Management of primary catheter malposition following totally implantable venous access port implantation via the internal jugular vein / 中华普通外科杂志

Objective:To investigate the characteristics of primary catheter malposition (PCM) following totally implantable venous access port (TIVAP) implantation via the internal jugular vein (IJV) and management strategies.Methods:Clinical data of 587 consecutive breast cancer patients undergoing TIVAP implantation via the IJV performed by single team at the Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University from Aug 2017 to Aug 2022 was retrospectively analyzed.Results:A total of 593 TIVAP were implanted and PCM was found in 18 cases (3.0%). Four hundred and twenty five TIVAP were implanted via the right IJV with one PCM case (0.2%). One hundred and sixty eight TIVAP implantations were performed via the left IJV and PCM occurred in 17 cases (10.1%). The interventional management with a pigtail catheter was performed as a first-line strategy in 11 of the 18 PCM cases, with a success in 10 cases and failure in one. Three cases were successfully managed with the digital subtraction angiography (DSA)-guided open approach. Four cases underwent blind open procedure firstly and 2 suffered a failure.Conclusions:A higher incidence of PCM is found in TIVAP implantations via the left IJV than the right one. The interventional management with a pigtail catheter or the DSA-guided open procedure proves to be feasible for the correction of PCM.

Strategic Ability Updating in Concurrent Games by Coalitional Commitment.

Strategic ability updating relates to establishing some required properties, which can be expressed by strategic abilities, in a multicomponent reactive system. We model such a reactive system as a concurrent game structure (CGS), which is the semantic model of Alternating-time Temporal Logic (ATL). Then, we propose coalitional commitment as a tool for achieving the required strategic ability updating. Intuitively, a coalitional commitment can extend the state space of a CGS by a context function and then delete some transitions by a coalitional normative system (CNS). We propose coordinated ATL (co-ATL) for reasoning about strategic abilities in the structures obtained from a CGS by implementing a CNS. The model-checking problem for co-ATL is proved to be PTIME-complete, just like that of ATL, and is thus tractable. Then, we characterize the limitation of coalitional commitment power by identifying the set of co-ATL formulas whose satisfaction cannot be established and the set of co-ATL formulas whose satisfaction cannot be avoided. Afterward, we show that the effectiveness problem, feasibility problem, and synthesis problem for coalitional commitment are PTIME-complete, NP-complete, and FNP-complete, respectively. Finally, we treat the coalitional commitment synthesis problem as an extended planning problem and present an algorithm based on the planning as model checking paradigm. Our work can be seen as an improvement for both social law research and planning via model checking research.