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Objectives: The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery. Methods: Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests. Results: Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions. Conclusions: The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery. Trial Registration: ClinicalTrial.gov [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of dynamic adaptive teaching model on surgical education. Methods Due to the COVID-19 pandemic in 2020, we adopted dynamic adaptive teaching model in the Department of Breast Surgery, Peking Union Medical College Hospital, which divided the whole curriculum into several individual modules and recombined different modules to accommodate to student's levels and schedules. Meanwhile, adaptive strategy also increased the proportion of online teaching and fully utilized electronic medical resources. The present study included quantitative teaching score (QTS) recorded from January 2020 to June 2020, and used the corresponding data from 2019 as control. The main endpoint was to explore the impact of dynamic adaptive teaching model on overall QTS and its interaction effect with trainer's experience and student category. Results Totally, 20 trainers and 181 trainees were enrolled in the present study. With implementation of dynamic adaptive strategy, the overall QTS decreased dramatically (1.76±0.84 vs. 4.91±1.15, t=4.85, P=0.005). The impact was consistent irrespective of trainers' experience (high experience trainers: 0.85±0.40 vs. 2.12±0.44, t=4.98, P=0.004; medium experience trainers: 0.85±0.29 vs. 2.06±0.53, t=4.51, P=0.006; and low experience trainers: 0.10±0.16 vs. 0.44±0.22, t=2.62, P=0.047). For resident (including graduate) and undergraduate student teaching, both QTS was lower with dynamic strategy (residents: 0.18±0.34 vs. 0.97±0.14, t=4.35, P=0.007; undergraduate students 1.57±0.55 vs. 3.77±1.24, t=3.62, P=0.015), but dynamic strategy was effective for post-doc student subgroup and reached comparable QTS as traditional model (0.00±0.00 vs. 0.17±0.41, t=1.00, P=0.363). Conclusions Dynamic adaptive teaching strategy could be a useful alternative to traditional teaching model for post-doc students. It could be a novel effective solution for saving teaching resources and providing individualized surgical teaching modality.

Background: Breast cancer has become a critical international healthcare issue. Specifically, among the different subtypes, breast cancer marked by human epidermal growth factor receptor 2 (HER2)-overexpression usually correlates with low survival and a poor prognosis and poses challenges in treatment, thus leading to high mortality., Case Description: A 54-year-old female patient was diagnosed with a large T4cN2aM0 stage IIIB breast tumor with HER2 overexpression. The tumor size was large, and there was a lack of opportunity for surgery. However, after neoadjuvant chemotherapy (NACT), the size of the tumor continuously shrank, and the patient successfully underwent a modified radical mastectomy. Even though a certain amount of mass remained and she did not complete six courses of NACT, our patient's postoperative pathological result still revealed that a pathological complete response (pCR) was achieved. The appropriate time window for choosing surgical intervention should be determined based on the patient's general condition instead of complying with the treatment guidelines. Also, imaging findings may be misleading in patients who have undergone NACT. Moreover, the regimen should be chosen flexibly., Conclusions: Patients with locally advanced breast cancer can still achieve a radical surgical resection following appropriate comprehensive treatment. Hopefully, this case can provide new ideas for surgeons when they face similar conditions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-92/coif). The authors have no conflicts of interest to declare., (2024 Gland Surgery. All rights reserved.)

Background: Given the limited access to breast cancer (BC) screening, the authors developed and validated a mobile phone-artificial intelligence-based infrared thermography (AI-IRT) system for BC screening., Materials and Methods: This large prospective clinical trial assessed the diagnostic performance of the AI-IRT system. The authors constructed two datasets and two models, performed internal and external validation, and compared the diagnostic accuracy of the AI models and clinicians. Dataset A included 2100 patients recruited from 19 medical centres in nine regions of China. Dataset B was used for independent external validation and included 102 patients recruited from Langfang People's Hospital., Results: The area under the receiver operating characteristic curve of the binary model for identifying low-risk and intermediate/high-risk patients was 0.9487 (95% CI: 0.9231-0.9744) internally and 0.9120 (95% CI: 0.8460-0.9790) externally. The accuracy of the binary model was higher than that of human readers (0.8627 vs. 0.8088, respectively). In addition, the binary model was better than the multinomial model and used different diagnostic thresholds based on BC risk to achieve specific goals., Conclusions: The accuracy of AI-IRT was high across populations with different demographic characteristics and less reliant on manual interpretations, demonstrating that this model can improve pre-clinical screening and increase screening rates., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To investigate the safety and efficacy of trastuzumab administered concurrently with anthracycline-containing adjuvant regimen for breast cancer., Methods: It is a prospective, randomized and controlled trial. Participants were randomized to receive trastuzumab administered concurrently or sequentially with anthracycline-containing adjuvant regimen. The primary endpoint was cardiac safety. The second endpoints were disease-free survival (DFS) and overall survival (OS)., Results: One hundred and nine breast cancer patients were enrolled and randomized in this trial. Fifty-five participants received trastuzumab administered concurrently with anthracycline-containing adjuvant regimen and 54 patients received trastuzumab administered sequentially with anthracycline. The primary cardiac event was asymptomatic decrease in the left ventricular ejection fraction (LVEF). There was no significant difference between concurrent and sequential groups in cardiac event rates (9.1% vs13.0%, P = 0.556), neither of LVEF values at basline or at 3, 6, 9 and 12 months during trastuzumab treatment (P > 0.05). Four patients (7.3%) in the concurrent group suffered local recurrences or distant metastases, and 6 participants (11.1%) in the sequential group had distant metastases. There was no significant difference between the two groups in DFS (P = 0.724). There was no death in both groups., Conclusions: Trastuzumab administered concurrently with anthracycline is a safe adjuvant regimen for breast cancer and does not increase cardiac events. Further research is needed to determine the efficacy of this treatment regimen.