Recently prepectoral breast reconstruction (PBR) has showed acceptable outcomes in the short-term. There are few evidence on long-term results and variables which could influence surgical safety. So ...far, no specific guidelines or indications have been developed for prepectoral technique and heterogeneous inclusion criteria had been used in previous reports.
This study revises a series of 397 patients. We conducted a retrospective comparative analysis of risk factors and outcomes between patients undergoing direct to-implant (DTI) and patients undergoing two-stages expander-assisted (TSE) PBR. Univariate binary logistic regression was performed to investigate the association between the incidence of postoperative and aesthetic complications and several variables.
521 breasts were included in the analysis, with an average follow-up of 38 months. 210 patients underwent DTI and 187 TSE PBR. No statistical differences were found between the two populations in term of the characteristics of patients, surgeries and outcomes. Binary logistic regression found no significant association in the TSE group. In the DTI group, a significant association was found between surgical complications and BMI and adjuvant radiotherapy. The association remained significant only for BMI, when investigated with the onset of aesthetic complications.
Lower BMI and adjuvant radiotherapy are significantly associated to a higher risk of developing a surgical complication in DTI PBR. Patients at lowest BMI with DTI are prone to develop an aesthetic complication. According to this analysis, we suggest to carefully choose candidates for PBR and propose new selection criteria for subcutaneous techniques.
Abstract Background Core needle biopsy (CNB) plays a crucial role as diagnostic tool for breast cancer (BC). The characterization of biomarkers status before surgical treatment is crucial when ...primary systemic therapy is a therapeutic option. The aim of this analysis was to report concordance between preoperative CNB and surgical specimen (SS) in evaluating biomarkers and molecular subtypes. Methods Data have been collected from a cohort of 101 patients affected by early BC treated at Careggi Florence University Hospital, between January 2014 and March 2015. The conformity between molecular subtype classification was tested using kappa (κ) test. Results Mean age was 57.5 years (range 29–86). There was concordance between the estrogen receptor (ER) assessment on CNB and SS in 95 cases (94.1%). Concordance of the progesterone receptor (PgR) assessment was observed in 89 cases (88.1%). Concordance for detecting immunohistochemistry-assessed BC molecular subtypes was 87.1% (κ = 0.78). Concerning Ki-67 evaluation, we report a concordance rate of 88.1% (κ = 0.68). The evaluation of luminal A plus luminal B/HER negative subgroup showed a κ-value of 0.65. Conclusions CNB showed good accuracy in evaluating hormonal receptors status, HER2, and BC molecular subtypes. Evaluation of Ki67 status was less accurate than other biomarkers; therefore, we recommend that it should be detected both on CNB and SS samples, especially in hormonal positive HER2 negative tumors, in order to avoid a misclassification of tumor subtypes that could lead to an omission of potential effective systemic therapy.
Although demand for prophylactic mastectomy is increasing over time among women at a high risk for breast cancer, there is a paucity of studies on long term patient-reported outcomes after this ...procedure.
Between January 2011 and January 2015, 46 patients documented BRCA1/2 mutation carriers, eligible for prophylactic nipple-sparing mastectomy (NSM) and immediate breast prosthetic reconstruction were registered at our Institution. Patients underwent NSM and subcutaneous reconstruction with implant covered by a titanium-coated polypropylene mesh (TiLoop®). The BREAST-Q questionnaire was given to patients prior to surgery and at 1 and 2 years follow-up points. Capsular contracture was evaluated by Baker scale. Surgical outcomes along with the changes in BREAST-Q score were analyzed over time.
Complications were reported in only one case and after two years the capsular contracture rates were acceptable (grade I: 65,2%; grade II: 32,6%; grade III 2,2%). At one year and two year follow-ups patients reported high rates in the measures of overall satisfaction with breasts (72,5 and 73,7 respectively), psychosocial well-being (78,4 and 78,6), sexual well-being (58,8 and 59,4), physical well-being (77,6 and 80,6) and overall satisfaction with outcome (75,7 and 79,7). A statistically significant increase in all BREAST-domains from the preoperative to the postoperative period was reported at one and two years follow-ups (p < 0,05).
Following bilateral prophylactic NSM and immediate subcutaneous reconstruction with TiLoop®, patients demonstrated high levels of satisfaction and quality of life as measured by BREAST-Q. 2-years outcomes confirmed high patient comfort with increased scores from the preoperative baseline level.
•Bilateral prophylactic NSM and DTI subcutaneous breast reconstruction with a titanium-coated polypropylene mesh for BRCA1/2 mutation carriers.•Outcomes evaluation with preoperative and postoperative BREAST-Q modules.•The technique provides acceptable complications rate and high levels of quality of life outcomes.
The purpose of this study is to describe a new algorithm based on a neural network approach (Passive microwave Neural network Precipitation Retrieval – PNPR) for precipitation rate estimation from ...AMSU/MHS observations, and to provide examples of its performance for specific case studies over the European/Mediterranean area. The algorithm optimally exploits the different characteristics of Advanced Microwave Sounding Unit-A (AMSU-A) and the Microwave Humidity Sounder (MHS) channels, and their combinations, including the brightness temperature (TB) differences of the 183.31 channels, with the goal of having a single neural network for different types of background surfaces (vegetated land, snow-covered surface, coast and ocean). The training of the neural network is based on the use of a cloud-radiation database, built from cloud-resolving model simulations coupled to a radiative transfer model, representative of the European and Mediterranean Basin precipitation climatology. The algorithm provides also the phase of the precipitation and a pixel-based confidence index for the evaluation of the reliability of the retrieval. Applied to different weather conditions in Europe, the algorithm shows good performance both in the identification of precipitation areas and in the retrieval of precipitation, which is particularly valuable over the extremely variable environmental and meteorological conditions of the region. The PNPR is particularly efficient in (1) screening and retrieval of precipitation over different background surfaces; (2) identification and retrieval of heavy rain for convective events; and (3) identification of precipitation over a cold/iced background, with increased uncertainties affecting light precipitation. In this paper, examples of good agreement of precipitation pattern and intensity with ground-based data (radar and rain gauges) are provided for four different case studies. The algorithm has been developed in order to be easily tailored to new radiometers as they become available (such as the cross-track scanning Suomi National Polar-orbiting Partnership (NPP) Advanced Technology Microwave Sounder (ATMS)), and it is suitable for operational use as it is computationally very efficient. PNPR has been recently extended for applications to the regions of Africa and the South Atlantic, and an extended validation over these regions (using 2 yr of data acquired by the Tropical Rainfall Measuring Mission precipitation radar for comparison) is the subject of a paper in preparation. The PNPR is currently used operationally within the EUMETSAT Hydrology Satellite Application Facility (H-SAF) to provide instantaneous precipitation from passive microwave cross-track scanning radiometers. It undergoes routinely thorough extensive validation over Europe carried out by the H-SAF Precipitation Products Validation Team.
Recently, prepectoral breast reconstruction is experiencing a revival. Despite the growing body of early reports about subcutaneous breast reconstruction, literature lacks in long-term results and ...studies focusing on patient-reported outcomes and health-related quality of life.
Between January 2012 and December 2016, patients undergoing mastectomy were enrolled at our institution. We selected patients diagnosed with breast cancer or genetic predisposition to breast cancer, undergoing conservative mastectomy, either nipple-sparing or skin-sparing mastectomy, and willing for prepectoral tissue expander reconstruction assisted by a synthetic mesh. Exclusion criteria were body mass index greater than 35 kg/m2 and pregnancy. BREAST-Q questionnaire was administered prior to surgery and after 1 year. Capsular contracture was evaluated using Baker scale. Oncological, surgical, and esthetic outcomes along with the changes in BREAST-Q score were analyzed over time.
One hundred eighty-seven patients were enrolled, with an average age of 55.5 years. One hundred thirty-seven unilateral mastectomy and 50 bilateral mastectomy procedures were performed, accounting for a total of 237 operated breasts. The average follow-up period after the second stage was 36.5 months. Postoperative complications that require a second operation occurred in 16 cases (6.7%) (4 wound dehiscence, 2 skin–nipple necrosis, 7 infections, and 3 seroma cases). A locoregional recurrence occurred in 3 cases (1.9%) and a systemic recurrence occurred in 2 cases (1.3%). Patients scored high level of satisfaction with outcome. Overall satisfaction with breasts, psychosocial well-being, and sexual well-being was all significantly increased after the surgery (p < 0.05).
Two-stage expander reconstruction technique provides the preservation of the pectoralis major muscle with an acceptable rate of complications. We confirm satisfactory patient-reported and esthetic results, with high patient comfort.
The Web has increasingly become the major source of information about health care, and patients who need to undergo breast reconstruction often use the internet to acquire an initial knowledge on the ...subject. We would like to present our study that investigates the quality of published information on pre-pectoral breast reconstruction. We searched the term “Pre-pectoral breast reconstruction” on Google
®
and Yahoo
®
. Forty-two web sites were selected and underwent qualitative and quantitative assessment using the expanded EQIP tool. The analysis of document contents showed a critical lack of information about qualitative risks and side-effects descriptions, treatment of potential complications, alert signs for the patient and precautions that the patient may take. Health professionals should inform patients about the potential difficulties of identifying reliable informational web sites about pre-pectoral breast reconstruction. The quality of available information should be improved, especially the important topics included in the content data section of the modified EQIP tool.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
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Since their discovery, Terrestrial Gamma ray Flashes (TGFs) exhibited an evident correlation with thunderstorms and lightning activity. The fleeting nature of these events and the heavy absorption of ...gamma rays in the lowest atmospheric layers severely hamper the observation of this phenomenon, making us reveal just a small fraction of a probably much wider population. As each thunderstorm produces a large amount of lightning discharges during its lifetime, it is reasonable that even a large amount of TGFs are produced during the same event. However, detection of multiple TGFs coming from the same storm is difficult to perform, as it requires the constant monitoring of a spatially limited geographic region: this is not an easy task to perform for satellites on high‐inclination orbits that make them experience nonnegligible latitudinal shifts at each orbital passage over a certain region, preventing the monitoring of a limited geographic region throughout successive overpasses. In this perspective, the quasi‐equatorial (2.5°) orbit of the Astrorivelatore Gamma ad Immagini LEggero (AGILE) satellite ensures a minimal latitudinal shift when flying over the same region at successive passages, allowing for the follow‐up of thunderstorms in time. We exploit this feature of the AGILE satellite to search for multiple TGFs coming from the same geographic region and, in particular, from the same thunderstorm. We carry out this search on the AGILE TGF database (2009–2016), ending up with a sample of 79 systems producing more than one TGF, both during the same overpass and up to four overpasses after. Data acquired by geostationary meteorological satellites and cross correlation with radio sferics detected by World Wide Lightning Location Network are used to support this investigation. The AGILE satellite for the first time clearly establishes the multiple occurrences of TGFs from convective thunderstorms, both on timescales of minutes to several hours.
Key Points
The AGILE satellite observed more TGFs originating from the same spatially limited geographic regions
This work represents an indirect evidence that more TGFs can be produced by thunderstorms throughout their lifetime
The orbit of the AGILE satellite is unique to perform follow‐up of thunderstorms in time
A multi-sensor analysis of convective precipitation events that occurred in central Italy in autumn 2012 during the HyMeX (Hydrological cycle in the Mediterranean experiment) Special Observation ...Period (SOP) 1.1 is presented. Various microphysical properties of liquid and solid hydrometeors are examined to assess their relationship with lightning activity. The instrumentation used consisted of a C-band dual-polarization weather radar, a 2-D video disdrometer, and the LINET lightning network. Results of T-matrix simulation for graupel were used to (i) tune a fuzzy logic hydrometeor classification algorithm based on Liu and Chandrasekar (2000) for the detection of graupel from C-band dual-polarization radar measurements and (ii) to retrieve graupel ice water content. Graupel mass from radar measurements was related to lightning activity. Three significant case studies were analyzed and linear relations between the total mass of graupel and number of LINET strokes were found with different slopes depending on the nature of the convective event (such as updraft strength and freezing level height) and the radar observational geometry. A high coefficient of determination (R2 = 0.856) and a slope in agreement with satellite measurements and model results for one of the case studies (15 October 2012) were found. Results confirm that one of the key features in the electrical charging of convective clouds is the ice content, although it is not the only one. Parameters of the gamma raindrop size distribution measured by a 2-D video disdrometer revealed the transition from a convective to a stratiform regime. The raindrop size spectra measured by a 2-D video disdrometer were used to partition rain into stratiform and convective classes. These results are further analyzed in relation to radar measurements and to the number of strokes. Lightning activity was not always recorded when the precipitation regime was classified as convective rain. High statistical scores were found for relationships relating lightning activity to graupel aloft.
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