Objective To summarize the experience of 23 cases of axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction, and to discuss its superiority and patient satisfaction. Methods The clinical data of 23 female breast cancer patients who underwent axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction from June 2021 to June 2022 in the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively included. We summarized the surgical procedures, surgical safety, and postoperative patient satisfaction. Results Twenty-three patients have operated the axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction successfully without nipple reconstruction. Among them, 9 patients underwent dual-main surgeons’ surgery, and 14 patients underwent one-main surgeon surgery. The surgery time ranges from 3.5 to 7.0 h, mean of 4.76 h, and the mean operation time of 9 patients underwent dual-main surgeons’ surgery was shorter than that of patients underwent one-main surgeons’ surgery. The blood loss ranges from 20 to150 mL, mean of 45.7 mL. The postoperative hospital stay range from 0 to 24 d, mean of 10.7 d. Four people suffered from complications: 1 patient with prosthesis moving up, 2 patients with nipple-areola complications, and 1 patient with subcutaneous emphysema. All 23 women were followed for 3 months, and no one suffered from recurrence, metastasis, and death during this period. We surveyed people by BREAST-Q scale when pre-operation, 1 month after the operation, and 3 months after the operation. Compared with preoperative patients, the sexual well-being, psychosocial well-being, and chest physical well-being of 1 month postoperative patients were decreased, but obviously increased in 2 months. The satisfaction with breast of 3 months of postoperative patients were higher than preoperative patients. Conclusions Endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction can achieve good cosmetic results and improve surgical safety. The dual-main surgeons’ surgery can decrease the operation time, so as to reduce the risk of anesthesia for patients.
Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.
The pediatric cadaver impact experiments were reconstructed using the validated finite element(FE) models of the 3-year-old and 6-year-old children. The effect of parameters, such as hammer size, material parameters and thorax anatomical structure characteristics, on the impact mechanical responses of 3-year-old and 6-year-old pediatric thorax was discussed by designing reasonable finite element simulation experiments. The research results showed that the variation of thorax contact peak force for 3-year-old group was far larger than that of 6-year-old group when the child was impacted by hammers with different size, which meant that 3-year-old child was more sensitive to hammer size. The mechanical properties of thoracic organs had little influence on the thorax injury because of the small difference between 3-year-old and 6-year-old child in this research. During the impact, rib deformation led to different impact location and deformation of internal organs because the 3-year-old and 6-year-old children had different geometrical anatomical structures, such as different size of internal organs. Therefore, the injury of internal organs in the two groups was obviously different. It is of great significance to develop children finite element models with high biofidelity according to its real anatomical structures.
Finite element (FE) model of thorax with high biofidelity is one of the most important methods to investigate thoracic injury mechanism because of the absence of pediatric cadaver experiments. Based on the validated thorax finite element model, the FE models with equivalent muscles and real geometric muscles were developed respectively, and the effect of muscle biofidelity on thoracic injury was analyzed with reconstructing pediatric cadaver thorax impact experiments. The simulation results showed that the thoracic impact force, the maximum displacement and the maximum von-Mises stress of FE models with equivalent muscles were slightly greater than those from FE models with real geometric muscles, and the maximum principal strains of heart and lung were a little lower. And the correlation coefficient between cadaver corridor and FE model with real muscles was also greater than that between cadaver corridor and FE model with equivalent muscles. As a conclusion, the FE models with real geometric muscles can accurately reflect the biomechanical response of thorax during the impact.
Microneedles have emerged as the new class of local drug delivery system that has broad potential for development. Considering that the microneedles can penetrate tissue barriers quickly, and provide localized and targeted drug delivery, their applications have gradually expanded to non-transdermal drug delivery recently, which are capable of providing rapid and effective treatment for injuries and diseases of organs or tissues. However, a literature search revealed that there is a lack of summaries of the latest developments in non-transdermal drug delivery research by using biomedical polymeric microneedles. The review first described the materials and fabrication methods for the polymeric microneedles, and then reviewed a representative application of microneedles for non-transdermal drug delivery, with the primary focus being on treating and repairing the tissues or organs such as oral cavity, ocular tissues, blood vessels and heart. At the end of the article, the opportunities and challenges associated with microneedles for non-transdermal drug delivery were discussed, along with its future development, in order to provide reference for researchers in the relevant field.
Ultraviolet radiation is a primary external factor contributing to skin photoaging, as it induces cellular deoxyribonucleic acid damage and collagen degeneration, thereby accelerating skin aging and increasing the risk of skin cancer. Currently, skin aging assessment mainly relies on dermatologists’ empirical judgment, which is inherently subjective and inefficient. To address these limitations, this study proposes a deep learning–driven intelligent skin aging classification method based on high-frequency ultrasound images. The proposed model employs efficient network version 2 (EfficientNetV2) as the backbone network and introduces the Gaussian error linear unit (GELU) activation function and layer normalization to enhance nonlinear feature representation and training stability. In addition, a global-aware temporal hierarchical network is integrated to enable efficient multi-scale feature extraction of skin tissue. A dual enhancement attention mechanism, combining parallel channel–spatial attention and squeeze-and-excitation modules, is further designed to improve the model’s sensitivity to key aging-related regions. Moreover, a multi-scale path dropout regularization strategy is adopted to effectively alleviate overfitting. Experiments conducted on a facial high-frequency ultrasound dataset collected from subjects aged 25~55 years demonstrate that the proposed method achieves an accuracy of 87.66%, a precision of 88.27%, a recall of 87.66%, an F1 score of 87.80%, and a specificity of 97.94%, consistently outperforming existing mainstream models. These results indicate that the proposed approach enables high-precision identification of skin aging levels and provides an efficient and objective auxiliary diagnostic tool for skincare, anti-aging treatment, and the prevention of photoaging-related skin diseases.
Objective To investigate the effectiveness of a modified double keystone design perforator island flap in repairing large skin and soft tissue defects in the posterior midline lumbar region following extensive excision for Bowen disease. Methods A retrospective analysis was conducted on the clinical data of 9 patients with Bowen disease in the posterior midline lumbar region admitted between January 2020 and June 2024. There were 4 males and 5 females; ages ranged from 55 to 80 years, with a mean age of 68.9 years. Lesions were located at L1-5 levels and concentrated near the midline posterior to the spinous processes. And the lesions were confined to the skin and subcutaneous tissue. The size of residual defects following extensive excision ranged from 6.0 cm×5.5 cm to 10.0 cm×8.5 cm. The modified double keystone design perforator island flaps were designed with the defect as the center. Subcutaneous and adipose tissues were dissected without incising the deep fascia, while preserving perforator vessels. The bilateral flaps were advanced toward the midline using V-Y advancement sutures; the size of unilateral flap ranged from 8.5 cm×3.5 cm to 15.0 cm×6.0 cm. The donor sites were directly sutured. Results Operations were successfully completed in all 9 cases. The operation time ranged from 80 to 100 minutes (mean, 90 minutes); intraoperative blood loss ranged from 20 to 80 mL (mean, 41.1 mL); and the length of hospital stay ranged from 9 to 15 days (mean, 10.4 days). All flaps survived, with only 1 case of mild fat liquefaction at the recipient site. All patients were followed up 9-18 months (mean, 12.4 months). All flaps were similar in texture, thickness, and color to the surrounding skin, with no obvious “cat’s ear” deformity observed. The lumbar mobility was normal, with no sensation of tightness or pain. At last follow-up, the subjective satisfaction, as assessed by the visual analogue scale (VAS) score, ranged from 7 to 10, with a mean of 8.7. No tumor recurrence was observed during follow-up. Conclusion For large defects resulting from extensive resection of Bowen disease in the posterior midline lumbar region, the use of a modified double keystone design perforator island flap offers the advantages of reliable blood supply, uniform tension distribution, no need for skin grafting, and minimal trauma at donor site.
The finite element method is a new method to study the mechanism of brain injury caused by blunt instruments. But it is not easy to be applied because of its technology barrier of time-consuming and strong professionalism. In this study, a rapid and quantitative evaluation method was investigated to analyze the craniocerebral injury induced by blunt sticks based on convolutional neural network and finite element method. The velocity curve of stick struck and the maximum principal strain of brain tissue (cerebrum, corpus callosum, cerebellum and brainstem) from the finite element simulation were used as the input and output parameters of the convolutional neural network The convolutional neural network was trained and optimized by using the 10-fold cross-validation method. The Mean Absolute Error (MAE), Mean Square Error (MSE), and Goodness of Fit (R2) of the finally selected convolutional neural network model for the prediction of the maximum principal strain of the cerebrum were 0.084, 0.014, and 0.92, respectively. The predicted results of the maximum principal strain of the corpus callosum were 0.062, 0.007, 0.90, respectively. The predicted results of the maximum principal strain of the cerebellum and brainstem were 0.075, 0.011, and 0.94, respectively. These results show that the research and development of the deep convolutional neural network can quickly and accurately assess the local brain injury caused by the sticks blow, and have important application value for understanding the quantitative evaluation and the brain injury caused by the sticks struck. At the same time, this technology improves the computational efficiency and can provide a basis reference for transforming the current acceleration-based brain injury research into a focus on local brain injury research.
Objective To preliminarily assess the ameliorative effect of Mom’s Good Mood (MGM) on the prevalence of antenatal depression based on a pilot study, and to provide evidence for a scale-up study. Methods This study was conducted in Ma’anshan Maternal and Child Health Center as a pilot study of an implementation study conducted in China called the Perinatal Depression Screening and Management (PDSM) program. In 2019, 1 189 participants (gestational week ≤14+6 weeks) were included in the implementation group. Females were recruited in the first trimester and followed up in the second and third trimesters. At each time point, the participants’ depression status was screened by the Edinburgh postpartum depression scale (EPDS), and those who were screened as having depression were provided the MGM intervention. In 2020, 1 708 participants who underwent screening with the EPDS in either the first, second or third trimester at Ma’anshan Maternal and Child Health Center were included in the control group. Mann?Whitney U test, Chi-square, and multivariate logistic regression analysis were used to compare the EPDS scores and depression prevalence between the control and implementation groups to assess the ameliorative effect of MGM (screening and intervention) on antenatal depression. Results In the first trimester, there were no statistically significant differences in EPDS scores or depression prevalence between the two groups (P>0.05). In the second and third trimesters, both the EPDS scores and depression prevalence of the implementation group were lower than those of the control group (P<0.05). After adjusting for confounders, logistic regression analysis showed that the risks of depression in the implementation group in both the second and third trimesters were lower than those in the control group (ORsecond trimester=0.55, 95%CI 0.37 to 0.81, P=0.003; ORthird trimester=0.51, 95%CI 0.35 to 0.74, P<0.001). Conclusion Implementation of the MGM based on the primary care system can effectively reduce the prevalence of antenatal depression, providing evidence for further scale up.