Two-stage Intervention Research Articles

Two-stage surgical intervention for a rare case of intersected nasoethmoidal encephalocele and open-lip schizencephaly in an infant: illustrative case.

Schizencephaly and encephaloceles are rare developmental birth defects, with the former involving abnormal clefts in the cerebral hemispheres connected to the ventricular system and the latter involving a neural tube defect characterized by the protrusion of brain tissue through an abnormal skull opening. These conditions are individually uncommon, and their simultaneous occurrence in a single patient is exceedingly unusual. This case report explores the intersection of these two rare congenital malformations in a 2-month-old female patient from an indigenous community in a rural area of Colombia. She presented with open-lip schizencephaly accompanied by a nasoethmoidal encephalocele and additional brain abnormalities, including septum pellucidum agenesis, corpus callosum dysgenesis, and a suspected bilateral optic nerve hypoplasia. Management involved a two-step surgical procedure, addressing hydrocephalus with a ventriculoperitoneal shunt and the encephalocele with posterior excision, thereby facilitating optimal cortical gray matter development and enhancing neurological outcomes. https://thejns.org/doi/10.3171/CASE24259.

Enhancing spelling skills in dyslexic primary students: A comparative study of remedial and compensatory interventions in chennai

Learning to spell poses significant challenges for young learners with dyslexia, who often encounter difficulties with phonological awareness and orthographic processing. This study explores the effectiveness of a structured, two-stage intervention aimed at enhancing spelling skills among 25 primary school students in Chennai, Tamil Nadu, whose native language is Tamil. In the initial four-week phase, participants engaged in remedial activities focused on developing phonological and orthographic awareness, essential foundations for accurate spelling. This phase targeted the students’ ability to recognize sound patterns and understand letter-sound associations, providing a base for further learning. In the following sixteen-week phase, the intervention expanded to include compensatory strategies designed to reinforce initial learning and foster a more comprehensive understanding of spelling. This phase incorporated the multimodal learning, combining visual, auditory, and kinesthetic techniques, as well as task-oriented exercises, play-based activities, and gamified methods to make the learning process more engaging and enjoyable. These varied approaches aimed to enhance students’ spelling skills while maintaining their interest and motivation. The study’s findings demonstrated that both the remedial and compensatory interventions had a positive impact on students' spelling abilities. However, while the phonological and orthographic methods helped build essential skills, they required a longer duration to ensure retention beyond the intervention period. Conversely, the integrated, multimodal approach introduced in the second phase resulted in faster and more substantial improvements. This outcome highlights the benefits of a dynamic, interactive approach in supporting dyslexic learners who are acquiring English as a second language, promoting both skill acquisition and engagement.

Advanced Setup and Techniques for Endovascular Treatment of Ruptured Intracranial Aneurysms

Despite advancements in neurosurgical techniques, subarachnoid hemorrhage(SAH) caused by the rupture of a partially thrombosed intracranial giant aneurysm remains a challenging clinical entity. This report describes the successful treatment of an 80-year-old male patient with SAH due to a ruptured, partially thrombosed intracranial giant aneurysm. The patient underwent a staged endovascular strategy using a flow diverter. The patient presented with SAH secondary to a ruptured, partially thrombosed intracranial giant aneurysm located at the C2 portion of the internal carotid artery and involving the origin of the posterior communicating artery(Pcom). Imaging revealed a dorsomedial rupture point on the aneurysm. A two-stage endovascular intervention(IVR) was performed. The first stage involved coil embolization aimed at covering the rupture point. Following the resolution of the vasospasm and the acute phase of SAH, the second stage involved the deployment of a pipeline embolization device. Digital subtraction angiography performed one month after the second stage IVR demonstrated a significant reduction in aneurysm filling, with preserved flow to the Pcom artery. We will discuss the technical details and rationale behind the staged endovascular approach in this complex case.

Study protocol of a sequential, multiple assignment, randomised trial using an adaptive intervention to reduce loneliness among Chinese older adults in Hong Kong

BackgroundLoneliness is a prevalent and alarming issue among older adults that requires effective interventions. While randomised controlled trials have been commonly undertaken to explore reduction in loneliness, there is a...

Splenic Artery Aneurysm Occlusion by Overlapping Gore® Viabahn® Endoprosthesis Devices

The first lienal artery aneurysm was discovered and described for the first time in 1770 by the Frenchman Beaussier during an autopsy. It was first visualised using X-rays in 1920 by the physicians Akbulut and Otan. The first surgical treatment of a splenic artery aneurysm was performed by sur-geons MacLeod and Maurice in 1940. The first minimally invasive endovascular therapies using coils, stents or a combination of the two devices for minimally invasive treatment of aneurysms of the lienal artery were reported in 1990, 1994 and 1995 (1,2,3). 63-year-old patient with a known aneurysmal arteriopathy of the thoracic aorta in the sense of an aortic dissection in coexistence with a 2.2 cm splenic artery aneurysm discovered by chance in the vascular surgery department of the Bürgerspital Solothurn. The interdisciplinary consensus primarily favoured vascular surgery or minimally invasive transcatheter treatment to eliminate the splenic artery aneurysm. The dissected thoracic aortic aneurysm detected in the pre-interventional CT of the thorax and abdomen, extending into the abdominal aorta, (Fig. 1) should only be treated with minimally invasive endovascular treatment using EVAR after stenting of the lienal artery aneurysm detected by CT (Fig. 9, 10, 11). A reverse therapeutic sequence would have allowed access to the lienal artery aneurysm only by fenestration of the EVAR. For the treatment of our patient's wide-neck aneurysm, the use of a Viabahn was chosen from the many known and proven occlusion materials as a significantly less invasive alternative to surgical treatment of the aneurysm by interdisciplinary consensus. Due to a technical complication during the deployment of the first vial, a two-stage angiographic therapeutic intervention was necessary.

Staged Regenerative-Phenotype Modification Therapy for Multiple RT3 Gingival Recessions in Periodontally Compromised Anterior Mandibular Teeth: A Case Report.

We report the successful treatment of multiple recession type (RT) 3 gingival recessions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-yearold man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective 'wall,' securing space for periodontal regeneration, enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regeneration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoidal surgical papilla and using a de-epithelialized CTG inserted beneath the tunneled flap. Root conditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, mean CAL gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype improved at the treated sites by the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes.

Strengthening contraceptive counselling services to empower clients and meet their needs: protocol for a two-stage, multiphase complex intervention in Pakistan and Nigeria

BackgroundHigh-quality contraceptive counselling can accelerate global efforts to reduce the unmet need for and suboptimal use of modern contraceptives. This study aims to identify a package of interventions designed to...

ORES: Open-Vocabulary Responsible Visual Synthesis

Avoiding synthesizing specific visual concepts is an essential challenge in responsible visual synthesis. However, the visual concept that needs to be avoided for responsible visual synthesis tends to be diverse, depending on the region, context, and usage scenarios. In this work, we formalize a new task, Open-vocabulary Responsible Visual Synthesis (ORES), where the synthesis model is able to avoid forbidden visual concepts while allowing users to input any desired content. To address this problem, we present a Two-stage Intervention (TIN) framework. By introducing 1) rewriting with learnable instruction through a large-scale language model (LLM) and 2) synthesizing with prompt intervention on a diffusion synthesis model, it can effectively synthesize images avoiding any concepts but following the user's query as much as possible. To evaluate on ORES, we provide a publicly available dataset, baseline models, and benchmark. Experimental results demonstrate the effectiveness of our method in reducing risks of image generation. Our work highlights the potential of LLMs in responsible visual synthesis. Our code and dataset is public available in https://github.com/kodenii/ORES.

The reduction in macrosomia prevalence over a decade following the intensive intervention programs

ObjectiveTo assess changes in macrosomia prevalence following a two-stage lifestyle intervention program. MethodsThe study collected annual delivery data from singleton pregnant women at the Beijing Obstetrics and Gynecology Hospital in Beijing, China (2014–2023). The first intervention stage involved nutritional assessment and lifestyle management in pregnancy, and maternal weight and fetal growth monitoring were added in the second stage, with intensive management as necessary. Pre-intervention births (2014–2016) served as controls. The change in macrosomia and low birth weight prevalence following the intervention was assessed by an interrupted time series analysis. ResultsAmong 126,824 pregnant women, macrosomia prevalence decreased from 7.11 % to 4.15 % over ten years, with an accelerated decrease post-intervention (p for slope = 0.050 and 0.004 for the first and second stages), primarily contributed by the reduction in excessive gestational weight gain (adjusted population attributable risk = 28.6 %, p for Granger cause = 0.0001). The change in the increasing rate of low-birth-weight prevalence was non-significant. ConclusionsMacrosomia prevalence significantly decreased over a decade following the intensive intervention programs.

SUPPORTING CHINESE FAMILY CAREGIVERS OF RELATIVES WITH DEMENTIA——A PILOT INTERVENTION STUDY IN SHANGHAI

Abstract Background Effective interventions are urgently needed to assist dementia family caregivers in China, where limited formal support and services are available. This pilot study aims to test a psychoeducational program that consists of information, skills training, and the use of binaural sound through the Processing Inner Strength toward Actualization Therapy (PISTA) device to alleviate caregiver burden and improve mental health outcomes. Methods Single subject design approach was used. Eight dementia family caregivers in Shanghai, China, were recruited and received a two-stage intervention over 12 weeks: Stage 1 (S1, Six 90-minute weekly sessions: Psychosocial education programs +PISTA) and Stage 2 (S2, Six 90-minute weekly sessions: Psychosocial education only). Caregiver outcomes, including caregiving burden, anxiety, depression, and positive aspects of caregiving (PAC), were assessed through established scales. Paired t-tests and visual analyses were used to compare outcome levels and trends between stages. Results Seven participants completed the entire study, and 1 participant dropped out during S2. Participants showed a decrease in caregiver burden, anxiety, and depression and an increase in PAC during S1. A similar trend was observed during S2 on burden, anxiety, and PAC outcomes, except for depression. Furthermore, the decrease in burden and anxiety scores and the increase in PAC scores were less salient during S2 than during S1, suggesting more effects were observed in S1 with PISTA. Conclusion Evidence is promising that psychoeducational programs combined with PISTA can lead to better psychological outcomes for dementia family caregivers. Findings need to be affirmed in future investigations using an experimental design.

Treatment of patients with posttraumatic deformities of the thoracolumbar spine using Schwab 5 osteotomy through combined and posterior approaches

Objective. To analyze the results of surgical treatment of patients with rigid posttraumatic deformities of the thoracolumbar spine operated on using Schwab 5 osteotomy through combined and posterior approaches.Material and Methods. A retrospective cohort study was conducted. Study group included 60 patients (m/f = 25/35). Median age was 48 (26–58) years, median time since injury was 11 (9–14) months, and minimum follow-up period was 2 years. A two-stage intervention with resection of the vertebral body, correction of the deformity, and placement of an interbody implant through the anterior approach followed by final fixation through the posterior approach (VCRa+p group) was performed in 29 cases. Vertebral body resection through the posterior approach with correction of the deformity, installation of an interbody implant, and rigid transpedicular fixation (VCRp group) was performed in 31 cases. In all patients, the magnitude of correction was assessed, as well as the following parameters: frontal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. The results of treatment were evaluated in dynamics by the level of pain syndrome (VAS) and quality of life (ODI), as well as based on the analysis of postoperative complications.Results. The groups were comparable in terms of gender, age, magnitude of the kyphotic component of the deformity, level of pain syndrome and degree of initial neurological deficit (p > 0.05). Correction of the deformity kyphotic component was significantly better in patients in the VCRp group compared to those in the VCRa+p group (p = 0.036). Both groups showed a significant decrease in the level of pain syndrome 3 months after surgery. However, further follow-up showed a tendency for back pain to increase on average one year after surgery in the VCRa+p group. A total of 67 complications were revealed in 40 (66.7 %) patients. Herewith, in the early postoperative period there were 55 complications in 31 patients, and in the late period there were 12 complications in 9 patients. Analysis of early complications showed a higher incidence of anemia (p = 0.002) and liquorrhea (p = 0.017) in the VCRp group compared to those in the VCRa+p group. The incidence of long-term complications did not differ significantly between groups (p = 0.866). An increase in back pain in the long-term period was observed in 12 (41.4 %) patients of the VCRa+p group and in 4 (12.9 %) patients of the VCRp group. Analysis of risk factors for this condition showed a tendency for back pain to increase in the long-term period in patients with residual local deformity against the background of low pelvic index values.Conclusion. Correction of the kyphotic component of deformity was significantly better in patients of the VCRp group, which was accompanied by greater surgical trauma and incidence of early postoperative complications. The tendency of patients’ quality of life to deteriorate in the long-term follow-up period seems to be related to the occurrence of pain syndrome in the lumbar spine in patients with residual kyphotic deformity against the background of initially low compensatory capabilities.

Revision Anterior Cruciate Ligament Reconstruction: Current Approaches to Preoperative Planning (Systematic Review)

Background. The number of primary anterior cruciate ligament (ACL) reconstructions increases every year, which causes an increase in revision interventions due to ACL graft failure. When studying the literature, we identify many factors that together influence the outcome of revision ACL reconstruction, but are not always taken into account by surgeons.
 Aim of the review — is to perform a systematic review of studies that evaluated the outcomes of revision anterior cruciate ligament reconstructions and to identify optimal solutions to the most common problems encountered in preoperative planning.
 Methods. Information search was performed in the eLIBRARY, PubMed, and Scopus databases for the period from 2013 to 2022. Studies describing the main aspects of revision ACL reconstruction were selected for analysis. Inclusion criteria were the following: mean patient follow-up period of no less than 12 months, number of observations of no less than 10 cases. After evaluation of 898 articles, 22 articles were included in the systematic review.
 Results. Five main factors that should be taken into account in preoperative planning of revision ACL reconstruction have been identified: choice of the graft, necessity of reconstruction of the anterolateral complex, correction of tibial plateau deformity in the sagittal plane, determination of indications for one- or two-stage intervention, method of bone defect replacement in two-stage surgical treatment.
 Conclusion. The patient’s autogenous tissues should be preferred when choosing a graft. Correction of excessive anteroposterior tibial plateau inclination angle is performed only at the second revision intervention if the inclination angle exceeds 12º. Reconstruction of the anterolateral complex should be performed in young, active patients who are involved in pivot sports and in case of severe anterior instability. When determining the possibility of performing revision ACL reconstruction in one or two stages, the canal diameter is not a crucial parameter, as it is necessary to take into account the possibility of fusion of the canals from the previous surgery with the newly created ones. If the canals have correct entry points, one-stage revision reconstruction can be performed with the canal width not exceeding 10 mm and depending on the expected diameter and type of the prepared tendon graft. Bone grafting of the secondary dilated canals in two-stage intervention can be carried out using any material, but allogenous bone or synthetic grafts have certain advantages.

Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia

ObjectivesFamily caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such...

Efficiency of two-stage extensive resection interventions in the surgical treatment of patients with disseminated echinococcosis of the liver

Introduction. Surgical operations are the main and effective option for treatment of hepatic echinococcosis. The problem of the choice of the type of surgical intervention in the advanced form of hepatic echinococcosis in the conditions of supposed deficiency of the organ functional reserves and development of post-resection hepatic insufficiency remains topical.The aim of the study was to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.Materials and methods. The paper presents the results of surgical treatment of 22 patients, 8 male (36.4%) and 14 female (63.6%) operated in the surgical department № 2 of Kuzbass Clinical Emergency Hospital named after M.A. Podgorbunskiy in Kemerovo. The criterion for inclusion in the study was to use of a two-stage extensive resection protocol.Results. The surgical staging methods used in our study to prevent post-resection liver failure showed efficacy in the following parameters: CT volumetry (p < 0.05), residual concentration of indocyanine green at 15 minutes (p < 0.05), statistical predictive model value (p < 0.05) and allowed to prepare patients for resection extensive intervention with a sufficient level of safety. Specific postoperative complications after extensive resection were identified in nine patients (40.1 %) and non-specific complication in three patients (13.6 %). Specific complications are mainly represented by manifestations of PPN manifistations − six cases (66.7 %), including 5 cases (83.3%) with “A” category according to ISGLS, with “B” category − one case (16.7 %). There were no fatalities or relapses in any of the study groups. Discussion When analysing the literature, there is a tendency to search for effective and safe methods of stopping the blood flow of the liver portal system in order to achieve vicarious hypertrophy of the remnant. A common technique for obtaining vicarious hypertrophy of the future liver remnant is radiopaque endosurgical embolization of the portal blood flow. However, there are technical limitations to the availability of the procedure. Laparoscopic clipping of the right portal vein branch is an alternative surgical option.Conclusion. Techniques to achieve vicarious hypertrophy of the liver remnant have proven effective and have prepared patients for extensive liver resections. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when performed in specialised hepatology centres.

Options for Two-Stage Extensive Liver Resections in the Surgical Treatment 
 of Advanced Liver Echinococcosis

Introduction. The major and effective option for the treatment of liver echinococcosis are surgical operations. To choose a type of surgical intervention in a common form of liver echinococcosis under suspected deficit in the functional reserves of the organ and developing post-resection liver failure remains challenging.The aim of the study is to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.Materials and methods. The study included clinical findings of 24 patients with advanced liver echinococcosis (9/37.5% men, 15/62.5% women) who underwent surgical treatment in Surgical Department №2, Kuzbass Clinical Emergency Hospital named after M. A. Podgorbunsky " (Kemerovo). The use of a two-stage major resection protocol was the criterion for inclusion in the study. Stage I was aimed to achieve vicarious hypertrophy of the contralateral lobe using various techniques to stop blood flow along the right branch of the portal vein. A two-stage protocol for extensive resection intervention was applied due to insufficient functional liver reserves and the small volume of the potential remnant; this resulted in the inability to safely use a single-stage extensive resection due to the predicted developing post-resection liver failure and a likely lethal outcome.Results and discussions. The applied surgical stage approaches for prevention of post-resection liver failure are effective due to the following parameters: CT volumetry (p0.05), residual concentration of indocyanine green at the 15th minute (p0.05), statistical model value (p0, 05). The level of effectiveness of the above technique is comparable with the laparotomic ligation of the right branch of the portal vein; however, the laparoscopic option is less traumatic, which can significantly reduce postoperative hospital stay (p0.05). In addition, there were no specific and nonspecific complications registered in case of the laparoscopic option.Conclusion. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when operations are performed in specialized hepatological centers using a comprehensive protocol for preoperative examination. They can be recommended in case of the initial significant deficit in the volume of the potential liver remnant and functional reserves of the organ.

Effects of a Primary Care-Based Engagement Intervention for Improving Use of ADHD Treatments

Uptake of attention deficit hyperactivity disorder (ADHD) treatments is low in primary care. A quasi-experimental study assessed the impact of a primary care-based engagement intervention to improve ADHD treatment use. Families of children with ADHD from four pediatric clinics were invited to participate in a two-stage intervention. The first step was an assessment battery to assess functioning and identify goals, followed by an in-office engagement session run by primary care staff. Of the 636 invited families, 184 (28.9%) completed ratings, with 95 (51%) families completing the engagement session. ADHD office visits varied based on the number of steps completed (0-2). ADHD prescriptions decreased over time in families completing neither step but increased for children previously unmedicated whose parents completed either step. Families completing both steps had the highest rates of nonmedication ADHD treatments. A brief two-step engagement intervention was associated with increased uptake of ADHD treatments.

Simultaneous two-stage surgical treatment for Chiari malformation association with occlusive hydrocephalus: a clinical case

Treatment of patients with the simultaneous presence of Chiari malformation type I (MC I) and hydrocephalus may include both one-stage and two-stage surgical interventions. The article describes the two-stage surgical treatment experience performed for the first time in the Republic of Tajikistan. Description of the case. A 50-year-old female patient with a three-year history of bursting headache, dizziness, nausea, and vomiting developed impaired coordination of movements and decreased visual acuity. Computed tomography (CT) revealedsigns of MC I: descent of the cerebellar tonsils 5 mm below the level of the foramen magnum and occlusive triventricular hydrocephalus with symmetrical enlargement of the lateral and third ventricles. The patient underwent surgery – endoscopic third ventriculocisternostomy (ETV) in combination with decompressive suboccipital craniectomy, which was supplemented by CI laminectomy. After the surgery, the symptoms regressed. According to the control CT scan, there was a moderate decrease in the size of the lateral and third ventricles, restoration of the normal anatomical structure of the posterior cranial fossa.

Methods to increase the effectiveness of cytoreductive surgical interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis

The expediency of performing two-stage cytoreductive interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis is presented. Ninety-two patients with complicated disseminated tumors of the abdominal cavity and pelvis were examined into two groups. The main group consisted of 33 patients who received surgical treatment by two-stage cytoreductive surgery. The control group included 59 patients who underwent single-stage cytoreductive operations. In both groups, life-threatening complications were dominated by primary tumor necrosis (main group, n = 15; control group, n = 31) and impaired intestinal patency (main group, n = 12; control group, n = 16, respectively). The average Charlson comorbidity index was 7.85 1.37 and 7.53 1.5 points, respectively. Anesthetic risk of grades IIIIV according to the classification of the American Society of Anesthesiologists was detected in 23 (69.7%) and 45 (76.27%) patients of the main and control groups, respectively. Functional status of 23 points on the Eastern Cooperative Oncological Group was established in 23 (69.7%) and 46 (77.9%) patients of the main and control groups, respectively. The peritoneal carcinomatosis index was significantly higher in the main group (13.1 6 vs 9.9 4.8 points) than in the control group (p = 0.012). A comparative analysis of the results obtained in the treatment of the main and control groups demonstrated that the two-stage cytoreductive surgical interventions can reduce the frequency of postoperative complications, primarily ClavienDindo grades IIIIV from 40.7 to 18.2% (p = 0.049) and mortality from 16.9% to 9.1% (p = 0.468) and increase the frequency of achieving complete cytoreduction from 49.1% to 90.9% (p = 0.002) and the frequency of intraperitoneal hyperthermic chemoperfusion from 40.7 to 93.9% (p 0.001). Thus, two-stage cytoreductive surgical interventions are a safe and effective technique in the surgical treatment of complicated disseminated tumors of the abdominal cavity and pelvis.

Effect of real-world fear on risky decision-making in medical school-based students: A quasi-experimental study.

Objective: To explore the effect of real-world fear on risky decision-making under certainty and uncertainty. Methods: This quasi-experimental study enrolled non-psychology undergraduate volunteers aged between 17 and 20 years old from the Preventive Medical Institute medical school in Xi'an. Participants were randomly divided into two groups, and each group received a two-stage crossover design intervention (of a calm and fearful situation) and completed the tasks of risky decision-making under uncertainty (the balloon analog risk task: BART) and certainty (the Cambridge gambling task: CGT), respectively. The primary outcomes included the behavioral impulsivity measured by the BART value, and the speed of decision-making, the quality of decisions, the adventure index, behavioral impulsivity, and risk adjustment measured by CGT. The secondary outcome was the concentration of cortisol in the saliva. Results: A total of 60 questionnaires and data were obtained from 60 participants (28 males and 32 females, aged 19.55 ± 0.75). Compared with the calm situation, participants were more likely to have a lower BART value (p = 0.013), slower speed of decision-making (p < 0.05), and higher adventure index (p = 0.018) in the fearful situation. The quality of decisions (p = 0.189), behavioral impulsivity index (p = 0.182), and risk adjustment (p = 0.063) between subjects in the fearful and calm situations were comparable. Furthermore, the mean value of the adventure index of CGT in male subjects was significantly higher than that in female subjects (p < 0.05), and the cortisol concentration in saliva during the fearful situation was significantly higher compared to the calm situation (p < 0.05). Conclusion: Fear might reduce behavioral impulsivity under uncertainty, and increase the adventure index under certainty in risky decision-making. Risky behavior might be influenced by gender: under certainty in risky decision-making, men were more adventurous. Additionally, fear increased the secretion of cortisol in saliva.

Experience Of Using Internal Fixation In The Treatment Of Patients With Inflammatory Complications Of Mandibular Fractures: A Retrospective Study

Study goal — To evaluate the efficacy of plate osteosynthesis in the treatment of patients with inflammatory complications of mandibular fractures on a large sample. Material and Methods — We conducted a retrospective analysis of medical records collected over 15 years in a group of patients with inflammatory complications of mandibular fractures. The analysis included medical records of patients who underwent plate osteosynthesis operations performed according to the surgical algorithm adopted in the clinic, in combination with a simultaneous directed antibacterial effect on the microflora of the pathological focus and osteoplastic replacement of defects. We identified 164 medical records meeting the search criteria distributed among two study groups. Group A included hospitalized patients with developed abscesses and phlegmons of soft tissues surrounding the fracture area. For them, two-stage surgical intervention was performed. Group B consisted of patients who had no suppurative process in soft tissues, which allowed them undergoing one-stage surgical treatment. Results — Good, satisfactory, and unsatisfactory surgical outcomes were obtained in 82.6%, 14.9%, and 2.4% of the patients, respectively. The differences between the comparison groups were not statistically significant. Conclusion — The clinical effectiveness of an integrated approach to the surgical treatment of patients with inflammatory complications of mandibular fractures, based on providing stable fixation of connected fragments as a critical factor in bone wound healing via osteosynthesis, was confirmed on large samples in both comparison groups.