Combined endovascular and open operative approach for mycotic carotid aneurysm

Mycotic aneurysms of the extracranial carotid artery are rare and warrant surgical intervention. Management involves open and endovascular approaches. We report the case of a 67-year-old woman with an Escherichia coli soft-tissue infection of the right retropharyngeal space and subsequent mycotic carotid aneurysm and thrombosis of the internal jugular vein. The patient presented with a pulsatile mass and right middle cerebral artery stroke. Our surgical management involved coil embolization of the aneurysm to provide for vascular control, with resection of the common carotid artery, internal carotid artery, and extracranial carotid artery branches, along with the internal jugular vein

Surgeons’ Knowledge Regarding Perioperative Pain Management in Patients With Opioid Use Disorder: A Survey Among 260 Members of the American College of Surgeons

BACKGROUND: Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care. METHODS: This study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association\u27s electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons\u27 management of perioperative pain in patients with opioid use disorder and perceived barriers in treatment. RESULTS: A total of 260 surgeons responded representing all specialties except ophthalmology. General surgery (66.5%) and plastic and reconstructive surgery (7.5%) represented the majority of responders. Ninety-five percent of surgeons reported treating a patient who used opioids in the past month and 86% encountered a patient with OUD. Nearly half (46%) reported being uncomfortable managing postoperative pain in patients with OUD. Most (67%) were not aware of any guidelines or standards pertaining to perioperative management of patients with OUD. While consultation was sought by 86% of surgeons, analyses identified lack of timely response and a lack of care coordination among specialists. Lack of knowledge and fear of harm (contributing further to addiction) were the most common themes. CONCLUSION: Nearly half of surgeons report discomfort caring for patients with OUD with the vast majority involving a consulting service to assist with their care. Most surgeons believe that it would be helpful to have guidelines regarding the care of these patients. This provides an opportunity for increased education and training on the perioperative management of patients with OUD and further collaboration with addiction medicine, psychiatry and pain management colleagues

Task-Oriented Conversational Behavior of Agents for Collaboration in Human-Agent Teamwork

International audienceCoordination is an essential ingredient for human-agent teamwork. It requires team members to share knowledge to establish common grounding and mutual awareness among them. This paper proposes a be-havioral architecture C 2 BDI that enhances the knowledge sharing using natural language communication between team members. Collaborative conversation protocols and resource allocation mechanism have been defined that provide proactive behavior to agents for coordination. This architecture has been applied to a real scenario in a collaborative virtual environment for learning. The solution enables users to coordinate with other team members

Ability of Group IVB metallocene polyethers containing dienestrol to arrest the growth of selected cancer cell lines

<p>Abstract</p> <p>Background</p> <p>Monomeric Group IVB (Ti, Zr and Hf) metallocenes represent a new class of antitumor compounds. There is literature on the general biological activities of some organotin compounds. Unfortunately, there is little information with respect to the molecular level activity of these organotin compounds. We recently started focusing on the anti-cancer activity of organotin polymers that we had made for other purposes and as part of our platinum anti-cancer effort.</p> <p>Methods</p> <p>For this study, we synthesized a new series of metallocene-containing compounds coupling the metallocene unit with dienestrol, a synthetic, nonsteroidal estrogen. This is part of our effort to couple known moieties that offer antitumor activity with biologically active units hoping to increase the biological activity of the combination. The materials were confirmed to be polymeric using light scattering photometry and the structural repeat unit was verified employing matrix assisted laser desorption ionization mass spectrometry and infrared spectroscopy results.</p> <p>Results</p> <p>The polymers demonstrated the ability to suppress the growth of a series of tumor cell lines originating from breast, colon, prostrate, and lung cancers at concentrations generally lower than those required for inhibition of cell growth by the commonly used antitumor drug cisplatin.</p> <p>Conclusion</p> <p>These drugs show great promise in vitro against a number of cancer cell lines and due to their polymeric nature will most likely be less toxic than currently used metal-containing drugs such as cisplatin. These drugs also offer several addition positive aspects. First, the reactants are commercially available so that additional synthetic steps are not needed. Second, synthesis of the polymer is rapid, occurring within about 15 seconds. Third, the interfacial synthetic system is already industrially employed in the synthesis of aromatic nylons and polycarbonates. Thus, the ability to synthesize large amounts of the drugs is straight forward.</p

The optimal treatment of type II and III odontoid fractures in the elderly: an updated meta-analysis

PurposeOdontoid fractures are the most common cervical spine fractures in the elderly, with a controversial optimal treatment. The objective of this review was to compare the outcome of surgical and conservative treatments in elderly (& GE; 65 years), by updating a systematic review published by the authors in 2013.MethodsA comprehensive search was conducted in seven databases. Clinical outcome was the primary outcome. Fracture union- and stability were secondary outcomes. Pooled point estimates and their respective 95% confidence intervals (CIs) were derived using the random-effects model. A random-effects multivariable meta-regression model was used to correct for baseline co-variates when sufficiently reported.ResultsForty-one studies met the inclusion criteria, of which forty were case series and one a cohort study. No clinical differences in outcomes including the Neck Disability Index (NDI, 700 patients), Visual Analogue Scale pain (VAS, 180 patients), and Smiley-Webster Scale (SWS, 231 patients) scores were identified between surgical and conservative treatments. However, fracture union was higher in surgically treated patients (pooled incidence 72.7%, 95% CI 66.1%, 78.5%, 31 studies, 988 patients) than in conservatively treated patients (40.2%, 95% CI 32.0%, 49.0%, 22 studies, 912 patients). This difference remained after correcting for age and fracture type. Fracture stability (41 studies, 1917 patients), although numerically favoring surgery, did not appear to differ between treatment groups.ConclusionWhile surgically treated patients showed higher union rates than conservatively treated patients, no clinically relevant differences were observed in NDI, VAS pain, and SWS scores and stability rates. These results need to be further confirmed in well-designed comparative studies with proper adjustment for confounding, such as age, fracture characteristics, and osteoporosis degree.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Games in Higher Education

International audienceThis entry presents an overview of how and why Learning Games are used in higher education.Learning Games can be defined as games that are designed to captivate the learners’ attention and facilitate their learning process. They have explicit educational purposes and can be used for teaching at all levels of education. All types of games can be used for learning: board games, card games, role-playing games, First Person Shooter games, simulation games, management games, puzzle games, treasure hunts…The main characteristic of Learning Games for higher education is the fact that they are designed to teach specific complex skills taught at university or during professional training programs. Unfortunately, it is not infrequent to observe strong opposition on the part of this target audience to this mode of learning, that these adult students associate with children.The use of Learning Games in primary school seems natural to teachers and is encouraged by specialists in didactics and neuroscience. This learning technique is much less frequently used in middle school and is almost completely absent from higher education. Yet teachers at all these levels are faced with the same problems, such as lack of motivation and investment, for which games are known to be an effective solution. This entry presents an overview of the games that can be used for higher education and the reasons why some teachers and students still show resistance to this type of learning. The numerous advantages of games for higher education will then be presented, citing games presently used in universities, in graduate schools and for professional training. Finally, thisDraft : Marfisi-Schottman I. (2019) Games in Higher Education. In: Tatnall A. (eds) Encyclopedia of Education and Information Technologies. Springer, Chamentry presents the current research questions that need to be addressed concerning the design of games for higher education and the acceptance of these games by teachers