Robotic nipple sparing mastectomy (R-NSM), which uses the da Vinci surgical platform, could perform NSM and immediate breast reconstruction through a small and inconspicuous extra-mammary axillary or ...lateral chest incision. R-NSM was reported with extremely low nipple areolar complex (NAC) necrosis rate, good cosmetic results, and high patient satisfaction. However, there was little evidence available comparing the effectiveness and safety of R-NSM and conventional NSM (C-NSM) in the management of breast cancer.
A case control comparison study was conducted for patients with breast cancer who underwent R-NSM or C-NSM with immediate gel implant breast reconstruction (IGBR) from July 2011 to September 2019 at a single institution to compare the clinical outcomes, patient-reported esthetic results, and medical cost.
According to the study design, 54 procedures of R-NSM were compared with 62 procedures of C-NSM in the surgical management of breast cancer combined with IGBR. Compared with C-NSM, R-NSM was associated with higher overall satisfaction (92% excellent and 8% good versus 75.6% excellent and 24.4% good, P = 0.046), and wound/scar related outcome in patient-reported esthetic results. The NAC ischemia/necrosis risk, overall complication rate, and blood loss were not significantly different between R-NSM and C-NSM groups. However, longer operation time and higher overall medical cost (10,877 ± 796 versus 5,702 ± 661 US Dollars, P<0.01) was observed in R-NSM group.
Compared with C-NSM, R-NSM showed comparable clinical outcomes and favorable patients’ satisfaction with the esthetic results, but at the price of longer operation time and higher cost.
The current study aims to evaluate the nipple and skin sensation following nipple-sparing mastectomy (NSM) and identify patient-, surgical-, or treatment-related factors affecting nipple or skin ...sensation in this cohort.
Patients who received NSM with postoperative nipple and skin sensation test evaluation at a single institution over the past 10 years were retrospectively retrieved from a prospectively collected breast cancer surgery database.
A total of 460 NSM procedures were included in this current study, with the mean age of 48.3 ± 9.1. Three-hundred eighty-three (83.3%) patients had breast reconstructions. One-hundred seventy-four (37.8%) received conventional NSM (C-NSM), 195 (42.4%) endoscopic-assisted NSM (E-NSM), and 91 (19.8%) robotic-assisted NSM (R-NSM) procedures. For nipple sensation assessment, 15 (3.3%) were grade 0, 83 (18.2%) grade I, 229 (49.7%) grade II, and 133 (28.9%) grade III (normal sensation), respectively, with mean grade score of 2.1 ± 0.7. The preserved (grade III) nipple sensation rate was 36.2% (63/174) in the C-NSM group, 26.7% (52/195) in the E-NSM group, and 19.7% (18/91) in the R-NSM group (P = 0.06). The "time since surgery to last evaluation" was significantly longer in the C-NSM group (45.6 ± 34 months) or E-NSM group (44.7 ± 35.8 months) as compared to R-NSM group (31.8 ± 16 months, P < 0.01). In multivariate analysis, peri-areolar incision showed higher grade of nipple sensation (OR: 2.1, P = 0.02) compared to upper outer quadrant incision, and longer follow-up time post-NSM showed significant improvement of nipple or skin sensation (> 60 months vs. ≦ 12 months: nipple odds ratio (OR) = 5.75, P < 0.01; skin, OR = 1.97, P < 0.05).
Our current analysis showed some factors to be related to postoperative nipple or skin sensation, and longer "time after surgery" was associated with significant improvement of nipple and skin sensation in patients who received NSM, regardless of the surgical approaches.
Our current analysis showed a significant portion of patients with decrease or loss of nipple or skin sensation after nipple-sparing mastectomy (NSM). Several factors associated with preserved nipple or skin sensation were identified, including age, surgical methods, surgical wound location, and association of time from surgery showing that improvement of partial nipple or skin sensation was evident after a longer follow-up.
•Strengthening by bottom NSM bars of 180cm lengths (straight and with 90° bent ends) recorded load capacity ratios of 177 and 185% respectively.•A maximum enhancement in the load capacity ratio of ...201% was recorded for beam strengthened with bottom NSM bars of 140 cm length and 45° bent ends.
The present paper studied experimentally and numerically the behavior of RC beams strengthened with near surface mounted (NSM) GFRP bars with and without end anchorage. Both bottom and side NSM strengthening technique were investigated and compared. The end anchorage was made by bent 150mm from the two ends of the NSM bars by 45° or 90°. The experimental results showed higher load carrying capacity for the RC beams strengthened by bottom NSM bars compared to those strengthened with side NSM ones due to the internal arm effect. The highest ratio of improvement in the load carrying capacity of strengthened beams compared with the control beam was 201% for strengthened beam with bottom NSM bars having end anchorage inclined by 45° while the lowest ratio was 142% for the same strengthened beam with side NSM. The experimentally investigated beams and other beams were numerically simulated using 3-D elastic-plastic finite element analysis. There is a good agreement between the numerical and the experimental results. Therefore, the numerical work was extended to focus on the effect of NSM location. These results showed that, strengthened beams by NSM bars with the same internal arms and without end anchorage recorded the same load carrying capacity regardless of the location of the NSM bars either bottom or side. Furthermore, strengthened beams by side NSM bars with end anchorage embedded horizontally in the confined portion of the beam cross section showed significant improvement in the load carrying capacity of the strengthened beams compared to those with end anchorage embedded vertically in the concrete cover of the beam side.
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•Steel wires were used as strengthening elements in the near-surface mounted method.•This method enhances the behaviour of masonry panels in aspects such as load-bearing capacity and ...dissipated energy.•The placement of steel wires along the wall in the diagonal direction is the best arrangement.
The use of masonry materials in load-bearing walls has a history of centuries. Many efforts have been made to overcome their poor structural strength; one such solution is the near-surface mounted method. In the present study, steel wires 2.5 mm in diameter were used as reinforcement in the near-surface mounted method to strengthen masonry walls. Compared to rival materials, steel wires enjoy such advantages as small dimensions, eliminating buckling damage, lower cost, and ease of installation. The objective of the study was to determine the feasibility of using wires in the near-surface mounted method and to identify the best wire arrangement. For the purposes of, eight masonry wall panels of 920 × 920 × 100 mm were constructed to investigate the effects of different steel wire arrangements on such panel properties as strength, load-bearing capacity, and wall pseudo-ductility. The results showed that steel wires placed along the wall in the diagonal direction had the best effects on improving the performance of the masonry wall panels. Experimental results confirmed the desirable effects of the steel wire in the near-surface mounted method. This is evidenced by a 21-fold increase in Load-bearing capacity, a 52-fold increase in energy dissipation, and a 17-time rise in shear modulus as a result of using the wires. The near-surface mounted method is an appropriate method to reduce damage to residential masonry buildings and to safeguard historical and cultural heritage monuments.
Endoscopic assisted breast surgery (EABS) or robotic assisted breast surgery (RABS) performed through minimal axillary and/or peri-areolar incisions has become the representative of minimal access ...breast surgery (MABS). We report the trend and clinical outcome of MABS for treatment of breast cancer.
Information on patients who underwent breast cancer operation by the principal investigator during the period of 2011 to 2020 was collected from a single institute for analysis. The clinical outcome, trend, and cost of MABS were analyzed and compared with conventional breast surgery (CBS).
A total of 824 breast cancer patients operated by a single surgeon were enrolled in this study: 254 received CBS and 570 received MABS, namely, 476 EABS and 94 RABS. From 2011 to 2020, the number of MABS performed annually has shown an increasing trend. Compared with CBS, MABS such as breast conserving surgery and nipple sparing mastectomy (NSM) have effectively reduced wound scar length. Since the sequential uprise from conventional NSM (C-NSM), dual-axillary-areolar-incision two dimensional (2D) endoscopic assisted NSM (E-NSM), single-axillary-incision E-NSM, robotic assisted NSM (R-NSM), and single-port 3D E-NSM, the development of minimal access mastectomies increasingly paralleled with NSM. The operation time of various MABS decreased significantly and showed no statistical difference compared with CBS. R-NSM was associated with highest cost, followed by 3D E-NSM, E-NSM, and C-NSM. The positive surgical margin rate and local recurrence rate of MABS and CBS were not statistically different.
MABS showed comparable clinical outcome and preliminary oncologic safety as CBS and has been increasingly performed as the surgical treatment of breast cancer, especially minimal access NSM.
Our center proposes a new technique that effectively provides space to broaden the surgical field of view and overcomes the limitations of endoscopy-assisted nipple-sparing mastectomy (E-NSM) by ...changing the dissection sequence and combining it with air inflation. The purpose of this study was to compare the clinical outcomes of the new technique designated "reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with subpectoral breast reconstruction (SBR)" and the conventional E-NSM (C-E-NSM) with SBR.
All patients undergoing E-NSM with SBR at our breast center between April 2017 and December 2022 were included in this study. The cohort was divided into the C-E-NSM group and the R-E-NSM group. The operation time, anesthesia time, medical cost, complications, cosmetic outcomes, and oncological safety were compared.
Twenty-six and seventy-nine consecutive patients were included in the C-E-NSM and R-E-NSM groups, with average ages of 36.9 ± 7.0 years and 39.7 ± 8.4 years (P=0.128). Patients in the R-E-NSM group had significantly shorter operation time (204.6 ± 59.2 vs. 318.9 ± 75.5 minutes, p<0.001) and anesthesia time (279.4 ± 83.9 vs. 408.9 ± 87.4 minutes, p<0.001) and decreased medical costs 5063.4 (4439.6-6532.3) vs. 6404.2 (5152.5-7981.5), USD, p=0.001 and increase SCAR-Q scores (77.2 ± 17.1 vs. 68.8 ± 8.7, P=0.002) compared to the C-E-NSM group. Although trends increased in both the excellent rate of Ueda scores (53.8% vs. 42.3%, P = 0.144), excellent rate of Harris scores (44.0% vs. 63.1%, P=0.102), and decreased surgical complications (7.6% vs. 19.2%, P = 0.135) were observed in the R-E-NSM group, the differences were not significant. There were no significant differences in oncological outcomes between the two groups.
R-E-NSM improves cosmetic outcomes and efficiency of C-E-NSM, reduces medical costs, and has a trend of lower surgical complications while maintaining the safety of oncology. It is a safe and feasible option for oncological procedures that deserves to be promoted and widely adopted in practice.
Abstract Tospovirus is the only genus containing virus species which infect plants in the Bunyaviridae family. The aims of this study were to understand the in vivo membrane association of the ...movement protein (NSm) of the tospovirus species Bean necrotic mosaic virus , Chrysanthemum stem necrosis virus , Tomato chlorotic spot virus and Tomato spotted wilt virus and the homologous and heterologous interactions among NSm and nucleocapsid protein (N). The results obtained by bimolecular fluorescence complementation (BiFC) assay and chemical treatments after membrane fractionation revealed that the four NSm proteins are associated with the biological membranes with the N- and C-termini oriented to the cytoplasm. BiFC analysis for protein–protein interactions showed: i) dimer formation for all NSm and N proteins; ii) interaction between NSm and the cognate N and iii) heterologous interactions between the NSm and N proteins. The implications of these interactions in the life cycle of tospoviruses are discussed.
•NSM and prestressed NSM are effective techniques that greatly enhanced the flexural behaviour of strengthened RC beams.•BFRP bars showed superior performance in strengthening of RC beams using NSM ...and prestressed NSM techniques.•The initial prestressing level greatly influence the flexural behavior of strengthened RC beams.•The high creep rupture strength of BFRP bars offers it a priority for strengthening RC beams using prestressed NSM technique compared to GFRP bars.
This research aimed at studying the flexural behavior of RC beams strengthened with near surface mounted (NSM) technique using basalt FRP (BFRP) bars to assess their efficiency for strengthening RC beams in order to be introduced as an alternative to other types of FRP bars. Moreover, this study investigated a new type of strengthening technique, named prestressed near surface mounted (PNSM) technique, which is expected to offer lots of advantages owing to combining two well-known “external prestressing” and “NSM” techniques. The variables considered in this study were the strengthening effect (unstrengthened and strengthened), the type of the FRP bars (BFRP and GFRP), the strengthening technique (NSM and PSNM), the initial prestressing level (30% and 50% of ultimate tensile capacity of BFRP bars), and the position of NSM FRP bars (bottom and side). The test results demonstrated the efficiency of using BFRP bars for strengthening RC beams with NSM and PNSM techniques. Additionally, BFRP bars offered additional advantage compared to GFRP bars when strengthened with PNSM technique owing to its higher creep rupture strength. Moreover, the test results proved that strengthening of RC beams with PNSM technique offers superior enhancement in the pre-cracking stage compared to NSM technique while sacrificing a great portion of beam’s ductility.
This paper presents the results on an experimental programme studying the flexural behaviour of internally reinforced Glass-Fibre Reinforced Polymer (GFRP) Reinforced Concrete (RC) beams strengthened ...with Carbon-FRP strips using the Near-Surface Mounted (NSM) technique. Their theoretical load-carrying capacity is assessed by a cracked sectional analysis. It is seen that NSM CFRP results an effective technique to enhance the flexural capacity of RC beams internally reinforced with GFRP bars, despite the high degrees of deformability of GFRP RC. Additionally, an a analytical study to evaluate the influence of different parameters on the flexural capacity of NSM CFRP strengthened concrete beams internally reinforced with either steel or GFRP bars is performed. In general, increasing the reinforcement ratio and mechanical properties, either internal or NSM, increases the flexural capacity. However, the change in the parameters may affect in a different way the ratios of increase and cause different modes of failure.
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