scholarly journals A Surgical Approach Decision-Making for Benign Presacral Tumors in Adult Women: A Case Series

2021 ◽  
Author(s):  
Huiyan LIAO ◽  
Jiamin Liu ◽  
Siyu Wu ◽  
Jing Xiao
Keyword(s):  
Decision Making ◽  
Adult Female ◽  
Surgical Approach ◽  
Case Series ◽  
Vaginal Surgery ◽  
Adult Women ◽  
Decision Strategy ◽  
Presacral Tumor ◽  
Important Approach ◽  
Post Operation

Abstract Background: The incidence of benign presacral tumor is relatively low in adults and is much higher in women than in men. However, by far, there is no standard surgical approach for women. The study hope to propose a reasonable surgical approach decision strategy exclusively for adult women, which is feasible for removing tumors in different sizes and different locations. Methods: 4 adult female patients with benign presacral tumor were admitted to our department for surgical treatment over these 5 years. Their tumors were removed by transvaginal, laparoscopic, and combined laparoscopic-vaginal surgery respectively. Results: The operations were all carried out successfully. Patients who have undergone repeated examinations in the follow-up after surgery have no tumor recurrence. Conclusion: A reasonable surgical approach decision-making is beneficial to the surgical procedure and post-operation recovery. Transvaginal approach is an uncommon but important approach for benign presacral tumors in adult female.

Patellar fractures in cats: Repair techniques and treatment decision-making

2021 ◽  
Vol 23 (7) ◽  
pp. 649-661
Author(s):  
Sorrel J Langley-Hobbs
Keyword(s):  
Decision Making ◽  
Case Reports ◽  
Case Series ◽  
Treatment Decision ◽  
Evidence Base ◽  
Treatment Technique ◽  
Treatment Decision Making ◽  
Fracture Types ◽  
Patellar Fractures ◽  
Repair Techniques

Practical relevance: While feline patellar fractures are not commonly encountered in practice, they tend to be found more often in younger cats; no breed or sex predispositions are recognised. If there is no evidence of a traumatic aetiology, the cat may be suspected of having patellar fracture and dental anomaly syndrome (PADS). Patellar fractures are easy to diagnose on lateral radiographs and there are several different fracture types. The type of fracture, the age of the cat at fracture occurrence and whether there is suspicion of a pathological aetiology are all relevant when considering treatment technique. Clinical challenges: While some cats with patellar fractures will do well with conservative management, surgical treatment is often indicated and decision-making can be challenging. Evidence base: Information and recommendations provided in this review are based on the literature and the author’s own clinical experience. There are several publications on PADS, but there is limited evidence as to what the underlying cause of this condition is, and the best method for managing patellar fractures is still an area where more research is needed. Aim: This review aims to gather the papers, case series and case reports published over the past few decades in order to discuss how best to manage different types of patellar fractures.

scholarly journals Biodegradable magnesium screws in elbow fracture fixation: Clinical case series

2021 ◽  
pp. 221049172098698
Author(s):  
Wai-Him Lam ◽  
Chi-Yin Tso ◽  
Ning Tang ◽  
Wing-Hoi Cheung ◽  
Ling Qin ◽  
...  
Keyword(s):  
Case Series ◽  
Elbow Fracture ◽  
Normal Range ◽  
Head Region ◽  
Screw Head ◽  
Loss Of Reduction ◽  
Clinical Series ◽  
Post Operation ◽  
Bioabsorbable Screws ◽  
Biodegradable Magnesium

Biodegradable magnesium-based implants are innovative alternatives that potentially eliminate the need for implant removal. Recent studies have demonstrated the osteogenic properties and bacterial inhibition potentials of magnesium screws. We reported a clinical series of three elbow fracture cases, where magnesium screws were used in the treatment of one radial head and two capitellum fractures. Postoperative clinical courses were uneventful, and fracture healing occurred within 3 months. In all cases, radiolucencies were observed around implants especially in the screw head region at 2 months post-operation, but disappeared with consolidation at 1 year post-operation. All patients achieved near normal range of motion, minimal symptoms and good functional outcomes. No complication such as failure of fixation, loss of reduction, malunion or infection was seen. No implant revision or removal was necessary. Magnesium bioabsorbable screws are shown to be a viable option for these fractures.

scholarly journals Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors: a prospective analysis of a case series

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wei Pang ◽  
Gang Liu ◽  
Yan Zhang ◽  
Yun Huang ◽  
Xinpu Yuan ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Mediastinal Lymph Node ◽  
Intraoperative Complications ◽  
Case Series ◽  
Type Ii ◽  
Clinical Trial Registry ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Estimated Blood Loss ◽  
Gastrointestinal Reconstruction

Abstract Background Although the morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Furthermore, no consensus exists on which surgical approach should be applied for Siewert type II AEG. The purpose of our study was to evaluate the technical safety and feasibility of a new surgical approach. Methods Sixty patients with Siewert type II AEG underwent laparoscopic total gastrectomy with the total laparoscopic transabdominal-transdiaphragmatic (TLTT) approach, which needs an incision in the diaphragm. Results The median operative time, reconstruction time, and estimated blood loss were 214.8 ± 41.6 min, 29.40 ± 7.1 min, and 209.0 ± 110.3 ml, respectively. All of the patients had negative surgical margins. Conclusion There were no intraoperative complications or conversions to open surgery. Our surgical procedure provides a unique option for the safe application of laparoscopic lower mediastinal lymph node dissection and gastrointestinal reconstruction. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014336. Registered on 31 December 2017 - Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.

scholarly journals Entangled and correlated photon mixed strategy for social decision making

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shion Maeda ◽  
Nicolas Chauvet ◽  
Hayato Saigo ◽  
Hirokazu Hori ◽  
Guillaume Bachelier ◽  
...  
Keyword(s):  
Game Theory ◽  
Decision Making ◽  
Mixed Strategy ◽  
Evolutionary Game ◽  
Slot Machines ◽  
Decision Strategy ◽  
Social Infrastructure ◽  
Positive Effects ◽  
Social Decision Making ◽  
The Given

AbstractCollective decision making is important for maximizing total benefits while preserving equality among individuals in the competitive multi-armed bandit (CMAB) problem, wherein multiple players try to gain higher rewards from multiple slot machines. The CMAB problem represents an essential aspect of applications such as resource management in social infrastructure. In a previous study, we theoretically and experimentally demonstrated that entangled photons can physically resolve the difficulty of the CMAB problem. This decision-making strategy completely avoids decision conflicts while ensuring equality. However, decision conflicts can sometimes be beneficial if they yield greater rewards than non-conflicting decisions, indicating that greedy actions may provide positive effects depending on the given environment. In this study, we demonstrate a mixed strategy of entangled- and correlated-photon-based decision-making so that total rewards can be enhanced when compared to the entangled-photon-only decision strategy. We show that an optimal mixture of entangled- and correlated-photon-based strategies exists depending on the dynamics of the reward environment as well as the difficulty of the given problem. This study paves the way for utilizing both quantum and classical aspects of photons in a mixed manner for decision making and provides yet another example of the supremacy of mixed strategies known in game theory, especially in evolutionary game theory.

scholarly journals Hierarchical decision processes that operate over distinct timescales underlie choice and changes in strategy

2016 ◽  
Vol 113 (31) ◽  
pp. E4531-E4540 ◽  
Author(s):  
Braden A. Purcell ◽  
Roozbeh Kiani
Keyword(s):  
Decision Making ◽  
Neural Mechanism ◽  
Decision Processes ◽  
Response Strategy ◽  
Limited Information ◽  
Decision Strategy ◽  
Stimulus Response ◽  
Hierarchical Decision ◽  
The Right ◽  
High Level

Decision-making in a natural environment depends on a hierarchy of interacting decision processes. A high-level strategy guides ongoing choices, and the outcomes of those choices determine whether or not the strategy should change. When the right decision strategy is uncertain, as in most natural settings, feedback becomes ambiguous because negative outcomes may be due to limited information or bad strategy. Disambiguating the cause of feedback requires active inference and is key to updating the strategy. We hypothesize that the expected accuracy of a choice plays a crucial rule in this inference, and setting the strategy depends on integration of outcome and expectations across choices. We test this hypothesis with a task in which subjects report the net direction of random dot kinematograms with varying difficulty while the correct stimulus−response association undergoes invisible and unpredictable switches every few trials. We show that subjects treat negative feedback as evidence for a switch but weigh it with their expected accuracy. Subjects accumulate switch evidence (in units of log-likelihood ratio) across trials and update their response strategy when accumulated evidence reaches a bound. A computational framework based on these principles quantitatively explains all aspects of the behavior, providing a plausible neural mechanism for the implementation of hierarchical multiscale decision processes. We suggest that a similar neural computation—bounded accumulation of evidence—underlies both the choice and switches in the strategy that govern the choice, and that expected accuracy of a choice represents a key link between the levels of the decision-making hierarchy.

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

DECISION STRATEGY CONCEPT TO IMPROVE ECONOMIC CONDITIONS OF RURAL HOUSEHOLDS

2020 ◽  
Vol 10 (4) ◽  
pp. 699-711
Author(s):  
M.A. Volokhova ◽  
Keyword(s):  
Decision Making ◽  
Rural Population ◽  
Methodological Approach ◽  
Rural Households ◽  
Well Being ◽  
Economic Situation ◽  
Living Standard ◽  
Rural Settlements ◽  
Decision Strategy ◽  
Saratov Region

Modern conditions for the development of market relations leave a significant imprint on all main aspects of rural life. The socio-economic situation of rural households is dangerously dependent on the fluctuations of various institutions, be it the labor institution, the food market or the production system. Under these conditions, increasing attention is being paid to the development of targeted programs to improve the living standard and the socio-economic situation of the population in rural settlements. The article discusses a methodological approach to assess the living standards of rural settlements in the context of municipal districts of the Saratov region, in particular, the Samoilovsky municipality. Basing on the participatory approach, categories of the rural population are determined by income level and a direct correlation dependence of the demographic situation (birth rate, mortality, migration rate) and the level of rural household income are revealed. The parameters of the resource of patience and the boundaries of the passive expectation for the poor and impoverished layers of the rural population, as well as the prerequisites for the passivity of the able-bodied population to participate in the processes of increasing their own well-being and well-being of others are determined. The conditions and parameters of the property status compelling the activation of the use of internal material and social sources of income are revealed. Three levels of decision-making strategies for improving the financial situation of the family are distinguished: employees, employers (agricultural enterprises and K(F)X), authorities (district administration). As a result, a concept of a decision-making strategy was developed to improve the material situation of households in rural settlements of the Saratov region. The economic factor (the size of wages) has one of the decisive effects on all the demographic processes taking place in society.

scholarly journals Symptomatic Tarlov Cysts: an MRI evaluation of case series and literature review

2013 ◽  
Vol 4 (3) ◽  
pp. 35-42
Author(s):  
Netra Rana ◽  
Shao Hui Ma ◽  
Ming Zhang ◽  
Subesh Dahal ◽  
Zhi-Gang Min
Keyword(s):  
Cyst Wall ◽  
Nerve Root ◽  
Signal Intensity ◽  
Case Series ◽  
Treatment Method ◽  
Outcome Data ◽  
Hyperintense Signal ◽  
Tarlov Cysts ◽  
Post Operation ◽  
Histological Confirmation

Corrections: on Page 38 in the 4th line of text, the information in brackets (Figure 1, 2, 3a and 4) was replaced on 24th June 2013 with (Figure 1. 2 3b and 4). The number of the references has also been changed. The corrected PDF is available by clicking the link below.Aim: To analyze the characteristics of symptomatic Tarlov cysts by MRI. Materials and Methods: Neuroimaging and clinical outcome data were reviewed of 48 consecutive patients treated for symptomatic Tarlov cysts. All patients were scanned under Philips Gyroscan Intera 1.5T scanner with spinal surface coils. Two widely used surgical procedures were performed, 1) incision and drainage of the cyst with imbrication of the redundant nerve root sheath, and 2) exposure of the cyst, drainage of cyst contents, identification of nerve roots, and cyst wall resection combined with duraplasty. The post-operation follow-up was obtained from return visits to the neurosurgery and orthopaedic out-patient department or by telephone questionnaires. Results: All cystic lesions showed hypointense signal intensity on T1WI and hyperintense signal intensity on T2WI, but the nerve root showed iso-intensity on T1WI and low signal intensity on T2WI. They were linear in shape on sagittal view, and hypo intense dotted spots within the cysts on traverse view. Surrounding structures of the larger cysts were compressed and had bone erosions in some cases; the spinal canal and the intervertebral foramen on the affected side were enlarged. The lesions/cyst wall showed no enhancement after gadolinium administration. Conclusion: MRI will give a definite diagnosis of Tarlov cysts if nerve root presents within the cyst cavity or in the cyst wall; eliminating the need for histological confirmation. A correct analysis of the characteristics of symptomatic Tarlov cysts by MRI, will document its usefulness in noninvasive diagnosis and aid in exploration of the simplest treatment method. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8056 Asian Journal of Medical Sciences 4(2013) 35-42

scholarly journals Surgical approach combining implantoplasty and reconstructive therapy with locally delivered antibiotic in the treatment of peri‐implantitis: A prospective clinical case series

2021 ◽  
Author(s):  
Iria González Regueiro ◽  
Natalia Martínez Rodriguez ◽  
Cristina Barona Dorado ◽  
Ignacio Sanz‐Sánchez ◽  
Eduardo Montero ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Clinical Case ◽  
Case Series
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