3714 research outputs found
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T-S fuzzy-model-based adaptive cruise control for longitudinal car-following considering vehicle lateral stability
No full textAdaptive cruise control is one of the essential technologies of advanced driver assistance systems, which is used to maintain a safe distance between an ego vehicle and a preceding vehicle and has been extensively applied in the automotive industry and control community. Note that some vehicle manoeuvres may approach handling limits to prevent collisions under complex road conditions, which often leads to vehicle lateral instability while cruising. In this study, a T-S fuzzy model predictive control framework is applied to the problem of adaptive cruise control. Variations in the preceding vehicle velocity and road surface conditions are considered to formulate adaptive cruise control as a tracking control problem of a T-S fuzzy system subject to parameter uncertainties and external persistent perturbations. Then, a robust positively invariant set is introduced to derive an admissible T-S fuzzy controller by solving a min-max optimization problem under a series of linear matrix inequality constraints. Finally, a CarSim/MATLAB joint simulation is conducted to illustrate the effectiveness of the proposed method, which ensures longitudinal adaptive cruise control for a car-following scenario with lateral vehicle stability
Non-prosthetic treatment using segmental osteotomy and bone grafting in a patient with cleft lip and palate
No full textThis case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate, showing a left alveolar cleft, lateral deviation of the major segment of the maxilla, and palatal transposition of the lateral incisor. Preoperatively, the midline of the upper central incisors was shifted by 7.0 mm to the right, the right lateral incisor showed palatal transposition, and the residual alveolar cleft was 6.5 mm. Segmental Le Fort I osteotomy of the major segment, and simultaneous bone grafting into the extended alveolar bone and former cleft region were performed at 18 years and 4 months of age. Thus, midline correction, alignment of the right lateral incisor, and cleft closure were achieved; no further prosthetic treatment was required
Germline predisposition to soft tissue sarcoma
No full textSoft tissue sarcoma (STS) most often occurs sporadically, but can also arise in the setting of a germline cancer predisposition syndrome (CPS). There is significant diversity amongst STS diagnoses as these tumors exhibit a variety of histologies, occur in all age groups, and can occur in any location in the body. This diversity is also reflected in the many known associated germline cancer predisposition associations. Some STS diagnoses, such as anaplastic rhabdomyosarcoma, are associated with high heritability and other STS, such as Ewing sarcoma, are notably absent from known CPS. Recognizing when a STS is more likely to be hereditary can influence clinical management. Individuals diagnosed with STS due to CPS may be at risk for other malignancies and should undergo additional surveillance for early detection. Additionally, family members should undergo genetic testing as they also may be at risk to develop STS and other CPS-associated malignancies. Some underlying cancer predisposition diagnoses may have implications for the treatment of a concurrent malignancy as in the case of PARP inhibitor therapy in the setting of homologous recombination deficiency. This review summarizes current knowledge of selected STS and their associations with CPS
The safety and efficacy of palbociclib in older patients with advanced breast cancer in a real-world setting
No full textAims: Palbociclib has been approved in combination with endocrine therapy (ET) for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC), regardless of age. Even though ABC is one of the most prevalent cancers in older patients, very few patients ≥ 65 years old were included in pivotal trials. Therefore, the current study evaluated the safety and efficacy of palbociclib in “real-world” routine treatment of unselected older patients with HR+/HER2- ABC. Methods: Data were collected on patients > 70 years old who were treated with palbociclib plus ET for HR+/HER2- ABC in our institution. We analyzed safety data (CTCAE v4.0 criteria) and outcomes, such as progression-free survival (PFS) and overall survival (OS), as well as any associations between main geriatric characteristics and our results. Furthermore, we assessed safety at a national level by analyzing all palbociclib-related adverse events (AEs) reported in the French Pharmacovigilance Database (FPVD) during the same period. Results: From February 2016 to July 2019, 52 patients were identified with a median age of 80.9 years, of whom 88% presented an AE. The most common grade 3-4 AE was neutropenia (64%). Median PFS and OS were nine months and not reached, respectively. The FPVD reports 227 cases of palbociclib-related AEs, with older and younger patients sharing similar characteristics. Conclusion: Palbociclib is well tolerated in older patients with efficacy comparable to that in younger patients. However, the addition of palbociclib to ET should be evaluated individually in this older and frailer subgroup
Amiodarone and postoperative atrial fibrillation
No full textNew-onset postoperative atrial fibrillation (POAF) develops in 10%-50% of patients after cardiac surgery. In this review, we focus on risk factors associated with POAF and the different pharmacological strategies used for prophylaxis, with special attention to amiodarone. The use of amiodarone will be discussed both as a prophylactic regimen used before and following cardiac surgery, but also as a rhythm control treatment in patients who develop POAF. Finally, we conclude by reviewing gaps in the literature on amiodarone and further studies which could close these gaps
Clinical translation of genetic testing in TTR Amyloidosis: genotype-phenotype correlations, management of asymptomatic carriers and familial screening
No full textTransthyretin (TTR)-related amyloidosis (ATTR) is a heterogeneous disease with different organ involvement depending on the type of TTR infiltration [mutated (vTTR) or wild-type (wtTTR)]. Genetic testing in ATTR is required to define diagnosis and identify asymptomatic at-risk family members. Since new therapies are maximally effective in the early stages of the disease, there is a growing agreement about the need for close monitoring of genotype-positive, phenotype-negative individuals to assure a prompt treatment when minor disease signs are detected. This review summarizes the complexity of genotype-phenotype correlation and revises the current indications with respect to familiar screening and management of asymptomatic carriers
Management of chronic type B aortic dissection
No full textThe standard of care first-line therapy for uncomplicated acute type B aortic dissection is medical therapy. As a result, many of these dissections progress to become chronic type B aortic dissections (CTBAD). In the following manuscript, we will outline the natural history of these lesions and review what constitutes a CTBAD by anatomy and chronology. We will also describe the long-term medical management and surveillance of these lesions, what constitutes high-risk features, and when intervention should be considered. Endovascular, open and hybrid management strategies, potential complications, and subsequently required surveillance will also be discussed. With proper medical management, surveillance, and intervention, CTBAD can be managed effectively and downstream morbidity minimized
Uniportal thoracoscopic decortication: start away from empyema approach
No full textAim: Video-assisted thoracoscopic surgery (VATS) is now a gold standard in treating early-stage empyema, while much debate still exists considering the effectiveness of this approach for late-stage empyema. Most concerns arise from the crowded rib cage, narrow working space, and ability to free trapped lungs quickly, mainly if uniportal VATS is used. However, unlike uniportal VATS lobectomy, there is no consensus about standard steps for uniportal VATS decortication to ensure smooth and effective surgery. We try to offer standard, easy-to-replicate steps for this approach to evaluate the efficacy and safety of the “start away from empyema” approach for uniportal VATS decortication in the management of stage II and III empyema.Methods: A prospective case series study has been conducted on 25 patients. All patients with stage II and III empyema were admitted to the Cardiothoracic Surgery Department between October 2017 and March 2020. VATS procedure was done under general anesthesia by a double-lumen tube for selective ventilation. Demographic data, preoperative diagnosis, intraoperative findings, hospital stay, and complications were recorded.Results: Twenty-five patients were enrolled in this study with a median age of 35 years. The duration of illness ranged between 14 and 60 days, with a median (IQR) of 25 (17) days. In (88%) of the patients, there was a successful outcome defined as a near-complete resolution on Chest X-ray (scoring of 3 or 4) and chest US (scoring of 2 or 3). Only three (12%) patients had a partially successful outcome. All patients with partial success suffered from infection associated with malignant effusion.Conclusion: “Start away from empyema” approach for uniportal VATS decortication in stage II and III empyema could be safe and effective in treating loculated nonmalignant pleural effusion
Augmented reality: the smart way to guide robotic urologic surgery
No full textThe development of a tailored, patient-specific medical and surgical approach is becoming the object of intense research. In robotic urologic surgery, where a clear understanding of case-specific surgical anatomy is considered a key point to optimizing the perioperative outcomes, such philosophy has gained increasing importance. Recently, significant advances in three-dimensional (3D) virtual modeling technologies have fueled the interest in their application in the field of robotic minimally invasive surgery for kidney and prostate tumors. The aim of the review is to provide a synthesis of current applications of 3D virtual models for robot-assisted radical prostatectomy and partial nephrectomy. Medline, PubMed, the Cochrane Database, and Embase were screened for literature regarding the use of 3D augmented reality (AR) during robot-assisted radical prostatectomy and partial nephrectomy. The use of 3D AR models for intraoperative surgical navigation has been tested in prostate and kidney surgery. Its application during robot-assisted radical prostatectomy has been reported by different groups as influencing the positive surgical margins rate and guiding selective bundle biopsy. In robot-assisted partial nephrectomy, AR guidance improves surgical strategy, leading to higher selective clamping, less healthy parenchyma loss, and better postoperative kidney function. In conclusion, the available literature suggests a potentially crucial role of 3D AR technology in improving perioperative results of robot-assisted urological procedures. In the future, artificial intelligence may represent the key to further improving this promising technology
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