Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reason...Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.展开更多
Background:Plasma expanders are widely used for acute normovolemic hemodilution(ANH).However,existing studies have not focused on large-volume infusion with colloidal plasma expanders,and there is a lack of studies th...Background:Plasma expanders are widely used for acute normovolemic hemodilution(ANH).However,existing studies have not focused on large-volume infusion with colloidal plasma expanders,and there is a lack of studies that compare the effects of different plasma expanders.Methods:The viscosity,hydrodynamic radius(Rh)and colloid osmotic pressure(COP)of plasma expanders were determined by a cone-plate viscometer,Zetasizer and cut-off membrane,respectively.Sixty male rats were randomized into five groups with Gelofusine(Gel),Hydroxyethyl Starch 200/0.5(HES200),Hydroxyethyl Starch 130/0.4(HES130),Hydroxyethyl Starch 40(HES40),and Dextran 40(Dex40),with 12 rats used in each group to build the ANH model.ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders.Acid-base,lactate,blood gas and physiological parameters were detected.Results:Gel had a lower intrinsic viscosity than HES200 and HES130(P<0.01),but at a low shear rate in a mixture of colloids,red cells and plasma,Gel had a higher viscosity(P<0.05 or P<0.01,respectively).For hydroxyethyl starch plasma expanders,the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of Rh from 10.7 nm to 20.2 nm.A severe ANH model,with the hematocrit of 40%of the baseline level,was established and accompanied by disturbances in acid-base,lactate and blood gas parameters.At the end of ANH and 60 min afterward,the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups.The systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)decreased significantly in all groups at the end of ANH.The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH.During the process of ANH,the Dex40 group showed a drop and recovery in SBP,DBP and MAP.The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points(P<0.05 or P<0.01).Conclusions:Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates.Rh and COP showed a strong correlation among hydroxyethyl starch plasma expanders.Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders.During the process of ANH,Dex40 displayed a V-shaped recovery pattern for blood pressure,and HES200 had the advantage in sustaining the DBP and MAP at some time points.展开更多
BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with ...BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.展开更多
In this note,we prove that expanders cannot be coarsely embedded into group extensions of sequences of groups which are coarsely embeddable into Hardamad manifolds and certain Banach spaces due to the similar concentr...In this note,we prove that expanders cannot be coarsely embedded into group extensions of sequences of groups which are coarsely embeddable into Hardamad manifolds and certain Banach spaces due to the similar concentration theorems.展开更多
True unilateral posterior crossbite in adults is a challenging malocclusion to treat,especially when we need to correct cross-arch segments with unwanted effects on non-cross segments.Conventional expansion methods ar...True unilateral posterior crossbite in adults is a challenging malocclusion to treat,especially when we need to correct cross-arch segments with unwanted effects on non-cross segments.Conventional expansion methods are expected to have some shortcomings;the Unilateral dental expander appliance used to restore unilateral cross bite dental arch is an uncommon appliance;for this,a designed new device is needed.This paper aimed to invite a new unilateral dental expander appliance(UDEX)to treat unilateral dental posterior crossbite in adults using available dental material,easy to use and handle,well tolerated by the patient,and biocompatible with oral structure.It could find that in all dental markets and dental clinics—an eighteen-year-old female with bilateral crossbite and upper and lower dental arch crowding.During active orthodontic treatment,a quad-helix expander had broken from one side at soldering between band and wire attachment.The patient did not show up to the clinic for a while due to COVID 19 pandemic lockdown,leading to a true unilateral crossbite at the dental arch’s upper left side,especially at the molar premolars area.This unilateral cross bite was treated using a new specially designed expanded appliance as a unilateral posterior cross bite dental maxillary expander.As a result of this study,orthodontic treatment was finished within(15)months,much less than expected.We obtained Class I molar and canine relationships with uncrossed dental arches in both upper arch sides,proper overbite and overjet with well-leveled and aligned teeth as it confirmed by clinical examination and radiographic images(OPG Orthopantomogram)and cephalometric radiograph(WebCeph analysis digitalized computer program).Conclude from that,the newly designed unilateral dental expander(UDEX)is proven to be useful for treating real unilateral posterior crossbites as single molar or premolar tooth and multiple joint unilateral crossed posterior teeth.Also,it could easily modify it for future unilateral crossed purposes.This appliance was fabricated using readily available dental material,well tolerated by patients,and reduced the need for excessive patient compliance.An orthodontist could fabricate devices,or cautious laboratory work is required;it can rapidly achieve favorable results.展开更多
BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy ...BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.展开更多
This article is dealing with a development of custom chip expander platform with the possibility of accurate temperature control and integration of additional silicon-based features. Such platform may serve as a usefu...This article is dealing with a development of custom chip expander platform with the possibility of accurate temperature control and integration of additional silicon-based features. Such platform may serve as a useful tool which facilitates the burdens connected with measurement and analysis tasks of experimental semiconductor structures. The devised solution provides the functionality of carrier substrate (Al2O3 compound) with CTE compatibility to the experimental silicon chip and is fully customizable with respect to a particular chip. It also allows achieving an easy fan-out of small-diameter chip terminals into a larger, more convenient area and placement of chip specimens conveniently into space-constrained chamber of the AFM microscopes, probe stations, etc. Real application of the developed chip expander platform is demonstrated in context of digital reconfigurable circuits based on polymorphic electronics. In this case the chip expander with attached polymorphic chip REPOMO is thermally stabilized at an ambient temperature level up to approximately 135。C and its sensitivity to this phenomenon is demonstrated.展开更多
Background Infection is a relevant complication of tissue expander surgery that may compromise the flap.The effects of meteorological variables on surgical site infection have been observed in many surgeries;however,t...Background Infection is a relevant complication of tissue expander surgery that may compromise the flap.The effects of meteorological variables on surgical site infection have been observed in many surgeries;however,their influence on tissue expander infection is unknown.Methods We identified tissue expander implantation and infection based on their International Classification of Diseases,10th revision,codes in electronic hospitalization summary reports of 26 cities from January 1,2014 to December 31,2015.The data of the present study were collected for administrative purposes without any personal identifiers.The Cox proportional hazard model was used to investigate the association between meteorological variables and tissue expander-related major infection with six covariates.Results A total of 3,089 patients were enrolled.Of them,8.7%experienced a major infection during the study period.The optimal daily average temperature was between 22.9℃and 26.8℃,and the risk of major infection was significantly decreased in this range.The minimal infection temperature was 24.4℃,with a hazard ratio of 0.85.When the average relative humidity was 37%,the infection risk was minimal with a hazard ratio of 0.86;however,a relative humidity of≥79%significantly increased the risk of infection.Conclusions This is the first study to investigate the impact of temperature and relative humidity on tissue expander-related major infection.Our study suggests that there may be an optimal range of both temperature(22.9℃–26.8℃)and relative humidity(<79%)that can lower the risk of major infection after tissue expander implantation.展开更多
文摘Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.
基金supported by the National Key Research and Development Program of China(2018YFC1106503)。
文摘Background:Plasma expanders are widely used for acute normovolemic hemodilution(ANH).However,existing studies have not focused on large-volume infusion with colloidal plasma expanders,and there is a lack of studies that compare the effects of different plasma expanders.Methods:The viscosity,hydrodynamic radius(Rh)and colloid osmotic pressure(COP)of plasma expanders were determined by a cone-plate viscometer,Zetasizer and cut-off membrane,respectively.Sixty male rats were randomized into five groups with Gelofusine(Gel),Hydroxyethyl Starch 200/0.5(HES200),Hydroxyethyl Starch 130/0.4(HES130),Hydroxyethyl Starch 40(HES40),and Dextran 40(Dex40),with 12 rats used in each group to build the ANH model.ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders.Acid-base,lactate,blood gas and physiological parameters were detected.Results:Gel had a lower intrinsic viscosity than HES200 and HES130(P<0.01),but at a low shear rate in a mixture of colloids,red cells and plasma,Gel had a higher viscosity(P<0.05 or P<0.01,respectively).For hydroxyethyl starch plasma expanders,the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of Rh from 10.7 nm to 20.2 nm.A severe ANH model,with the hematocrit of 40%of the baseline level,was established and accompanied by disturbances in acid-base,lactate and blood gas parameters.At the end of ANH and 60 min afterward,the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups.The systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)decreased significantly in all groups at the end of ANH.The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH.During the process of ANH,the Dex40 group showed a drop and recovery in SBP,DBP and MAP.The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points(P<0.05 or P<0.01).Conclusions:Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates.Rh and COP showed a strong correlation among hydroxyethyl starch plasma expanders.Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders.During the process of ANH,Dex40 displayed a V-shaped recovery pattern for blood pressure,and HES200 had the advantage in sustaining the DBP and MAP at some time points.
文摘BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.
文摘In this note,we prove that expanders cannot be coarsely embedded into group extensions of sequences of groups which are coarsely embeddable into Hardamad manifolds and certain Banach spaces due to the similar concentration theorems.
文摘True unilateral posterior crossbite in adults is a challenging malocclusion to treat,especially when we need to correct cross-arch segments with unwanted effects on non-cross segments.Conventional expansion methods are expected to have some shortcomings;the Unilateral dental expander appliance used to restore unilateral cross bite dental arch is an uncommon appliance;for this,a designed new device is needed.This paper aimed to invite a new unilateral dental expander appliance(UDEX)to treat unilateral dental posterior crossbite in adults using available dental material,easy to use and handle,well tolerated by the patient,and biocompatible with oral structure.It could find that in all dental markets and dental clinics—an eighteen-year-old female with bilateral crossbite and upper and lower dental arch crowding.During active orthodontic treatment,a quad-helix expander had broken from one side at soldering between band and wire attachment.The patient did not show up to the clinic for a while due to COVID 19 pandemic lockdown,leading to a true unilateral crossbite at the dental arch’s upper left side,especially at the molar premolars area.This unilateral cross bite was treated using a new specially designed expanded appliance as a unilateral posterior cross bite dental maxillary expander.As a result of this study,orthodontic treatment was finished within(15)months,much less than expected.We obtained Class I molar and canine relationships with uncrossed dental arches in both upper arch sides,proper overbite and overjet with well-leveled and aligned teeth as it confirmed by clinical examination and radiographic images(OPG Orthopantomogram)and cephalometric radiograph(WebCeph analysis digitalized computer program).Conclude from that,the newly designed unilateral dental expander(UDEX)is proven to be useful for treating real unilateral posterior crossbites as single molar or premolar tooth and multiple joint unilateral crossed posterior teeth.Also,it could easily modify it for future unilateral crossed purposes.This appliance was fabricated using readily available dental material,well tolerated by patients,and reduced the need for excessive patient compliance.An orthodontist could fabricate devices,or cautious laboratory work is required;it can rapidly achieve favorable results.
文摘BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.
文摘This article is dealing with a development of custom chip expander platform with the possibility of accurate temperature control and integration of additional silicon-based features. Such platform may serve as a useful tool which facilitates the burdens connected with measurement and analysis tasks of experimental semiconductor structures. The devised solution provides the functionality of carrier substrate (Al2O3 compound) with CTE compatibility to the experimental silicon chip and is fully customizable with respect to a particular chip. It also allows achieving an easy fan-out of small-diameter chip terminals into a larger, more convenient area and placement of chip specimens conveniently into space-constrained chamber of the AFM microscopes, probe stations, etc. Real application of the developed chip expander platform is demonstrated in context of digital reconfigurable circuits based on polymorphic electronics. In this case the chip expander with attached polymorphic chip REPOMO is thermally stabilized at an ambient temperature level up to approximately 135。C and its sensitivity to this phenomenon is demonstrated.
文摘Background Infection is a relevant complication of tissue expander surgery that may compromise the flap.The effects of meteorological variables on surgical site infection have been observed in many surgeries;however,their influence on tissue expander infection is unknown.Methods We identified tissue expander implantation and infection based on their International Classification of Diseases,10th revision,codes in electronic hospitalization summary reports of 26 cities from January 1,2014 to December 31,2015.The data of the present study were collected for administrative purposes without any personal identifiers.The Cox proportional hazard model was used to investigate the association between meteorological variables and tissue expander-related major infection with six covariates.Results A total of 3,089 patients were enrolled.Of them,8.7%experienced a major infection during the study period.The optimal daily average temperature was between 22.9℃and 26.8℃,and the risk of major infection was significantly decreased in this range.The minimal infection temperature was 24.4℃,with a hazard ratio of 0.85.When the average relative humidity was 37%,the infection risk was minimal with a hazard ratio of 0.86;however,a relative humidity of≥79%significantly increased the risk of infection.Conclusions This is the first study to investigate the impact of temperature and relative humidity on tissue expander-related major infection.Our study suggests that there may be an optimal range of both temperature(22.9℃–26.8℃)and relative humidity(<79%)that can lower the risk of major infection after tissue expander implantation.
