Breast cancer is a significant health problem worldwide, being the most frequent cancer in females and one of the most lethal. The current approach to breast cancer has moved away from the morbid Halsted radical mastectomy to breast-conserving surgery (BCS). Although BCS, supplemented by radiotherapy, has the same survival rates as the Halsted procedure, it is associated with significantly good post-operative outcomes. Oncoplastic breast surgery (OBS) combines the principles of breast cancer removal and reconstruction, allowing for the removal of larger tumors while maintaining the breast appearance by reshaping the breast tissue. In this article, the current evidence for the clinical, cosmetic, and oncological outcomes of OBS is reviewed. The evidence demonstrates the safety and potential benefits of OBS in comparison to BCS in the removal of breast cancer. The article provides a background on the various classifications of OBS, including the evolution from volume-based to ptosis-based classifications by the American Society of Breast Surgeons. A comparison is made between volume displacement techniques, such as therapeutic mammoplasties, and volume replacement techniques, including regional perforator flaps and fat grafts. The article also discusses the challenges facing the adoption of OBS across the world, including the disparity in training between surgeons in developed and developing countries. Additionally, the article presents the challenges facing the adoption of OBS, including the risk of fat necrosis and fibrosis. The article also presents the future direction in the development of OBS, including the use of extreme oncoplastic techniques in the removal of breast cancer using neoadjuvant chemotherapy. Additionally, the article presents the use of artificial intelligence in the pre-operative modeling of breast tissue using robotic-assisted tissue transfer. OBS is the current gold standard in the removal of breast cancer.

A 41-years-old woman presented with left-sided headache, diplopia, and ptosis of the left eyelid. Cerebral computed tomography angiography revealed a left persistent primitive trigeminal artery cavernous sinus fistula and a dissecting aneurysm in the V4 segment of the left vertebral artery. Digital subtraction angiography confirmed the diagnosis. The fistula was successfully occluded using dual-microcatheter coil embolization combined with Onyx-18 injection, assisted by balloon protection of the internal carotid artery. The vertebral artery dissecting aneurysm was managed conservatively by administering dual antiplatelet therapy (aspirin (100 mg/day) and clopidogrel (75 mg/day) for 3 months). Follow-up imaging at 11 months demonstrated complete resolution of the aneurysm.

The biomechanical mechanism between genital hiatus (GH), intra-abdominal pressure (IAP) and pelvic organ prolapse (POP) is currently unclear. Therefore, two biomechanical models for comparative analysis are developed to discuss the biomechanical relations of IAP and GH with prolapse of anterior and posterior vaginal walls (AVW and PVW) in the injured pelvic floor system. Based on the magnetic resonance imaging (MRI) of the pelvic floor of a healthy woman, we developed two 2D finite element models by using mechanical equivalence to represent the physiological and pathological states respectively. Both models contain hollow structure rectum. We simulated biomechanical characteristics of POP progression under different IAP and GH values in the PVW injury. In the pathological state with an IAP of 83.9 cmH2O, the descending displacement of the cervix increased from 14.3 to 20.9 mm when the GH increased from 10 to 40 mm. The maximum stress of AVW and perineal body (PB) rose from 0.343 to 0.611 MPa, from 0.190 to 0.974 MPa, respectively. Compared with the physiological state, the initial GH is a significant influence on POP progression. The increase of GH leads to a reduction or loss of biomechanical support for the bladder. The influence of IAPs and GH interaction exacerbates the injury and mechanical imbalance in the pathological state, which triggers increased stress in the AVW and PB, the descending displacements of the cervix and PVM, and exacerbates POP progression.

This case report demonstrates the removal of an intravesical Gellhorn pessary and management of a large vesicovaginal fistula. A 79-year-old woman with a history of pelvic organ prolapse treated with a Gellhorn pessary three years prior presented with recurrent urinary tract infections and continuous urinary leakage. CT imaging showed the pessary to be intravesical. After surgical clearance, she underwent cystoscopy and vaginoscopy under anesthesia with the goal of transvaginal removal. The pessary was fully embedded in the bladder lumen and could not be mobilized using laser transection, cutting, or grasping techniques. A guidewire was passed through a pessary drainage port and retrieved endoscopically, allowing counter-traction to gradually mobilize the pessary sideways. It was grasped with clamps and removed transvaginally through the large fistula site. Two-month follow-up cystoscopy showed resolution of bladder inflammation. MRI with vaginal contrast demonstrated a persistent large vesicovaginal fistula. Due to age and medical frailty, she underwent Latzko colpocleisis with suprapubic catheter placement for bladder drainage. At four weeks, cystography confirmed fistula closure. At the last follow-up, the patient reported no leakage, normal voiding, and resolution of infections.

Quantitative eyelid analysis is crucial for diagnosing and managing eyelid disorders, such as ptosis, and for surgical planning. However, traditional manual measurements of Marginal Reflex Distance (MRD) and Corneal Exposure Ratio are often error-prone and inconsistent. Existing deep learning approaches using RGB imaging face challenges in accurately delineating eye structures due to insufficient contrast and varying iris pigmentation. This study introduces a comprehensive system integrating infrared (IR) imaging with deep learning-based eye segmentation to overcome these limitations. The system utilizes an IR camera with facial rotation compensation for consistent image acquisition and employs deep learning algorithms optimized for IR imaging characteristics. A dataset of 2,121 IR images from 303 patients (internal validation) and 406 public dataset images (external validation) was used. Multiple models including RITnet and SegFormer were evaluated, with data augmentation techniques applied to improve performance. SegFormer with data augmentation demonstrated the highest performance, achieving mean IoU of 0.9325 for internal validation and 0.9288 for external validation. Our automated system achieved improved precision compared to manual measurements, with MRD1 MSE of 0.362±0.511 mm and MRD2 MSE of 0.286±0.324 mm. This proposed system offers a robust, efficient, and standardized approach for quantitative eyelid analysis, leveraging IR imaging advantages to address the shortcomings of conventional assessment methods and providing clinical-grade accuracy for automated eyelid parameter measurement.

Mitochondrial diseases are rare multisystem disorders caused by pathogenic variants in mitochondrial or nuclear DNA. We report a 23-year-old male presenting with exercise intolerance, fatigue, sluggish responsiveness, and a history of ptosis and bilateral hearing loss. Echocardiography revealed left ventricular hypertrophy, while brain MRI showed cerebellar atrophy and ventricular enlargement. Laboratory tests demonstrated elevated serum lactate, HbA1c, and high-sensitivity cardiac troponin T. Targeted sequencing identified a pathogenic m.3243A > G variant in the MT-TL1 gene with 55.6% heteroplasmy, confirming mitochondrial encephalomyopathy with cardiac involvement. This case highlights the phenotypic heterogeneity and diagnostic challenges of m.3243A > G-related disorders.

This study documents an exceptionally rare instance of primary myofibroma originating in the sphenoid sinus of a 60-year-old female patient, who presented with acute progressive diplopia, ptosis, and headache. Preoperative imaging identified a hypervascular lesion within the sphenoid sinus, accompanied by significant bone destruction. The patient underwent successful gross total resection via an endoscopic endonasal transsphenoidal approach, which enabled complete tumor excision, preservation of vital neurovascular structures, and effective skull base reconstruction. Postoperatively, the patient's neurological deficits improved significantly without complications. Histopathological and immunohistochemical evaluations, which were positive for smooth muscle actin (SMA) and Vimentin, confirmed the diagnosis. The tumor's high-risk features, such as its deep location, bone infiltration, and a 15% Ki-67 proliferation index, prompted a postoperative multidisciplinary team to consider adjuvant radiotherapy due to the increased risk of local recurrence. This case demonstrates that endoscopic resection is a safe and effective primary treatment for this rare condition and underscores the importance of individualized risk assessments and a multidisciplinary approach in managing high-risk sphenoid sinus myofibroma in adults.