Changing Susceptibility of Staphylococci in Patients with Implant-Based Breast Reconstructions: A Single-Center Experience.

Background and Objectives: Infections and capsular contractures remain unresolved issues in implant-based breast reconstruction. Capsular contractures are thought to be caused by the endogenous flora of the nipple duct. However, little is known about the antibiotic susceptibility of the microorganisms involved. This study aimed to evaluate the composition of endogenous breast flora and its antimicrobial susceptibility in patients with breast cancer. This study will aid in selecting a prophylactic antibiotic regimen for breast reconstruction surgery. Materials and Methods: We obtained bacteriologic swabs from the nipple intraoperatively in patients who underwent implant-based breast reconstruction following nipple-sparing mastectomy between January 2019 and August 2021. Antibiotic susceptibility tests were performed according to the isolated bacteriology. Statistical analysis was performed based on several patient variables to identify which factors influence the antibiotic resistance rate of endogenous flora. Results: A total of 125 of 220 patients had positive results, of which 106 had positive culture results for coagulase-negative Staphylococcus species (CoNS). Among these 106 patients, 50 (47%) were found to have methicillin-resistant staphylococci, and 56 (53%) were found to have methicillin-susceptible staphylococci. The methicillin resistance rate in the neoadjuvant chemotherapy group (56.3%) was significantly higher (OR, 2.3; p = 0.039) than that in the non-neoadjuvant chemotherapy group (35.5%). Conclusions: Based on the results, demonstrating high and rising incidence of methicillin-resistant staphylococci of nipple endogenous flora in patients with breast cancer compared to the past, it is necessary to consider the selection of prophylactic antibiotics to reduce infections and capsular contracture after implant-based breast reconstruction.

Experience of the waiting area as perceived by haemodialysis patients and family carers.

AIM: To identify the meaning of the waiting area based on the experiences of haemodialysis patients and their carers and to develop an optimal social environment for meaningful nursing care. BACKGROUND: Haemodialysis patients require treatment three times a week and they and their carers spend much of their time in waiting areas, where they experience a unique culture. Limited qualitative research has focused on the culture of the waiting area among haemodialysis patients in South Korea. DESIGN: A qualitative study using an ethnographic approach. METHODS: Eighteen participants were recruited in a hospital waiting area. The data were collected via participant observations and interviews from 24 November 2015-21 April 2016. Spradley's research sequence was employed to analyse the data. RESULTS: Three themes were identified that describe the unique characteristics of the waiting area: sharing information and consoling, inhabiting a separate area of ease and discomfort and experiencing vigilance and unsure stillness. The overarching theme was a boundary space that presented antithetical and dynamic patterns. CONCLUSIONS: This study contributes to a better understanding of the distinct culture experienced by haemodialysis patients in the waiting area and the findings can help nurses deliver more meaningful care. Nursing interventions germane to psychological and emotional support and applicable nursing education should be seriously considered for haemodialysis waiting rooms.

Prospective Study Comparing Two Second-Look Ultrasound Techniques: Handheld Ultrasound and an Automated Breast Volume Scanner.

OBJECTIVES: The aim of this study was to compare the diagnostic performance of handheld ultrasound (US) and an automated breast volume scanner (ABVS) as second-look US techniques subsequent to preoperative breast magnetic resonance imaging (MRI). METHODS: We prospectively enrolled patients with breast cancer who underwent handheld US and ABVS examinations as second-look US modalities for additional suspicious lesions found via preoperative breast MRI. We reviewed each second-look US modality independently and evaluated the detection rate of each modality. We then analyzed the correlation between the detection rate and the MRI factors (size, distance, and enhancement type). RESULTS: From March to September 2014, both types of second-look US examinations were performed on 40 patients with breast cancer who had 76 additional suspicious lesions detected via preoperative breast MRI. The detection rate of the ABVS was higher than that of handheld US for the second-look examination (94.7% versus 86.8%; P< .05). Among the 76 total lesions, 7 were only identified by the ABVS, 1 was only found by handheld US, and 3 were not detected by either the ABVS or handheld US. When we analyzed the correlation between the detection rate and MRI factors, the only meaningful factor was the enhancement type. The ability to detect a nonmass lesion was lower than the ability to detect a mass-type lesion (P < 0.05) for both the ABVS and handheld US. CONCLUSIONS: For a second-look US examination subsequent to preoperative breast MRI in patients with breast cancer, the ABVS is a more efficient modality than handheld US for preoperative evaluations. However, both techniques have limitations in detecting nonmass lesions.

Silicon photonic receiver and transmitter operating up to 36 Gb/s for λ~1550 nm.

We present the hybrid-integrated silicon photonic receiver and transmitter based on silicon photonic devices and 65 nm bulk CMOS interface circuits operating over 30 Gb/s with a 10(-12) bit error rate (BER) for λ ~1550nm. The silicon photonic receiver, operating up to 36 Gb/s, is based on a vertical-illumination type Ge-on-Si photodetector (Ge PD) hybrid-integrated with a CMOS receiver front-end circuit (CMOS Rx IC), and exhibits high sensitivities of -11 dBm, -8 dBm, and -2 dBm for data rates of 25 Gb/s, 30 Gb/s and 36 Gb/s, respectively, at a BER of 10(-12). The measured energy efficiency of the Si-photonic receiver is 2.6 pJ/bit at 25 Gb/s with an optical input power of -11 dBm, and 2.1 pJ/bit at 36 Gb/s with an optical power of -2 dBm. The hybrid-integrated silicon photonic transmitter, comprised of a depletion-type Mach-Zehnder modulator (MZM) and a CMOS driver circuit (CMOS Tx IC), shows better than 5.7 dB extinction ratio (ER) for 25 Gb/s, and 3 dB ER for 36 Gb/s. The silicon photonic transmitter achieves the data transmission with less than 10(-15) BER at 25 Gb/s, 10(-14) BER at 28 Gb/s, and 6 x 10(-13) BER with the energy efficiency of ~6 pJ/bit at 30 Gb/s.

Low-cost design and fabrication of an anthropomorphic robotic hand.

Human hand signifies a magnificent and challenging example for scientists and engineers trying to replicate its complex structure and functionality. This paper proposes a bio-mechatronic approach for the design of an anthropomorphic artificial hand capable of performing basic human hand motions with fundamental gripping functionality. The dexterity of the artificial hand is exhibited by imitating the natural motion of the human fingers. Imitation is produced according to the data acquired from the flex sensors attached to the human fingers. In order to have proper gripping, closed-loop control is implemented using the tactile sensors. Feedback for the closed-loop control is provided by force sensing resistors (FSRs), attached on the fingertips of the robotic hand. These sensors also enable handling of fragile objects. The mathematical model is derived using forward kinematics and also simulated on MATLAB to ascertain the position of robotic fingers in 3D space.

What Is the Minimum Number of Sutures for Microvascular Anastomosis during Replantation?

As vessel diameter decreases, reperfusion after anastomosis becomes more difficult. When a blood vessel is sutured, its inner diameter becomes narrower owing to the thickness of the suture material and the number of sutures. To minimize this, we attempted replantation using a 2-point suture technique. We reviewed cases of arterial anastomosis in vessels with a diameter of less than 0.3 mm during replantation performed over a four-year period. In all cases, close observation was followed by absolute bed rest. If reperfusion was not achieved, a tie-over dressing was applied, and hyperbaric oxygen therapy was administered in the form of a composite graft. Of the 21 replantation cases, 19 were considered successful. Furthermore, the 2-point suture technique was performed in 12 cases, of which 11 survived. When three or four sutures were performed in nine patients, eight of these cases survived. Composite graft conversion was found in three cases in which the 2-point suture technique was used, and two of these cases survived. The survival rate was high in cases where 2-point sutures were used, and there were few cases of conversion to a composite graft. Reducing the number of sutures aids in optimizing reperfusion.

Correlation between Collagen Type I/III Ratio and Scar Formation in Patients Undergoing Immediate Reconstruction with the Round Block Technique after Breast-Conserving Surgery.

The aim of this study was to investigate the relationship between the collagen type I/III ratio and scarring in patients who underwent immediate reconstruction with the round block technique (RBT) after breast conservation surgery. Seventy-eight patients were included, and demographic and clinical characteristics were recorded. The collagen type I/III ratio was measured using immunofluorescence staining and digital imaging, and scarring was assessed using the Vancouver Scar Scale (VSS). The mean VSS scores were 1.92 ± 2.01 and 1.79 ± 1.89, as assessed by two independent plastic surgeons, with good reliability of the scores. A significant positive correlation was found between VSS and the collagen type I/III ratio (r = 0.552, p < 0.01), and a significant negative correlation was found between VSS and the collagen type III content (r = -0.326, p < 0.05). Multiple linear regression analysis showed that the collagen type I/III ratio had a significant positive effect on VSS (ß = 0.415, p = 0.028), whereas the collagen type I and collagen type III content had no significant effect on VSS. These findings suggest that the collagen type I/III ratio is associated with scar development in patients undergoing RBT after breast conservation surgery. Further research is needed to develop a patient-specific scar prediction model based on genetic factors affecting the collagen type I/III ratio.

Review of 107 Oncoplastic Surgeries Using an Acellular Dermal Matrix with the Round Block Technique.

The round block technique (RBT) is an oncoplastic surgery method that uses volume displacement techniques after partial mastectomy. However, cosmetic problems occur after tissue rearrangement in patients with small breasts or those in whom a large amount of breast tissue is excised. Therefore, we used an acellular dermal matrix (ADM) when the volume was insufficient after tissue rearrangement. Patients who underwent breast reconstruction using the ADM with the RBT after breast-conserving surgery (BCS) were included. The ADM graft was performed in two layers. First, it was placed on the glandular flap, and the patient was then seated to ascertain the degree of deformity. If the volume was insufficient, a graft was also performed under the skin flap. Overall, 107 oncoplastic surgeries were performed. Tumors were most commonly located in the upper outer quadrant of the breast, and the mean resected breast tissue was 27.1 g. Seroma was the most common complication, but it improved with several aspirations. There were no major complications or cosmetic problems requiring reoperation. Therefore, if the ADM was used for defects that could not be reconstructed with the RBT alone, safe and cosmetically good results could be obtained.

"Tear-Drop Appearance" Wrap: A Novel Implant Coverage Method for Creating Natural Contour in Prepectoral Prosthetic-Based Breast Reconstruction.

Various implant wrapping methods with acellular dermal matrix (ADM) have been introduced, but most focus on random trimming and suturing aimed to maximize implant coverage. Here we present our clinical experience using a "tear-drop appearance" wrapping method to achieve natural contours through upper pole volume replacement. We retrospectively reviewed the data of 56 consecutive cases of prepectoral prosthetic-based breast reconstruction (PPBR) using this wrapping method following nipple-sparing mastectomy between March 2020 and June 2021. The "tear-drop appearance" wrapping design creates an anatomical tear-drop-shaped pocket to encourage lower pole fullness and create a natural contour through upper pole volume replacement by ADM. Patients' baseline characteristics, operative data, and complications were analyzed. Aesthetic outcomes were measured using the BREAST-Q and Aesthetic Item Scale (AIS). A successful reconstruction was achieved without major complications and using a single ADM sheet. Four types and three sizes of ADMs were used. The mean resected breast tissue weight was 274.3 g, while the mean implant volume was 230.0 cc. The average BREAST-Q and AIS scores were 4.6 ± 0.8 and 4.5 ± 0.7, respectively. Owing to its simplicity, reproducibility, and effectivity, this method is an excellent implant coverage option that achieves a natural contour in PPBR.

[The Experience of Fluid Management in Hemodialysis Patients].

PURPOSE: The purpose of this study was to explore the experience of fluid management in hemodialysis patients by describing how they manage fluid intake and what affects fluid management. METHODS: Purposive sampling yielded 11 patients who have received hemodialysis for one year or longer in one general hospital. Data were collected through in-depth interviews and analysed using Giorgi's phenomenological method. Data collection and analysis were performed concurrently. RESULTS: The findings regarding how hemodialysis patients manage fluid intake were classified into four constituents: 'recognizing the need for fluid control', 'observing the status of fluid accumulation', 'controlling fluid intake and output', 'getting used to fluid management'. The factors that affect fluid management of hemodialysis patients were revealed as 'willpower', 'change in the mindset', 'support system', and 'emotional state'. CONCLUSION: The study results show that hemodialysis patients manage fluid intake through food and exercise as well as interpersonal relationships. These findings suggest that strategies in the development of nursing interventions for hemodialysis patients should be directed at assisting them in familiarization with fluid management based on an understanding of their sociocultural contexts.

Formation control for a network of small-scale robots.

In this paper, a network of small-scale robots (typically centimeter-scale robots) equipped with artificial actuators such as electric motors is considered. The purpose of this network is to have the robots keep a certain formation shape (or change to another formation shape) during maneuvers. The network has a fixed communication topology in the sense that robots have a fixed group of neighbors to communicate during maneuvers. Assuming that each robot and its actuator can be modeled as a linear system, a decentralized control law (such that each robot activates its actuator based on the information from its neighbors only) is introduced to achieve the purpose of formation keeping or change. A linear matrix inequality (LMI) for deriving the upper bound on the actuator's time constant is also presented. Simulation results are shown to demonstrate the merit of the introduced control law.

Forensic application of SNP-based resequencing array for individual identification.

In forensic field investigations using single nucleotide polymorphism (SNP) have been performed for various purposes. Based on the characteristics of SNP, it is essential to have a multi-amplification technology and a platform to analyze the amplified SNP markers accurately. Here, we have developed a platform based on the resequencing array of Affymetrix analyzing 169 SNP markers amplified via multiplex PCR and verified its forensic application. From the 1000 genomes database, the SNP markers were selected under the condition of less than 0.04 fixation index (Fst) and 0.3 linkage disequilibrium (LD) R(2) value, and 0.4-0.5 minor allele frequency (MAF). It was identified that more than 120 out of 169 SNPs were able to be typed with approximately 10pg of DNA and artificially degraded samples in various tests. The DNA extracted from bones also showed a similar rate of success. The results indicated that our platform has a potential role to assist the current short tandem repeat (STR) method in analyzing harsh samples, such as bone or degraded DNA. With a possibility to expand the platform, it was expected to apply to various uses in different areas in the future.