Kinect based system applied to breast cancer conservative treatment

Tese de Mestrado Integrado. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 201

Chest Masculinization Surgery: Outcomes, Challenges, And Opportunities For Innovation In Gender-Affirming Care

With the increasing demand for gender-affirming surgeries, it has become paramount for plastic and reconstructive surgeons to evaluate their techniques through assessment of clinical outcomes and patient satisfaction. Chest wall masculinization is the most commonly performed gender-affirming surgical intervention for transgender male and non-binary patients. The procedure has been cited to alleviate gender dysphoria, defined as the stress that results from the incongruence between one’s sex assigned at birth and one’s gender identity. Peri-areolar and double-incision mastectomy with free nipple grafts, are the most common techniques employed in chest masculinization surgery, but are limited by their relative inconsistency and inefficiency in reconstructing a natural anterior contour that comprehensively resembles that of a cis-masculine chest. The proposed “hockey stick” approach expands on the widely performed double-incision mastectomy to the axilla, with an additional step of revising the lateral chest wall folds of tissue excess. The central purpose of this study is to compare the “hockey stick” incision to existing reconstructive options, with respect to clinical outcomes and patient satisfaction. In addition, this review will discuss multiple challenges and considerations, with respect to validated survey instruments, access to care, healthcare disparities, legislative acts, insurance coverage, medical education, the Coronavirus pandemic, and evolving terminology, that may complicate the delivery of gender-affirming care. With such investigations and analyses, we hope to provide a valuable introduction and resource for healthcare providers, trainees, and medical students to refer to in the context of gender-affirming care. Patients who received chest masculinization surgery at Yale-New Haven Hospital were included in our analysis. A retrospective chart review, comprising demographic variables, procedural details, and post-operative events, was conducted. Selected modules from a validated survey instrument, the BODY-Q, were measured. Patients were classified by body mass index and incision, which included peri-areolar, inframammary fold, and “hockey stick” incision by date. 27 of 73 (37.0%) participants completed the full survey and were included in the analysis. The “hockey stick” incision had comparable patient satisfaction and post-operative outcomes, compared to peri-areolar and double-incision mastectomy with free nipple graft techniques. Greater BMI patients had a higher incidence of wound dehiscence, compared to other weight classifications. The “hockey stick” incision is a readily performed, effective surgical technique for building a cis-masculine appearing chest in transgender men with efficient and predictable outcomes. While performed in patients with higher BMI, the “hockey stick” confers equivalent patients. Future outcomes should include a greater sample of patients. Gender-affirming surgery presents with promising opportunities to innovate new techniques and study clinical outcomes and patient satisfaction. Amidst such advancements, it is imperative to recognize the barriers in delivering gender-affirming care, to collaborate with other stakeholders, and together, strengthen efforts in medical education, policy, entrepreneurship, research, and advocacy for transgender and non-binary patients. There is great potential for plastic surgeons and their colleagues to lead the movement - to best serve the social and healthcare needs of such communities

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Autologous fat transplantation to the female breast after surgery and radiotherapy assessment of patient-reported outcomes, radiology and gene expression patterns

Autologous fat transplantation (AFT) is commonly used as a complementary method to enhance breast appearance after breast surgery, radiotherapy and breast reconstruction. Some of the indications for AFT to the breast are contour irregularities, volume deficits, chronic wounds, soft tissue indurations and scarring. Although AFT is well established with the primary aim with AFT is to enhance the patient’s satisfaction, research on patient perceptions is sparse. In the 1980s the American Society of Plastic Surgeons (former American Society of Plastic and Reconstructive Surgeons) expressed the concern that AFT could lead to false- positive radiological findings that subsequently would lead to excessive examinations. In 2009 they requested more studies on AFT to breast cancer patients. Apart from using autologous fat as a filler and to soften the breast tissue, AFT can be used to mitigate radiation-induced fibrosis and dermatitis. The effect of AFT on radiation-damaged tissue is well described clinically, but the biological processes behind the effects are still unknown. These issues were also studied in the present research. A retrospective study (I) was carried out on 43 patients using a study-specific questionnaire to assess their perceptions of the results of AFT. Post-operative complications were also recorded. The patients reported overall good results and only one minor complication was found in all patients. In a prospective case-series (II) patient-reported outcomes were assessed in 48 patients using a study-specific questionnaire and the 36-Item Short Form Health Survey (SF-36), before, and up to two years after AFT. Sixteen of the 20 items in the questionnaire were significantly improved two years post-operatively, including pain, scars, appearance and softness of the breast, as well as inclination to perform physical activities in public areas. The scores obtained with SF-36 concerning health related quality of life did not change after AFT, and did not differ from a Swedish reference population. In the third study (III), 44 patients underwent mammography and ultrasound before and one year after AFT. Assessment was carried out by experienced radiologists. No difference in the overall assessment (BI-RADS score 2) could be seen. AFT was found to significantly increase the number of breasts with oil cysts, where the breasts with oil cysts had been transplanted with larger volumes of fat. Finally, gene expression in adipose tissue was investigated with microarray technique and Hallmark gene set enrichment analysis (IV). Biopsies were taken from the adipose tissue of the irradiated breast and the contralateral non-irradiated breast of ten women before AFT. Biopsies were also taken bilaterally one year after AFT of the irradiated breast. Among the 3000 most differentially expressed genes comparing irradiated and non-irradiated biopsies before AFT, 45 enriched pathways were found. After AFT to the irradiated breast, 575 of the 3000 previously differentially expressed genes were reversed in the irradiated and AFT treated adipose tissue, and thus affected by AFT. Among these 575 genes, 13 pathways were identified, all of them also found in the pre-operative analysis. The leading canonical pathways in the two analyses were interferon gamma response, hypoxia and epithelial mesenchymal transition. The conclusions drawn from these studies are that AFT was perceived as a good complementary method of treatment by the patients, who experienced improvements in several aspects, and that AFT has no or little negative effects on post-operative radiological assessment. Furthermore, may AFT reverse differential gene expression in genes involved in inflammation, hypoxia and fibrosis that could have been caused by radiotherapy

The disavowment of Black women’s bodies: the rise of the Brazilian butt lift

In this project, I want to breakdown the fascination and phenomena of the Black woman's body, precisely the assumption that being a Black woman or girl automatically means you will have a very pronounced butt. I wanted to understand from other Black women's perspectives what it means to feel more valuable when they have the ideal 'thick black woman' body and how that affects them in their daily decisions. I look to social media as a foundation to see the impact that Instagram, YouTube, and cultural expectations influence the decisions of young girls and women. This desire to have a larger, rounder behind has taken on a life of its own, as we see with the surge of the very dangerous and sometimes deadly plastic surgery procedure the Brazilian butt lift (BBL). The BBL is not new to the world of plastic surgery and augmentation, but it has seen an increasing rise in social media access. More and more women are seeking out the BBL, traveling, and even documenting their journeys to share with other women who may be interested in the procedure. What I am most interested in is the 'why' why are these women, specifically Black women willing to put themselves in a position that could end with pain or death, especially in a society that is so quick to marginalize them and their bodies. From the historical approach, I examine how the Black woman's body has been violently used for medical purposes and how this new phenomenon of the BBL is, in a way repeating this history