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Background: The postoperative phase of cardiac surgery in pediatric patients with congenital heart disease often involves the management of pulmonary hypertension, which can significantly affect recovery and long-term prognosis. Inhaled iloprost is a potent acute pulmonary vasodilator with a rapid onset of action and has been shown to be effective and safe in patients with pulmonary arterial hypertension, improving clinical parameters by lowering pulmonary artery pressure. In our study, we will share the results of patients with pulmonary hypertension after pediatric cardiac surgery in whom we used inhaled iloprost. Results: A total of 9 patients who received inhaled iloprost between 2020 and 2023 were included in the retrospective study. The age of the patients ranged between 10 days and 11 months, with a mean of 207.77 days (6.92 months) ± 105.78 days (3.52 months). Five patients were male (55.55%), and four were female (44.45%). Three of the patients had trisomy 21 (33.3%) genetic mutations. Conclusions: The limited number of case series in the literature support the potential of inhaliloprost as an effective and safe therapeutic option for the treatment of pulmonary hypertension in the pediatric population after congenital heart surgery. The findings of this study support the literature and suggest that inhaliloprost is effective. Due to the limited number of patients, further research is needed to determine the safety and efficacy of these drugs, especially to determine the dose, route, and duration of administration in intubated patients. [ABSTRACT FROM AUTHOR]

Background: Diaphragmatic paralysis due to phrenic nerve injury is a rare but potentially serious complication following congenital cardiac surgery, with reported incidences ranging from 0.28 to 5.6%. Early plication has been recommended for children diagnosed with diaphragmatic paralysis, especially those requiring prolonged respiratory support after cardiopulmonary bypass. It is important to note that late plication may jeopardize the results of successful surgical plication due to diaphragm atrophy. Results: This retrospective study was performed between May 2020 and June 2023. Patients who could not be weaned from the ventilator and underwent diaphragmatic plication in symptomatic patients after phrenic nerve injury were included in the study. During the study period, 22 (3.5%) of 624 pediatric patients operated for congenital heart disease required diaphragm plication. The mean age of the patients ranged from 1 month to 13 years with a mean of 23.88 ± 37.99 months. Fourteen (63.6%) of the patients were female, and 8 (36.4%) were male. Two of the patients (9%) were exited due to ventilator-associated pneumonia and sepsis. Conclusions: In conclusion, diaphragmatic paralysis after congenital heart surgery is a rare but important complication that can lead to serious respiratory and cardiac problems. Diaphragmatic plication has been shown to be an effective intervention for pediatric patients with the potential to improve pulmonary function, reduce dyspnea, and minimize complications associated with diaphragmatic paralysis. Careful consideration of patient selection, timing, and potential complications is crucial in optimizing the outcomes of this surgical intervention. [ABSTRACT FROM AUTHOR]

Safety stock is an important method to overcome variability in inventory management. The classical approach to safety stock decisions relies on historical demand and lead time statistical data, which may not capture the uncertainty and complexity of the real world. Human knowledge and experience are valuable assets for making better decisions, especially when facing unpredictable situations. The fuzzy method is widely used for employing human intuition for decisions. When fuzzy opinions are input, decisions can be made proactively rather than reactively while benefiting from future predictions. The paper aims to integrate human intuition using Hexagonal Type-2 Fuzzy Sets (HT2FS) for safety stock management. HT2FS is a generalization of Interval Type-2 Fuzzy Sets that can represent more uncertainty in the membership functions. Predictions may be integrated into the safety stock models using human intuition. The proposed model uses novel fuzzy approaches to integrate human intuition into the traditional safety stock model. Applying fuzzy sets to safety stock management allowed experts' opinions under fuzzy logic to be integrated into decision-making. The proposed novel approach uses the centre of gravity method of Polygonal Interval Type-2 Fuzzy sets for defuzzification, which is a computationally efficient method that can handle any shape of the footprint of uncertainty. A mathematical model is developed to validate fuzzy opinions that may replace historical data. The data is received from a real-life case, and human intuition is integrated using an expert’s input. After the validation, a real-life numerical example has been considered to illustrate the model and its validity compared to the classical model. The outcomes show that the proposed model may contribute to the classical models, mainly when experts' inputs offer good predictions. When expert opinion on HT2FS is used for a real-life case, the results show that the expert's better representation of future variances lowers total cost by 2.8%. The results, coupled with the sensitivity analysis, underline that the proposed approach may contribute to the literature on safety stock management. [ABSTRACT FROM AUTHOR]

ABC analysis is an efficient and easy-to-use methodology to classify inventory based on a single or multi-criteria basis that may consist of thousands of items. The first study by Dickie (Fact Manag Maint 109(7):92–94, 1951), based on a single criterion, is considered to be limited now. New studies focus on Multi-Criteria-Inventory Classification (MCIC) since such an extension of the criteria fits the realities of modern business decisions. The proposed approach in this study uses three-phased MCIC incorporating analytical hierarchy process (AHP), Fuzzy C-Means (FCM) algorithm, and a newly proposed Revised-Veto (Rveto) phase to meet the ABC classification principles and increase its applicability and flexibility. This new approach is called AHP–FCM–Rveto and proposed in this study for the first time. A numerical example taken from the literature is used to compare AHP–FCM–Rveto with other methods, and the results also show that the proposed methodology performs better. In the real-life example, the main advantage of compliance with the Pareto principle of the proposed method is shown. [ABSTRACT FROM AUTHOR]