Alternative Approach Research Articles

Weft-Knitted Strain Sensors for Motion Capture

Motion capture, especially of the knee angle, is an important component for situational triggering of functional electrical stimulation (FES). One major disadvantage of commercial FES devices is their bulky design that prevents unobtrusive wearing in everyday life and limits the patient’s free choice of appearance. This paper presents an alternative approach of sensors for motion capture in form of textile-based strain sensors. These can be integrated in a FES system in form of functional leggings, which make the FES system suitable for an unobtrusive daily use. Textile sensors, especially knitted sensors have already proven to be very promising to detect tensile strain. In particular, weft-knitted strain sensors, which can be integrated directly into the clothing during the knitting process, have the potential to detect the knee angle and therefore derive the gait phase due to the bending of the limbs without disturbing the wearer unnecessarily. Different designs of the weft-knitted strain sensor and their influence on the measurement behaviour of the sensor have been investigated. The weft-knitted strain sensor can be directly integrated in the knee area of the functional leggings to be used as a soft trigger to initiate electrical impulses for FES.

Enhancing mathematical simulation: a novel integro spline quasi-interpolation for nonlocal dynamical systems

ABSTRACT In this research, we present a novel and computationally streamlined method to tackle nonlocal initial value problems through a combination of modeling and simulation. Our approach utilizes the Integro spline quasi-interpolation technique, renowned for its effectiveness in approximating nonlocal integrals. To validate the efficacy of our proposed method, we conduct comprehensive comparisons with alternative approaches found in the existing literature for integrating nonlocal functions. Additionally, we successfully apply our suggested approach to address nonlocal Riccati, resistor-inductor circuit, and Airy oscillator dynamical systems. The numerical results obtained from these applications convincingly demonstrate the advantages and effectiveness of our developed approach in enhancing mathematical simulation.

Comparative effectiveness of carbon nanoparticles and biochar in alleviating copper stress in corn (Zea mays L.)

The application of carbon nanoparticles (CNPs) and biochar in agriculture for improving plant health and soil quality and alleviating metal stress offers alternative approaches to meet the ever-increasing demand for food. However, poor understanding of their roles in improving crop production under Cu stress represents a significant obstacle to their wide application in agriculture. To clarify how CNPs and biochar affect corn (Zea mays L.) seed germination, seedling growth, plant health, and nutrient uptake under different Cu stress levels, soil-less Petri-dish and greenhouse soil-based bioassays were conducted. The results revealed that CNPs and biochar stimulated corn seed germination and seedling growth. Besides, they were effective in immobilizing Cu2+ sorption in sandy soil and alleviating Cu stress for plant growth, as shown by the increased plant height and dry biomass. The plant nutrient uptake efficiency (NUE) was significantly increased by CNPs, with a maximum increase of 63.1% for N and 63.3% for K at the highest Cu2+ stress level (400 mg Cu2+ L−1). In contrast, non-significant effects on NUE were observed with biochar treatments regardless of Cu stress levels. Interestingly, CNPs significantly increased plant uptake of Cu in the Petri dish test, while biochar inhibited plant uptake of Cu under both experimental conditions. Principle component analysis (PCA) and Pearson correlation analysis indicated that CNPs mitigated Cu stress mainly by elevating antioxidant enzyme activities, enhancing plant photochemical efficiency, and increasing plant uptake of N and K, while biochar was more likely to reduce bioavailability and uptake of Cu in the plant. These findings have great implications for the application of CNPs and biochar as plant growth stimulators and de-toxicity agents in agriculture.

Virtual Reality and Mixed Reality-Assisted Endoscopic DCR in Extremely Complex Lacrimal Obstructions.

To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)-assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions. A prospective, non-randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post-traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real-time-rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes. The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeon's view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds. Virtual reality and mixed reality-assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post-traumatic SALDOs. Level 4 Laryngoscope, 2024.

Nanoscale surface metrology with a liquid crystal-based phase-shifting angular shearing interferometer.

In this Letter, a phase-shifting angular shearing interferometer has been proposed for the application in optical surface metrology (SM) by using a combination of a wedge-shaped liquid crystal (LC) cell and a polarization phase shifter. The demonstration of this angular shearing interferometer for step height measurement is accomplished with the help of a phase-shifting technique. Four phase-shifted interferograms produced by a geometrical phase shifter are subjected to a simplified Wiener deconvolution method, which resembles a simple analysis technique for shearing interferograms in comparison to alternative approaches. A simulation study has been conducted to validate the proposed technique. The experimental results show an accuracy of 5.56% for determining the step height, which also agrees with the results obtained by atomic force microscopy. Owing to the tunability of birefringence, the proposed LC-based angular shearing interferometry technique will be useful to control spatial resolution in optical metrology.

Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use

Study Design Literature review. Objective This review aims to explore current opioid use trends for surgical management of facial fractures, as well as methods and alternative treatments to decrease opioid use. Methods Review of selected literature from Medline and Google Scholar. Results Despite the devastating effects of the opioid epidemic and recent policy changes aimed at reducing unnecessary opioid prescription, opioids remain commonly used for pain management after facial fracture repair. Recently, use of multimodal analgesic therapy has been suggested to decrease opioid dosage utilized for post-operative pain control. Alternatives to medication therapies have been proposed for pain management; however, standardized recommendations for pain management in facial fracture patients remain unclear. Conclusions Further research is required to establish evidence-based recommendations for pain management in craniofacial fracture repair.

Determination of norfloxacin, cipfloxacin, levofloxacin and moxifloxacin in urine by HPLC with a two-channel fluorescence detector

A sensitive HPLC-FLD method with two-channel fluorescence detection was established and validated for quantification of four fluoroquinolones (norfloxacin, ciprofloxacin, levofloxacin and moxifloxacin) in urine samples. The fluorescent detector was set at two-channel excitation and emission wavelengths: 280/445 nm (for NOR, CIP) and 290/500 nm (for LEVO, MOXI). The measurement protocol was in compatible with both of the sample treatment procedures including the liquid-liquid extraction (LLE) and solid-phase extraction (SPE). The method was well-validated with the limit of quantification: 0.027; 0.034; 0.024; 0.020 µg/mL (for LLE), and 0.028; 0.033; 0.024; 0.020 µg/mL (for SPE) for NOR, CIP, LEVO, MOXI, respectively. The method has been proved to be precise and accurate, with the relative standard deviation lower than 3% and the recovery ranging from 98.0%¸102.0%, for all fluoroquinolones. The proposed HPLC-FLD method provides an alternative approach for the simultaneous analysis of fluoroquinolones in urine. ® 2023 Journal of Science and Technology - NTTU

Optimizing organically nano-fabricated Ni metal complexes for enhanced antioxidant and anticancer activity using response surface methodology

Abstract Background Researchers, prompted by the toxicity and side effects associated with cisplatin, are exploring alternative approaches for developing transition metal-based anticancer agents. Employing a green biochemical approach, we transformed Nickel pyridine dicarboxylic acid compounds into the nanoscale using the aqueous extract of Macrotyloma uniflorum (horse gram). Results Characterization of the biosynthesized nanoparticles involved electronic and IR spectroscopy. A scanning electron microscope revealed a predominant spherical shape for most Nickel nanoparticles (Ni-NPs), with XRD patterns indicating particle sizes ranging from approximately 30–150 nm. The nanoparticles were evaluated for their free radical scavenging efficiency and in vitro anti-malignant properties against HeLa and A549 cancer cell lines. Numerical optimization of the DPPH and MTT assays was conducted using response surface methodology (RSM), focusing on the effects of 3,4-pyridine dicarboxylic acid (ML1), 2,4-pyridine dicarboxylic acid (ML2), nickel nanoparticles concentration, and temperature. In this investigation, the incorporation of Horse Gram seed extract (Macrotyloma uniflorum) has unveiled its abundance in phenolic and flavonoid compounds, widely acknowledged for their robust antioxidant activity in the existing literature. Conclusion The present study highlights the potential for refining the bio-toxicity and biochemical attributes of Ni-NPs to pave the way for a new generation of versatile anticancer agents with clinically established efficacy. Notably, the anticipated data closely corresponds with experimental outcomes, reinforcing the trustworthiness and validity of the RSM model for examining anticancer and antioxidant properties in this context. ML2 exhibited heightened antioxidant and anticancer activities in comparison to ML1 nanoparticles. Graphical abstract

Goethe’s Platonic Natural Philosophy: How Goethean Science Provides an Alternative Conception of the Cosmos

While popularly known for his works of literature and poetry, Johann Wolfgang von Goethe viewed his lesser-known scientific pieces as his most enduring achievement. I will argue that Goethe’s unique scientific methodology is informed by a metaphysical commitment to a form of Platonism and that Goethe provides an intriguing alternative paradigm that unifies science, philosophy, theology, and ethics. I begin by demonstrating how Goethe’s concept of the Urphänomen offers a Platonic conception of natural beings. I then briefly outline how this alternative scientific approach ultimately derives from his Platonic commitments. Next, I demonstrate the ethical and spiritual implications of Goethean science, establishing that Goethe’s approach bridges the divide between our scientific endeavors and spiritual formation. There is, then, a continued relevance for Goethe in conversations regarding ecological ethics and our perception of nature.

Waste to Resource: Surface Modification of Electric Arc Furnace Flue Dust by Ball Milling and In Situ Carbonization

AbstractIn this article, instead of synthesizing the electrode active material using expensive precursors that lead to high carbon emissions to the atmosphere during fabrication, an alternative engineering approach is presented for the utilization of the electric arc furnace flue dust, which is an industrial waste, as anode material in lithium-ion batteries. In this scope, firstly ball milling of the flue dust with citric acid is applied and then in situ carbonization conditions are optimized by pyrolyzing the mixture at different temperatures (600 °C and 750 °C) and times (4 h and 6 h). Every sample delivers capacities greater than graphite. Structural, morphological, and chemical characterization results demonstrate that the designed method not only promotes the formation of a nanometer-thick carbon layer formation over the particles but also induces partial phase transformation in the structure. The best performance is achieved when citric acid is used as the carbon source and the ball-milled powder is treated at 600 °C for 4 h in nitrogen (C6004): It delivers 714 mAh g−1 capacity under a current load of 50 mA g−1 after 100 cycles. This research is expected to set an example for the utilization of different industrial wastes in high value-added applications, such as energy storage. Graphical Abstract

Assessing the Feasibility and Safety of the Toumai® Robotic System in Urologic Surgery: Initial Experience.

Purpose Robotic surgery using da Vinci surgical system has gained prominence in urology, emerging robotic platforms are expanding its applications and increasing affordability. We assess the feasibility and safety of a novel system, the Toumai® robotic system in various urological surgeries. Methods This prospective study was conducted at the first affiliated hospital of Zhengzhou university. Twenty consecutive patients underwent renal and prostatic surgery with the Toumai®. The study assessed technical feasibility (conversion rate) and safety (perioperative complications) of the procedures as primary outcomes. Secondary endpoints included key surgical perioperative outcomes; functional and oncologic results. The Endoscopic Surgical System operates within a master-slave protocol, comprising a Surgeon Console, Patient Platform, and Vision Platform Results Seventeen patients underwent various nephrectomy procedures and three underwent radical prostatectomy. There was no conversion to alternative surgical approach, a single (Clavien-Dindo grade ≥3b) complication occurred and no readmission was recorded within 30 days. The median operative time was 120, 140, and 210 minutes for partial nephrectomy, radical nephrectomy and radical prostatectomy respectively. Off clamp partial nephrectomy was performed in one case and the warm ischemia time in the remaining two case was eighteen minutes. The median docking time was 22 minutes for nephrectomy and 20 minutes for radical prostatectomy, no major robotic malfunction was encountered. At three months follow-up, no tumor recurrence was recorded, renal function was well preserved and the continence status was satisfactory. Conclusions We present the initial clinical utilization of an innovative robotic platform. Complex urological interventions were successfully completed without conversions and with minimal complications. Further investigations are warranted to confirm these initial findings.

"Comparison of Outcomes After Autologous Breast Reconstruction: Latissimus Dorsi with Immediate Fat Transfer vs. Abdominally Based Free Flaps".

Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared to implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to non-microsurgeons. This study aims to compare the two procedures concerning their clinical and patient-reported outcomes one year postoperatively. We conducted a retrospective review of LIFTs and Ab-FFs performed between March 2017 and August 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Abdomen, Back, Psychosocial Well-being, Physical Well-being: Chest, Abdomen, Back, and Sexual Well-being. Of the 281 included patients (408 breasts), 211 received Ab-FF, and 70 received LIFT. One-year follow-up (median [IQR]: 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. In addition, obesity predicted dehiscence, while bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by one year postoperatively. Although Ab-FF is the gold-standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may subsequently be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can also be utilized by more plastic surgeons who are either not microsurgically trained or do not have an environment that fosters Ab-FF.

Discovery of the sEH Inhibitor Epoxykynin as a Potent Kynurenine Pathway Modulator.

Disease-related phenotypic assays enable unbiased discovery of novel bioactive small molecules and may provide novel insights into physiological systems and unprecedented molecular modes of action (MMOA). Herein, we report the identification and characterization of epoxykynin, a potent inhibitor of the soluble epoxide hydrolase (sEH). Epoxykynin was discovered by means of a cellular assay monitoring modulation of kynurenine (Kyn) levels in BxPC-3 cells upon stimulation with the cytokine interferon-γ (IFN-γ) and subsequent target identification employing affinity-based chemical proteomics. Increased Kyn levels are associated with immune suppression in the tumor microenvironment and, thus, the Kyn pathway and its key player indoleamine 2,3-dioxygenase 1 (IDO1) are appealing targets in immuno-oncology. However, targeting IDO1 directly has led to limited success in clinical investigations, demonstrating that alternative approaches to reduce Kyn levels are in high demand. We uncover a cross-talk between sEH and the Kyn pathway that may provide new opportunities to revert cancer-induced immune tolerance.

Targeted sequencing from cerebrospinal fluid for rapid identification of drug-resistant tuberculous meningitis.

Mortality from tuberculous meningitis (TBM) remains around 30%, with most deaths occurring within 2 months of starting treatment. Mortality from drug-resistant strains is higher still, making early detection of drug resistance (DR) essential. Targeted next-generation sequencing (tNGS) produces high read depths, allowing the detection of DR-associated alleles with low frequencies. We applied Deeplex Myc-TB-a tNGS assay-to cerebrospinal fluid (CSF) samples from 72 adults with microbiologically confirmed TBM and compared its genomic drug susceptibility predictions to a composite reference standard of phenotypic susceptibility testing (pDST) and whole genome sequencing, as well as to clinical outcomes. Deeplex detected Mycobacterium tuberculosis complex DNA in 24/72 (33.3%) CSF samples and generated full DR reports for 22/24 (91.7%). The read depth generated by Deeplex correlated with semi-quantitative results from MTB/RIF Xpert. Alleles with <20% frequency were seen at canonical loci associated with first-line DR. Disregarding these low-frequency alleles, Deeplex had 100% concordance with the composite reference standard for all drugs except pyrazinamide and streptomycin. Three patients had positive CSF cultures after 30 days of treatment; reference tests and Deeplex identified isoniazid resistance in two, and Deeplex alone identified low-frequency rifampin resistance alleles in one. Five patients died, of whom one had pDST-identified pyrazinamide resistance. tNGS on CSF can rapidly and accurately detect drug-resistant TBM, but its application is limited to those with higher bacterial loads. In those with lower bacterial burdens, alternative approaches need to be developed for both diagnosis and resistance detection.

An Alternative Approach Using the Firefly Algorithm and a Hybrid Method Based on the Artificial Bee Colony and Cultural Algorithm for Reservoir Operation

In reservoir operation rule curves, it is necessary to apply rule curves to guide long-term reservoir management. This study proposes an approach to optimizing reservoir operation rule curves (RORCs) using intelligent optimization techniques from the firefly algorithm (FA) and a unique combination method utilizing the artificial bee colony and cultural algorithm (ABC-CA). The aim is to establish a connection with the simulation model to determine the optimal RORCs for flood control. The proposed model was used to determine the optimal flood control RORC for the Nam-Oon Reservoir (NOR) in northeastern Thailand. A minimum frequency and minimum average of excess water were provided as an objective function for assessing the efficiency of the search process. The evaluation of the effectiveness of flood control RORCs involved expressing water scarcity and excess water situations in terms of frequency, magnitude, and duration using historical inflow data synthesized from 1000 events. The results demonstrated that when using the obtained RORC to simulate the NOR system for reducing flooding in long-term operations, excess water scenarios were smaller than those using the current RORC. The results showed that the excess water scenario using the RORC obtained from the proposed model can reduce the excess water better than the current RORC usage scenario. In decreasing flood situations, the newly acquired RORC from the suggested FA and ABC-CA models performed better than the current RORC.

Beyond network connectivity: A classification approach to brain age prediction with resting-state fMRI

The brain is a complex, dynamic organ that shows differences in the same subject at various periods. Understanding how brain activity changes across age as a function of the brain networks has been greatly abetted by fMRI. Canonical analysis consists of determining how alterations in connectivity patterns (CPs) of certain regions are affected. An alternative approach is taken here by not considering connectivity but rather features computed from recordings at the regions of interest (ROIs). Using machine learning (ML) we assess how neural signals are altered by and prospectively predictive of age and sex via a methodology that is novel in drawing upon pairwise classification across six decades of subjects’ chronological ages. ML is used to answer the equally important questions of what properties of the computed features are most predictive as well as which brain networks are most affected by aging. It was found that there is decreased differentiation among the neural signals of older subjects that are separated in age by the same number of years as younger subjects. Furthermore, the burstiness of the signals change at different rates between males and females. The findings provide insight into brain aging via an ROI-based analysis, the consideration of several feature groups, and a novel classification-based ML pipeline. There is also a contribution to understanding the effects of data aggregated from different recording centers on the conclusions of fMRI studies.

Efflux pump inhibitor, phenylalanine-arginine beta-naphthylamide analog potentiates the activity of 5-O-mycaminosyltylonolide for multi-drug resistant Pseudomonas aeruginosa.

The emergence and spread of antimicrobial resistance are global threats. Pseudomonas aeruginosa (P. aeruginosa) is responsible for a substantial proportion of this global health issue because of its intrinsic resistance to many antibiotics due to the impermeability of its outer membrane and its multidrug efflux pump systems. Therefore, therapeutic drugs are limited, and the development of new drugs is extremely challenging. As an alternative approach, we focused on a combinational treatment strategy and found that 5-O-mycaminosyltylonolide (OMT) showed potent antibacterial activity against P. aeruginosa in the presence of an efflux pump inhibitor, phenylalanine-arginine beta-naphthylamide (PAβN). In this report, we prepared a PAβN derivative and compared the potentiation activity of OMT by PAβNs against multidrug-resistant P. aeruginosa clinical isolates.

Should We Stop Glucagon-Like Peptide-1 Receptor Agonists Before Surgical or Endoscopic Procedures? Balancing Limited Evidence With Clinical Judgment.

The American Society of Anesthesiologists (ASA) Task Force recently recommended discontinuing glucagon-like peptide-1 receptor agonist (GLP-1 RA) agents before surgery because of the potential risk of pulmonary aspiration. However, there is limited scientific evidence to support this recommendation, and holding GLP-1 RA treatment may worsen glycemic control in patients with diabetes. As we await further safety data to manage GLP-1 RA in the perioperative period, we suggest an alternative multidisciplinary approach to manage patients undergoing elective surgery. Well-conducted observational and prospective studies are needed to determine the risk of pulmonary aspiration in persons receiving GLP-1 RA for the treatment of diabetes and obesity, as well as the short-term impact of discontinuing GLP-1 RA on glycemic control before elective procedures in persons with diabetes.

Cost-effectiveness of nivolumab versus surveillance for the adjuvant treatment of patients with urothelial carcinoma who are at high risk of recurrence: a US payer perspective

ABSTRACT Aim To evaluate the cost-effectiveness of adjuvant nivolumab compared with surveillance for the treatment of patients with high-risk muscle-invasive urothelial carcinoma (MIUC) after radical resection from a US healthcare payer perspective and to investigate the impact of alternative modeling approaches on the cost-effectiveness results. Material and Methods A four-state, semi-Markov model consisting of disease free, local recurrence, distant recurrence, and death health states was developed to investigate the cost-effectiveness of nivolumab compared with surveillance over a 30-year time horizon. The model used data from the randomized CheckMate 274 study (NCT02632409) and published literature to inform transitions among health states, and inputs on cost, utility, adverse event, and disease management. Scenario analyses were conducted to investigate the impact of model structure and key assumptions on the results. One-way deterministic and probabilistic sensitivity analysis were conducted to investigate the robustness of the results. Results Total expected costs were higher with nivolumab ($162,278) compared with surveillance ($63,027). Nivolumab was associated with improved survival (1.61 life-years gained compared with surveillance) and an incremental gain of 0.98 quality-adjusted life-years (QALYs). Although total treatment costs were higher for nivolumab, cost offsets were observed because of delayed or avoided recurrences and deaths experienced with nivolumab compared with observation. The incremental cost-effectiveness and cost-utility ratios were $61,462/life-year and $100,930/QALY. Limitations At the time of analysis, CheckMate 274 had limited follow-up on disease-free survival and no overall survival data. The limited evidence necessitated assumptions on modeling survival after each type of recurrence. Conclusions Nivolumab is estimated to be a life-extending and cost-effective option for adjuvant treatment of MIUC for patients who are at high risk of recurrence after undergoing radical resection in the United States. Using a threshold of $150,000/QALY, the cost-effectiveness conclusions remained consistent across the scenario and sensitivity analyses conducted.

Acute type a aortic dissection: when not to operate, a review

Acute type A aortic dissection (ATAAD) is a surgical emergency with a nonoperative mortality rate of up to 1% per hour and an operative mortality rate as high as 24%. Therefore, evaluation of comorbidities and patient presentation characteristics prompts a pause for risk stratification before proceeding to the operating room, as emergent surgery may not always be the optimal approach. This comprehensive review explores key considerations in ATAAD management, emphasizing the need for nuanced decision making, by considering medical management and delayed surgery as an alternative management approach for high-risk populations such as the frail or patients who have a history of cardiac surgery. Beyond the immediate threat of aortic rupture, organ malperfusion stands out as the most feared complication of ATAAD, also elevating perioperative risk significantly. In such cases, careful assessment of patient’s hemodynamic status is paramount. For stable patients, a thorough preoperative strategy and multidisciplinary discussions are encouraged. Notably, the advent of endovascular techniques provides viable lower-risk alternatives to the traditional open approach. The consequences of ATAAD surgical intervention extend beyond the immediate procedural concerns, with a substantial impact on the patient’s overall function. Prioritizing patient-centered care becomes imperative in aligning management with individual goals of care. This review seeks to provide insights into these considerations by offering a stepwise approach to patient-centered decision-making in ATAAD management.