Unsuccessful Group Research Articles

Unsuccessful Recanalization versus Medical Management of Patients with Large Ischemic Core : Analysis of the ANGEL-ASPECT Randomized Trial.

The outcomes of patients with large ischemic core who fail to recanalize with endovascular therapy (EVT) compared to medical management (MM) are uncertain. The objective was to evaluate the clinical and safety outcomes of patients who underwent EVT in patients with large ischemic core and unsuccessful recanalization. This was apost hoc analysis of the ANGEL-ASPECT randomized trial. Unsuccessful recanalization was defined as patients who underwent EVT with eTICI 0-2a. The primary endpoint was 90-day very poor outcome (mRS 5-6). Multivariable logistic regression was conducted controlling for ASPECTS, occlusion location, intravenous thrombolysis, and time to treatment. Of 455 patients 225 were treated with MM. Of 230 treated with EVT, 43 (19%) patients had unsuccessful recanalization. There was no difference in 90-day very poor outcomes (39.5% vs. 40%, aOR 0.93, 95% confidence interval, CI 0.47-1.85, p = 0.95), sICH (7.0% vs. 2.7%, aOR 2.81, 95% CI 0.6-13.29, p = 0.19), or mortality (30% vs. 20%, aOR 1.65, 95% CI 0.89-3.06, p = 0.11) between the unsuccessful EVT and MM groups, respectively. There were higher rates of ICH (55.8% vs. 17.3%, p < 0.001), infarct core volume growth (142.7 ml vs. 90.5 ml, β = 47.77, 95% CI 20.97-74.57 ml, p < 0.001), and decompressive craniectomy (18.6% vs. 3.6%, p < 0.001) in the unsuccessful EVT versus MM groups. In arandomized trial of patients with large ischemic core undergoing EVT with unsuccessful recanalization, there was no difference in very poor outcomes, sICH or death versus medically managed patients. In the unsuccessful EVT group, there were higher rates of any ICH, volume of infarct core growth, and decompressive craniectomy.

Association of Range of Motion Deficit and Recurrence of Pain After Treatment of Adhesive Capsulitis.

We evaluated the factors influencing the duration of significant pain reduction after conservative management for adhesive capsulitis (AC). Follow-up for 6-8months was performed with 141 patients with AC who experienced significant pain reduction after treatment. Clinical and demographic factors, numeric rating scale (NRS) scores, and shoulder range of motion (ROM) were collected and assessed pretreatment (T0), at 5weeks post-treatment (T1), and at 6-8months post-treatment (T2). Patients were divided into successful (n = 96) and unsuccessful (n = 45) NRS groups according to the degree of pain reduction at T2. We assessed post-treatment NRS and ROM improvement scores within each group and compared these parameters between the two groups. Significant NRS and ROM improvements were achieved in all patients who participated in our study. The unsuccessful NRS group demonstrated a lack of significant improvement in abduction at T1 and T2. All T1 and shoulder ROM measurements among the unsuccessful NRS group were significantly smaller than those among the successful NRS group. Failure to achieve a significant improvement in abduction angle after conservative management of AC was significantly associated with pain recurrence.

Higher degree of dysfunctional attitudes and beliefs and higher scores of frustration intolerance in women with unsuccessful weight loss

Background/Aim. Obesity is a chronic and relapsing condition, and since recently, it has been considered a global epidemic. Current guidelines for tripartite treatment of obesity emphasize a program of lifestyle modifications such as medical nutrition therapy, aerobic exercise, and behavioral intervention. The aim of the study was to evaluate whether specific psychological factors (general attitudes and beliefs and frustration tolerance) could be predictors of successful weight loss, i.e., factors that can be further addressed as part of the integrated therapy approach. Methods. A total of 84 consecutive overweight and obese female participants who were apparently healthy and homogeneous in age, level of education, and marital or employment status were prescribed the same medical nutrition therapy protocol as a single six-month therapeutic intervention. Prior to starting the therapy, the General Attitude and Belief Scale (GABS) and the Frustration Discomfort Scale (FDS) were administered. The participants were divided into two groups: successful (group A) and unsuccessful (group B). Group A, or the successful group [with the mean body mass index (BMI) ? standard deviation (SD) of 24.1 ? 5.81 kg/m2], consisted of 40 participants who have reached the corresponding loss, i.e., they lost ? 10% of the starting body weight (BW). Group B, or the unsuccessful group (with the mean BMI ? SD of 28.51 ? 2.74 kg/m2), consisted of 44 participants who have not reached the corresponding loss, i.e., they lost &lt; 10% of the starting BW. Results. Participants in group B had significantly higher scores (p &lt; 0.05) on the GABS subscales for the Need for Approval, Need for Comfort, and Other Downing. A statistically significant difference between groups (p &lt; 0.05) was shown for FDS subscales of Emotional Intolerance, Entitlement, and Achievement Frustration. Conclusion. Results of our study showed that participants who were unsuccessful in medical nutrition therapy had a higher degree of dysfunctional attitudes and beliefs and higher scores of frustration intolerance when compared to successful participants. The recommendation, based on our results, would be to include psychotherapeutic techniques in the integrative obesity treatment, aimed at cognitive changes and increasing frustration tolerance.

Challenges to the effectiveness of next-generation sequencing in formalin-fixed paraffin-embedded tumor samples for non-small cell lung cancer

IntroductionNext-generation sequencing (NGS) of Formalin-Fixed and Paraffin-Embedded (FFPE) specimens is routine in precision oncology practice. However, results are not always conclusive, and it is important to identify which factors may influence FFPE tumor sequencing success. Materials and methodsHere, we evaluated the influence of pre-analytical factors on 705 samples of non-small cell lung cancer specimens that underwent NGS testing. Factors such as tumor site, tumor cell percentage, fragment size, primary tumor or metastasis, presence of necrosis, DNA purity, DNA concentration, sample origin and year of testing. ResultsThe overall NGS success rate was 84.9 % (n = 599). Bone site specimens had a very low success rate (42.1 %), differing from lung samples (79.8 %) (P < 0.05). Samples with tumor percentages <5 % (success rate of 44.4 %) represented 14.1 % of failed sequencings. Moreover, samples with tumor percentages >10 %–20 % (82 %) did not differ from those with >30 % (88.9 %) on sequencing outcomes (P = 0.086). Specimens that provided DNA concentrations >2.0 ng/uL, 1.0–2.0 ng/uL, 0.5–1.0 ng/uL and <0.5 ng/uL had success rates of 92 %, 77.1 %, 61.3 % and 20.4 %, respectively. Small fragments (≤0.2 cm2) had a success rate of 74.7 % and were more prevalent in the unsuccessful group (P < 0.05). ConclusionsOur results suggest that tumor percentage, fragment size, decalcified bone specimens, and DNA concentration are potential modifiers of NGS success rates. Interestingly, specimens with tumor percentages between 10 % and 20 % have the same sequencing outcome than specimens with >30 %. These results can strengthen the understanding of factors that lead to NGS success variability.

Heart Failure-Related Outcomes in Patients with Left Ventricular Dysfunction Undergoing Percutaneous Chronic Total Occlusion Revascularization.

The presence of a chronic total occlusion (CTO) and severe left ventricular (LV) systolic dysfunction are known negative prognostic factors in patients with coronary artery disease. Several studies have examined the effect of CTO revascularization on mortality, symptoms, occurrence of myocardial infarction (MI), and cardiac function in patients with normal or reduced LV function. However, the effect of CTO revascularization on heart failure-related events in patients with LV dysfunction, such as heart failure hospitalization (HFH), the occurrence of atrial fibrillation (AF), and a worsening renal function (WRF), has not yet been evaluated. To assess the success rate and safety of CTO percutaneous coronary interventions (PCIs) in coronary patients with LV ejection fractions of 40% and evaluate the impact of successful CTO revascularization on HFH, occurrence of AF, and WRF. Prospectively, data were collected from CTO PCIs performed at three referral centers and analyzed. From a total of 1435 CTO PCIs, 132 (9.2%) patients with a left ventricular ejection fraction (LVEF) of 40% were included in this analysis. The median follow-up duration was 23.18 months (interquartile range (IQR): 11.02-46.66 months). A successful CTO PCI was achieved in 109 of these patients, while the procedure was unsuccessful in 23 patients (82.5% procedural success rate). Overall, the intervention had an acceptable number of peri-procedural (or in-hospital) complications (9.1%). During the follow-up period, the rates of all-cause death, cardiovascular death, and non-fatal MI were not significantly different between the two groups. The rates of HFH were significantly lower in the successful PCI group, while WRF and AF did not differ between successful and unsuccessful PCI groups. Successful PCI and higher estimated glomerular filtration rate (eGFR) were independent predictors of a lower risk of HFH, while prior stroke and diabetes were independent predictors of a higher risk of HFH. In patients with reduced LV systolic function (ejection fraction, EF 40%), CTO PCI is a safe and effective procedure and successful CTO PCI is independently associated with a lower risk of HFH during follow-up. Further expansion of this cohort is necessary to confirm these results.

Impact of Successful Recanalization and Clinical Outcomes of Patients With Acute Ischemic Stroke with 5 or More Thrombectomy Passes

Background As the number of thrombectomy passes increases during endovascular therapy (EVT) for acute stroke, neurointerventionalists must weigh the risks of potential complications against the risk of failing to recanalize the affected vessel. Thus, we investigated the effectiveness and safety of EVT for patients with acute stroke in which ≥5 EVT passes were performed. Methods This retrospective cohort study from January 2013 to December 2022 included 31 thrombectomy‐capable centers. Patients in whom ≥5 EVT passes were made were included in the analysis. The patients with successful recanalization defined as modified Thrombolysis in Cerebral Infarction ≥2b at 5, 6, 7, or more passes were compared with unsuccessful recanalization. We also compared procedure time, separated by 30 minutes. Primary outcome was a favorable 90‐day outcome (modified Rankin scale score of 0–2). Secondary outcomes were intracranial hemorrhage and death. Results A total of 407 patients met the inclusion criteria, of which 175 were women (43.1%); the mean age was 67.3 years. In 265 (65.1%) patients, successful recanalization was achieved: 134 patients with 5 passes, 67 patients with 6 passes, and 64 with ≥7 passes. Intravenous recombinant tissue plasminogen activator administration was more common in the unsuccessful recanalization group (successful recanalization with 5, 6, and ≥7 EVT passes and unsuccessful recanalization: 35.3%, 30.3%, 18.8%, and 45.4%, respectively). Successful recanalization with 5, 6, and ≥7 EVT passes was associated with favorable outcome compared with unsuccessful recanalization group (adjusted odds ratio successful recanalization with 5, 6, and ≥7 EVT passes to unsuccessful recanalization [95% CIs]: 8.29 [2.13–32.3]; 14.0 [3.27–60.3]; and 5.26 [1.12–24.8], respectively). However, symptomatic intracranial hemorrhage was not significantly different between the groups. Regarding procedure time, favorable outcome was not significantly different in each group, while symptomatic intracranial hemorrhage occurred more frequently in the 60 to 89 minutes group compared with the &lt;30 minutes group (adjusted odds ratio, 60–89 minutes group to &lt;30 minutes group [95% CI]: 5.86 [1.09–31.6]). Conclusion These findings suggest that a benefit in outcome persists for recanalization, without significant increase in complications. In addition, there was no significant difference in favorable outcomes among procedure time.

Single tertiary center experience using Gore Cardioform Atrial Septal Defect Occluder for secundum atrial septal defect closure with a focus on deficient rims.

The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited. All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35°, 0°, and 90° were assessed for anterior-superior (AS) and posterior (P), anterior-inferior (AI) and posterior-superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims less than 5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group. In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 ± 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias. Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.

Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry

ObjectiveWhile most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. MethodsThis is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. ResultsA global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients’ health status improved significantly only in successful group. ConclusionsNo significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success.

How do drivers' attitudes to low emission zones change after experiencing it? – A pilot study in Norway

Air quality is a problematic issue in many urban areas in the world, and transport contributes to this. This study investigates attitudes towards a piloted low emission zone (LEZ) and distance-based differentiated road user charging (RUC) system. Both policy instruments are likely to be implemented in combination in Norway, aiming at curbing local environmental issues in the largest cities and cover other external costs of car use. The piloted system uses GNSS to track the vehicles and we focus specifically on plug-in hybrid vehicles (PHEVs). The drivers in the experiment were encouraged to use electricity as much as possible within the LEZs, and the drivers were given a monetary incentive which simulates a distance-based RUC within the zones. Forty participants tested the system for several weeks. The technical data from the vehicles, and the participants' attitudes were measured both before and after testing the system and were analysed together to measure the participants' behavioural change and how this correlated with their attitudes towards the system. The results revealed a significant change in the drivers' attitudes before and after testing the system. The participants who were successful in using the LEZ system as intended (i.e. increased use of the electricity mode within the LEZ) gained a more positive attitude. There was no difference between the successful and the unsuccessful groups in their attitudes towards distance-based RUC. These findings highlight the importance of understanding how innovative transport policies aiming at regulating negative externalities from car use are affecting people's everyday life, as this is the major explanatory variable for user acceptance. Furthermore, the study also shows that using distance-based RUC as an incentive for stimulating to a mode shift to the electric engine in PHEVs is a promising avenue.

Determinants of successful parallel wire technique in percutaneous coronary intervention to coronary chronic total occlusion

BackgroundMany techniques and concepts have been developed in the field of percutaneous coronary intervention to chronic total occlusion (CTO). Parallel wire technique (PWT) is still an important technique in antegrade approach. The purpose of this study was to identify the determinants of successful PWT in coronary CTO. MethodsWe reviewed consecutive 451 CTO lesions that were treated with PCI in our medical center. The overall success rate of PCI to CTO during the study period was 92.2 % (416/451). Of 451 CTO lesions, we excluded 333 CTO lesions in which PTW was not performed. We included 118 CTO lesions in which PWT was performed, and divided them into the successful PWT group (n = 65) and the unsuccessful PWT group (n = 53) according to the procedure success of PWT. Multivariate logistic regression analysis were performed to find the determinants of successful PWT. ResultsThe prevalence of the sufficient clarity of CTO exit site was significantly higher in the successful PWT group (46.2 %) than in the unsuccessful PWT group (11.3 %) (p < 0.01). Multivariate logistic regression analysis revealed that the J-CTO score was inversely associated with successful PWT (OR 0.66, 95 % CI 0.44–0.99, P = 0.04), whereas the sufficient clarity of CTO exit site was associated with successful PWT (OR 5.16, 95 % CI 1.75–15.20, P < 0.01). ConclusionsThe J-CTO score was inversely associated with successful PWT, whereas the sufficient clarity of CTO exit site was associated with successful PWT. The low J-CTO score and the sufficient clarity of CTO exit site may be the determinants of successful PWT.

Hematolojik Parametrelerin Transforaminal Epidural Steroid Enjeksiyonu Sonrası Ağrı Azalması Üzerine Etkisi

Objective: Since inflammation plays an important role in radiculopathies, and that neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR) are known to be associated with inflammation, the effects of these values on transforaminal epidural steroid injections (TFESI) in patients with lumbar radiculopathy were investigated. Methods: A total of 101 patients, who were diagnosed with lumbar radiculopathy and underwent TFESI, were retrospectively analyzed. Therapeutic success was considered to be a ≥ 50% decrease in visual analog scale (VAS) scores one month after TFESI. The patients in the study were placed in two groups according to whether their treatment was successful or unsuccessful, according to this criteria, and hemogram parameters in the two groups were then compared. Results: The study included 46 female and 55 male patients with a mean age of 49.43 ± 13.29. The median duration of symptoms was 3.0 (3.0-8.0) months. It was found that there was no significant difference between the groups in terms of neutrophil, lymphocyte, monocyte, platelet counts, mean plazma volümü (MPV), kırmızı hücre dağılım genişliği (RDW), platelet/ lenfosit oranı (PLR), sistemik inflamatuar indeks (SII), sedimentation, and C-reactive protein (CRP), although it was observed that there were significant increases in NLR in the successful group [2.34 (1.70-3.17)], as compared to the unsuccessful group [1.79 (1.51-2.57)] (p=0.026). Conclusion: Neutrophil/lymphocyte ratio is able to predict the response to TFESI treatment in patients with lumbar radiculopathy, in that patients with a higher NLR demonstrate a better response. Keywords: Hemogram parameters, inflammation, neutrophil to lymphocyte ratio, lumbar disc herniation, lumbar radiculopathy

The OdonAssist inflatable device for assisted vaginal birth—the ASSIST II study (United Kingdom)

Decreasing rates of assisted vaginal birth have been paralleled with increasing rates of cesarean deliveries over the last 40 years. The OdonAssist is a novel device for assisted vaginal birth. Iterative changes to clinical parameters, device design, and technique have been made to improve device efficacy and usability. This study aimed to determine if the feasibility, safety, and efficacy of the OdonAssist device were sufficient to justify conducting a future randomized controlled trial. An open-label nonrandomized study of 104 participants having a clinically indicated assisted vaginal birth using the OdonAssist was undertaken at Southmead Hospital, Bristol, United Kingdom. Data were also collected from participants who consented to participate in the study but for whom trained OdonAssist operators were not available, providing a nested cohort. The primary clinical outcome was the proportion of births successfully expedited with the OdonAssist. Secondary outcomes included clinical, patient-reported, operator-reported, device and health care utilization. Neonatal outcome data were reviewed at day 28, and maternal outcomes were investigated up to day 90. Given that the number of successful OdonAssist births was ≥61 out of 104, the hypothesis of a poor rate of 50% was rejected in favor of a good rate of ≥65%. Between August 2019 and June 2021, 941 (64%) of the 1471 approached, eligible participants consented to participate. Of these, 104 received the OdonAssist intervention. Birth was assisted in all cephalic vertex fetal positions, at all stations ≥1 cm below the ischial spines (with or without regional analgesia). The OdonAssist was effective in 69 of the 104 (66%) cases, consistent with the hypothesis of a good efficacy rate. There were no serious device-related maternal or neonatal adverse reactions, and there were no serious adverse device effects. Only 4% of neonatal soft tissue bruising in the successful OdonAssist group was considered device-related, as opposed to 20% and 23% in the unsuccessful OdonAssist group and the nested cohort, respectively. Participants reported high birth perception scores. All practitioners found the device use to be straightforward. Recruitment to an interventional study of a new device for assisted vaginal birth is feasible; 64% of eligible participants were willing to participate. The success rate of the OdonAssist was comparable to that of the Kiwi OmniCup when introduced in the same unit in 2002, meeting the threshold for a randomized controlled trial to compare the OdonAssist with current standard practice. There were no disadvantages of study participation in terms of maternal and neonatal outcomes. There were potential advantages of using the OdonAssist, particularly reduced neonatal soft tissue injury. The same application technique is used for all fetal positions, with all operators deeming the device straightforward to use. This study provides important data to inform future study design.

High-velocity nasal insufflation success assessment using ROX index in patients with acute respiratory failure

Abstract Background High-velocity nasal insufflation (Hi-VNI) in patients with acute respiratory failure (ARF) gives humidified, heated oxygen, with a higher velocity, and gas flow up to 40 l/min, and FiO2 up to 1.0 through more comfortable, relatively small nasal prongs. respiratory rate-oxygenation (ROX) index is an easy bedside test, variable with time, and helps in decision making in the daily follow-up of patients on Hi-VNI. Aim The aim was to validate the accuracy of ROX index in the early detection of patients with ARF who will fail using Hi-VNI and need early intubation without worsening their clinical prognosis. Patients and methods A prospective observational cohort study was performed on 40 patients with ARF who received Hi-VNI treatment. Application of Hi-VNI was done once indicated, and after 2, 6, and 12 h, intensivists calculated ROX indices. Then, follow-up patients was performed for the need for intubation, ICU length of stay, and 28-day mortality. Results Patients treated with Hi-VNI were divided into two groups: the successful group and the unsuccessful group. A total of 20 patients (50%) required intubation after Hi-VNI. Their median ROX indices were 4.25, 4.6, and 4.8 after 2, 6, and 12 h, respectively. The ROX index can predict the risk of intubation in patients with ARF. However, in the successful group, ROX indices were 6.35, 6.29, and 7.05 after 2, 6, and 12 h, respectively. The ROX index was an accurate predictor of success (area under the curve=1.00). Conclusion In patients with ARF treated by Hi-VNI, the ROX index is a bedside test, daily used in ICU, and can early predict patients who will fail using Hi-VNI and need intubation, thus avoiding delayed intubation and worse clinical outcome.

P-159 Impact of the symbiotic metabolites D-amino acids on preimplantation development

Abstract Study question Are the metabolites derived from the symbiotic microbiota of reproductive tract involved in preimplantation development? Summary answer The metabolites derived from the symbiotic microbiota of reproductive tract, D-amino acid（D-AA）, contributed to preimplantation development. What is known already It has been known that Lactobacillus exist in the vagina as symbiotic bacteria. Though it was thought that Lactobacillus keep the pH environment acidic and prevent infection by pathogenic bacteria, thereby keeping the uterus and fallopian tubes sterile in mammal, we have identified Staphylococcus aureus in oviductal lavage fluid from female mice and confirmed that the antibiotics disrupt the implantation pattern. In human, the vaginal microbiota is reported to be dominated by Lactobacillus, which produces D-amino acids (D-AA). These findings suggest the involvement of bacterial metabolites D-AA in the establishment of human pregnancy. Study design, size, duration 23 women undergoing in vitro fertilization (IVF) treatment at Keio University Hospital from 2019 to 2021 were assessed for eligibility. 3 were excluded due to spontaneous pregnancy or infectious disease. Twenty subjects were allocated to the successful pregnancy group (S-group (8); mean ± standard deviation 35.5 ± 2.8 years) defined as gestational sac detected on ultrasound at 5 weeks' gestation; and to the unsuccessful pregnancy group (U- group (12); 35.5 ± 2.7 years)). Participants/materials, setting, methods Genomic DNA (gDNA) extracted from vaginal and intrauterine samples at each menstrual cycle was used for metagenome analysis at the genus and the species levels by next-generation sequencing, and by quantitative real-time PCR. Amino acids were analyzed using a two-dimensional HPLC. Immunocytochemical staining by a polyclonal antibody to D-AA oxidase (DAO), which catabolizes D-AA, was performed using B6D2F1 mice and mice with a natural point-mutation G181R in DAO gene, which abolishes DAO activity. Main results and the role of chance Both vaginal/uterine bacterial counts were higher in the luteal phase than in the follicular phase. Vaginal bacterial counts in the S-group were lower than those in the U- group. The composition of microbiota of the vaginal samples (N = 23) shifted from the follicular to the luteal phase, with Lactobacillus spp. predominating. However, there was no significant difference in the ratio of Lactobacillus spp. between the S- and U-groups. The intrauterine samples of the S-group contained a high abundance of L. crispatus, L. gasseri, and L. ultunensis, while the U-group contained a high abundance of L. jensenii. Next, we analyzed the Lactobacillus metabolite, D-AA, and detected D-Ser, D-Ala, D-Asn, and D-Pro in the vaginal, uterine, and follicular fluid of the S-group. Follicular fluid that developed into blastocysts contained more D-AA than that of arrested embryos (N = 2). To investigate the significance of D-AA in the preimplantation development, mouse embryos were cultured in amino acid-depleted medium. All of them arrested (0.0%: 0/78), whereas 41% (25/61) of the embryos with D-AA added to the amino acid-depleted medium developed into blastocysts. We confirmed the expression of DAO in oocytes and blastocysts. DAO-null mice had fewer births than wild type. Limitations, reasons for caution The main limitation is the differences of symbiotic microbiota in reproductive tract and embryonic development between mice and humans; it may be difficult to apply the results of this analysis to humans. Wider implications of the findings Our results display a correlation between species-level microbiome profiling and IVF outcomes. In addition, microbiota-derived metabolites D-AA are suggested to be crucial mediators of embryo development. These findings could give rise to the development of new diagnostic techniques and drug. Trial registration number Not applicable

Impact of plaque and luminal morphology in balloon angioplasty of the femoropopliteal artery: an intravascular ultrasound analysis.

To assess the effect of plaque and luminal morphologies in balloon angioplasty of femoropopliteal lesions using intravascular ultrasound (IVUS). This retrospective, observational study analyzed 836 cross-sectional images using IVUS, from 35 femoropopliteal arteries of patients who underwent endovascular treatment between September 2020 and February 2022. Pre- and post-balloon angioplasty images were matched per 5 mm. Post-balloon angioplasty images were grouped into successful (n = 345) and unsuccessful (n = 491) groups. Plaque and luminal morphologies (such as severity of calcification, vascular remodeling, and plaque eccentricity) were extracted before the balloon angioplasty procedure to identify the predictors of unsuccessful balloon angioplasty. Additionally, 103 images with severe dissection were analyzed using IVUS and angiography. In univariate analyses, the predictive factors for unsuccessful balloon angioplasty were vascular remodeling (p < .001), plaque burden (p < .001), lumen eccentricity (p < .001), and balloon/vessel ratio (p = .01). Predictive factors for severe dissections were the guidewire route (p < .001) and balloon/vessel ratio (p = .04). In multivariate analysis, the predictive factors for unsuccessful balloon angioplasty included lumen eccentricity (odds ratio [OR]: 3.99, 95% confidence interval [CI]: 1.28-12.68, p = .02) and plaque burden (OR: 1.03, 95% CI: 1.02-1.04; p < .001). For severe dissections, the independent risk factor was an eccentric guidewire route (OR: 2.10, 95% CI: 1.22-3.65, p = .01). High plaque burden and luminal eccentricity were risk factors for failed femoropopliteal artery balloon angioplasty. Additionally, eccentric guidewire routes predicted severe dissection.

Decision-making tree for optimal Woven EndoBridge device sizing with ideal Woven EndoBridge-aneurysm volume (iWAVe) ratio

PurposeOptimal size selection is important for successful Woven EndoBridge (WEB) treatment. Conventional recommendations for WEB sizing based on aneurysm width and height sometimes require device exchange. We aimed to design a novel volume-based parameter, the ideal WEB-aneurysm volume (iWAVe) ratio, for optimal WEB sizing. MethodsConsecutive patients who underwent WEB treatment for wide-neck bifurcation aneurysms between January 2021 and May 2022 were retrospectively reviewed. Aneurysm volume was automatically calculated using software. We measured the aneurysm volume based on the expected position of the device within the aneurysm. The WAVe ratio was defined as the ratio of the aneurysm volume to WEB volume. We dichotomized aneurysms treated with a successful sizing or unsuccessful sizing for WEB (successful group and unsuccessful group, respectively). ResultsThirty-five patients were eligible for study enrollment. Ten patients (28.6%) needed to exchange the WEB on the first attempt and required another WEB on the second attempt resulting in deployment success. Hence, 35 aneurysms were in the successful group and 10 were in the unsuccessful group. The median WAVe ratio was 1.0 (range 0.76–1.31) in the successful group and 1.27 (0.58–1.89) in the unsuccessful group. Using logistic regression, iWAVe ratio was from 0.90–1.16 to secure a >80% probability of success by the 95% lower confidence limit. The sensitivity and specificity of the iWAVe ratio for optimal size selection on the first attempt were 0.60 and 1.00, respectively. ConclusionDecision-making based on aneurysm width and the iWAVe ratio could promote optimal WEB sizing.

Mechanism of community quitters' psychological traits on their smoking cessation effects: Based on a study of community intervention.

We study the relationship between psychological traits of smokers and their smoking cessation effects, and provide more scientific evidence for smoking cessation intervention. The study was conducted as a nested case-control study. Smokers who participated in the community smoking cessation intervention projects in Beijing in 2018-2020, were selected as the research participants and divided into two groups: a successful smoking cessation and unsuccessful smoking cessation group, according to their smoking cessation effects at 6 months. Psychological traits of quitters including smoking abstinence self-efficacy, willingness to quit smoking, and trait coping style, were compared between the two groups, and a structural equation model was established for confirmatory factor analysis to analyze their mechanisms. There were differences in smoking cessation results between the successful smoking cessation group and the unsuccessful smoking cessation group in terms of smoking abstinence self-efficacy and willingness to quit smoking. Willingness to quit smoking (OR=1.06; 95% CI: 1.008-1.118) is a risk factor, while smoking abstinence self-efficacy in habit/addiction situations (OR=0.77; 95% CI: 0.657-0.912) is a protective factor. The results of the structural equation model showed that smoking abstinence self-efficacy (β=0.199, p=0.002) and trait coping style (β= -0.166, p=0.042) could influence smoking cessation effects. The structural equation model was well fitted, which showed that smoking abstinence self-efficacy (β=0.199, p=0.002) and trait coping style (β= -0.166, p=0.042) might have influenced the effect of smoking cessation among smokers. Willingness to quit smoking has a positive impact on the smoking cessation effect, while smoking abstinence self-efficacy in habit/addiction situations and negative trait coping style have a negative impact. Smoking abstinence self-efficacy and trait coping styles can significantly affect smoking cessation outcomes.

The V1 transition ratio: electrocardiographic criterion for predicting the success of ablation for outflow tract premature ventricular contractions

Abstract Funding Acknowledgements Type of funding sources: None. Background Several electrocardiographic (ECG) criteria have been proposed for distinguishing left from right ventricular outflow tract premature ventricular contractions (OTPVCs) origins. However, electrocardiographic criteria predicting successful catheter ablation (CA) for OTPVCs are still unknown regardless of right and left ventricular origins. Methods We enrolled 63 patients who underwent CA for OTPVCs from September 2020 to August 2022, except patients with bundle branch block and axis deviation in 12-lead ECG. Radiofrequency catheter ablation (RFCA) was performed using 3D-mapping system and irrigation catheter. Electrocardiographic parameters of successful and unsuccessful patients were retrospectively analyzed. The transition ratios were calculated by the percentage R-wave during PVC (R/R+S) PVC divided by the percentage R-wave in sinus rhythm (R/R+S) SR . Success of CA for OTPVCs was defined as absence of targeted PVCs during all follow up visits and PVC burden &amp;lt;5% on follow-up period. Results 54 patients (85.7%) were success and 9 patients (14.3%) were unsuccess. Age, sex, Ejection Fraction (EF) and the burden of PVCs before CA were similar between 2 group. (Age: 50±15 vs 54±12 years, p=0.51, male: 46.3 vs 53.7%, p=0.73, EF: 66(58-73) vs 69(59-74), p=0.52, burden of PVCs: 22(17-29) vs 15(13-33)%, p=0.45). V1 transition ratio of unsuccessful group was significantly higher than successful group. (0.70(0.32-1.49) vs 1.55(1.09-9.37), p=0.013) V2 and V3 transition ratios were not significantly different between the two groups. The best cutoff values of V1 transition ratio were 1.0 (AUC 0.78, 95%CI: 0.61-0.94, sensitivity 0.70, specificity 0.88). Conclusion V1 transition ratio&amp;gt;1.0 is more likely to be associated with a higher rate of RFCA failure of OTPVCs.

Predictors of Relevant Changes in Pain and Function for Adolescents with Idiopathic Scoliosis following Surgery.

Retrospective analysis of longitudinal data. To evaluate clinically relevant change in surgical outcomes for Adolescents with Idiopathic Scoliosis (AIS), comparing those who achieved smallest detectable change (SDC) in pain and function at 1-year post-surgery and those who did not, and to evaluate the influencing factors. The SDC is recommended to evaluate the surgical outcomes of AIS. However, little is known about the use of SDC in AIS and its influencing factors. This was a retrospective analysis of longitudinal data from patients who underwent surgical correction at a tertiary spinal centre from to 2009-2019. Surgical outcomes were assessed at short-term (6wk, 6mo) and long-term (1- and 2-years) post-surgery using the Scoliosis Research Society (SRS-22r). The difference between 'successful' (≥ SDC) and 'unsuccessful' (< SDC) groups was assessed using an independent t-test. Univariate and logistic regression analyses enabled the assessment of influencing factors. All SRS-22r domains decreased in the short term, except for self-image and satisfaction. In the long term, self-image increased by 1.21 and function increased by 0.2, and pain decreased by 0.1. In all SRS-22r domains 'successful' group had low pre-surgery scores and were statistically different to the 'unsuccessful group'. The difference remained statistically significant at 1-year for most SRS-22r domains. Being older and having low pre-surgery SRS-22r scores increased the chances of achieving SDC function at 1-year. Achieving SDC in the pain domain was significantly associated with age, sex, length of hospital stay, and pre-surgical scores. Notably, the self-image domain showed the largest change compared to other SRS-22r domains. A low preoperative score increases the likelihood of clinical benefit from surgery. These findings demonstrate the utility of SDC for assessing the benefits and factors that may underpin surgical benefit in AIS.

The success rate of cardiopulmonary resuscitation and its correlated factors in patients with emergency prehospital cardiac arrest

ABSTRACT To assess the initial success rate and its correlated factors on cardiopulmonary resuscitation (CPR) in emergency prehospital cardiac arrest patients. The clinical information of 429 patients with cardiac arrest who underwent prehospital CPR in the fourth hospital of Hebei Medical University from Jan 2020 to Apr 2022 were evaluated. The patients were divided into the successful group (ROSC, n = 25) and the unsuccessful group (non-ROSC, n = 404) according to whether the autonomous circulation (ROSC) was resumed. The univariate analysis was performed to evaluate the differences in age, the start time of CPR, the application of electric defibrillation, and other related data between the two groups. The multivariate analysis evaluated protective factors affecting CPR’s success in prehospital cardiac arrest patients. Patients with cardiogenic causes had the highest success rate of cardiopulmonary resuscitation. The causes of traffic accidents and drowning account for a low proportion. Furthermore, the median CPR length was 25.0 min, alternating from 1.5 to 64 mi. The univariate analysis revealed that age, the start time of CPR, application of electric defibrillation, and adrenaline dosage were correlated with CPR attempts (p < 0.05). Multivariate logistic regression analysis showed that the age of patients with prehospital CA, the location of prehospital CA, etiology, bystander CPR, CPR start time, defibrillation start time, tracheal intubation time, type of rhythm before resuscitation, adrenaline dosage <5 mg, and adrenaline administration time were all the influencing factors of prehospital CPR success (p < 0.01). The factors affecting CPR’s success rate in prehospital CA patients are complicated. Establishing a few procedures to diminish the incidence of these risk factors is crucial.