Immediate Breast Reconstructions in the Treatment of Breast Cancer

Breast cancer is the most common form of potentially fatal cancer in women in the Western world. Better understanding of the breast cancer disease process together with developments in treatments have led to improved survival and reduced risk of recurrence, significantly influencing the acceptance of breast reconstructions as part of breast cancer treatment. Skin-sparing mastectomy followed by immediate breast reconstruction has proved superior to other forms of breast reconstruction in terms of aesthetic outcome. However, due to the relatively recent introduction of skin-sparing mastectomy concerns on the surgical and oncological safety of the operation persist. The aim of the present study is to evaluate the surgical and oncological safety of skin-sparing mastectomy and immediate breast reconstruction in a consecutive patient series with ensuing follow-up. Subsequent aims of the study are to examine possibilities of reducing surgical complications of the operation and to assess the feasibility of sentinel node biopsy together with immediate breast reconstruction. The study population comprises a consecutive series of patients having undergone skin-sparing mastectomy followed by immediate breast reconstruction at the Helsinki University Central Hospital between 1992 and 2006. In Study I, the hospital records of 207 patients, operated between 1992 and 2001, were analyzed for surgical complications and recurrences of breast cancer during follow-up. In Study II, 60 consecutive patients were randomized into either conventional diathermy or radiofrequency coagulation groups to examine possibilities of reducing skin-flap complications. Study III consists of 62 consecutive breast cancer patients evaluated for the feasibility of sentinel node biopsy simultaneously with immediate breast reconstruction. In Study IV, hospital records were analyzed to examine local recurrence of breast cancer in a consecutive series of 146 patients with Stage I or II disease. Post-operative complications in Study I included native skin-flap necrosis (10.1%), hematoma (10.1%), anastomose thrombosis (5.3%), infection (3.4%), hernia (2.6%) and loss of one microvascular flap (0.7%). The Stage I and II patients in Study IV had a local recurrence rate of 2.7%, an isolated regional lymph node recurrence rate of 2.1% and a systemic recurrence rate of 2.7%, during a mean follow-up time of 51 months. The Stage III patients in study I had a locoregional recurrence rate of 31.3% during follow-up. Radiofrequency coagulation in Study II did not decrease skin-flap complications when compared with conventional diathermy. An increased skin-flap complication rate in Study II was associated with smoking and the type of skin incision used. In Study III, eleven patients had tumor positive sentinel nodes, nine of which were detected intraoperatively. Skin-sparing mastectomy followed by immediate breast reconstruction is a safe procedure both surgically and oncologically, especially for early stage breast cancer. Tennis racket type incision is associated with an increased skin-flap complication rate. Sentinel node biopsy with intraoperative assessment of sentinel node metastases is feasible in patients undergoing immediate breast reconstruction.

Effect of recrystallization and grain growth on the mechanical properties of an extruded AZ21 Mg alloy

An experimental investigation into the effect of microstructural changes, which occur during post-extrusion annealing of a Mg based AZ21 alloy, on tensile and fatigue properties is conducted. Mechanical properties in the as-cast, as-extruded, and microstructural states that correspond to recovery, recrystallization and grain growth stages of annealing are compared. Results show that these microstructural changes do not alter the yield strength of the alloy markedly whereas significant differences were noted in the ultimate tensile strength as well as ductility. The initiation of abnormal grain growth (or secondary recrystallization) renders the tensile stress-strain response elastic perfectly plastic and results in a large drop in ductility, as high as similar to 60% during intermediate stages of abnormal grain growth, vis-A-vis the ductility of the as-extruded alloy. While the fatigue performance of all the wrought alloys is far superior to as expected, abnormal grain growth leads to a marked decrease in the endurance that of the as-cast alloy, limit. Possible microscopic origins of these are discussed. (C) 2009 Elsevier B.V. All rights reserved.

Nano-meter scale plasticity in KBr studied by nanoindenter and force microscopy

The early stages of plasticity in KBr single crystals have been studied by means of nano-meter-scale indentation in complementary experiments using both a nanoindenter and an atomic force microscope. Nanoindentafion experiments precisely correlate indentation depth and forces, while force microscopy provides high-resolution force measurements and images of the surface revealing dislocation activity. The two methods provide very similar results for the onset of plasticity in KBr. Upon loading we observe yield of the surface in atomic layer units which we attribute to the nucleation of single dislocations. Unloading is accompanied by plastic recovery as evident from a non-linear force distance unloading curve and delayed discrete plasticity events.

γ-Y2Si2O7, a machinable silicate ceramic: Mechanical properties and machinability

In this paper, the mechanical properties of bulk single-phase γ-Y2Si2O7 ceramic are reported. γ-Y2Si2O7 exhibits low shear modulus, excellent damage tolerance, and thus has a good machinability ready for metal working tools. To understand the underlying mechanism of machinability, drilling test, Hertzian contact test, and density functional theory (DFT) calculation are employed. Hertzian contact test demonstrates that γ-Y2Si2O7 is a "quasi-plastic" ceramic and the intrinsically weak interfaces contribute to its machinability. Crystal structure characteristics and DFT calculations of γ-Y2Si2O7 suggest that some weakly bonded planes, which involve Y-O bonds that can be easily broken, are the sources of the low shear deformation resistance and good machinability.

A numerical study of crack tip constraint in ductile single crystals

In this work, the effect of crack tip constraint on near-tip stress and deformation fields in a ductile FCC single crystal is studied under mode I, plane strain conditions. To this end, modified boundary layer simulations within crystal plasticity framework are performed, neglecting elastic anisotropy. The first and second terms of the isotropic elastic crack tip field, which are governed by the stress intensity factor K and T-stress, are prescribed as remote boundary conditions and solutions pertaining to different levels of T-stress are generated. It is found that the near-tip deformation field, especially, the development of kink or slip shear bands, is sensitive to the constraint level. The stress distribution and the size and shape of the plastic zone near the crack tip are also strongly influenced by the level of T-stress, with progressive loss of crack tip constraint occurring as T-stress becomes more negative. A family of near-tip fields is obtained which are characterized by two terms (such as K and T or J and a constraint parameter Q) as in isotropic plastic solids.

Free-volume dependent pressure sensitivity of Zr-based bulk metallic glass

Instrumented indentation experiments on a Zr-based bulk metallic glass (BMG) in as-cast, shot-peened and structurally relaxed conditions were conducted to examine the dependence of plastic deformation on its structural state. Results show significant differences in hardness, H, with structural relaxation increasing it and shot peening markedly reducing it, and slightly changed morphology of shear bands around the indents. This is in contrast to uniaxial compressive yield strength, sigma(y), which remains invariant with the change in the structural state of the alloys investigated. The plastic constraint factor, C = H/sigma(y), of the relaxed BMG increases compared with that of the as-cast glass, indicating enhanced pressure sensitivity upon annealing. In contrast, C of the shot-peened layer was found to be similar to that observed in crystalline metals, indicating that severe plastic deformation could eliminate pressure sensitivity. Microscopic origins for this result, in terms of shear transformation zones and free volume, are discussed.

High-strength bulk Al-based bimodal ultrafine eutectic composite with enhanced plasticity

An in situ bulk ultrafine bimodal eutectic Al-Cu-Si composite was synthesized by solidification. This heterostructured composite with microstructural length scale hierarchy in the eutectic microstructure, which combines an ultrafine-scale binary cellular eutectic (alpha-Al + Al2Cu) and a nanometer-sized anomalous ternary eutectic (alpha-Al + Al2Cu + Si), exhibits high fracture strength (1.1 +/- 0.1 GPa) and large compressive plastic strain (11 +/- 2%) at room temperature. The improved compressive plasticity of the bimodal-nanoeutectic composite originates from homogeneous and uniform distribution of inhomogeneous plastic deformation (localized shear bands), together with strong interaction between shear bands in the spatially heterogeneous structure.

Adjuvant Arteriovenous Fistula for Infrapopliteal Bypass Patency

A lack of suitable venous graft material or poor outflow is an increasingly encountered situation in peripheral vascular surgery. Prosthetic grafts have clearly worse patency than vein grafts in femorodistal bypass surgery. The use of an adjuvant arteriovenous fistula (av-fistula) at the distal anastomosis has been postulated to improve the flow and thus increase prosthetic graft patency. In theory the adjuvant fistula might have the same effect in a compromised outflow venous bypass. A free flap transfer also augments graft flow and may have a positive effect on an ischaemic limb. The aim of this study was to evaluate the possible benefit of an adjuvant av-fistula and an internal av-fistula within a free flap transfer on the patency and outcome of an infrapopliteal bypass. The effect of the av-fistula on bypass haemodynamics was also assessed along with possible adverse effects. Patients and methods: 1. A prospective randomised multicentre trial comprised 59 patients with critical leg ischaemia and no suitable veins for grafting. Femorocrural polytetrafluoroethylene (PTFE) bypasses with a distal vein cuff, with or without an adjuvant av-fistula, were performed. The outcome was assessed according to graft patency and leg salvage. 2. Haemodynamic measurements were performed to a total of 50 patients from Study I with a prolonged follow-up. 3. Nine critically ischaemic limbs were treated with a modified radial forearm flap transfer in combination with a femorodistal bypass operation. An internal av-fistula was created within the free flap transfer to increase flap artery and bypass graft flow. 4. The effect of a previous free flap transfer on bypass haemodynamics was studied in a case report. 5. In a retrospective multicentre case-control study, 77 infrapopliteal vein bypasses with an adjuvant av-fistula were compared with matched controls without a fistula. The outcome and haemodynamics of the bypasses were recorded. Main results: 1. The groups with and without the av-fistula did not differ as regards prosthetic graft patency or leg salvage. 2. The intra- and postoperative prosthetic graft flow was significantly increased in the patients with the av-fistula. However, this increase did not improve patency. There was no difference in patency between the groups, even in the extended follow-up. 3. The vein graft flow increased significantly after the anastomosis of the radial forearm flap with an internal av-fistula. 4. A previously performed free flap transfer significantly augmented the flow of a poor outflow femoropedal bypass graft. 5. The adjuvant av-fistula increased the venous infrapopliteal bypass flow significantly. The increased flow did not, however, lead to improved graft patency or leg salvage. Conclusion: An adjuvant av-fistula does not improve the patency of a femorocrural PTFE bypass with a distal vein cuff despite the fact that the flow values increased both in the intraoperative measurements and during the immediate postoperative surveillance. The adjuvant av-fistula increased graft flow significantly also in a poor outflow venous bypass, but regardless of this the outcome was no improved. The adjuvant av-fistula rarely caused adverse effects. In a group of diabetic patients, the flow in a vascular bypass graft was augmented by an internal av-fistula within a radial forearm flap and similarly in a patient with a previous free flap transfer, a high intraoperative graft flow was achieved due to the free flap shunt effect.

Constitutive equation for elevated temperature flow behavior of plain carbon steels using dimensional analysis

Dimensional analysis using π-theorem is applied to the variables associated with plastic deformation. The dimensionless groups thus obtained are then related and rewritten to obtain the constitutive equation. The constants in the constitutive equation are obtained using published flow stress data for carbon steels. The validity of the constitutive equation is tested for steels with up to 1.54 wt%C at temperatures: 850–1200 °C and strain rates: 6 × 10−6–2 × 10−2 s−1. The calculated flow stress agrees favorably with experimental data.

Crack Tip Fields in a Single Edge Notched Aluminum Single Crystal Specimen

We report a combined experimental and computational study of a low constraint aluminum single crystal fracture geometry and investigate the near-tip stress and strain fields. To this end, a single edge notched tensile (SENT) specimen is considered. A notch, with a radius of 50 µm, is taken to lie in the (010) plane and its front is aligned along the [101] direction. Experiments are conducted by subjecting the specimen to tensile loading using a special fixture inside a scanning electron microscope chamber. Both SEM micrographs and electron back-scattered diffraction (EBSD) maps are obtained from the near-tip region. The experiments are complemented by performing 3D and 2D plane strain finite element simulations within a continuum crystal plasticity framework assuming an isotropic hardening response characterized by the Pierce–Asaro–Needleman model. The simulations show a distinct slip band forming at about 55 deg with respect to the notch line corresponding to slip on (11-bar 1)[011] system, which corroborates well with experimental data. Furthermore, two kink bands occur at about 45 deg and 90 deg with respect to the notch line within which large rotations in the crystal orientation take place. These predictions are in good agreement with the EBSD observations. Finally, the near-tip angular variations of the 3D stress and plastic strain fields in the low constraint SENT fracture geometry are examined in detail.

Ion irradiation enhances the mechanical performance of metallic glasses

We demonstrate that irradiation may enhance the plasticity in metallic glasses by increasing the free-volume content via micropillar compression experiments on an ion-irradiated bulk metallic glass (BMG). Results show that irradiation decreases the flow stress and enhances the shear band formation by lowering the magnitude of stress serrations in plastic flow regime. These results highlight that amorphous alloys can mitigate the deleterious affects of severe ion irradiation as compared to their crystalline counterparts. (C) 2009 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Brain imaging of chronic pain

Acute pain has substantial survival value because of its protective function in the everyday environment. Instead, chronic pain lacks survival and adaptive function, causes great amount of individual suffering, and consumes the resources of the society due to the treatment costs and loss of production. The treatment of chronic pain has remained challenging because of inadequate understanding of mechanisms working at different levels of the nervous system in the development, modulation, and maintenance of chronic pain. Especially in unclear chronic pain conditions the treatment may be suboptimal because it can not be targeted to the underlying mechanisms. Noninvasive neuroimaging techniques have greatly contributed to our understanding of brain activity associated with pain in healthy individuals. Many previous studies, focusing on brain activations to acute experimental pain in healthy individuals, have consistently demonstrated a widely-distributed network of brain regions that participate in the processing of acute pain. The aim of the present thesis was to employ non-invasive brain imaging to better understand the brain mechanisms in patients suffering from chronic pain. In Study I, we used magnetoencephalography (MEG) to measure cortical responses to painful laser stimulation in healthy individuals for optimization of the stimulus parameters for patient studies. In Studies II and III, we monitored with MEG the cortical processing of touch and acute pain in patients with complex regional pain syndrome (CRPS). We found persisting plastic changes in the hand representation area of the primary somatosensory (SI) cortex, suggesting that chronic pain causes cortical reorganization. Responses in the posterior parietal cortex to both tactile and painful laser stimulation were attenuated, which could be associated with neglect-like symptoms of the patients. The primary motor cortex reactivity to acute pain was reduced in patients who had stronger spontaneous pain and weaker grip strength in the painful hand. The tight coupling between spontaneous pain and motor dysfunction supports the idea that motor rehabilitation is important in CRPS. In Studies IV and V we used MEG and functional magnetic resonance imaging (fMRI) to investigate the central processing of touch and acute pain in patients who suffered from recurrent herpes simplex virus infections and from chronic widespread pain in one side of the body. With MEG, we found plastic changes in the SI cortex, suggesting that many different types of chronic pain may be associated with similar cortical reorganization. With fMRI, we found functional and morphological changes in the central pain circuitry, as an indication of central contribution for the pain. These results show that chronic pain is associated with morphological and functional changes in the brain, and that such changes can be measured with functional imaging.

Low-Temperature Processing of ZrB2-ZrC Composites by Reactive Hot Pressing

Dense ZrB2-ZrC and ZrB2-ZrC x∼0.67 composites have been produced by reactive hot pressing (RHP) of stoichiometric and nonstoichiometric mixtures of Zr and B4C powders at 40 MPa and temperatures up to 1600 °C for 30 minutes. The role of Ni addition on reaction kinetics and densification of the composites has been studied. Composites of ∼97 pct relative density (RD) have been produced with the stoichiometric mixture at 1600 °C, while the composite with ∼99 pct RD has been obtained with excess Zr at 1200 °C, suggesting the formation of carbon deficient ZrC x that significantly aids densification by plastic flow and vacancy diffusion mechanism. Stoichiometric and nonstoichiometric composites have a hardness of ∼20 GPa. The grain sizes of ZrB2 and ZrC x∼0.67 are ∼0.6 and 0.4 μm, respectively, which are finer than those reported in the literature.

Microstructural stability and creep in nanocrystals

Microstructural stability is an important consideration during high temperature deformation and processing of nanomaterials. We will address issues relating to triple junctions in limiting grain growth during creep as well as densification. Although early studies on deformation have considered diffusion creep as a possible rate controlling deformation mechanism in nanocrystals, a critical inspection of available data indicates that there is no strong evidence for conventional diffusion creep in such materials. The possibility of diffusion creep by rapid diffusion along triple junctions will be analyzed, and interface controlled diffusion creep will also be discussed critically. It is shown that the critical grain size for dislocation activity is similar to that for occurrence of conventional diffusion creep.

Microplastic ingestion by scleractinian corals

We report for the first time the ingestion of microplastics by scleractinian corals, and the presence of microplastics in coral reef waters adjacent to inshore reefs on Australia’s Great Barrier Reef (GRE, 18°31′S 146°23′E). Analysis of samples from sub-surface plankton tows conducted in close proximity to inshore reefs on the central GBR revealed microplastics, similar to those used in marine paints and fishing floats, were present in low concentrations at all water sampling locations. Experimental feeding trials revealed that corals mistake microplastics for prey and can consume up to ~50 μg plastic cm−2 h−1, rates similar to their consumption of plankton and Artemia nauplii in experimental feeding assays. Ingested microplastics were found wrapped in mesenterial tissue within the coral gut cavity, suggesting that ingestion of high concentrations of microplastic debris could potentially impair the health of corals.