Pregnancy-associated breast cancer: a case report and literature review

Pregnancy-associated breast cancer (PABC) is a rare, yet significant clinical entity which presents itself during pregnancy or within one year postpartum. This case report and literature review discusses the case of a 33-year-old G1P0 woman diagnosed with PABC at 38 weeks’ gestation with an uncomplicated pregnancy and no significant risk factors. Fine needle aspiration revealed a left-sided metaplastic grade 3 invasive ductal carcinoma with heterogeneous mesenchymal differentiation and focal ductal carcinoma in situ, and an uncomplicated nipple-sparing mastectomy was undertaken at three weeks’ post-partum. This case report emphasises the need for early diagnosis and the importance of screening for breast cancer during pregnancy, and advocates for a low threshold to screen for PABC in all pregnancies. The literature review also provides updated insights into the presentation, diagnosis, and management of PABC. We explore the diagnostic challenges associated with PABC, including physiological changes in breast tissue during pregnancy, limitations of imaging modalities, and the importance of considering PABC as a differential diagnosis

Enhancing Hand Fracture Care: A Prospective Study of Artificial Intelligence Application With ChatGPT

Purpose: The integration of artificial intelligence and machine learning technologies into the medical field has brought about remarkable advancements, particularly in the domain of clinical decision support systems. However, it is uncertain how they will perform as clinical decision-makers. Methods: This prospective cohort study evaluates the potential of incorporating ChatGPT-4 plus into the management of subcapital fifth metacarpal fractures. The treatment recommendations provided by ChatGPT-4 plus were compared with those of the two control groups—the attending clinic plastic surgeon and an independent expert panel. The primary outcome measures, operative or conservative, were compared between the groups. Intraclass correlation of 0.61 infers moderate reliability in the consistency of recommended management plans across all groups. Results: Key predictors for opting for operative management, regardless of the decision-maker, included clinical signs of scissoring, extension deficit, and radiographic evidence of intra-articular extension. Conclusions: These findings support the potential for artificial intelligence applications in enhancing diagnostic and treatment decisions. Type of study/level of evidence: Therapeutic IV. © 2024 The Author

Treatment of Atrophic Acne Scarring with Fractional Microplasma Radiofrequency: A Multicentric Experience

Background: Atrophic scarring is a severe form-disfiguring sequela of acne, which can lead to negative effect on patients' life. Fractional microplasma radiofrequency (RF) has emerged as a promising modality, leveraging dermal fibroblast remodeling to enhance aesthetic results for scars and hyperpigmentation. This study evaluates the efficacy and safety of high-power fractional microplasma RF for atrophic acne scars, considering patient tolerance to procedural discomfort. Methods: In this prospective study, 95 Chinese patients with atrophic facial acne scars underwent three sessions of fractional microplasma RF treatment, with assessments at 1, 3, and 6 months post-treatment. Patients were categorized based on treatment power: Group A (50-70 W) and Group B (70-85 W). Efficacy was determined by three independent dermatologists using digital photographs and Echelle d'Evaluation Clinique des Cicatrices d'Acn & eacute; (ECCA) scores, and patient-reported outcomes gauged satisfaction levels. Results: Eighty-six patients completed the study. Significant improvements were observed, with a reduction in ECCA scores from 107.21 to 42.27 (P<0.05), demonstrating notable scar amelioration across both groups, albeit with a superior outcome in Group B. All patients experienced transient side effects such as pain, erythema, and edema, deemed tolerable with no long-term adverse effects reported. The treatment was well-received, with high satisfaction rates, underscoring its efficacy and acceptable safety profile. Conclusion: Fractional microplasma RF therapy, particularly at higher power settings, is an effective and safe option for treating atrophic acne scars, offering significant aesthetic improvement with manageable discomfort. This modality presents a valuable addition to acne scar management strategies, especially for patients with darker skin tones seeking minimal downtime and reduced risk of hyperpigmentation. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/

Can AI Answer My Questions? Utilizing Artificial Intelligence in the Perioperative Assessment for Abdominoplasty Patients

Background Abdominoplasty is a common operation, used for a range of cosmetic and functional issues, often in the context of divarication of recti, significant weight loss, and after pregnancy. Despite this, patient-surgeon communication gaps can hinder informed decision-making. The integration of large language models (LLMs) in healthcare offers potential for enhancing patient information. This study evaluated the feasibility of using LLMs for answering perioperative queries.Methods This study assessed the efficacy of four leading LLMs-OpenAI's ChatGPT-3.5, Anthropic's Claude, Google's Gemini, and Bing's CoPilot-using fifteen unique prompts. All outputs were evaluated using the Flesch-Kincaid, Flesch Reading Ease score, and Coleman-Liau index for readability assessment. The DISCERN score and a Likert scale were utilized to evaluate quality. Scores were assigned by two plastic surgical residents and then reviewed and discussed until a consensus was reached by five plastic surgeon specialists.Results ChatGPT-3.5 required the highest level for comprehension, followed by Gemini, Claude, then CoPilot. Claude provided the most appropriate and actionable advice. In terms of patient-friendliness, CoPilot outperformed the rest, enhancing engagement and information comprehensiveness. ChatGPT-3.5 and Gemini offered adequate, though unremarkable, advice, employing more professional language. CoPilot uniquely included visual aids and was the only model to use hyperlinks, although they were not very helpful and acceptable, and it faced limitations in responding to certain queries.Conclusion ChatGPT-3.5, Gemini, Claude, and Bing's CoPilot showcased differences in readability and reliability. LLMs offer unique advantages for patient care but require careful selection. Future research should integrate LLM strengths and address weaknesses for optimal patient education.Level of Evidence V 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

Experience in Post-Bariatric Abdominoplasty for Patients with Significant Weight Loss: A Prospective Study

Background: Abdominoplasty is a critical aesthetic and functional procedure for individuals who have undergone massive weight loss. Numerous techniques have been proposed to optimize aesthetic results while minimizing complications. Methods: This prospective study examined 500 patients who underwent abdominoplasty during body-contouring procedures between 1 January 2018 and 31 December 2021 at a tertiary center. The Skin-Adipose Tissue-Muscle (SAM) protocol was employed to analyze the operative strategies and complication rates and compare them with the existing literature. Furthermore, patient satisfaction and aesthetic outcomes were measured one year post-operation using a comprehensive four-point questionnaire evaluated by the patients themselves and two independent surgeons. Results: Participants had an average age of 34.8 years and a mean BMI of 31.1 kg/m2. The surgeries included 328 full abdominoplasties and 172 T-inverted abdominoplasties. Notable complications included wound infection (4%), wound dehiscence (8.6%), tissue necrosis (0.6%), seroma (8.4%), and hematoma (2.6%). A higher BMI was correlated with an increased risk of complications and lower patient satisfaction. Data analysis was performed using Stata version 18 software. Conclusions: The increasing prevalence of obesity highlights an urgent need for more bariatric surgeries and subsequent abdominoplasties to mitigate the effects of massive weight loss. A crucial link between elevated BMI and a heightened risk of postoperative complications, emphasizing the necessity for standardized surgical protocols tailored to individuals with higher BMI, was noted. Innovatively, future studies must further investigate the intricate dynamics between BMI and surgical risks. Exploring and establishing uniform, adaptive surgical guidelines promise to revolutionize patient care by significantly reducing complications and enhancing recovery and satisfaction following abdominoplasty

Perforator Selection with Computed Tomography Angiography for Unilateral Breast Reconstruction: A Clinical Multicentre Analysis

Background and Objectives: Despite CTAs being critical for preoperative planning in autologous breast reconstruction, experienced plastic surgeons may have differing preferences for which side of the abdomen to use for unilateral breast reconstruction. Large language models (LLMs) have the potential to assist medical imaging interpretation. This study compares the perforator selection preferences of experienced plastic surgeons with four popular LLMs based on CTA images for breast reconstruction. Materials and Methods: Six experienced plastic surgeons from Australia, the US, Italy, Denmark, and Argentina reviewed ten CTA images, indicated their preferred side of the abdomen for unilateral breast reconstruction and recommended the type of autologous reconstruction. The LLMs were prompted to do the same. The average decisions were calculated, recorded in suitable tables, and compared. Results: The six consultants predominantly recommend the DIEP procedure (83%). This suggests experienced surgeons feel more comfortable raising DIEP than TRAM flaps, which they recommended only 3% of the time. They also favoured MS TRAM and SIEA less frequently (11% and 2%, respectively). Three LLMs-ChatGPT-4o, ChatGPT-4, and Bing CoPilot-exclusively recommended DIEP (100%), while Claude suggested DIEP 90% and MS TRAM 10%. Despite minor variations in side recommendations, consultants and AI models clearly preferred DIEP. Conclusions: Consultants and LLMs consistently preferred DIEP procedures, indicating strong confidence among experienced surgeons, though LLMs occasionally deviated in recommendations, highlighting limitations in their image interpretation capabilities. This emphasises the need for ongoing refinement of AI-assisted decision support systems to ensure they align more closely with expert clinical judgment and enhance their reliability in clinical practice

Catquest-9SF questionnaire shows greater visual functioning in bilateral cataract populations : A prospective study

Purpose: Visual functioning evaluated by the Catquest-9SF questionnaire has shown to be a valid measure for assessing a patient's prioritization for cataract surgery. This study adapted Catquest-9SF for visual function outcomes post uni-lateral cataract surgery or bi-lateral cataract surgery. Methods: Visual functioning was assessed before and after uni-lateral or bi-lateral cataract surgery using the Catquest-9SF questionnaire. Patients were enrolled to this study prior to their cataract surgery between March 29 and April 30, 2021 at Shellharbour Hospital, Australia. Catquest-9SF questionnaires were completed prior to and 3 months post surgery. Resulting data were assessed for fit to a Rasch model using WINSTEPS software (version 4.2.0). Catquest-9SF data analysis of Chi-square, Wilcoxon sum test, and Fischer's test were performed in R (version 4.1.0). P value <.05 was considered statistically significant. Results: Sixty-one patients (mean age = 73.2 years, 62% female) were included for analysis. Catquest-9SF response thresholds, adequate precision (person separation index = 2.58, person reliability = 0.87, Cronbach's alpha = 0.74), uni-dimensionality, and no misfits (infit range 0.65-1.33; outfit range 0.64-1.31) were recorded. The mean of item calibration for patients was -0.22 post-operatively. There was significant (P <.05) improvement (16.3%) in visual functions across all nine Catquest 9-SF items. There was a significant mean visual function difference between patients with uni-lateral (10.1%) and bi-lateral cataract surgery (22.3%) pre-operatively and post-operatively. Conclusion: The Catquest-9SF questionnaire showed excellent psychometric properties and can assess visual functioning in an Australian population. There was a significant improvement in patient visual function post cataract surgery and higher functioning with bi-lateral cataract surgery

Cutaneous amyloidosis mimicking basal cell carcinoma: a case series and literature review

Background: Amyloidosis is characterized by extracellular amyloid protein deposi - tion. When amyloidosis intersects with basal cell carcinoma (BCC ), it introduces complex di - agnostic challenges. This study explored the overlap between primary localized cutaneous amyloidosis (PLCA ) and BCC, examining amyloid deposits in BCC, systemic amyloidosis risk in PLCA, and various treatment methods. Methods: Two case studies were discussed, followed by a literature review, in which PubMed, Web of Science, EMBASE, and the Cochrane Library databases were utilized. The search, cov - ering studies from infinity up to January 2024, focused on "cutaneous amyloidosis," "basal cell carcinoma," and related terms. Articles in English detailing the clinical presentation, diag - nostic methods, treatment, and outcomes of cutaneous amyloidosis mimicking BCC were in - cluded. Data extraction and synthesis were performed by two independent reviewers. Case Series: This study highlighted two cases exemplifying the complexity of diagnosing BCC and PLCA. The first case (a 64 -year -old with a nodule on the cheek ) and the second (a 67 -year - old with a nodular lesion on the upper lip cheek ) were initially suspected as BCC and were later identified as PLCA upon histopathological examination. Discussion: The diagnosis of amyloidosis within BCC nodules remains a diagnostic challenge. Although their coexistence is relatively prevalent, their local recurrence rates remain deba - table. Various diagnostic and therapeutic approaches have been suggested, such as topical creams and phototherapy. However, none have garnered conclusive and consistent evidence to establish reliable clinical application. Conclusion: The findings emphasized the importance of considering alternative pathologies in differential diagnoses. Future research should focus on understanding systemic amyloidosis risks and optimizing care for both conditions. (c) 2024 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons

Clinical Practice Guidelines For the Management of Hepatocellular Carcinoma: A Systematic Review

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally, including Australia. The absence of a consensus clinical practice guideline (CPG) specific to HCC management poses challenges in reducing morbidity, mortality, and improving patient recovery. This systematic review aims to evaluate the existing evidence and assess the potential of published guidelines, including those with an international scope, to provide guidance for healthcare professionals in Australia. Methods: Electronic search of MEDLINE, Embase, Cochrane Library, Google Scholar, and PubMed was conducted. Peer-reviewed English language articles from 2005 to June 2022 were included if they described management of HCC as part of an evidence-based overall management plan or CPG. The quality of the included CPGs was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results: Twenty-one articles from 16 regions throughout the world were included in this review. All included guidelines (n = 21, 100%) recommended evaluating cirrhosis, hepatitis B, and hepatitis C as potential risk factors of HCC. Obesity and non-alcoholic fatty liver disease were recommended by 19 CPGs (91%) as risk factor for HCC. Fourteen guidelines (67%) endorsed using the BCLC staging system. Eighteen guidelines (86%) recommended a multidisciplinary approach for the management of HCC. Eighteen guidelines (86%) advised that surveillance using ultrasound should be implemented in all cirrhotic patients every 6 months regardless of the cause of cirrhosis. AGREE II mean overall assessment score was 90% indicating that all guidelines included were highly recommended in majority of domains. Conclusions: The included CPGs provided a comprehensive approach, emphasizing the evaluation of risk factors, utilization of the BCLC staging system, and the importance of a multidisciplinary approach. Regular surveillance using ultrasound for cirrhotic patients was widely recommended. An understanding of contemporary international CPGs can prioritize aspects of the management of HCC to assist healthcare professionals to develop a national guideline to enable standardized, comprehensive, and evidence-based care for patients with HCC