Tuberous breast (TB) deformity can be corrected with implant augmentation or autologous fat grafting (lipofilling), but comparative patient-reported outcomes are uncertain. To compare postoperative health-related quality of life and satisfaction after lipofilling versus implants in TB correction, hypothesizing better outcomes and fewer complications with lipofilling. This is a single-center retrospective cohort of consecutive TB patients treated 2013–2024. Eligible patients underwent implant augmentation with glandular remodeling or exclusive lipofilling by six surgeons. Patient-reported outcomes were collected ≥6 months postoperatively using the postoperative BREAST-Q® Augmentation module (five domains). Complications, number of procedures, and hospital stay were recorded. Group differences used Welch and Chi-square tests (α = 0.05). Of 53 eligible patients, 40 completed the survey (20 lipofilling; 20 implants). BREAST-Q® domain scores were similar for Satisfaction with Breasts (p = 0.21), Psychosocial Well-being (p = 0.11), and Sexual Well-being (p = 0.34). Lipofilling showed higher Physical Well-being (p < 0.01) and Satisfaction with Outcome (p = 0.01). The mean number of procedures did not differ (1.53 vs. 1.41; p = 0.28). Hospital stay was shorter after lipofilling (1.7 vs. 2.1 days; p < 0.01), and complications were less frequent (p = 0.014). In this retrospective cohort, lipofilling was associated with higher BREAST-Q® Satisfaction with Outcome and better Physical Well-being, a shorter hospital stay, and fewer complications than implants, without more reinterventions. Prospective adjusted studies with pre-/postoperative BREAST-Q® are warranted. 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 .
Rationale: Excessive stress (distending pressure), strain (volume deformation), and drop in inspiratory alveolar pressure are proposed mechanisms for patient self-inflicted lung injury. Objectives: To dissect the influence of inspiratory effort, respiratory mechanics, and ventilation mode on lung stress, strain, and drop in inspiratory alveolar pressure; and explore their impact on oxygenation and lung compliance. Methods: International cohort study analyzing respiratory recordings (esophageal pressure) of patients with acute hypoxemic respiratory failure. Association between muscular pressure (Pmus), surrogates of stress (driving trans-alveolar pressure), strain (tidal volume), and inspiratory alveolar pressure relative to PEEP were explored with mixed-models, including interactions for ventilation mode, respiratory system elastance, and synchrony. Association between these and changes in oxygenation and lung compliance were explored. Measurements and main results: 60 patients from 15 centers represented 528 recordings (339,796 breaths). For each cmH(2)O Pmus increase there was an increase in driving trans-alveolar pressure (median[CI 95%] 0.28[0.27-0.29]cmH(2)O) and tidal volume (0.16[0.16-0.17]ml/kg of predicted body weight) and decrease in alveolar pressure (-0.25[0.24-0.6]cmH(2)O, p<0.001). Volume-control ventilation showed less increase in stress and strain surrogates than pressure-targeted modes, but more drop in alveolar pressure (p<0.001, Pmus:mode interaction). Breath-stacking was infrequent and associated with higher stress. Lower inspiratory alveolar pressure relative to PEEP was associated with subsequent worsening oxygenation (p=0.04) and higher stress with worsening lung compliance (p=0.023). Conclusion: Strong efforts are associated with high surrogates for lung stress, strain, and lower inspiratory alveolar pressure relative to PEEP, differently according to the mode of ventilation, being associated with subsequent worsening oxygenation and lung compliance.
Robot-assisted partial nephrectomy (RAPN) and percutaneous thermal ablation (PTA) are established treatment options for localized renal tumors. While RAPN remains the standard-of-care, PTA is increasingly adopted, particularly in patients unfit for surgery. Evidence on how tumor complexity influences comparative outcomes between these two approaches remains limited. We conducted a systematic review of major database up to December 2025 and meta-analysis. Studies directly comparing PTA and RAPN in patients with localized Renal Cell Carcinoma (RCC) were included. Outcomes of interest included local recurrence (LR), recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), overall survival (OS), estimated glomerular filtration rate (eGFR) variation, and complication rates (overall and Clavien-Dindo ≥ III). When feasible, subgroup analyses were performed according to tumor complexity (RENAL ≥ 7 or PADUA ≥ 8). Seventeen studies encompassing 2516 patients met the inclusion criteria. Patients undergoing PTA were older with higher comorbidity burden than those treated with RAPN. Primary technical failure of the first PTA session occurred in approximately 10.9
Breast cryoablation has emerged as a minimally invasive alternative to lumpectomy for selected patients with small, biologically favorable breast cancers. Its appeal lies in the combination of focal tumor destruction, outpatient treatment under local anesthesia, low procedural burden, and potentially improved cosmetic and functional outcomes. However, cryoablation should not be viewed as a simple technical substitute for surgery: its oncologic credibility depends on appropriate tumor selection, accurate imaging-based staging, adequate ablative margins, and coherent integration with adjuvant therapy and follow-up. This review summarizes the current evidence on breast cryoablation, focusing on biological rationale, validation studies with surgical confirmation, prospective non-excision cohorts, practical indications, and post-ablation imaging surveillance. Surgical-validation studies show that cryoablation can achieve high rates of complete tumor destruction, but mainly in a narrow subgroup of small, ultrasound-visible, hormone receptor-positive, HER2-negative invasive ductal carcinomas, particularly those measuring 15-20 mm or less. These studies also show that failure often reflects occult multifocality or underestimation of microscopic disease extent rather than failure to destroy the index lesion itself. Prospective non-excision studies, particularly ICE3 and FROST, have moved the field beyond feasibility alone. In highly selected older women with low-risk tumors, ICE3 reported a low 5-year ipsilateral breast tumor recurrence rate of 4.3%, while FROST showed similarly encouraging local control, with a 5-year ipsilateral breast tumor recurrence rate of 3.6%, and underscored the importance of structured post-ablation verification. These results also reflect technical progress, as single-probe liquid nitrogen platforms have simplified and standardized treatment delivery compared with earlier multi-probe approaches. Current evidence therefore supports cryoablation only within a narrow clinical setting. Broader adoption will require standardized patient selection, harmonised adjuvant strategies, robust imaging follow-up, and comparative trials against surgery or endocrine therapy-based approaches.
