A systematic review comparing the functional changes and complications of DIEP and TRAM flaps in patients receiving breast reconstruction

Aim: Treatment for breast cancer may involve unilateral or bilateral mastectomy, with subsequent breast reconstruction surgery. Using autologous tissue flaps during reconstructive surgery is increasingly popular. The aim of this systematic review was to determine if the DIEP flap is more effective than the TRAM flap for breast reconstruction in females after a mastectomy in terms of donor site morbidity, recipient site morbidity, and functional outcome. Methods: Studies were identified using the databases Medline and Embase and applying predefined search criteria. The limits applied were; peer-reviewed, published between January 1980 to May 2013, human trials, English language. Study inclusion followed a review of the title, abstract, and full text by two independent researchers. Results: Two trends were identified. 1) DIEP flap surgery reduces the risk of abdominal weakness without increasing the risk of flap complications if performed by a surgeon well trained in microsurgery; 2) TRAM flap surgery remains a good alternative due to its evolution towards muscle-sparing techniques. Conclusion: This appears to be the first systematic review in this area of research. The evidence demonstrates that DIEP flap reduces postoperative abdominal morbidity, with no increased flap complication compared to the TRAM flap if performed by a surgeon well trained in microsurgery

Realistic interpretation of a superposition state does not imply a mixture

Contrary to previous claims, it is shown that, for an ensemble of either single-particle systems or multi-particle systems, the realistic interpretation of a superposition state that mathematically describes the ensemble does not imply that the ensemble is a mixture. Therefore it cannot be argued that the realistic interpretation is wrong on the basis that some predictions derived from the mixture are different from the corresponding predictions derived from the superposition state

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Psychological development of infants and children and their practical importance in Singapore

Journal of the Singapore Paediatric Society17162-66SPSJ

Paediatric ultrasonography: I: general aspects

Journal of the Singapore Paediatric Society1919-15SPSJ

Studies on structural haemoglobinopathies in Singapore

Journal of the Singapore Paediatric Society16133-41SPSJ

Prevention of congenital heart disease

Singapore Medical Journal143137-141SIMJ

Phenylketonuria in Chinese in Singapore

Journal of the Singapore Paediatric Society20269-72SPSJ