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BACKGROUND: Minimally invasive techniques have demonstrated several advantages over the open approach. In the field of prostate cancer, the LAP-01 trial demonstrated the superiority of robotic-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) when comparing continence at 3-month after surgery, with no statistically significant differences at 6 and 12 months of follow-up. OBJECTIVES: Externally validate the LAP-01 study and compare functional outcomes between the two minimally invasive approaches. MATERIAL AND METHODS: This retrospective study, conducted by a single surgeon (MRB), utilized data from a prospectively collected database, which included patients who underwent both RARP or LRP. Data regarding baseline characteristics, continence (assessed through the 24-h Pad test and ICIQ questionnaire) and potency were collected at multiple time points: 1 and 6 weeks after catheter removal, 3-, 6-, and 12-months post-surgery. RESULTS: The study encompasses 601 patients, 455 who underwent LRP and 146 RARP. The median age at diagnosis was 64 for LRP and 62 for RARP, while the median PSA levels at diagnosis were 6.7 ng/mL for LRP and 6.5 ng/mL for RARP. Bilateral nerve-sparing procedures were performed in 34.07 % of LRP cases and 51.37 % of RARP cases. RARP exhibited a significant advantage over LRP both in continence and potency. Continence rates at 3-, 6- and 9-month after radical prostatectomy (RP) were 36.43 %, 61.86 % and 79.87 % for LRP, compared to 50.98 %, 69.87 % and 91.69 % for RARP. Potency rates at the same intervals were 0.90 %, 3.16 % and 6.39 % for LRP, and 6.19 %, 9.16 % and 18.96 % for RARP. These rates were more pronounced in patients with bilateral nerve-sparing. CONCLUSION: Our study demonstrates that RARP results in significantly better continence recovery and superior potency outcomes throughout the entire follow-up period compared to LRP, even at the beginning of the robotic approach learning curve.
Assuntos
Laparoscopia , Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Incontinência Urinária , Humanos , Masculino , Prostatectomia/métodos , Prostatectomia/efeitos adversos , Laparoscopia/métodos , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Seguimentos , Complicações Pós-Operatórias , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/prevenção & controle , Estudos Prospectivos , PrognósticoRESUMO
[This corrects the article DOI: 10.3389/fnbot.2023.1211570.].
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Introduction: We introduce a bio-inspired navigation system for a robot to guide a social agent to a target location while avoiding static and dynamic obstacles. Robot navigation can be accomplished through a model of ring attractor neural networks. This connectivity pattern between neurons enables the generation of stable activity patterns that can represent continuous variables such as heading direction or position. The integration of sensory representation, decision-making, and motor control through ring attractor networks offers a biologically-inspired approach to navigation in complex environments. Methods: The navigation system is divided into perception, planning, and control stages. Our approach is compared to the widely-used Social Force Model and Rapidly Exploring Random Tree Star methods using the Social Individual Index and Relative Motion Index as metrics in simulated experiments. We created a virtual scenario of a pedestrian area with various obstacles and dynamic agents. Results: The results obtained in our experiments demonstrate the effectiveness of this architecture in guiding a social agent while avoiding obstacles, and the metrics used for evaluating the system indicate that our proposal outperforms the widely used Social Force Model. Discussion: Our approach points to improving safety and comfort specifically for human-robot interactions. By integrating the Social Individual Index and Relative Motion Index, this approach considers both social comfort and collision avoidance features, resulting in better human-robot interactions in a crowded environment.
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El eritema anular centrífugo es una enfermedad poco común, habitualmente idiopática y con una gran variedad de diagnósticos diferenciales. Puede asociarse a diversas patologías de origen infeccioso, autoinmune y neoplásico, obligando al médico a considerarlas para su descarte. Tanto clínica como histopatológicamente se diferencia en dos tipos, el superficial y el profundo, siendo el de tipo profundo el menos frecuente. Actualmente, su fisiopatología es bastante desconocida, lo que dificulta la posibilidad de llegar a un consenso de cuál sería el mejor esquema de tratamiento para este cuadro. Se presenta el caso de una paciente de 62 años con eritema anular centrífugo de tipo profundo, con evolución progresiva e intermitente.
Erythema annulare centrifugum is an uncommon, usually idiopathic disease with a great variety of differential diagnoses. It may occur associated with infectious, auto-immune or neoplastic pathologies which the physician must consider in order to rule them out. There are two clinical and histopathological types, superficial and deep, deep being the less frequent. Its pathophysiology has not yet been well elucidated making it difficult to reach a consensus for its treatment. We present the case of a 52 year old with deep erythema annulare centrifugum with a progressive, intermittent clinical course.
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El xantogranuloma juvenil es una forma de histiocitosis de células no Langerhans que suele afectar a los niños y niñas dentro de los primeros años de vida. Su principal relevancia radica en la posible asociación a neurofibromatosis tipo 1, ya que su presentación conjunta conlleva un mayor riesgo de desarrollo de leucemia mielomonocítica crónica juvenil. Se presenta el caso de un lactante diagnosticado con neurofibromatosis tipo 1 en que se detectan lesiones múltiples compatibles con xantogranuloma juvenil.
Juvenile xanthogranuloma is a form of non-Langerhans cell histiocytosis which usually affects boys and girls in their early years. Its importance stemsfrom its possible association with neurofibromatosistype 1 asthe combined presentation brings a heightened risk of developing chronic juvenile myelomonocytic leukemia. We present the case of an infant diagnosed with neurofibromatosistype I who was found to have multiple lesions compatible with the diagnosis of juvenile xanthogranuloma.
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La aplasia medular es una enfermedad infrecuente caracterizada por pancitopenia en contexto de una médula ósea hipocelular. La aplasia medular asociada a hepatitis (HAAA) se considera una variante de la aplasia medular severa que se desarrolla luego de un episodio agudo de hepatitis. Se presenta con mayor frecuencia en adolescentes y adultos jóvenes de sexo masculino y tiene peor pronóstico que la aplasia medular por otras causas. La hepatitis es una enfermedad frecuente en la población pediátrica, sin embargo la HAAAcorresponde a una complicación extraña y grave, por lo que es fundamental para el médico general y especialista, sospechar esta asociación e iniciar una estrecha vigilancia y tratamiento. Se expone el caso de un adolescente de 13 años que es derivado hacia el Hospital Dr. Gustavo Fricke por cuadro de hepatitis, el que posteriormente desarrolla pancitopenia franca de rápida instalación.
Aplastic anemia is an infrequent disease characterized by pancytopenia with hypocellular bone marrow. Hepatitis associated aplastic anemia (HAAA) is considered to be a variant of severe aplastic anemia following an episode of acute hepatitis. It is more commonly seen in young adult or adolescent males and its prognosis is poorer than that of other aplastic anemias. Hepatitis is common in the pediatric population, however hepatitis associated aplastic anemia is a strange and serious complication and it is of utmost importance that the general doctor and the specialist suspect the association in order to monitor patients closely and treat opportunely. We present the case of a 13 year old adolescent with hepatitis referred to Hospital Gustavo Fricke who afterwards presented sudden serious pancytopenia.
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La acropaquia es un trastorno que puede presentarse en forma aislada o formar parte del síndrome de osteoartropatía hipertrófica, entidad caracterizada por periostosis, dolor articular y acropaquia. Cuando este síndrome es causado por una mutación genética específica, se denomina osteoartropatía hipertrófica primaria. Este raro desorden hereditario se asocia, además, a alteraciones dermatológicas típicas, como hiperseborrea, acné, engrosamiento de pliegues faciales, entre otras. Una asociación rara vez descrita es la queratodermia palmoplantar. Se presenta el caso de una mujer de 46 años con osteoartropatía hipertrófica primaria asociada a queratodermia palmoplantar que asistió a la unidad de dermatología del Hospital Gustavo Fricke, Viña del Mar, Chile.
Clubbing is a disorder that can be an isolated finding or be part of the hypertrophic osteoarthropathy syndrome, an entity characterized by periostosis, joint pain and clubbing. When this syndrome is caused by a specific genetic mutation, it is called primary hypertrophic osteoarthropathy. This rare hereditary disorder is also associated with typical dermatological findings, such as hyperseborrhea, acne and facial feature coarsening. An association rarely described is palmoplantar keratoderma. We present the case of a 46-year-old woman with primary hypertrophic osteoarthropathy and palmoplantar keratoderma who came to the dermatology unit of Gustavo Fricke Hospital, Viña del Mar, Chile.