The Efficacy of Simultaneous Breast Reconstruction and Contralateral Balancing Procedures in Reducing the Need for Second Stage Operations

Mark L Smith,Emily M Clarke-Pearson,Michael Vornovitsky,Joseph H Dayan,William Samson,Mark R Sultan 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: Patients having unilateral breast reconstruction often require a second stageprocedure on the contralateral breast to improve symmetry. In order to provide immediatesymmetry and minimize the frequency and extent of secondary procedures, we beganperforming simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach. Methods: One-hundred and two consecutive breast reconstructions with simultaneouscontralateral balancing procedures were identified. Data included patient age, body massindex (BMI), type of reconstruction and balancing procedure, specimen weight, transfusionrequirement, complications and additional surgery under anesthesia. Unpaired t-tests wereused to compare BMI, specimen weight and need for non-autologous transfusion. Results: Average patient age was 48 years. The majority had autologous tissue-only reconstructions(94%) and the rest prosthesis-based reconstructions (6%). Balancing proceduresincluded reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty(1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologousblood transfusion rate was 9%. There was no relationship between BMI or reduction specimenweight and need for transfusion. We performed secondary surgery in 24% of the autologousgroup and 100% of the prosthesis group. Revision rate for symmetry was 13% in theautologous group and 17% in the prosthesis group. Conclusions: Performing balancing at the time of breast reconstruction is safe and mosteffective in autologous reconstructions, where 87% did not require a second operation forsymmetry.

Phase equilibria and processing of infrared optical ceramics on the join CaLa2S4-La2S3

William B. White,Daniel L. Chess,Catherine A. Chess,Judith A. Marks 한양대학교 세라믹연구소 2010 Journal of Ceramic Processing Research Vol.11 No.4

Processing techniques have been developed for the fabrication of optically transparent, theoretically dense CaLa2S4 – La2S3ceramics with a potential application as windows for the mid-infrared. Extreme care is needed to avoid oxygen. Best results were obtained by pre-sintering in an H2S/H2 atmosphere followed by hot-isostatic pressing. Microstructures, hardness measurements, and infrared absorption spectra serve to characterize the various processing procedures.

The Efficacy of Simultaneous Breast Reconstruction and Contralateral Balancing Procedures in Reducing the Need for Second Stage Operations

Smith, Mark L.,Clarke-Pearson, Emily M.,Vornovitsky, Michael,Dayan, Joseph H.,Samson, William,Sultan, Mark R. Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.5

Background Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach. Methods One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion. Results Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group. Conclusions Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry.

The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health

Michael L Eisenberg,Deron Galusha,William A. Kennedy,Mark R. Cullen 대한남성과학회 2018 The World Journal of Men's Health Vol.36 No.3

The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.

Type VI secretion is a major virulence determinant in <i>Burkholderia mallei</i>

Schell, Mark A.,Ulrich, Ricky L.,Ribot, Wilson J.,Brueggemann, Ernst E.,Hines, Harry B.,Chen, Dan,Lipscomb, Lyla,Kim, H. Stanley,Mrá,zek, Jan,Nierman, William C.,DeShazer, David Blackwell Publishing Ltd 2007 Molecular microbiology Vol.64 No.6

<P><B>Summary</B></P><P> <I>Burkholderia mallei</I> is a host‐adapted pathogen and a category B biothreat agent. Although the <I>B. mallei</I> VirAG two‐component regulatory system is required for virulence in hamsters, the virulence genes it regulates are unknown. Here we show with expression profiling that overexpression of <I>virAG</I> resulted in transcriptional activation of ∼60 genes, including some involved in capsule production, actin‐based intracellular motility, and type VI secretion (T6S). The 15 genes encoding the major sugar component of the homopolymeric capsule were up‐expressed > 2.5‐fold, but capsule was still produced in the absence of <I>virAG</I>. Actin tail formation required <I>virAG</I> as well as <I>bimB</I>, <I>bimC</I> and <I>bimE</I>, three previously uncharacterized genes that were activated four‐ to 15‐fold when VirAG was overproduced. Surprisingly, actin polymerization was found to be dispensable for virulence in hamsters. In contrast, genes encoding a T6S system were up‐expressed as much as 30‐fold and mutations in this T6S gene cluster resulted in strains that were avirulent in hamsters. SDS‐PAGE and mass spectrometry demonstrated that BMAA0742 was secreted by the T6S system when <I>virAG</I> was overexpressed. Purified His‐tagged BMAA0742 was recognized by glanders antiserum from a horse, a human and mice, indicating that this Hcp‐family protein is produced <I>in vivo</I> during infection.</P>

B Cell–Intrinsic mTORC1 Promotes Germinal Center–Defining Transcription Factor Gene Expression, Somatic Hypermutation, and Memory B Cell Generation in Humoral Immunity

Raybuck, Ariel L.,Cho, Sung Hoon,Li, Jingxin,Rogers, Meredith C.,Lee, Keunwook,Williams, Christopher L.,Shlomchik, Mark,Thomas, James W.,Chen, Jin,Williams, John V.,Boothby, Mark R. American Association of Immunologists 2018 Journal of Immunology Vol. No.

<P>B lymphocytes migrate among varied microenvironmental niches during diversification, selection, and conversion to memory or Ab-secreting plasma cells. Aspects of the nutrient milieu differ within these lymphoid microenvironments and can influence signaling molecules such as the mechanistic target of rapamycin (mTOR). However, much remains to be elucidated as to the B cell–intrinsic functions of nutrient-sensing signal transducers that modulate B cell differentiation or Ab affinity. We now show that the amino acid–sensing mTOR complex 1 (mTORC1) is vital for induction of Bcl6—a key transcriptional regulator of the germinal center (GC) fate—in activated B lymphocytes. Accordingly, disruption of mTORC1 after B cell development and activation led to reduced populations of Ag-specific memory B cells as well as plasma cells and GC B cells. In addition, induction of the germ line transcript that guides activation-induced deaminase in selection of the IgG1 H chain region during class switching required mTORC1. Expression of the somatic mutator activation-induced deaminase was reduced by a lack of mTORC1 in B cells, whereas point mutation frequencies in Ag-specific GC-phenotype B cells were only halved. These effects culminated in a B cell–intrinsic defect that impacted an antiviral Ab response and drastically impaired generation of high-affinity IgG1. Collectively, these data establish that mTORC1 governs critical B cell–intrinsic mechanisms essential for establishment of GC differentiation and effective Ab production.</P>

Integral nuclear data validation using experimental spent nuclear fuel compositions

Ian C. Gauld,Mark L. Williams,Franco Michel-Sendis,Jesus S. Martinez 한국원자력학회 2017 Nuclear Engineering and Technology Vol.49 No.6

Measurements of the isotopic contents of spent nuclear fuel provide experimental data that are a prerequisitefor validating computer codes and nuclear data for many spent fuel applications. Under theauspices of the Organisation for Economic Co-operation and Development (OECD) Nuclear EnergyAgency (NEA) and guidance of the Expert Group on Assay Data of Spent Nuclear Fuel of the NEAWorkingParty on Nuclear Criticality Safety, a new database of expanded spent fuel isotopic compositions has beencompiled. The database, Spent Fuel Compositions (SFCOMPO) 2.0, includes measured data for more than750 fuel samples acquired from 44 different reactors and representing eight different reactor technologies. Measurements for more than 90 isotopes are included. This new database provides data essentialfor establishing the reliability of code systems for inventory predictions, but it also has broader potentialapplication to nuclear data evaluation. The database, together with adjoint based sensitivity and uncertaintytools for transmutation systems developed to quantify the importance of nuclear data onnuclide concentrations, are described.

A Snack Formulated with Ingredients to Slow Carbohydrate Digestion and Absorption Reduces the Glycemic Response in Humans: A Randomized Controlled Trial

Candida J. Rebello,William D. Johnson,Yang Pan,Sandra Larrivee,Dachuan Zhang,Mark Nisbet,Jodee Johnson,YiFang Chu,Frank L. Greenway 한국식품영양과학회 2020 Journal of medicinal food Vol.23 No.1

This study compared the effect of a snack with ingredients to slow carbohydrate digestion (Test-snack) on postprandial blood glucose and insulin concentrations and subjective appetite ratings. We hypothesized that Test-snack would lower glucose and insulin responses and reduce appetite compared with a Control-snack. Overweight or obese subjects (n = 17) completed a randomized crossover study. Glucose, insulin, and appetite ratings were measured before consuming each snack or white bread (Bread) and over a period of 4 h. Subjects received Test-snack, Control-snack, or Bread in random order at least a week apart. The a priori primary outcome was the glucose response, and the secondary outcomes were appetite ratings and insulin responses. Mixed effects statistical models were used to perform analysis of variance in terms of the area under curve (AUC) and at specific time points. The 2-h AUC for glucose was significantly lower with Test-snack compared to Control-snack and Bread (AUC and 95% confidence intervals: Test = 2186.43 [1783.36–2589.51]; Control = 3293.75 [2893.97–3693.54]; Bread = 2800.28 [2405.79–3194.77] mg/dL · min). Four-hour AUC for glucose, and insulin, followed a similar pattern except that Test-snack did not differ from Bread. The glucose concentrations peaked at 45 min under all three conditions, but Test-snack elicited a lower response than Control-snack and Bread (P < .01). Test increased fullness and satisfaction and reduced hunger and prospective intake compared to Bread (P < .02), but was not significantly different from Control-snack. Ingredients that slow carbohydrate digestion in a snack reduce the postprandial glucose and insulin responses compared to a product without these ingredients.

Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis

Mohsin Ilyas Malik,Mark Litzow,William Hogan,Mrinal Patnaik,Mohammad Hassan Murad,Larry J. Prokop,Jeffrey L. Winters,Shahrukh Hashmi 대한혈액학회 2014 Blood Research Vol.49 No.2

Background The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus- host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies. Methods We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted. End points included RR: complete response (CR), overall response rates (ORR), and organ- specific RR. The initial search generated 312 studies, of which 18 met the selection criteria (N=595). A random effects model was used for pooled rates. Results Pooled CR rates and ORR were 29% (confidence interval [CI], 19‒42%) and 64% (CI, 65‒ 82%), respectively. One-year overall survival was available for 4 studies only and was 49% (CI, 29‒70%). The pooled RR for skin, liver, ocular, oral, lung, gastrointestinal and musculoskeletal SR-cGVHD was 74%, 68%, 60%, 72%, 48%, 53%, and 64%, respectively. There was a significant heterogeneity among studies due to differences in ECP schedules and duration. No significant differences in responses to ECP for pediatric and adult populations were found. Sensitivity analysis could not be undertaken due to a limited number of prospective studies. Conclusion ECP is an effective therapy for oral, skin, and liver SR-cGVHD, with modest activity in lung and gastrointestinal SR-cGVHD.

Colovesical Fistula: Should It Be Considered a Single Disease?

Qamar Hafeez Kiani,Mark L. George,Emin A. Carapeti,Alexis M. P. Schizas,Andrew B. Williams 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.2

different aetiologies. Methods: Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies. Results: A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48–75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17–70 days vs. 16 days; IQR, 11–25 days; P < 0.001). Conclusion: Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.