Surgical Treatment of Appendiceal Adenocarcinoid (Goblet Cell Carcinoid)

Adenocarcinoid of the appendix is an infrequent tumor with histologic features of both adenocarcinoma and carcinoid tumor. Although its malignant potential remains unclear, adenocarcinoids seem to be biologically more aggressive than conventional carcinoids. The aim of this study was to analyze long-term results of surgical treatment for appendiceal adenocarcinoid. A retrospective review (1991-2003) identified seven patients (median age 72, range 27-81 years) treated for appendiceal adenocarcinoid. The clinical data of these patients were reviewed. Follow-up was complete for all patients (median 60 months, range 24-108 months). Most cases presented with associated acute appendicitis (71%). First intention surgery consisted of appendectomy (m = 6) and right hemicolectomy (m = 1). In three patients, additional surgical procedures were performed (right colectomy). Indications for colectomy were tumor size (three cases) associated with appendectomy margin invasion in one case. One patient with lymph node and peritoneal involvement experienced recurrence 9 months after hemicolectomy and died of the disease at 2 years. One patient subsequently died of colon carcinoma 6 years after adenocarcinoid treatment. Five patients were alive without disease at the time of the last follow-up. Synchronous or metachronous colon carcinomas developed in three patients (43%). Our results suggest that appendectomy alone could be used for appendiceal adenocarcinoid provided that the tumor (1) is less than 1 cm; (2) does not extend beyond the appendix adventitia; (3) has less than 2 mitoses/10 high power fields; and (4) has surgical margins that are tumor free. Otherwise, carcinologic right colectomy seems to be indicated. The risk for developing colorectal adenocarcinoma seems to be extremely high in patients treated for appendiceal adenocarcinoid and warrants close follow-up with colonoscopic screenin

Laparoscopic versus open resection for appendix carcinoid

Background: Since an increasing number of appendectomies are performed via laparoscopy, it is crucial to determine the impact of this approach on appendix carcinoid (AC) outcome. The goal of this study was to compare results of laparoscopic (LAP) versus open (OP) appendectomy for AC according to intend to treat approach. Methods: A retrospective review (1991-2003) identified 39 patients (median age, 36 years; range, 12-83) treated by laparoscopy (LAP) or laparotomy (OP) for AC in a single institution. Follow-up was complete for all patients (median, 67 months; range, 4-132). Results: Most cases had associated acute appendicitis (64%). Median carcinoid size was 1.1 cm (range, 0.3-5) and 0.4 cm (range, 0.2-3) in the LAP and OP groups, respectively. LAP and OP were performed in 21 (54%) and 18 (46%) patients, respectively. Surgical margins were positive in two patients in the LAP group and one patient in the OP group (p = 0.6). Right colectomies were performed for AC >2 cm in five patients after LAP and in four patients after OP (p = 0.9). Actuarial 5-year survival rates were 100 and 94% in the LAP and OP groups, respectively (p = 0.2). Two patients died in the OP group, one due to metastatic carcinoid and the other due to metachronous colorectal cancer. Synchronous or metachronous colorectal carcinomas developed in six patients (15%). Conclusion: Laparoscopic appendectomy is a safe procedure for AC, with carcinologic and long-term results similar to those of conventional appendectomy. Thus, pre- or per-operative suspicion of AC is not a contraindication to LAP. Prognosis of AC appears more dependent on carcinoid malignant potential or associated tumors. Risk for developing colorectal adenocarcinoma is high in AC patients and warrants follow-up of all patients with colonoscopic screenin

Experimental performance analysis of biplane VAWT configurations

This paper aim to develop a new Darrieus wind turbine configurations based on the concept of biplane blades in order to improve the performances of the machine. The performances of the new design were investigated numerically and experimentally. Firstly a 2-D steady numerical simulation of an isolated two blades is carried out to exhibit the aerodynamic performance behavior. Secondly experiences are made on different Darrieus wind turbine by considering the biplane blade models. The experiments are carried out in wind tunnel by testing firstly: two, three and four blades Darrieus wind turbine as well as the biplane new configurations. The results of static torque and rotational speeds versus a wind velocity are presented. The obtained results corresponding to the new machines present a great improvement in the performances

Évaluation individuelle et collective dans les jeux sérieux collaboratifs : application à la gestion de crise

Les jeux sérieux (serious-games en anglais) sont de plus en plus utilisés dans le domaine de la formation, le but étant alors d'apprendre une ou plusieurs compétences liée(s) à un métier ou à des qualités plus générales, à un ou plusieurs apprenants (joueurs), ceci avec une dimension ludique. Mesurer qualitativement ou quantitativement le succès ou non de cet apprentissage, ce qui relève au final d'un processus d'évaluation du ou des l'apprenant(s), constitue ces dernières années un enjeu majeur dans les jeux sérieux s'ajoutant aux problématiques plus classiques de conception et de scénarisation.Dans un contexte de jeux sérieux multi-acteurs, avec apprentissage de tâches collaboratives réalisées par différents acteurs humains ou virtuels partageant un but commun, cette recherche s'intéresse au processus d'évaluation des apprenants, conduisant à une évaluation tant individuelle que collective. Nous proposons tout d'abord un cadre méthodologique pour l'évaluation des apprenants pour de tels jeux. Ce cadre méthodologique est basé sur le concept « d'espace d'évaluation » associé à un point de vue correspondant à un objectif d'évaluation particulier, Nous proposons ensuite une architecture logicielle spécifique à base d'agents, d'une part permettant à des apprenants humains et des joueurs virtuels d'interagir (simulation de comportements), et d'autre part supportant une évaluation tant individuelle que collective des apprenants. Cette architecture logicielle est implémentée et intégrée au jeu sérieux SIMFOR, et sa mise en oeuvre est illustrée sur un scénario réaliste relatif à la formation à la gestion de crise.Serious Games (SG) are increasingly used in the field of training, SG aims to teach one or more skills(s) related to a business or to more general qualities, to one or more learners (players), this with a playful dimension. Usually, SG aims a specific training objective related to a specific context training which can be linked to a trade (eg fire ), a body of knowledge (school or university), or the acquisition of social skills (conflict management, cooperation ...). To Measure the success or failure of this learning is ultimately an assessment process of the learner(s) and in recent years became a major issue in SG in addition to issues classic design and screenwriting.In the context of multi-player SG, with a collaborative tasks learning performed by different learners (or virtual actor) sharing a common goal, our research focuses on the assessment of learning processes, leading to both individual and collective assessment. We propose first a methodological framework for learners assessment. This methodological framework is based on the "Evaluation space" concept associated with a specific view corresponding to a particular assessment objective, leading to the calculation of indicators, based on specific knowledge models representation and assessment. In order to operationalize this methodological assessment framework, we propose a agents based architecture, on the one hand allowing human learners and virtual players (simulation of behavior) interaction, and other hand supporting individual and collective learners' assessment. This architecture is implemented and integrated to the SIMFOR SG, and illustrated in a crisis management scenario exercise

Evaluation Multi-critères et Distribuée pour l'Apprentissage Collectif de Procédures dans un Jeux Sérieux pour la Gestion de Crise

National audienceLes jeux sérieux sont de plus en plus utilisés pour la formation, et en particulier dans le domaine de la gestion de crise. Afin d'améliorer la formation, l'évaluation des apprenants peut fournir des indications sur ce qui a été bien ou mal appris au cours d'une session de formation. Cette appréciation se complexifie lorsqu'elle doit prendre en compte non seulement les actions individuelles des acteurs mais également le résultat de leurs interactions (actions collectives). De plus, selon la nature des phénomènes à émuler (incendie, pollution...) et le nombre d'acteurs impliqués, des besoins de simulations s'ajoutent (propagation incendie, simulation de comportement d'acteurs absents...). L'évaluation des apprenants implique ainsi l'acquisition d'un ensemble hétérogène d'informations à la fois par leur nature (données brutes, connaissances, procédures) et par leur source (niveau logiciel). Cet article propose une approche multi-agents répondant à deux objectifs: i) permettre la production et l'exploitation de ces informations hétérogènes en vue de produire des indicateurs qui alimenteront une évaluation multi-critères; et ii) mettre en œuvre le processus d'évaluation par un système multi-agents accompagnant la production d'évaluations individuelles et collectives. Cette approche est développée et illustrée sur le jeu sérieux SIMFOR dédié à la gestion de crise pour le faire évoluer vers un Système tutoriel

Marié / Oulhaci Abdelkader

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A MultiAgent Architecture for Collaborative Serious Game applied to Crisis Management Training: Improving Adaptability of Non Played Characters

ISBN: 2034-8800 - http://eudl.eu/doi/10.4108/sg.1.2.e7National audienceno abstrac

A MultiAgent Architecture for Collaborative Serious Game applied to Crisis Management Training: Improving Adaptability of Non Player Characters

International audienc

A MultiAgent Architecture for Collaborative Serious Game applied to Crisis Management Training: Improving Adaptability of Non Player Characters

Serious Games (SG) are more and more used for training, as in the crisis management domain, where several hundred stakeholders can be involved, causing various organizational difficulties on field exercises. SGs specific benefits include player immersion and detailed players’ actions tracking during a virtual exercise. Moreover, Non Player Characters (NPC) can adapt the crisis management exercise perimeter to the available stakeholders or to specific training objectives. In this paper we present a Multi-Agent System architecture supporting behavioural simulation as well as monitoring and assessment of human players. A NPC is enacted by a Game Agent which reproduces the behaviour of a human actor, based on a deliberative model (Belief Desire Intention). To facilitate the scenario design, an Agent editor allows a designer to configure agents’behaviours. The behaviour simulation was implemented within the pre-existing SIMFOR project, a serious game for training in crisis management

Quand référer aux urgences un patient présentant des douleurs abdominales?

When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral