The Experience of Breast Reconstructive Microsurgery

Autologous techniques in oncoplastic breast surgery may result in graft donor site morbidity. Microsurgery has become a new surgical modality for breast reconstruction; it is a less invasive procedure. In recent experience, we have applied microsurgical technique in oncoplastic breast procedures to minimize morbidity.We reviewed the charts of breast cancer/tumor patients with microsurgical reconstruction.From February 2013 to July 2016, we performed 36 perforator flaps for breast reconstruction. The mean age of the patients was 44.4±6.7 years old, with the median tumor size of 3.7 (1.5-20) cm. No special type of carcinoma (NST) was accounted in 25 (69.4%) cases. Oncoplastic breast conserving surgery (OPS) was the procedure of choice in 17 (47.2%) cases and mastectomy was followed by free flap in 19 (52.8%) patients. In OPS, we used various perforator flaps to cover the defect. Thoracodorsal artery perforator flap (TDAP) was the most common technique used in 8 (22.2%) cases, then lateral intercostal artery (LICAP) flap in 6 (16.7%) cases, anterior intercostal artery (AICAP) flap in 1 (2.8%) cases, and superficial epigastric artery (SEAP) flap in 2 (5.6%) cases. Deep inferior artery perforator (DIEP) free flap was the reconstruction option after mastectomy. During follow-up with the mean time of 12.7±11.4 months, there were 1 local recurrence, 2 regional and systemic metastases, and 1 death due to cerebrovascular disease. There were no flap loss after pedicle perforator reconstruction but total flap necrosis occurred in 5 patients with DIEP free flap. In one patient, we successfully salvaged the flap that had venous congestion. There was no seroma at donor site and no limitation in abdominal wall function after DIEP reconstruction.In our experience, microsurgical reconstruction in breast surgery has been a safe procedure and has less donor site morbidity. Flap failure rate may be improved by refining microsurgical techniqu

Durability and Microstructure Characteristics of Concrete with Supplementary Cementitious Materials

Considering the environmental impact of cement manufacturing industries, this paper concerns the potential of using supplementary cementitious materials (SCMs), like fly ash and ground granulated blast furnace slag, as being essential to replacing the existing Ordinary Portland Cement (OPC). The objective of this paper is to study the microstructural characteristics of concrete with SCMs and improve the durability of the product to increase the lifespan of concrete structures. Replacement SCMs in OPC are 0, 40, 50, and 60 by percentage of cement weight, and we have taken a water-binder ratio of 0.40 for M40 grade and 0.28 for M60 grade concrete. The physical properties and chemical composition of OPC, Ground Granulated Blast-furnace Slag (GGBS), and fly ash were identified, and three different experiments were conducted to determine the resistance to penetration of chloride ions and corrosion processes. The rapid chloride permeability test, accelerated corrosion, and sorptivity tests were employed to measure concrete's resistance to the effects of aggressive environments and examine the durability properties. The most performed grade samples were analyzed as individual microspheres with Scanning Electron Microscopy (SEM), Energy Dispersive X-Ray Spectroscopy (EDXS), and X-ray diffraction. Significant improvements in various concrete properties were achieved through the partial replacement of fly ash and GGBS with cement. Doi: 10.28991/CEJ-2022-08-04-05 Full Text: PD

An investigation of traditional uses and anti-inflammatory property of Clematis buchananiana De Candolle and Tupistra nutans Wall. ex Lindl.: Native ethnomedicinal plants from Sikkim, India

In the traditional medicinal system of Sikkim Clematis buchananiana and Tupistra nutans is used extensively to treat various ailments, however, they have not been validated for their anti-inflammatory property by in vitro method. Therefore, the present study was carried out to investigate specific ethnomedicinal uses, in-vitro anti-inflammatory property, and phytochemical constituents of Clematis buchananiana and Tupistra nutans. The ethnomedicinal usage was studied by calculating the value for fidelity level, use-value, and informant consensus factor. Stabilization of human red blood cell membrane and protein denaturation method was used to study anti-inflammatory property. The phytochemicals were analysed by the methods described elsewhere. Clematis buchananiana was found to be used more frequently for sinusitis, headache, cold and Tupistra nutans for high blood pressure, diabetes and stomach-ache. Both C. buchananiana and T. nutans was found to inhibit the HRBC membrane and protein denaturation effectively in a dose-dependent manner. However, inhibition of haemolysis and protein denaturation by C. buchananiana was found to be higher than T. nutans at all doses. The phytochemical screening revealed the presence of anti-inflammatory metabolites such as flavonoids and phenolics in both the plants. The results provide evidence for the anti-inflammatory property of C. buchananiana and T. nutans

Role of trans-Planckian modes in cosmology

Motivated by the old trans-Planckian (TP) problem of inflationary cosmology, it has been conjectured that any consistent effective field theory should keep TP modes `hidden' behind the Hubble horizon, so as to prevent them from turning classical and thereby affecting macroscopic observations. In this paper we present two arguments against the Hubble horizon being a scale of singular significance as has been put forward in the TP Censorship Conjecture (TCC). First, refinements of TCC are presented that allow for the TP modes to grow beyond the horizon while still keeping the de-Sitter conjecture valid. Second, we show that TP modes can turn classical even well within the Hubble horizon, which, as such, negates this rationale behind keeping them from crossing it. The role of TP modes is known to be less of a problem in warm inflation, because fluctuations start out usually as classical. This allows warm inflation to be more resilient to the TP problem compared to cold inflation. To understand how robust this is, we identity limits where quantum modes can affect the primordial power spectrum in one specific case.Comment: 33 pages, comments welcome; v2: References updated, matches published versio

Massive symptomatic subependymoma of the lateral ventricles: case report and review of the literature

Subependymomas are benign intraventricular tumors with an indolent growth pattern, which are usually asymptomatic, and most commonly occur in the fourth and lateral ventricles. When symptomatic, subependymomas often obstruct critical portions of the cerebrospinal fluid (CSF) pathway, causing hydrocephalus, and range from 3 cm to 5 cm in size. We report a case of an unusually massive subependymoma of the lateral ventricles treated with subtotal resection, ventriculoperitoneal shunt, and post-surgical radiation. The clinical course, radiographic and pathologic characteristics of this massive intraventricular subependymoma are discussed, as well as the differential diagnosis of lateral ventricular masses and a review of the literature concerning subependymomas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46667/1/234_2005_Article_1342.pd