27 research outputs found
Association of Image-Defined Risk Factors with Clinical, Biological Features and Outcome in Neuroblastoma
No full textBackground: Neuroblastoma (NB) is the most common pediatric extracranial solid tumor and the most common cancer encountered in children younger than 12 months of age. Localized tumors have a good prognosis, but some cases undergo treatment failure and recurrence. The aim of the study was to analyze the link between the neuroblastoma risk factors and the prognosis for patients diagnosed with NB. Method: All patients admitted to the department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, between 1 January 2010 and 1 July 2022 were included in this analysis when diagnosed with neuroblastoma. Results: Thirty-one patients with NB were admitted to the surgical department, 20 boys and 11 girls. We observed an association between large tumors and positive imaging-defined risk factor (IDRF) status; The Fisher test showed an association between the tumor’s diameter when bigger than 8 cm and a positive IDRF status, with p < 0.001. We supposed that positive IDRF status at diagnosis may be linked to other prognostic factors. We discovered that an NSE value over 300 was associated with IDRF status (p < 0.001, phi = 0.692) and death. Conclusions: This study confirms the impact of IDRF status at diagnosis as it can be clearly correlated with other risk factors, such as a high level of NSE, MYCN amplification status, large tumor size, incomplete tumor resection, and an unfavorable outcome
DEZVOLTAREA EDUCAȚIEI NATO PENTRU ASIGURAREA CALITĂȚII PRIN IMPLEMENTAREA MODELULUI DE INSTRUIRE „ÎNVĂȚĂ-VIZIONEAZĂ-INTREABĂ”
No full textLucrarea prezintă o analiză detaliată și o metodă de implementare a modelului de instruire „Învață-Vizionează-Întreabă” (IVI), ca o potențială soluție, pentru a îmbunătăți instruirea în domeniul asigurării calității în cadrul NATO. Prin abordarea cerințelor rapid evolutive din cadrul domeniilor specializate, modelul IVI integrează instrumente digitale și metode tradiționale de predare pentru a crea o experiență de învățare care să răspundă nevoilor cursantului. Modelul este alcătuit din trei componente interdependente: modulul Învață, reprezentat de un curs online structurat; modulul Vizionează, susținut de un canal YouTube specializat pentru o înțelegere vizuală îmbunătățită; și modulul Întreabă, creat cu ajutorul unui chatbot bazat pe Inteligență Artificială (IA) pentru o învățare interactivă. Această abordare inovatoare oferă diverse stiluri de învățare, conferind sistemului eficacitate și accesibilitate continuă. Lucrarea analizează în continuare deficiențele identificate în modelele tradiționale de instruire, subliniind nevoia de elemente practice, vizuale și interactive în educația modernă. Este explorată opțiunea integrării asistentului IBM WatsonX ca și chatbot conversațional IA, în cadrul modelul IVI, evidențiind avantajele sale în furnizarea de interacțiuni consistente, precise și ușor de utilizat, comparat cu modelele IA de tip Generative Pre-trained Transformer (GPT). Adițional, este descris un proces alcătuit din șapte pași destinat adaptării modelului IVI la diverse domenii, precum și descrierea unei proces de îmbunătățire continuă pentru asistentul IBM WatsonX, asigurând relevanța și eficiența acestuia în peisajul educațional aflat în evoluție rapidă. Modelul IVI, prin întrebuințarea unică a tehnologiilor educaționale moderne, nu numai că îmbunătățește experiența de învățare din carul cursul NATO de asigurare a calității (S7-137), dar are și potențialul de a fi adaptat în diverse domenii de specialitate, promițând o forță de muncă mai eficientă
ADVANCING NATO'S QUALITY ASSURANCE EDUCATION BY IMPLEMENTING THE 'LEARN-WATCH-ASK' TRAINING MODEL
No full textThe paper introduces a detailed analysis and a method of implementing the "Learn-Watch-Ask" (LWA) training model, as a potential solution, to enhance quality assurance training within NATO. By addressing the fast-evolving demands of specialized domains, the LWA model integrates digital tools with traditional teaching methods to create a learning experience that is responsive to the student`s needs. The model is comprised of three interdependent components: the Learn module, represented by a structured online course; the Watch module, supported by a specialized YouTube channel for enhanced visual understanding; and the Ask module, created with an AI-driven chatbot for interactive learning. This innovative approach supports diverse learning styles, offering 24/7 accessibility and effectiveness. The paper further digs deeper into the identified shortcomings of traditional training models, emphasizing the need for practical, visual, and interactive elements in modern education. It explores the integration of the IBM WatsonX Assistant as a conversational AI chatbot in the LWA model, highlighting its advantages in providing consistent, accurate, and user-friendly interactions over Generative Pre-Trained (GPT) AI models. Additionally, a 7-step process for adapting the LWA model to various domains is outlined, as well as the description of a comprehensive continuous improvement loop for the IBM WatsonX Assistant, ensuring its relevance and efficiency in the rapidly evolving educational landscape. The LWA model, with its unique approach to modern educational techniques, not only enhances the learning experience for NATO’s Quality Assurance Course (M7-137) but also has the potential to be adapted across various specialized domains, promising a more effective and efficient workforce
Our Experience with Cyst Excision and Hepaticoenterostomy for Choledocal Cyst: A Single Center Case Review of 16 Patients
No full textBackground and Objectives: Choledocal cyst is a rare congenital disease of the biliary tree defined by dilatation of the extrahepatic and/or intrahepatic biliary ducts. Untreated, it leads to complications such as cholangitis, stone formation and malignant degeneration. The standard treatment for choledocal cyst is complete excision and subsequent biliary reconstruction via hepaticojejunostomy or hepatiocoduodenostomy. Materials and Methods: We report our experience with 16 pediatric cases of choledocal cyst over a 10-year period. Results: The predominant symptoms were nausea and jaundice, both at 62.5% (n = 10), followed by abdominal pain at 56.3% (n = 9). Ultrasonography was the diagnostic method used in all patients. Computed tomography was used in 75% (n = 12) and magnetic resonance imaging in 25% (n = 4) of cases. Age at the time of intervention ranged from 2 months to 17 years with a mean of 4 years and 5 months. The open approach was used in nine patients and the laparoscopic approach was used in seven patients, with one conversion to open surgery. Complete excision of the choledocal cyst was performed in 15 cases (93.7%), and partial excision with mucosectomy was performed in one case (6.2%). Eight patients (50%) underwent hepaticoduodenostomy and eight (50%) underwent hepaticojejunostomy, out of which one was attempted laparoscopically but was converted. We had a postoperative complication rate of 12.5% (n = 2) represented by anastomotic leak and pancreatitis. Conclusions: From our experience with these cases, we concluded that a wide hepaticoduodenostomy constitutes a favorable choice over the traditional hepaticojejunostomy, being more physiological and less time consuming
Motion training on a validated mechanical ERCP simulator improves novice endoscopist performance of selective cannulation: a multicenter trial
No full textBackground and study aims Current data show that traditional training methods in endoscopic retrograde cholangiopancreatography (ERCP) fall short of producing competent trainees. We aimed to evaluate whether a novel approach to simulator-based training might improve the learning curve for novice endoscopists training in ERCP.Methods We conducted a multicenter, randomized controlled trial using a validated mechanical simulator (the Bokoski-Costamagna trainer). Trainees with no experience in ERCP received either standard cannulation training or motion training before undergoing standard cannulation training on the mechanical simulator. Trainees were timed and graded on their performance in selective cannulation of four different papilla configurations.Results Thirty-six trainees (16 in the motion training group, 20 in the standard group) performed 720 timed attempts at cannulating the bile duct on the simulator. Successful cannulation was achieved in 698 of 720 attempts (96.9%), with no significant difference between the two study groups ( P =0.37). Trainees in the motion training group had significantly lower median cannulation times compared to the standard group (36 vs. 48 seconds, P =0.001) and better technical performance on the first papilla type ( P =0.013).Conclusions Our findings suggest that motion training could be an innovative method aimed at accelerating the learning curve of novice trainees in the early phase of their training. Future studies are needed to establish its role in ERCP training programs
Asynchronous P Systems
No full textIn this paper, the authors propose a new approach to fully asynchronous P systems, and a matching complexity measure, both inspired from the field of distributed algorithms. The authors validate the proposed approach by implementing several well-known distributed depth-first search (DFS) and breadth-first search (BFS) algorithms. Empirical results show that the proposed P algorithms have shorter descriptions and achieve a performance comparable to the corresponding distributed algorithms.</p
Asynchronous P Systems (Draft)
No full textIn this paper, we propose a new approach to fully asynchronous P systems,
and a matching complexity measure, both inspired from the eld of distributed
algorithms. We validate our approach by implementing several well-known distributed
depth- first search (DFS) and breadth- rst search (BFS) algorithms. Empirical results
show that our P algorithms achieve a performance comparable to the standard versions
Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (rmds): systematic reviews and meta-analyses informing the 2021 eular recommendations for lifestyle improvements in people with
No full textThis work was funded by the European League Against Rheumatism.
SMMV and JMG are supported by Versus Arthritis (grant number 21755) and the
NIHR Manchester Biomedical Research Centre. The views expressed are those of
the author(s) and not necessarily those of the NHS, the NIHR or the Department of
Health.Gwinnutt J.M., Wieczorek M., Cavalli G., Balanescu A., Bischoff-Ferrari H.A., Boonen A., De Souza S., De Thurah A., Dorner T.E., Moe R.H., Putrik P., Rodríguez-Carrio J., Silva-Fernández L., Stamm T., Walker-Bone K., Welling J., Zlatković-Švenda M.I., Guillemin F., Verstappen S.M.M
Cholecystectomy in Children: Indications and Timing
No full textBackground: Pediatric cholelithiasis has become increasingly diagnosed, partly due to enhanced imaging accessibility and rising obesity rates. Despite laparoscopic cholecystectomy being the standard treatment, the optimal timing for surgery remains debated, especially in complicated cases. The aim of our study is to analyze the demographic, clinical, and surgical characteristics of pediatric patients undergoing cholecystectomy and to identify the most favorable timing for surgery in terms of outcomes and complications. Material and methods: A retrospective study was conducted on 101 pediatric patients who underwent cholecystectomy between 2015 and 2024 at a tertiary children’s hospital. Patients were categorized based on surgical timing: elective, early (day 1–4), intermediate (day 5–14), and delayed (after day 14). Demographic data, clinical presentation, laboratory values, imaging, operative time, intraoperative findings, and postoperative complications were analyzed. Results: The median age was 15 years, with 64.35% female. Obesity was highly prevalent and significantly associated with choledocholithiasis and pancreatitis. Elective and delayed surgeries (after 14 days) had the shortest operative times (median: 2 h) and the lowest complication rates. Early surgeries (within 4 days) showed longer operative times and a higher incidence of intraoperative difficulties and complications. Histopathological findings did not influence clinical management, suggesting potential for selective examination. Conclusions: Elective or delayed cholecystectomy after a “cool-down” period of 5–14 days provides the most favorable outcomes in pediatric patients with complicated cholelithiasis. Conservative management remains appropriate for asymptomatic cases. A standardized approach to surgical timing may reduce complications and hospital cost
Dysplasia Epiphysealis Hemimelica (Trevor’s Disease) in Children, Two New Cases: Diagnosis, Treatment, and Literature Review
No full textDysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results
