The past, the present and the future of UK breast reconstruction—are our practices outdated in 2020?

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Realizing Spin-Hamiltonians in Nanolaser Lattices

We demonstrate both theoretically and experimentally that coupled metallic nanolasers can be used to emulate spin-Hamiltonians. Depending on the geometry of the array, we observe ferromagnetic and antiferromagnetic behaviors, as well as geometric frustration

A Novel Protocol for Stevia Rebaudiana (Bert.) Regeneration

Stevia rebaudiana Bertoni has sweet substances (stevioside) in its leaves that are free of calories and their consumption is beneficial for diabetic patients and is also helpful in high blood pressure also. Because of low capability in seed germination, tissue culture is an appropriate method for propagation of this plant. In the current study, optimization of stevia in vitro cultivation via direct organogenesis with different explants, light intensities and plant hormones has been examined. These treatments included BAP (at 0.5, 1, 1.5 and 2mg/l) in combination with  2,4-D, IBA and NAA (each with concentrations of 0.1, 0.2 and 0.5mg/l) and different light intensities (Dark, 2000, 4000 and 6000 lux). MS was utilized as a basal medium. Results indicated the highest rate of organogenesis (85%) occurred on the axillary buds explants with a medium containing 1.5mg/l BAP + 0.1mg/l NAA under 6000 lux light intensity. Also, the highest range of primary organ per explant (42) with 0.3cm length was achieved at this condition. The most efficient medium for rhizogenesis i.e. 100% root production along with the highest root number (11 with approximately 7.13cm length) was obtained in presence of activated charcoal and 1mg/l of IBA. At the end of rhizogenesis experiments, the plantlet length and node multiplicity were 12.8cm and 7 respectively. Greenhouse cultivation of these plantlets was successful

Deep Learning with Photonic Neural Cellular Automata

Rapid advancements in deep learning over the past decade have fueled an insatiable demand for efficient and scalable hardware. Photonics offers a promising solution by leveraging the unique properties of light. However, conventional neural network architectures, which typically require dense programmable connections, pose several practical challenges for photonic realizations. To overcome these limitations, we propose and experimentally demonstrate Photonic Neural Cellular Automata (PNCA) for photonic deep learning with sparse connectivity. PNCA harnesses the speed and interconnectivity of photonics, as well as the self-organizing nature of cellular automata through local interactions to achieve robust, reliable, and efficient processing. We utilize linear light interference and parametric nonlinear optics for all-optical computations in a time-multiplexed photonic network to experimentally perform self-organized image classification. We demonstrate binary classification of images in the fashion-MNIST dataset using as few as 3 programmable photonic parameters, achieving an experimental accuracy of 98.0% with the ability to also recognize out-of-distribution data. The proposed PNCA approach can be adapted to a wide range of existing photonic hardware and provides a compelling alternative to conventional photonic neural networks by maximizing the advantages of light-based computing whilst mitigating their practical challenges. Our results showcase the potential of PNCA in advancing photonic deep learning and highlights a path for next-generation photonic computers

Assessment of breast symmetry in breast cancer patients undergoing therapeutic mammaplasty using the Breast Cancer Conservation Therapy cosmetic results software (BCCT.core)

Background: Therapeutic mammaplasty (TM) is a standard oncoplastic technique utilising aesthetic breast reduction principles to facilitate tumour resection and breast reshaping. Simultaneous contralateral mammaplasties are often performed to maintain symmetry. BCCT.core software, which principally assesses breast symmetry, has been previously employed for evaluating cosmetic results after standard breast conservation therapy and latterly TMs for upper pole tumours. The purpose of this study was to validate this novel tool for TMs in all breast zones. Methods: Standardised photographs of 20 consecutive patients who underwent TM were evaluated for symmetry using BCCT.core versus a plastic surgical panel completing a visual analogue scale. Results were rated as (excellent/good/fair/poor). Outcomes between the two methods were compared. Results: Twenty patients aged 37 to 63 years with a median 36G bra size had 22 TMs (18 unilateral, 2 bilateral). Indications were invasive breast cancer (87%) and ductal carcinoma in situ (DCIS) (13%). The median (range) tumour size was 22.5 mm (6–90 mm) with a resection weight of 245.8 g (16–1,079 g). Primary nipple pedicles were superomedial (63%), inferior (21%) and superolateral (16%). Five patients required a secondary glandular pedicle for volume redistribution to maintain breast shape. The BCCT.core software vs. panel symmetry assessments were 37% vs. 39% (excellent), 63% vs. 50% (good) and 0% vs. 11% (fair). Wilcoxon matched-pairs sign rank tests and Spearman rank correlations found the pairings to be statistically significant (P<0.05). Conclusions: Despite small patient numbers, BCCT.core gave comparable findings with the panel and is thus useful for objectively assessing cosmesis of TMs in all breast zones

Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus.

Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer.Peer Reviewe

Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys

Introduction: Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women. Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule. Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years. Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%

The successful use of disparate pedicle types for bilateral therapeutic mammaplasties during breast conservation surgery

This case illustrates the successful use of non-identical pedicles in bilateral therapeutic mammaplasty (TM). A 58-year-old patient presented with a left-sided upper inner quadrant multifocal invasive [no special type (NST)] tumour and a right-sided upper outer quadrant unifocal invasive tubular carcinoma with surrounding ductal carcinoma in situ (DCIS). Her tumour locations necessitated simultaneous bilateral TM using different pedicle types. A superomedial pedicle T-scar breast reduction was undertaken on the right to resect the upper outer quadrant tumour whilst a superolateral nipple transposition pedicle was used on the left breast to enable the wide resection of the two tumours located superomedial to the nipple. The location and size of the tumour also required the use of a secondary infero-medially based pedicle for volume displacement on the left breast. Patient received adjuvant chemotherapy and radiotherapy. A year after surgery the patient has acceptable cosmetic results in terms of symmetry, breast contour and increasingly inconspicuous scars