CT reconstruction using diffusion posterior sampling conditioned on a nonlinear measurement model.

Purpose: Recently, diffusion posterior sampling (DPS), where score-based diffusion priors are combined with likelihood models, has been used to produce high-quality computed tomography (CT) images given low-quality measurements. This technique permits one-time, unsupervised training of a CT prior, which can then be incorporated with an arbitrary data model. However, current methods rely on a linear model of X-ray CT physics to reconstruct. Although it is common to linearize the transmission tomography reconstruction problem, this is an approximation to the true and inherently nonlinear forward model. We propose a DPS method that integrates a general nonlinear measurement model. Approach: We implement a traditional unconditional diffusion model by training a prior score function estimator and apply Bayes' rule to combine this prior with a measurement likelihood score function derived from the nonlinear physical model to arrive at a posterior score function that can be used to sample the reverse-time diffusion process. We develop computational enhancements for the approach and evaluate the reconstruction approach in several simulation studies. Results: The proposed nonlinear DPS provides improved performance over traditional reconstruction methods and DPS with a linear model. Moreover, as compared with a conditionally trained deep learning approach, the nonlinear DPS approach shows a better ability to provide high-quality images for different acquisition protocols. Conclusion: This plug-and-play method allows the incorporation of a diffusion-based prior with a general nonlinear CT measurement model. This permits the application of the approach to different systems, protocols, etc., without the need for any additional training.

Total substitution and partial modification of the set of non-ribosomal peptide synthetases clusters lead to pyoverdine diversity in the Pseudomonas fluorescens complex.

Pyoverdines are high affinity siderophores produced by most Pseudomonas with a wide role in microbial interspecies interactions. They are primarily composed of a conserved chromophore moiety, an acyl side chain and a peptide backbone which may be highly variable among strains. Upon ferric iron sequestration, pyoverdines are internalized through specialized receptors. The peptide precursor of pyoverdine, termed ferribactin, is synthesized by a set of non-ribosomal peptide synthetase (NRPS) enzymes and further modified by tailoring enzymes. While PvdL, the NRPS responsible for the synthesis of the peptide moiety that derives into the chromophore is conserved, the NRPSs for the peptide backbone are different across fluorescent Pseudomonas. Although the variation of pyoverdine is a widely recognized characteristic within the genus, the evolutionary events associated with the diversity and distribution of this trait remain mostly unknown. This study analyzed the NRPSs clusters for the biosynthesis of the peptide backbone of ferribactin in the genomes of a representative subset of strains of the Pseudomonas fluorescens complex. Bioinformatic analysis of the specificity of adenylation domains of the NRPSs allowed the prediction of 30 different pyoverdine variants. Phylogenetic reconstruction and mapping of the NRPS clusters pinpointed two different general levels of modifications. In the first level, a complete replacement of the set of NRPRs by horizontal transfer occurs. In the second level, the original set of NRPSs is modified through different mechanisms, including partial substitution of the NRPS genes by horizontal transfer, adenylation domain specificity change or NRPS accessory domain gain/loss.

Anatomic femoral tunnel and satisfactory clinical outcomes achieved with the modified transtibial technique in anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

Background: Anatomic anterior cruciate ligament (ACL) reconstruction is considered the gold standard treatment for ACL injuries because it aims to restore the knee's normal anatomy and stability, while also protecting long-term knee health. Long-term clinical and radiological outcomes after ACL reconstruction using the modified TT technique are unclear. Objective: To assess the clinical and radiological outcomes following ACL reconstruction using modified transtibial (TT) techniques at a minimum 12-month follow-up. Design: A systematic review with meta-analysis. Methods: PubMed, EMBASE, Web of Science, the Cochrane Library, and MEDLINE databases were searched from the inception to December 1, 2022. PICO search strategy was used to identify studies applying modified TT techniques on patients with ACL reconstruction and a minimum follow-up of 12 months. Eligible studies were identified independently by two reviewers. We extracted data on patient demographics, surgical characteristics, patient reported outcomes including subjective evaluations and clinical outcomes. Radiological data including femoral and tibial tunnel position, femoral and tibial tunnel length, and femoral tunnel angle were also extracted. The tunnel position was evaluated using the quadrant method based on three-dimensional computed tomography (3D CT) images. The standardized mean difference (SMD) and 95 % confidence interval (CI) were calculated for clinical and radiological outcomes. Results: Sixteen studies involving 628 patients were finally included. The SMD of Lysholm (90.39; 95 % CI 83.41-97.38), IKDC (86.07; 95 % CI 79.84-92.31), and Tegner (6.15; 95 % CI 3.96-8.33) scores were considered satisfactory. The depth of the femoral tunnel showed a pooled SMD of 30.08 % (95 % CI 28.25-31.91 %), and the height showed a pooled SMD of 37.72 % (95 % CI 35.75-39.70 %). The pooled SMD for the femoral tunnel angle in the coronal plane was 48.27°(95 % CI 43.14-53.40°), and the pooled SMD for the femoral tunnel length was 33.98 mm (95 % CI 29.03-38.93 mm). Conclusions: This investigation has shown that modified TT technique can create an anatomic femoral tunnel and maintain optimal tunnel length and angulation. Most patients had satisfactory subjective outcomes and physical examinations after ACL reconstruction using modified TT technique. This information may assist in guiding expectations of clinicians and patients following ACL reconstruction with modified TT technique.

Nipple Areola Complex Reconstruction: An 8-Year Experience With Modified Technique and Systematic Review.

Background: Nipple areola complex reconstruction is often the last procedure offered to patients undergoing breast reconstruction. Although comparatively minor, this final step creates the focal point of the breast while signifying the end of an often long and difficult journey for patient and surgeon. The literature demonstrates that nipple areolar complex (NAC) reconstruction conveys a positive impact on overall body image while defining the final aesthetic outcome. This paper presents a novel technique for NAC reconstruction developed at a UK tertiary referral center. It is supported by a systematic review of the current literature. Methods: Between 2014 and 2022, a new technique was used to reconstruct the NAC using a modification of the C-V flap with a full-thickness skin graft (FTSG) and later nipple tattoo, if required. Patients were followed up in clinic noting complications, satisfaction, and need for revision surgery. The study was completed by conducting a systematic review of the literature assessing areolar reconstruction with skin grafts, according to PRISMA guidelines. Discussion: This technique provides excellent results in terms of patient satisfaction and objective outcomes (complication rate, need for revision procedures, and loss of projection requiring further surgery). This literature review reflects alternative techniques and highlights the advantages of using a modified C-V flap with FTSG, in terms of morbidity and patient satisfaction. Conclusions: NAC reconstruction is the "cherry on top" at the end of the breast reconstructive journey. This paper advocates a technique that is reproducible, with minimal complications, excellent outcomes, and long-standing results.

Reconstruction of Complex Upper Extremity Wounds With Novosorb Biodegradable Temporizing Matrix Versus Integra Collagen-Chondroitin Silicone: A Cost Analysis.

Background: Reconstruction of upper extremity wounds with dermal matrices can reduce the length of hospitalization and surgical complexity without compromising functional outcomes. We aimed to compare costs between Novosorb biodegradable temporizing matrix (BTM) and Integra collagen-chondroitin silicone (CCS) bilayer. Methods: A chart review was performed for patients with isolated upper extremity traumatic wounds who underwent reconstruction with either BTM or CCS between January 2017 and May 2022. Demographic data, surgical procedures, outcomes, and costs were collected for analysis. Results: Twenty-seven patients were included: 18 BTM and 9 CCS. There were no differences in age, sex, wound size, or dermal template size. Skin grafting was required less frequently in BTM compared with CCS (44.4% vs 55.6%, P = .013). Time to skin graft was longer in the BTM group (43.4 days vs 21.4 days, P = .002). The BTM group experienced fewer complications (33.3% vs 55.6%, P = .002). The mean number of secondary procedures required after template placement was 0.67 in BTM compared with 1.56 in CCS, P = .049. When factoring in the cost of product, the cost of reconstruction with BTM was significantly lower than CCS ($1361.92 vs $3185.71, P = .049). Conclusions: Novosorb BTM is a more cost-effective option when compared with CCS for reconstruction of upper extremity soft tissue defects.

An integrated method for phenotypic analysis of wheat based on multi-view image sequences: from seedling to grain filling stages.

Wheat exhibits complex characteristics during its growth, such as extensive tillering, slender and soft leaves, and severe organ cross-obscuration, posing a considerable challenge in full-cycle phenotypic monitoring. To address this, this study presents a synthesized method based on SFM-MVS (Structure-from-Motion, Multi-View Stereo) processing for handling and segmenting wheat point clouds, covering the entire growth cycle from seedling to grain filling stages. First, a multi-view image acquisition platform was constructed to capture image sequences of wheat plants, and dense point clouds were generated using SFM-MVS technology. High-quality dense point clouds were produced by implementing improved Euclidean clustering combined with centroids, color filtering, and statistical filtering methods. Subsequently, the segmentation of wheat plant stems and leaves was performed using the region growth segmentation algorithm. Although segmentation performance was suboptimal during the tillering, jointing, and booting stages due to the glut leaves and severe overlap, there was a salient improvement in wheat leaf segmentation efficiency over the entire growth cycle. Finally, phenotypic parameters were analyzed across different growth stages, comparing automated measurements of plant height, leaf length, and leaf width with actual measurements. The results demonstrated coefficients of determination ( R 2 ) of 0.9979, 0.9977, and 0.995; root mean square errors (RMSE) of 1.0773 cm, 0.2612 cm, and 0.0335 cm; and relative root mean square errors (RRMSE) of 2.1858%, 1.7483%, and 2.8462%, respectively. These results validate the reliability and accuracy of our proposed workflow in processing wheat point clouds and automatically extracting plant height, leaf length, and leaf width, indicating that our 3D reconstructed wheat model achieves high precision and can quickly, accurately, and non-destructively extract phenotypic parameters. Additionally, plant height, convex hull volume, plant surface area, and Crown area were extracted, providing a detailed analysis of dynamic changes in wheat throughout its growth cycle. ANOVA was conducted across different cultivars, accurately revealing significant differences at various growth stages. This study proposes a convenient, rapid, and quantitative analysis method, offering crucial technical support for wheat plant phenotypic analysis and growth dynamics monitoring, applicable for precise full-cycle phenotypic monitoring of wheat.

Interfacial coupling of Ce-CoSe2 nanoneedle arrays with MXene for efficient overall water splitting.

Designing highly effective, low-cost bifunctional electrocatalysts without noble metals for overall water splitting remains a significant challenge. In this work, interfacial coupling of Ce-doped CoSe2 nanoneedle arrays with MXene (Ce-CoSe2/MXene) is developed via the facile hydrothermal and selenization methods. The extensive specific surface area and favorable hydrophilicity of Ti3AlC2, combined with the optimized electronic structure and abundant active sites from Ce-doping and selenization, contribute to the exceptional bifunctional electrocatalytic performance of the Ce-CoSe2/MXene electrode. Specifically, this heterostructure achieves a low hydrogen evolution reaction (HER) overpotential of 34 mV at 10 mA cm-2, an oxygen evolution reaction (OER) overpotential of 279 mV at 100 mA cm-2, and an overall water splitting (OWS) potential as low as 1.45 V at 10 mA cm-2. In-situ Raman spectroscopy reveals that surface reconstruction would improve catalytic activity and stability. Theoretical calculations indicate that the Ce-CoSe2/MXene can improve the adsorption of intermediates and facilitate HER/OER process by lowering the kinetic barrier, thereby enhancing electrocatalytic activity. This research marks a substantial advancement in the development of low-cost, efficient electrocatalysts for overall water splitting.

The Impact of Scars After DIEP-Flap Breast Reconstruction on Satisfaction and HR-QoL: A Cross-Sectional Study Comparing BREAST-Q Scores.

BACKGROUND: Although deep inferior epigastric perforator (DIEP) flap breast reconstruction is the most widely used technique for autologous breast reconstruction, this technique leads to large scars in visible areas on breast and abdomen. So far, limited studies have thoroughly addressed the impact of breast and abdominal scars on satisfaction and Health-related Quality of Life (HR-QoL). OBJECTIVES: This research aimed to determine whether women with no/minor scar symptoms after undergoing DIEP-flap breast reconstruction differ in satisfaction and perceived HR-QoL from women with symptomatic scars. MATERIALS AND METHODS: In this cross-sectional survey study, women who had previously undergone DIEP-flap breast reconstruction completed an online survey. Patient-reported scar quality was assessed with the Patient and Observer Scar Assessment Scale (POSAS), and satisfaction and HR-QoL with BREAST-Q. Independent-samples t-tests were conducted to compare BREAST-Q scores between women with no/minor scar symptoms (POSAS overall opinion score 1-3) and women with symptomatic scars (POSAS overall opinion score 4-10). RESULTS: A total of 248 women completed the survey. Women with scar symptoms had significantly worse BREAST-Q scores on 'Satisfaction with breasts,' 'Physical well-being,' 'Psychosocial well-being' and, 'Sexual well-being' compared to women with no/minor scar symptoms (p ≤ 0.001). CONCLUSION: After DIEP-flap breast reconstructions, women with symptomatic breast and abdominal scars had a clinically relevant and statistically significant lower degree of satisfaction and HR-QoL compared to women who had no/minor scar symptoms. We therefore recommend to explicitly and repeatedly address inevitability of visible scars after DIEP-flap breast reconstruction, aiming to improve preoperative patient selection and post-operative expectation management. 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 .

Evaluation under loading detects medial meniscus extrusion in patients with reconstructed anterior cruciate ligament and restricted knee extension.

PURPOSE: Some patients who undergo anterior cruciate ligament (ACL) reconstruction experience abnormal mechanical stress in the meniscus. Medial meniscal extrusion (MME) is reflected in the pathological condition of the meniscus, which expands owing to repetitive mechanical stress. Thus, the effect of the reconstructed ACL on increasing MME under weight-bearing conditions remains unclear. This study investigated the effect of ACL reconstruction on meniscal extrusion under non-weight-bearing and weight-bearing conditions. METHODS: Seventeen patients who underwent unilateral ACL reconstruction (ACL group) and 20 age-matched healthy volunteers (control group) were enrolled. Ultrasonography was performed in the supine, standing, and walking positions in preoperative and postoperative ACL patients. MME during walking was evaluated based on the dynamic behavior of extrusion, and kinetic and kinematic data were synchronously obtained. Moreover, the ACL group underwent magnetic resonance imaging (MRI) evaluation at two points: preoperatively and 12 months postoperatively, and the ultrasound findings were compared. RESULTS: MME in the supine position measured using both ultrasonography and MRI was not significantly different preoperatively and postoperatively in the ACL group. However, postoperative MME and dynamic behavior of extrusion under standing and walking conditions were significantly higher than those in the preoperative state (dynamic behavior: 0.9 ± 0.4 mm preoperatively, 1.2 ± 0.4 mm postoperatively). Moreover, the deficits in knee extension during walking persisted postoperatively and were significantly higher than those in the control group. CONCLUSION: MME in patients with ACL reconstruction including meniscus repair was different under mechanical stress compared to the non-weight bearing condition.

A preliminary study of the mechanical properties of 3D-printed personalized mesh titanium alloy prostheses and repair of hemi-mandibular defect in dogs.

This study is a preliminary investigation exploring the mechanical properties of three-dimensional (3D)-printed personalized mesh titanium alloy prostheses and the feasibility of repairing hemi-mandibular defects. The ANSYS 14.0 software and selective laser melting (SLM) were used to produce personalized mesh titanium alloy scaffolds. Scaffolds printed using different parameters underwent fatigue property tests and scanning electron microscopy (SEM) of the fracture points. Models of hemi-mandibular defects (encompassing the temporomandibular joint) were created using beagle dogs. Freeze-dried allogeneic mandibles or 3D-printed personalized mesh titanium alloy prostheses were used for repair. Gross observation, computed tomography (CT), SEM, and histological examinations were used to compare the two repair methods. The prostheses with filament diameters of 0.5 and 0.7 mm could withstand 14,000 times and >600,000 cycles of alternating stresses, respectively. The truss-structure scaffold with a large aperture and large aperture ratio could withstand roughly 250,000 cycles of alternating forces. The allogeneic mandible graft required intraoperative shaping, while the 3D-printed mesh titanium alloy prostheses were personalized and did not require intraoperative shaping. The articular disc on the non-operated sides experienced degenerative changes. No liver and kidney toxicity was observed in the two groups of animals. The 3D-printed mesh titanium alloy prostheses could effectively restore the shape of the mandibular defect region and reconstruct the temporomandibular joint.

Use of Free Internal Mammary Artery Perforator Flap Harvested With Minimally Invasive Approach for Facial Reconstruction: Report of Two Cases.

The internal mammary artery perforator (IMAP) flap has been widely used for chest wall and neck reconstruction. The color of its skin paddle closely resembles that of facial skin, making it attractive for facial reconstruction. However, there has been insufficient investigations reporting the use of free IMAP flap. Furthermore, even in such studies, somewhat invasive procedures, including rib cartilage resection, were employed to ensure sufficient pedicle length, potentially increasing donor morbidity. Our report presents two cases of successful facial defect reconstruction using a free IMAP flap harvested with minimal donor site damage, showing its feasibility. In the first case, a 48-year-old male underwent wide excision for a malignant melanoma on his right cheek, resulting in a 4 × 4.5 cm full-thickness defect. A free IMAP flap with a 2.5 cm pedicle, was harvested without rib cartilage resection, preserving IMA main trunk, and transferred with anastomosed to the angular vessels within the defect. The second patient presented with a 4.5 × 3.5 cm basal cell carcinoma on the left cheek, necessitating wide excision and leaving a 6 × 5 cm defect. A free IMAP flap was harvested with the same approach and successfully reconstructed the defect with connected to the superficial temporal vessels using vascular bridge. Both patients were discharged complication-free, with no recurrence during 24 and 15 months of follow-up, respectively. They were highly satisfied with the final skin color and texture outcomes. Harvesting a free IMAP flap while minimizing donor morbidity may offer an attractive option for facial reconstruction.

Surface Reconstruction Regulation of Co3N Through Heterostructure Engineering Toward Efficient Oxygen Evolution Reaction.

Oxygen evolution reaction (OER) electrocatalysts generally experience structural and electronic modifications during electrocatalysis. This phenomenon, referred to as surface reconstruction, results in the formation of catalytically active species that act as real OER sites. Controlling surface reconstruction therefore is vital for enhancing the OER performance of electrocatalysts. In this study, a new approach is introduced of heterostructure engineering to facilitate the surface reconstruction of target catalysts. Using MnCo carbonate hydroxide (MnCo─CH)@Co3N as a demonstration, it is discovered that the surface reconstruction occurs more readily and rapidly on MnCo─CH@Co3N than on Co3N. More interestingly, during the reconstruction process, Mn species migrate to the surface, enabling the in situ formation of highly active Mn-doped CoOOH. Consequently, the MnCo─CH@Co3N catalyst after reconstruction exhibits a low overpotential of 257 mV at 10 mA cm-2, compared to 379 mV of individual Co3N. This work offers fresh perspectives on understanding the enhanced OER performance of heterostructure electrocatalysts and the role of heterostructure in promoting surface reconstruction.

Reconstruction and Solidification of Dion-Jacobson Perovskite Top and Buried Interfaces for Efficient and Stable Solar Cells.

Quasi-two-dimensional (Q-2D) perovskites show great potential in the field of photonic and optoelectronic device applications. However, defects and local lattice dislocation still limit performance and stability improvement by nonradiative recombination, unpreferred phase distribution, and unbonded amines. Here, a low-temperature synergistic strategy for both reconstructing and solidifying the perovskite top and buried interface is developed. By post-treating the 1,4-phenylenedimethanammonium (PDMA) based (PDMA)MA4Pb5I16 films with cesium acetate (CsAc) before thermal annealing, a condensation reaction between R-COO- and -NH2 and ion exchange between Cs+ and MA+ occur. It converts the unbonded amines to amides and passivates uncoordinated Pb2+. Meanwhile, it adjusts film composition and improves the phase distribution without changing the out-of-plane grain orientation. Consequently, performance of 18.1% and much-enhanced stability (e.g., stability for photo-oxygen increased over 10 times, light-thermal for T90 over 4 times, and reverse bias over 3 times) of (PDMA)MA4Pb5I16 perovskite solar cells are demonstrated.

Urethroplasty- a single centre single surgeon experience.

INTRODUCTION: Male urethral stricture affects 100 in 100,000 men. These are investigated using uroflowmetry, retrograde urethrography and cystourethroscopy. Management is usually endoscopic with urethral dilation or direct visual internal urethrotomy, although they have high failure rates. It is now recommended that urethroplasty is performed earlier. In this study we have reviewed a single surgeons experience with urethroplasty and patient outcomes. METHODS: We retrospectively reviewed a prospectively maintained database of all urethroplasty operations performed in our hospital over a 5 -year period. RESULTS: Forty-five patients were identified, with a mean age of 46. The most common presenting symptom was poor flow (100%). Uroflowmetry was performed in 31 of 45 patients(69%). More patients had a urethrogram (58%) than flexible cystoscopy (38%). Most strictures were idiopathic (67%). Mean stricture length was 2.6 cm. 71% did not require any further intervention. Five patients required repeat surgery. Four required DVIU and one required a repeat urethroplasty. DISCUSSION: The most popular techniques for urethroplasty in the UK are augmentation urethroplasty using a buccal mucosal graft and anastomotic urethroplasty, both of which we describe. There are variations in what is deemed as successful surgery. The most widely used definition is 'the lack of need for any further operative intervention'. We have recently adopted Patient Reported Outcome Measures using a validated questionnaire to measure the patients perception of a successful outcome. Complex strictures have a higher incidence of complications. 42% of our cohort were complex and we describe results comparable to the published literature.

Forensic entomology in homicide cases: study of a corpse found inside a buried vehicle.

Forensic entomology plays a crucial role in death investigations, particularly in estimating the postmortem interval (PMI). This study presents a forensic entomology case involving a corpse found in a buried utility vehicle. The victim was in an advanced state of decomposition, with autopsy findings revealing gunshot wounds. Cadaveric fauna was collected at the scene and during the autopsy. The analysis revealed a diverse insect community, with predominance of Compsomyiops fulvicrura and Piophila casei. The time of development of species like Dermestes maculatus and Necrobia rufipes was used to estimate the minimum PMI. The presence and low abundance of Calliphora vicina, a species preferring lower temperatures, shed light on the seasonal conditions at the time of death and suggested possible body concealment shortly after death. This research is the first to report insects as evidence in a corpse found in a buried vehicle and contributes to the body of knowledge in forensic entomology. The study also suggests that the use of entomological evidence can provide additional information about the season in which the body was concealed, making it a valuable tool in death investigation and crime scene reconstruction. Finally, it emphasizes the need for proper sampling, expert identification, and close collaboration between forensic entomologists and pathologists.

Functional reconstruction of tissue defects after total parotidectomy using a modified submandibular gland flap.

OBJECTIVE: Reconstruction of soft tissue defects after total parotidectomy requires a feasible and effective pedicled flap with sufficient volume. In this study, we introduce a modified submandibular gland flap (SMGF) for functional reconstruction of soft tissue defects resulting from total parotidectomy. MATERIALS AND METHODS: This study included 12 patients diagnosed with parotid gland carcinoma undergoing total parotidectomy and ipsilateral selective neck dissection. The modified SMGF was harvested and transferred to the parotid bed. This procedure was coupled with anastomosis between the parotid gland duct and Wharton's duct. The feasibility of the surgery, postoperative complications, facial profile restoration, and salivary secretion were assessed. RESULTS: All SMGFs pedicled only over the proximal facial artery survived without major complications. Facial profiles were well-restored, and salivary secretion was partially reserved. During the postoperative follow-up, no tumor recurrence was observed in any of the cases, and the volume of the SMGFs did not show obvious atrophy. CONCLUSIONS: The modified SMGF is a viable solution for volume restoration and functional reconstruction after total parotidectomy. CLINICAL RELEVANCE: This modified technique is simple and feasible for the functional reconstruction of soft tissue defects after total parotidectomy compared to other flaps and is worthy of clinical promotion.

Capsular contracture in breast reconstruction: A systematic review and meta-analysis.

BACKGROUND: Capsular contracture after implant-based breast reconstruction is not an uncommon problem and affects reconstruction outcomes. It can be influenced by various factors, such as the plane of implant placement, implant surface and implant type. This systematic review and meta-analysis aimed to evaluate how the abovementioned risk factors can affect capsular contracture rates. METHODS: A systematic review and meta-analysis was performed. PubMed MEDLINE, EMBASE (OvidSP) and Cochrane Library were searched. Comparison groups included subpectoral versus prepectoral implant placement, smooth versus textured implants and saline versus silicone implants. Odds ratios (ORs) were calculated for capsular contracture for each group. The level of evidence was evaluated using the Oxford Centre for Evidence-Based Medicine. RESULTS: Twenty-three studies met the inclusion criteria. Sixteen studies compared subpectoral versus prepectoral implant placement, with no statistically significant differences in capsular contracture rates [OR, 1.21; 95% confidence interval (95% CI), 0.75-1.95; P = 0.44]. Five studies compared smooth versus textured implants, with no statistically significant differences in capsular contracture rates (OR, 0.99; 95% CI, 0.50-1.93; P = 0.97). Two studies compared saline versus silicone implants for capsular contracture. Patients receiving saline implants had significantly lower capsular contracture rates than silicone implants (OR, 0.19; 95% CI, 0.08-0.43; P < 0.0001). CONCLUSIONS: Implant-based breast reconstruction using saline implants demonstrated reduced capsular contracture rates compared to silicone implants. However, no significant differences were observed in capsular contracture rates between subpectoral versus prepectoral implant placement and smooth versus textured implants.

Case report: Aortobiiliac bypass with autotransplantation of the horseshoe kidney and renal vascular reconstruction.

INTRODUCTION AND IMPORTANCE: This case report describes the rare encounter of a large infrarenal abdominal aortic aneurysm (AAA) and a horseshoe kidney (HEN), which was managed through comprehensive preoperative planning and effective multidisciplinary collaboration, with the patient being fully informed and consenting to the publication of data and images. CASE PRESENTATION: The patient was referred to the Department of Vascular Surgery with increasing abdominal pain. Computed tomography angiography showed that the aneurysm was significantly advanced. For surgical correction of the aortic aneurysm, the horseshoe kidney was autotransplanted intraoperatively to ensure renal vascular reconstruction for further renal perfusion after treatment of the aneurysm. DISCUSSION: Abdominal aortic aneurysm carries a significant risk of rupture, with more than half of ruptures being fatal before reaching the hospital. When the AAA occurs concomitantly with a HEN, detailed imaging is critical for planning the procedure, as the unusual arterial supply to the HEN complicates the procedure and requires careful strategies to protect renal function while treating the aneurysm. CONCLUSION: The treatment of complex cases with severe disease manifestations and difficult anatomy requires careful planning to ensure effective treatment and optimise patient survival and quality of life.

Spitzoid melanoma of the finger: a case report.

BACKGROUND: Melanoma is the most malignant skin tumor, with a high metastatic potential. Spitzoid melanoma is a subtype of melanoma requiring rapid management and extensive tumor resection. We have set the goal to recognize anatomical peculiarities and difficulties diagnoses posed by this type of tumor, as well as to recognize the management modalities, especially the surgical one, of malignant spitzoid melanoma. CASE PRESENTATION: A 25-year-old Tunisian male patient had consulted for nodular lesion of the right index, evolving for 4 years. A malignant tumor was strongly suspected, then confirmed as a melanoma by a biopsy excision. Initially, the excision was incomplete in depth, suggesting a complementary surgery, but the patient refused it; 3 years later, the patient again consulted after the appearance of an axillary lymphadenopathy and worsening of the skin lesion. A supplement of tumor removal with lymph node biopsy were performed. It was decided to perform an amputation of the second ray and the first commissure with cheiroplasty, reconstructing a four-finger hand. An homolateral axillary cleaning was performed at the same time. The postoperative result is considered esthetically and functionally satisfying. The evolution was marked by the appearance of pulmonary metastases, requiring adjuvant chemotherapy. A regression of the nodule under the mammary skin and total disappearance of axillary nodes have been marked; but the patient's condition rapidly deteriorated, and he died after a 2-month decline. CONCLUSION: Spitzoid melanoma is exceptional, posing difficulties in diagnostics, and it should not be underestimated, considering that it may involve the vital prognosis. Knowledge of this rare form of melanoma is important to avoid misdiagnosis, which delays diagnosis and subsequent therapy.