Safe and successful pregnancy following breast cancer treatment in young patients 35 years old or under without invasive fertility preservation: a retrospective study.

Purpose: Recent advances in the treatment of breast cancer have led to the improvement of breast cancer patient's survival. With the prolonged survival of these patients, pregnancy became an important issue, especially in young cancer patient aged 35 years or under. Increased hormone levels during pregnancy, however, raise concerns about elevating the risk of cancer recurrence. The aim of this study was to validate the notion of increased risk associated with pregnancy after breast cancer treatment in young patients. Methods: From January 2009 to December 2020, newly diagnosed breast cancer patients 35 years old or under who underwent optimal surgery in Korea University Guro Hospital were enrolled in this study. Patients were categorized into 3 groups: nulliparous, pregnancy prior to treatment of breast cancer, and patients with pregnancy after breast cancer treatment. Their overall survival and disease-free survival were evaluated. Results: A total of 107 patients were enrolled in this study. Thirteen patients (12.1%) conceived and successfully delivered. The mean follow-up period after surgery was 58.9 (± 33.5) months. There was no significant difference in overall survival (P = 0.608) and disease-free survival (P = 0.591) among different groups. Conclusion: In young patients, pregnancy after treatment for breast cancer did not affect their overall survival or diseasefree survival as compared to nullipara or previously delivered groups. Therefore, pregnancy counseling should not be prevented in young breast cancer patients 35 years old or under.

Plasma-discharge-integrated slot structure for microwave power limiter.

A slot structure was combined with a discharge electrode to limit incident high-power microwaves via the integration of plasma discharge. At the target resonating frequency of 9.45 GHz, the surface current was concentrated at an electrode, and the electric field was enhanced by the proposed design to lower the response power level of the incident signal. When a low-power signal is injected, plasma is not generated, and the incident wave travels without insertion loss. Double-stage slot structures were utilized to broaden the band-pass characteristics in the frequency domain, and the demonstrated plasma limiter exhibited an insertion loss of 1.01 dB at 9.45 GHz. The xenon gas pressure was optimized with the shortest distance of 100 µm between the upper and lower electrodes to reduce the discharge power of the plasma. In the case of a high-power signal input, as xenon-gas breakdown occurred, the transmitted signal was close to zero, and most of the high-power signal was reflected with a blocking efficiency of 40.55 dB. The demonstrated result will be useful to protect the receiver of a radio detection and ranging system from the high power microwave.

Transparent and Flexible Graphene Pressure Sensor with Self-Assembled Topological Crystalline Ionic Gel.

This study demonstrates transparent and flexible capacitive pressure sensors using a high-k ionic gel composed of an insulating polymer (poly(vinylidene fluoride-co-trifluoroethylene-co-chlorofluoroethylene), P(VDF-TrFE-CFE)) blended with an ionic liquid (IL; 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl) amide, [EMI][TFSA]). The thermal melt recrystallization of the P(VDF-TrFE-CFE):[EMI][TFSA] blend films develops the characteristic topological semicrystalline surface of the films, making them highly sensitive to pressure. Using optically transparent and mechanically flexible graphene electrodes, a novel pressure sensor is realized with the topological ionic gel. The sensor exhibits a sufficiently large air dielectric gap between graphene and the topological ionic gel, resulting in a large variation in capacitance before and after the application of various pressures owing to the pressure-sensitive reduction of the air gap. The developed graphene pressure sensor exhibits a high sensitivity of 10.14 kPa-1 at 20 kPa, rapid response times of <30 ms, and durable device operation with 4000 repeated ON/OFF cycles. Furthermore, broad-range detections from lightweight objects to human motion are successfully achieved, demonstrating that the developed pressure sensor with a self-assembled crystalline topology is potentially suitable for a variety of cost-effective wearable applications.

Under- and Normal-Weight Patients Are More Susceptible to Recurrence of Phyllodes Tumor.

Purpose: Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to identify clinicopathological factors associated with the recurrence of PTs. Method: From January 2009 to December 2019, we identified 100 patients who underwent definitive surgery for PT. Clinicopathological risk factors associated with the recurrence of PT were assessed. Results: The median age of the patients was 44 y (range, 19-62 y), and the median tumor size was 4 cm (0.8-30 cm). At a median follow-up of 26.7 mo (0-103 mo), 22 of the 100 patients experienced local recurrence. In the univariate and multivariate analyses, body mass index ≥ 23 kg/m2 (P = 0.042 in the univariate analysis; P = 0.039 in the multivariate analysis), tumor size ≥ 5 cm (P = 0.006 in the univariate analysis; P = 0.036 in the multivariate analysis), and the presence of stromal overgrowth (P = 0.032 in the univariate analysis; P = 0.040 in the multivariate analysis) were associated with an increased risk of local recurrence. Resection margins and grade were not associated with local recurrence. Conclusion: Normal- or underweight patients and those with larger tumor sizes were more prone to local recurrence. Further larger, multicenter studies with a long-term follow-up are required.

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional Nipple-Sparing Mastectomy for Breast Cancer Based on Initial Experience.

PURPOSE: Endoscopic breast surgery for patients with breast cancer was introduced for its superior cosmetic outcomes; it was initially studied in the field of breast-conserving surgery and, more recently, in robotic-assisted nipple-sparing mastectomy (NSM). The main purpose of this study was to investigate the feasibility and safety of endoscopic NSM (E-NSM) in patients with breast cancer by comparing E-NSM and conventional NSM (C-NSM). METHODS: Between May 2017 and October 2020, we retrieved the records of 45 patients who underwent NSM with permanent silicone implants and divided them into the E-NSM group (20 patients) and the C-NSM group (25 patients), depending on the use of the endoscopic device. We also analyzed demographic information, pathology, operative time, and complications. RESULTS: No significant differences were observed between the 2 groups based on demographic information, postoperative pathological data, mean length of hospital stay, and total number of complications. The mean preparation time for surgery was comparable between both groups. Compared to the C-NSM group, the E-NSM group had a significantly longer mean operative time and, subsequently, a significantly longer mean total operative time and number of complications. CONCLUSION: The results showed that E-NSM was feasible and safe with a more inconspicuous incision in patients with breast cancer.

Detailed comparison of the da Vinci Xi and S surgical systems for transaxillary thyroidectomy.

ABSTRACT: Robotic surgical systems have evolved over time. The da Vinci Xi system was developed in 2014 and was expected to solve the shortcomings of the previous S system. Therefore, we conducted this study to compare these 2 systems and identify if the Xi system truly improves surgical outcomes.In this retrospective study, a total of 86 patients with unilateral papillary thyroid carcinoma without central lymph node involvement underwent gasless transaxillary hemithyroidectomy using 2 robotic systems, the da Vinci S and Xi. Forty patients were in the da Vinci S group and 46 patients were in the da Vinci Xi group. All surgeries were performed by 1 surgeon (YWC). All surgery video files were analyzed to compare the duration of each surgical step.The total operation time was significantly shorter in the Xi group than in the S group (153.0 minutes vs 105.7 minutes, P < .01). Time for robot docking was shorter in the Xi group (19.8 minutes vs 10.6 minutes, P < .01), and all procedures performed in the console also required a shorter time in this group. The overall complication rate did not differ significantly (P = .464).The da Vinci Xi system made robotic thyroidectomy easier and faster without increasing the complication rate. It is a safe and valuable system for robotic thyroidectomy.

Papillary Thyroid Cancer Tumor Spheres Cultured by Passaging Without Sorting Exhibit Cancer Stemness.

AIM: Cancer stem-like cell (CSC) markers and the role of CSCs derived from papillary thyroid carcinoma (PTC) in pathogenesis are unclear. This study aimed to investigate CSC properties using tumor spheres from passaged PTC cells but without sorting CSCs. MATERIALS AND METHODS: To identify the properties of CSCs derived from PTC, the expression of SRY-box transcription factor 2(SOX2), octamer-binding transcription factor 4 (OCT4), Nanog homeobox (NANOG), thyroglobulin (TG), thyroid-stimulating hormone receptor (TSHR), E-cadherin, YES-associated protein 1 (YAP1), and signal transducer and activator of transcription 3 (STAT3) was investigated in tumor spheres serially passaged without sorting CSCs. RESULTS: The cultured tumor spheres had cancer stemness; high expression of OCT4, SOX2, NANOG, and YAP1; low expression of E-cadherin; and varied expression of TG, TSHR, and STAT3. PTC tumor spheres transfected with small interfering RNA targeting YAP1 had fewer CSC properties than the non-transfected tumor spheres did. CONCLUSION: Tumor spheres derived from PTC cells by passaging without sorting CSCs have more stem-like cell properties, and less differentiation potential. Thus, this simple and cost-effective method can be used for the enrichment of PTC stemness for employment in cell-based models, reducing the need for use of animal models.

Slippery and Wear-Resistant Surfaces Enabled by Interface Engineered Graphene.

Friction and wear remain the primary cause of mechanical energy dissipation and system failure. Recent studies reveal graphene as a powerful solid lubricant to combat friction and wear. Most of these studies have focused on nanoscale tribology and have been limited to a few specific surfaces. Here, we uncover many unknown aspects of graphene's contact-sliding at micro- and macroscopic tribo-scales over a broader range of surfaces. We discover that graphene's performance reduces for surfaces with increasing roughness. To overcome this, we introduce a new type of graphene/silicon nitride (SiNx, 3 nm) bilayer overcoats that exhibit superior performance compared to native graphene sheets (mono and bilayer), that is, display the lowest microscale friction and wear on a range of tribologically poor flat surfaces. More importantly, two-layer graphene/SiNx bilayer lubricant (<4 nm in total thickness) shows the highest macroscale wear durability on tape-head (topologically variant surface) that exceeds most previous thicker (∼7-100 nm) overcoats. Detailed nanoscale characterization and atomistic simulations explain the origin of the reduced friction and wear arising from these nanoscale coatings. Overall, this study demonstrates that engineered graphene-based coatings can outperform conventional coatings in a number of technologies.

Detailed comparison of robotic and endoscopic transaxillary thyroidectomy.

BACKGROUND: Robotic thyroidectomy is increasingly used for patients with papillary thyroid carcinoma (PTC). We compared the differences between robotic and endoscopic transaxillary thyroidectomy with regard to surgical procedures. METHODS: This retrospective study enrolled 40 patients with PTC who underwent robotic hemithyroidectomy (robot group) using the Da Vinci S system and 37 patients (endoscopic group) who underwent endoscopic hemithyroidectomy. Video files of surgery for all patients were analyzed to compare the operation procedures: (flap creation, docking [only for robot group], dissection of the superior pole, dissection of the inferior pole, identification of parathyroid glands [PTGs] and the recurrent laryngeal nerve [RLN], dissection of the thyroid along the trachea, bleeding control, application of a drain, and wound closure). The duration of each procedure and the clinicopathological characteristics were analyzed. RESULTS: Procedure time for patients in the robot group was shorter for inferior pole dissection and for identification of the PTGs and RLN (37.5 min vs. 50.5 min, p = 0.008). Mean total operative times for the two groups were comparable (153.0 min vs. 150.2 min, p = 0.732); however, excluding the docking procedure, operation time was shorter for the robot group (133.3 min vs. 150.2 min, p = 0.038). The number of sacrificed PTGs was also significantly smaller in the robot group (0.35 ± 0.53 vs. 0.65 ± 0.68, p = 0.036). CONCLUSION: Compared to endoscopic thyroidectomy, robotic transaxillary thyroidectomy involved a shorter time for inferior pole dissection and PTGs and RLN identification; moreover, more PTGs were spared using this procedure.

Sentinel lymph node detection using fluorescein and blue light-emitting diodes in patients with breast carcinoma: A single-center prospective study.

BACKGROUND: Sentinel lymph node (SLN) biopsy is an essential procedure for lymph node staging in patients with breast carcinoma. Technetium-99m-labelled nanocolloid (99mTc) is the most accurate and widely used lymphatic mapping agent; however, there are concerns pertaining to the associated exposure to radiation. Studies focusing on new agents are required. We aimed to evaluate the feasibility and safety of SLN detection using fluorescein and blue light-emitting diodes (LEDs) in breast carcinoma patients. METHODS: In this prospective study, a total of 61 patients with breast carcinoma, requiring SLN biopsy, were enrolled. Both fluorescein and 99mTc were intradermally injected into the areola of the affected breast of each patient. SLNs stained with fluorescein were detected using blue LED light first, and then, any remaining SLNs were detected using a gamma detection probe. The detection rate was analyzed, and the presence of complications was investigated. RESULTS: SLNs dyed with fluorescein using blue LED light were visualized in 57 of 61 patients (93.4%). None of the patients experienced complications related to the use of fluorescein or blue LED light. CONCLUSIONS: The detection of SLNs using fluorescein and blue LED light was feasible and safe in patients with breast carcinoma. This technique involves the use of visible light, allowing for SLNs to be viewed with the naked eye, and is quantifiable, easy to use, and economical.

Direct Synthesis of a Self-Assembled WSe2 /MoS2 Heterostructure Array and its Optoelectrical Properties.

Functional van der Waals heterojunctions of transition metal dichalcogenides are emerging as a potential candidate for the basis of next-generation logic devices and optoelectronics. However, the complexity of synthesis processes so far has delayed the successful integration of the heterostructure device array within a large scale, which is necessary for practical applications. Here, a direct synthesis method is introduced to fabricate an array of self-assembled WSe2 /MoS2 heterostructures through facile solution-based directional precipitation. By manipulating the internal convection flow (i.e., Marangoni flow) of the solution, the WSe2 wires are selectively stacked over the MoS2 wires at a specific angle, which enables the formation of parallel- and cross-aligned heterostructures. The realized WSe2 /MoS2 -based p-n heterojunction shows not only high rectification (ideality factor: 1.18) but also promising optoelectrical properties with a high responsivity of 5.39 A W-1 and response speed of 16 µs. As a feasible application, a WSe2 /MoS2 -based photodiode array (10 × 10) is demonstrated, which proves that the photosensing system can detect the position and intensity of an external light source. The solution-based growth of hierarchical structures with various alignments could offer a method for the further development of large-area electronic and optoelectronic applications.

Atomic-Level Customization of 4 in. Transition Metal Dichalcogenide Multilayer Alloys for Industrial Applications.

Despite many encouraging properties of transition metal dichalcogenides (TMDs), a central challenge in the realm of industrial applications based on TMD materials is to connect the large-scale synthesis and reproducible production of highly crystalline TMD materials. Here, the primary aim is to resolve simultaneously the two inversely related issues through the synthesis of MoS2(1- x ) Se2 x ternary alloys with customizable bichalcogen atomic (S and Se) ratio via atomic-level substitution combined with a solution-based large-area compatible approach. The relative concentration of bichalcogen atoms in the 2D alloy can be effectively modulated by altering the selenization temperature, resulting in 4 in. scale production of MoS1.62 Se0.38 , MoS1.37 Se0.63 , MoS1.15 Se0.85 , and MoS0.46 Se1.54 alloys, as well as MoS2 and MoSe2 . Comprehensive spectroscopic evaluations for vertical and lateral homogeneity in terms of heteroatom distribution in the large-scale 2D TMD alloys are implemented. Se-stimulated strain effects and a detailed mechanism for the Se substitution in the MoS2 crystal are further explored. Finally, the capability of the 2D alloy for industrial application in nanophotonic devices and hydrogen evolution reaction (HER) catalysts is validated. Substantial enhancements in the optoelectronic and HER performances of the 2D ternary alloy compared with those of its binary counterparts, including pure-phase MoS2 and MoSe2 , are unambiguously achieved.

Electronic Structure of Nonionic Surfactant-Modified PEDOT:PSS and Its Application in Perovskite Solar Cells with Reduced Interface Recombination.

The interfacial properties of organolead halide perovskite solar cells (PSCs) affect the exciton and charge-transport dynamics significantly. Thus, proper modification of the interfaces between perovskite and charge-transport layers is an efficient method to increase the power conversion efficiency (PCE) of PSCs. In this work, we explore the effect of a nonionic surfactant, that is, Triton X-100 (TX) additive, in the poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) hole-transport layer. The electronic structure of TX-modified PEDOT:PSS is investigated with ultraviolet/X-ray photoelectron spectroscopy and X-ray absorption spectroscopy with various TX concentrations. The surface of the TX-modified PEDOT:PSS layer showed high TX content, and thus the semimetallic properties of PEDOT:PSS were suppressed conspicuously by its insulating nature. With the TX-modified PEDOT:PSS, the PCE of methylammonium lead iodide (MAPbI3) PSCs increased significantly. To elucidate the origin of the improved device performance, the electrical properties and photoluminescence were investigated comprehensively. Consequently, it was found that the TX additive inhibits interface recombination between PEDOT:PSS and MAPbI3, which is caused by the suppression of semimetallic properties of the PEDOT:PSS surface. Hence, we fabricated flexible PSCs successfully using a graphene electrode and TX-modified PEDOT:PSS.

Stretchable Electroluminescent Display Enabled by Graphene-Based Hybrid Electrode.

Stretchable alternating-current electroluminescent (ACEL) devices are required due to their potential in wearable, biomedical, e-skin, robotic, lighting, and display applications; however, one of the main hurdles is to achieve uniform electroluminescence with an optimal combination of transparency, conductivity, and stretchability in electrodes. We therefore propose a fabrication scheme involving strategically combining two-dimensional graphene layers with a silver nanowire (Ag NW)-embedded PEDOT:PSS film. The developed hybrid electrode overcomes the limitations of commonly known metallic NWs and ionic conductor-based electrodes for ACEL applications. Furthermore, the potential of the hybrid electrode is realized in demonstrating large-area stretchable ACEL devices composed of an 8 × 8 passive array. The prototype ACEL passive array demonstrates efficient and uniform electroluminescence under high levels of mechanical deformation such as bending, rolling, twisting, and stretching.

The expression of insulin receptor substrate 1 and estrogen receptor as prognostic factor on breast cancer patient.

BACKGROUND: Insulin receptor substrate 1 (IRS-1) has been known to be an associated factor with breast cancer progression. However, there has been little study with respect to the relationship between the expression of IRS-1 and breast cancer prognosis in clinical practice. In this study, we evaluated the impact of the estrogen receptor (ER) and IRS-1 on the recurrence and survival of breast cancer patients. METHODS: We analyzed the pathologic finding of 376 tissue samples from breast cancer patients who received proper treatment between January 1990 and December 2006 using the tissue microarray. We measured the expression of ER and IRS-1 by immunohistochemistry staining and analyzed the difference of recurrence and survival rate in each subgroup of ER and IRS-1. RESULTS: Our results show that there is a significant difference of disease-free survival (DFS) according to ER and IRS-1 subgroups with both univariate and multivariate analyses. Specifically, ER-positive and IRS-1-positive breast cancer samples showed improved DFS compared to ER-positive and IRS-1-negative breast cancer (adjusted hazard ratio: 2.17; 95% confidence interval: 1.15-4.09; P = 0.01). There was a difference of overall survival according to ER and IRS-1 subgroups by univariate analysis (P = 0.01), but not by multivariate analysis (P = 0.36). CONCLUSION: ER and IRS-1 subgroups appear to be critical factors for the prediction of breast cancer recurrence. In particular, we suggest that the patients who have ER-positive and IRS-1-negative breast cancer undergo more aggressive treatment because they have poorer prognoses.

Extent of central lymph node dissection for papillary thyroid carcinoma in the isthmus.

PURPOSE: The incidence of papillary thyroid carcinoma (PTC) arising from the isthmus is low; however, these tumors have aggressive clinical and pathological features. Moreover, the existing guidelines regarding the extent of surgery for this type of tumor are unclear. METHODS: This study enrolled 282 patients who underwent total thyroidectomy with bilateral central lymph node dissection. The patients were divided into 2 groups based on the location of the median line of the PTC. Group I included patients in whom the median line was located between the lateral margins of the trachea; group II included all others. We compared the 2 groups and conducted a multivariate analysis to assess risk factors for contralateral node metastasis from a PTC arising from the isthmus. RESULTS: Patients in group I had significantly higher frequencies of extrathyroidal extension and central lymph node metastasis. Group I also had a higher frequency of contralateral node metastasis, and a tumor size >1.0 cm was identified as an independent risk factor for contralateral node metastasis among patients in this group. CONCLUSION: Bilateral central lymph node dissection could be considered for patients with isthmic PTCs >1.0 cm in size who have clinically suspicious node metastasis.

Lymph node ratio as an alternative to pN staging for predicting prognosis after neoadjuvant chemotherapy in breast cancer.

Axillary nodal status is one of the most important prognostic factors in breast cancer. The lymph node ratio (LNR) has been suggested as an independent prognostic factor because the number of dissected and involved lymph nodes might differ across institutions. Neoadjuvant chemotherapy (NAC) has been the preferred treatment method for reducing tumor mass in the breast and axillary area. However, NAC can reduce total number of excised lymph nodes compared with upfront surgery. Therefore, an emerging question is whether axillary nodal status and LNR following NAC can accurately predict prognosis. We evaluated the prognostic value of axillary nodal status and LNR after NAC. A total of 236 patients were enrolled. Patients were divided into four groups according to the following cut-off values for LNR: 0 (n = 107), 0.01-0.20 (n = 68), 0.21-0.65 (n = 50) and >0.65 (n = 11). Pathologic complete responses were observed in 16.9% of the overall cohort. In univariate analysis, pathologic N stage was a significant prognostic factor of disease free survival (DFS, p = 0.013) and overall survival (OS, p = 0.004). However, in multivariate analysis, hormone receptor status (p = 0.043) and LNR (p = 0.028) were significantly associated with DFS and LNR (p = 0.017) showed statistical significance for OS; however, pathologic N stage was no longer significantly associated with DFS or OS. Traditional nodal staging has been accepted as an important prognostic factor; however, our result indicated that the nodal ratio could be an alternative to pN staging as a prognostic factor after NAC in breast cancer.

Comparison of skin-sparing mastectomy using LigaSure™ Small Jaw and electrocautery.

BACKGROUND: Skin-sparing mastectomy (SSM) is increasingly used in patients with breast cancer. We compared the differences between use of electrocautery and LigaSure™ Small Jaw in patients with breast cancer who underwent SSM. METHODS: Between January 2012 and December 2015, 81 patients with breast cancer who underwent SSM were selected and were divided into the electrocautery group and the LigaSure™ Small Jaw group based on the devices that were used. Clinicopathological characteristics, body mass index, operative time, and weight of removed breast were obtained from medical records. Total amount and days of drain use, until removal, and postoperative skin necrosis, requiring debridement, were also analyzed. RESULTS: The study population consisted of 50 patients in the electrocautery group and 31 in the LigaSure™ Small Jaw group. The latter group has significantly shorter operative time (117.5 ± 16.9 vs. 104.0 ± 23.6 min, P = 0.004). The mean total volume of drainage was less (805 ± 278 vs. 694 ± 131 mL, P = 0.017) and mean duration of drainage was also significantly shorter in the LigaSure™ Small Jaw group (11.3 ± 2.5 vs. 10.1 ± 2.0 days, P = 0.029). CONCLUSIONS: The use of LigaSure™ Small Jaw during skin-sparing mastectomy shortened the operative time and duration of drainage and reduced the total volume of drainage.

Significance of micrometastases in the calculation of the lymph node ratio for papillary thyroid cancer.

PURPOSE: The lymph node ratio (LNR) is an important prognostic factor in papillary thyroid carcinoma (PTC), but micrometastases in cervical lymph nodes (LNs) are not of great clinical importance. In this study, we analyzed the accuracy of prediction of the prognosis depending on whether micrometastases were included in the number of metastatic LNs when calculating LNR. METHODS: The study included 353 PTC patients who underwent total thyroidectomy with neck LN dissection, and calculated LNR by 2 methods according to whether micrometastases were included in the number of metastatic LNs: Method 1 did not and method 2 did include. To compare the predictive values of LNR by the 2 methods, correlation coefficients and receiver operating characteristic (ROC) curves were analyzed. RESULTS: Positive correlations were found between LNR and preablation stimulated thyroglobulin (sTg) levels in both methods, but the correlation between method 1 LNR and preablation sTg level was significantly stronger than that for method 2 (Fisher z = 1.7, P = 0.045). The areas under these 2 independent ROC curves were analyzed; the prognostic efficacy of method 1 LNR was more accurate than that of method 2 LNR, and the difference was statistically significant (P = 0.0001). CONCLUSION: Regional recurrence of PTC can be predicted more accurately by not including micrometastases in the number of metastatic LNs when calculating LNR.