Assessment of POSSUM score in surgical department

Catedra Chirurgie Generală şi Semiologie, USMF „N.Testemițanu”, Chișinău, Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Aprecierea obiectivă a riscului operator a devenit o condiție esențială pentru practica contemporană a departamentelor chirurgicale. Astfel, scorul POSSUM (Physiological and Operative Severity Score for enUmerating Morbidity and mortality) la momentul actual constituie unul din sistemele precise și accesibile în aprecierea mortalității și morbidității postoperatorii, fiind unul din puținile ce evaluează atît factorii fiziologici individuali cît și cei legați nemijlocit de actul chirurgical. Metode: Au fost analizate retrospectiv 99 de fișe ale pacienților ce s-au aflat la tratament în perioada postoperatorie în departamentul ATI și au inclus informația necesară colectării parametrilor scorului fiziologic (12 paramentrii); precum și a celui operator (6 paramentri). Lipsa aprecierii statutului neurologic comform scalei Glasgow a impus omiterea pacienților cu un scor mai mic de 15p conform acestui indice. Mortalitatea probabilă a fost calculată comform variantei modificate a scalei, P- POSSUM. Analiza statistică a datelor s-a efectuat prin intermediului programului SPSS v.16.0. Rezultate: În lotul de studiu mortalitatea prognozată medie a fost de 12.5%, exprimat în cifre absolute a constituit 12 decese, iar numărul real fiind de 22 decese. Limita de probabilitate a mortalității de 10% pare a fi una critică, 20 din decese clasîndu-se după această valoare. Morbiditatea medie prognozată a constituit 35,4%, cea reală fiind de 31,3%, raportul între numărul de cazuri reale și cele probabile fiind de 0.89. Concluzii: Scorul POSSUM asigură un pronostic relativ veridic al mortalității și morbidității postoperatorii. Prognozarea mai obiectivă a rezultatelor tratamentului chirurgical este strâns legată de determinarea precisă a paramentrilor incluși.Introduction: Objective assessment of operative risk has become an essential condition for the practice of modern surgical departments. Thus, the POSSUM score (Physiological and Operative Severity Score for enUmerating Morbidity and mortality), at this moment, is one of the accurate and accessible systems used for assessment of postoperative mortality and morbidity, one of the few that assesses both individual physiological factors as well as those directly related to the surgery. Methods: We analyzed retrospectively 99 files of patients who have been treated in the postoperative period in the ICU and which included the information necessary for calculation of physiological score (12 parameters), as well as the operative score (6 parameters). Lack of possibility to assess the neurological status using Glasgow scale imposed the exclusion of patients with a score less than 15p. The mortality was calculated with the modified version of the score, P-POSSUM. Statistical data analysis was performed by using SPSS v.16.0. Results: The average forecast mortality was 12.5%, expressed in absolute values it accounted for 12 deaths, while the real number of deaths was 22. The limit of 10% for the probable mortality seems to be a critical one, 20 deaths were observed after this value. Average forecast morbidity was 35.4%, while the real one was 31.3%, the ratio between the number of real and probable cases was 0.89. Conclusions: The POSSUM score provides a relatively truthful prediction of the postoperative mortality and morbidity. Objective forecasting of surgical treatment results is closely connected with precise determination of included parameters

Acceptance conditions in automated negotiation

In every negotiation with a deadline, one of the negotiating parties has to accept an offer to avoid a break off. A break off is usually an undesirable outcome for both parties, therefore it is important that a negotiator employs a proficient mechanism to decide under which conditions to accept. When designing such conditions one is faced with the acceptance dilemma: accepting the current offer may be suboptimal, as better offers may still be presented. On the other hand, accepting too late may prevent an agreement from being reached, resulting in a break off with no gain for either party. Motivated by the challenges of bilateral negotiations between automated agents and by the results and insights of the automated negotiating agents competition (ANAC), we classify and compare state-of-the-art generic acceptance conditions. We focus on decoupled acceptance conditions, i.e. conditions that do not depend on the bidding strategy that is used. We performed extensive experiments to compare the performance of acceptance conditions in combination with a broad range of bidding strategies and negotiation domains. Furthermore we propose new acceptance conditions and we demonstrate that they outperform the other conditions that we study. In particular, it is shown that they outperform the standard acceptance condition of comparing the current offer with the offer the agent is ready to send out. We also provide insight in to why some conditions work better than others and investigate correlations between the properties of the negotiation environment and the efficacy of acceptance condition

Statin utilization and lipid goal attainment in high or very-high cardiovascular risk patients: Insights from Italian general practice

Background and aims: Statin utilization and lipid goal achievement were estimated in a large sample of Italian patients at high/very-high cardiovascular (CV) risk. Methods: Patients aged â¥18 years with a valid low-density lipoprotein cholesterol (LDL-C) measurement in 2015 were selected from the IMS Health Real World Data database; non-high-density lipoprotein cholesterol (non-HDL-C) was assessed in those with available total cholesterol measurements. Index dates were defined as the last valid lipid measurement in 2015. Patients were hierarchically classified into mutually exclusive risk categories: heterozygous familial hypercholesterolemia (primary and secondary prevention), atherosclerotic CV disease (including recent acute coronary syndrome [ACS], chronic coronary heart disease, stroke, and peripheral arterial disease), and diabetes mellitus (DM) alone. Statin and non-statin lipid-modifying therapy (LMT) use, and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline-recommended goal attainment, were assessed. Results: Among 66,158 patients meeting selection criteria, the overall rate of LMT prescriptions was 53.3%, including 7.7% on high-intensity statin therapy. Statin use was highest for recent ACS and lowest for DM alone. LDL-C goal attainment was 16.0% for <1.8 mmol/l and 45.0% for <2.5 mmol/l; 24.3% reached non-HDL-C <2.6 mmol/l and 52.2% were at <3.3 mmol/l. Goal achievement was greatest with high-intensity statin use. Conclusions: Statin use in this cohort was consistent with previous reports in Italian patients at high/very-high CV risk, and low relative to statin use in other European countries. The low rate of ESC/EAS lipid goal attainment observed was consistent with outcomes of other European studies

Strategies of the treatment of cardiac prosthetic valve thrombosis

Departamentul Cardiochirurgie, Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Fenomenul de tromboză şi „pannus” tromboză rămîne printre complicaţiile ce necesită intervenţie promptă în cardiochirurgie. Material şi metode: Din 1670 de pacienţi operaţi în departamentul nostru – 1260 (74,2%) prezentau patologii valvulare. S-au protezat 1164 valve cardiace: din ele 145 – cu proteze biologice; 1019 – cu proteze mecanice. Tromboza protezelor s-a depistat la 28 pacienţi (60% din cazurile disfuncţiilor de proteză şi 2,2% din numărul total al pacienţilor), cu vîrstă cuprinsă între 35 şi 63 de ani. Tratament chirurgical s-a efectuat la 9 pacienţi, tromboliză – la 19 pacienţi. Rezultate: În ultimii 6-7 ani, tratamentul medicamentos de tromboliză în trombozele protezelor valvulare, se realizează reuşit cu alteplaza şi reteplaza. Tromboliza a fost efectuată la 19 pacienţi. Efecte: în 17 cazuri – recuperarea completă a funcţiilor protezelor cu normalizarea gradientului transprotetic şi a presiunii sistolice în ventricolul drept. Au survenit complicaţii: un caz – atac ischemic tranzitor cerebral şi 2 cazuri letale. Concluzii: Pacienţii cu tomboză a protezelor valvulare în stare critică (edem acut pulmonar, hipotensiune, insuficienţă cardiacă IV NYHA) se supun, după confirmare ecografică, terapiei trombolitice intravenoase. Tratamentul de tromboliză are o eficacitate înalta în tromboza protezelor valvulare, rata complicaţiilor cu embolii este joasă, motiv din care tratamentul respectiv poate fi implementat ca unul de primă linie în tromboza protezelor valvulare, în absenţa contraindicaţiilor. În cazul răspunsului parţial la tratamentul de tromboliză, pacientul poate fi operat în condiţii hemodinamice satisfăcătoare şi cu un risc scăzut.Introduction: The phenomenon of thrombosis and “pannus” thrombosis prevails among the complications that require prompt intervention in cardiac surgery. Material and methods: In our department 1670 patients were operated on: 1260 had valve pathology (74.2%). Totally 1164 heart valves were replaced: 145 – biological prostheses and 1019 – mechanical ones. Prosthesis thrombosis took place in 28 patients (60% of prosthetic dysfunction and 2.2% of the total number of operated patients) aged from 35 to 63 years old. Nine patients underwent surgical treatment, 19 patients – were treated by thrombolysis. Results: During last 6-7 years the thrombolysis treatment with alteplase and reteplase has been successfully implemented in the therapy of thrombosis of prosthetic valve. Thrombolysis was performed in 19 patients. The results are the following: in 17 cases – complete recovery of the prosthesis function with normalization of trans-prosthetic gradient and systolic pressure in right ventricle was observed. One case has been complicated with cerebral transitory ischemic attack and 2 cases of mortality were registered. Conclusions: The patients with prosthesis thrombosis who are in critical condition (acute pulmonary edema, hypotension, heart failure NYHA IV) should immediately receive ultrasound confirmation of the need of intravenous thrombolitic therapy. The thrombolysis efficacy in prosthesis thrombosis is high; the rate of embolic complications is low, which can be used as the first line treatment for all patients with prosthetic thrombosis in the absence of contraindications. In the case of partial response to the thrombolysis patient can be operated in satisfactory hemodynamic conditions and with decreased surgical risk

The diagnosis and surgical treatment of cardiac tumors

Departamentul Cardiochirurgie, Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Cu toate că tumorile cardiace se întâlnesc destul de rar, diagnosticul precoce stabilit ne oferă posibilitatea de a efectua un tratament chirurgical radical şi eficace. Material şi metode: Au fost analizate protocoalele intervenţiilor chirurgicale la 86 de pacienţi cu tumori cardiace, care s-au tratat pe parcursul anilor 1983-2014 (primele 6 luni), vârsta bolnavilor a variat între 15-73 ani (media 53,7 ani). La 79 (91,8%) pacienţi tumorile au fost benigne şi la 7 (8,2%) – maligne. Rezultate: Diagnoza preoperatorie a fost stabilită analizând evoluţia simptomelor clinice şi rezultatele investigaţiilor instrumentale (ecocardiografia, CT, RMN). Morfologia tumorilor se prezintă în felul următor: mixoame – 71 de cazuri, rabdomioame – 2 cazuri, leiomioame – 2 cazuri, hemangiom – 1 caz, fibrom – 1 caz, mezoepitelioame – 2 cazuri, diferite sarcoame – 7 cazuri. Recidivă a mixomului atrial stâng s-a întâlnit la 2 pacienţi (2,8%), care au fost cu succes reoperaţi. Mortalitatea postoperatorie a constituit 8,2% (7 pacienţi), fapt care demonstrează eficacitatea tratamentului chirurgical. Concluzii: Tumorile cardiace primare trebuie înlăturate chirurgical. Vârsta pacienţilor şi severitatea insuficienţei cardiace nu poate servi ca contraindicaţie către operaţie. Tumorile cardiace maligne au un prognostic nefavorabil.Introduction: Although cases of cardiac tumors are very rare, the early determined diagnosis gives us the possibility to perform an efficient and radical surgical treatment. Material and methods: The surgical records of 86 patients with cardiac tumors who were operated during 1983-2014 (first 6 months) were analyzed; patients age varies between 15-73 years (mean 53.7 years). In 79 (91.8%) patients the tumors were benign and in 7 (8.2%) cases – malignant.Results: Analyzing the evolution of clinical symptoms, the instrumental investigations results (echocardiography, CT, RMN) the preoperative diagnosis was determined. The morphology of the tumors were presented as follows: myxoma – 71 cases, rhabdomyoma – 2 cases, leiomyoma – 2 cases, hemangioma – 1 case, fibroids – 1 case, myoepithelioma – 2 cases, various sarcomas – 7 cases. Left atrial myxoma recurrence was determined in 2 patients (2.8%) who were successfully supposed to the repeated intervention. Postoperative mortality was 8.2 % (7 patients), that demonstrates the effectiveness of surgical treatment. Conclusions: The primary cardiac tumors should be removed in a surgical way. The patients' age and the severity of heart failure could not serve as a contraindication for surgery. Malignant cardiac tumors have a poor prognostic

Network analyses in systems biology: new strategies for dealing with biological complexity

The increasing application of network models to interpret biological systems raises a number of important methodological and epistemological questions. What novel insights can network analysis provide in biology? Are network approaches an extension of or in conflict with mechanistic research strategies? When and how can network and mechanistic approaches interact in productive ways? In this paper we address these questions by focusing on how biological networks are represented and analyzed in a diverse class of case studies. Our examples span from the investigation of organizational properties of biological networks using tools from graph theory to the application of dynamical systems theory to understand the behavior of complex biological systems. We show how network approaches support and extend traditional mechanistic strategies but also offer novel strategies for dealing with biological complexity

Normal and intruder configurations in Si- 34 populated in the beta(-) decay of Mg-34 and Al-34

The structure of Si-34 was studied through gamma spectroscopy separately in the beta(-) decays of Mg-34 and Al-34 at the ISOLDE facility of CERN. Different configurations in Si-34 were populated independently from the two recently identified beta-decaying states in Al-34 having spin-parity assignments J(pi) = 4(-) dominated by the normal configuration pi(d(5/2))(-1) circle times nu(f(7/2)) and J(pi) = 1(+) by the intruder configuration pi(d(5/2))(-1) circle times nu(d(3/2))(-1) (f(7/2))(2). The paper reports on spectroscopic properties of Si-34 such as an extended level scheme, spin and parity assignments based on log(ft) values and gamma-ray branching ratios, absolute beta feeding intensities, and neutron emission probabilities. A total of 11 newly identified levels and 26 transitions were added to the previously known level scheme of Si-34. Large scale shell-model calculations using the SDPF-U-MIX interaction, able to treat higher order intruder configurations, are compared with the new results and conclusions are drawn concerning the predictive power of SDPF-U-MIX, the N = 20 shell gap, the level of mixing between normal and intruder configurations for the 0(1)(+), 0(2)(+), and 2(1)(+) states, and the absence of triaxial deformation in Si-3(4).Peer reviewe

Morse theory and multiple periodic solutions of some quasilinear difference systems with periodic nonlinearities

We consider the system of difference equations Δ ( Δ un - 1 1 - | Δ un - 1 | 2 ) = ∇ Vn ( un ) + h n , un = un + T ( n ∈ ℤ ) , with Δ un = un + 1 - un ∈ ℝ N, Vn = Vn ( x ) ∈ C 2 ( ℝ N , ℝ ), Vn + T = Vn, h n + T = h n for all n ∈ ℤ and some positive integer T, Vn ( x ) is ω i-periodic ( ω i > 0) with respect to each x i ( i = 1 , ... , N) and ∑ j = 1 T h j = 0. Applying a modification argument to the corresponding problem with a left-hand member of p-Laplacian type, and using Morse theory, we prove that if all its solutions are non-degenerate, then the difference system above has at least 2 N geometrically distinct T-periodic solutions

Measuring the performance of online opponent models in automated bilateral negotiation

n important aim in bilateral negotiations is to achieve a win-win solution for both parties; therefore, a critical aspect of a negotiating agent’s success is its ability to take the opponent’s preferences into account. Every year, new negotiation agents are introduced with better learning techniques to model the opponent. Our main goal in this work is to evaluate and compare the performance of a selection of state-of-the-art online opponent modeling techniques in negotiation, and to determine under which circumstances they are beneficial in a real-time, online negotiation setting. Towards this end, we provide an overview of the factors influencing the quality of a model and we analyze how the performance of opponent models depends on the negotiation setting. This results in better insight into the performance of opponent models, and allows us to pinpoint well-performing opponent modeling techniques that did not receive much previous attention in literature