Contralateral internal mammary artery perforator flap for large inner chest wall defect repair and immediate breast reconstruction after excision of large malignant inner breast tumors.

OBJECTIVES: Large breast tumor resection can cause chest wall defects that are difficult to close. A combination of oncoplastic techniques is required to repair chest wall defects and immediately reconstruct the breast. In this report, we present the use of the contralateral internal mammary artery perforator (IMAP) flap to repair large chest wall defects and perform breast reconstruction for a series of patients. METHODS: Between July 2013 and June 2020, 10 patients and 4 patients underwent chest wall defect repair and breast reconstruction, respectively, with contralateral IMAP flaps. The average body mass index was 26.9 kg/m2 (range: 21.5-33.7 kg/m2 ). Tumor sizes varied from 2.5 × 1.5 × 0.8 to 9.5 × 6.0 × 4.0 cm3 . Defect sizes ranged from 16 × 10 to 8 × 4 cm2 . All patients underwent multiple imaging examinations to exclude abnormalities. Primary outcomes included complete tumor resection and flap survival. Secondary outcomes included the BREAST-Q results and bilateral breast symmetry measurements. RESULTS: All flaps exhibited good postoperative survival and were between 20 × 12 and 10 × 5 cm2 . Two patients experienced minor complications that did not influence outcomes. No obvious donor site complications were observed. The BREAST-Q results indicated favorable reconstructive efficacy, with "satisfaction with breasts," "physical well-being (chest)," and "satisfaction with the outcome" scores of 77.8 (range: 58-87), 83.2 (range: 77-89), and 80.1 (range: 70-88), respectively. No signs of tumor recurrence were observed during a median follow-up period of 53.5 months (range: 6-83 months). However, poor postoperative bilateral breast symmetry was observed (vertical extent: 0.63 [range: 0.36-0.88]; horizontal extent: 0.64 [range: 0.41-0.80]). CONCLUSIONS: IMAP flaps are reliable options for chest wall defect repair and breast reconstruction for selected patients with locally advanced breast cancer and inner breast tumors. Despite poor postoperative bilateral breast symmetry, most patients reported excellent outcomes.

Advances in emission control of diesel vehicles in China.

Diesel vehicles have caused serious environmental problems in China. Hence, the Chinese government has launched serious actions against air pollution and imposed more stringent regulations on diesel vehicle emissions in the latest China VI standard. To fulfill this stringent legislation, two major technical routes, including the exhaust gas recirculation (EGR) and high-efficiency selective catalytic reduction (SCR) routes, have been developed for diesel engines. Moreover, complicated aftertreatment technologies have also been developed, including use of a diesel oxidation catalyst (DOC) for controlling carbon monoxide (CO) and hydrocarbon (HC) emissions, diesel particulate filter (DPF) for particle mass (PM) emission control, SCR for the control of NOx emission, and an ammonia slip catalyst (ASC) for the control of unreacted NH3. Due to the stringent requirements of the China VI standard, the aftertreatment system needs to be more deeply integrated with the engine system. In the future, aftertreatment technologies will need further upgrades to fulfill the requirements of the near-zero emission target for diesel vehicles.

Clover-Style Fasciocutaneous Perforator Flap for Reconstruction of Massive Sacral Pressure Sores.

BACKGROUND: As a common complication of the long-term bedridden patients, pressure sore is a great challenge for surgeons. The purpose of this study was to explore the surgical method of using a clover-style fasciocutaneous perforator flap raised on the buttocks for the treatment of massive sacral pressure sores and report the clinical outcomes. METHODS: The study included 15 patients from January 2015 to June 2017 with an average age of 52.87 years (range, 32-73 years). The size of the sacral pressure sores ranged from 10 cm × 13 cm to 18 cm × 20 cm. The defects were reconstructed using a fasciocutaneous perforator flap raised on the buttocks after debridement and vacuum sealing drainage treatment for 1 to 2 weeks. All the donor areas were sutured directly. RESULTS: All flaps survived completely; 13 patients achieved healing by primary intention, and the other 2 patients achieved healing by secondary intention. At the mean follow-up period of 20.8 months (range, 12-46 months), the appearance of the flap, including its texture and color, in all patients was satisfactory. No patients had deep infection, necrosis, or shrinkage of the flap during the follow-up period. One patient had a recurrent bedsore during the 2-year follow-up. CONCLUSIONS: The clover-style fasciocutaneous perforator flap is ideal for the reconstruction of massive sacral pressure sores because it is a relatively simple procedure and results in good appearance and function, few complications, and a low recurrence rate.

Antibacterial, antiviral, and biodegradable collagen network mask for effective particulate removal and wireless breath monitoring.

Functional face masks that can effectively remove particulate matter and pathogens are critical to addressing the urgent health needs arising from industrial air pollution and the COVID-19 pandemic. However, most commercial masks are manufactured by tedious and complicated network-forming procedures (e.g., meltblowing and electrospinning). In addition, the materials used (e.g., polypropylene) have significant limitations such as a lack of pathogen inactivation and degradability, which can cause secondary infection and serious environmental concerns if discarded. Here, we present a facile and straightforward method for creating biodegradable and self-disinfecting masks based on collagen fiber networks. These masks not only provide superior protection against a wide range of hazardous substances in polluted air, but also address environmental concerns associated with waste disposal. Importantly, collagen fiber networks with naturally existing hierarchical microporous structures can be easily modified by tannic acid to improve its mechanical characteristics and enable the in situ production of silver nanoparticles. The resulting masks exhibit excellent antibacterial (>99.99%, 15 min) and antiviral (>99.999%, 15 min) capabilities, as well as high PM2.5 removal efficiency (>99.9%, 30 s). We further demonstrate the integration of the mask into a wireless platform for respiratory monitoring. Therefore, the smart mask has enormous promise for combating air pollution and contagious viruses, managing personal health, and alleviating waste issues caused by commercial masks.

Tuning Strain Sensor Performance via Programmed Thin-Film Crack Evolution.

Stretchable strain sensors with well-controlled sensitivity and stretchability are crucial for applications ranging from large deformation monitoring to subtle vibration detection. Here, based on single-metal material on the elastomer and one-pot evaporation fabrication method, we realize controlled strain sensor performance via a novel programable cracking technology. Specifically, through elastomeric substrate surface chemistry modification, the microcrack generation and morphology evolution of the strain sensing layer is controlled. This process allows for fine tunability of the cracked film morphology, resulting in strain sensing devices with a sensitivity gauge factor of over 10 000 and stretchability up to 100%. Devices with a frequency response up to 5.2 Hz and stability higher than 1000 cycles are reported. The reported strain sensors, tracking both subtle and drastic mechanical deformations, are demonstrated in healthcare devices, human-machine interaction, and smart-home applications.