Medicine and Pharmacology

Abstract: Background: Adipose tissue expansion in obesity is accompanied by extracellular matrix (ECM) remodelling, regulated by matrix metalloproteinases (MMPs). Visceral adipose tissue (VAT) is metabolically more active than subcutaneous adipose tissue (SAT). However, depot-specific differences in proteolytic activity and protein glycooxi-dation remain incompletely characterized. Methods: In this case-control study, we assessed the activity of six matrix metallo-proteinases (MMP-1, -2, -7, -9, -11, -13) using a fluorescence resonance energy transfer (FRET) assay and quantified advanced glycation and glycooxidation-related markers in paired VAT, SAT and plasma samples obtained from 40 patients with obesity and 21 non-obese controls. Results: The activities of all assessed MMPs were greater in patients with obesity than in the control group (p < 0.01 for all MMPs). Direct tissue-compartment comparisons showed that MMP activity and glycooxidation-related markers were most pronounced in VAT, with markedly higher values in obese individuals compared with controls. In VAT of obese individuals, median MMP activity was approximately 50–60% higher compared with controls. Amyloid cross-β-structure, vesperlysine and pentosidine were significantly elevated in VAT in obesity, whereas plasma levels were markedly lower and showed limited group differences. No significant differences were observed between obese par-ticipants with and without metabolic syndrome. Conclusions: Obesity is associated with a depot-specific molecular profile charac-terized by enhanced proteolytic and glycooxidative activity predominantly within vis-ceral adipose tissue. These findings highlight the importance of tissue-compartment–specific assessment in obesity.

Abstract: Early-onset colorectal cancer (EOCRC), defined as colorectal cancer diagnosed before the age of 50 years, has become an emerging global health concern due to its steadily increasing incidence. Compared with late-onset colorectal cancer, EOCRC often presents with more advanced disease and exhibits distinct clinical and biological characteristics. Notably, younger patients are more likely to present with synchronous metastases and multi-organ dissemination at the time of diagnosis. This mini-review summarises current evidence regarding metastatic patterns and the biological mechanisms underlying multi-organ metastasis in EOCRC. The liver remains the most common metastatic site in EOCRC, primarily due to portal venous drainage from the colorectal region. However, studies suggest that EOCRC patients have a higher likelihood of additional metastatic involvement of the lungs, peritoneum, and distant lymph nodes, with occasional spread to the bone and brain. Several biological mechanisms may contribute to this aggressive metastatic behaviour. Distinct molecular alterations, including KRAS and BRAF mutations and microsatellite instability, have been reported in EOCRC and may influence tumour progression and metastatic potential. In addition, tumour microenvironmental changes such as epithelial–mesenchymal transition and angiogenesis play critical roles in facilitating tumour invasion, intravasation, and colonisation of distant organs. Hereditary predisposition, lifestyle-related risk factors, and gut microbiome alterations have also been implicated in EOCRC pathogenesis. A clearer understanding of the metastatic cascade and its molecular drivers in EOCRC is essential for improving early detection and developing targeted therapeutic strategies. Future research integrating molecular profiling and clinical outcomes may help optimize personalised treatment approaches and improve prognosis in this increasingly recognised patient population.

Abstract: Background: Non-colorectal cancer liver metastases (NCRLM) represent a therapeutically challenging condition with poorly defined locoregional treatment options. This study evaluates the safety, oncological efficacy, and survival outcomes of microwave ablation (MWA) for NCRLM in a large single-centre series. Methods: Retrospective analysis of a prospectively collected database of patients undergoing MWA for NCRLM between January 2010 and December 2024 at a high-volume hepatobiliary centre. Endpoints were safety, efficacy, Textbook Outcome (TO) achievement, and overall survival (OS). Results: A total of 138 patients underwent 172 MWA across eight primary tumour categories. Major complications (Clavien-Dindo≥3) occurred in 1.8% of procedures, with a median hospital stay of 2 days and a 30-day mortality of 0.6%. Complete response (CR) was achieved in 77% of procedures. TO was achieved in 54% of procedures, with incomplete CR as the primary driver of failure. Five-year OS varied markedly by histology: 100% for GIST, 80.0% for GEP-NET, 44.7% for breast cancer, and 0% for pancreatic adenocarcinoma. The video-assisted approach was associated with superior OS compared to percutaneous ablation (5-year OS 54.4% vs. 26.0%, p=0.00025). Repeat MWA was the most frequent treatment for first hepatic recurrence (43%), and 50.0% of patients achieved non-evidence of disease (NED) at final follow-up. Conclusions: MWA is a safe and repeatable locoregional treatment for NCRLM, with outcomes driven by primary tumour biology. The high rate of liver-dominant recurrence treated with repeat MWA, combined with a final NED rate of 50%, supports MWA as a platform for iterative locoregional disease control in selected patients.

Abstract: Background/Objectives: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory disease of the breast that may present with recurrent and treatment-resistant courses and can clinically and radiologically mimic breast cancer. Despite its benign nature, IGM may significantly impair quality of life, and its underlying pathophysiology remains unclear. This study aimed to evaluate oxidative stress and DNA damage in patients with IGM. Methods: In this prospective case–control study, 28 patients with clinically and histopathologically confirmed idiopathic granulomatous mastitis who had not received corticosteroid or immunosuppressive therapy within the previous six months were enrolled. An age-matched control group of 27 healthy women was included. Venous blood and urine samples were collected for the assessment of total oxidant status (TOS), total antioxidant status (TAS), and calculation of the oxidative stress index (OSI). Mononuclear leukocyte DNA damage was evaluated using the alkaline Comet assay, and urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) levels were measured by ELISA. Sociodemographic data, laboratory and imaging results of the patients were also evaluated. Results: The mean ages of the patient and control groups were 37.3 ± 5.3 and 35.4 ± 8.6 years, respectively, with no significant difference (p = 0.081). Patients exhibited significantly higher inflammatory markers and oxidative stress parameters, including TOS, OSI, and urinary 8-OHdG (p < 0.05), whereas TAS did not differ between groups (p = 0.534). Comet assay analysis demonstrated significantly increased tail intensity (%) and tail moment in the patient group (p = 0.029 and p = 0.016). Conclusions: IGM is associated with increased oxidative stress and mononuclear leukocyte DNA damage. These findings suggest that oxidative stress-induced DNA damage may play a role in the pathophysiology of IGM and highlight the potential value of antioxidant-based therapeutic strategies as adjunctive treatment options.

Abstract: This study investigated the expression of E-cadherin, N-cadherin, vimentin, Snail1, Slug (Snail2), Twist, ZEB1, ZEB2, and E47 in oral squamous cell carcinoma (OSCC) and assessed their association with clinicopathological parameters and patient survival. Immunohistochemical analysis was performed in OSCC samples, and correlations with clinicopathological variables and survival outcomes were evaluated. E-cadherin expression was detected in 54.5% of cases, vimentin in 39.6%, N-cadherin in 2.5%, Snail in 59.4%, Slug in 82.4%, ZEB1 in 3%, Twist in 94.5%, and E47 in 4.2% of tumors. Loss of E-cadherin was significantly associated with advanced clinical stage. N-cadherin expression was linked to moderate or poor differentiation, while vimentin expression correlated with lymph node metastasis, advanced stage, poor differentiation, recurrence, and disease-related death. Snail1 and Slug were associated with tobacco use, and Slug also with alcohol consumption. Complete epithelial–mesenchymal transition (EMT), defined by loss of E-cadherin and vimentin expression, was associated with poorer survival. Co-expression of vimentin and N-cadherin was linked to worse disease-specific and overall survival. However, only clinical stage remained independently associated with survival in multivariate analysis. In conclusion, vimentin expression is associated with aggressive tumor behavior, and EMT-related transcription factors are linked to tobacco exposure.

Abstract: Background/Objectives: In laparoscopic and robot-assisted surgery, bleeding may rapidly impair operative-field readability and procedural safety. In the broader Robin Heart teleoperation framework, interpretation of such events is relevant not only for scene understanding, but also as a potential prerequisite for future safety-oriented supervisory functions under communication-degraded conditions. The aim of this study was to assess whether a deep learning model for blood segmentation could provide outputs suitable for preliminary image-level temporal characterization of visible blood-region behavior in laparoscopic video. Methods: The model was first trained on a simulated bleeding dataset prepared under controlled conditions and then fine-tuned on annotated frames from robot-assisted laparoscopic hysterectomy video. Additional limited adaptation and held-out evaluation were performed on annotated bleeding-related episodes derived from the public GynSurg dataset. Segmentation performance was assessed using the Dice coefficient and Intersection over Union (IoU). Temporal analysis was performed on representative internal and external sequences using mask-derived descriptors and auxiliary optical-flow-based motion descriptors computed after camera-motion compen-sation within the detected blood ROI. Results: The model achieved Dice/IoU values of 0.94/0.89 on the simulated validation set, 0.907/0.830 on the internal operative validation set, and 0.764/0.626 on the annotated external GynSurg subset. The combined descriptor set differentiated more dynamic and unstable progression profiles from more spatially coherent ones across both datasets. Peak dA/dt reflected abrupt visible blood-area ex-pansion, temporal IoU described mask stability over time, and optical-flow-based de-scriptors provided additional information on local motion activity. A peak-only descrip-tion was insufficient to fully characterize the observed progression patterns. Conclusions: The results support the feasibility of combining deep-learning-based blood segmentation with temporal and optical-flow-based descriptors for exploratory image-level character-ization of visible blood-region behavior in laparoscopic video. Within the Robin Heart development pathway, such descriptors may in the future serve as candidate components of image-analysis support modules for safety-oriented teleoperative scenarios. At this stage, they should be interpreted as exploratory image-derived indicators rather than clinically validated markers of bleeding severity.

Abstract: Background. Staple line leak after sleeve gastrectomy remains one of the least predictable complications in bariatric surgery. Despite numerous proposed explanations, no consensus pathogenetic model exists. Objective. To develop a biomechanical model accounting for the mechanism of staple line failure after sleeve gastrectomy. Model. The present work proposes the formula: Leak = Obstruction & "Dog Ear". Leak is posited to be the predictable consequence of two co-occurring conditions: (1) mechanical or functional obstruction generating excess intraluminal pressure in the proximal gastric sleeve, and (2) a "dog ear" — a residual triangular pouch at the angle of His acting as a gas-and-fluid trap that prevents pressure decompression into the esophagus. Neither factor alone is sufficient: isolated obstruction results in stenosis; an isolated “dog ear”, in the absence of elevated pressure, remains clinically inconsequential. Conclusion. The formula Leak = Obstruction & "Dog Ear" offers a reproducible biomechanical framework for understanding and preventing staple line failure after sleeve gastrectomy. Prospective experimental investigation is required.

Abstract: Background: Tissue expanders with metallic ports are commonly used in postmastectomy breast reconstruction but can produce significant CT artifacts, which impair accurate de-lineation of target volumes during radiotherapy planning. The Motiva Flora® expander incorporates an integrated RFID (radiofrequency identification) valve, designed to be magnet-free and MRI-conditional, potentially minimizing image distortion and im-proving the precision of treatment planning. This pilot study aims to quantitatively compare the extent of CT image distortion observed in radiotherapy simulation scans between conventional metallic-valve expanders and RFID-valve expanders, evaluating their impact on radiotherapy planning quality. Methods: Between January 2024 and September 2025, fourteen consecutive patients who underwent postmastectomy two-stage breast reconstruction followed by adjuvant RT at Hospital Santa Maria della Misericordia (Udine, Italy) were included. Seven patients received Motiva Flora® tissue expanders with a non-metallic RFID port, and seven received Mentor CPX4® expanders with a conventional metallic port. The volume of areas with a significant level of artifacts (Artifact Volume) was quantitatively evaluated by delineating the CT image area of distortion caused by the valve. Moreover, a comparison of the ratio between artifact volume and Clinical Target Volume (Artifact volume/CTV volume) between expander types to assess potential imaging-related distortions has been made. Group comparisons of volume ratio were performed using Welch’s t-test. Results: Patients reconstructed with Motiva Flora® showed a mean artifact volume of 24.5 ± 10.3 cc, whereas those with Mentor CPX4® expanders presented a mean artifact volume of 64.2 ± 38.1 cc. The ratio between artifact volume and Clinical Target Volume (CTV) was lower in patients reconstructed with Motiva expanders compared to those reconstructed with Mentor expanders and this difference resulted significative at the Wilch’s t-test (p=0.046). Conclusions: The reduced CT distortion observed with the RFID valve–equipped Motiva Flora suggests a superior radiological compatibility compared to conventional metallic-port expanders, with po-tential to enhance the accuracy of radiotherapy planning.

Abstract: Background: Receptor status may change during metastatic progression, potentially altering therapeutic decisions and outcomes. The aim of this study was to determine ER, PR, and HER2 changes in thoracic metastases [pleura, lung, lymph node, pericardium, chest wall] of breast cancer and to evaluate their impact on survival. Methods: Data of 46 women who underwent interventional procedure for thoracic metastasis of breast cancer and had available ER/PR/HER2 assessment in both primary and corresponding metastatic tissues were retrospectively analyzed. Post-metastasis survival was calculated from the date of histopathological confirmation of metastatic disease. The associations of primary breast cancer receptor status, metastatic receptor status, and receptor conversion at metastasis with survival outcomes were investigated. Results: The pleura was the most common metastatic site [54,3%]. In primary tumors, ER, PR, and HER2 positivity rates were 87%, 63%, and 21%, respectively, whereas in metastatic tissues they were 69.6%, 45.7%, and 25.6%. ER loss was observed in 17.4% of cases, with no gain detected. PR loss occurred in 23.9% and gain in 6.5%, while HER2 loss and gain were observed in 7.0% and 11.6% of cases, respectively. Univariate analysis identified pleural metastasis [HR = 3,442, p = 0,017], ER negativity in metastatic tissue [HR = 3,306, p = 0,008], PR negativity in metastatic tissue [HR = 2,793, p = 0,037], and ER loss [HR = 3,095, p = 0,022] as adverse prognostic factors. In multivariate analysis, pleural metastasis [HR = 4,424, p = 0,009] and ER loss [HR = 3,669, p = 0,010] remained independent predictors of poor survival. No significant association was found between HER2 status and survival. Conclusion: ER loss and pleural metastasis are independent adverse prognostic factors in thoracic metastases of breast cancer. Re-evaluation of receptor status in metastatic disease is crucial for optimal treatment selection and prognostic assessment.

Abstract: Background Basal cell carcinoma (BCC) represents the most common malignancy worldwide. Although most tumours can be successfully treated with surgical excision, a subset may develop aggressive behaviour characterised by extensive local invasion, repeated recurrences and progression to locally advanced disease. However, the definition of locally advanced basal cell carcinoma (laBCC) remains heterogeneous and largely based on subjective clinical judgement. Objectives To propose a reproducible clinical scoring system aimed at objectively identifying locally advanced basal cell carcinoma and supporting therapeutic decision-making. Methods At the Unit of Plastic and reconstructive surgery and Skin Cancer Unit of IRCCS-Centro di Riferimento Oncologico della Basilicata, Italy we recruited patients with histologically confirmed BCC between 2005 and 2024. A multidimensional clinical scoring system (Fabrizio Score, FS), integrating tumour-related, patient-related and healthcare accessibility parameters, was applied to the study population. Score attribution was independently performed by physicians from the hospital health management service to minimise operator bias. Results Among 3,125 basal cell carcinomas diagnosed during the study period, 1,851 cases were evaluated using the proposed scoring system. A total of 1,627 tumours had an FS < 14 and were treated surgically. Two hundred and eighteen cases (FS 14–16) received neoadjuvant therapy. Only 15 patients (0.8%) were ultimately classified as having truly locally advanced disease and treated with systemic therapy. Conclusions The Fabrizio Score may represent a practical and reproducible clinical tool for the objective identification of locally advanced basal cell carcinoma and may support multidisciplinary therapeutic decision-making. Prospective multicentre validation studies are warranted.

Abstract: Background. Spleen-preserving (SP) distal pancreatectomy (DP) with splenic vessels resection (SVR) (Warsaw procedure, WP) is an option for treatment of tumors with low-malignant potential. The reverse blood flow through the short gastric arteries (SGA) explains the preservation of the spleen after SVR, but leaves the source of blood supply to the SGAs hidden. The types of blood supply to the spleen after WP and their incidence have not been previously described, nor has the significance of these types for locally advanced pancreatic head cancers (LAPHC) surgery. Aim. To determine the main types of the spleen blood supply after WP, and to assess feasibility and safety of splenic artery (SA) rotation for the organ-preserving surgery of LAPHC. Methods. Retrospective analysis of demographic and perioperative data, including CT scans analysis, overall (OS) and progression-free (PFS) survival after 71 SP DP SVR and 41 SP SVR pancreaticoduodenectomies (PD) and total pancreatectomies (TP) for LAPHC (2007-2025). Results: In 134 SP procedures, SA was resected in 115 cases (71DP, 9 TP, 3 central, 32 PD). Indications for surgery were MCN (41), IPMN (14), CSA(3), NEN(25), SPPN(8), PHDAC(40), sarcoma(1), autoimmune(1), and calculous chronic pancreatitis(1). There were no deaths and ischemia-related splenectomies. Morbidity-31%(n23), Dindo-Clavien (D-C)> 3b-2,8%, POPF grade B-n7(10.6%), splenic infarctions on CT after SVR-n18(23%), with one symptomatic. CT revealed three types of arterial blood supply to the spleen after SPDPSVR: left gastric artery(LGA) type (n50,70,5%), gastro-epyploic arcade (GEA) type(n9,12,5%), and an intermediate type(n12,17%). Spleen- and pancreas tail-preserving SVR pancreatectomies for LAPHC (n41) were accompanied by rotation of the SA to substitute resected SMA(n19) and CHA(n15) for 26 Whipples and 8TPs. There were no ischemic complications. D-C >3-19.5%. Median OS and PFS for PDAC was 35 and 21 months for 29.5 months median follow-up. Conclusion. The main collaterals supplying the spleen after WP are LGA branches (~ 90%). This knowledge with strict adherence to the developed criteria safely preserves the spleen, pancreatic tail and stomach during pancreatectomies with SA resection, including its rotation for substitution of the SMA and CHA in LAPHC.

Abstract: Background: Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, yet remain underreported due to limited data systems. This study describes the epidemiology of burn patients admitted to two major burn centers in Addis Ababa, Ethiopia, and identifies predictors of in-hospital mortality. Methods: A cross-sectional study was conducted among patients with new burn inju-ries admitted between September 1, 2021, and November 1, 2023, at Addis Ababa Burn, Emergency, and Trauma Center (AaBET) and Yekatit 12 Hospitals. Data were extracted from medical records. Descriptive statistics summarized patient characteristics, and binary logistic regression with multivariable analysis identified factors associated with in-hospital mortality using adjusted odds ratios (AORs) and 95% confidence intervals (CI). Results: Chart completeness was 96.2%. Among 800 patients, 57% were female, with a median age of 18 years (range: 0–89); approximately 80% were under 30 years. Scalds were the leading cause (49.1%). In-hospital mortality was 8.5% (95% CI: 6.5–10.4). Sig-nificant predictors included inhalation injury (AOR 6.53), TBSA ≥15% (AOR 3.33), deep burns (AOR 1.96), and ICU admission (AOR 14.42). Conclusion: In-hospital mortality was moderate, disproportionately affecting children and young adults, underscoring the need to strengthen critical care and management of severe burns.

Abstract: After repair of Boerhaave syndrome, assessment of repair integrity is important because occult dehiscence may progress to mediastinitis or pleural sepsis. Water-soluble contrast esophagography is commonly used before resuming oral intake, but absence of contrast extravasation does not necessarily exclude a small or contained defect. We report a 59-year-old man with post-emetic distal esophageal rupture who underwent emergency primary repair with pleural-flap buttress and drainage. Although he remained clinically stable, water-soluble contrast esophagography on postoperative day (POD) 7 showed no extravasation. Because feeding decisions required greater structural confidence, low-insufflation carbon dioxide (CO₂) esophagogastroduodenoscopy (EGD) was performed on POD 9 and revealed focal suture-line dehiscence. Oral intake was deferred, and conservative management with fasting and total parenteral nutrition was continued. Serial reassessment suggested a contained defect, and oral intake was reintroduced cautiously. A regular diet was started only after POD 28 endoscopy showed marked interval healing, and follow-up endoscopy at 3 months confirmed complete mucosal healing. This case highlights that negative postoperative contrast esophagography does not exclude persistent dehiscence and that low-insufflation CO₂ endoscopy may provide useful complementary structural information in selected patients.

Abstract: Background/Objectives: The main objective of the study was to determine the frequency of patients who underwent breast conserving surgery (BCS) and those with modified radical mastectomy and to compare the clinical-paraclinical parameters between these groups. Methods: We conducted an observational, retrospective study, which included 101 patients diagnosed with breast cancer that had surgical interventions between January 2024 and April 2025. Results: The BCS category was represented by 36.6& cases, while 63.4% were in the mastectomy subgroup. Hemoglobin at the time of admission had an average of 13 g/dL, the difference between the 2 categories of patients being statistically significant. (13.7 vs 12.7, p=0.010). Conclusions: Although it has been a hotly debated topic in recent years, the choice of surgical technique for breast tumors still presents novelties and interest in surgical specialties. Selection criteria such as disease stage, histopathological subtype, and the intervention chosen by the surgeon may vary and oncological results may be comparable.

Abstract: Background: Cervical anastomosis is widely used in esophageal cancer surgery. Although thoracic inlet size has been associated with anastomotic complications in retrosternal reconstruction, their relevance in posterior mediastinal (PM) reconstruction remains uncertain. This study evaluated whether thoracic inlet dimensions influence postoperative outcomes after cervical anastomosis performed through the PM route. Methods: A retrospective review was conducted on patients who underwent PM reconstruction between January 2021 and March 2025. Preoperative computed tomography was used to measure interclavicular distance (ICD), sterno-vertebral distance (SVD), and thoracic inlet area (TIA). Demographic, operative, and postoperative variables were analyzed. Univariable comparisons were performed according to postoperative mortality, and multivariable logistic regression was used to assess the independent association between TIA and mortality. Results: Sixty-seven patients were included. Postoperative complications occurred in 20 patients (29.9%), and anastomotic leakage was observed in 10 (15.0%). Overall mortality was 13.4% (n = 9). Among non-survivors, 6 patients (66.7%) had anastomotic leakage, compared with 4 of 58 survivors (6.9%). Thoracic inlet area was significantly lower in non-survivors than in survivors (median 513.5 vs 703.3 mm², p = 0.012). In multivariable logistic regression analysis adjusted for age, ASA classification, and sex, TIA demonstrated an inverse association with mortality (OR 0.996, 95% CI 0.992–1.000, p = 0.060), although statistical significance was not retained after adjustment. Conclusions: A smaller thoracic inlet area was associated with increased postoperative mortality after PM esophagectomy. The markedly higher rate of anastomotic leakage among non-survivors suggests that leakage may represent an important clinical pathway linking thoracic inlet geometry to adverse outcomes. Larger multicenter studies are needed to validate the prognostic relevance of thoracic inlet anatomy in PM reconstruction.

Abstract: Pregnancy-associated breast cancer (PABC) is a rare but increasingly encountered clinical entity, largely driven by delayed childbearing, and poses significant diagnostic and therapeutic challenges due to physiological breast changes and concerns regarding fetal safety. This narrative review aims to synthesize current evidence on the epidemiology, clinical presentation, diagnostic strategies, surgical management, systemic therapy, obstetrical considerations, and emerging applications of artificial intelligence in PABC. A comprehensive literature search was conducted across major databases, prioritizing recent studies, international guidelines, and large cohort analyses. Available evidence indicates that PABC is frequently diagnosed at a more advanced stage, partly due to delayed recognition. Ultrasound represents the first-line imaging modality, while mammography with shielding and selected MRI protocols may be safely used for staging. Surgical treatment is feasible during pregnancy, and anthracycline-based chemotherapy, with selected taxanes, can be administered during the second and third trimesters with acceptable maternal and fetal outcomes. In contrast, radiotherapy and most targeted therapies are deferred until postpartum. Obstetrical management should aim to avoid iatrogenic prematurity while ensuring adequate fetal monitoring. A multidisciplinary, trimester-adapted approach remains essential, although further prospective studies are required to address existing evidence gaps and optimize long-term outcomes.

Abstract: Background: Risk stratification in cardiac surgery has long depended on logistic regression models built from a fixed set of preoperative variables an approach that, while extensively validated, cannot capture the complexity of real patient physiology. Deep learning (DL) offers a fundamentally different paradigm, one capable of detecting non-linear interactions across high-dimensional datasets. We conducted this systematic review and meta-analysis to quantify whether that theoretical advantage translates into measurably better prediction of postoperative mortality after cardiac SurgeryMethods: We searched PubMed/MEDLINE, Embase, and IEEE Xplore following PRISMA 2020 and Cochrane Prognosis Methods Group guidelines. Eligible studies directly compared DL architectures against established risk scores namely EuroSCORE II or STS-PROM for short-term mortality in adult cardiac surgery populations. Methodological quality was assessed with PROBAST+AI. Because raw AUC values are bounded and violate normality assumptions required for standard pooling, all estimates were logit-transformed prior to meta-analysis using a restricted maximum likelihood random-effects model.Results: Six studies met inclusion criteria, representing 250,560 patients across markedly different clinical settings. Deep learning models shows to have achieved a pooled AUC of 0.856 (95% CI: 0.774 - 0.913). This came with a caveat: between-study heterogeneity was substantial (I² = 91.3%), reflecting the diversity of architectures, cohort sizes, and institutional contexts included. Traditional risk scores yielded a pooled AUC of 0.815 (95% CI: 0.754–0.864; I² = 77.9%).Conclusion: DL models outperform conventional risk scores on discrimination. The gap, however, sits alongside serious unresolved questions heterogeneity is high, calibration data are largely absent from the primary literature, and most evidence comes from retrospective single-centre cohorts. Standardized reporting frameworks are a prerequisite, not a recommendation, before these models enter routine clinical practice.

Abstract:

Background: In non-obese patients with type 2 diabetes mellitus (T2DM), metabolic surgery is often limited by the unexpected inconsistent outcomes. Although pylorus-preserving gastric bypass procedures have been widely adopted, incomplete foregut exclusion frequently results in unsatisfactory glycemic control or relapse. To address this limitation, we propose Single Anastomosis Pyloro-Enterostomy (SAPE), designed to achieve complete duodenal exclusion while maintaining pyloric sphincter function. Methods: Based on long-term clinical observation and analysis of incretin dynamics, SAPE was developed as a loop-type single-anastomosis configuration incorporating a sufficiently long biliopancreatic (BP) limb. The duodenal tissue attached to the pyloric ring is completely removed, and the small intestine is anastomosed directly to the pylorus using interrupted sutures to preserve sphincteric motility. Anatomical design was guided by evidence from enteroendocrine physiology, epithelial-mesenchymal crosstalk, and reprogramming of regional intestinal identity after anastomosis. Results: Compared with pylorus-preserving duodenal-jejunal bypass (DJB) and other incomplete foregut-excluding procedures, SAPE theoretically enables more profound and durable suppression of a key diabetogenic signal originating from the proximal small intestine. The combination of complete duodenal exclusion and an adequately long BP limb minimizes the re-expansion of proximal epithelial identity and maintains long-term glycemic improvement without compromising digestive continuity or nutritional status. Conclusion: SAPE may provide a physiologically optimized surgical framework for the treatment of non-obese T2DM by integrating anatomical precision with metabolic efficacy. This technique ensures complete foregut exclusion, preserves pyloric function, and potentially prevents enteroendocrine reprogramming associated with late glycemic relapse. Further clinical evaluation is warranted to confirm its metabolic and functional outcomes.

Abstract: Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) optimizes aesthetic outcomes, yet transection of intercostal sensory nerves commonly results in persistent nipple-areolar complex (NAC) anesthesia and, in some patients, denervation-related symptoms. NAC neurotization has emerged as an intraoperative strategy intended to improve protective sensation and potentially erogenous sensation by reconnecting donor intercostal nerves to the retroareolar plexus or to targets within the nipple. Here, we provide an anatomy-first narrative synthesis of the medial and lateral sensory corridors, with emphasis on the lateral cutaneous branches of T3–T5 and the reported anatomical landmarks that facilitate donor identification during NSM. We then review the biological constraints governing regeneration across the long trajectories typical of IBBR, including evidence suggesting reduced performance of acellular nerve allografts with increasing gap length and the rationale for autologous nerve transfers. Technical approaches are organized by (i) donor selection and harvest depth, (ii) graft choice, and (iii) distal coaptation strategies ranging from subareolar stump coaptation to targeted NAC reinnervation and direct nipple neurotization techniques. We also summarize the current clinical evidence regarding sensory recovery kinetics, safety and complications, operative time and cost, and propose practical checkpoints for intraoperative decision-making and standardized postoperative assessment. Collectively, available data support NAC neurotization as a feasible adjunct to NSM-IBBR, while highlighting the need for harmonized outcome reporting and longer follow-up to define comparative effectiveness among techniques.

Abstract: Soft tissue reconstruction often requires biomaterials that provide temporary mechanical support while allowing vascular integration and tissue remodeling. In reconstructive breast surgery, these demands converge within a uniquely challenging environment characterized by large surface areas, variable perfusion, frequent exposure to radiation, and reliance on prosthetic implants. As a result, breast reconstruction has emerged as a clinically relevant model for evaluating the performance and limitations of soft tissue scaffolds. Acellular dermal matrices (ADM) were initially adopted to provide biologically derived reinforcement based on the premise of host integration and neovascularization. While ADM reshaped implant-based reconstruction, accumulating clinical experience has revealed important constraints, including variability in mechanical properties, inconsistent vascularization, susceptibility to fibrosis, and limited performance in compromised tissue beds. These limitations have driven increasing interest in synthetic polymer scaffolds engineered for predictable mechanics, controlled degradation, and scalable manufacturing. This narrative review examines the evolution from ADM to synthetic and hybrid scaffold systems in breast reconstruction. We discuss how scaffold architecture, thickness, porosity, and degradation kinetics influence angiogenesis, immune response, and mechanical load transfer during healing. Hybrid strategies that integrate selective bioactivity within synthetic frameworks are also considered, highlighting both their translational promise and practical challenges. These concepts are particularly relevant for implant-based breast reconstruction, where scaffold performance directly influences complication rates, implant stability, and long-term reconstructive outcomes.