A Game Theoretical Method for Cost-Benefit Analysis of Malware Dissemination Prevention

Copyright © Taylor & Francis Group, LLC. Literature in malware proliferation focuses on modeling and analyzing its spread dynamics. Epidemiology models, which are inspired by the characteristics of biological disease spread in human populations, have been used against this threat to analyze the way malware spreads in a network. This work presents a modified version of the commonly used epidemiology models Susceptible Infected Recovered (SIR) and Susceptible Infected Susceptible (SIS), which incorporates the ability to capture the relationships between nodes within a network, along with their effect on malware dissemination process. Drawing upon a model that illustrates the network’s behavior based on the attacker’s and the defender’s choices, we use game theory to compute optimal strategies for the defender to minimize the effect of malware spread, at the same time minimizing the security cost. We consider three defense mechanisms: patch, removal, and patch and removal, which correspond to the defender’s strategy and use probabilistically with a certain rate. The attacker chooses the type of attack according to its effectiveness and cost. Through the interaction between the two opponents we infer the optimal strategy for both players, known as Nash Equilibrium, evaluating the related payoffs. Hence, our model provides a cost-benefit risk management framework for managing malware spread in computer networks

Surgical Outcomes in Syndromic Tetralogy of Fallot: A Systematic Review and Evidence Quality Assessment

Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital heart defects. We sought to summarize all available data regarding the epidemiology and perioperative outcomes of syndromic ToF patients. A PRISMA-compliant systematic literature review of PubMed and Cochrane Library was performed. Twelve original studies were included. The incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4–52.2) and trisomy 21 (41.9%; 95% CI 37.7–46.3). Complete surgical repair was performed in 75.2% of the patients (n = 161/214; 95% CI 69.0–80.1) and staged repair in 24.8% (n = 53/214; 95 CI 19.4–30.9). Relief of RVOT obstruction was performed with transannular patch in 64.7% (n = 79/122; 95% CI 55.9–72.7) of the patients, pulmonary valve-sparing technique in 17.2% (n = 21/122; 95% CI 11.5–24.9), and RV-PA conduit in 18.0% (n = 22/122; 95% CI 12.1–25.9). Pleural effusions were the most common postoperative complications (n = 28/549; 5.1%; 95% CI 3.5–7.3). Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9–6.4) of the patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5–12.7). Genetic syndromes are seen in approximately 15% of ToF patients. Long-term survival exceeds 90%, suggesting that surgical management should be dictated by anatomy regardless of genetics

Splenic trauma : WSES classification and guidelines for adult and pediatric patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.Peer reviewe

Adrenal ganglioneuroma: What you need to know

Adrenal ganglioneuromas (GNs) constitute rare, differentiated tumors which originate from neural crest cells. GNs are usually hormonally silent and tend to be discovered incidentally on imaging tests. Adrenalectomy is the gold standard for the treatment of primary adrenal GNs. Nevertheless, preoperative differential diagnosis of GNs remains extremely challenging, and thus histopathological examination is required in order to confirm the diagnosis of GN. Overall, prognosis after surgical resection seems to be excellent, without any recurrences or need for adjuvant therapy

Bioprosthetic Valves for Lifetime Management of Aortic Stenosis: Pearls and Pitfalls

This review explores the use of bioprosthetic valves for the lifetime management of patients with aortic stenosis, considering recent advancements in surgical (SAV) and transcatheter bioprostheses (TAV). We examine the strengths and challenges of each approach and their long-term implications. We highlight differences among surgical bioprostheses regarding durability and consider novel surgical valves such as the Inspiris Resilia, Intuity rapid deployment, and Perceval sutureless bioprostheses. The impact of hemodynamics on the performance and durability of these prostheses is discussed, as well as the benefits and considerations of aortic root enlargement during Surgical Aortic Valve Replacement (SAVR). Alternative surgical methods like the Ross procedure and the Ozaki technique are also considered. Addressing bioprosthesis failure, we compare TAV-in-SAV with redo SAVR. Challenges with TAVR, such as TAV explantation and considerations for coronary circulation, are outlined. Finally, we explore the potential challenges and limitations of several clinical strategies, including the TAVR-first approach, in the context of aortic stenosis lifetime management. This concise review provides a snapshot of the current landscape in aortic bioprostheses for physicians and surgeons

Violent death and trauma in Norse mythology: a systematic reading of the Prose Edda

Background: This paper attempts to assess surgical knowledge presented in Norse mythology. The Prose Edda constitutes the most comprehensive source of Norse mythology. Literature and myth offer unique educational insights into life practices of previous eras, provided approached with a cautious and unbiased perspective. Methods: English translations of Gylfaginning and Skáldskaparmál, texts from the Prose Edda, were systematically reviewed. International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10) definitions for trauma and violent death were utilized. A basic tabulation was followed for the recording of extracted data, including the chapter, characters involved and the text extract. Recorded cases were categorized by applying three distinct classifications and assessed by body part affected, cause of morbidity/mortality and character involved. Results: A total of 52 cases of trauma were identified (19 cases in Gylfaginning and 33 in Skaldskaparsmal). In 27 cases of injury the afflicted body region was unspecified, but in the majority of specified cases it concerned a craniofacial trauma. 37 events were an outcome of personal assault, whereas 11 occurred during warfare. Moreover, three cases were suicides and one an accident. Critical assessment of the texts indicates that the predominant theme of Gylfaginning is the struggles of Norse Gods, whilst Skáldskaparmál tales revolve mostly around humans. Notably, a lack of allusion to medical knowledge and surgical practice is observed. Conclusion: The systematic reading of the Prose Edda highlights the common theme of violence in Norse Mythology and distinguishes beheading in battle. The absence of documentation on medical practice is in accordance with the fact that Scandinavian mythological texts rarely elaborate on disease

Preventing pediatric cardiothoracic trauma: Role of policy and legislation

Data from the last 50 years suggest that pediatric patients typically suffer cardiothoracic injuries following blunt traumatic force (70%) in the setting of either motor vehicle crashes (53.5%) or vehicle-pedestrian accidents (18.2%). Penetrating trauma accounts for 30% of pediatric cardiothoracic injuries, half of which are gunshot wounds. Graduated driver licensing programs, gun-control legislation, off-road vehicle regulation, initiatives such as “Prevent the Bleed”, as well as professional society recommendations are key in preventing pediatric cardiothoracic injuries