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Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1369
Author(s):  
Hae Do Jung ◽  
Youna Hong ◽  
Joo Yong Lee ◽  
Seon Heui Lee

Background and Objectives: This systematic review and meta-analysis was conducted to analyze the treatment outcomes of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) according to the ureteral stone size. Materials and Methods: In this systematic review, relevant articles that compared SWL and URSL for treatment of ureteral stones were identified. Articles were selected from four English databases including Ovid-Medline, Ovid-EMBASE, the Cochrane Central Register of controlled Trials (Central), and Google Scholar. A quality assessment was carried out by our researchers independently using the Scottish Intercollegiate Guidelines Network (SIGN). A total of 1325 studies were identified, but after removing duplicates, there remained 733 studies. Of these studies, 439 were excluded, 294 were screened, and 18 met the study eligibility criteria. Results: In randomized control trial (RCT) studies, URSL showed significantly higher SFR than SWL (p < 0.01, OR= 0.40, 95% CI 0.30–0.55, I² = 29%). The same results were shown in sub-group analysis according to the size of the stone (<1 cm: p < 0.01, OR = 0.40, 95% CI 0.25–0.63; >1 cm: p < 0.01, OR = 0.38, 95% CI 0.19–0.74, I² = 55%; not specified: p < 0.01, OR = 0.43, 95% CI 0.25–0.72, I² = 70%). In the non-RCT studies, the effectiveness of the URSL was significantly superior to that of SWL (p < 0.01, OR = 0.33, 95% CI 0.21–0.52, I² = 83%). Retreatment rate was significantly lower in URSL than in SWL regardless of stone size (p < 0.01, OR = 10.22, 95% CI 6.76–15.43, I² = 54%). Conclusions: Meta-analysis results show that SFR was higher than SWL in URSL and that URSL was superior to SWL in retreatment rate. However, more randomized trials are required to identify definitive conclusions.


2021 ◽  
Vol 12 ◽  
Author(s):  
Qi Wei ◽  
Gangxian Fan ◽  
Zhenzhu Li ◽  
Qingbo Wang ◽  
Ke Li ◽  
...  

Background: Bilateral chronic subdural hematoma (bCSDH) is a frequent condition commonly linked to the need for retreatment; however, the reason for this high retreatment rate remains unclear. The middle meningeal artery (MMA) was found to have a relationship with the occurrence and development of chronic subdural hematomas. This study examines a possible method to reduce bCSDH recurrence using bilateral MMA embolization combined with bilateral burr-hole drainage.Materials and Methods: Ten patients with bCSDH who underwent bilateral MMA embolization combined with bilateral burr-hole drainage at our hospital between June 2018 and May 2020, were retrospectively analyzed. Patients' clinical information, prognoses, imaging results, as well as surgical results were documented and analyzed.Results: Ten patients were diagnosed with bCSDH with no comorbid brain diseases. They underwent bilateral MMA embolization combined with bilateral burr-hole drainage. We embolized the MMA immediately before burr hole drainage successfully and employed angiography to validate these results. All the patients attained relief of symptoms without adverse events, and no re-expansion or relapse was reported in the follow-up computed tomography.Conclusion: Bilateral MMA embolization combined with bilateral burr-hole drainage is an available treatment for patients with bCSDH and may have the potential for preventing recurrence.


2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 165-165
Author(s):  
Sara J Trojan ◽  
Jerilyn Hergenreder ◽  
Landon Canterbury ◽  
Tyler Leonhard ◽  
John M Long

Abstract Crossbred steers [British x Continental x Bos Indicus; n = 1844; initial body weight (BW) = 248 ± 28 kg] were used to evaluate the effects of chromium propionate supplementation to calf-fed steers in a commercial feedyard on growth performance, carcass characteristics and health. Steers were blocked by initial BW; pens were assigned randomly to one of two dietary treatments within block. Treatments, replicated in 15 pens/treatment with 57 to 62 head per pen, included: 1) control, 0 mg supplemental Cr/kg dietary dry matter (DM) (CTL); 2) 0.50 mg supplemental Cr/kg dietary DM (chromium propionate; KemTRACE® Chromium 0.04%, Kemin Industries, Des Moines, IA) (CR). Due to inadvertent oversight, during the final 30 days on feed, CR cattle did not receive trace minerals, vitamins, an ionophore, antibiotic, or ractopamine-hydrochloride. Final BW, average daily gain (ADG) and DM intake did not differ among treatments (P ≥ 0.25). Gain efficiency was greater (P = 0.03) for CTL than CR (0.16 vs. 0.15). Hot carcass weight and dressing percentage were similar among treatments (P ≥ 0.19). Yield grade was higher for CR than CTL (2.44 vs. 2.27; P &lt; 0.01); 12th-ribfat tended to be greater for CR than CTL (P = 0.09), and longissimus area was greater for CTL vs. CR (P &lt; 0.01). Marbling score tended (P = 0.10) to be greater for CR than CTL. Steers fed CR tended (P = 0.07) to have a greater distribution of prime carcasses than CTL (1.9% vs. 0.07%), and percentage choice carcasses was higher for CR than CTL (67.34% vs. 61. 71%, P = 0.01). Respiratory morbidity (12.20%), and retreatment rate did not differ among treatments (P ≥ 0.20). In the absence of a beta-agonist, CR steers had higher quality carcasses, and similar ADG and HCW to CTL.


2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jing Chen ◽  
Nuo Xu ◽  
Huilan Sun ◽  
Gang Chen

Purpose. The intravenous glucocorticoid (iv GC) represents the mainstay of therapy for Graves’ ophthalmopathy (GO), but uncertainty remains concerning the optimal regimen. Although the European Group on Graves’ Orbitopathy (EUGOGO) regimen has been commonly employed, evidence for its superiority to other regimens is still lacking. The aim of this meta-analysis was to compare the efficacy and safety of the EUGOGO regimen with higher-dose regimens in the management of GO. Methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies comparing the EUGOGO regimen with higher-dose regimens was conducted. PubMed, Embase, and Web of Science databases were searched for relevant studies. The efficacy outcomes were response rate, change in clinical activity score (CAS), rate of proptosis improvement, and retreatment rate. The safety outcome was the incidence of adverse events. Results. In the five included eligible trials, 136 participants in the EUGOGO regimen and 177 participants in higher-dose regimens were evaluated. Compared with the EUGOGO regimen, higher-dose regimens had no beneficial effect on the response rate, change of CAS, rate of proptosis improvement, and retreatment rate (OR: 1.3; 95% CI: 0.36–4.65; SMD: –0.04; 95% CI: –0.54, 0.45; OR: 0.79; 95% CI: 0.44–1.44; OR: 0.87; 95% CI: 0.27–2.77). For the incidence of adverse events, the results also showed no significant difference between the 2 groups (OR: 1.14; 95% CI: 0.62–2.09). Conclusion. The current evidence showed that the efficacy of the EUGOGO regimen was comparable with higher-dose regimens. Since there was no significant difference in the incidence of adverse events between the two regimens, appropriate selection of patients and careful monitoring were required in both regimens. More well-designed, large-scale, and longer follow-up period studies were needed to further verify the finding of this analysis.


2021 ◽  
pp. 159101992110217
Author(s):  
Mohamed MA Zaitoun ◽  
Islam El Malky ◽  
Sebastian Winklhofer ◽  
Anton Valavanis ◽  
Gerasimos Baltsavias

Purpose The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature. Methods Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome. Results The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero. Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence. Conclusion Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.


2021 ◽  
Vol 12 ◽  
Author(s):  
Alejandro M. Spiotta ◽  
Min S. Park ◽  
Richard J. Bellon ◽  
Bradley N. Bohnstedt ◽  
Albert J. Yoo ◽  
...  

Introduction: Penumbra SMART COIL® (SMART) System is a novel generation embolic coil with varying stiffness. The study purpose was to report real-world usage of the SMART System in patients with intracranial aneurysms (ICA) and non-aneurysm vascular lesions.Materials and Methods: The SMART Registry is a post-market, prospective, multicenter registry requiring ≥75% Penumbra Coils, including SMART, PC400, and/or POD coils. The primary efficacy endpoint was retreatment rate at 1-year and the primary safety endpoint was the procedural device-related serious adverse event rate.Results: Between June 2016 and August 2018, 995 patients (mean age 59.6 years, 72.1% female) were enrolled at 68 sites in the U.S. and Canada. Target lesions were intracranial aneurysms in 91.0% of patients; 63.5% were wide-neck and 31.8% were ruptured. Adjunctive devices were used in 55.2% of patients. Mean packing density was 32.3%. Procedural device-related serious adverse events occurred in 2.6% of patients. The rate of immediate post-procedure adequate occlusion was 97.1% in aneurysms and the rate of complete occlusion was 85.2% in non-aneurysms. At 1-year, the retreatment rate was 6.8%, Raymond Roy Occlusion Classification (RROC) I or II was 90.0% for aneurysms, and Modified Rankin Scale (mRS) 0-2 was achieved in 83.1% of all patients. Predictors of 1-year for RROC III or retreatment (incomplete occlusion) were rupture status (P &lt; 0.0001), balloon-assisted coiling (P = 0.0354), aneurysm size (P = 0.0071), and RROC III immediate post-procedure (P = 0.0086) in a model that also included bifurcation aneurysm (P = 0.7788). Predictors of aneurysm retreatment at 1-year was rupture status (P &lt; 0.0001).Conclusions: Lesions treated with SMART System coils achieved low long-term retreatment rates.Clinical Trial Registration:https://www.clinicaltrials.gov/, identifier NCT02729740.


2021 ◽  
Vol 6 (1) ◽  
pp. e000695
Author(s):  
Pia Lundgren ◽  
Lena Jacobson ◽  
Anna-Lena Hård ◽  
Abbas Al-Hawasi ◽  
Eva Larsson ◽  
...  

ObjectivePrematurity is a major risk factor for retinopathy of prematurity (ROP). We aimed to elucidate ROP prevalence, treatment and retreatment in infants born before 24 gestational age (GA) weeks in a Swedish cohort.Methods and analysisInfants with completed ROP screening, born at <24 GA weeks, 2007–2018 in Sweden were included. Data of GA, birth weight (BW), sex, neonatal morbidities, maximal ROP stage, aggressive posterior ROP (APROP), ROP treatments, treatment modality and treatment centre were retrieved.ResultsIn total, 399 infants, with a mean GA of 23.2 weeks (range 21.9–23.9) and a mean BW of 567 g (range 340–874), were included. ROP was detected in 365 (91.5%) infants, 173 (43.4%) were treated for ROP and 68 of 173 (39.3%) were treated more than once. As the first treatment, 142 (82.0%) received laser and 29 (16.1%) received intravitreal injection of antivascular endothelial growth factor (anti-VEGF). Retreatment was performed after first laser in 46 of 142 (32.4%) and in 20 of 29 (69.0%) after first anti-VEGF treatment. Retreatment rate was not associated with GA, BW or sex but with APROP, treatment method (anti-VEGF) and treatment centre where the laser was performed (p<0.001). Twenty eyes progressed to retinal detachment, and two infants developed unilateral endophthalmitis after anti-VEGF treatment.ConclusionInfants, born at <24 weeks’ GA, had high rates of treatment-warranting ROP and retreatments. Treatment centre highly influenced the retreatment rate after laser indicating that laser treatment could be improved in some settings.


Author(s):  
Rita Golfieri ◽  
Mario Bezzi ◽  
Gontran Verset ◽  
Fabio Fucilli ◽  
Cristina Mosconi ◽  
...  

Abstract Purpose The aim of this retrospective multicentric study was to compare the tumour response rates of Balloon-occluded Transarterial Chemoembolisation (B-TACE) to non-B-TACE using propensity score matching (PSM) in patients with hepatocellular carcinoma and to investigate the clinical benefit, such as lower rates of TACE re-intervention achieved using B-TACE. Material and Methods The B-TACE procedures (n = 96 patients) were compared with a control group of non-B-TACE treatments (n = 434 pts), performed with conventional (cTACE) or drug-eluting microspheres TACE (DEM-TACE). Data were collected from six European centres from 2015 to 2019. Objective responses (OR) and complete response (CR) rates after the first session and the number of TACE re-interventions were evaluated using PSM (91 patients per arm). Results The best target OR after PSM were similar for both B-TACE and non-B-TACE (90.1% and 86.8%, p = 0.644); however, CR at 1–6 months was significantly higher for B-TACE (59.3% vs. 41.8%, p = 0.026). Patients treated with B-TACE had a significantly lower retreatment rate during the first 6 months (9.9%% vs. 22.0%, p = 0.041). Post-embolisation syndrome (PES) rates were 8.8% in non-B-TACE and 41.8% in B-TACE (p < 0.001), with no significant differences between groups regarding major adverse events. Conclusion B-TACE is safe and effective, achieving higher CR rates than non-B-TACE. Patients undergoing B-TACE had a significantly lower retreatment rate within the first 6 months but higher PES rates. Level of Evidence III Level 3, retrospective study.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sae-Yeon Won ◽  
Volker Seifert ◽  
Daniel Dubinski ◽  
Sepide Kashefiolasl ◽  
Nazife Dinc ◽  
...  

AbstractTo clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. However, the microsurgical outcome has still been elusive concerning wide neck aneurysms (WNA). A retrospective single center study was performed with all patients with ruptured WNA (rWNA) and unruptured WNA (uWNA) admitted to author´s institute between 2007–2017. Microsurgical outcome was evaluated according to Raymond-Roy occlusion grade and follow-up angiography was performed to analyze the stability of neck/aneurysm remnants and retreatment poverty. Of 805 aneurysms, 139 were rWNA (17.3%) and 148 uWNA (18.4%). Complete occlusion was achieved in 102 of 139 rWNA (73.4%) and 112 of 148 uWNA (75.6%). Neck remnants were observed in 36 patients with rWNA (25.9%) and 30 patients with uWNA (20.3%), 1 (0.7%) and 6 (4.1%) patients had aneurysmal remnant, respectively. Overall complication rate was 11.5%. At follow-up (939/1504 months), all remnants were stable except for one, which was further conservatively treated with marginal retreatment rate under 1%. Even the risk of de-novo aneurysm was higher than the risk for remnant growth (2.6% vs 0% in rWNA; 8.7% vs 5.3% in uWNA) without significant difference. Microsurgical clipping is effective for complete occlusion of r/uWNA with low complication. Furthermore, the risk of remnant growth is marginal even lower than the risk of de-novo rate low retreatment rate.


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alejandro Spiotta ◽  
Reade A De Leacy ◽  
Bradley N Bohnstedt ◽  
David Fiorella ◽  
Clemens M Schirmer ◽  
...  

Introduction: We report the durability of treatment with SMART COIL System at one-year in patients with ruptured aneurysms enrolled in the SMART registry. Materials and Methods: The SMART Registry is a prospective, multi-center registry study. Procedures must employ ≥75% of the SMART, PC400, or POD coils to meet registry criteria. Patients with ruptured aneurysms presenting prior to the procedure were included in this analysis. SMART Registry endpoints include retreatment rates at one year, procedural device-related serious adverse events (SAE), and the ability to achieve adequate occlusion at immediate post-procedure. Results: Of the 905 enrolled patients with aneurysms, 31.8% (288/905) of patients had ruptured aneurysms (74.0% female; mean age 58.0 ± 13.5 years). Ruptured aneurysms were small (<4 mm) in 16.7% (48/288), medium (≥4mm to 10mm) in 68.4% (197/288), large (>10 to 25 mm) in 14.6% (42/288), giant (>25) in 0.3% (1/288), and the mean size was 6.9 mm (SD 3.5 ). Hunt and Hess grade ≥3 was reported in 43.8% (123/281) of patients. The anterior cerebral artery had 33.7% (97/288) of all ruptured aneurysms and the internal carotid artery had 30.6% (88/288). Stent-assisted coiling and balloon-assisted coiling were performed in 7.6% (22/288) and 31.3% (90/288) of patients, respectively. Mean packing density for ruptured aneurysms was 33.4% (SD 20.9). In patients with ruptured aneurysms, retreatment rate at one year was 16.5% (33/200). Procedural device-related SAEs were observed in 3.1% subjects (9/288). Raymond Class I or II was observed in 84.6% (242/286) at immediate post-procedure and in 84.3% (161/191) at one year. The multivariate analysis showed that neck width ≥4 mm (OR 2.56, 95% CI 1.21-5.44, P=0.0144) and male gender (OR 2.17 95% CI 1.05-4.49, P=0.0376) were predictors of Raymond Class III or retreatment at one year. Conclusion: This analysis suggests that the SMART COIL System achieves adequate embolization and retreatment rates in ruptured aneurysms at one year.


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