Intraoperative evaluation of sentinel lymph nodes in patients with breast cancer treated with systemic neoadjuvant therapy.

AIMS: Touch preparation (TP) and frozen section (FS) are the two methods routinely used in the intraoperative evaluation (IOE) of sentinel lymph nodes (SLNs) to detect metastases in patients with breast cancer. Both methods are extremely sensitive and specific in the primary surgery (non-neoadjuvant systemic therapy (non-NST)) setting. Since NST introduces unique challenges in the IOE of SLNs, the aim was to determine the accuracy of TP and FS in the IOE of SLNs in the NST setting and compare the results with the non-NST setting and to examine factors that contribute to any differences. METHODS: We analysed 871 SLNs from 232 patients (615 SLNs from NST and 256 SLNs from non-NST settings) between 2016 through 2019. RESULTS: In the NST group, TP alone (n=366) had a sensitivity of 45.7% and specificity of 99.7%; FS alone (n=90) had a sensitivity of 83.3% and specificity of 100%. When both TP and FS (n=135) were used, the sensitivity was 80.3% and the specificity was 98.6%.In the non-NST group, TP alone (n=193) had a sensitivity of 66.7% and specificity of 100%; FS alone (n=22) had a sensitivity and specificity of 100%; and combined TP and FS (n=34) had a sensitivity and specificity of 100% and 96%, respectively. CONCLUSIONS: Evaluating SLNs intraoperatively in the NST setting can be challenging secondary to therapy-related changes. In the NST setting, FS has higher sensitivity and specificity compared with TP for the IOE of SLNs and should be the preferred method.

An Appraisal of pH triggered Bacitracin drug release, through composite hydrogel systems.

Comparative investigations on environmentally triggered drug delivery and wound healing characteristics of flexible hydrogel composites, Chitosan-Gelatin (C/G) and 2-Hydroxyethyl Methacrylate-Gelatin (H/G); are presented here. These composites, prepared through facile synthesis and curing methods, indicate the potential to smartly respond to the pH changes in wounds by releasing drug simultaneously and aiding in faster healing. An in-vitro investigation of the composite characteristics were included testing for Equilibrium Water Capacity Studies, Fourier Transform Infrared Spectroscopy (FTIR) investigations as well as UV based drug release and gravimetric hydrogel degradation profiles. This was followed by cutaneous application testing of the hydrogel systems in balb-c mice. Observations and testing results indicated the potential applicability of the hydrogel systems as dressings for topical/transdermal applications, provided that further detailed in-vivo characteristics are accounted for.

A 54-Year-Old Woman With Shortness of Breath After Nephrolithotomy.

CASE PRESENTATION: A 54-year-old woman was admitted to the general medical floor after undergoing percutaneous nephrolithotomy via the supracostal approach. On postprocedure day 1, she developed low-grade fever, dry cough, shortness of breath, and palpitations.

Sudden Cardiac Death in a Patient with Anomalous Origin of Right Coronary Artery with Concomitant Sinus of Valsalva Aneurysm.

Anomalous origin of right coronary artery (ARCA) arising from the left sinus of Valsalva (a congenital cardiac abnormality) and sinus of Valsalva aneurysm (SOVA) are rare and often have asymptomatic conditions. However, symptoms could range from chest pain, shortness of breath, palpitations, syncope to sudden cardiac death (SCD). The co-existence of these two anomalies (ARCA + SOVA) could lead to potential adverse outcomes in the absence of early intervention. The presence of these two conditions together increases the risk of SCD as reported in our case of a young male who presented to the emergency department with chest pain.

Age cutoff for reporting of benign-appearing endometrial cells in Papanicolaou specimens; should it be raised? A 10-year retrospective study from a large county hospital.

INTRODUCTION: The recommendation for reporting benign-appearing endometrial cells in Papanicolaou specimens was increased from 40 to 45 years in the 2014 edition of The Bethesda System. Recent studies suggest that increasing the reporting age to 50 years would have no significant negative impact. Reporting of benign endometrial cells may trigger unnecessary procedures and increase the cost of patient care. The goal of our study was to perform cytohistologic correlations and determine an optimal age cutoff for reporting endometrial cells in cervical cytology specimens. MATERIALS AND METHODS: The pathology database was searched between 2006 and 2015 for Papanicolaou tests with benign-appearing endometrial cells that were followed by endometrial sampling within 1 year of the cytology result in women ≥45 years. In cases where more than one follow-up surgical specimen was available, only the most significant result was included. Endometrial carcinoma or atypical hyperplasia was considered a significant histologic result. The data were organized into 4 age groups, 45 to 49, 50 to 54, 55 to 59, and ≥60 years. RESULTS: Among 453,420 Papanicolaou specimens, 1121 cases reported endometrial cells in women ≥45 years. Of these, 588 (52%) had an endometrial biopsy/curettage or hysterectomy. Benign diagnosis was reported for 558 (95%) and 12 (2%) samples were insufficient for diagnosis. Significant histologic findings were present in 18 (3%) of cases, of which all were endometrial carcinoma. The difference was statistically significant between the age groups 45 to 54 and ≥55 (1.5% versus 17% of cases had significant endometrial pathology, P < 0.05). CONCLUSIONS: Increasing the current reporting age appears safe and may improve efficiency and cost savings.

Synthetic polymeric biomaterials for wound healing: a review.

Wounds are of a variety of types and each category has its own distinctive healing requirements. This realization has spurred the development of a myriad of wound dressings, each with specific characteristics. It is unrealistic to expect a singular dressing to embrace all characteristics that would fulfill generic needs for wound healing. However, each dressing may approach the ideal requirements by deviating from the 'one size fits all approach', if it conforms strictly to the specifications of the wound and the patient. Indeed, a functional wound dressing should achieve healing of the wound with minimal time and cost expenditures. This article offers an insight into several different types of polymeric materials clinically used in wound dressings and the events taking place at cellular level, which aid the process of healing, while the biomaterial dressing interacts with the body tissue. Hence, the significance of using synthetic polymer films, foam dressings, hydrocolloids, alginate dressings, and hydrogels has been reviewed, and the properties of these materials that conform to wound-healing requirements have been explored. A special section on bioactive dressings and bioengineered skin substitutes that play an active part in healing process has been re-examined in this work.

Morbidity and Mortality: A Case Report of Metastatic Bone Disease.

Metastatic prostate cancer and multiple myeloma (MM) usually present with bone lesions, posing a diagnostic challenge in males presenting in late stages. In this case report, an 86-year-old male who had not seen a physician in over 30 years presented with complaints of hip pain and progressive difficulty in walking for three weeks. Outpatient X-ray of the right hip showed multiple lytic bone lesions, raising suspicion of MM. Other laboratory tests revealed elevated serum calcium and elevated prostate-specific antigen (PSA), supporting a diagnosis of prostate cancer. The patient was admitted for further workup. Magnetic resonance imaging (MRI) of the spine showed diffuse metastatic disease throughout the spine as well as pelvis with multilevel central canal and neuro-foraminal narrowing due to degenerative changes. Central canal narrowing at L1-L2 due to tumor involvement could not be ruled out on MRI. Subsequently, urology was consulted and the patient was taken to the operating room for prostate biopsy and possible bilateral orchiectomy. Two intraoperative prostate biopsies were negative for malignancy but patient underwent bilateral orchiectomy due to high clinical suspicion for prostate cancer. Bone lesions in the pelvis were so extensive that orthopedic surgeons recommended complete non-weight bearing as the risk of fracture with weight bearing was thought to be very high. Eventually, laboratory workup for MM came out to be positive. Radiation oncologist recommended radiation therapy; however, at this point, the patient refused further intervention. He opted for palliative care. Consequently, a bone marrow biopsy could not be obtained for a definitive diagnosis of MM. The patient was eventually discharged to a nursing home for hospice care. This case sheds light on the importance of preventative care in routine outpatient setting, which can often screen, identify, and detect malignancies at earlier stages. It also signifies the importance of an interdisciplinary approach and precise knowledge in differentiating and diagnosing such malignancies. In our patient's case, his extensive bone disease precluded his ability to be weight bearing which is an uncommon finding only seen in extensive metastatic bone disease. A definitive diagnosis is warranted to guide appropriate management.

A biaxial strain-based expansion mechanism for auxetic stent deployment.

BACKGROUND: Auxetics, a special class of materials, tend to expand both in the radial and longitudinal directions when a unidirectional tensile force is applied. Recently, studies have come up with new designs for auxetic vascular and nonvascular stents which are deployed with commercial balloon catheters. There are some inherent limitations associated with a unidirectional application of expansion force in the effective deployment of stents. This work proposed a solution to some of these limitations through the use of a biaxial mode of a predetermined strain-based expansion mechanism. METHOD: The design incorporated a pressure-activated crank-slider mechanism. Fabrication of a prototype for experimental verification was carried out through milling and high-speed lathe machining. The testing of the device employed the use of auxetic stents, fabricated from a biocompatible polymer. A finite element study is presented to extrapolate experimental results to a broader range of operation and working conditions. RESULTS AND CONCLUSIONS: The expansion mechanism is similar in operation to the opening of an umbrella. The length of the connected auxetic stent increases when internal hydraulic pressure is applied. The degree of linear expansion in 1 direction influences the expansion of auxetic stent in the lateral direction. As the device exerts pressure longitudinally, a larger amount of the force is distributed on the unit cells/hinges which ultimately results in an increased expansion of the stent.

Macro-scale model study of a tunable drug dispensation mechanism for controlled drug delivery in potential wound-healing applications.

BACKGROUND: Auxetic materials tend to exhibit stretching in the direction of the applied load as well as in the perpendicular direction. This may be an inherent property of the material, or it might be a particular structural characteristic that confers it with auxetic properties. In this study, the auxetic properties of a rotating squares auxetic design were utilized in tandem with a stretching mechanism to manufacture a device that offers the advantages of adjustable pore size and hence tunable drug delivery characteristics. METHODS: An auxetic polyurethane film was fabricated through the polymer casting technique. An acrylonitrile-butadiene-styrene (ABS) plastic mold for polymer casting was made through additive manufacturing. Stereolithography was used for fabrication of the mechanism that controlled pore size of the polymeric auxetic film. A laminate arrangement of the film and the mechanism was devised, through which movement of the mechanism controlled stretching of the auxetic film underneath. RESULTS: Results were analyzed through image processing. It was observed that a 2-dimensional increase (in length and width) of the auxetic film took place that corresponded to an increase in pore size of the film. Several mathematical correlations were drawn up. CONCLUSIONS: It may be concluded that the first factor controlling drug release kinetics is the pore size of the film. This study explored a prototype mechanism that has the potential for being used in devices for controlled drug delivery or in smart bandage systems that may enhance wound healing in chronic wound treatment.

Electromechanically Actuated Multifunctional Wireless Auxetic Device for Wound Management.

The design and fabrication of a wound healing device for chronic wounds, with multiple functions for controlled drug delivery and exudate removal, has been described in this paper. The structural features have been machined and modified through laser cutting in a biocompatible polymer cast. Miniaturized versions of electronically actuated (lead-screw and pulley) mechanisms are used for the specific purpose of controlled drug delivery. These mechanisms have been studied and tested, being controlled through a microcontroller setup. An auxetic polymeric barrier membrane has been used for restricting the drug quantities administered. Drug delivery mechanisms are powered wirelessly, through an external, active RF component; this communicates with a passive component that is buried inside the wound healing device. The exudate removal efficiency of the device has been assessed through several simple tests using simulated wound exudate. It has been found that reasonably precise quantities of drug dosages to be administered to the wound site can be controlled through both drug delivery mechanisms; however, the lead-screw mechanism provides a better control of auxetic barrier membrane actuation and hence controlled drug delivery. We propose that this device can have potential clinical significance in controlled drug delivery and exudate removal in the management of chronic wounds.

New Biofunctional Loading of Natural Antimicrobial Agent in Biodegradable Polymeric Films for Biomedical Applications.

The study focuses on the development of novel Aloe vera based polymeric composite films and antimicrobial suture coatings. Polyvinyl alcohol (PVA), a synthetic biocompatible and biodegradable polymer, was combined with Aloe vera, a natural herb used for soothing burning effects and cosmetic purposes. The properties of these two materials were combined together to get additional benefits such as wound healing and prevention of surgical site infections. PVA and Aloe vera were mixed in a fixed quantity to produce polymer based films. The films were screened for antibacterial and antifungal activity against bacterial (E. coli, P. aeruginosa) and fungal strains (Aspergillus flavus and Aspergillus tubingensis) screened. Aloe vera based PVA films showed antimicrobial activity against all the strains; the lowest Aloe vera concentration (5%) showed the highest activity against all the strains. In vitro degradation and release profile of these films was also evaluated. The coating for sutures was prepared, in vitro antibacterial tests of these coated sutures were carried out, and later on in vivo studies of these coated sutures were also performed. The results showed that sutures coated with Aloe vera/PVA coating solution have antibacterial effects and thus have the potential to be used in the prevention of surgical site infections and Aloe vera/PVA based films have the potential to be used for wound healing purposes.

Auxetic polymeric bone plate as internal fixator for long bone fractures: Design, fabrication and structural analysis.

INTRODUCTION: Injuries cover about 11% of World's Disease Burden depicting fractures to be the leading severe consequence of trauma. Fractures occur due to force impact or osteoporosis. Fracture healing is a complicated process. Fracture fixation techniques focus on imparting reduction to fractured fragments and induce healing. When considering possible fixation methods, the aspect of micro-movement is an important one, as this induces callus formation which tends to be a crucial step for fracture healing. Internal fixation of long bone fractures using metallic plates has been carried out since decades and recently advancements have been in synthesizing biodegradable plates as well. The purpose of this research was to fabricate an Auxetic Polymeric Bone Plate that can be used as an internal fixator for long bone fracture; this bone plate renders micro-movement due to its counter intuitive behavior, has the potential to reduce the effect of stress shielding and allow the same range of motion as that of natural bone. METHODS: Polyurethane was chosen as a material for the fabrication of the Auxetic device because of its biocompatibility and non-toxic effects. The plate was then tested for mechanical properties such as Tensile and Compression testing to determine the strength. RESULTS AND DISCUSSION: The tensile testing of the Auxetic polyurethane specimens showed that the mean of the Poisson's ratio of the samples lies between -0.68 and -0.87 at different uni-axial tensile load values. The Auxetic structure of our device has the potential to allow for efficient fixation because its negative Poisson's ratio offers micro-movement, thereby causing fixation with relative stability rather than absolute stability. The Auxetic bone plate can be superior to contemporary plate fixation systems, as it demands meaningfully small contact points. The suitable mechanical properties might lessen stress shielding effects that are normally caused by rigid bone plates. The Auxetic nature of the bone will help align and sustain the bone fragments with small fracture gaps in order to impart appropriate assembly to accomplish bone healing.

Lobular carcinoma of the breast with gastrointestinal metastasis.

We present the case of a 74-year-old woman with metastatic lobular carcinoma with an occult breast primary presenting as a suspected ampullary tumor due to its ampullary metastasis. The patient's clinical presentation is of interest in two aspects. First, lobular carcinoma of the breast metastatic to the ampulla is extremely rare. Second, in the absence of a detectable primary lesion, prior history of malignancy, or distinguishing clinical, radiological, and endoscopic features, histopathological assessments are pivotal for arriving at the appropriate diagnosis and for optimizing treatment.

Auxetic coronary stent endoprosthesis: fabrication and structural analysis.

BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design was obtained via laser cutting, and surface treatment was performed with acid pickling and electropolishing, followed by an annealing process. In vitro mechanical analysis was performed to analyze the mechanical performance of the auxetic coronary stent. Scanning electronic microscopy (SEM) was used to determine the effects of fabrication processes on the topography of the auxetic stent. RESULTS AND CONCLUSIONS: The elastic recoil (3.3%) of the in vitro mechanical analysis showed that the auxetic stent design effectively maintained the luminal patency of the coronary artery. Also, the auxetic coronary stent showed no foreshortening, therefore it avoids the problem of stent migration, by expanding in both the radial and longitudinal directions. By virtue of its synclastic behavior, the auxetic stent bulges outward when it is radially expanded through an inflated balloon.

Basal cell adenoma of the breast.

Salivary gland-like neoplasms of the breast are a known entity. A single novel case of basal cell adenoma of the breast is presented, and the presentation, treatment, and morphologic features of this case are discussed.