Degree of satisfaction of women treated with reconstruction and dermopigmentation of the nipple-areola complex after breast reconstruction.

OBJECTIVE: To evaluate the degree of satisfaction of women treated with dermopigmentation and reconstruction of the Areola-Nipple Complex (ANC) after breast reconstruction, as well as their demographic profile and clinical-evolutionary characteristics. METHODS: Descriptive observational study including 128 women treated with dermopigmentation after oncologic breast reconstruction during 2018. In 2021 they were administered an adapted satisfaction questionnaire, which contains 27 items and categorizes satisfaction from 1-5, in addition other clinical-evolutionary and demographic variables were collected. RESULTS: Mean age was 51 (±9) years, 89.1% had previously undergone PDA reconstruction. Mean satisfaction with dermopigmentation was 4.4 (±0.88) and 3.79 (±1.06) for PDA reconstruction. Complications were rare, but 54.5% (n = 54) of the patients reported that the CAP reconstruction did not offer the expected projection, 91.6% (n = 98) that the color had faded and 51.4% (n = 55) would choose permanent tattooing. It was perceived that, the higher the satisfaction of the CAP, the higher the satisfaction of dermopigmentation, while the older the age and previous chemotherapy treatment the lower the color durability (p value ≤ 0.05). CONCLUSIONS: Patients who underwent reconstructive breast surgery show a high degree of satisfaction with dermopigmentation and surgical reconstruction of the PDA, but reiterate the low projecticity of the dermopigmentation and the surgical reconstruction of the PDA, but reiterate the low degree of satisfaction with the dermopigmentation.

A Mediterranean-Style Diet Plan Is Associated with Greater Effectiveness and Sustainability in Weight Loss in Patients with Obesity after Endoscopic Bariatric Therapy.

This study aimed to investigate the impact of a Mediterranean-style diet on weight loss effectiveness and sustainability in patients with obesity who underwent endoscopic bariatric therapies (EBT), relative to a protein diet plan. Thus, 132 patients with obesity (BMI 30-40 kg/m2) who underwent EBT, were asked to follow a Mediterranean-style diet plan (n = 52) or a protein diet plan (n = 26) for six months. General linear models were used to compare outcome variables between dietary intervention groups. Results showed that participants who followed a Mediterranean-style diet plan lost 14.2% more weight (95% CI: 3.0; 25.3), compared with those who followed a protein diet plan. Additionally, following a Mediterranean-style diet plan was associated with the sustainability of weight loss. Note that three months after the end of the dietary intervention, the patients who followed a Mediterranean-style diet plan were still losing weight (-1.2 ± 3.0 kg), while those with a protein diet plan gained, on average, 2.4 ± 3.3 kg (p < 0.001). Therefore, we conclude that combining EBT with a Mediterranean-style diet plan could represent an effective dietary intervention to improve the effectiveness and sustainability of weight loss after an EBT.

Mechanical and Chemical Characterisation of TiN and AlTiSiN Coatings on a LPBF Processed IN718 Substrate.

Wear-resistant coatings development is progressively increasing steeply due to their advantages when applied to mechanical components subjected to abrasive and destructive environments. Titanium nitride (TiN) coating is typically used to enlarge tools and components' service life and improve their surface quality. On the other hand, AlTiSiN coating intends to be applied to more aggressive environments such as spatial satellites components exposed to solar radiation, extremely high temperatures, and random particles impact. In this work, specimens of Inconel 718 (IN718) were fabricated via laser powder bed fusion (LPBF), and physical vapour deposition (PVD)-deposited with TiN and AlTiSiN as coatings to mechanically and chemically characterise their surface. In this respect, microhardness testing and chemical analysis via glow discharge optical emission spectroscopy (GDOES) were performed. Later, roughness and wear behaviour analyses were carried out to evaluate the mechanical performance of both coatings and their surface and morphological features. The experimental observations allowed the analysis of both studied coatings by comparing them with the substrate processed via LPBF.

Analysis of the Part Distortions for Inconel 718 SLM: A Case Study on the NIST Test Artifact.

The present paper evaluates the misalignment and geometry distortion of the standard National Institute of Standards and Technology (NIST) test artifact in Inconel 718 alloy, when several layers with and without supports are employed to manufacture it by the Selective Laser Melting (SLM) process. To this end, a coordinate-measuring machine (CMM) is used to measure the geometrical distortion in each manufacturing configuration, following the same measurement protocol. The results show that the laser path strategy favors a thermal gradient which, consequently, induces geometrical distortions in the part. To prove this hypothesis, a numerical simulation is performed to determine the thermal gradient and the pattern of the residual stresses. It was found that the geometrical distortion certainly depends on the position of the feature position and laser strategy, where thermal cycles and residual thermal stresses had an impact in the end-part geometry, especially if a high strength-to-weight ratio commonly used in aeronautics is present.

Surface Damaging of Brass and Steel Pins when Sliding over Nitrided Samples Cut by Finishing and Roughing EDM Conditions.

In the forging industry, surface quality and surface treatments of dies are crucial parameters to extend their life. These components are usually machined by milling or by Electrical Discharge Machining (EDM), and the final surface roughness depends on the machining techniques and operational conditions used in its fabrication. After milling, a nitriding treatment is widely applied to extend its service life. Nevertheless, no scientific report that informs about nitriding after EDM has been found. Accordingly, this work focuses on the wear and friction behavior of pins made of brass and medium carbon steel sliding over AISI H13 discs, made by wire EDM in the conditions of finishing and roughing. The discs are plasma nitride, and their effect on the wear during pin-on-disc tests is evaluated. In this sense, the analysis of the surface damage for the different pins will help us to understand the service life and wear evolution of the forging dies. The results show that plasma nitride reduces the friction and prevents the degradation of the pin, independently of the material of the pin, when sliding over finishing and roughing EDM conditions.

Bio-Inspired Functional Surface Fabricated by Electrically Assisted Micro-Embossing of AZ31 Magnesium Alloy.

Developing bio-inspired functional surfaces on engineering metals is of extreme importance, involving different industrial sectors, like automotive or aeronautics. In particular, micro-embossing is one of the efficient and large-scale processes for manufacturing bio-inspired textures on metallic surfaces. However, this process faces some problems, such as filling defects and die breakage due to size effect, which restrict this technology for some components. Electrically assisted micro-forming has demonstrated the ability of reducing size effects, improving formability and decreasing flow stress, making it a promising hybrid process to control the filling quality of micro-scale features. This research focuses on the use of different current densities to perform embossed micro-channels of 7 µm and sharklet patterns of 10 µm in textured bulk metallic glass dies. These dies are prepared by thermoplastic forming based on the compression of photolithographic silicon molds. The results show that large areas of bio-inspired textures could be fabricated on magnesium alloy when current densities higher than 6 A/mm2 (threshold) are used. The optimal surface quality scenario is obtained for a current density of 13 A/mm2. Additionally, filling depth and depth-width ratio nonlinearly increases when higher current densities are used, where the temperature is a key parameter to control, keeping it below the temperature of the glass transition to avoid melting or an early breakage of the die.

Estimation of Specific Cutting Energy in an S235 Alloy for Multi-Directional Ultrasonic Vibration-Assisted Machining Using the Finite Element Method.

The objective of this work is to analyze the influence of the vibration-assisted turning process on the machinability of S235 carbon steel. During the experiments using this vibrational machining process, the vibrational amplitude and frequency of the cutting tool were adjusted to drive the tool tip in an elliptical or linear motion in the feed direction. Furthermore, a finite element analysis was deployed to investigate the mechanical response for different vibration-assisted cutting conditions. The results show how the specific cutting energy and the material's machinability behave when using different operational cutting parameters, such as vibration frequency and tool tip motion in the x-axis, y-axis, and elliptical (x-y plane) motion. Then, the specific cutting energy and material's machinability are compared with a conventional turning process, which helps to validate the finite element method (FEM) for the vibration-assisted process. As a result of the operating parameters used, the vibration-assisted machining process leads to a machinability improvement of up to 18% in S235 carbon steel. In particular, higher vibration frequencies were shown to increase the material's machinability due to the specific cutting energy decrease. Therefore, the finite element method can be used to predict the vibration-assisted cutting and the specific cutting energy, based on predefined cutting parameters.

Model Based on an Effective Material-Removal Rate to Evaluate Specific Energy Consumption in Grinding.

Grinding energy efficiency depends on the appropriate selection of cutting conditions, grinding wheel, and workpiece material. Additionally, the estimation of specific energy consumption is a good indicator to control the consumed energy during the grinding process. Consequently, this study develops a model of material-removal rate to estimate specific energy consumption based on the measurement of active power consumed in a plane surface grinding of C45K with different thermal treatments and AISI 304. This model identifies and evaluates the dissipated power by sliding, ploughing, and chip formation in an industrial-scale grinding process. Furthermore, the instantaneous positions of abrasive grains during cutting are described to study the material-removal rate. The estimation of specific chip-formation energy is similar to that described by other authors on a laboratory scale, which allows to validate the model and experiments. Finally, the results show that the energy consumed by sliding is the main mechanism of energy dissipation in an industrial-scale grinding process, where it is denoted that sliding energy by volume unity decreases as the depth of cut and the speed of the workpiece increase.

Influence of the Regime of Electropulsing-Assisted Machining on the Plastic Deformation of the Layer Being Cut.

In this article, the influence of electropulsing on the machinability of steel S235 and aluminium 6060 has been studied during conventional and electropulsing-assisted turning processes. The machinability indices such as chip compression ratio ξ , shear plane angle ϕ and specific cutting energy (SCE) are investigated by using different cutting parameters such as cutting speed, cutting feed and depth of cut during electrically-assisted turning process. The results and analysis of this work indicated that the electrically-assisted turning process improves the machinability of steel S235, whereas the machinability of aluminium 6060 gets worse. Finally, due to electropluses (EPs), the chip compression ratio ξ increases with the increase in cutting speed during turning of aluminium 6060 and the SCE decreases during turning of steel S235.

Time measurement characterization of stand-to-sit and sit-to-stand transitions by using a smartphone.

The aim of this study is to analyze a common method to measure the acceleration of a daily activity pattern by using a smartphone. In this sense, a numerical approach is proposed to transform the relative acceleration signal, recorded by a triaxial accelerometer, into an acceleration referred to an inertial reference. The integration of this acceleration allows to determine the velocity and position with respect to an inertial reference. Two different kinematic parameters are suggested to characterize the profile of the velocity during the sit-to-stand and stand-to-sit transitions for Parkinson and control subjects. The results show that a dimensionless kinematic parameter, which is linked to the time of sit-to-stand and stand-to-sit transitions, has the potential to differentiate between Parkinson and control subjects.

Current-Induced Ductility Enhancement of a Magnesium Alloy AZ31 in Uniaxial Micro-Tension Below 373 K.

The size effects in metal forming have been found to be crucial in micro-scale plastic deformation or micro-forming processes, which lead to attenuation of the material's formability due to the increasing heterogeneity of the plastic flow. The use of an electric field during micro-scale plastic deformation has shown to relieve size effects, enhance the material's formability, modify the microstructure, etc. Consequently, these electric-assisted (EA) micro-forming processes seem to bring many potential benefits that need to be investigated. Accordingly, here we investigated the influence of an electric field on the size effects to describe the fracture behavior in uniaxial micro-tension tests of an AZ31 alloy with various grain sizes. In order to decouple the thermal-mechanical and microstructure changes, room temperature (RT), oven-heated (OH), air-cooled (AC), and EA uniaxial micro-tension tests were conducted. The size effects contribution on the fracture stress and strain showed a similar trend in all the testing configurations. However, the smallest fracture stresses and the largest fracture strains were denoted in the EA configuration. EBSD examination shows that current-induced dynamic recrystallization (DRX) and texture evolution could be negligible under the studied conditions. The kernel average misorientation (KAM) maps give the larger plastic deformation in the EA specimens due to the reduction of plastic micro-heterogeneity. Finally, the fracture morphology indicates that the current-induced ductility enhancement may be attributed to the arrest of micro-crack propagation and the inhibition of void initiation, growth, and coalescence caused by lattice melting and expansion.

Differential diagnosis between Parkinson's disease and essential tremor using the smartphone's accelerometer.

BACKGROUND: The differential diagnosis between patients with essential tremor (ET) and those with Parkinson's disease (PD) whose main manifestation is tremor may be difficult unless using complex neuroimaging techniques such as 123I-FP-CIT SPECT. We considered that using smartphone's accelerometer to stablish a diagnostic test based on time-frequency differences between PD an ET could support the clinical diagnosis. METHODS: The study was carried out in 17 patients with PD, 16 patients with ET, 12 healthy volunteers and 7 patients with tremor of undecided diagnosis (TUD), who were re-evaluated one year after the first visit to reach the definite diagnosis. The smartphone was placed over the hand dorsum to record epochs of 30 s at rest and 30 s during arm stretching. We generated frequency power spectra and calculated receiver operating characteristics curves (ROC) curves of total spectral power, to establish a threshold to separate subjects with and without tremor. In patients with PD and ET, we found that the ROC curve of relative energy was the feature discriminating better between the two groups. This threshold was then used to classify the TUD patients. RESULTS: We could correctly classify 49 out of 52 subjects in the category with/without tremor (97.96% sensitivity and 83.3% specificity) and 27 out of 32 patients in the category PD/ET (84.38% discrimination accuracy). Among TUD patients, 2 of 2 PD and 2 of 4 ET were correctly classified, and one patient having PD plus ET was classified as PD. CONCLUSIONS: Based on the analysis of smartphone accelerometer recordings, we found several kinematic features in the analysis of tremor that distinguished first between healthy subjects and patients and, ultimately, between PD and ET patients. The proposed method can give immediate results for the clinician to gain valuable information for the diagnosis of tremor. This can be useful in environments where more sophisticated diagnostic techniques are unavailable.

Consumo crónico de olmesartán como causa de enteropatía "sprue-like" / Chronic consumption of olmesartan as a cause of "sprue-like" enteropathy

La diarrea es un efecto secundario habitual a la toma de fármacos, y en algunas ocasiones la enteropatía perdedora de proteínas tipo "sprue like" puede estar detrás de esta patología. El estudio de esta enfermedad puede suponer un desafío importante para el clínico, sobre todo en los casos que cursan con serología negativa para enfermedad celiaca. La atrofia vellositaria duodenal secundaria a la ingesta de micofenolato-mofetil y metotrexate es bien conocida y descrita desde hace tiempo, pero desde la inclusión en la posológica habitual de olmesartán como antihipertensivo de primera elección hemos objetivado un repunte importante de esta entidad. Debido al amplio uso de esta medicación, queremos poner de manifiesto esta enteropatía iatrogénica a través de dos casos clínicos ocurridos en nuestro hospital en 2014.(AU()

Diarrhea is a common side effect of medical treatment. "Sprue like" enteropathy may be behind this pathology. The study of this disease can be an important clinical challenge, especially in those cases with negative serology for celiac disease. Duodenal villous atrophy secondary to the intake of mycophenolate mofetil and methotrexate have been well known and described but since the inclusion of olmesartán as a first-line antihypertensive, we have seen an important rebound of this entity. Due to the wide use of this medication we want to report this iatrogenic effect through two clinical cases that occurred in our hospital in 2014.(AU)

[Optimization and improvement of surgical indicators in the urology department of a regional hospital of the ministry of health of the Junta de Andalucía]. / OPTIMIZACIÓN Y MEJORA DE LOS INDICADORES QUIRÚRGICOS DEL SERVICIO DE UROLOGÍA DE UN HOSPITAL COMARCAL DE LA CONSEJERÍA DE SALUD DE LA JUNTA DE ANDALUCÍA.

OBJECTIVES: To improve the rates of surgical activity and average waiting times for surgery, and to optimize the number of surgical indications in the Urology Department of a Regional Hospital. METHODS: A study and analysis of the surgical activity and different indexes in 2014 was performed comparing the first half of the year and the second half after implementation of improvement measures. STUDY VARIABLES: operating room occupancy rate, average hospital stay, cancellations, surgical complexity, average number of surgeries per operative room, average global waiting time and waiting time by 120 and 180 days guarantee decrees following the Junta de Andalucía standards. RESULTS: In comparison with the first half of 2014, in the second half the operating room occupancy rate increased from 79% to 85%, the average stay decreased from 6 to 3 days, and a decrease in cancellations from 9% to 6% was observed. Moreover, a decrease in the mean waiting times was observed for surgeries subject to both the 120 days and 180 days guarantee decree and a decrease in the number of surgical indications in urology through the implementation of protocols based on clinical practice guidelines. CONCLUSIONS: Despite the limitations of the study, and being a small Department in a district hospital, we observed that optimization of resources, implementation of protocols, and clinical pathways can improve and optimize different indicators of surgical activity.

Optimización y mejora de los indicadores quirúrgicos del Servicio de Urología de un Hospital comarcal de la consejería de salud de la Junta de Andalucía / Optimization and improvement of surgical indicators in the urology department of a regional hospital of the ministry of health of the Junta de Andalucía

OBJETIVO: Mejorar los índices de actividad quirúrgicos y los tiempos de espera media quirúrgicos, así como optimizar el número de indicaciones quirúrgicas en el Servicio de Urología de un Hospital Comarcal. MÉTODOS: Se realiza un estudio y análisis de la actividad quirúrgica y diferentes índices en el año 2014 comparando el primer semestre con el segundo semestre tras la aplicación de medidas de mejora. Índices y variables analizadas: Índice de ocupación de quirófano, estancia media, cancelaciones, complejidad quirúrgica, número medio cirugías/quirófano, tiempo medio de espera global y por decretos de garantía 120 y 180 días según normas de la Junta de Andalucía. RESULTADOS: Respecto al primer semestre de 2014, en el segundo semestre de 2014 se observa un aumento del índice de ocupación de quirófano desde el 79% al 85%, con un descenso de la estancia media de 6 a 3 días y un descenso de las cancelaciones de quirófano de 9% a 6%. Además se observa un descenso en los tiempos medios de espera quirúrgica tanto para las cirugías sujetas a decreto de garantía 120 días como 180 días y un descenso en el número de indicaciones quirúrgicas desde la consulta de urología gracias a la aplicación de protocolos basados en guías de práctica clínica. CONCLUSIONES: A pesar de las limitaciones propias del estudio y tratarse de un servicio pequeño de un hospital comarcal, se observa que la optimización de los recursos, la aplicación de protocolos y vías clínicas permite mejorar y optimizar diferentes indicadores de actividad quirúrgica

OBJECTIVES: To improve the rates of surgical activity and average waiting times for surgery, and to optimize the number of surgical indications in the Urology Department of a Regional Hospital. METHODS: A study and analysis of the surgical activity and different indexes in 2014 was performed comparing the first half of the year and the second half after implementation of improvement measures. Study variables: operating room occupancy rate, average hospital stay, cancellations, surgical complexity, average number of surgeries per operative room, average global waiting time and waiting time by 120 and 180 days guarantee decrees following the Junta de Andalucía standards. RESULTS: In comparison with the first half of 2014, in the second half the operating room occupancy rate increased from 79% to 85%, the average stay decreased from 6 to 3 days, and a decrease in cancellations from 9% to 6% was observed. Moreover, a decrease in the mean waiting times was observed for surgeries subject to both the 120 days and 180 days guarantee decree and a decrease in the number of surgical indications in urology through the implementation of protocols based on clinical practice guidelines. CONCLUSION: Despite the limitations of the study, and being a small Department in a district hospital, we observed that optimization of resources, implementation of protocols, and clinical pathways can improve and optimize different indicators of surgical activity

Impact of hip anatomical variations on the cartilage stress: a finite element analysis towards the biomechanical exploration of the factors that may explain primary hip arthritis in morphologically normal subjects.

BACKGROUND: Hip arthritis is a pathology linked to hip-cartilage degeneration. Although the etiology of this disease is not well defined, it is known that age is a determinant risk factor. However, hip arthritis in young patients could be largely promoted by biomechanical factors. The objective of this paper is to analyze the impact of some normal anatomical variations on the cartilage stress distributions numerically predicted at the hip joint during walking. METHODS: A three-dimensional finite element model of the femur and the pelvis with the most relevant axial components of muscle forces was used to simulate normal walking activity. The hip anatomical condition was defined by: neck shaft angle, femoral anteversion angle, and acetabular anteversion angle with a range of 110-130°, 0-20°, and 0-20°, respectively. The direct boundary method was used to simulate the hip contact. FINDINGS: The hydrostatic stress found at the cartilage and labrum showed that a ±10° variation with respect to the reference brings significant differences between the anatomic models. Acetabular anteversion angle of 0° and femoral anteversion angle of 0° were the most affected anatomical conditions with values of hydrostatic stress in the cartilage near 5MPa under compression. INTERPRETATION: Cartilage stresses and contact areas were equivalent to the results found in literature and the most critical anatomical regions in terms of tissue loads were in a good accordance with clinical evidence. Altogether, results showed that decreasing femoral or acetabular anteversion angles isolatedly causes a dramatic increase in cartilage loads.

Usefulness of intra-abdominal pressure in a predominantly medical intensive care unit.

BACKGROUND: The deleterious effects of elevated intra-abdominal pressure (IAP) have been known for more than a century. The proposed objectives were to measure changes in IAP and analyze increase-related factors and complications and whether high IAP and its persistence are related to complications and mortality in a predominantly medical intensive care unit. METHODS: Over a 1-year period, we conducted a prospective cohort study in which IAP was measured using the bladder method. Hospitalization time, demographic variables, diagnosis on admission, APACHE II score, and clinical complications were recorded. RESULTS: A total of 130 patients were studied. Overall mean IAP was 12.3 mm Hg (standard deviation [SD], 3.79; 95% confidence interval [CI], 11.7-13), and on the first day, 12.68 mm Hg (SD, 5.32; 95% CI, 11.8-13.6); maximum IAP was 16.4 mm Hg (SD, 4.6; 95% CI, 15.6-17.2). A positive correlation was found between IAP, APACHE (Acute Physiology And Chronic Health Evaluation) II, and age. Higher IAP values were independently associated with higher age, prolonged activated partial thromboplastin time, need for dialysis, and intolerance to enteral feeding. The value showing the best sensitivity and specificity in predicting mortality was persistence of IAP 20 mm Hg or greater for 4 days or more. The number of days with IAP 20 mm Hg or greater was a factor associated with a higher risk of death (odds ratio, 2.3). Patients who died showed a tendency to increased IAP. CONCLUSION: In this study, a threshold IAP of 20 mm Hg and its permanence over time were the best predictive factors of complications and mortality. Among other relationships, we also observed that older patients had higher IAP. High IAP was a cause of intolerance to enteral nutrition.