Search Results (29)

Background: The diagnostic process for probable benign breast lesions involves a 1–40% upgrade rate to malignancy when biopsy (cytology and/or histology) is compared with surgery. In a previously conducted clinical randomized trial, we aimed to examine diagnostic discrepancies between prior biopsy results and subsequent vacuum-assisted excision (VAE). Methods: This study is a post hoc analysis of the Swedish VAE randomized trial. Patients were enrolled between November 2019 and August 2022. All patients who underwent a biopsy before VAE were included in this study. Pathology reports from the initial biopsy, VAE, surgical excision, and recurrence were collected. In addition, we conducted clinical follow-up, including imaging, for at least 2 years. Results: The study population included 169 patients with 169 lesions, of whom 71 underwent fine-needle aspiration cytology (FNA), and 126 underwent core-needle biopsy (CNB) before VAE. The diagnostic discrepancy between FNA and VAE was 38% (27/71). The discrepancy between CNB and VAE was 29% (37/126). The upgrade rate to cancer was 7% (5/71) for FNA and 5% (6/126) for CNB. In the CNB group, the highest upgrade rate to cancer occurred in patients with prior atypical ductal hyperplasia (ADH) on CNB (3/12, 25%). Conclusions: The upgrade rate in histopathological diagnosis between prior CNB and VAE was high (15%), and even higher when comparing FNA with VAE (24%). Our findings support avoiding FNA for BI-RADS 3 and 4a lesions and suggest that multi-round VAE may be a safe and effective alternative to surgery for selected cases, particularly those with ADH on CNB. Full article

Pectus excavatum (PE) is the most frequent chest wall deformity, representing 65–95% of all cases, with an estimated prevalence of up to 1 in 300 births. Despite its frequency, it remains underrecognized in sports cardiology. PE results from sternal depression and narrowing of the anterior chest, which may lead to cardiac compression, impaired diastolic filling, and reduced stroke volume during exercise. Consequently, athletes with PE often present with cardiovascular symptoms such as exercise-induced dyspnoea, chest pain, palpitations, presyncope, or reduced physical fitness. Electrocardiographic changes, including right bundle branch block, axis deviation, atrial enlargement, T-wave inversion, QS complexes or Brugada phenocopies, are frequent and may mimic serious cardiovascular conditions, complicating pre-participation screening. Furthermore, PE is associated with potentially high-risk conditions including mitral valve prolapse, ventricular arrhythmias, and connective tissue disorders such as Marfan syndrome, which carry implications for sports eligibility and safety. Assessment of athletes with PE requires multimodal imaging (echocardiography, computed tomography, magnetic resonance), cardiopulmonary exercise testing, and exclusion of concomitant cardiovascular disease. Treatment strategies range from conservative approaches (physiotherapy, vacuum bell therapy) to surgical correction, most commonly with the Nuss procedure, which can improve cardiac function, exercise capacity, and quality of life. Management should involve shared decision making between clinicians, athletes, and families, weighing potential risks against athletic aspirations. Awareness of PE in sports cardiology is crucial, as it not only influences differential diagnosis and screening outcomes but also impacts career decisions and the psychological well-being of athletes. Full article

To improve the efficiency of aquatic environmental monitoring, an in-situ solid-phase extraction (SPE) system using amphibious (waterproof) drones was developed and validated using recovery testing with samples containing known concentrations of systemic insecticides in the laboratory and using real samples from natural water bodies. The system used a water-resistant linear actuator for continuous aspiration at 1–10 mL min⁻¹ through a pre-washed hydrophilic–lipophilic balanced SPE cartridge. The system functioned properly during field sampling using vacuum-mode filtration to avoid overpressure, overcurrent, and contamination through repeated filtration. The recovery tests using 10 ng L⁻¹ of each target analyte in ultra-pure water samples produced satisfactory recovery results of 89–96% (relative standard deviation < 10%). In the real sampling of water bodies, the developed system was able to detect target analytes of 0.9–180 ng L⁻¹. The results are comparable to those obtained using in-situ manual SPE from boat sampling, irrespective of differences in the two aspiration systems. These findings suggest that the application of the developed drone-assisted in situ SPE system can improve the efficiency of real-sample monitoring of natural water bodies. Full article

Hydatidiform mole is a trophoblastic disorder resulting from abnormal fertilization. Diagnosis is established through a combination of clinical findings, elevated serum human chorionic gonadotropin (hCG) levels, and characteristic features on transvaginal ultrasound. Timely and accurate diagnosis is essential for initiating prompt treatment and preventing medical complications. Uterine evacuation, preferably via vacuum aspiration, is the treatment of choice due to its high efficacy and safety profile. Adjunctive techniques, such as hysteroscopy and intraoperative ultrasonography, enhance the safety and effectiveness of uterine evacuation and should be available to patients, especially at specialized referral centers equipped to manage this diagnosis. In selected cases, particularly in women with fulfilled reproductive goals or those at a high risk of developing post-molar gestational trophoblastic neoplasia (GTN), total abdominal hysterectomy is appropriate. Postoperative follow-up with serial measurements of hCG is essential for monitoring remission and for the early detection of post-molar GTN, which develops in approximately 20% of cases of complete molar pregnancies and 1–4% of partial molar pregnancies. This article provides a comprehensive review of the diagnosis of hydatidiform mole and the surgical techniques employed in the treatment of this condition, emphasizing individualized care and the use of appropriate surgical strategies to treat complications associated with this trophoblastic disease. Full article

Background/Objective: Early pregnancy loss is often caused by chromosomal abnormalities, necessitating accurate diagnostic tools. While product of conception (POC) chromosomal testing is commonly used, it can be limited by culture failure or an inability to obtain fetal tissue due to spontaneous expulsion. Cell-free fetal DNA (cff DNA) analysis provides a non-invasive alternative; however, its effectiveness in early pregnancy loss, particularly in cases where fetal components are still minimal, has not been fully established. The objective of this study was to evaluate the accuracy of pre- and postoperative cff DNA analysis for detecting fetal aneuploidy by comparing the results to those of POC chromosomal testing. Methods: In this single-center prospective cohort study, 50 women undergoing manual vacuum aspiration for pregnancy loss before 12 weeks of gestation were enrolled (February 2022–December 2024). Cff DNA analysis was performed on maternal blood samples collected pre- and postoperatively. The primary outcome was concordance between the cff DNA and POC results. Sensitivity, specificity, and factors affecting concordance were also assessed. Results: Eight participants were excluded due to unsuccessful POC culture (n = 3), suspected maternal tissue contamination in the POC sample (n = 1), mosaicism (n = 3), or triploidy (n = 1), resulting in 42 evaluable cases. Preoperative cff DNA analysis showed 88.1% concordance with POC (sensitivity 86.4% and specificity 90.0%). Postoperative analysis showed 78.6% concordance (sensitivity 72.7% and specificity 85.0%). Conclusions: The Cff DNA analysis of preoperative and postoperative maternal blood samples showed generally good concordance with conventional POC chromosomal testing in detecting fetal aneuploidy in early pregnancy loss. Full article

Mammography is an essential tool in breast screening, often revealing lesions that appear as microcalcifications with or without an associated mass. Decisions about biopsy requirements are guided by the BI-RADS system, aiming to confirm the histopathology of suspicious lesions while avoiding unnecessary procedures. A vacuum-assisted breast biopsy (VABB) is a minimally invasive procedure for diagnosing breast abnormalities. Precise lesion targeting is ensured under stereotactic guidance, reducing the need for repeated procedures. Compared to traditional core needle biopsy (CNB) and fine-needle aspiration cytology (FNAC), it differs in using vacuum assistance to gather more tissue volume, increasing diagnostic accuracy and reducing the likelihood of histological underestimation. This is particularly crucial in cases where microcalcifications are the primary finding, as they are often the earliest signs of ductal carcinoma in situ (DCIS). Managing such findings requires precise diagnostic tools to differentiate benign from malignant lesions without subjecting patients to unnecessary surgical interventions. Building on several years of experience in our department, we have assembled a selection of ten interesting cases encountered in our clinical practice. Each case is documented with paired mammographic images and their corresponding image of histopathological findings, offering a comprehensive view of the diagnostic journey. These cases were selected for their educational value, highlighting the integration of imaging modalities, histopathological evaluation, and clinical decision-making. All cases underwent an extensive diagnostic workup at our facility. This compilation aims to provide valuable insights for both clinicians and researchers, offering a deeper understanding of advanced diagnostic techniques and their role in improving patient outcomes. Full article

Background/Objectives: Vacuum-assisted excision (VAE) is a minimally invasive technique for breast tumor treatment, offering precision, comfort, and quick recovery. It is widely used for benign breast lesions and is playing an increasingly important role in the therapeutic management of non-surgical patients or patients who refuse surgery. Optimal outcomes require an understanding of device features to tailor treatment to each lesion. The Mammotome^® Elite 10G operates in a fixed mode, while the Mammotome^® Revolve EX 8G offers multiple aspiration levels and aperture windows for greater versatility. This study analyzed the specimen features (weight and length), comparing the weight obtained from two different VAE systems to aid the appropriate selection of a device based on the clinical setting. It also determined the number of specimens needed to achieve the 4 g diagnostic threshold. Methods: The Mammotome^® Elite 10G and the Mammotome^® Revolve EX were evaluated under controlled conditions. For Mammotome^® Revolve EX, combinations of five aspiration levels and three aperture lengths (12 mm, 18 mm, and 25 mm) were tested. Twelve samples were collected from a chicken breast phantom for each setting. Specimen weights and the minimum excisions required to reach the 4 g threshold were analyzed. Results: The mean weight per sample for the Mammotome^® Elite 10G was 0.16 ± 0.04 g. For the Mammotome^® Revolve EX, the weights increased with aperture size and aspiration level, ranging from a minimum of 0.132 ± 0.028 g (a window length of 12 mm and aspiration level 1) to a maximum of 0.407 ± 0.055 g (a window length of 25 mm and aspiration level 5). The 25 mm window at aspiration level 5 achieved the 4 g threshold in as few as 10 samples. By comparison, the Mammotome^® Elite required up to 26 samples. Conclusions: Compared to the Mammotome Elite, Mammotome^® Revolve EX offers superior versatility and efficiency, reducing patient discomfort by minimizing the required samples. Its technical advantages make it a valuable tool for both diagnostic and therapeutic applications. Full article

The paper analyses multi-variant energy simulations carried out in IDA ICE 4.8 software for a newly designed single-family building within the framework of the 4E Idea. This idea assumes the use of energy-saving, ecological, ergonomic, and economic solutions in construction and building operation. Energy simulations were conducted to evaluate the annual energy-saving potential of the developed architectural house concept, which incorporates ergonomic analyses and cost-effective construction solutions. Analyses were conducted to optimise the non-renewable primary energy index by selecting mechanical ventilation system (CAV or VAV) with heat recovery; the configuration of photovoltaic module installation in terms of their location and orientation; the exposure and type of solar thermal collectors (flat and vacuum); and the use of two types of heat pumps (air- and ground-source). The most favourable energy performance of the building was achieved with an HVAC system equipped with a VAV mechanical ventilation system with heat recovery, an on-grid photovoltaic installation, vacuum solar thermal collectors, and a ground-source heat pump with a horizontal heat exchanger. This configuration resulted in a primary energy index value of 2 kWh/m²/year. The results of the analyses carried out for the 4E building concept may serve as a reference point for future energy-efficient building designs aspiring to meet higher standards of sustainable development. Full article

Purpose: To compare anterior chamber stability and surgical efficiency in one-handed phacoemulsification, comparing Ozil and Active Sentry (AS) handpieces. Methods: Observational and comparative study. Selected patients were divided into two groups, AS and Ozil handpieces, and underwent one-handed phacoemulsification. Parameters like IOP per quadrant, vacuum, and aspiration flow were fixed in all surgeries. The study endpoints were intraoperative anterior chamber instability score (IACIS), cumulative dissipated energy (CDE), followability, and surgery duration. Results: Mean age was 71.42 years in the AS group vs. 73.97 in the Ozil Group. Mean Axial Length was 22.85 ± 1.21 mm with Active Sentry vs. 23.3 ± 1.29 mm with Ozil (p = 0.324). IACIS was 0.10 ± 0.30 with AS vs. 0.63 ± 0.71 with Ozil (˂0.001*). CDE was 9.95 ± 4.76 percent-seconds with AS vs. 10.89 ± 6.55 percent-seconds with Ozil (0.519). The followability score was 0.74 ± 0.855 with AS vs. 0.83 ± 0.874 with Ozil (p = 0.678). Surgery duration was 19.00 ± 5.44 min with AS vs. 24.57 ± 6.51 with Ozil (p < 0.001). Conclusions: The Active Sentry handpiece improves anterior chamber stability in one-handed phacoemulsification while maintaining surgical performance during nucleus removal without an auxiliary side-port. To the best of our knowledge, this is the first study demonstrating that the Active Sentry handpiece can increase anterior chamber stability not only in conventional phacoemulsification but also in one-handed phacoemulsification. Full article

Esophagectomy, while a pivotal treatment for esophageal cancer, is not without adverse events. Among these, anastomotic leak (AL) is the most feared complication, threatening patient lives and incurring significant healthcare costs. The management of AL is complex and lacks standardization. Given the high morbidity and mortality rates associated with redo-surgery, which poses risks for already fragile patients, various endoscopic treatments have been developed over time. Self-expandable metallic stents (SEMSs) were the most widely used treatment until the early 2000s. The mechanism of action of SEMSs includes covering the wall defect, protecting it from secretions, and promoting healing. In 2010, endoscopic vacuum therapy (EVT) emerged as a viable alternative for treating ALs, quickly gaining acceptance in clinical practice. EVT involves placing a dedicated sponge under negative pressure inside or adjacent to the wall defect, aiming to clear the leak and promote granulation tissue formation. More recently, the VAC-Stent entered the scenario of endoscopic treatment of post-esophagectomy ALs. This device combines a fully covered SEMS with an integrated EVT sponge, blending the ability of SEMSs to exclude defects and maintain the patency of the esophageal lumen with the capacity of EVT to aspirate secretions and promote the formation of granulation tissue. Although the literature on this new device is not extensive, early results from the application of VAC-Stent have shown promising outcomes. This review aims to synthesize the preliminary efficacy and safety data on the device, thoroughly analyze its advantages over traditional techniques and disadvantages, explore areas for improvement, and propose future directions. Full article

The growing demand for agricultural output and limited resources encourage precision applications to generate higher-order output by utilizing minimal inputs of seed, fertilizer, land, and water. An electronically operated planter was developed, considering problems like ground-wheel skidding, field vibration, and the lack of ease in field adjustments of ground-wheel-driven seed-metering plates. The seed-metering plate of each unit of the developed planter is individually driven by a brushless direct current (BLDC) motor, and a BLDC motor-based aspirator is attached for pneumatic suction of seeds. The revolutions per minute (RPM) of the seed-metering plate are controlled by a microcontroller as per the received data relating to RPM from the ground wheel and the current RPM of the seed-metering plate. A feedback loop with proportional integral derivative (PID) control is responsible for reducing the error. Additionally, each row unit is attached to a parallelogram-based depth control system that can provide depth between 0 and 100 mm. The suction pressure in each unit is regulated as per seed type using the RPM control knob of an individual BLDC motor-based aspirator. The row-to-row spacing can be changed from 350 mm to any desired spacing. The cotton variety selected for the study was RCH 659, and the crucial parameters like orifice size, vacuum pressure, and forward speed were optimized in the laboratory with the adoption of a central composite rotatable design. An orifice diameter of 2.947 mm with vacuum pressure of 3.961 kPa and forward speed of 4.261 km/h was found optimal. A quality feed index of 93% with a precision index of 8.01% was observed from laboratory tests under optimized conditions. Quality feed index and precision index values of 88.8 and 12.75%, respectively, were obtained from field tests under optimized conditions. Full article

New suction endoscopes, ureteral access sheaths (UAS) and catheters aim to improve the efficacy of flexible ureteroscopy and optimize its safety. Suction UAS with non-flexible tips have shown promising results, especially in maintaining low intrarenal pressure, but also in removing small debris and reducing the “snow globe” effect. In addition, suctioning UAS with a flexible tip offers the advantage of being able to be navigated through the pyelocaliceal system to where the laser lithotripsy is performed. It can also remove small stone fragments when the flexible ureteroscope is retracted, using the Venturi effect. Direct in-scope suction (DISS) involves aspirating dust and small stone debris through the working channel of a flexible ureteroscope, thus regulating intrarenal pressure and improving visibility. Steerable aspiration catheters are other devices designed to increase stone clearance of the pyelocaliceal system. They are inserted under fluoroscopic guidance into every calyx after retraction of the flexible ureteroscope, alternating irrigation and aspiration to remove dust and small gravels. Combining flexible-tip suction UAS and the DISS technique may offer some advantages worth evaluating. The advantage of using these instruments to achieve a low intrarenal pressure was demonstrated. The true practical impact on the long-term stone-free status is a matter requiring further studies. Full article

Following the vision of the European Commission, organisations and workers establishing Industry 5.0 approaches aspire to more future-proof, resilient, sustainable, and human-centred European industries. In this contribution, we explore how technological innovations that contribute to a “win–win” interaction with involved stakeholders may be advanced in a human-centred and transparent proceeding supported by impartial expert translators who provide information or knowledge-based guidance for decision-makers, initiators and implementers in manufacturing innovation driven by sustainability. We elaborate a stepwise procedure for agreeing on milestones and conjointly treading the path towards solving innovation challenges during a translation process. We exemplify the technological aspects of such a process using an innovation case aiming at identifying parameters for enhancements in a vacuum-bagging process applied to the manufacturing of composite parts from prepregs based on condensation-curing matrix resins made from renewable resources. In detail, we present a straightforward design of an experimental approach varying the dwelling temperature and the temperature ramps during the curing of stacked prepregs. In this way, we demonstrate that for cured composites comprising a poly(furfuryl alcohol)-based matrix, the porosity and connected mechanical properties achieved with autoclave-free curing processes sensitively depend on these process parameters. Applying the resulting data-based model is shown to support decision-making for sustainable composite manufacture. Full article

Osteomyelitis of the tibia is a challenging condition, particularly when it occurs as a result of trauma. This abstract presents a case study detailing the successful staged treatment of posttraumatic tibial osteomyelitis utilizing a unique combination of rib graft and serratus anterior muscle. This medical abstract presents a case study of a 52-year-old male with a history of heavy smoking and obliterating arteriopathy of the lower limbs. The patient sustained a traumatic open fracture classified as Type IIIA Gustilo Anderson involving one-third of the distal right tibia diaphysis, with an associated right fibular malleolus fracture. The treatment approach comprised multiple stages, focusing on wound management, infection control, and limb salvage. The initial stage involved the application of an external fixation device in the emergency setting. Seven days later, an osteosynthesis procedure was performed using a Kuntscher nail and wire cerclage. However, complications emerged, with wound dehiscence and purulent secretion observed at 14 days postsurgery. Subsequently, secondary suturing was carried out at the 20-day mark. The second stage of the treatment involved implant removal, wide excisional debridement, pulse lavage, osteoclasia, and relaxation of the peroneal malleolus. A monoplane external fixation system was applied. As a part of postoperative care, aspiration therapy with a vacuum pump was administered, along with a 10-day course of vancomycin according to the antibiogram. Positive clinical signs of healing were noted, and sterile cultures confirmed the results. The third stage of the intervention focused on grafting the osteo-muscular defect, utilizing autografts from the rib and serratus anterior muscle. The external fixator was maintained in place during this phase. In the fourth and final stage, after an 8-week integration period of the musculocutaneous flap, the external fixator was removed, and internal fixation was accomplished with a blocked Less Invasive Stabilization System (LISS) plate inserted using the Minimally Invasive Plate Osteosynthesis (MIPO) technique. This case underscores the significance of a multistage approach in managing complex limb injuries, emphasizing the importance of timely intervention, infection control, and innovative techniques for limb salvage and restoration of function. Full article

Mosquitoes are pests of horses, but mosquito trap efficacy data, especially the ability of traps to protect horses, are lacking. Studies were conducted to investigate the comparative attraction between traps and horses, increase trap attraction by adding horse odors to the airstream of a trap, determine the spatial distribution of adult mosquitoes, estimate the numbers of mosquitoes feeding on horses, determine the relative attraction of horses to mosquitoes, and estimate the range of mosquitoes’ attraction between two horses. When a horse and a mosquito trap were placed 3.5 m apart, there was a significant reduction in mosquitoes entering the trap. Adding horse odors to the airstream of a trap produced equivocal results because the horse providing the odors influenced the trap catches. Mosquitoes were not evenly distributed across the study site, which emphasized the importance of trap placement. Vacuuming mosquitoes from the horses in different seasons demonstrated that 324 and 359 mosquitoes per hour were feeding during the two studies. Separate analysis of data from the two horses vacuumed simultaneously revealed that one horse attracted twice as many mosquitoes as the other. This caused the results of a study to determine the attraction range of two horses moved from 3.5 to 20.4 m apart to be inconclusive. Full article