Search Results (73)

To achieve obstacle-avoiding puncture in breast interventional surgery, a robotics system based on three-fingered breast target-point manipulation is proposed and designed. Firstly, based on the minimum number of control points required for three-dimensional breast deformation control and the bionic structure of the human hand, the structure and control scheme of the robotics system based on breast target-point manipulation are proposed. Additionally, the workspace of the robotics system is analyzed. Then, an optimal control point selection method based on the minimum resultant force principle is proposed to achieve precise manipulation of the breast target point. Concurrently, a breast soft tissue manipulation framework incorporating a Model Reference Adaptive Control (MRAC) system is developed to enhance operational accuracy. A dynamic model of breast soft tissue is developed by using the manipulative force–displacement data obtained during the process of manipulating breast soft tissue with mechanical fingers to realize the manipulative force control of breast tissue. Finally, through simulation and experiments on breast target-point manipulation tasks, the results show that this robotic system can achieve spatial control of breast positioning at arbitrary points. Meanwhile, the robotic system proposed in this study demonstrates high-precision control with an accuracy of approximately 1.158 mm (standard deviation: 0.119 mm), fulfilling the requirements for clinical interventional surgery in target point manipulation. Full article

Background/Objectives: Morphological spinal alterations in adolescents, including idiopathic scoliosis (IS) and postural scoliotic attitudes (paramorphisms), may be associated with leg length discrepancy (LLD) and breast asymmetry (BA). This study aimed to assess the prevalence and characteristics of LLD and BA in adolescents with spinal paramorphisms and dysmorphisms (IS), and to explore associations between these asymmetries and spinal curve features. Methods: A cross-sectional observational study was conducted. Adolescents aged 10–18 years were included. LLD was measured clinically via direct tape measurement and, when necessary, ultrasound. BA was assessed via visual inspection. Spinal deformities were characterized via clinical and radiological examination. Results: Among the 44 participants, 26 (60%) had IS and 18 (40%) had postural scoliotic attitudes. LLD was present in 79.5% (mean 0.7 ± 0.6 cm; all mild). BA was observed in 14% of the sample. LLD was more frequent in IS (87%) than in postural scoliotic attitudes (72%). In lumbar postural curves, the shorter limb was consistently ipsilateral to the curve convexity. In IS, no consistent association was found between LLD and curve characteristics. BA was slightly more prevalent in IS (19%) than postural scoliotic attitudes (17%), with no consistent pattern relative to curve convexity. Conclusions: Mild LLD is common in adolescents with spinal asymmetries and reflects general population norms. While LLD may influence compensatory postural curves, it does not appear to affect IS curve patterns or severity. BA is more frequent in IS, but shows variable association with curve features. Considering LLD and BA prevalence in adolescents with spinal asymmetries routine assessment is warranted, though their impact on IS progression is limited. Full article

Breast cancer is a major health concern for women worldwide, and therefore, understanding various changes acquired by breast cancer cells is relevant to a better comprehension of the disease. One such change includes alterations to the mechanical properties of breast cancer cells. For example, cells with high malignant potential show lower adhesion forces and higher cell deformability. Mechanical forces, including tensile and compressive forces of the cytoskeleton and the extracellular matrix such as integrin, collagen, and the basement membrane, can affect BC cells. These forces alter the properties of cancer cells, drive them towards invasiveness due to different motility and proliferative profiles, and change their microenvironment. This study will focus on the mechanical characteristics of breast cancer cells and the extracellular matrix. Furthermore, changes induced in breast cancer cells following exposure to mechanical forces will be reviewed. Genes that link phenotype to mechanical forces and the implications of these forces for diagnostics and treatment will be discussed. Full article

Background/Objectives: As the incidence of breast cancer increases, reliable, effective, and innovative solutions are required for breast deformities following breast-conserving surgery. We aimed to evaluate the biocompatibility and efficacy of optimized three-dimensional (3D) micro-nanofiber scaffolds and demonstrate their clinical potential through preclinical experiments. Methods: Seven-week-old male Sprague-Dawley rats were randomized into four groups. Group I (control group) received a 2-dimensional (2D) micro-nanofiber scaffold weighing 0.2 g; Groups II–IV received 3D micro-nanofiber scaffolds weighing 0.2, 0.3, and 0.6 g, respectively. These were subcutaneously implanted into the dorsal region and harvested with the surrounding tissues at 4, 8, and 16 weeks for histological evaluation. Results: The number of inflammatory cells was higher in Group IV than in Groups II and III at 4 weeks, with a significant increase in Group IV (p < 0.01) compared with that in Group I. At 8 weeks, it was significantly increased in Group III compared with that in Group I. Furthermore, at 16 weeks, it was significantly reduced in Group IV (p < 0.05) compared with that in Group I. The fibrosis depth in the 3D scaffolds revealed significant differences in Groups II, III, and IV (p < 0.001) compared with Group I at 4 weeks. The collagen fiber densities in the 3D groups were higher than those in the 2D group at 8 and 16 weeks. There were no statistically significant differences between the 3D groups. Conclusions: Absorbable 3D micro-nanofiber scaffolds enhance tissue integration and extracellular matrix formation following post-mastectomy breast reconstruction. Full article

Breast reconstruction after mastectomy improves the quality of life for many patients with breast cancer. There is uncertainty regarding eligibility criteria for reconstruction, timing (immediate or delayed—with or without radiotherapy), outcomes of nipple-sparing compared to skin-sparing mastectomy, selection criteria and surgical factors influencing outcomes of nipple-sparing mastectomy, prepectoral versus subpectoral implants, use of acellular dermal matrix, and use of autologous fat grafting. We conducted a systematic review of these topics to be used as the evidence base for an updated clinical practice guideline on breast reconstruction for Ontario Health (Cancer Care Ontario). The protocol was registered on PROSPERO, CRD42023409083. Medline, Embase, and Cochrane databases were searched until August 2024, and 229 primary studies met the inclusion criteria. Most studies were retrospective non-randomized comparative studies; 5 randomized controlled trials were included. Results suggest nipple-sparing mastectomy is oncologically safe, provided there is no clinical, radiological, or pathological indication of nipple-areolar complex involvement. Surgical factors, including incision location, may affect rates of complications such as necrosis. Both immediate and delayed reconstruction have similar long-term outcomes; however, immediate reconstruction may result in better short to medium-term quality of life. Evidence on whether radiotherapy should modify the timing of initial reconstruction or expander-implant exchange was very limited; studies delayed reconstruction after radiotherapy by at least 3 months and, more commonly, at least 6 months to avoid the period of acute radiation injury. Radiation after immediate reconstruction is a reasonable option. Surgical complications are similar between prepectoral and dual-plane or subpectoral reconstruction; prepectoral placement may give a better quality of life due to lower rates of long-term complications such as pain and animation deformity. Autologous fat grafting was found to be oncologically safe; its use may improve quality of life and aesthetic results. Full article

Lung cancer is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths Each year, more people die of lung cancer than colon, breast, and prostate cancer combined. The early detection of lung cancer is critical for improving patient outcomes, and automation through advanced image analysis techniques can significantly assist radiologists. This paper presents the development and evaluation of a computer-aided diagnostic system for lung cancer screening, focusing on pulmonary nodule segmentation in low-dose CT images, by employing HighRes3DNet. HighRes3DNet is a specialized 3D convolutional neural network (CNN) architecture based on ResNet principles which uses residual connections to efficiently learn complex spatial features from 3D volumetric data. To address the challenges of processing large CT volumes, an efficient patch-based extraction pipeline was developed. This method dynamically extracts 3D patches during training with a probabilistic approach, prioritizing patches likely to contain nodules while maintaining diversity. Data augmentation techniques, including random flips, affine transformations, elastic deformations, and swaps, were applied in the 3D space to enhance the robustness of the training process and mitigate overfitting. Using a public low-dose CT dataset, this approach achieved a Dice coefficient of 82.65% on the testing set for 3D nodule segmentation, demonstrating precise and reliable predictions. The findings highlight the potential of this system to enhance efficiency and accuracy in lung cancer screening, providing a valuable tool to support radiologists in clinical decision-making. Full article

Cancer chemotherapeutics administered to cancer patients via traditional oral or parenteral routes often encounter poor bioavailability and severe systemic side effects. Skin delivery is a promising alternative route with reduced side effects and improved therapeutic efficacy and has gained significant attention in recent years. With conventional or deformable liposomal nanocarriers as a skin permeation strategy, cancer chemotherapeutics can be delivered via skin route, offering an option for more efficient therapy. This review summarizes the recent advances in liposome nanocarrier efficacy to enhance the skin delivery of chemotherapeutics with a wide range of physicochemical properties (log P_oct from −0.89 to 5.93, MW from 130 to 1415) in targeting local skin cancer, breast cancer, and tumor metastasis and delivering the drug to systemic circulation to treat distal cancers. The potential mechanisms of skin permeation enhancement by different type of liposomes are also discussed in this review. Full article

Background: A series of spiro-fused heterocyclic compounds containing cyclopropa[a]pyrrolizidine-2,3′-oxindole and 3-spiro[3-azabicyclo[3.1.0]-hexane]oxindole frameworks were synthesized and studied for their in vitro antiproliferative activity against human erythroleukemia (K562), cervical carcinoma (HeLa), acute T cell leukemia (Jurkat), melanoma (Sk-mel-2) and breast cancer (MCF-7) as well as mouse colon carcinoma (CT26) cell lines. Methods: Cell proliferation was evaluated in vitro by MTS assay. Confocal microscopy was used to study actin cytoskeleton structure and cell motility. Cell cycle analysis was evaluated by flow cytometry. Results: It was found that compounds 4, 8, 18 and 24 showed antiproliferative activity against the Jurkat, K-562, HeLa and Sk-mel-2 cell lines with IC₅₀ ranging from 2 to 10 μM (72 h). Evaluation of the impact on cell cycle progression showed that the tested compounds achieved significant cell-cycle perturbation with a higher accumulation of cells in the SubG1 and G0/G1 phases of the cell cycle, in comparison to the negative control. I Incubation with tested compounds led to the disappearance of stress fibers (granular actin was distributed diffusely in the cytoplasm in up to 38% of treated HeLa cells) and changes in the number of filopodia-like deformations (reduced from 93% in control cells to 64% after treatment). The impact on the Sk-mel-2 cell actin cytoskeleton structure was even greater: granular actin was distributed diffusely in the cytoplasm in up to 90% of treated cells while the number of filopodia-like deformations was reduced by up to 23%. A scratch test performed on the human melanoma cell line showed that these cells did not fill the scratched strip and lose their ability to move under treatment. Conclusions: The obtained results support the antitumor effect of the tested spiro-compounds and encourage the extension of this study in order to improve their anticancer activity as well as reduce their toxicological risks. Full article

Background/Objectives: The rising incidence of breast cancer has led to more mastectomies and increased demand for reconstruction. While retropectoral reconstruction with expanders is common, it has complications like postoperative pain and animation deformity. Prepectoral reconstruction, aided by advancements in biological and synthetic meshes, offers a promising alternative. Methods: This study prospectively evaluated the “Prepectoral Breast Reconstruction Assessment Score” on 20 patients undergoing mastectomy at Policlinico Umberto I, Rome, from July 2022 to February 2024. Patients with scores between 5 and 8 were included. The procedure involved the use of ADM (Acellular Dermal Matrix) or titanium-coated polypropylene mesh, followed by postoperative expansions and final implant placement after six months. Results: The mean age of patients was 51.85 years, with a mean BMI of 24.145 kg/m². ADM was used in 15 cases and synthetic mesh in 5. Complications were one exposure of the expander, one superficial skin necrosis and one seroma. Statistical analysis showed a trend toward fewer complications with higher scores, though this was not statistically significant (p-value = 0.139). Conclusions: Prepectoral reconstruction with expanders is a viable option, offering benefits such as reduced operating time, better volume control, and a more natural breast contour compared to the retropectoral approach. Although the trend suggests fewer complications with higher assessment scores, further studies with larger samples are needed for confirmation. Full article

Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory breast condition often mistaken for inflammatory breast cancer and, therefore, requires a biopsy for accurate diagnosis. Although not cancerous, IGM can cause emotional distress because of severe pain and ensuing breast deformity. Differentiating IGM from other breast inflammations caused by infections is essential. IGM mostly affects premenopausal women and is potentially associated with recent pregnancies and breastfeeding. The risk factors, including smoking and contraceptive use, have inconsistent associations. Steroid responses suggest an autoimmune component, though specific markers are lacking. Methods: We performed a narrative review on potential risk factors, diagnostics, and therapy of IGM. Results: Diagnostics and clinical management of IGM are challenging. The treatment options include NSAIDs, steroids, surgery, antibiotics, immunosuppressants, prolactin suppressants, and observation, each with varying effectiveness and side effects. Conclusions: Current IGM treatment evidence is limited, based on case reports and small series. There is no consensus on the optimal management strategy for this disease. The GRAMAREG study by the EUBREAST Study Group aims to collect comprehensive data on IGM to improve diagnostic and treatment guidelines. By enrolling patients with confirmed IGM, the study seeks to develop evidence-based recommendations, enhancing patient care and understanding of this condition. Full article

Minimally invasive interventional surgery is commonly used for diagnosing and treating breast cancer, but the high fluidity and deformability of breast tissue reduce intervention accuracy. This study proposes a bionic breast interventional robot that mimics the scorpion’s predation process, actively manipulating tissue deformation to control target displacement and enhance accuracy. The robot’s structure is designed using a modular method, and its kinematics and workspace are analyzed and solved. To address the nonlinear breast tissue deformation problem, a hierarchical tissue method is proposed to simplify the three-dimensional problem into a two-dimensional one. A two-dimensional tissue deformation solver is established based on the minimum energy method for quick resolution. The problem is treated as quasi-static, deriving the displacement relationship between external manipulation points and internal tissue targets. The method of active manipulation of tissue deformation is simulated using MATLAB (2019-b) software to verify the feasibility of the method. Results show maximum errors of 1.7 mm for prostheses and 2.5 mm for in vitro tissues in the X and Y directions. This method improves intervention accuracy in breast surgery and offers a new solution for breast cancer diagnosis and treatment. Full article

(1) Background: Aquafilling, a filler initially designed for contouring the face, was developed in 2005 by the company Biomedica, Czech Republic. It is composed of 98% hydrophilic gel and 2% copolyamide. Since 2008 the use was expanded for augmentation of the breast and gluteal region. It is suitable as a nonsurgical method for patients who want discreet augmentation and would like to avoid undergoing an operation. This method promises long-term results lasting up to 10 years. However, according to the literature Aquafilling gel can cause long-term complications; (2) Methods: This case report presents a male patient who experienced severe complications following Aquafilling injections for breast augmentation after ten years of treatment; (3) Results: A 51-year-old male patient presented to our emergency room with complaints of pain, firmness, major pre-pectoral swelling and asymmetry in his breasts. Due to the severity of the clinical appearance and the patient’s discomfort, surgical intervention was deemed necessary. After undergoing three operations the patient was treated successfully and could be discharged for outpatient controls. The patient still did not show any signs of complications, three months after the event; (4) Conclusions: Although the patient has made a rapid recovery, as a result of the surgical procedure, we would recommend treating the breast region with small incisions and drainage in the future. This would have a better aesthetic result. Still there is no antidote available for the treatment of Aquafilling gel. It can only be removed by surgical debridement or irrigation and drainage. Full article

Poland syndrome (PS) is a rare congenital musculoskeletal entity occurring in approximately 1 in 30,000 newborns that manifests with variable symbrachydactyly, ipsilateral costochondral deformities, an absence of pectoral muscles, and breast underdevelopment. These have potential impacts on social, somatic, and psychological functionality, often leading affected individuals to seek expert opinions on corrective surgery. Due to phenotypic variability, strict management guidelines are lacking, with treatment decisions often based on the specialist’s personal experience rather than published evidence. Comprehensive imaging with CT and MRI with 3D reconstruction is crucial for providing a descriptive assessment of musculoskeletal defects. Management is multidisciplinary, involving thoracic, plastic, and pediatric surgeons and hand surgery specialists, as well as psychologists and developmental growth specialists. Surgery should achieve both structural and cosmetic correction to reverse the psychological and social impact and achieve patient satisfaction. We aim to provide thoracic surgeons the essential answers for sharing with affected adult individuals during consultations focusing on chest surgical correction. Full article

The need for a long-term solution for filling the defects created during partial mastectomies due to breast cancer diagnosis has not been met to date. All available defect-filling methods are non-permanent and necessitate repeat procedures. Here, we report on novel injectable porous hydrogel structures based on the natural polymers gelatin and alginate, which are designed to serve for breast reconstruction and regeneration following partial mastectomy. The effects of the formulation parameters on the mechanical and physical properties were thoroughly studied. The modulus in compression and tension were in the range of native breast tissue. Both increased with the increase in the crosslinker concentration and the polymer–air ratio. Resilience was very high, above 93% for most studied formulations, allowing the scaffold to be continuously deformed without changing its shape. The combination of high resilience and low elastic modulus is favored for adipose tissue regeneration. The physical properties of gelation time and water uptake are controllable and are affected mainly by the alginate and N-(3-dimethylaminopropyl)-N’-ethylcarbodiimide hydrochloride (EDC) concentrations and less by the polymer–air ratio. In vitro cell viability tests were performed on mouse preadipocytes and indicated high biocompatibility. The minimally invasive nature of this approach, along with the excellent properties of the scaffold, will enable the filling of complex voids while simultaneously decreasing surgical costs and greatly improving patient well-being. Full article

Background and Objectives: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. Materials and Methods: A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. Results: Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300–455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire (p < 0.001). Conclusions: Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain. Full article