Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Introduction The demand for prophylactic mastectomy has increased significantly over the last 10 years. This can be explained by a substantial gain of knowledge about the clinical risk and outcome of patients with high risk mutations such as BRCA1 and 2, the improved diagnostic possibilities for detecting the genetic predisposition for the development of breast cancer and the awareness for those mutations by health care professionals as well as patients. In addition to expander-to-implant reconstruction and microsurgical flap surgery, definitive immediate reconstruction with subpectoral insertion of breast implants is often preferred. The prosthesis is covered at its inferior pole by a synthetic mesh or acellular dermal matrix. In these cases, in addition to the silicone prosthesis, a further foreign body must be implanted. This can be exposed in the event of wound healing disorder or necrosis of the usually thin soft tissue covering after subcutaneous mastectomy, thus calling into question the reconstructive result. In this study, the coverage of the lower pole by a caudal deepithelialized dermis flap, which allows the implant to be completely covered with well vascularized tissue, is compared to coverage by a synthetic mesh or acellular dermal matrix. Patients and methods From January 2014 to June 2020, 74 patients (106 breasts) underwent breast reconstruction following uni or bilateral prophylactic mastectomy. Reconstruction was performed with autologous tissue (15 breasts), with tissue expander or implant without implant support (15 breasts), with implant and use of an acellular dermal matrix or synthetic mesh (39 breasts) and with implant and caudal dermis flap (37 breasts). In this study, we compared the patients with implant and dermal matrix/mesh to the group reconstructed with implant and dermal flap. Results In the group with the caudal dermis flap, 4 patients developed skin necrosis, which all healed conservatively due to the sufficient blood supply through the dermis flap. In the group with the use of a synthetic mesh or acellular dermal matrix, skin necrosis was found in three cases. In one of these patients the implant was exposed and had to be removed. Discussion For patients with excess skin or macromastia, the caudal dermis flap is a reliable and less expensive option for complete coverage of an implant after prophylactic mastectomy. In particular, the vascularized dermis flap can protect the implant from the consequences of skin necrosis after prophylactic mastectomy

Stacking Polymorphism in PtSe2 Drastically Affects Its Electromechanical Properties

PtSe2 is one of the most promising materials for the next generation of piezoresistive sensors. However, the large-scale synthesis of homogeneous thin films with reproducible electromechanical properties is challenging due to polycrystallinity. It is shown that stacking phases other than the 1T phase become thermodynamically available at elevated temperatures that are common during synthesis. It is shown that these phases can make up a significant fraction in a polycrystalline thin film and discuss methods to characterize them, including their Seebeck coefficients. Lastly, their gauge factors, which vary strongly and heavily impact the performance of a nanoelectromechanical device are estimated

Recommendations for the Use of Antibiotics in Primary and Secondary Esthetic Breast Surgery

The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with β-lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered <60 minutes before incision to guarantee high serum levels during surgical procedure

Color Change Effect in an Organic-Inorganic Hybrid Material Based on a Porphyrin Diacid

Porphyrinic materials show a range of interesting and useful optical and electrical properties. The less well-known sub-class of porphyrin diacids has been used in this work to construct an ionic hybrid organic-inorganic material in combination with a halogenidometalate anion. The resulting compound, $[H_6TPyP][BiCl_6]_2$ (1) (TPyP = tetra(4-pyridyl)porphyrin) has been obtained via a facile solution based synthesis in single crystalline form. The material exhibits a broad photoluminescence emission band between 650 and 850 nm at room temperature. Single crystals of $[H_6TPyP][BiCl_6]_2$ show a photocurrent in the fA and a much higher dark current in the nA range. They also display an unexpected reversible color change upon wetting with different liquids. This phenomenon has been investigated with optical spectroscopy, SEM, XPS and NEXAFS techniques, showing that a surface-based structural coloration effect is the source of the color change. This stands in contrast to other materials where structural coloration typically has to be introduced through elaborate, multi-step processes or the use of natural templates. Additionally, it underscores the potential of self-assembly of porphyrinic hybrid compounds in the fabrication of materials with unusual optical properties

Создание Web-сайта предприятия

В современном мире постоянно развивающихся технологий для каждой компании как никогда важна автоматизация бизнес-процессов, позволяющая выйти на более высокий уровень. На сегодняшний день осталось немного мест на нашей планете, где люди не могут выйти в Интернет. Всемирная паутина настолько охватила мир, что пользователи зачастую чувствуют себя беспомощными без той информации, которую она может дать. Реклама в печатных изданиях не способна в полной мере осветить деятельность фирмы, информация в рекламных буклетах и брошюрах быстро теряет актуальность. Именно поэтому все больше предприятий идут на создание качественного сайта с целью более эффективной реализации своей продукции или услуг. Цель данного проекта – повышение качества услуг, предоставляемых предприятием за счет разработки интерактивного Web-сайта. При создании хорошо спланированного, интерактивного информационного сайта, приходится применять не только технологические знания, но и аналитические, что позволяет более полно раскрыть специфику специальности «прикладная информатика в экономике». Работа над проектом, целью которого является разработка Web-сайта, начинается с определения концепции ресурса. Интерфейс и конкретное наполнение (контент) сайта зависят от целого ряда факторов, главными среди них являются объем и состав задач, которые планируется решать с помощью данного сайта, а также его целевая аудитория. В заключении сделаны выводы по проекту, определены пути его внедрения на объекте и направления дальнейшего совершенствования.In today's world of evolving technologies for each company are more important than ever to automate business processes, allowing to reach a higher level. To date, there are few places on our planet where people can't get online. The world wide web so swept the world that users often feel helpless without the information that it can give. Advertising in printed publications is not able to fully cover the activities of the company, the information in the brochures and pamphlets are quickly losing relevance. That is why more and more companies are going to create a quality website to more effectively market their products or services. The purpose of this project is to improve the quality of services provided by the company through the development of an interactive Web site. When you create a well-planned, interactive information website, it is necessary to apply not only technical knowledge, but also analytical, which allows to better reveal the specifics of the specialty "applied Informatics in Economics". Work on the project, whose goal is the development of a Web site begins with the definition of the concept resource. Interface and specific content (content) of the site depend on a number of factors, chief among these are the volume and composition of tasks that will be solved with the help of this website and its target audience. In conclusion, the findings of that project, identifies ways of its implementation at the facility and areas for further improvement

Interfacial Synthesis of Layer-Oriented 2D Conjugated Metal-Organic Framework Films towards Directional Charge Transport

The development of layer-oriented two-dimensional conjugated metal-organic frameworks (2D c-MOFs) enables an access to direct charge transport, dial-in lateral/vertical electronic devices and unveil transport mechanisms, but remains a significant synthetic challenge. Here we report the novel synthesis of metal-phthalocyanine-based p-type semiconducting 2D c-MOF films (Cu2[PcM-O8], M=Cu or Fe) with an unprecedented edge-on layer-orientation at the air/water interface. The edge-on structure for-mation is guided by the pre-organization of metal-phthalocyanine ligands, whose basal plane is perpendicular to the water surface due to their π-π interaction and hydrophobicity. Benefiting from the unique layer orientation, we are able to investigate the lateral and vertical conductivities by DC methods, and thus demonstrate an anisotropic charge transport in the resulting Cu2[PcCu-O8] film. The directional conductivity studies combined with theoretical calculation identify that the intrinsic conductivity is dominated by charge transfer along the interlayer pathway. Moreover, a macroscopic (cm2-size) Hall-effect measurement reveals a Hall mobility of ~4.4 cm2 V-1 s-1 for the obtained Cu2[PcCu-O8] film. The orientation control in semiconducting 2D c-MOFs will enable the develop-ment of various optoelectronic applications and the exploration of unique transport properties

A Comparison of Cloud Storage Technologies as Sources of Digital Evidence

Due to their ease of use and their reliability, managed storage services in the cloud have become a standard way to store personal files for many users. In fact, many apps on mobile devices use local storage on the client merely as a cache for data that is fully stored on a remote server. Consequently, data from cloud storage services is an increasingly valuable source of digital evidence in forensic investigations. This document presents the results of a student project that was performed at Friedrich-Alexander-Universität Erlangen-Nürnberg in the winter term 2021/22. Six groups of students analyzed the most relevant network storage technologies (Samba, Nextcloud, Dropbox, Google Drive, OneDrive, iCloud) regarding two questions: (1) What effect does data acquisition by the client have on the data stored on the server? (2) Does the technology support delayed verification of data acquisition in any way? The two questions refer to critical aspects of forensic evidence collection, namely in what way does evidence collection interfere with the evidence, and how easy is it to prove the provenance of data in a forensic investigation. In the concluding discussion we compare the different technologies and develop a taxonomy of storage services that can be used to assess other cloud storage services with regarding the evidental value of data acquired from them

Sexual Dimorphic Regulation of Body Weight Dynamics and Adipose Tissue Lipolysis

BACKGROUND: Successful reduction of body weight (BW) is often followed by recidivism to obesity. BW-changes including BW-loss and -regain is associated with marked alterations in energy expenditure (EE) and adipose tissue (AT) metabolism. Since these processes are sex-specifically controlled, we investigated sexual dimorphisms in metabolic processes during BW-dynamics (gain-loss-regain). RESEARCH DESIGN: Obesity was induced in C57BL/6J male (m) and female (f) mice by 15 weeks high-fat diet (HFD) feeding. Subsequently BW was reduced (-20%) by caloric restriction (CR) followed by adaptive feeding, and a regain-phase. Measurement of EE, body composition, blood/organ sampling were performed after each feeding period. Lipolysis was analyzed ex-vivo in gonadal AT. RESULTS: Male mice exhibited accelerated BW-gain compared to females (relative BW-gain m:140.5±3.2%; f:103.7±6.5%; p<0.001). In consonance, lean mass-specific EE was significantly higher in females compared to males during BW-gain. Under CR female mice reached their target-BW significantly faster than male mice (m:12.2 days; f:7.6 days; p<0.001) accompanied by a sustained sex-difference in EE. In addition, female mice predominantly downsized gonadal AT whereas the relation between gonadal and total body fat was not altered in males. Accordingly, only females exhibited an increased rate of forskolin-stimulated lipolysis in AT associated with significantly higher glycerol concentrations, lower RER-values, and increased AT expression of adipose triglyceride lipase (ATGL) and hormone sensitive lipase (HSL). Analysis of AT lipolysis in estrogen receptor alpha (ERα)-deficient mice revealed a reduced lipolytic rate in the absence of ERα exclusively in females. Finally, re-feeding caused BW-regain faster in males than in females. CONCLUSION: The present study shows sex-specific dynamics during BW-gain-loss-regain. Female mice responded to CR with an increase in lipolytic activity, and augmented lipid-oxidation leading to more efficient weight loss. These processes likely involve ERα-dependent signaling in AT and sexual dimorphic regulation of genes involved in lipid metabolism