Management Outcomes Research Articles

The Diagnostics and Management of Bronchopulmonary Sequestration: An International Survey among Specialized Caregivers.

Our objective was to explore the treatment preferences for bronchopulmonary sequestration (BPS) among an international group of specialized caregivers. Sixty-three participants from 17 countries completed an online survey concerning the diagnostics, treatment, and follow-up. Recruitment took place among members of the Collaborative Neonatal Network for the first European Congenital Pulmonary Airway Malformation Trial Consortium and through the Association for European Pediatric and Congenital Cardiology working group database. Most of the 63 participants were pediatric surgeons (52%), followed by pediatric pulmonologists (22%), and pediatric cardiologists (19%). The majority (65%) treated more than five cases per year and 52% standardly discussed treatment in a multidisciplinary team. Half of the participants (52%) based the management on the presence of symptoms, versus 32% on the intralobar or extralobar lesion localization. Centers with both surgical and interventional cardiac/radiological facilities (85%) preferred resection to embolization in symptomatic cases (62 vs. 15%). In asymptomatic cases too, resection was preferred over embolization (38 vs. 9%); 32% preferred noninterventional treatment, while 11% varied in preference. These treatment preferences were significantly different between surgeons and nonsurgeons (p < 0.05). Little agreement was observed in the preferred timing of intervention as also for the duration of follow-up. This survey demonstrates a variation in management strategies of BPS, reflecting different specialist expertise. Most centers treat only a handful of cases per year and follow-up is not standardized. Therefore, management discussion within a multidisciplinary team is recommended. Recording patient data in an international registry for the comparison of management strategies and outcomes could support the development of future guidelines. Level IV.

Diagnostic, Management, and Neonatal Outcomes of Colorectal Cancer during Pregnancy: Two Case Reports, Systematic Review of Literature and Metanalysis.

Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy.

Abstract B030: Synergistic antitumor effects of cold atmospheric plasma and temozolomide in glioblastoma: multimodal approaches integrating in-vitro, in vivo, and in silico investigations for novel and enhanced therapeutic advancements

Abstract Glioblastoma multiforme (GBM) is a common and aggressive brain cancer with a median survival rate of 12 to 18 months after diagnosis. Despite standard treatments, including surgery, radiotherapy, and Temozolomide (TMZ), GBM remains highly resistant to therapy due to its infiltrative pattern of invasion, rapid growth, and propensity to relapse [1]. While overall mortality rates remain high, there is a crucial need for a better understanding of the molecular mechanisms and gene mutations involved in GBM and the development of more effective and adaptive therapeutic approaches. Modulating reactive oxygen species (ROS) levels has been suggested as a therapeutic strategy to selectively target the destruction of cancer cells. To address this, we propose a combination therapy utilizing multi-operational plasma devices, including using cold atmospheric plasma (CAP) jet and plasma discharge tube (PDT) in conjunction with TMZ for GBM treatment. CAP functions by elevating reactive oxygen and nitrogen species (RONS) levels and specifically targeting tumor spread. We investigated various plasma devices and their characteristics using optical emission spectroscopy (OES) and measured the electromagnetic potential and emissions of the PDT. The OES of PDT displayed a similar spectrum as the CAP jet, indicating the presence of ROS. In this study, we performed transcriptomic analysis of glioblastoma cells using high throughput deep RNA-Seq with next-generation sequencing (NGS) to quantify genome-wide gene expression changes. Additionally, we examined signaling pathways and predicted structural changes in consequential proteins caused by gene spectrum up or down-regulation. Our results demonstrate that the combination treatment of CAP and TMZ downregulated vital genes involved in MAPK, P53, DNA repair, and cell cycle pathways. The combination of CAP &amp; TMZ showed a significant antitumor effect, inducing apoptosis and damaging essential proteins in GBM cells. In vitro and microscopic studies verified these results, showing nuclear and cell membrane disruption in cancer cells post-plasma treatment. Our findings demonstrate that the combination of CAP/PDT and TMZ effectively sensitizes GBM cells to TMZ, leading to apoptosis. We have previously shown a non-invasive application of CAP jet on the skull of tumor-bearing mice causing ~78% tumor inhibition [2]. Our current study highlights the potential of PDT for non-invasive treatment in vitro, offering a modality for intracranial delivery in in-vivo models. In conclusion, we propose CAP/PDT and TMZ combination therapy as novel non-invasive treatments for GBM in murine models. This approach offers a promising avenue for addressing the dire need for more effective treatments with minimal impact on normal cells. Further investigations and validation in clinical settings are warranted to significantly improve GBM management and patient outcomes.

Clinical manifestations and genetic mutation analysis of patients with mucopolysaccharidosis type VII in China

ObjectiveThis study aimed to explore the clinical and genetic features of Chinese patients with mucopolysaccharidosis type VII (MPS VII), thereby improving early detection, disease management, and patient outcomes. MethodsA retrospective review of medical records for five patients presenting with coarse facial features, rib protrusion, chest deformities, and scoliosis was conducted. Exome sequencing was employed to identify causative genetic mutations. ResultsThe study comprised five patients (four males, one female) with disease onset at six months of age (range: 0–1.5 years). Common symptoms included coarse facial features, skeletal abnormalities, delayed motor and language development, and intellectual disability. Approximately 80% of the patients exhibited multiple skeletal dysplasias, enlarged adenoids or tonsils, and snoring; 60% had hernias; 40% reported hearing loss and hepatosplenomegaly. Less frequent manifestations were short stature, valvular heart disease, non-immune hydrops fetalis, and corneal opacity. All patients demonstrated elevated urine glycosaminoglycans levels and absent β-glucuronidase activity in leukocytes. Exome sequencing identified compound heterozygous mutations in the GUSB gene in all four tested patients, uncovering seven mutations in total, three of which were novel (c.189G > A, c.869C > T, and c.1745 T > C). Furthermore, prenatal diagnosis through chorionic villus sampling in subsequent pregnancies of one patient's mother revealed both fetuses had normal β-glucuronidase activity and no disease-causing mutations in the GUSB gene. ConclusionThe study's patients all presented with classic symptoms of MPS VII due to β-glucuronidase deficiency, with three new pathogenic mutations identified in the GUSB gene. Genetic counseling and prenatal testing were highlighted as crucial for disease prevention.

Comparison of facet fusion rates and clinical outcomes between cortical bone trajectory screw and percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis

BACKGROUND CONTEXTCortical bone trajectory (CBT) screws have been introduced as an alternative technique for pedicle screw (PS) insertion because they have greater contact with the cortex and a greater uniaxial pullout load than traditional PS. CBT screwing can also minimize muscle dissection. However, CBT screws and traditional PSs have not yet been compared in terms of fusion rates and clinical outcomes for particular operative procedures. PURPOSEThis study aimed to assess the fusion rate and clinical outcomes of facet fusion (FF) fixed with CBT screws (CBT-FF) and to compare them with those of FF fixed with percutaneous PS (PPS-FF). STUDY DESIGNRetrospective study. PATIENT SAMPLERecords of 68 patients who underwent CBT-FF for single-level degenerative lumbar spondylolisthesis (DLS) with at least 1 year of follow-up were retrospectively reviewed. The control group comprised 143 patients who underwent PPS-FF under the same conditions. OUTCOME MEASURESComputed tomography was performed to confirm fusion. Therapeutic effectiveness was assessed as a clinical outcome using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Roland-Morris Disability Questionnaire (RMDQ), and visual analog scale (VAS) preoperatively and 1 year postoperatively. The rate of revision surgery was also calculated. Intraoperative blood loss was measured. METHODSFusion rate, clinical outcomes, revision surgery rate, and intraoperative blood loss of CBT-FF and PPS-FF were compared. RESULTSThe CBT-FF and PPS-FF fusion rates were 91.2% and 90.1%, respectively. The JOABPEQ category scores demonstrated therapeutic effectiveness in 74.5% and 77.1% of the patients for low back pain; the corresponding proportions for walking ability were 84.7% and 89.3%, respectively. No significant differences in therapeutic effectiveness were observed for any category, including the RMDQ and VAS scores for buttock and lower limb pain. Three patients required revision surgery for adjacent segment disease between 6 months and 3.5 years after CBT-FF (revision surgery rate, 4.4%), whereas the revision surgery rate for PPS-FF was 6.3% (9/143 cases). Average intraoperative blood loss was significantly less in the CBT-FF group than in the PPS-FF group. CONCLUSIONSBoth procedures were equally useful in terms of fusion rate and clinical outcomes for DLS management.

Implementation of the empowerment model of female laborers on Arabica coffee processing industry in Bangli Regency, Bali Province

The Model Analytic Hierarchy Process (AHP) selection of the female laborers' empowerment strategy at UPH which refers to the results of the SWOT analysis shows that strengthening the competence of women laborers' is the main priority of empowerment as a solution to gap performance of female laborers' in the arabica coffee processing industry in Bali. Based on the model, the purpose of this research is to increase the capability of female laborers. The search for female laborers' empowerment needs using the method of appreciative inquiry, through (a) rapid research involving multidisciplinary teams; (b) in-depth interviews and direct observation; (c) Interactive Management sessions; (d) peer review. The main results of the implementation of strategies for strengthening female laborers capability in UPH Kintamani Indonesia are (a) achievement of capability outcome in technical and production management and processing, as well as in UPH institution management; (b) documents of infrastructure development needs in the UPH and roadmap of UPH development documents, SOPs (machine utilization and added value enhancements), and regulations on strategic partnership arrangements. Empowerment of female laborers in UPH Kintamani Indonesia needs to be continuously evaluated and the results are followed up to produce premium-quality Arabica coffee production processed in accordance with IG certification, supported by distinctive product design innovations to support business independence and partnership contract sustainability.

The COVID-19 quandemic

BackgroundThe terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic – a portmanteau of “quantification” and “pandemic”.Main textThe use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management.Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking.ConclusionA quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities.

POSTOPERATIVE INFECTIONS OF THE LUMBAR SPINE: PRESENTATION AND MANAGEMENT

: Postoperative infections of the lumbar spine pose significant challenges in clinical management and patient outcomes. Despite advances in surgical techniques and perioperative care, these infections continue to occur, leading to increased morbidity and healthcare costs. Understanding the presentation and management of these infections is crucial for optimizing patient care and outcomes. The objective of the study is to assess the prevalence of spinal surgeries, comorbidities, diagnostic modalities, treatment approaches, and their correlations in managing surgical site infections among patients at Khyber Teaching Hospital. Medical records of 800 patients who underwent lumbar spine surgery at Khyber Teaching Hospital from 2020 to 2022 were retrospectively reviewed. Data regarding patient demographics, surgical details, infection characteristics, microbiological findings, treatment modalities, and outcomes were collected and analyzed. Descriptive statistics were used to summarize the findings, and inferential statistics were employed to explore associations between variables. The study comprised 800 spinal surgery patients at Khyber Teaching Hospital, with a mean age of 58 ± (12.3 SD) years. Laminectomy was the most common procedure (43.75%), followed by discectomy (22.5%). Clinical inspection was predominantly used for SSI diagnosis (95.6%), and post-surgical measures included debridement, antibiotics and cultures. Correlation analysis revealed varying associations between surgeries and post-operative symptoms. The Treatment outcomes showed high-resolution rates, with surgical debridement demonstrating the highest efficacy. This study reveals laminectomy as the most common procedure. As laminectomy was the most common procedure done, that’s why SSI was more common in these procedures. Key diagnostic methods for detecting surgical site infections (SSI) was clinical examination of wound status and pus discharge. The study revealed that patients with early surgical debridement had the best outcome in early resolution of infection and wound healing. Thus, Correlation analysis between surgeries and symptoms guides clinical decisions, with surgical debridement followed by antibiotics showing the highest efficacy in resolving infections. These findings stress the need for tailored patient care strategies to enhance outcomes and reduce complications in spinal surgery.

Uveal melanoma in the Iranian population: two decades of patient management in a tertiary eye center

BackgroundTo assess the characteristics and outcomes of uveal melanoma management at a tertiary center in the Middle East.MethodsA study on 164 patients with uveal melanoma was conducted by reviewing the available medical records, ultrasound, and pathology report results. Age at diagnosis, tumor location and size, treatment mode, visual outcome, metastasis, mortality, and survival were studied.ResultsThe mean age of patients was 52.0 ± 15.0 years, and 52.5% were male. Choroidal melanoma was the most common uveal melanoma, followed by the ciliary body and iris melanoma. The mean thickness of tumors was 8.29 ± 3.29. The majority of patients (n = 111, 67.9%) were managed by brachytherapy with ruthenium-106 plaques. Enucleation was performed primarily in 46 (28%) patients and secondarily in nine (5.5%) patients. The sexual disparity was detected as the proximity of uveal melanoma to the fovea in males. For a 61-month mean follow-up period, mortality occurred in eight of our cases, six of which were due to metastasis. The most common site for distance metastasis was the liver (5/6), followed by the lung (1/6). The five-year and eight-year overall survival (OS) rate was 0.947%± 0.019. The 5-year survival rate reached zero in metastatic patients. OS was not statistically different depending on the age, tumor diameters, the primary treatment received, or the histopathologic findings (p > 0.50 for all).ConclusionIn this study, individuals diagnosed with UM exhibited an OS rate of around 94% at the five-year mark, which remained consistent up to eight years. Notably, the presence of distance metastasis emerged as the sole statistically significant factor influencing overall survival.

The impact of integrating rabbit haemorrhagic disease virus (K5) release with pindone baiting on wild rabbit populations.

Several conventional and recently available tools are available for an integrated control of European rabbits in Australia. We quantified the impact of the release of rabbit haemorrhagic disease virus K5 (RHDV K5, hereafter K5) and pindone (2-pivalyl-1,3-indandione)baiting at 13 sites within Cudlee Creek fire scar in the Adelaide Hills, South Australia. K5 release was followed by pindone baiting between December 2021 and March 2022; the application of both control methods followed industry best practice. We counted rabbits using spotlights before and after the application of both control methods. Fly samples and livers from dead rabbits were collected to track K5 transmission within and between sites, and to detect the natural circulation of rabbit haemorrhagic disease virus 2 (RHDV2). K5 release had minimal impact on rabbit populations, with treated populations increasing by a mean of 65.5% at 14 days post-release and 27.9% at 77 days post-K5 release across all sites, comparable to the changes at control sites. K5 detection in flies up to 77 days post its release, and its detection in rabbit livers, demonstrates that it can survive and transmit in the environment for prolonged periods and that it can lethally infect some rabbits. This limited impact of K5 is consistent with previous studies and may be explained by pre-existing RHDV/RHDV2 immunity in the target populations or the presence of young rabbits with natural innate RHDV immunity. The detection of K5 in flies from control sites demonstrates that it was vectored beyond its release location. A reduction in rabbit counts post-pindone baiting was observed at most treatment sites, with a mean population reduction of 36.6% across all sites. Landholders need to carefully and strategically plan their integrated rabbit control programmes. Not all combinations of controls, even if theoretically logical, achieve meaningful outcomes for rabbit management.

Abstract B022: Conversion from minimally invasive surgical approaches to open surgery among endometrial cancer patients in a national cancer patients’ registry

Abstract Endometrial cancer (EC) ranks as the predominant gynecological malignancy in the US. While minimally invasive surgical (MIS) techniques have revolutionized EC management, conversion to laparotomy remains a concern, with reported rates varying widely. Factors influencing this conversion, including patient characteristics and tumor attributes, have not been fully understood. Addressing this gap, our study employs a national registry to analyze patient, tumor, and surgeon-related factors contributing to the transition from MIS to laparotomy in EC cases. Results: 0ur results showed, 3.4% (135/4028) experienced planned MIS-to-open conversion. Demographic disparities were absent between conversion and MIS groups. Conversion was more prevalent in obese (29%) and morbidly obese (37%) patients (P=0.04), linked to prior abdominal surgery (63% vs 52%; P=0.001). Endometrioid EC predominated (59%) in the converted group, with higher non-endometrioid rates (serous carcinoma 16%, clear cell carcinoma 4%, carcinosarcoma 5%, mixed histology 12%; all P&amp;lt;0.01). Advanced FIGO stages were more common in conversions (stage II: 5%, stage III: 25%, stage IV: 9%; all P&amp;lt;0.001). Type II (24%) and type III (5%) hysterectomies were more frequent in conversions (P&amp;lt;0.001). Logistic regression indicated BMI, prior surgery, FIGO stage, histology, and operation type affected conversion (p&amp;lt;0.001), explaining 12.3% of variance. Indications for conversion included uterine size, adhesions, and disease extent. Conclusion: the adoption of minimally invasive surgery (MIS) has become increasingly popular for managing endometrial cancer (EC), attributed to enhanced perioperative outcomes. However, prudent patient selection and surgical planning are imperative to mitigate the risk of unplanned transition to open surgery. Predictive factors for such conversion include uterine size, prior abdominal surgeries, surgical complexity, disease extent, and histologic types. Further prospective research is warranted to validate these findings and identify individuals at conversion risk. Ultimately, a personalized surgical approach, tailored to individual patient attributes, remains pivotal for optimizing outcomes in EC management. Citation Format: Abdelrahman Yousif, Julie Ngo, Deena Abdel-Gadir, Jenny Lachance, Benjamin Mize, Ilana Chefetz. Conversion from minimally invasive surgical approaches to open surgery among endometrial cancer patients in a national cancer patients’ registry [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr B022.

Shoulder balance in Lenke type 2 adolescent idiopathic scoliosis: correlations among radiological indices, cosmetic indices, and patient-reported outcomes.

The aim of this study was to investigate the correlation between radiological indices of shoulder balance (SB) and cosmetic indices of shoulder deformity in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) and to determine the extent to which patient-reported outcomes (PROs) correlate with these measurements. Current management decisions and outcomes for SB in AIS are primarily based on radiological measurements. It is crucial to understand how these radiological parameters and cosmetic indices relate to patient satisfaction. The authors analyzed the preoperative radiological and photographic indices of SB, along with PROs, in patients with Lenke type 2 AIS. Lateral SB parameters included the radiological shoulder height (RSH) and clavicle angle, while medial SB parameters included the first rib angle and T1 tilt angle. Photographic indices included the shoulder height angle (SHA), axilla height angle (AHA), and the left/right trapezius angle (LRTA) ratio. The authors assessed the self-image, mental health, and total score domains of the Korean version of the 22-item Scoliosis Research Society questionnaire. In their analysis of Lenke type 2 patients, the authors found that correlation coefficients between radiological measurements and photographic indices ranged from -0.25 to 0.47, among which only lateral SB including clavicle angle and RSH showed a significant correlation with anterior and posterior photographic indices. No statistically significant correlations were found between radiological measurements and PROs. Anterior photographic indices including SHA and AHA significantly correlated with all three PROs (p < 0.05). Radiological shoulder parameters did not accurately reflect the perceived SB. Anterior photographic indices were reliable for evaluating clinical SB in patients with Lenke type 2 AIS and correlated with PROs. Spine surgeons may benefit from paying more attention to anterior photographic indices when making surgical decisions regarding clinical SB.

Perioperative management and postoperative outcomes of locally advanced thymic epithelial tumors: a narrative review.

Thymic epithelial tumors (TETs) are frequently diagnosed at an advanced stage, highlighting the importance of understanding the treatment strategies for these cases. Surgical intervention after chemotherapy or chemoradiotherapy presents specific challenges and underscores the crucial role of perioperative management. This study aimed to explore the perioperative management and postoperative outcomes in patients with locally advanced TETs. Relevant studies published between 2000 and 2022 were identified through PubMed searches using a combination of the following terms: "Locally advanced TETs", "Thymoma", "Thymic cancer", "Surgery", "Induction therapy", and "Postoperative outcomes". We analyzed available data to describe the perioperative management and postoperative outcomes of locally advanced TETs. Surgical outcomes after induction therapy for locally advanced TETs were analyzed for 18 references (total n=646) between 2000 and 2022. The primary objective of induction therapy for locally advanced TETs is complete tumor resection. In recent years, many medical centers have adopted systemic chemotherapy and chemoradiation for the treatment of thymoma and thymic carcinoma, respectively. During surgical intervention, resecting the surrounding organs, such as the lungs, pericardium, and phrenic nerves, is a common practice. Additionally, there may be cases wherein vascular resection of the superior vena cava (SVC) and innominate veins is necessary. Techniques and strategies for revascularization without complications are crucial in these situations. The incidence of postoperative complications varied significantly, ranging from 4.8% to 42%. However, perioperative mortality is typically reported to be approximately 0%, with only two reports showing mortality rates of 1.8% and 9.0%. The short-term postoperative outcomes of surgical treatment following induction therapy for locally advanced TETs were generally deemed acceptable. However, incomplete resection may occur, particularly when the tumor invades the pulmonary artery or aorta. Hence, careful evaluation the indications for surgery is crucial, considering the patient's overall condition and treatment response.

Aczel–Alsina T-norm based group decision-making technique for the evaluation of electric cars using generalized orthopair fuzzy aggregation information with unknown weights

Data management and finding precise outcomes from large amounts of information are among the biggest challenges for scientists. The technique of multi-attribute group decision-making (MAGDM) is a valuable tool for investigating fuzzy data precisely. The key objective of the paper is to redefine the q-rung orthopair (q-RO) fuzzy set (FS) (q-ROFS) in the term of interval-valued and proposed new aggregation operators (AOs) based on the Aczel-Alsina (AA) t-norm (TN) and t-conorm (TCN) operations. The AA operational laws are a generalized form of existing TNs and TCNs and give more reliable results because they can fluctuate in their parametric values. The concept of interval-valued enlarges the space of membership degree (MD) and non-membership degree (NMD) for decision-makers. By taking qth power, the interval-valued q-ROFS (IV-q-ROFS) structure. The IV-q-ROFS can handle the uncertainty and vagueness in data, then interval-valued intuitionistic FS (IV-IFS) and interval-valued Pythagorean FS (PyFS) (IV-PyFS) and provide accurate results. The thought of power AOs (PAOs) makes the relationship between weight vectors and reduces the chances of uncertainty in aggregated results. By taking advantage of PAOs, this article is devoted to introducing the interval-valued q-ROF Aczel-Alsina power-weighted averaging (IV-q-ROFAAPWA) and interval-valued q-ROF Aczel-Alsina power-weighted geometric (IV-q-ROFAAPWG) operators. The fundamental axioms of AOs, idempotency, boundedness, and monotonicity, are also discussed. To illustrate the importance of suggested AOs, the real-life problem of electric car selection was solved by applying the MAGDM method using the proposed IV-q-ROFAAPWA and IV-q-ROFAAPWG operators. The comparison of proposed AOs with currently present AOs is also part of the article. We finally constructed solid conclusions.

Microsurgical treatment of posterior circulation aneurysms: an institutional experience from Nepal.

Management strategies and outcomes of patients with posterior circulation aneurysms are varied due to uncertainty in the optimal treatment modality and limited experience of neurosurgeons. Data are scarce regarding patients with posterior circulation aneurysms from developing countries. This study aims to describe the clinical characteristics, management strategies and outcome of patients with these aneurysms treated microsurgically in an academic institute in Nepal. The clinical records of patients confirmed to have posterior circulation aneurysms treated microsurgically between July 2014 and July 2022 were retrospectively reviewed. Demographic and clinical characteristics, morphometric characteristics of aneurysms, management strategies, postoperative complications, and 1-year outcomes were described. Out of 220 aneurysms in 190 patients, 20 were posterior circulation aneurysms. The median age of the patients was 43 (15-60) years. All were ruptured aneurysms. The admission Hunt and Hess grades of 18 (90%) patients were less than or equal to III. The posterior inferior cerebellar artery (8) was the commonest location. The postoperative complications rate was 20%, with the overall mortality of 10%. 80% of patients had a favourable outcome at 1-year follow-up. The patient characteristics and outcome are comparable with those described in the literature from other countries. With an individualized and careful selection strategy, our results are satisfactory despite fewer operations.

Leadership Styles and Change Management: A Comprehensive Analysis

This review paper delves into the symbiotic nature of leadership styles and change management in organizational settings. In the spheres of increasing dynamism and development modern leadership becomes a pivot point enabling an organization or institution to new waters. a detailed review of leadership approaches in the research on transactional, transformational, situational, and charismatic branches how they contribute to change management. Acknowledging the need for adaptive leadership, this paper is dedicated to exploring the strategic coherence of leading styles vis-a-vis their peculiarities, claiming that such a relation matters for organizational resiliency. Leaders often must use subtle tactics to overcome challenges that can occur during change processes. This paper’s contribution to the current leadership discourse is the elaboration of how various leadership styles interact with change management processes. To this end, it seeks to clarify our understanding of the connection between leadership approaches and organizational adaptation by conducting an in-depth investigation into dynamic interactions that exist between leadership styles and change management processes. This review serves as an appetizer for understanding how effective change management outcomes are achieved through the strategic utilization of different leadership styles. This review presents a roadmap to grasp the relationship between types of leadership and effective change management.

UNEVENTFUL PREGNANCY IN DIDELPHYS UTERUS DELIVERED THROUGH CAESAREAN SECTION: A CASE REPORT

Didelphys uterus, also known as "double uterus," is a rare congenital anomaly characterised by the presence of two separate uteri, each with its cervix. This happens as a result of the Müllerian duct embryonic fusion failing. The chance of having a pregnancy in one of the uteri without having any complications during pregnancy is relatively low. We are reporting a case of a 24-year-old primigravida woman with a didelphys uterus. The patient presented with the complaint of leaking per vaginum at term gestation in hospital IPD. She had undergone ultrasonography many times during her pregnancy, but no ultrasound finding suspects any congenital anomaly of the uterus. During the ninth month of gestation, when the patient came with leaking per vaginal, two vagina were discovered with a thick longitudinal vaginal septum, so she underwent an elective caesarean section due to the potential risks associated with vaginal delivery and under the suspicion of two separate uteri. During caesarean section, uterus didelphys was confirmed as two uteri with separate fallopian tubes and ovary; one was gravid, and another was non-gravid. The management of this condition requires careful planning and coordination among the multidisciplinary team to ensure a successful and safe outcome. The present case report reveals her history, diagnostic workup, caesarean delivery, and management outcome.

Complex stab related injuries involving the diaphragm, bowel and cystic duct: a case report

Penetrating abdominal trauma is a major killer worldwide. Biliary duct injuries resulting from penetrating stab wounds are rare but potentially life-threatening occurrences. This case report outlines a rare case, diagnosis, surgical management, and postoperative outcomes of a patient who sustained a cystic duct injury due to a penetrating stab wound. There is paucity of such cases in the literature. A 55-year-old man sustained a penetrating wound and was found to have cystic duct injury intra-operatively along with other multi-visceral injury. The patient underwent a cholecystectomy with the management of associated injuries. The report aims to highlight the rarity yet the possibility of such injuries and emphasize the importance of a high index of suspicion.

Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury.

Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia. We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay. Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups. Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.

Deep learning techniques for imaging diagnosis and treatment of aortic aneurysm.

This study aims to review the application of deep learning techniques in the imaging diagnosis and treatment of aortic aneurysm (AA), focusing on screening, diagnosis, lesion segmentation, surgical assistance, and prognosis prediction. A comprehensive literature review was conducted, analyzing studies that utilized deep learning models such as Convolutional Neural Networks (CNNs) in various aspects of AA management. The review covered applications in screening, segmentation, surgical planning, and prognosis prediction, with a focus on how these models improve diagnosis and treatment outcomes. Deep learning models demonstrated significant advancements in AA management. For screening and diagnosis, models like ResNet achieved high accuracy in identifying AA in non-contrast CT scans. In segmentation, techniques like U-Net provided precise measurements of aneurysm size and volume, crucial for surgical planning. Deep learning also assisted in surgical procedures by accurately predicting stent placement and postoperative complications. Furthermore, models were able to predict AA progression and patient prognosis with high accuracy. Deep learning technologies show remarkable potential in enhancing the diagnosis, treatment, and management of AA. These advancements could lead to more accurate and personalized patient care, improving outcomes in AA management.