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En este documento, abordamos el caso de una mujer de 40 años con antecedente de síndrome antifosfolipídico que acudió a la consulta externa de Reumatología del Hospital de Especialidades Dr. Teodoro Maldonado Carbo con hipertensión no controlada, fatiga, diferencia de presión arterial en extremidades y pulsos arteriales disminuidos en la extremidad izquierda. La angiotomografía toraco-abdominal mostró estenosis severa de la aorta abdominal a nivel renal y de tercios proximales de arterias renales. El antecedente de síndrome antifosfolipídico y la forma de presentación de su cuadro clínico provocó un retraso en el diagnóstico precoz de la vasculitis. Los estudios de imágenes contribuyeron a diferenciar el tipo de compromiso vascular confirmándose el diagnóstico de Arteritis de Takayasu. Es importante la necesidad de considerar Arteritis de Takayasu en el diagnóstico diferencial en pacientes jóvenes con hipertensión para evitar un aumento de la morbilidad y la discapacidad causados por esta enfermedad.

Background:. Enhanced recovery after surgery (ERAS) protocols have been associated with hypotensive episodes after autologous breast reconstruction. Gabapentin (Gaba), a nonopioid analgesic used in ERAS, has been shown to attenuate postoperative hemodynamic responses. This study assesses ERAS’s impact, with and without Gaba, on postoperative hypotension after microvascular breast reconstruction. Methods:. Three cohorts were studied: traditional pathway, ERAS + Gaba, and ERAS no-Gaba. We evaluated length of stay, inpatient narcotic use [morphine milligram equivalents (MME)], mean systolic blood pressure, hypotension incidence, and complications. The traditional cohort was retrospectively reviewed, whereas the ERAS groups were enrolled prospectively after the initiation of the protocol in April 2019 (inclusive of Gaba until October 2022). Results:. In total, 441 patients were analyzed. The three cohorts, in the order mentioned above, were similar in age and bilateral reconstruction rates (57% versus 61% versus 60%). The ERAS cohorts, both with and without Gaba, had shorter stays (P < 0.01). Inpatient MME was significantly less in the ERAS + Gaba cohort than the traditional or ERAS no-Gaba cohorts (medians: 112 versus 178 versus 158 MME, P < 0.01). ERAS + Gaba significantly increased postoperative hypotensive events on postoperative day (POD) 1 and 2, with notable reduction after Gaba removal (P < 0.05). Across PODs 0–2, mean systolic blood pressure was highest in the traditional cohort, followed by ERAS no-Gaba, then the ERAS + Gaba cohort (P < 0.05). Complication rates were similar across all cohorts. Conclusions:. Postmicrovascular breast reconstruction, ERAS + Gaba reduced overall inpatient narcotic usage, but increased hypotension incidence. Gaba removal from the ERAS protocol reduced postoperative hypotension incidence while maintaining similar stay lengths and complication rates.

Aerial robots, or unmanned aerial vehicles (UAVs), are widely used in 3D reconstruction tasks employing a wide range of sensors. In this work, we explore the use of wide baseline and non-parallel stereo vision for fast and movement-efficient long-range 3D reconstruction with multiple aerial robots. Each viewpoint of the stereo vision system is distributed on separate aerial robots, facilitating the adjustment of various parameters, including baseline length, configuration axis, and inward yaw tilt angle. Additionally, multiple aerial robots with different sets of parameters can be used simultaneously, including the use of multiple baselines, which allows for 3D monitoring at various depth ranges simultaneously, and the combined use of horizontal and vertical stereo, which improves the quality and completeness of depth estimation. Depth estimation at a distance of up to 400 m with less than 10% error using only 10 m of active flight distance is demonstrated in the simulation. Additionally, estimation of a distance of up to 100 m with flight distance of up to 10 m on the vertical axis and horizontal axis is demonstrated in an outdoor mapping experiment using the developed prototype UAVs.

Ureteroiliac fistula is a rare complication associated with ureteral stenting and iliac artery reconstruction and can lead to life-threatening hemorrhage. We report a case of acute bleeding from a ureteroiliac fistula in an 89-year-old man with bladder cancer who had undergone pelvic radiation, radical cystectomy, and ileal conduit complicated by ureteral strictures requiring routine stent exchanges. Multidisciplinary diagnostic therapies revealed the fistula, which was treated with hypogastric artery coiling and covered stent placement. No further bleeding issues had resulted from the fistula at 11 months of follow-up. The presence of a ureteroiliac fistula should be considered in any patient with a similar history.

Aerial manipulation aims to combine the versatility and the agility of aerial platforms with the manipulation capabilities of robotic arms. Their fast deployment allows for their implementation in maintenance tasks and support during disaster situations. However, the under-actuated nature of multirotor UAVs limits the magnitude and direction of the forces an aerial vehicle can safely exert during manipulation tasks. In this paper, the problems associated with UAVs and torsional tasks constraints regarding valve turning are addressed. An add-on thrust vectoring device which enhances manipulation options available to a conventional multirotor UAV is developed and described. The proposed system allows for a partial decoupling of the attitude and velocity vector of a multirotor. This permits stable translational flight and higher torque capabilities for torsional tasks. The separation of attitude and the velocity vector that allows for the design of a passive mechanism for valve operation is presented in this paper as well. The experimental results illustrate the forces and torques that can be generated in the evaluated operation modes.

Background:. Individuals with genetic susceptibility to breast cancer may pursue bilateral prophylactic mastectomy (BPM) and subsequent breast reconstruction. This study aimed to characterize immediate reconstructive trends following BPM. Methods:. The ACS-NSQIP database (2010 -2019) was used to examine differences in demographics and operative outcomes based on breast reconstruction technique following BPM and factors predicting reconstruction type. Results:. Of 1945 patients (mean age, 43.8 ± 11.3 years), implant-based reconstruction (IBR) was most frequently (71.8%) performed following BPM. Patients who underwent IBR (n = 1396) were younger (42.6 years, P < 0.001), more likely to be White (P < 0.05), and more likely to have a BMI less than 25 (P < 0.001). Patients who underwent autologous reconstruction (AR) (n = 186, 45.8 years) were more likely to be Black or African American and have a BMI of 25–30. Patients who underwent mastectomy only (MO) without immediate reconstruction (n = 363) were older (47.6 years), more likely to be Asian, and more likely to have a BMI greater than 35. The MO cohort had the highest frequency of diabetes or smoking history. AR was associated with longer operations, longer lengths of stay, and increased complications. Increasing age and BMI were predictive of AR or MO compared to IBR. Smoking was predictive of MO. Conclusion:. This is the first large-scale study of genetically susceptible patients who underwent BPM demonstrating a significant relationship between patient demographics, operative outcomes, and immediate reconstruction technique. These results provide valuable insight for surgeons and patients during the shared decision-making process.

In this work, a new method for aerial robot remote sensing using stereo vision is proposed. A variable baseline and flexible configuration stereo setup is achieved by separating the left camera and right camera on two separate quadrotor aerial robots. Monocular cameras, one on each aerial robot, are used as a stereo pair, allowing independent adjustment of the pose of the stereo pair. In contrast to conventional stereo vision where two cameras are fixed, having a flexible configuration system allows a large degree of independence in changing the configuration in accordance with various kinds of applications. Larger baselines can be used for stereo vision of farther away targets while using a vertical stereo configuration in tasks where there would be a loss of horizontal overlap caused by a lack of suitable horizontal configuration. Additionally, a method for the practical use of variable baseline stereo vision is introduced, combining multiple point clouds from multiple stereo baselines. Issues from using an inappropriate baseline, such as estimation error induced by insufficient baseline, and occlusions from using too large a baseline can be avoided with this solution.

In aerial manipulation, the position and size of a manipulator attached to an aerial robot defines its workspace relative to the robot. However, the working region of a multipurpose robot is determined by its task and is not always predictable prior to deployment. In this paper, the development of a multipurpose manipulator design for a three-armed UAV with a large workspace around its airframe is proposed. The manipulator is designed to be lightweight and slim in order to not disrupt the UAV during in-flight manipulator movements. In the experiments, we demonstrate various advanced and critical tasks required of an aerial robot when deployed in a remote environment, focusing on the landing and docking tasks, which is accomplished using a single manipulator system.

In this study, we propose a multirotor aerial robot for high-pressure washing tasks at high altitudes. The aerial robot consists of a multirotor platform, an add-on planar translational driving system (ATD), a visual sensing system, and a high-pressure washing system. The ATD consists of three ducted fans, which can generate force in all directions on the horizontal plane. The ATD also allows the multirotor to suppress the reaction force generated by the nozzle of a high-pressure washing system and inject water accurately. In this study, we propose a method to precisely inject water by installing an ATD in the multirotor and using its driving force to suppress the reaction force and move the multirotor while keeping its posture horizontal. The semi-autonomous system was designed to allow the operator to maneuver the multirotor while maintaining a constant distance from the wall by the sensor feedback with onboard LiDAR or stereo camera. In the experiment, we succeeded in performing the high-pressure washing task in a real environment and verified that the reaction force generated from the nozzle was actually suppressed during the task.

Dynamic frequency tuning of the 40.67 GHz intermode beat frequency of a 1255 nm emitting 1 mm long monolithic self mode-locked single section optical frequency comb InAs/InGaAs quantum dot laser across 70 MHz is experimentally demonstrated by fine-delay dual-cavity controlled all optical self-injection. Fiber-based macroscopic optical delay lengths are 9.4 m (round-trip time of 62.7 ns) and 16.5 m (round-trip time of 110.1 ns), the maximum studied microscopic delay tuning times are 40 ps and the optical self-injection strengths are below 0.02%. For selected delay times, the lowest intermode beat frequency line width amounts to 2 kHz indicating an improvement of carrier phase coherence by a factor of 700 as compared to the free-running laser. We validate these experimental results by a simple and universal stochastic time-domain model which is applied for the first time to model a self mode-locked quantum dot laser subject to optical self-injection. Modeling results are in good quantitative agreement.

Este trabajo se adentra en las dinámicas de construcción identitaria y en las formas de representación de la cultura gamer ecuatoriana. Se introduce en los grupos sociales relevantes, en los espacios reales-virtuales y en los artefactos que conforman esta cibercultura. Analiza el conjunto de actores, humanos y no-humanos, que configuran el entorno del gamer ecuatoriano y que, a su vez, estructuran su identidad como sus formas de representarse. Este trabajo considera que la identidad y la representación de los gamers ecuatorianos están construidas por una tensión de códigos derivados de los entornos virtuales y sociales, como multidimensionales y complejos, que necesitamos desentrañar y comprender en su densidad.

La Facultad de Ingeniería Mecatrónica de la Universidad Santo Tomás, seccional Bucaramanga, inició en el año 2005 el proceso de formulación y desarrollo de un trabajo cuya idea se originó por parte de la Clínica Materno Infantil San Luis en Bucaramanga; la cual consistió en la posibilidad de construir un equipo que permitiera aplicar hipotermia cerebral en neonatos, con el fin de prevenir las complicaciones derivadas de la Encefalopatía Hipóxico Isquémica (EHI), que es una de las principales causas de enfermedades neurológicas en neonatos. El presente trabajo describe la forma en que se diseñó y construyó el prototipo inicial de una máquina que, a través de un sistema de enfriamiento de estado sólido basado en células peltier, produce hipotermia a nivel cerebral en neonatos. Se describe de igual forma el desarrollo de un segundo prototipo a partir de las mejoras realizadas al primero en diferentes aspectos de su estructura. El segundo prototipo obtenido es una máquina que permite aplicar una adecuada temperatura de enfriamiento en el cerebro de los neonatos de manera estable y por el tiempo que especifiquen los especialistas médicos.

Technology has become a necessity in our everyday lives and essential for completing activities we typically take for granted; technologies can assist us by completing set tasks or achieving desired goals with optimal affect and in the most efficient way, thereby improving our interactive experiences. This paper presents research that explores the representation of user interaction levels using an intelligent hybrid system approach with agents. We evaluate interaction levels of Human-Computer Interaction (HCI) with the aim of enhancing user experiences. We consider the description of interaction levels using an intelligent hybrid system to provide a decision-making system to an agent that evaluates interaction levels when using interactive modules of a museum exhibition. The agents represent a high-level abstraction of the system, where communication takes place between the user, the exhibition and the environment. In this paper, we provide a means to measure the interaction levels and natural behaviour of users, based on museum user-exhibition interaction. We consider that, by analysing user interaction in a museum, we can help to design better ways to interact with exhibition modules according to the properties and behaviour of the users. An interaction-evaluator agent is proposed to achieve the most suitable representation of the interaction levels with the aim of improving user interactions to offer the most appropriate directions, services, content and information, thereby improving the quality of interaction experienced between the user-agent and exhibition-agent.

Technological advancements have revolutionized the proliferation and availability of information to users, which has created more complex and intensive interactions between users and systems. The learning process of users is essential in the construction of new knowledge when pursuing improvements in user experience. In this paper, the interruption factor is considered in relation to interaction quality due to human–computer interaction (HCI) being seen to affect the learning process. We present the results obtained from 500 users in an interactive museum in Tijuana, Mexico as a case study. We model the HCI of an interactive exhibition using belief–desire–intention (BDI) agents; we adapted the BDI architecture using the Type-2 fuzzy inference system to add perceptual human-like capabilities to agents, in order to describe the interaction and interruption factor on user experience. The resulting model allows us to describe content adaptation through the creation of a personalized interaction environment. We conclude that managing interruptions can enhance the HCI, producing a positive learning process that influences user experience. A better interaction may be achieved if we offer the right kind of content, taking the interruptions experienced into consideration.

The present study aimed to conduct a neutrosophic analysis of internal and external ethical factors affecting the supply chain of a painting company in the city of Quito. To achieve this, the SWOT method was applied, coupled with the neutrosophic AHP method for prioritizing and weighting the most influential factors. The results obtained allowed for the identification of the factors that had the greatest impact on the system, as per the opinions of the consulted experts. The combination of the neutrosophic AHP and SWOT analysis methods has proven to be a powerful tool for addressing ethical challenges in business decisionmaking, and the results obtained can serve as a guide for implementing effective ethical strategies in the supply chain. [ABSTRACT FROM AUTHOR]