[The DIEP Flap as Method of Choice in Breast Reconstruction - Results and Protocol for Succesful Reconstruction]. / Der DIEP Lappen als Standard in der autologen Brustrekonstruktion - Ergebnisse und Algorithmus zur erfolgreichen Rekonstruktion.

BACKGROUND: Autologous breast reconstruction is becoming increasingly important, especially in light of the increased rates of prophylactic mastectomies with BRCA mutations. Regarding the indications and complications between free TRAM and free DIEP flaps for autologous breast reconstruction the current data is not clear. MATERIALS AND METHODS: All patients who received an autologous breast reconstruction between January 2010 and January 2014 using free DIEP or free MS-2-TRAM flaps were included in the study. The choice of flap between DIEP and MS-2-TRAM was performed by a standardised algorithm with preoperative CT angiography, intraoperative evaluation of the flap perfusion and Doppler detection. The analysis took into account partial flap necrosis <20% and >20%), complete flap loss, flap necrosis and surgical revision of the anastomosis. RESULTS: The study considered 362 women who received a total of 419 free flaps for breast reconstruction. 66 patients received a bilateral reconstruction (52 double DIEPS, 9 DIEP and MS2 TRAM and 5 double MS2 TRAMs). The total flap loss was 0.24%. Partial necrosis <20% occurred in 0.72% (DIEP 0.82%, MS2 TRAM 0%), partial necrosis >20% in 0.72% (DIEP 0.69% MS2 TRAM 0.98%). One DIEP flap was lost (0.24%). After implementing our protocol the rate of MS-2-Tram flaps could be reduced to 10-15% of all autologous breast reconstruction procedures as compared to the years before. CONCLUSION: Through the application of the presented algorithm for breast reconstruction with free DIEP flap, such surgery is a safe treatment option if it is done at high frequency in a microsurgical centre. Flap loss and complications are not increased compared to MS2 TRAM flaps. The decision for the selection of the appropriate flap for breast reconstruction should be based on the presented algorithm in order to achieve secure and reproducible results.

Feeding fish meal and extruded soybeans enhances the conjugated linoleic acid (CLA) content of milk.

Twelve multiparous Holstein cows averaging 65 (33 to 122) DIM were used in a 4 x 4 Latin square for 4-wk periods to determine whether feeding fish oil as fish meal would stimulate increased amounts of milk conjugated linoleic acid (cis-9, trans-11 C18:2; CLA) and transvaccenic acid (trans-11 C18:1; TVA) when the cows were fed extruded soybeans to supply additional linoleic acid. Treatment diets were 1) control; 2) 0.5% fish oil from fish meal; 3) 2.5% soybean oil from extruded soybeans; and 4) 0.5% fish oil from fish meal and 2% soybean oil from extruded soybeans. Diets were formulated to contain 18% crude protein and were composed (dry basis) of 50% concentrate mix, 25% corn silage, and 25% alfalfa hay. Intake of DM was not affected by diet. Milk production was increased by diets 2, 3, and 4 compared with diet 1 (control). Milk fat and milk protein percentages decreased with diets 3 and 4. Milk fat yield was not affected by treatments, but yield of milk protein was increased with supplemental fish meal and extruded soybeans or their blend. When diets 2, 3, or 4 were fed, concentrations of cis-9, trans-11 CLA in milk fat increased by 0.4-, 1.4-, and 3.2-fold, and TVA concentrations in milk fat increased by 0.4-, 1.8-, and 3.5-fold compared with the control milk fat. Increases in TVA and cis-9, trans-11 CLA were 91 to 109% greater when a blend of fish meal and extruded soybeans was fed than the additive effect of fish meal and extruded soybeans. This suggested that fish oil increased the production of CLA and TVA from other dietary sources of linoleic acid such as extruded soybeans.

Conjugated linoleic acid and other beneficial fatty acids in milk fat from cows fed soybean meal, fish meal, or both.

Twelve multiparous Holstein cows at 48 +/- 8 DIM were used in a 4 x 4 Latin square with 21-d periods to determine the effect of replacing soybean meal with fish meal on feed intake, milk yield, and milk composition. Fish meal substituted for soybean meal on an isonitrogenous basis at 0, 25, 50, and 100% of supplemental protein. Total mixed diets were (DM basis) 25% corn silage, 25% alfalfa hay, and 50% concentrate mix. Intake of DM (27.9, 27.8, 26.1, and 25.8 kg/d for diets 1 to 4, respectively) was similar for all diets. Milk yield (37.5, 37.8, 37.2, and 37.7 kg/d) was not affected by diets. Milk protein percentages (3.23, 3.24, 3.31, and 3.35) increased with 100% fish meal supplementation and tended to be higher with 50% fish meal supplementation compared with 100% soybean meal diet. Milk fat percentages (3.18, 2.99, 3.04, and 2.87) and yield were lower with the 100% fish meal than with the 100% soybean meal diet. Concentration of n-3 fatty acids in milk fat (0.54, 0.56, 0.63, and 0.72 g/100 g fatty acids) increased as the proportion of fish meal in the diet increased. Concentrations of c9,t11 conjugated linoleic acid (CLA; 0.39, 0.44, 0.46, and 0.72 g/100 g fatty acids) and transvaccenic acid (TVA; 1.09, 1.19, 1.28, and 1.54 g/100 g of fatty acids) were higher with the 100% fish meal diet than with the 100% soybean meal diet. A total replacement of soybean meal with fish meal in the diet of lactating cows increased milk protein percentages and the beneficial fatty acids (CLA, TVA, and n-3 FA) in milk fat.

Blood amino acids and milk composition from cows fed soybean meal, fish meal, or both.

Twelve multiparous Holstein cows at 48 +/- 8 d in milk were used in a 4 x 4 Latin square with 21-d periods to determine the effect on feed intake, milk yield, milk composition, and blood amino acids when soybean meal was replaced with fish meal. Fish meal substituted for soybean meal on an isonitrogenous basis at 0, 25, 50, and 100% of supplemental protein. Total mixed diets were (dry matter basis) 25% corn silage, 25% alfalfa hay, and 50% concentrate mix. Intake of dry matter (27.9, 27.8, 26.1, and 25.8 kg/d for diets 1 to 4, respectively) was similar for all diets. Milk yield (37.5, 37.8, 37.2, and 37.7 kg/d) was not affected by diets. Milk protein percentages (3.23, 3.24, 3.31, and 3.35) increased with 100% fish meal supplementation and tended to be higher, with 50% fish meal supplementation compared with 100% soybean meal diet. Milk fat percentages (3.18, 2.99, 3.04, and 2.87) and yields were lower with the 100% fish meal than with the 100% soybean meal diet. Molar proportions of ruminal volatile fatty acids and ammonia were not greatly affected by diet. Fish meal supplementation slightly improved Met status, as shown when blood amino acid data were evaluated. Both extraction efficiency and transfer efficiency of amino acids from the blood by the mammary gland indicated that Met, Lys, and Phe were the most limiting amino acids in all diets. Replacing as much as 50 or 100% of dietary soybean meal with fish meal may improve the amino acid balance and increase the protein content in milk; however, feeding 100% fish meal will likely decrease milk fat percentages.

Chemopreventive effects of sandalwood oil on skin papillomas in mice.

The essential oil, emulsion or paste of sandalwood (Santalum album L) has been used in India as an ayurvedic medicinal agent for the treatment of inflammatory and eruptive skin diseases. In this investigation, the chemopreventive effects of sandalwood oil (5% in acetone, w/v) on 7,12-dimethylbenz(a)anthracene-(DMBA)-initiated and 12-O-tetradecanoyl phorbol-13-acetate(TPA)-promoted skin papillomas, and TPA-induced ornithine decarboxylase (ODC) activity in CD1 mice were studied. Sandalwood oil treatment significantly decreased papilloma incidence by 67%, multiplicity by 96%, and TPA-induced ODC activity by 70%. This oil could be an effective chemopreventive agent against skin cancer.

Effects of diallyl sulfide and diallyl disulfide on cisplatin-induced changes in glutathione and glutathione-S-transferase activity.

The effects of diallyl sulfide (DAS) and diallyl disulfide (DADS) on cisplatin-induced changes in glutathione (GSH) and glutathione-S-transferase (GST) activity in rat liver and kidney was investigated. Cisplatin treatment significantly (p < 0.05) decreased GSH and GST activity in both liver and kidney. DADS treatment significantly (p < 0.05) enhanced GSH and GST activity in rat liver and kidney. Furthermore, DADS treatment reversed the effect of cisplatin on GSH and GST activity both in liver and kidney. Administration of DADS with cisplatin could enhance GSH and GST activity and lower cisplatin-induced nephrotoxicity.