Immediate breast reconstruction after mastectomy for cancer

Background: Immediate breast reconstruction after mastectomy has increased over the past decade following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. Broadly, it is undertaken in the treatment of breast cancer, after prophylactic mastectomy in high-risk patients, and in the management of treatment failure after breast-conserving surgery and radiotherapy. Immediate breast reconstruction can be achieved reliably with a variety of autogenous tissue techniques or prosthetic devices. Careful discussion and evaluation remain vital in choosing the correct technique for the individual patient.

Methods: This review is based primarily on an English language Medline search with secondary references obtained from key articles.

Results and conclusion: Immediate breast reconstruction is a safe and acceptable procedure after mastectomy for cancer; there is no evidence that it has untoward oncological consequences. In the appropriate patient it can be achieved effectively with either prosthetic or autogenous tissue reconstruction. Patient selection is important in order to optimize results, minimize complications and improve quality of life, while simultaneously treating the malignancy. Close cooperation and collaboration between the oncological breast and reconstructive achieve these objectives.

The structural response of an oscillating wave surge converter to wave slamming

This paper describes the problems in experimentally obtaining hydrodynamic loads on an oscillating wave surge converter during slamming events, with the aim of furthering understanding of full scale hydrodynamic loads that flap type devices must be designed to withstand. Including how hydro-elastic effects and structural response are linked and why they are essential to the measurement of impulsive hydrodynamic loads. A combined experimental and numerical structural response study carried out on a 40th scale Oyster model drew conclusions on the structural vibration observed in the strain gauge load cell measurement. A further structural response study on a piezo electric load measurement device gave an insight into the advantages it could bring to reducing hydro-elastic effects.

Development and validation of Fluid Structure Interaction Methods for an Oscillating Wave Surge Converter

The term fatigue loads on the Oyster Oscillating Wave Surge Converter (OWSC) is used to describe hydrostatic loads due to water surface elevation with quasi-static changes of state. Therefore a procedure to implement hydrostatic pressure distributions into finite element analysis of the structure is desired. Currently available experimental methods enable one to measure time variant water surface elevation at discrete locations either on or around the body of the scale model during tank tests. This paper discusses the development of a finite element analysis procedure to implement time variant, spatially distributed hydrostatic pressure derived from discretely measured water surface elevation. The developed method can process differently resolved (temporal and spatial) input data and approximate the elevation over the flap faces with user defined properties. The structural loads, namely the forces and moments on the body can then be investigated by post processing the numerical results. This method offers the possibility to process surface elevation or hydrostatic pressure data from computational fluid dynamics simulations and can thus be seen as a first step to a fluid-structure interaction model.

An anatomical study of the arterial and nerve supply of the infrahyoid muscles

A precise knowledge of the sources of the arterial and neural supply of the sternohyoid (SH), sternothyroid (STM), and superior belly of omohyoid (OM) is of value to surgeons using the infrahyoid muscles in reconstruction procedures of the head and neck. This study was designed to define the anatomical bases of the variable sources of the arterial and neural supply of these muscles. Fourteen cadavers were unilaterally dissected in the neck region, and the arterial pedicles of these muscles were followed and accurate measurements were taken. For the SH, two arterial pedicles (superior and inferior) originated from the superior thyroid artery ST and supplied the muscle in 57.1% of cases. The inferior pedicle was absent in 42.9% of cases. As regards the STM, one arterial pedicle from the ST supplied its upper end by multiple branches in 57.1% of cases. In 14.3% of cases, branches from the inferior thyroid artery (IT) supplied the STM in addition to its supply from the ST. As regards the OM, two arterial pedicles originated from the ST and supplied its upper and lower ends in 57.1% of cases. The main artery from the ST to the superior belly of OM entered at its superior portion. The ansa cervicalis (AC) innervated the infrahyoid muscles. SH usually had a double nerve supply. In 57.1% of cases, its superior part was innervated by the nerve to the superior belly of OM. Its inferior part received branches from the AC. In 35.7% of cases, its superior part received direct branches from the AC. As regards the STM, in (71.4%) of cases, a common trunk arose from the loop and supplied the inferior part of both the SH and STM. The nerve supply to the superior belly of OM originated from the AC below the loop in 64.3% of cases. These data will be useful for preserving the neuro-vascular supply of the infrahyoid muscles during flap preparation.

Mode of insertion of the abductor hallucis muscle in human feet and its arterial supply

The abductor hallucis flap is commonly used as a pedicled flap (distally or proximally based) in the management of ankle, heel, and mid-foot lesions, where it is ideally used for closing defects. This study investigates the anatomical details of this muscle regarding its various forms of insertion and its arterial supply in 15 cadaveric feet. Four types of insertion could be distinguished: type A, insertion at the proximal phalanx of the big toe (46.7%); type B, insertion by two slips into the base of the proximal phalanx and the sesamoid bone (33.3%); type C, insertion at the sesamoid bone (6.7%); And type D, the insertion is divided into superficial tendinous and deep fleshy parts which are attached to the base of the proximal phalanx and to the metatarsophalangeal joint capsule of the big toe, respectively (13.3%). As regards the arterial supply, three patterns were noticed: pattern A (40%) where the medial plantar artery (MPA) is divided into superficial and deep branches that supplied the muscle; pattern B (53.3%) where the MPA failed to produce a deep branch but instead continued as the superficial branch supplying the two ends of the muscle; and pattern C (6.6%) where the MPA continued as a deep branch supplying the muscle. A superficial branch of MPA provided a branch to the abductor hallucis muscle from its proximal part. In two specimens (13.3%), the lateral plantar artery shared in the supply of the most proximal part of the muscle. These results can be useful in determining the appropriate flap design based on the abductor hallucis type of insertion and the pattern of its arterial supply in the patients.

The Vertical Distribution and Evolution of Slam Pressure on an Oscillating Wave Surge Converter

The accurate definition of the extreme wave loads which act on offshore structures represents a significant challenge for design engineers and even with decades of empirical data to base designs upon there are still failures attributed to wave loading. The environmental conditions which cause these loads are infrequent and highly non-linear which means that they are not well understood or simple to describe. If the structure is large enough to affect the incident wave significantly further non-linear effects can influence the loading. Moreover if the structure is floating and excited by the wave field then its responses, which are also likely to be highly non-linear, must be included in the analysis. This makes the description of the loading on such a structure difficult to determine and the design codes will often suggest employing various tools including small scale experiments, numerical and analytical methods, as well as empirical data if available.
Wave Energy Converters (WECs) are a new class of offshore structure which pose new design challenges, lacking the design codes and empirical data found in other industries. These machines are located in highly exposed and energetic sites, designed to be excited by the waves and will be expected to withstand extreme conditions over their 25 year design life. One such WEC is being developed by Aquamarine Power Ltd and is called Oyster. Oyster is a buoyant flap which is hinged close to the seabed, in water depths of 10 to 15m, piercing the water surface. The flap is driven back and forth by the action of the waves and this mechanical energy is then converted to electricity.
It has been identified in previous experiments that Oyster is not only subject to wave impacts but it occasionally slams into the water surface with high angular velocity. This slamming effect has been identified as an extreme load case and work is ongoing to describe it in terms of the pressure exerted on the outer skin and the transfer of this short duration impulsive load through various parts of the structure.
This paper describes a series of 40th scale experiments undertaken to investigate the pressure on the face of the flap during the slamming event. A vertical array of pressure sensors are used to measure the pressure exerted on the flap. Characteristics of the slam pressure such as the rise time, magnitude, spatial distribution and temporal evolution are revealed. Similarities are drawn between this slamming phenomenon and the classical water entry problems, such as ship hull slamming. With this similitude identified, common analytical tools are used to predict the slam pressure which is compared to that measured in the experiment.

On the use of OpenFOAM to model Oscillating wave surge converters

The Computational Fluid Dynamic (CFD) toolbox OpenFOAM is used to assess the applicability of Reynolds-Averaged Navier-Stokes (RANS) solvers to the simulation of Oscillating Wave Surge Converters (OWSC) in significant waves. Simulation of these flap type devices requires the solution of the equations of motion and the representation of the OWSC’s motion in a moving mesh. A new way to simulate the sea floor inside a section of the moving mesh with a moving dissipation zone is presented. To assess the accuracy of the new solver, experiments are conducted in regular and irregular wave traces for a full three dimensional model. Results of acceleration and flow features are presented for numerical and experimental data. It is found that the new numerical model reproduces experimental results within the bounds of experimental accuracy.

Wave Interaction with an Oscillating Wave Surge Converter, Part 1: Viscous Effects

Bottom hinged oscillating wave surge converters are known to be an efficient method of extracting power from ocean waves. The present work deals with experimental and numerical studies of wave interactions with an oscillating wave surge converter. It focuses on two aspects: (1) viscous effects on device performance under normal operating conditions; and (2) effects of slamming on device survivability under extreme conditions. Part I deals with the viscous effects while the extreme sea conditions will be presented in Part II. The numerical simulations are performed using the commercial CFD package ANSYS FLUENT. The comparison between numerical results and experimental measurements shows excellent agreement in terms of capturing local features of the flow as well as the dynamics of the device. A series of simulations is conducted with various wave conditions, flap configurations and model scales to investigate the viscous and scaling effects on the device. It is found that the diffraction/radiation effects dominate the device motion and that the viscous effects are negligible for wide flaps.

IMRT for image-guided single vocal cord irradiation

PURPOSE: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques.

METHODS AND MATERIALS: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions.

RESULTS: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose ± standard deviation to the planning target volume was 67 ± 1 Gy. The contralateral vocal cord dose was reduced from 66 ± 1 Gy in the conventional plans to 39 ± 8 Gy and 36 ± 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk.

CONCLUSIONS: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

Hydrodynamic Loading on a Bottom Hinged Oscillating Wave Surge Converter

This paper presents experimental and numerical studies into the hydrodynamic loading of a bottom-hinged large buoyant flap held rigidly upright in waves. Possible applications and limitations of physical experiments, a linear potential analytical method, a linear potential numerical method, a weakly non-linear tool and RANS CFD simulations are discussed. Different domains of applicability of these research techniques are highlighted considering the validity of underlying assumptions, complexity of application and feasibility in terms of resources like time and computing power needed to obtain results. Conclusions are drawn regarding the future extension of the numerical methods to the case of a moving flap.

p63 drives invasion in keratinocytes expressing HPV16 E6/E7 genes through regulation of Src-FAK signalling

Using microarray information from oro-pharyngeal data sets and results from primary human foreskin keratinocytes (HFK) expressing Human Papilloma Virus (HPV)-16 E6/E7 proteins, we show that p63 expression regulates signalling molecules which initiate cell migration such as Src and focal adhesion kinase (FAK) and induce invasion in 3D-organotypic rafts; a phenotype that can be reversed by depletion of p63. Knockdown of Src or FAK in the invasive cells restored focal adhesion protein paxillin at cell periphery and impaired the cell migration. In addition, specific inhibition of FAK (PF573228) or Src (dasatinib) activities mitigated invasion and attenuated the expression/activity of matrix metalloproteinase 14 (MMP14), a pivotal MMP in the MMP activation cascade. Expression of constitutively active Src in non-invasive HFK expressing E6/E7 proteins upregulated the activity of c-Jun and MMP14, and induced invasion in rafts. Depletion of Src, FAK or AKT in the invasive cells normalised the expression/activity of c-Jun and MMP14, thus implicating the Src-FAK/AKT/AP-1 signalling in MMP14-mediated extra-cellular matrix remodelling. Up-regulation of Src, AP-1, MMP14 and p63 expression was confirmed in oro-pharyngeal cancer. Since p63 transcriptionally regulated expression of many of the genes in this signalling pathway, it suggests that it has a central role in cancer progression.

Relative Contribution of P5 and Hap Surface Proteins to Nontypable Haemophilus influenzae Interplay with the Host Upper and Lower Airways

Nontypable Haemophilus influenzae (NTHi) is a major cause of opportunistic respiratory tract disease, and initiates infection by colonizing the nasopharynx. Bacterial surface proteins play determining roles in the NTHi-airways interplay, but their specific and relative contribution to colonization and infection of the respiratory tract has not been addressed comprehensively. In this study, we focused on the ompP5 and hap genes, present in all H. influenzae genome sequenced isolates, and encoding the P5 and Hap surface proteins, respectively. We employed isogenic single and double mutants of the ompP5 and hap genes generated in the pathogenic strain NTHi375 to evaluate P5 and Hap contribution to biofilm growth under continuous flow, to NTHi adhesion, and invasion/phagocytosis on nasal, pharyngeal, bronchial, alveolar cultured epithelial cells and alveolar macrophages, and to NTHi murine pulmonary infection. We show that P5 is not required for bacterial biofilm growth, but it is involved in NTHi interplay with respiratory cells and in mouse lung infection. Mechanistically, P5NTHi375 is not a ligand for CEACAM1 or α5 integrin receptors. Hap involvement in NTHi375-host interaction was shown to be limited, despite promoting bacterial cell adhesion when expressed in H. influenzae RdKW20. We also show that Hap does not contribute to bacterial biofilm growth, and that its absence partially restores the deficiency in lung infection observed for the ΔompP5 mutant. Altogether, this work frames the relative importance of the P5 and Hap surface proteins in NTHi virulence.

Extreme Loads on an Oscillating Wave Surge Converter

A major difficulty in the design of full scale Wave Energy Converters is the need to design for two conflicting design criteria. In one instance devices must be designed to couple heavily to the incident wave force resulting in the efficient extraction of energy in small sea states, however devices must also be capable of withstanding the harsh conditions encountered during extreme seas. This paper presents an initial investigation of the extreme wave loading of a generic, surface-piercing, pitching flap-type device deployed in near shore wave conditions. Slamming of the flap is selected as the extreme load event for further investigation and the experimental methodologies employed are described. Preliminary results showing both local and global loading under such events are presented for the case of a flap tested in a 3-dimensional environment. Results are presented which show flap slamming effects on the pressures experienced on the front face of the flap.

Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China

Purpose: To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there. Methods: Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points). Results Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up. Conclusions: Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.

Computerized key of the genus genus Laimaphelenchus Fuchs, 1937

The Order Aphelenchida contains several genera of economic importance, namely Aphelenchoides and Bursaphelenchus. Nematode species belonging to these 2 genera frequently co-habit with other genera such as Laimaphelenchus. It is therefore important to clearly distinguish them, as well as understand the group´s biodiversity. A computerized, or e-key, for the genus Laimaphelenchus Fuchs has been developed in the BiKey Identification system (Dianov & Lobanov, 1996-2004). The e-key includes 14 species and 34 characters (from 2 to 6 character states each). It also includes the built-in algorithm ranging characters according their diagnostic values to minimize the number of the diagnosis steps (average number of steps is 2.7; values are re-calculated at each step). The most important characters (as calculated by BiKey) are: length of posterior branch of the female genital system; excretory pore position; vulval anterior flap shape; number pairs of mail tale papillae; male bursa shape (ventral view); number of tail tip setae in female; female tail tip stub shape; presence of mucro on tail tip in male. Key is pictorial (image-operating), multientry, as other BiKey products.