The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Poly(Lactic Acid) Block Copolymers with Poly(Hexylene Succinate) as Microparticles for Long-Acting Injectables of Risperidone Drug

In the present work, Risperidone microparticles from poly(lactic acid)/poly(hexylene succinate) (PLA-b-PHSu) block copolymers in different ratios, 95/05, 90/10 and 80/20 w/w, were examined as long-acting injectable formulations. Nuclear magnetic resonance (NMR) was used to verify the successful synthesis of copolymers. Enzymatic hydrolysis showed an increase in weight loss as the content of PHSu increased, while the cytotoxicity studies confirmed the biocompatibility of the copolymers. The polyesters were further used to encapsulate Risperidone by spray drying. The drug-loaded microparticles were studied by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and X-ray diffraction (XRD). SEM microphotographs confirmed that spherically shaped microparticles were prepared with sizes about 5–12 μm, while XRD and differential scanning calorimetry (DSC) studies evidenced that Risperidone was encapsulated in amorphous form. The drug loading and the entrapment efficiency of Risperidone were studied as well as the in vitro release from the prepared microparticles. As the content of PHSu increased, a higher release of Risperidone was observed, with PLA-b-PHSu 80/20 w/w succeeding to release 100% of RIS within 12 days. According to theoretical modeling, the kinetics of RIS release from PLA-b-PHSu microparticles is complex, governed by both diffusion and polymer erosion

Médecine d'urgence [Emergency medicine: updates 2015]

The year 2015 was marked by several publications questioning the practice of emergency medicine. The systematic administration of oxygen in STEMI patients offers no benefit. Similarly, medical expulsive therapy in patients with ureteric stones was questioned. Administration of steroids for acute radiculopathy showed only short-term, but no mid-term pain improvement. Several studies have demonstrated the benefit combining intraarterial and intravenous thrombolytic therapy for ischemic stroke. However, studies assessing optimal management strategy for patients hospitalized with community acquired pneumonia, showed conflicting results. Finally, these developments occur in the context of an aging population and increase of pre-hospital management for the elderly, raising the question of how to reduce hospital admissions in this population

Influence of Graphene Platelet Aspect Ratio on the Mechanical Properties of HDPE Nanocomposites: Microscopic Observation and Micromechanical Modeling

A series of high-density polyethylene nanocomposites filled with different diameter sizes (5, 15, and 25 μm) of graphene nanoplatelets at various amounts (0.5–5 wt.%) are prepared by the melt-mixing method. The effect of diameter size and filler content on the mechanical properties is reported, and the results are discussed in terms of morphology and the state of dispersion within the polymer matrix. The measured stiffness and strength of the nanocomposites were found to be mainly influenced by the filler aspect ratio and the filler-matrix adhesion. Fractography was utilized to study the embrittleness of the nanocomposites, and the observations revealed that a ductile to brittle transition is caused by a micro-deformation mechanism change in the nanocomposites. Several micromechanical models for the prediction of mechanical properties of nanocomposites, taking into consideration filler aspect ratio, percolation effect, and interphase regions, are considered. The three-phase model proposed by Ji accurately predicts the stiffness of graphene nanoplatelets with a higher diameter size, while Takayanagi modified model II was found to show good agreement with the experimental results of smaller ones at low filler content. This study demonstrates that the diameter size of the filler plays a central role in determining the mechanical properties