Nipple Sparing Mastectomy Techniques: A Literature Review and an Inframammary Technique

Nipple sparing mastectomy (NSM) has quickly become an accepted technique for patients with selected cancers and for risk reducing surgery. Much of its surgical acceptance over the last decade has been based on the low risk of nipple areolar complex (NAC) occurrence in breast cancer patients. Improved patient satisfaction due to improved cosmetic outcomes with reconstruction have also driven its popularity. We reviewed current English journals to determine the NSM techniques which achieve the lowest complications, best outcomes, and best patient satisfaction. We researched studies showing reductions in complications with improved surgical techniques and patient selection which have been implicated in improved results. In the studies reviewed, incision placement, away from the nipple, resulted in the lowest rates of ischemic nipple complications and the best cosmetic outcomes. The effect of other factors such as surgeon experience and thickness of skin flap development were more difficult to prove. Leaving a 2-3 mm rim of tissue around the nipple bundle was shown to help preserve the nipple vascularity. Lower complication rates with improved outcomes and patient satisfaction were reported in the literature in patients with B or smaller cup sizes, non-smokers, and patients with lower body mass index (BMI). Incision placement, away from the nipple, with preservation of a 2-3 mm rim of tissue around the nipple bundle along with careful patient selection were the most significant variables reviewed which helped to lower complications rates of NSM. Coordinated surgical planning with the breast and plastic surgeons to determine the best surgical approach for each individual patient is necessary to obtain the best results. Although short-term oncologic follow-up seems to be acceptable, longer follow-up will still be needed to define the best breast cancer surgical candidates for the nipple sparing approach

Preliminary study of discrimination of human vocal commands in walrus (Odobenus rosmarus divergens)

Walruses seem to use various acoustic signals in social context. So, the auditory faculty is seems to be important for walruses. Can walruses understand another animals' vocal information using auditory sense? This study tested whether a male walrus could discriminate human vocal words and perform different actions corresponding to each one under various conditions. The subject, a male walrus (Odobenus rosmarus) named Pou, was set on the ground, and the experimenter spoke one of the ten words to the subject under the following conditions; (1) The experimenter stood close to the subject and spoke each vocal stimulus wearing a black cloak and goggles so that the experimenter's eye and body movements would not influence the subject's behavior, (2) A wooden board was placed between the experimenter and the subject so that the subject could not see the experimenter, (3) A wooden board was placed between the experimenter and the subject so that the subject could not to see the experimenter, and the experimenter uttered each vocal stimulus through an audio speaker. Under each condition, when the subject performed the correct action corresponding to the vocal stimulus, he was rewarded with a piece of fish. As a result, the subject responded correctly to almost all the human vocal stimuli in every condition, including when the speaker was not visible. This means that he was indeed responding to the vocal words and not the experimenter's cues. This study demonstrated that walruses can hear and identify human vocal words using their auditory sense and can form correspondence between vocal words and their meanings

Uber den Einfluβ der ultravioletten Strahlen die Gallensiureausscheidung in der Galle

1. Die Menge der Galle und der Gallensaure der Gallenblasenfistel tragenden Hunde wird durch Bestrahlung des Korpers mit ultravioletten Strahlen vermehrt. 2. Die Menge der Galle und der Gallensaure des Fistelhundes wird durch Futterung mit Ergosterin vermehrt und diese Vermehrungbei Zufuhr von Ergosterin durch Bestrahlung des Hundekorpers mit ultravioletten Strahlen verstarkt. 3. Die Gallensekretion und Gallensaureausscheidung des Fistelhundes wird durch Ftitterung mit Shiitake vermehrt und diese Vermehrung durch Bestrahlung des Hundekorpers verstarkt. Bei Verabreichung von mit ultravioletten Strahlen bestrahltem Shiitake tritt diese viel starker auf als bei Verabreichung von nichtbestrahltem. Aus diesen Ergebnissen scheint hervorzugehen, da&#946; die Gallensaurebildung im Organismus mit der Bestrahlung des Korpers und der Nahrung eng verknupft ist.</p

Biochemische Untersuchungen uber die &#945;-Scymmolschwefelsaure.

Der Einflu&#946; der &#945;-Scymnolschwefelsaure und Taurocholsaure aus Gallensekretion, Hamolyse sowie Lipasewirkung wurde vergleichend untersucht und die Ergebnisse sind folgende : 1. Die Gallensekretion der Kaninchenleber wurde durch Zufuhr von &#945;-Scymnolschwefelsaure ziemlich stark gesteigert und zwar ist die die Gallensekretion steigernde Wirkung der&#945;-Scymnolschwefelsaure etwas starker und langer anhaltend, als die der Taurocholsaure. 2. Die hamolytische Wirkung der &#945;-Scymnolschwefelsaure wurde viel starker als die der Taurocholsaure gefunden. 3. Die lipasef6rdernde Wirkung der &#945;-Scymnolschwefelsaure wurde als viel weniger stark als die der Taurocholsaure gefunden.</p

Ectopic adrenal adenoma causing gross hematuria: Steroidogenic enzyme profiling and literature review

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149375/1/iju512068.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149375/2/iju512068_am.pd

Metal-free syn-dioxygenation of alkenes

Reactions employing inexpensive reagents from sustainable sources and with low toxicity are becoming increasingly desirable from an academic and industrial perspective. A fascinating example of a synthetic transformation that requires development of alternative procedures is the osmium catalysed dihydroxylation. Recently there has been considerable interest in achieving this reaction through metal-free procedures. This review describes the methods available for metal-free syn-dioxygenation of alkenes

Sequential MyD88-Independent and -Dependent Activation of Innate Immune Responses to Intracellular Bacterial Infection

AbstractMicrobial infections induce chemokine and cytokine cascades that coordinate innate immune defenses. Infection with the intracellular bacterial pathogen Listeria monocytogenes induces CCR2-dependent monocyte recruitment and activation, an essential response for host survival. Herein we show that invasive L. monocytogenes, but not killed or noninvasive bacteria, induce secretion of MCP-1, the requisite chemokine for monocyte recruitment. Induction of MCP-1, but not TNF or IL-12, following L. monocytogenes infection is MyD88 independent. Consistent with these results, MyD88 deficiency does not impair monocyte recruitment to L. monocytogenes infected spleens, but prevents monocyte activation. Our results indicate that distinct microbial signals activate innate immune responses in an ordered, step-wise fashion, providing a mechanism to specify and modulate antimicrobial effector functions