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The Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease

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Open Journal of Internal Medicine 2014年第4期4卷 108-114页

作者： Jospeh F. Renzulli II Michael M. Maddox omar nadeem Simone Thavaseelan Gyan Pareek Anthony E. Mega Warren Alpert Medical School Brown University Providence USA

Introduction: With the widespread use of robot-assisted radical prostatectomy (RARP), a stage migration to less aggressive prostate cancer (CaP) may be expected in pathological specimens due to over-treatment of low risk disease. It is unclear whether implementation of a multidisciplinary clinic (MDC) model would offset this phenomenon. We sought to analyze our database for possible stage migration in prostatectomy specimens in the setting of MDC. Methods: A total of 262 patients who underwent open prostatectomy (OP) from 2004 to 2006 and 757 patients who underwent RARP from 2007 to 2011 were identified from our prospective database. The implementation of MDC occurred concurrently at the time of RARP initiation. Demographic data, pathology, positive margin rates along with standard CaP reporting data were recorded. The two groups were compared with regards to percentage of cases stratified by Gleason grade. Results: The number of CaP cases managed at our institution increased considerably after the introduction of robotics and MDC. There was a significant decrease in the patients with Gleason 6 CaP undergoing RARP as compared with OP (p = 0.001). Additionally, RARP was performed on a significantly greater percentage of Gleason 7 disease (p < 0.001). When comparing pathological stage, there was a significant increase in the incidence of pT3 disease following RARP (p < 0.0001). Conclusions: The introduction of a MDC and minimally invasive radical prostatectomy did not result in an increased application of surgery for the treatment of low risk prostate cancer. This highlights the importance of MDC in a large volume RARP program.

关键词： Prostate Cancer Robotics Multidisciplinary Care

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Secure and Reliable Routing in the Internet of Vehicles Network:AODV-RL with BHA Attack Defense

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Computer Modeling in Engineering & Sciences 2024年第4期139卷 633-659页

作者： nadeem Ahmed Khalid Mohammadani Ali Kashif Bashir Marwan omar Angel Jones Fayaz Hassan School of Electronic Science Beijing University of Post and TelecommunicationBeijing100086China Department of Computer Science Huanggang Normal UniversityHuanggangChina Department of Computing and Mathematics Manchester Metropolitan UniversityManchesterUK Woxsen School of Business Woxsen UniversityHyderabad502345India Department of Computer Science and Mathematics Lebanese American UniversityBeirutLebanon Information Technology and Management Illinois Institute of TechnologyChicagoUSA College of Computing Capital Technology UniversityLaurelUSA

Wireless technology is transforming the future of transportation through the development of the Internet of Vehicles(IoV).However,intricate security challenges are intertwinedwith technological progress:Vehicular ad hoc Networks(VANETs),a core component of IoV,face security issues,particularly the Black Hole Attack(BHA).This malicious attack disrupts the seamless flow of data and threatens the network’s overall reliability;also,BHA strategically disrupts communication pathways by dropping data packets from legitimate nodes *** the importance of this challenge,we have introduced a new solution called ad hoc On-Demand Distance Vector-Reputation-based mechanism Local Outlier Factor(AODV-RL).The significance of AODVRL lies in its unique approach:it verifies and confirms the trustworthiness of network components,providing robust protection against *** additional safety layer is established by implementing the Local Outlier Factor(LOF),which detects and addresses abnormal network *** testing of our solution has revealed its remarkable ability to enhance communication in ***,Our experimental results achieve message delivery ratios of up to 94.25%andminimal packet loss ratios of just 0.297%.Based on our experimental results,the proposedmechanismsignificantly improves VANET communication reliability and *** results promise a more secure and dependable future for IoV,capable of transforming transportation safety and efficiency.

关键词： Black hole attack IoV vehicular ad hoc network AODV routing protocol

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