Management of the penetrating atherosclerotic ulcer in the descending thoracic aorta

2021 ◽  
pp. 021849232110331
Author(s):  
Nehman Meharban ◽  
Wahaj Munir ◽  
Mohammed Idhrees ◽  
Ali Bashir ◽  
Mohamad Bashir
Keyword(s):  
Decision Making ◽  
Management Strategies ◽  
Surgical Approaches ◽  
Data Sets ◽  
Intramural Haematoma ◽  
Type B ◽  
Penetrating Atherosclerotic Ulcer ◽  
First Line Therapy ◽  
Insidious Onset ◽  
Invasive Intervention

Penetrating atherosclerotic ulcers present with an insidious onset with a reported mortality of 9%, varying across populations. With vast arrays of risk factors and potentially ominous complications, it is vital to efficiently provide optimum strategies for management. There exists controversy in the literature regarding management, especially for Type B penetrating atherosclerotic ulcers; the decision-making framework encompasses numerous factors in considerations for medical management versus invasive intervention and choice of endovascular versus open repair in the latter. The concomitant presence of intramural haematoma adds further complexity to the already intricate decision-making for management. We performed searches through PubMed and SCOPUS analysing studies reporting outcomes for management strategies for penetrating atherosclerotic ulcers treatment, focusing on Type B, further seeking to analyse studies reporting their experiences of PAU patients with concomitant intramural haematoma. Our review highlights the ambiguity and controversy existing in the literature, comprising studies burdened by their inherent hindering limitations of their single-centre retrospective experiences. Endovascular therapy has come to the forefront of penetrating atherosclerotic ulcers management, often considered first line therapy. In the case of penetrating atherosclerotic ulcers alongside intramural haematoma, there have been reports of potential hybrid surgical approaches to management. Studies further show misdiagnosis of penetrating atherosclerotic ulcers in earlier data sets further complicates management. However, it is clear we must progress on the journey towards precision medicine, allowing delivery of optimum care to our patients.

scholarly journals Biomechanics of thoracic discectomy

2001 ◽  
Vol 11 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Andrew E. Wakefield ◽  
Michael P. Steinmetz ◽  
Edward C. Benzel
Keyword(s):  
Decision Making ◽  
Management Strategies ◽  
Surgical Approaches ◽  
Decision Making Process ◽  
Thoracic Disc Herniation ◽  
Unique Region ◽  
Surgical Decision ◽  
Thoracic Discectomy ◽  
Thoracic Disc ◽  
Surgical Decision Making

The thoracic spine is a structurally unique region that renders it uniquely suceptible to thoracic disc herniation. Surgical management strategies are complicated, in part, by the regional anatomical and biomechanical nuances. Surgical approaches include posterior, posterolateral, and anterior routes. Each isassociated with specific indications and contraindications. The biomechanical principles and safe anatomical trajectories must be considered in the surgical decision-making process. These issues are discussed in the pages that follow.

scholarly journals A top-level model of case-based argumentation for explanation: Formalisation and experiments

2021 ◽  
pp. 1-36
Author(s):  
Henry Prakken ◽  
Rosa Ratsma
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Linear Models ◽  
Evaluation Studies ◽  
Data Sets ◽  
Machine Learning Applications ◽  
Level Model ◽  
Similarities And Differences ◽  
Further Development ◽  
Case Based

This paper proposes a formal top-level model of explaining the outputs of machine-learning-based decision-making applications and evaluates it experimentally with three data sets. The model draws on AI & law research on argumentation with cases, which models how lawyers draw analogies to past cases and discuss their relevant similarities and differences in terms of relevant factors and dimensions in the problem domain. A case-based approach is natural since the input data of machine-learning applications can be seen as cases. While the approach is motivated by legal decision making, it also applies to other kinds of decision making, such as commercial decisions about loan applications or employee hiring, as long as the outcome is binary and the input conforms to this paper’s factor- or dimension format. The model is top-level in that it can be extended with more refined accounts of similarities and differences between cases. It is shown to overcome several limitations of similar argumentation-based explanation models, which only have binary features and do not represent the tendency of features towards particular outcomes. The results of the experimental evaluation studies indicate that the model may be feasible in practice, but that further development and experimentation is needed to confirm its usefulness as an explanation model. Main challenges here are selecting from a large number of possible explanations, reducing the number of features in the explanations and adding more meaningful information to them. It also remains to be investigated how suitable our approach is for explaining non-linear models.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

scholarly journals White matter tracts characteristics in habitual decision-making circuit underlie ritual behaviors in anorexia nervosa

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Reza Tadayonnejad ◽  
Fabrizio Pizzagalli ◽  
Stuart B. Murray ◽  
Wolfgang M. Pauli ◽  
Geena Conde ◽  
...  
Keyword(s):  
Decision Making ◽  
Anorexia Nervosa ◽  
White Matter ◽  
Symptom Severity ◽  
Structural Characteristics ◽  
Data Sets ◽  
White Matter Tracts ◽  
Compulsive Behaviors ◽  
Positive Correlations ◽  
Brain Behavior

AbstractAnorexia nervosa (AN) is a difficult to treat, pernicious psychiatric disorder that has been linked to decision-making abnormalities. We examined the structural characteristics of habitual and goal-directed decision-making circuits and their connecting white matter tracts in 32 AN and 43 healthy controls across two independent data sets of adults and adolescents as an explanatory sub-study. Total bilateral premotor/supplementary motor area-putamen tracts in the habit circuit had a significantly higher volume in adults with AN, relative to controls. Positive correlations were found between both the number of tracts and white matter volume (WMV) in the habit circuit, and the severity of ritualistic/compulsive behaviors in adults and adolescents with AN. Moreover, we found a significant influence of the habit circuit WMV on AN ritualistic/compulsive symptom severity, depending on the preoccupations symptom severity levels. These findings suggest that AN is associated with white matter plasticity alterations in the habit circuit. The association between characteristics of habit circuit white matter tracts and AN behavioral symptoms provides support for a circuit based neurobiological model of AN, and identifies the habit circuit as a focus for further investigation to aid in development of novel and more effective treatments based on brain-behavior relationships.

scholarly journals Analytical hierarchy process - bocr applied for the best lean project selection for production lines

2020 ◽  
Vol 11 (1) ◽  
pp. 054
Author(s):  
José Antonio De Miranda Lammoglia ◽  
Nilson Brandalise ◽  
Cecilia Toledo Hernandez
Keyword(s):  
Decision Making ◽  
Lean Manufacturing ◽  
Production Management ◽  
Production Systems ◽  
Management Strategies ◽  
Investment Project ◽  
Production Volume ◽  
Production Lines ◽  
Global Competitiveness ◽  
Investment Projects

The scenario of global competitiveness demands more and more of the organizations the search for continuous improvement. For survival, in the face of adverse market conditions, modern production management strategies are essential to make production processes increasingly efficient, lean and sustainable, minimizing losses in their production systems. In this sense, when thinking about changes in production lines, in search of improvements in their process, criteria that provide Benefits, Opportunities, Costs and Risks (BOCR) should be considered. In this way, managers and executives should rely on tools and methods that allow them to guide their decisions in a clear way. The objective of this work is to apply a method of Decision Making with Multiple Criteria to the alternatives of investment projects in production lines in Lean Manufacturing concept. As a general result, it was possible to observe the applicability of the AHP BOCR method for the decision-making case involving several criteria and subcriteria for choosing the Lean investment project in the steel environment, the preferred alternative being the discontinuity of the production line 1 and the absorption of their respective production volume by production lines 2 and 3 through investments in them.

scholarly journals Clinical implications of different morphotypes of ulcer-like projections in type b intramural haematoma

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 5940-5940
Author(s):  
S. Moral Torres ◽  
A. Evangelista ◽  
D. Gruosso ◽  
H. Cuellar ◽  
V. Galuppo ◽  
...  
Keyword(s):  
Clinical Implications ◽  
Intramural Haematoma ◽  
Type B

Patients’ Preferences’ Impact on Decision Making for Clinical Solitary Thyroid Nodule in a Global Healthcare Setting: A Clinical Study

2021 ◽  
Vol 3 (2) ◽  
pp. 48-58
Author(s):  
Abdalla Y Bashir ◽  
Keyword(s):  
Decision Making ◽  
Thyroid Nodule ◽  
Thyroid Surgery ◽  
Frozen Section ◽  
Management Strategies ◽  
Healthcare Setting ◽  
Objective Evaluation ◽  
Needle Aspiration ◽  
Solitary Thyroid Nodule ◽  
Risk Of Malignancy

Objective: Evaluation of patients’ preferences (PP) impact on decision-making for solitary thyroid nodule management. Study Design: A retrospective review of prospectively collected data in patients with clinical solitary nodules admitted for thyroid surgery. PP survey in various management strategies included determinants of surgery, fine-needle aspiration cytology (FNAC), frozen section (FS), and PP for total thyroidectomy (TT) or total lobectomy (TL) compared to guidelines concordance. Results: Thyroid surgery was performed for 558 patients, 75.8% were females and 43.7% were international. FNAC was done in 79.8% and refused by 20.2% due to the misperception that it spreads cancer. The risk of malignancy was the reason for choosing surgery in 35.1%. FS was preferred by 87% of the patients for decision-making (TT vs TL) in our setting with available pathology resources and low FS cost. FS based decisions were more guideline-concordant (79%) with TT performed in 41% patients compared to 74.4% in PP based decisions alone (P < 0.001). 57.9% of the patients preferred surgeon authorization for decision-making when FS was unavailable. Papillary thyroid carcinoma (PTC) occurred in 85.3%. FS diagnosed PTC in 79% of the patients with malignant nodules in inconclusive FNACs (Bethesda I, III, IV, and V). Conclusion: Decisions (TT vs TL) based on PP and beliefs compared to FS based decisions were less guideline-concordant (21% vs 79%) with more TT performed (74.4% vs 41%) (P < 0.001). Advancing patients’ knowledge on their disease, guidelines, and equipoise awareness is needed for better-shared decision-making.

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