Average Operation Research Articles

A Cost Analysis of Enucleation and Evisceration Surgeries for Treatment of Blind, Painful Eyes.

The purpose of this study is to assess the surgical costs of enucleations and eviscerations and their relation to current reimbursement rates using time-driven activity-based costing. This is a retrospective study of patients undergoing enucleation and evisceration surgeries with attachment of muscles (Current Procedural Terminology 65105 and 65093) for a diagnosis of blind, painful eye, from January 1, 2019, to December 31, 2023, at a single, tertiary level, teaching hospital. A time-driven activity-based cost analysis for day of surgery was performed. Operative reports, perioperative times, and supply costs were extracted from the electronic medical record, and average reimbursement fees were taken from Center for Medicare and Medicaid Services data. In the 5-year study span, 110 patients underwent enucleation and 52 underwent evisceration for a primary indication of blind, painful eye by 10 different surgeons. The average operating room time and surgical time for enucleation was approximately 9 minutes longer compared with evisceration (p < 0.01). Both surgeries on average resulted in a negative margin with enucleations costing on average $624 more than eviscerations. The breakeven total operating room time for enucleation and evisceration surgery was approximately 86.3 and 83.1 minutes, respectively. From the sample, approximately 79% of enucleation and 60% of evisceration surgeries resulted in a net negative margin. On average, the cost of enucleation and evisceration surgeries exceeded the reimbursement amount set by the Center for Medicare and Medicaid Services. Compared with enucleation, evisceration was more time and cost-effective by only a modest margin.

Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery

BACKGROUND: Safety in cardiac surgical procedures is predicated on effective team dynamics. This study associated operative team familiarity (ie, the extent of clinical collaboration among surgical team members) with procedural efficiency and Society of Thoracic Surgeons (STS) adjudicated patient outcomes. METHODS: Institutional STS adult cardiac surgery registry and electronic health record data from 2014 to 2021 were evaluated across 3 quaternary hospitals. Team familiarity was defined as the mean number of cardiac operations performed by surgeon-anesthesiologist, surgeon-perfusionist, and anesthesiologist-perfusionist dyads within 1 year of the operation. The primary outcomes were (1) safety, measured by the STS’ composite major morbidity and operative mortality measure, and (2) procedural efficiency, assessed by cardiopulmonary bypass duration. Team familiarity was stratified by terciles (low, moderate, and high) for crude analyses and analyzed continuously for adjusted analyses. Multivariable logistic and linear regression models were used to assess the association between team familiarity and outcomes. RESULTS: Team familiarity was calculated for 13 581 operations. The median (interquartile range) patient age was 64 (55–72) years, and 31.9% (4328/13 581) were women. Terciles of team familiarity were defined as low (&lt;6.00 average shared operations), moderate (6.00–9.67), and high (&gt;9.67). Teams in lower terciles had higher observed STS morbidity and mortality rates (low, 17.9%; moderate, 18.0%; high, 16.0%; P =0.02) and longer median cardiopulmonary bypass duration (low, 137 minutes; moderate, 131 minutes; high, 118 minutes; P &lt;0.001). After risk adjustment, team familiarity was not significantly associated with STS morbidity and mortality (estimate, −0.001 [95% CI, −0.998 to 0.997]) but was inversely associated with cardiopulmonary bypass duration (estimate, −2.02 minutes per 1 unit increase in team familiarity [95% CI, −2.30 to −1.75]). CONCLUSIONS: Increased team familiarity was not associated with STS morbidity and mortality but was inversely correlated with cardiopulmonary bypass duration, demonstrating potential benefit. Interventions aimed at improving team familiarity among operative teams may increase procedural efficiency.

The Scarab Technique for Correction of Late-Presenting Sagittal Suture Craniosynostosis.

Sagittal synostosis (SS) is the most prevalent form of craniosynostosis. It is the premature fusion of the sagittal suture, resulting in a "boat like" skull shape. Early surgical intervention is crucial to prevent complications, yet no standard procedure exists for patients over 12 months old. This study introduces the "Scarab technique", a novel surgical approach for late-presenting SS cases diagnosed after 1 year of age. A single-center, board-approved retrospective review was conducted from May 2017 to June 2020. The Scarab technique was used exclusively for delayed SS diagnosed after 1 year old. A 4cm craniectomy was outlined around the sagittal suture, and vascularized scarab bone flaps attached to the parietal bone vasculature were created. These extension flaps were then lifted for further biparietal and bitemporal expansion, followed by an occipital-type advancement and fixation with resorbable plates and screws. A total of 7 patients with delayed sagittal synostosis diagnosis underwent scarab technique surgery. The majority were male (71%) and Caucasian (43%). Mean surgery age was 2.6 years (SD=1.3), with 3.43-hour average operation time (SD=0.86), 101.4mL estimated blood loss (SD=54.5), 3.85 days in the PICU (SD=0.69), and only 1 patient with a resolved postoperative infection. The Scarab technique is an effective alternative for treating delayed sagittal craniosynostosis, yielding statistically significant improvements in head shape and overall development post-surgery. Further long-term analysis and multicenter comparative studies with alternative techniques are warranted to fully assess its efficacy and outcomes.

Model predictive control parameter optimization method for autonomous vehicles

Aiming at the problem of insufficient tracking accuracy and long computational time of model predictive control algorithm in trajectory tracking of autonomous vehicles, a model predictive control parameter optimization method based on a nondominated sorting whale optimization algorithm was proposed. In this method, the parameter optimization problem of the model predictive control algorithm was transformed into a multiobjective optimization problem, with the predictive horizon, control horizon, and sample time as optimized objectives and the sum of squared lateral trajectory errors and computational time as optimized variables. The multiobjective optimization problem was solved using the nondominated sort whale optimization algorithm, and then the Pareto optimal solution set was obtained. The best solution was determined using the expert scoring method, continuous order weighted average operator method, game theory combination weighting method, and technique for order preference by similarity to the ideal solution method. Finally, the phase plane method is used to analyze the vehicle handling stability. The experimental results show that compared with the initial method, the lateral trajectory errors of the proposed method are reduced by 66.09% on average, and the computational time is reduced by 54.68% on average. Therefore, the proposed method is considered to be an effective method for parameter optimization of model predictive control.

Convergence analysis of novel discontinuous Galerkin methods for a convection dominated problem

In this paper, we propose and analyze a numerically stable and convergent scheme for a convection-diffusion-reaction equation in the convection-dominated regime. Discontinuous Galerkin (DG) methods are considered since standard finite element methods for the convection-dominated equation cause spurious oscillations. We choose to follow a DG finite element differential calculus framework introduced in Feng et al. (2016) and approximate the infinite-dimensional operators in the equation with the finite-dimensional DG differential operators. Specifically, we construct the numerical method by using the dual-wind discontinuous Galerkin (DWDG) formulation for the diffusive term and the average discrete gradient operator for the convective term along with standard DG stabilization. We prove that the method converges optimally in the convection-dominated regime. Numerical results are provided to support the theoretical findings.

Clinical efficacy on the reconstruction of bone defects using modular hemipelvic prosthesis in patients with pelvic tumors

ObjectiveTo evaluate the clinical efficacy of modular hemipelvic prosthesis replacement in the treatment of pelvic tumors and the relationship between postoperative functional recovery and the position deviation of the hip rotation center.MethodsA retrospective research was conducted involving 56 patients who underwent surgical resection of pelvic tumors followed by modular hemipelvic prosthesis reconstruction between 2010 and 2016. Comprehensive data encompassing preoperative conditions, intraoperative and postoperative follow-up information were systematically collected. Limb function was evaluated at 1, 3, 6, and 12 months postoperatively using the Musculoskeletal Tumor Society Scores (MSTS). The positional deviation of the hip joint’s rotational center was quantified. Statistical analyses were performed utilizing SPSS 26.0 software.ResultsAll surgical interventions were successful, with an average operation time of 268.82 ± 42.17 min and mean intraoperative blood loss of 1086.64 ± 538.28 ml. Postoperative complications were noted in 26.79% of patients, predominantly comprising incision-related issues. Hip dislocation was documented in 5.4% of cases, while seven patients experienced prosthesis loosening or fracture during follow-up. A statistically significant improvement in MSTS scores was observed, increasing from an average of 14.3 at 1 month to 21.1 at 12 months postoperatively. The recorded minor deviations in the position of the prosthetic hip joint’s rotational center did not exhibit a significant correlation with functional outcomes. The observed survival rates were 94.64%, 83.93%, 73.21%, and 48.21% at 1, 2, 3, and 5 years, respectively.ConclusionsThe modular hemipelvic prosthesis serves as an effective reconstructive solution for bone defects resulting from pelvic tumor resection, facilitating early functional rehabilitation. The prosthesis demonstrates commendable adaptability and mechanical properties, with a low incidence of complications such as hip dislocation and wound-related issues, thereby contributing to favorable functional recovery of the affected limb.

A Method for Determining the Importance of Critical Emergency Indicators Based on Multi-granularity Uncertain Language

In view of the complexity of emergencies and the subjectivity of decision-makers, a method of determining key emergency indicators based on multi-granularity uncertainty language is proposed. Firstly, decision members use preferred uncertain language phrases to represent the importance of each key indicator and use transformation functions to carry out the consistent transformation of this multi-granularity uncertain language information. Secondly, the group evaluation vector is obtained by using the extended weighted average operator of uncertainty, and then the weight vector of each key index is obtained by using the decision theory of uncertain language. Finally, an example is given to verify the practicability and effectiveness of the proposed method.

Suspension and suturing technique can reduce the incidence of anastomotic leakage after rectal cancer excision: a single, prospective, cohort study

To evaluate the value of suspension and suturing technique in the prevention of anastomotic leakage of rectal cancer following double stapling technique. We performed a cohort study between August 2018 and December 2021 and analyzed the patients with rectal cancer underwent radical resection and double stapling technique at the department of general surgery. 324 patients were recruited in this research. There were 124 patients in control group and 200 patients in study group. There was a total of 19 patients present with anastomotic leakage. The incidence of anastomotic leakage was 5.8%. 12 patients were in control group and 7 in study group. The incidence of anastomotic leakage in control group was 9.7%. while the incidence of anastomotic leakage in study group was 3.5%, which was significantly lower than that in control group (p = 0.021). There were 4 patients present with anastomotic bleeding in control group (3.2%) while there were 6 cases with anastomotic bleeding in study group (3%) with no statistical differences. The average operation time of patients with anastomotic leakage was longer than that of patients without anastomotic leakage (p = 0.048). The intraoperative blood loss of patients with anastomotic leakage was more (p = 0.003) and the proportion of diabetes in anastomotic leakage group was larger (p = 0.003). Suspension and suturing technique could reduce the incidence of anastomotic leakage of patients with rectal cancer underwent double stapling technique. It is safe, simple, and easy to perform. Operation time, intraoperative blood loss, and diabetes may be high-risk factors of anastomotic leakage.

Digital Replantation In Hours Versus Out of Hours: A Retrospective Review of Outcomes.

The British Society for Surgery of the Hand's (BSSH) Getting It Right First Time (GIRFT) guidelines recommend that surgery for traumatic amputations of the digits is ideally performed during normal working hours even if this results in a delay of up to 24 hours. To compare current practice against the BSSH GIRFT guideline regarding the timing of digital replantation and to compare the success rate of replantation performed within working hours (same or next day) and outside of working hours. A single-centre retrospective analysis of two years of digital replantation was performed. A comparison was made between success rate of those operated within and outside of normal working hours. Secondary outcomes included operating time, rate of revision surgery, rate of interposition vein grafting, and the effect of the mechanism of injury on success rate. A total of 32 digital replantation attempts were included in 21 patients. 71.9% of cases (n=23) were performed within normal working hours, demonstrating good compliance with GIRFT guidelines. The success rate of digital replantation attempts was 68.8% overall (n=22). The success rate of same day in hours replantation was 66.7% (n=6), 78.6% (n=11) for next day in hours replantation, and 55.6% (n=5) for digital replantation attempts made out of hours. Revision surgery was required in 28.13% of all replant attempts (n=9). 55.56% (n=5) of cases requiring revision were ultimately successful. The rate of vein graft use was highest in cases taking place same day in hours (75%; n=3) and lowest in cases same day out of hours (22% n=2). The average operating time per digit was 5.5 hours for same day in hours cases, 4.8 hours for next day in hours cases, and 7.1 hours for out of hours cases. Digital replantation during normal working hours was associated with higher success rate although no statistically significant difference was observed between timing groups. Replantation during normal working hours was associated with shorter operating time per digit, and lower revision rate, although statistical testing was not performed.

Multi-objective optimization design of steel cross section of integrated supports and hangers based on NSGA-Ⅱ and MDOS

The stability and safety of building Mechanical, Electrical, and Plumbing (MEP) systems are significantly influenced by the steel section design of integrated supports and hangers. Traditional design methods, reliant on empirical steel section selection, are often inefficient and can result in unnecessary material usage. This paper introduces a novel multi-objective optimization approach that enhances the section design process by minimizing material costs and maximizing bending performance of supports and hangers. Firstly, the Non-dominated Sorting Genetic Algorithm II (NSGA-II) is employed to identify an array of optimal cross-sectional designs that reconcile economic considerations with structural mechanical performance. Subsequently, in order to pinpoint the most suitable design from the resulting Pareto-optimal scheme, the Method of Determining the Optimal Scheme (MDOS) is proposed. MDOS harnesses expert scoring, the Continuous ordered weighted averaging (COWA) operator, game theory, and the Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) to objectively evaluate and prioritize design schemes according to stakeholder preferences and project-specific criteria. Finally, the optimization results are analyzed and the influence of different spacing of supports and hangers and different subjective weight factors on the selection of cross-section is studied. The findings reveal that the method can precisely determine all cross-section designs that adhere to the established constraints, achieving a 4.09-fold enhancement in design efficiency. It was observed that the two outlined objectives are predominantly affected by the height of the web. The distribution trend of the optimal solution value of the independent variable is almost the same under the condition of different values of the supports and hangers spacing. With the change of subjective weight, the cross section selection focuses on three optimal schemes. Therefore, the proposed method can be used as reference for similar steel design optimization.

Assessing the adoption barriers for the AI in food supply chain finance applying a hybrid interval-valued Fermatean fuzzy CRITIC-ARAS model

The identification and evaluation of barriers to artificial intelligence (AI) adoption in food supply chain finance (FSCF) can be addressed as a multiattribute decision-making problem. However, only a few studies have reported the application of decision models for evaluating barriers to the implementation of AI in FSCF, especially within an uncertain context. Hence, this work explores the evaluation issue of implementation barriers via an integrated decision model. In this model, the conventional additive ratio assessment (ARAS) model integrated with the Choquet integral and criteria importance through intercriteria correlation (CRITIC) is extended into the interval-valued Fermatean fuzzy (IVFF) setting for ranking the barriers. The IVFF weighted average operator based on the Choquet integral is introduced to form a group decision matrix. Then, the developed ARAS model with the IVFF-CRITIC method is proposed to evaluate the implementation barriers for AI in FSCF, which can depict the interactions between the barriers. Finally, a case of an FSCF, including four participants, is presented to illustrate the application of the reported model and demonstrate its reliability. The result shows that “Data privacy” (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${c_{10}}$$\\end{document}) is the main barrier impeding AI adoption in FSCF, and the participant “small and medium-sized processing enterprises” (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${a_3}$$\\end{document}) has the highest barrier level to AI adoption.

Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.

Objectives: This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. Methods: A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. Results: Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. Conclusions: US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.

Abstract 4119303: The New Strait-Jacket Designed for Endovascular Therapy Reduces the First Reperfusion Time of Emergency Thrombectomy for Stroke

Introduction: Conscious sedation during cerebrovascular interventional surgery can shorten the time of vascular recanalization and bring significant benefits to patients, but patients are often difficult to cooperate, which affects the operation of interventional surgery. This study aims to develop a novel cerebral vascular intervention strait-jacket and explore its safety and effectiveness in emergency cerebral vascular intervention surgery. Methods: Using the convenient sampling method, patients with acute large artery occlusion stroke who underwent emergency mechanical thrombectomy in Zhongnan Hospital of Wuhan University from September 2018 to March 2021 were selected as the research objects. The control group was treated with conventional restraint belt, and the experimental group was treated with new cerebrovascular interventional surgery strait-jacket. The first reperfusion time, total operation time, modified Rankin score (mRS) at 30 days, intraoperative limb prolapse rate, average surgical cost, and safety indicators were compared between the two groups. The t test, Mann-Whitney U test or Fisher exact test were used for comparison between groups according to the data type. A p&lt;0.05 indicated statistical significance. Results: The new type of cerebrovascular interventional surgical strait-jacket developed in this study are shown in Figure 1, which have been patented and transformed into products. A total of 140 patients were included for mechanical thrombectomy, randomly divided into an experimental group (n=69) and a control group (n=71). Using the new strait-jacket significantly shortened the first reperfusion time (43.5±13.7 vs 50.7±15.7, P=0.039) and the total operation time (81.1±12.6 vs 93.2±21.1, P=0.027). There was a significant decrease in limb dislodgement rate (0% vs 35.2%, P&lt;0.001) and a noticeable reduction in average surgical cost (76315±12400 vs 81462±14142 P=0.040) by using the strait-jacket. In terms of safety performance, using the strait-jacket significantly lower rates of skin redness than the control group (8.7% vs 42.3%, P&lt;0.001). Conclusion: The new type of cerebrovascular interventional surgical strait-jacket is safe, which can effectively shorten the operation time, reduce the rate of intraoperative limb prolapse and the average operation cost, and can bring good social benefits.

Clinical Comparison of Endoscopic Posterior Lumbar Interbody Fusion and Open Posterior Lumbar Interbody Fusion for Treating Lumbar Spondylolisthesis.

A retrospective case-control study. To compare the clinical efficacy of endoscopic (Endo) and open posterior lumbar interbody fusion (PLIF) in treating lumbar spondylolisthesis. Endo-PLIF has emerged as a new technique for treating lumbar spondylolisthesis. We propose Endo-PLIF as an alternative method. Sixty-four patients with single-segment lumbar spondylolisthesis underwent Endo-PLIF (n = 39) or open PLIF (n = 25) treatment. Demographic data, perioperative parameters, and radiographic parameters were recorded. Clinical results were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The fusion rate was evaluated by computed tomography at 12 months postoperatively. In addition, a case-control process was included to ensure unbiased comparisons. The average operation time was longer in the Endo-PLIF group. Endo-PLIF showed advantages in reducing blood loss, shortening hospital stay, and early ambulation, but with a longer x-ray exposure time. Both VAS and ODI scores significantly improved in both groups, but the VAS for back pain was lower in the Endo-PLIF group. The radiographic results were similar in both groups. Three patients in the Endo-PLIF group had minor complications. Two patients in the open PLIF group experienced cerebrospinal fluid leakage. Both VAS and ODI scores significantly improved in both groups compared with preoperative scores, but the Endo-PLIF group showed more significant improvement at early follow-up (P < 0.05). There was no significant difference in interbody fusion rate between the two groups. Both Endo-PLIF and open PLIF are effective for treating single-segment lumbar spondylolisthesis. Endo-PLIF shows advantages in reducing blood loss, shortening hospital stays, and promoting early ambulation, with comparable fusion rates and patient satisfaction to open PLIF. Despite minor complications in the Endo-PLIF group and cerebrospinal fluid leakage in the open PLIF group, both procedures lead to significant improvements in pain and disability scores, with Endo-PLIF demonstrating more significant early improvements.

Assessing national governance modernization: Leveraging the ordered weighted geometric composition operator

The national governance modernization is an important part of Chinese-style modernization. It is of great importance to advance the modernization process by assessing the modernization level of national governance. In this paper, we propose a new method for assessing the national governance modernization using the ordered weighted geometric composition operator (OWGC). First, defining the OWGC by introducing the average operator. The application of the OWGC in measuring the national governance modernization is then demonstrated and the general measurement procedure is presented. Finally, empirical data are used to analyze the degree and regional differences in national governance modernization. The empirical results obtained by using the OWGC not only show uneven development between different provinces, but also reflect the development strengths and weaknesses of each region, which will help provide guidelines for improving the level of modernization and promoting coordinated regional development delivery.

Relationship between stone volume, average CT value and operation time and efficiency before ureteral soft lens laser lithotripsy.

Soft ureteroscopic holmium laser lithotripsy is becoming increasingly popular as the preferred method for treating mid-to-lower ureteral stones. Studies have indicated that the size, composition, hardness, and fragility of the stones can impact the treatment's effectiveness. To explore the relationship between stone volume, average CT value and operation time and efficiency before ureteral soft lens laser lithotripsy. Our study on 126 patients undergoing ureteroscopic holmium laser lithotripsy for ureteral calculi from May 2020 to January 2022 categorized them into groups based on stone volume and CT value. We compared surgical outcomes and analyzed correlations between stone characteristics, operation parameters, and stone clearance rate to identify independent risk factors influencing treatment efficacy. Group A demonstrated significantly shorter operation durations and lower blood loss compared to Group B, along with higher single stone clearance rates and fewer postoperative complications. Similarly, Group C exhibited shorter operation times, reduced blood loss, higher stone clearance rates, and lower complication rates than Group D. Preoperative stone volume and CT value correlated positively with operation time and stone clearance rate, with both factors identified as independent risk factors affecting ureteral stone clearance following holmium laser lithotripsy. The stone volume and average CT value before ureteral soft lens laser lithotripsy show a positive correlation with operation time and efficiency, indicating that larger stone volumes and higher CT values lead to slower lithotripsy speeds and reduced operation efficiency. Furthermore, preoperative stone volume and average CT value are identified as independent risk factors for residual stones.

OWA operators in the insurance industry

In this paper, we examine a possible application of ordered weighted average (OWA for short) aggregation operators in the insurance industry. Aggregation operators are essential tools in decision-making when a single value is needed instead of a couple of features. Information aggregation necessarily leads to information loss, at least to a specific extent. Whether we concentrate on extreme values or middle terms, there can be cases when the most important piece of the puzzle is missing. Although the simple or weighted mean considers all the values there is a drawback: the values get the same weight regardless of their magnitude. One possible solution to this issue is the application of the so-called Ordered Weighted Averaging (OWA) operators. This is a broad class of aggregation methods, including the previously mentioned average as a special case. Moreover, using a proper parameter (the so-called orness) one can express the risk awareness of the decision-maker. Using real-life statistical data, we provide a simple model of the decision-making process of insurance companies. The model offers a decision-supporting tool for companies.

Fairly Aggregation Operators Based on Complex p, q-Rung Orthopair Fuzzy Sets and Their Application in Decision-Making Problems

The decision-making technique is used to evaluate the best optimal among the collection of finite alternatives. Further, the technique of complex p, q-rung orthopair fuzzy (CPQROF) set is very reliable and dominant due to parameters “p” and “q”. In contrast, the technique of simple q-rung orthopair fuzzy sets is the special case of the CPQROF set. The major theme of this article is to expose the novel theory of fairly operational laws based on CPQROF numbers (CPQROFNs). Further, we evaluate the weighted fairly aggregation operators based on CPQROF information, called CPQROF weighted fairly averaging (CPQROFWFA) operator and CPQROF ordered weighted fairly averaging (CPQROFOWFA) operator. Some properties are also discussed for the above operators. Additionally, we validate the system of multi-attribute decision-making (MADM) difficulties based on initiated operators. Finally, we associate our suggested ranking consequences with approximately prevailing techniques to demonstrate the proposed theory's sovereignty and validity.

A Novel Unilateral Bi/Multi-Portal Endoscopic Transforaminal Interbody Fusion Utilizing Uniaxial Spinal Endoscope Instead of Arthroscope: Technical Note and Preliminary Clinical Results.

Currently, traditional UBE surgery, which is based on arthroscope, has been increasingly employed for complex lumbar degenerative diseases. However, this approach is associated with complications such as intraoperative dural sac tears, nerve root injuries, and postoperative epidural hematomas. In response to these challenges, we propose a novel technique utilizing uniaxial spinal endoscope to replace arthroscope-Unilateral Bi/Multi-Portal Endoscopy (UME). This new method has successfully treated complex lumbar disc herniation and spinal stenosis, resulting in improved postoperative outcomes and a reduction in complications. Based on the previous findings, we utilized uniaxial spinal endoscopy as the primary operating method, with the assistance of multi-portal endoscopic techniques (UME-TLIF), to perform transforaminal lumbar interbody fusion. The feasibility and preliminary clinical results have been presented in this paper. A total of 18 patients (8 men and 10 women, aged 52.6 ± 15.29 years) diagnosed with lumbar degenerative diseases, such as giant lumbar disc herniation, severe lumbar spinal stenosis, or lumbar spondylolisthesis, were included in this study from January 2022 to March 2023. Various parameters including operation time, ambulatory time, intraoperative fluoroscopy times, hospitalization days, and complications were recorded during the perioperative period. Clinically relevant symptoms were evaluated and documented 1, 3, 6, and 12 months postoperatively. Visual analogue scale (VAS) scores for lower back pain and leg pain, as well as the Oswestry disability index (ODI), were measured. The extent of lumbar interbody fusion was assessed using lumbar X-ray and CT scans at the 12-months follow-up. MRI was performed to assess the degree of nerve decompression in patients at the same time points. The paired t-test or Wilcoxon signed-rank test were used as statistical methods. The single-segment UME-TLIF procedure had an average operation time of 211 ± 53.3 min, and the average number of X-rays taken during the operation was 11.78 ± 5.32. Patients were able to walk and perform functional exercises approximately 35.11 ± 8.41 h post-surgery, and the average duration of hospital stay was 8.5 ± 2.27 days. The VAS and ODI values at each time point post-surgery were significantly lower than the respective pre-surgery values (p < 0.05). Two patients developed postoperative sensory disturbances which significantly improved with conservative treatment. Furthermore, a follow-up CT scan conducted 12 months post-surgery showed 100% fusion rate of the surgical segments in all patients. UME-TLIF is an endoscopy-assisted fusion procedure that minimizes muscle damage in patients and allows early rehabilitation. This technique broadens the surgical applications of uniaxial spinal endoscope as a surgical tool, particularly benefitingpatients diagnosed with severe lumbar disc herniation and lumbar instability.

Probabilistic linguistic multi-attribute group decision making method considering the important degrees of experts and attributes

The probabilistic linguistic term set (PLTS) uses multiple linguistic terms to express experts’ opinions and reflects the preference degree of experts for different linguistic terms, which can be flexibly applied to multi-attribute group decision making (MAGDM). First, considering the weights of the ordered positions and importance of each probabilistic linguistic element (PLE), the PLE hybrid weighted averaging (PLEHWA) operator is defined, which can transform a PLTS into a linguistic term with the position-associated weights. Then, the new operations of PLTSs are proposed, which can guarantee that the operation results of the normalized PLTSs retain the complete PLTS. Then the probabilistic linguistic induced ordered weighted averaging (PLIOWA) operator is extended, and its properties are discussed. Subsequently, the probabilistic linguistic MAGDM method considering the important degrees of experts and attributes is proposed. In the probabilistic linguistic MAGDM method, a linear programming model is established based on the PLEHWA operator to determine the important degrees of attributes on each expert. The important degrees of experts are derived based on the differences between the weighted linguistic ratings of different experts. Using the PLIOWA operator, the collective ratings of alternatives are obtained to rank alternatives. Finally, two practical cases are shown in order to express the effectiveness of the proposed method.