotary instruments and 2.5% sodium hypochlorite. At the next visit, patients were enrolled and randomly assigned into 2 groups on the basis of the obturation protocol: CWC with AH Plus sealer and SBO with Endoseal TCS. Patients were assessed for the level of postoperative pain using a numeric rating scale. The quality of root canal obturation was evaluated in terms of the sealer extrusion, root-filling voids, and level of root filling. The participants were recalled after at least 6 months. Healing of the teeth was determined as a decrease in Periapical Index score and resolution of symptoms. The results were statistically compared by using the χ2 test or Fisher exact test, followed by multivariate analysis with logistic regression. ResultsA total of 74 teeth were included in the analysis (79% recalls), and the mean follow-up period was 17 months (6–29 months). Two groups expressed identical distribution of postoperative pain (P = .973) and similar quality of root canal obturation. The total success rates were 93.2% (CWC 92.3%, SBO 94.3%) by loose criteria and 60.8% (CWC 51.3%, SBO 71.4%) by strict criteria, with no significant differences between the 2 groups. The success rate by loose criteria in teeth with sealer extrusion was significantly lower than those in teeth without sealer extrusion (P = .049). ConclusionsSBO using an Endoseal TCS could be a possible alternative to CWC using AH Plus. Sealer extrusion and postoperative pain were found to negatively impact prognosis of the endodontic treatment.

The process to obtain reimbursement for enzymatic debridement in clinically deep burns

Introduction Burn eschar removal by enzymatic debridement with NexoBrid® (EDNX) results in a maximum preservation of all viable tissue, which is the main advantage over traditional tangential excision. The authors participated in a marketing authorization holder process to obtain reimbursement from the national health authorities in Belgium. Material and methods The reimbursement process consisted of three phases, as specified by the reimbursement regulations required by the Belgian National Institute for Health and Disability Insurance (NIHDI). Results Forty-one patients with clinically deep 2nd and 3rd degree burns, treated with EDNX in two Belgian burn centers, were included in the registry for the first phase of the reimbursement process. The total success rate of the EDNX treatment was 95.1% (39/41). Over half of the burn wounds treated with NexoBrid® (55.2%) did not require any additional surgical debridement or skin grafting. To obtain definitive reimbursement, an extra 16 patients were included. In this population, 51.4% did not require any surgical intervention. The total success rate of the EDNX debridement in this group was 100%. Based on an estimated market share of 12% and around 75 patients in the third year after final reimbursement, a market access consultant calculated that NexoBrid® will realize yearly savings for the Belgian Healthcare budget of at least €30.000. Conclusion Based on the results of this Belgian registry study in combination with the yearly healthcare budget savings, the NIHDI granted a final reimbursement for EDNX treatment in adults, endorsed by the Minister of Health on November 5th, 2019.

System for Fusion of Face and Speech Modalities Using DTCWT+QFT and MFCC+RASTA Techniques

Objectives: The main objective is to propose a multimodal biometric system by forming a fusion of Face and Speech modalities using DTCWT+QFT techniques for face and MFCC+RASTA Techniques for Speech recognitions. The experimental results are compared with existing works and analysed the performance with counterparts. Methods: The proposed model, make use of DTCWT and QFT techniques to extract the features of face images and perform fusion of both. The MFCC and RASTA techniques are implemented to extract features of speech data and then fusion is applied. Various databases discussed and utilized for both face and speech recognition system proposed. Findings: The results of experimentation are compared with existing systems and analysis proved than the proposed system is placed in better position. The fusion of DTCWT and QFT techniques for face recognition system is implemented and the results using performance parameters such as False Acceptation Ratio (FAR), False Rejection Ratio (FRR), Total Success Rate (TSR), Partial Error Rate (PER), Equal Error Rate (EER) are tabulated for six different types of face data sets. The average performance of the results is compared with four existing fusion techniques and showed that the proposed system performs better. The fusion of MFCC and RASTA techniques for speech recognition system is implemented and the performance is measured by calculating accuracy, precision, recall and F1-score. These results are compared with five different schemes and proved that proposed system of fusion of face and speech traits works better for human recognitions. Novelty: Fusion of two algorithms for face recognition is implemented and the results analysed. Then the fusion of two algorithms for speech recognition is implemented and the results are analysed. The novel approach is presented to combine both face and speech recognition system in to single system to improve the security using multimodal biometrics. Keywords: DTCWT; QFT; RASTA; MFCC; Feature Extraction; Fusion

Surgical management of Helveston syndrome (Triad exotropia)

PurposeTo evaluate and compare different surgical approaches for the treatment of Helveston syndrome and provide further information for preoperative planning.MethodsFrom February 2008 to December 2018, data of 52 patients with Helveston syndrome were retrospectively reviewed. Different surgical approaches were selected based on the extent of A-pattern exotropia, dissociated vertical deviation (DVD), and both superior oblique muscle overaction (SOOA) with fundus photograph intorsion. Eye position, A-pattern, DVD, superior oblique muscle function, and binocular vision function were evaluated pre- and postoperatively. The average follow-up duration was 20.5 months.ResultsNine cases underwent simultaneous horizontal deviation correction with bilateral superior rectus recession, 24 underwent simultaneous horizontal deviation correction with bilateral superior oblique muscle lengthening, and 19 underwent two stages of horizontal deviation correction with superior oblique muscle lengthening, and later bilateral superior rectus recession. A-pattern, DVD, SOOA, and fundus intorsion were all collapsed in all patients postoperatively. Forty-five patients had an orthophoric eye position with considerably aligned ocular movements postoperatively. The total success rate was 86.5%. Postoperatively, eight of the 10 patients with diplopia experienced a recovery of binocular single vision and three had a recovery of rudimentary stereopsis (Titmus 3000–400 s of arc). The compensatory head posture of patients improved significantly postoperatively.ConclusionsThe surgical planning of Helveston syndrome should be designed based on the degree of the A-pattern, SOOA, DVD, and the intorsion in fundus photographs, and the appropriate approach should be selected to improve patient satisfaction.

Outcome and early complications of Endoscopic Retrograde Cholangio-Pancreatography (ERCP): a cross-sectional study on 626 Patients

Background. ERCP is the gold standard procedure for diagnosis and potential treatment of biliary-pancreatic disorders with various distributions in different areas of the world. The study aimed to evaluate the findings, outcome, complications and technical experiences of ERCP, also by considering the correlation of findings with liver function tests (LFT) and imaging. Methods. In this descriptive – cross sectional data-based study for 12 years from 2007, 626 (43.9% male and 56.1%female; mean age 60 Ys) consecutive patients were subjected with therapeutic purpose at two referral hospitals. Results. Epigastric pain (40%), jaundice (39.4%) and pruritus (38.1%) were the most common indications. CBD was cannulated by optimal wire- guided sphincterotomy in 486(77.6%) patients. Precut was performed in 65(10.6%) with successful cannulation in 61 cases (93.8%) and 7.7% of complications, including perforation. A total success rate of 98% was obtained. The most common diagnoses were CBD stone(s) in 322 (51.4%) and biliary-pancreatic cancers in 114 (18.2%) of cases. No LFT (ALT, ALP and Bilirubin) predicted the diagnoses. The higher concordance rate of imaging studies in comparison with ERCP was 75% for stone(s) and the lower rate of 11.1% for tumors. Metallic stents were used in 15(2.4%) of inoperable malignant cases with life expectancy of more than 6 months. Complications occurred in 29 cases (4.6%) including duodenal perforation (0.8%), pancreatitis (1.6%) and bleeding (1.2%). Mortality rate was 0.4%. Conclusion. Although no single laboratory or imaging can exactly predict the finding or outcome, but by considering judicious case selection, appropriate use of available tools and standard techniques, the procedure could be safe with a few complications and higher success rates.