Impact of Robotic-Assisted Thoracic Surgery on the Completion of Adjuvant Chemotherapy Following Lung Cancer Resection.

Background Adjuvant chemotherapy can further improve treatment outcomes following the resection of non-small cell lung cancer (NSCLC). However, in practice, some patients are unable to tolerate all prescribed chemotherapy. One of the factors which may implicate adjuvant chemotherapy completion is a surgical technique. We investigated the impact of robotic-assisted thoracic surgery (RATS), a form of minimally invasive surgery, on chemotherapy completion. Methods We conducted a retrospective study of NSCLC patients who underwent adjuvant platinum-based chemotherapy at our institution during 2010-2020. The primary outcome of interest was chemotherapy completion, defined as receiving all 4 cycles of chemotherapy. We also performed an exploratory analysis to identify factors associated with chemotherapy completion. Results Analyses included 165 patients: 95 patients underwent traditional thoracotomy, and 70 patients underwent RATS. Baseline characteristics were comparable except for smaller tumor size and lower stage in the RATS group. Median operative time was longer in the RATS group than in the thoracotomy group: 198 vs. 139 minutes, p<0.001. Chemotherapy completion rates were not significantly different between groups: 74.3% vs. 75.8%, p=0.83, respectively. In addition, no significant difference was found in the incidences of postoperative complications between groups. In a propensity score matched analysis, there was also no difference in the chemotherapy completion rates between groups. Multivariable logistic regression analysis indicated that independent factors predicting completion of adjuvant chemotherapy were body mass index, postoperative complications, year of treatment, and T-stage. Conclusion In this large cohort of NSCLC patients who received adjuvant chemotherapy, no association was found between surgical technique and adjuvant chemotherapy completion.

A Case Report of the Reconstruction of a Bone Defect Following Resection of a Comminuted Fracture of the Lateral Clavicle Using a Titanium Prosthesis.

Introduction: This case report describes the reconstruction of a severe comminuted fracture and bone defect in the lateral half of the clavicle using a novel titanium prosthesis. This unique prosthesis has been specifically designed and three dimensionally printed for the clavicle, as opposed to the Oklahoma cemented composite prosthesis used in common practice. The aims of this study were to: (1) describe the prosthesis, its stress analysis, and its surgical fixation and (2) to demonstrate the results of the 2-year follow-up of the patient with the lateral clavicle prosthesis. Patient's Main Concerns: A 20-year-old, right-handed woman complaining of severe pain in the right shoulder was admitted to our hospital following a traffic accident. Physical examination revealed pain, swelling, tenderness, limb weakness, asymmetric posturing, and loss of function in the right shoulder. Diagnosis, Intervention, and Outcomes: Radiographic evaluation in the emergency room showed complete destruction with a comminuted fracture of the lateral half of the right clavicle and a comminuted fracture of the coracoid. We designed a new prosthesis for the lateral half of the clavicle, which was then tested by finite element analysis and implanted. Use of the new prosthesis was effective in the reconstruction of the comminuted fracture in the lateral half of the clavicle. After 2 years of follow-up, the patient had an aesthetically acceptable curve and was able to perform her activities of daily living. Her pain was relieved, and the disabilities of the arm, shoulder, and hand score improved. Active range of motion of the shoulder joint and muscle strength were also improved. Conclusion: This novel prosthesis is recommended for reconstruction of the lateral half of the clavicle following development of bony defects due to fracture. Our patient achieved functional and aesthetic satisfaction with this prosthesis.

Toward an integrated traffic law enforcement and network management in connected vehicle environment: Conceptual model and survey study of public acceptance.

The increasing number of traffic accidents and their associated traffic congestion have prompted the development of innovative technologies to curb such problems. This paper proposes a novel score-based traffic law-enforcement and network management system (SLEM) that is based on connected vehicles (CV) technology. SLEM assigns a score to each driver which reflects her/his driving performance and compliance with traffic laws. The proposed system adopts a rewarding mechanism that rewards high-performing drivers and penalizes low-performing drivers who fail to obey the laws. The reward mechanism is in the form of a route guidance strategy that restricts low-score drivers from accessing certain roadway sections and time periods that are strategically selected in order to achieve an optimal traffic pattern in the network in which high-score drivers experience less congestion and a higher level of safety. A nationwide survey study was conducted to measure public acceptance of the proposed system. Another survey targeted a focused group of traffic operation and safety professionals. Based on the results of these surveys, a set of logistic regression models were developed to examine the sensitivity of public acceptance to policy and behavioral variables. The results showed that about 65.7 percent of the public and about 60.0 percent of professionals who participated in this study support the real-world implementation of SLEM.

Highlighting the medical applications of 3D printing in Egypt.

Computer-assisted designing/computer-assisted manufacturing (CAD/CAM) technology has enabled medical practitioners to tailor physical models in a patient and purpose-specific fashion. It allows the designing and manufacturing of templates, appliances and devices with a high range of accuracy using biocompatible materials. The technique, nevertheless, relies on digital scanning (e.g., using intraoral scanners) and/or digital imaging (e.g., CT and MRI). In developing countries, there are some technical and financial limitations of implementing such advanced tools as an essential portion of medical applications. This paper focuses on the surgical and dental use of 3D printing technology in Egypt as a developing country.

A novel design of a computer-generated splint for vertical repositioning of the maxilla after Le Fort I osteotomy.

OBJECTIVE: The objective of this study was to evaluate the efficacy of a novel tooth/bony-supported virtual splint design to control the maxillary vertical, rotational, and anteroposterior intraoperative movements. STUDY DESIGN: A tooth/bone-borne splint was designed to position the osteotomized maxilla intraoperatively. Lateral cephalometric radiographs were obtained 1 week before the operation and 1 week after to compare the planned and actual movements of the maxilla. RESULTS: The paired t test showed no significant difference between the planned and actual movements in both the vertical and horizontal measurements (P ≤ .05). The difference between the planned and actual horizontal movements in 4 (66.7%) of the 6 patients was 1 mm or less. For the vertical movements, 5 (83.3%) of the 6 patients showed a difference equal to or less than 1 mm. CONCLUSIONS: The 2-piece surgical stent showed accurate control on the osteotomized maxilla and succeeded its repositioning to the preplanned positions.