Ergonomic mastectomy bra design: Effect on core body temperature and thermal comfort performance.

The accumulation of sweat and heat between the skin and the prosthesis is one of the common causes of discomfort experienced by post-mastectomy women who wore silicone-type external breast prostheses. This study aimed 1) to investigate the effect of a newly designed heat-reduction mastectomy bra on the thermal responses and thermal comfort performance; and 2) to propose an evaluation protocol for post-mastectomy products. The heat-reduction bra and the conventional bra were made of the same textile materials but the cup of the bra under discussion had a polyurethane cup with a perforated structure along the breast root/inframammary fold. The inframammary fold is often aggravated by heat, sweat, maceration, chafe, and lack of air circulation. Nine healthy male participants were recruited to participate in the study since the women who had undergone double-mastectomy were sensitive about their scars. An ingestible telemetric pill sensor was used to collect the data of core body temperature. Participants performed a 70-min five-phase exercise protocol wearing the heat-reduction bra and the conventional bra together with a silicone prosthesis with ventilation holes on the bottom. Physiological responses (i.e., core body temperature, skin temperature, temperature between bra and prosthesis, skin humidity and humidity between bra and prosthesis) and subjective sensation responses were measured. The results were statistically significant and the conventional mastectomy bra showed a higher core body temperature than that of the heat-reduction mastectomy bra (37.3 ± 0.3 °C to 38.2 ± 0.5 °C vs. 37.2 ± 0.3 °C to 38.0 ± 0.3 °C) starting from the middle of the sitting phase to the running phase and post-exercise resting (F = 164.2, p < 0.001). Both factors, the bra and the phase, have significant effects on the core body temperature (F = 14.5, p < 0.001). The heat-reduction mastectomy bra demonstrated optimum thermal comfort performance in both the temperature and humidity than the conventional mastectomy bra.

Profile of mood states and quality of life of Chinese postmastectomy women in Hong Kong: Integrating variable- and person-centered approaches.

Understanding the mood state and its relationship with quality of life (QOL) of mastectomy recipients can serve as baseline within which a sound rehabilitation program can be developed. This study therefore was conducted to facilitate a better understanding of participants' postmastectomy mood states, identify their potential predictors, identify clusters of mood profiles, and clarify between-cluster differences in terms of QOL. Hong Kong mastectomy patients completed the Profile of Mood States and Ferrans and Powers Quality of Life Index. We extended the complementary strengths of the application of both variable- and person-centered approaches to clarify relationships and to identify profiles of mood states in relation to QOL in a sample of 200 women who had undergone a mastectomy in Hong Kong. Simultaneous regression identified age and educational attainment as predictors of mood states, and cluster analysis identified three distinct mood profiles that are able to explain differences in various measures of QOL after mastectomy. Implications for future research and practice are discussed.

Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices.

BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS: AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001). CONCLUSION: LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.

Controlled Activation for Interrogation of the Electrophysiological Substrate.

Ectopic activation and conduction may give rise to arrhythmias when a diseased myocardial substrate exists. Electrophysiological mapping studies that record electrical properties of the heart in sinus rhythm may fail to uncover pro-arrhythmic substrates that are triggered by ectopy. In this study we use simulation and experimental models of clinical, trackable, loop catheters to interrogate regions of myocardium by stimulating and recording with multiple activation patterns. Longitudinal and traverse conduction velocities of the tissue were acquired from the pacing protocol. Artifacts resulting from variable distance between the recording electrodes and pacing site were also detected and removed. This study demonstrates that the mapping of local tissue properties with variable activation patterns is feasible and can expose features of the electrophysiological substrate that can not be recovered during sinus conduction.

Role of endothelial nitric oxide synthase in endothelial activation: insights from eNOS knockout endothelial cells.

The objective of this study was to determine whether absence of endothelial nitric oxide synthase (eNOS) affects the expression of cell surface adhesion molecules in endothelial cells. Murine lung endothelial cells (MLECs) were prepared by immunomagnetic bead selection from wild-type and eNOS knockout mice. Wild-type cells expressed eNOS, but eNOS knockout cells did not. Expression of neuronal NOS and inducible NOS was not detectable in cells of either genotype. Upon stimulation, confluent wild-type MLECs produced significant amounts of NO compared with N(omega)-monomethyl-l-arginine-treated wild-type cells. eNOS knockout and wild-type cells showed no difference in the expression of E-selectin, P-selectin, intracellular adhesion molecule-1, and vascular cell adhesion molecule-1 as measured by flow cytometry on the surface of platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31)-positive cells. Both eNOS knockout and wild-type cells displayed the characteristics of resting endothelium. Adhesion studies in a parallel plate laminar flow chamber showed no difference in leukocyte-endothelial cell interactions between the two genotypes. Cytokine treatment induced endothelial cell adhesion molecule expression and increased leukocyte-endothelial cell interactions in both genotypes. We conclude that in resting murine endothelial cells, absence of endothelial production of NO by itself does not initiate endothelial cell activation or promote leukocyte-endothelial cell interactions. We propose that eNOS derived NO does not chronically suppress endothelial cell activation in an autocrine fashion but serves to counterbalance signals that mediate activation.