Is music intervention effective in reducing anxiety and pain during breast biopsy procedure? A systematic review and meta-analysis of randomized controlled trials.

PURPOSE: To evaluate the evidence from randomized clinical trials (RCTs) about the effect of music intervention in reducing patients' anxiety during breast biopsy. METHODS: Electronic databases including PubMed, Cochrane Library, Scopus, and Web of Science were searched using the relevant MeSH terms. The inclusion criteria were all RCTs assessing the effect of music therapy versus no music in reducing anxiety during breast biopsy. The extracted outcomes were anxiety and pain during breast biopsy. They were pooled as mean difference (MD) with a 95% confidence interval (CI) in a fixed-effects model, using Review Manager 5.3 software for windows. The quality of included studies was assessed with the Cochrane risk of bias assessment tool (RoB 1.0). Then, the outcomes of our meta-analyses were independently evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to know the grade of their evidence. RESULTS: The final analysis included five RCTs. We found a positive effect of music therapy in reducing anxiety levels compared with control group (MD = - 2.11; 95% CI (- 4.16 to - 0.06); p = 0.04). No difference between music and control groups regarding pain associated with breast biopsy (MD = 0.22; 95% CI (- 0.81 to 1.25); p = 0.68). The GRADE rating of our outcomes was low for anxiety levels and very low for pain during the biopsy. CONCLUSIONS: Music therapy could be an effective, simple, non-pharmacological option in relieving anxiety during breast biopsy; however, it had no effect on procedure-associated pain. More large and high-quality studies are needed to confirm our results.

Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room.

OBJECTIVE: We detail the association of sedentary behavior with a variety of health problems and provide the radiologist with a number of simple activities and techniques that can improve overall health while still meeting the productivity demands of a high-volume practice. Although these techniques are well known and recognized in the fitness and nutrition literature, they are not widely used in the radiology reading room. The computer- and workstation-based work routinely performed by diagnostic radiologists typically occurs in the seated position, leading to more than 8 hours per day of sitting. Studies have found that even for those who exercise regularly, spending increased time sitting can negate the healthful effects of exercise. Time spent in a seated or sedentary position leads to slowing of one's metabolism, with negative resultant effects. CONCLUSION: The concept of nonexercise activity thermogenesis (NEAT) will be described, with examples given of how to burn more calories while at work and, therefore, improve the health of the diagnostic radiologist. NEAT refers to the energy expended during activities of daily living, excluding sportlike or intentional exercise. The concept of NEAT must be understood by radiologists, because it allows the development of multiple strategies to combat the ill effects of sitting while working. Adding intermittent movement and stretching exercises throughout the day can stimulate metabolism. An understanding of the association of sedentary work behavior with a number of health risks is crucial for radiologists so that they can implement basic changes into their work routine, allowing them to increase activity to address and avoid these potential health hazards.

Practical prototype for energy management system in smart microgrid considering uncertainties and energy theft.

The conventional electrical grid faces significant issues, which this paper aims to address one of most of them using a proposed prototype of a smart microgrid energy management system. In addition to relying too heavily on fossil fuels, electricity theft is another great issue. The proposed energy management system can simultaneously detect electricity theft and implement demand response tactics by employing time-of-use pricing principles and comparing real electricity consumption with grid data. The system uses the Al-Biruni earth radius (BER) optimization algorithm to make smart choices about how to distribute the load, intending to reduce energy consumption and costs without sacrificing comfort. As a bonus, it considers limitations imposed by battery charging/discharging and decentralized power generation. Incorporating sensors and SCADA-based monitoring, the system provides accurate measurement and management of energy usage through load monitoring and control. An intuitive mobile app also helps consumers connect, allowing for more active participation and better control over energy use. Extensive field testing of the prototype shows that by moving loads from peak period to another off-peak period, electricity expenditures can be reduced by up to 48.45%. The energy theft value was calculated to be 1199 W, proving that the system's theft detection model was effective.

Defining pseudoptosis (bottoming out) 3 years after short-scar medial pedicle breast reduction.

BACKGROUND: Pseudoptosis (bottoming out) is a well-observed phenomenon occurring after all types of breast reduction surgery. The authors' team previously reported the use of three-dimensional (3D) imaging to demonstrate that significant morphologic changes occur in the breast during the first year after short-scar medial pedicle breast reduction. This study extended this evaluation to postoperative year 3. METHODS: Patients undergoing short-scar medial pedicle breast reduction had 3D photographs taken using the Canfield Vectra 3-pod system or the Konica Minolta V910 during postoperative follow-up visits at 1 month, 1 year, 2 years, and 3 years. Patients were assessed for pseudoptosis and breast morphologic changes using the 3D-based measurements. RESULTS: During the 3 year period, 10 patients completed the study. The total breast volume decreased significantly during the first postoperative year by 20.6% (P < 0.05). No change in volume occurred during postoperative years 2 and 3 (P > 0.05). Pseudoptosis was documented in the first postoperative year by a 6% migration of breast tissue from the upper pole to the lower pole of the breast (P < 0.05), without significant change noted during the next 2 postoperative years (P > 0.05). This redistribution of the breast parenchyma correlated with a decrease in breast anteroposterior projection of 10.6 mm (P < 0.05) during the same period, with an insignificant change during postoperative years 2 and 3. During the first postoperative year, 3D comparative analysis recorded a 4.4-mm difference in the 3D topography (P < 0.05) and no further changes thereafter. The angle of breast projection showed a significant decrease of 17% (P < 0.05) in the first postoperative year and no change in subsequent years. CONCLUSION: Three-dimensional photography is a useful tool enabling the plastic surgeon to monitor the postoperative changes in breast morphology objectively. This study provides quantifiable data demonstrating that pseudoptosis and tissue redistribution are limited to the initial postoperative year for patients undergoing short-scar medial pedicle breast reduction. The kinetic change in the breasts during postoperative years 2 and 3 appears to be minimal. Studies comparing the changes in morphology over time with different techniques of breast reduction are underway.

Metered-dose inhaler efficiency enhancement: a case study and novel design.

The efficiency of the metered-dose inhaler (MDI) is a critical issue in aerosol medicine because it deals with delivering a life-saving medication to patients with various lung diseases. Mouthpiece diameter, air flow rate, and entrance angle are among many parameters that influence the MDI penetration efficiency. It is well known that inertial impaction accounts for the massive aerosol deposition in the oral airway. In this study, the authors present a novel simple modification of the inhaler mouthpiece using a wire-based jet depressor to reduce the inertial impaction of aerosols. A 0.5 mm diameter wire is placed inside the MDI mouthpiece at a distance of 2 mm in front of the MDI nozzle. Two mouthpieces were modified and employed in the experiments (16 and 20 mm). The penetration efficiencies are measured and the results of the modified mouthpiece are compared with the conventional mouthpiece. The experiments are conducted at three different air flow rates (30, 60, and 90 L/min) and five entrance/spray angles (0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees). The results show that the new modified mouthpiece has higher aerosol penetration efficiency than the ones with the conventional mouthpiece. A second type of experiment is conducted to evaluate the relative strength of the aerosol impaction.

Balloon-based in vitro MDI aerosol deposition experiments on the effects of mouthpiece diameter.

For this article, we studied the effects of mouthpiece diameter and flow rate on aerosol penetration efficiency for metered-dose inhaler (MDI) applications. Measurements show that increasing the mouthpiece diameter has a moderate and positive influence on the particle penetration efficiency of the MDI. The particle penetration efficiency increases monotonically with the increase of the mouthpiece diameter from 16 mm to 20 mm. Second, the experiments show that airflow rate has an apparent and significant effect on particles deposition in the oral airway. The reduction of the airflow rate from 90 L/min to 30 L/min tripled the penetration efficiency of the MDI. A new experimental system has been employed to measure the particles deposition in the human airways. Expansion balloons were used to induce airflow as well as to collect the penetrated particles through an airway cast. The potential advantages of the balloon-based experimental system are simplicity, accuracy, and cost-effectiveness.

Utilization of the track embolization technique to improve the safety of percutaneous lung biopsy and/or fiducial marker placement.

PURPOSE: The purpose of the study was to describe and present outcomes of the track embolization technique with absorbable hemostat gelatin powder during percutaneous computed tomography (CT)-guided lung biopsy and/or fiducial marker placement versus the standard of care (no track embolization) in an attempt to decrease rates of pneumothorax (PTX), chest tube placement, hemorrhage and/or complications, and average cost per patient. MATERIALS AND METHODS: An institutional review board-approved, case-control, retrospective study was performed in which 125 consecutive patients who underwent track embolization were compared with 124 consecutive controls at one institution. For subjects in whom the track embolization technique was utilized, it was performed passively through a coaxial needle as it was removed. All procedures were performed by one of three attending interventional radiologists. For each group, medical records and procedure images were reviewed for PTX occurring postprocedure, PTX requiring chest tube placement, and occurrence of minor or major complication and/or hemorrhage. Comparison was made with published complication rates, and a cost-per-patient analysis was performed. Statistical analysis was performed utilizing Fisher's Exact Test. RESULTS: In track embolization cases versus controls, there were statistically significant reduction in PTX (8.8% vs. 21%; P=.007) and reduction in PTX requiring chest tube placement (4% vs. 8.1%; P=.195). This compares favorably to previously published rates of PTX and chest tube placement of 8%-64% and 1.6%-17%, respectively. None of the pneumothoraces occurring at time of needle placement increased in size with use of the track embolization technique. There were no major complications (including neurological sequela) in the track embolization group. In track embolization cases versus controls, there was a statistically significant reduction in both the rate of major hemorrhage (0% vs. 4%; P=.029) and average cost per patient ($262.40 vs. $352.07; P=.044). CONCLUSIONS: CT-guided percutaneous lung biopsy and/or fiducial marker placement were safer utilizing the track embolization technique during trocar removal. In addition, this technique was cost effective in the study population.

The volumetric analysis of fat graft survival in breast reconstruction.

BACKGROUND: Fat grafting has emerged as a useful method for breast contouring in aesthetic and reconstructive patients. Advancements have been made in fat graft harvest and delivery, but the ability to judge the overall success of fat grafting remains limited. The authors applied three-dimensional imaging technology to assess volumetric fat graft survival following autologous fat transfer to the breast. METHODS: Fat grafting surgery was performed using a modified Coleman technique in breast reconstruction. Patients undergoing the procedure were entered into the study prospectively and followed. Three-dimensional imaging was performed using the Canfield Vectra system and analyzed using Geomagic software. Breasts were isolated as closed objects, and total breast volume was calculated on every scan. RESULTS: The data stratified patients into three groups with statistically significant parameters based on the volume of fat injected. The largest injected group (average volume, 151 cc) retained a volume of 86.9 percent (7 days postoperatively), 81.1 percent (16 days), 57.5 percent (49 days), and 52.3 percent (140 days). The smallest group (average, 51 cc) retained a volume of 87.9 percent (7 days postoperatively), 75.8 percent (16 days), 56.6 percent (49 days), and 27.1 percent (140 days). The intermediate group (average, 93 cc) retained 90.3 percent (7 days postoperatively), 74 percent (16 days), 45.7 percent (49 days), and 38.1 percent (140 days). Of note, irradiation or prior breast procedure type did not seem to affect the volume retention rate. CONCLUSIONS: The authors' data suggest that fat retention is volume and time dependent. Patients receiving higher volumes of injected fat had slower volume loss and greater total volume retention.