Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques

Background: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.

Immediate reconstruction following breast-conserving surgery: Management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving Surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving Surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled Surgical margin status on the type of breast-conserving Surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic Surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment Of Surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving Surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins: however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic Surgeon and careful intraoperative management, (C) 2008 Elsevier Ltd. All rights reserved.

Immediate conservative breast surgery reconstruction with perforator flaps: New challenges in the era of partial mastectomy reconstruction?

Introduction: Although the use of local flaps in conservative breast surgery (CBS) reconstruction is a reliable technique, little information has been available regarding outcome following the use of perforator flaps. The purpose of this study is to analyze the feasibility, surgical planning and outcome following CBS reconstruction with intercostal artery perforator (ICAP) flap. Patients/methods: Thirteen patients underwent CBS reconstructions with an ICAP flap. These flaps were raised from adjacent tissue located on the lateral and thoracic region and based on perforators originating from the costal and muscular segment of the intercostal vessels. The technique was indicated in patients with small/moderate volume breasts. Results: Mean time of follow-up was 32 months. Flap complications were evaluated and information on patient satisfaction were collected. 61.5 percent had tumors located in the lower-outer quadrants and 69.2 percent had tumors measuring 2 cm or less (T1). Complications occurred in 3 patients (23%), including wound dehiscence in 2 patients and fat necrosis in one. All cases were treated by conservative approach with a good result. No flap loss or wound infection were reported. 90 percent were either satisfied or very satisfied with their result. Conclusion: The ICAP flap is a reliable technique for immediate CBS reconstruction. The technique is advantageous because it does not require the use of muscle transfer, with minimum donor site morbidity. Success depends on patient selection, coordinated planning with the oncological surgeon and careful intra-operative management. (C) 2011 Elsevier Ltd. All rights reserved.

Effect of enzymatic pretreatment and increasing the organic loading rate of lipid-rich wastewater treated in a hybrid UASB reactor

This study aimed at evaluating the effect of increasing organic loading rates and of enzyme pretreatment on the stability and efficiency of a hybrid upflow anaerobic sludge blanket reactor (UASBh) treating dairy effluent. The UASBh was submitted to the following average organic loading rates (OLR) 0.98 Kg.m(-3).d(-1), 4.58 Kg.m(-3).d(-1), 8.89 Kg.m(-3).d(-1) and 15.73 Kg.m(-3).d(-1), and with the higher value, the reactor was fed with effluent with and without an enzymatic pretreatment to hydrolyze fats. The hydraulic detention time was 24 h, and the temperature was 30 +/- 2 degrees C. The reactor was equipped with a superior foam bed and showed good efficiency and stability until an OLR of 8.89 Kg.m(-3).d(-1). The foam bed was efficient for solid retention and residual volatile acid concentration consumption. The enzymatic pretreatment did not contribute to the process stability, propitiating loss in both biomass and system efficiency. Specific methanogenic activity tests indicated the presence of inhibition after the sludge had been submitted to the pretreated effluent It was concluded that continuous exposure to the hydrolysis products or to the enzyme caused a dramatic drop in the efficiency and stability of the process, and the single exposure of the biomass to this condition did not inhibit methane formation. (C) 2011 Elsevier B.V. All rights reserved.

Inexpensive footwear decreases joint loading in elderly women with knee osteoarthritis

Recent literature has highlighted that the flexibility of walking barefoot reduces overload in individuals with knee osteoarthritis (OA). As such, the aim of this study was to evaluate the effects of inexpensive, flexible, non-heeled footwear (Moleca (R)) as compared with a modern heeled shoes and walking barefoot on the knee adduction moment (KAM) during gait in elderly women with and without knee OA. The gait of 45 elderly women between 60 and 70 years of age was evaluated. Twenty-one had knee OR graded 2 or 3 according to Kellgren and Lawrence`s criteria, and 24 who had no OA comprised the control group (CG). The gait conditions were: barefoot, Moleca (R), and modern heeled shoes. Three-dimensional kinematics and ground reaction forces were measured to calculate KAM by inverse dynamics. For both groups, the Moleca (R) provided peak KAM and KAM impulse similar to barefoot walking. For the OA group, the Moleca (R) reduced KAM even more as compared to the barefoot condition during midstance. On the other hand, the modern heeled shoes increased this variable in both groups. Inexpensive, flexible, and non-heeled footwear provided loading on the knee joint similar to a barefoot gait and significant overload decreases in elderly women with and without knee OA, compared to modern heeled shoes. During midstance, the Moleca (R) also allowed greater reduction in the knee joint loads as compared to barefoot gait in elderly women with knee OA, with the further advantage of providing external foot protection during gait. (C) 2011 Elsevier B.V. All rights reserved.

Efficient bulk-loading on dynamic metric access methods

This paper presents a new technique and two algorithms to bulk-load data into multi-way dynamic metric access methods, based on the covering radius of representative elements employed to organize data in hierarchical data structures. The proposed algorithms are sample-based, and they always build a valid and height-balanced tree. We compare the proposed algorithm with existing ones, showing the behavior to bulk-load data into the Slim-tree metric access method. After having identified the worst case of our first algorithm, we describe adequate counteractions in an elegant way creating the second algorithm. Experiments performed to evaluate their performance show that our bulk-loading methods build trees faster than the sequential insertion method regarding construction time, and that it also significantly improves search performance. (C) 2009 Elsevier B.V. All rights reserved.

Efficiency in the loading of a sodium magneto-optical trap from alkali metal dispensers

We study the loading of sodium atoms into a magneto-optical trap from current-controlled sodium metal dispensers. Contrary to what was previously reported [V. Wippel, C. Binder, W. Huber, L Windholz, M. Allegrini, F. Fuso, E. Arimondo, Eur. Phys. J. D 17 (2001) 2851 we demonstrate a significantly higher number of trapped atoms that make Na dispensers a feasible source of atoms for cold-atom studies. The inherent rise in pressure that naturally arises from metal dispensers as they are heated to release atoms is partially controlled by placing the metal dispensers near the pumping port where an ion pump is connected. We also study the effects of placing the sodium dispensers at different distances from the main vacuum chamber where the atoms are trapped and the effectiveness of using a Zeeman slower to cool the atoms as they emerge from the dispensers. We observe trapping of up to 1.9 x 10(8) atoms, which is significantly higher by almost three orders of magnitude than previously reported experiments. (C) 2008 Elsevier B.V. All rights reserved.

WHICH TOPOLOGIES HAVE IMMEDIATE PREDECESSORS IN THE POSET OF HAUSDORFF TOPOLOGIES?

We study which topology have an immediate predecessor in the poset of Sigma(2) of Hausdorff topologies on set X. We show that certain classes of H-closed topologies, do have predecessors. and we give examples of second countable H-closed topologies which are not upper Sigma(2.)

Stress responses of juvenile matrinxã (Brycon amazonicus) after transport in a closed system under different loading densities

Neste estudo, foram investigadas as densidades de carga adequadas para transporte de matrinxãs juvenis em sistema fechado com sacos plásticos. O transporte de 4h foi feito com peixes (23,5±0,4g; 11,6 (0,08cm) em jejum por 24h, em densidades de 83g L-1 (D1), 125g L-1 (D2), 168g L-1 (D3) e 206g L-1 (D4). Os peixes foram amostrados antes do transporte (AT), logo após o transporte (chegada) (DT) e 24h depois. A qualidade da água foi monitorada antes da captura dos peixes nos tanques de depuração, após o transporte nos sacos plásticos e nos tanques de recuperação. O oxigênio da água diminuiu para valores inferiores a 4mg L-1 em D2, D3 e D4, a temperatura esteve em torno de 32°C, pH 6,5-6,78, a amônia total foi de 1,09-1,7mg L-1, a amônia não-ionizada foi de 3,58-9,33 x 10³mg L-1 e alcalinidade 134-165mg CaCO3 L-1. O cortisol plasmático e a glicose sanguínea aumentaram após o transporte nos peixes em todas as densidades ensaiadas, voltando aos valores controle 24h depois. Os valores de osmolaridade não mudaram logo após o transporte, mas aumentaram 24h depois de modo igual em todas as densidades. O cloreto plasmático diminuiu na chegada, de modo inversamente proporcional à densidade de carga. O hematócrito diminuiu 24h depois da chegada dos peixes, em todas as densidades testadas, mas não houve diferença no número de eritrócitos. Não houve mortalidade até uma semana após o transporte. O matrinxã mostrou ser uma espécie tolerante a altas densidades de carga em embalagens para transporte além de suportar baixos níveis de oxigênio na água.

Development and validation of a dissolution test for diltiazem hydrochloride in immediate release capsules

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Transducer Loading Effect on the Performance of PZT-Based SHM Systems

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fractal characterization of brittle fracture in ceramics under mode I stress loading

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fractal behavior throughout stretch zone of 15-5PH steel under elastic-plastic loading conditions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Parameterized fast decoupled power flow methods for obtaining the maximum loading point of power systems. Part I. Mathematical modeling

The conventional Newton and fast decoupled power flow (FDPF) methods have been considered inadequate to obtain the maximum loading point of power systems due to ill-conditioning problems at and near this critical point. It is well known that the PV and Q-theta decoupling assumptions of the fast decoupled power flow formulation no longer hold in the vicinity of the critical point. Moreover, the Jacobian matrix of the Newton method becomes singular at this point. However, the maximum loading point can be efficiently computed through parameterization techniques of continuation methods. In this paper it is shown that by using either theta or V as a parameter, the new fast decoupled power flow versions (XB and BX) become adequate for the computation of the maximum loading point only with a few small modifications. The possible use of reactive power injection in a selected PV bus (Q(PV)) as continuation parameter (mu) for the computation of the maximum loading point is also shown. A trivial secant predictor, the modified zero-order polynomial which uses the current solution and a fixed increment in the parameter (V, theta, or mu) as an estimate for the next solution, is used in predictor step. These new versions are compared to each other with the purpose of pointing out their features, as well as the influence of reactive power and transformer tap limits. The results obtained with the new approach for the IEEE test systems (14, 30, 57 and 118 buses) are presented and discussed in the companion paper. The results show that the characteristics of the conventional method are enhanced and the region of convergence around the singular solution is enlarged. In addition, it is shown that parameters can be switched during the tracing process in order to efficiently determine all the PV curve points with few iterations. (C) 2003 Elsevier B.V. All rights reserved.

Parameterized fast decoupled power flow methods for obtaining the maximum loading point of power systems. Part II. Performance evaluation

The parameterized fast decoupled power flow (PFDPF), versions XB and BX, using either theta or V as a parameter have been proposed by the authors in Part I of this paper. The use of reactive power injection of a selected PVbus (Q(PV)) as the continuation parameter for the computation of the maximum loading point (MLP) was also investigated. In this paper, the proposed versions obtained only with small modifications of the conventional one are used for the computation of the MLP of IEEE test systems (14, 30, 57 and 118 buses). These new versions are compared to each other with the purpose of pointing out their features, as well as the influence of reactive power and transformer tap limits. The results obtained with the new approaches are presented and discussed. The results show that the characteristics of the conventional FDPF method are enhanced and the region of convergence around the singular solution is enlarged. In addition, it is shown that these versions can be switched during the tracing process in order to efficiently determine all the PV curve points with few iterations. A trivial secant predictor, the modified zero-order polynomial, which uses the current solution and a fixed increment in the parameter (V, theta, or mu) as an estimate for the next solution, is used for the predictor step. (C) 2003 Elsevier B.V. All rights reserved.