Immediate latissimus dorsi pedicle flap reconstruction following the removal of an eight kilogram giant phyllodes tumour of the breast: a case report

<p>Abstract</p> <p>Introduction</p> <p>Phyllodes tumors account for less than 1% of breast tumors in women, and giant phyllodes tumors are those that are larger than 10 cm in diameter. Removal of such large tumors places a huge burden on the surgeon to reconstruct a breast that is aesthetically acceptable by the patient. We report what may be the largest giant phyllodes tumor and, most likely, the first latissimus dorsi flap used to cover such a large defect caused by the resection.</p> <p>Case presentation</p> <p>We report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes. Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm. The patient had a mastectomy with an immediate latissimus dorsi pedicled myocutaneous flap reconstruction. The breast weighed 8.27 kg, and <it>ex </it><it>vivo</it>, the tumor measured 280 mm by 250 mm by 180 mm. Histopathologic analysis confirmed the diagnosis as a giant phyllodes tumor. At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.</p> <p>Conclusion</p> <p>Giant phyllodes tumors are very rare tumors that can reach up to 40 cm in diameter. Reconstruction of such a defect is a great challenge, and we report what we believe is the first latissimus dorsi flap to cover successfully a defect of approximately 400 mm by 350 mm.</p

Clinical Pharmacokinetics and Dose Recommendations for Posaconazole in Infants and Children.

OBJECTIVES: The objectives of this study were to investigate the population pharmacokinetics of posaconazole in immunocompromised children, evaluate the influence of patient characteristics on posaconazole exposure and perform simulations to recommend optimal starting doses. METHODS: Posaconazole plasma concentrations from paediatric patients undergoing therapeutic drug monitoring were extracted from a tertiary paediatric hospital database. These were merged with covariates collected from electronic sources and case-note reviews. An allometrically scaled population-pharmacokinetic model was developed to investigate the effect of tablet and suspension relative bioavailability, nonlinear bioavailability of suspension, followed by a step-wise covariate model building exercise to identify other important sources of variability. RESULTS: A total of 338 posaconazole plasma concentrations samples were taken from 117 children aged 5 months to 18 years. A one-compartment model was used, with tablet apparent clearance standardised to a 70-kg individual of 15 L/h. Suspension was found to have decreasing bioavailability with increasing dose; the estimated suspension dose to yield half the tablet bioavailability was 99 mg/m2. Diarrhoea and proton pump inhibitors were also associated with reduced suspension bioavailability. CONCLUSIONS: In the largest population-pharmacokinetic study to date in children, we have found similar covariate effects to those seen in adults, but low bioavailability of suspension in patients with diarrhoea or those taking concurrent proton pump inhibitors, which may in particular limit the use of posaconazole in these patients

Infantile zinc deficiency: Association with autism spectrum disorders

Elucidation of the pathogenesis and effective treatment of autism spectrum disorders is one of the challenges today. In this study, we examine hair zinc concentrations for 1,967 children with autistic disorders (1,553 males and 414 females), and show considerable association with zinc deficiency. Histogram of hair zinc concentration was non-symmetric with tailing in lower range, and 584 subjects were found to have lower zinc concentrations than −2 standard deviation level of its reference range (86.3–193ppm). The incidence rate of zinc deficiency in infant group aged 0–3 year-old was estimated 43.5 % in male and 52.5 % in female. The lowest zinc concentration of 10.7 ppm was detected in a 2-year-old boy, corresponding to about 1/12 of the control mean level. These findings suggest that infantile zinc deficiency may epigenetically contribute to the pathogenesis of autism and nutritional approach may yield a novel hope for its treatment and prevention

How Smart Cities Transform Operations Models: A New Research Agenda for Operations Management in the Digital Economy

The notion of smart cities is growing in prominence in the digital economy. The integration of urban infrastructures with information and communication technologies (ICT) enables the development of new operations models. Digitised infrastructures offer opportunities for public and private organisations to design and deliver more customer-centric products or services, particularly for those that require geographical proximity with consumers in the O2O (online to offline) context. A framework is developed and used to analyse three case examples. These cases illustrate the emergence of new operations models and, demonstrate how smart cities are re-defining the characteristics of operations models around their scalability, analytical output and, connectivity. We also explore the feasibility, vulnerability and acceptability of each new operation. This paper contributes to our understanding of how smart cities can potentially transform operational models, and sets out a research agenda for operations management in smart cities in the digital economy

Flow cytometric analysis of lectin-stained haemocytes of the honeybee (Apis mellifera)

The study evaluated the technical feasibility of distinguishing the different honeybee blood cells by flow cytometric analysis with and without staining by 3 lectins: soybean agglutinin (SBA), concanavalin A (ConA) and wheat germ agglutinin (WGA). Flow cytometric analysis of unstained cells provided a forward scatter-side scatter dotplot with no distinct haemocyte population. Examination of blood samples stained with FITC-labelled ConA or WGA revealed a notable population of fluorescently marked cells on FL1-histograms. Microscopic analysis, run parallel, demonstrated low fluorescence of the granular cells, strong fluorescence of the plasmatocytes, with P1's stained all over their surfaces and P2's with a rather dotted appearence. Prohaemocytes were not stained at all. SBA-FITC did not stain honeybee haemocytes as demonstrated by both the flow cytometric and the microscopic examinations

A Cryptosporidium parvum oocyst low molecular mass fraction evokes a CD4(+) T-cell-dependent IFN-gamma response in bovine peripheral blood mononuclear cell cultures

&lt;p&gt;T-Cell antigens that induce the in-vitro interferon-gamma response during Cryptosporidium parvum infection of neonatal calves were identified. A total oocyst extract was separated into a high and a low Mr fraction by a microfiltration technique. Both the high and low Mr fractions evoked an in-vitro interferon-gamma response in naturally infected animals, although strong individual differences between the hosts were observed. Using a complement-mediated technique CD4+ T-cells or WC1+gammadelta T-cells were depleted, whereupon the remaining lymphocyte cultures were stimulated with the different antigen preparations. It was shown that the in-vitro interferon-gamma response of Cryptosporidium-infected calves is CD4+ T-cell-dependent.&lt;/p&gt;</p