Endovascular treatment for acute basilar artery occlusion: Descriptive analysis of the experience in a comprehensive stroke centre

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique

Conflict resolution in the era of cognitive multicriteria decision-making: an AHP-retributive approach

This paper puts forth the foundation for a different type of negotiation that reflects in a more realistic way the behavior of human beings when making complex decisions, aligned with the cognitive process involved. The positive and the negative aspects of decisions reflect two components in the human brain: the nucleus accumbens and the amygdala. The first component deals with behavior related to rewards or potential gains, and the other with behavior related to risk aversion or potential losses. Negotiations require communication, learning, accommodation of positions, and development of alternatives and modification of constraints. Negotiation support systems help and advice negotiators; structure and analyze the problem; elicit preferences to construct a preference function; visualize different aspects of the problem and the process; and facilitate communication and learning. The methodology used is based on the Analytic Hierarchy Process previously employed in a retributive conflict in which each party calculates the incremental benefits it gets and the costs to its opponent. The Israeli–Palestinian conflict is used to show the viability of the approach and the type of inputs we need to study conflicts with this approach. The negotiation platform that we describe here help the actors to start and engage a negotiation from noncooperative parties. It can also be used in human– negotiations to expedite reaching an agreement if one exists. However, we are not seeking automated negotiations. Advantages and risks of Artificial Intelligence contribution in negotiation support systems for cognitive and retributive conflict resolution based on AHP (CRCR-AHP) are also discussed

Surgery for Palmar Hyperhidrosis: Patient Selection and Extent of Surgery An Evidence-Based Approach

Video-thoracoscopic sympathectomy is an effective therapy for patients with severe primary palmar hyperhidrosis who are reaching the latter part of their teenage years. However, the best level, the extent of sympathectomy, and the optimal technique used to interrupt the sympathetic chain remain subjects of debate. Our review shows that single resection should be preferred to multiple levels of resection. In cases of isolated palmar hyperhidrosis, T3 is the level of choice, although T4 may be also reasonable. All procedures have similar outcomes, but sympathicotomy may be preferred because it is more simple and less extensive than others