Nursing Care and Causative Analysis of Grade IV Capsular Contracture Following Breast Cancer Expander Implantation

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.

Influence of heat treatment on microstructure,mechanical and corrosion behavior of WE43 alloy fabricated by laser-beam powder bed fusion

Magnesium(Mg)alloys are considered to be a new generation of revolutionary medical metals.Laser-beam powder bed fusion(PBF-LB)is suitable for fabricating metal implants withpersonalized and complicated structures.However,the as-built part usually exhibits undesirable microstructure and unsatisfactory performance.In this work,WE43 parts were firstly fabricated by PBF-LB and then subjected to heat treatment.Although a high densification rate of 99.91%was achieved using suitable processes,the as-built parts exhibited anisotropic and layeredmicrostructure with heterogeneously precipitated Nd-rich intermetallic.After heat treatment,fine and nano-scaled Mg24Y5particles were precipitated.Meanwhile,theα-Mg grainsunderwent recrystallization and turned coarsened slightly,which effectively weakened thetexture intensity and reduced the anisotropy.As a consequence,the yield strength and ultimate tensile strength were significantly improved to(250.2±3.5)MPa and(312±3.7)MPa,respectively,while the elongation was still maintained at a high level of 15.2%.Furthermore,the homogenized microstructure reduced the tendency of localized corrosion and favoredthe development of uniform passivation film.Thus,the degradation rate of WE43 parts was decreased by an order of magnitude.Besides,in-vitro cell experiments proved their favorable biocompatibility.

Lateral earth pressure of granular backfills on retaining walls with expanded polystyrene geofoam inclusions under limited surcharge loading

Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.

Analysis of Profile and Unsteady Flow Performance of Variable Base Circle Radius Scroll Expander

To study the complex internal flow field variation and output characteristics of a variable base radius scroll expander,this paper uses dynamic mesh techniques and computational fluid dynamics(CFD)methods to perform transient numerical simulations of a variable base radius scroll expander.Analysis of the flow field in the working cavity of a variable base radius scroll expander at different spindle angles and the effect of different profiles,speeds and pressures on the output characteristics of the scroll expander.The results of the study show that due to the periodic blocking of the inlet by the orbiting scroll,the fluid hits the internal walls of the expander at different flow rates,with excessive mechanical losses,resulting in an uneven distribution of the internal flow field.At the same temperature,pressure and scroll plate diameter,the variable base radius scroll expander increases the output torque by 0.046 N·m,the output power by 9.634 W and the isentropic efficiency by 3.8%compared to the fixed base circle scroll expander.As the speed is inversely proportional to the output torque,the isentropic efficiency of the expander tends to increase and then decrease as the speed increases.The density of the fluid is directly proportional to the pressure over a range of pressures.As the pressure increases from 0.6 to 0.9 Mpa,the average mass flow rate and isentropic efficiency increase by 0.02357 kg/s,and 6.61%,respectively.

Key Factors to Consider When Introducing a New Vaccine in Low-Income Settings: Lessons from Malawi Expanded Program on Immunization

Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.

Heuristic Expanding Disconnected Graph:A Rapid Path Planning Method for Mobile Robots

Existing mobile robots mostly use graph search algorithms for path planning,which suffer from relatively low planning efficiency owing to high redundancy and large computational complexity.Due to the limitations of the neighborhood search strategy,the robots could hardly obtain the most optimal global path.A global path planning algorithm,denoted as EDG*,is proposed by expanding nodes using a well-designed expanding disconnected graph operator(EDG)in this paper.Firstly,all obstacles are marked and their corners are located through the map pre-processing.Then,the EDG operator is designed to find points in non-obstruction areas to complete the rapid expansion of disconnected nodes.Finally,the EDG*heuristic iterative algorithm is proposed.It selects the candidate node through a specific valuation function and realizes the node expansion while avoiding collision with a minimum offset.Path planning experiments were conducted in a typical indoor environment and on the public dataset CSM.The result shows that the proposed EDG*reduced the planning time by more than 90%and total length of paths reduced by more than 4.6%.Compared to A*,Dijkstra and JPS,EDG*does not show an exponential explosion effect in map size.The EDG*showed better performance in terms of path smoothness,and collision avoidance.This shows that the EDG*algorithm proposed in this paper can improve the efficiency of path planning and enhance path quality.

Compression properties of cost-efficient porous expanded clay reinforced AA7075 syntactic foams fabricated by industrial-oriented die casting technology

In today’s manufacturing industries,hard competition between rival firms makes it compulsory for researchers to design lighter and cheaper machine components due to the megatrends of cost-effectiveness and anti-pollution.At this point,aluminum syntactic foams(ASFs)are new-generation engineering composites and come into the upfront as a problem-solver.Owing to their features like low density,sufficient elongation,and perfect energy absorption ability,these advanced foams have been considerably seductive for many industrial sectors nowadays.In this study,an industrial-oriented automatic die casting technology was used for the first time to manufacture the combination of AA7075/porous expanded clay(PEC).Micro evaluations(optical and FESEM)reveal that there is a homogenous particle distribution in the foam samples,and inspections are compatible with the other ASF studies.Additionally,T6 aging heat treatment was operated on one half of the produced foams to explore the probable impact of aging on the compressive responses.Attained results show that PEC particles can be an alternative to expensive hollow spheres used in the previous works.Besides,a favorable relationship is ascertained between the aging treatment and mechanical properties such as compression strength and plateau strength.

Optimization of Channel Structure of Alkaline Water Electrolyzer by Using an Expanded Mesh as a Bipolar Plate

Alkaline water electrolysis(AWE)is the most mature technology for hydrogen production by water electrolysis.Alkaline water electrolyzer consists of multiple electrolysis cells,and a single cell consists of a diaphragm,electrodes,bipolar plates and end plates,etc.The existing industrial bipolar plate channel is concave-convex structure,which is manufactured by complicated and high-cost mold punching.This structure still results in uneven electrolyte flow and low current density in the electrolytic cell,further increasing in energy consumption and cost of AWE.Thereby,in this article,the electrochemical and flow model is firstly constructed,based on the existing industrial concave and convex flow channel structure of bipolar plate,to study the current density,electrolyte flow and bubble distribution in the electrolysis cell.The reliability of the model was verified by comparison with experimental data in literature.Among which,the electrochemical current density affects the bubble yield,on the other hand,the generated bubbles cover the electrode surface,affecting the active specific surface area and ohmic resistance,which in turn affects the electrochemical reaction.The result indicates that the flow velocity near the bottom of the concave ball approaches zero,while the flow velocity on the convex ball surface is significantly higher.Additionally,vortices are observed within the flow channel structure,leading to an uneven distribution of electrolyte.Next,modelling is used to optimize the bipolar plate structure of AWE by simulating the electrochemistry and fluid flow performances of four kinds of structures,namely,concave and convex,rhombus,wedge and expanded mesh,in the bipolar plate of alkaline water electrolyzer.The results show that the expanded mesh channel structure has the largest current density of 3330 A/m^(2)and electrolyte flow velocity of 0.507 m/s in the electrolytic cell.Under the same current density,the electrolytic cell with the expanded mesh runner structure has the smallest potential and energy consumption.This work provides a useful guide for the comprehensive understanding and optimization of channel structures,and a theoretical basis for the design of large-scale electrolyzer.

Expandable endoprostheses in skeletally immature patients:Where we are

Approximately 45 percent of malignant bone tumors are seen under the age of 16 and one of the important results of growth plate sacrification in patients with immature skeletons is limb inequality.Until the early 1990s,the treatment options for these patients were rotationplasty or amputation.Multimodal approaches that combine imaging,chemotherapy,and surgical techniques have enabled the development of limb-preserving methods with satisfactory results.In order to overcome inequality problems,expandable prostheses have been developed in the 1980s.Extendable endoprosthesis replacements have been improved over the years and are now an established and safe alternative.Noninvasive prostheses appear to be advantageous compared to minimally invasive expandable prostheses that require multiple surgical procedures,but the complication rate remains high.Therefore,although expandable prostheses are not the definitive answer to the treatment of bone sarcomas in skeletally immature children,they are still a suitable interim choice until full adulthood is achieved.Due to reported high complication rates,the procedures require significant experience and are recommended for use only in specialized cancer centers.

Study of Rice Husks and Expanded Polystyrene Composites for Construction Applications

In the current context of environmental challenges, this study focuses on developing innovative and eco-friendly composites using rice husk and recycled expanded polystyrene. This dual-responsibility approach valorizes a by-product like rice husk, often considered waste, and reuses polystyrene, a plastic waste, thereby contributing to CO2 emission reduction and effective waste management. The manufacturing process involves dissolving recycled polystyrene into a solvent to create a binder, which is then mixed with rice husk and cold-compacted into composite materials. The study examines the impact of two particle sizes (fine and coarse) and different proportions of recycled polystyrene binder. The results show significant variations in the mechanical characteristics of the composites, with Modulus of Rupture (MOR) values varying from 2.41 to 3.47 MPa, Modulus of Elasticity (MOE) ranging from 223.41 to 1497.2 MPa, and Stiffness Coefficient (K) from 5.04 to 33.96 N/mm. These characteristics demonstrate that these composites are appropriate for various construction applications, including interior decoration, panel claddings, and potentially for furniture and door manufacturing when combined with appropriate coatings. This study not only highlights the recycling of agricultural and plastic waste but also provides a localized approach to addressing global climate change challenges through the adoption of sustainable building materials.

Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures

BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic strictures.Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is scarce.Due to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy.This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents.METHODS Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query.Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records.The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months.Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for≤120 d or>120 d.RESULTS During the study period,a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course.In 33 ERCPs,the stent was removed or exchanged on a 3-month interval.No pancreatitis,perfor-ations or deaths occurred.Minor post-ERCP complications were similar between the 3-month(abdominal pain and intraductal migration)and 6-month(abdominal pain,septic shower and embedded stent)groups-6.1%vs 9.1%respectively,P=0.40.All strictures resolved at the end of the stenting course,but the stenting course was variable from 3 to 22 months.The recurrence rate for stenting courses lasting for up to 120 d was 71.4%and 21.4%for stenting courses of 121 d or over(P=0.03).There were 28 patients that were treated with a single ERCP with Kaffes,21 with removal after 120 d and 7 within 120 d.There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course(71.0%vs 10.0%,P=0.01).CONCLUSION Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.

The expanding amyloid family:Structure,stability,function,and pathogenesis

The hidden world of amyloid biology has suddenly snapped into atomic-level focus,revealing over 80 amyloid protein fibrils,both pathogenic and functional.Unlike globular proteins,amyloid proteins flatten and stack into unbranched fibrils.Stranger still,a single protein sequence can adopt wildly different two-dimensional conformations,yielding distinct fibril polymorphs.

Configuration Consideration for Expander in Transcritical Carbon Dioxide Two-Stage Compression Cycle

To investigate the configuration consideration of expander in transcritical carbon dioxide two-stage compression cycle, the best place in the cycle should be searched for to reinvest the recovery work so as to improve the system efficiency. The expander and the compressor are connected to the same shaft and integrated into one unit, with the latter being driven by the former, thus the transfer loss and leakage loss can be decreased greatly. In these systems, the expander can be either connected with the first stage compressor (shortened as DCDL cycle) or the second stage compressor (shortened as DCDH cycle), but the two configuration ways can get different performances. By setting up theoretical model for two kinds of expander configuration ways in the transcritical carbon dioxide two-stage compression cycle, the first and the second laws of thermodynamics are used to analyze the coefficient of performance, exergy efficiency, inter-stage pressure, discharge temperature and exergy losses of each component for the two cycles. From the model results, the performance of DCDH cycle is better than that of DCDL cycle. The analysis results are indispensable to providing a theoretical basis for practical design and operating.

Parameters Optimization of Laser-Induced Breakdown Spectroscopy Experimental Setup for the Case with Beam Expander

Improvement of measurement precision and repeatability is one of the issues currently faced by the laser-induced breakdown spectroscopy （LIBS） technique, which is expected to be capable of precise and accurate quantitative analysis. It was found that there was great potential to improve the signal quality and repeatability by reducing the laser beam divergence angle using a suitable beam expander （BE）. In the present work, the influences of several experimental parameters for the case with BE are studied in order to optimize the analytical performances： the signal to noise ratio （SNR） and the relative standard deviation （RSD）. We demonstrate that by selecting the optimal experimental parameters, the BE-included LIBS setup can give higher SNR and lower RSD values of the line intensity normalized by the whole spectrum area. For validation purposes, support vector machine （SVM） regression combined with principal component analysis （PCA） was used to establish a calibration model to realize the quantitative analysis of the ash content. Good agreement has been found between the laboratory measurement results from the LIBS method and those from the traditional method. The measurement accuracy presented here for ash content analysis is estimated to be 0.31%, while the average relative error is 2.36%.

Expander implantation for correction of high-riding nipple with enlarged nipple-areola complex using revision mastopexy: A case report

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.

Thermodynamic Comparison Analysis on CO_2 Transcritical Reverse Cycles with IHX or Expander

To improve the coefficient of performance （COP） of CO2 transcritical reverse cycle and determine the most efficient cycle, comparison analysis on （single-and） two-stage CO2 transcritical cycles with internal heat exchanger （IHX） or expander is presented adopting the principle of thermodynamics. Results indicate that the COP of four cycles,namely single-stage compression with IHX （SI）, single-stage compression with expander （SE）, two-stage compression with IHX （TI） and two-stage compression with expander （TE）, can be ranged as TE>SE>TI>SI. It presents that adopting an expander to recover expansion power is the primary method to improve the COP of CO2 transcritical reverse cycle if the efficiency of the expander is up to a certain value. Under supposed operating condition, where the outlet temperature of gas cooler is 35 ℃ and the evaporating temperature is 5 ℃, the COP of TE cycle is about 4200 higher than that of SI cycle when the expander efficiency is 0.6 and the degree of superheat of IHX is 15 ℃. Therefore TE cycle is the most recommendatory one and it is better to adopt TE in those high-cooling capacity systems because its technology cost will be higher.

Effects of different plasma expanders on rats subjected to severe acute normovolemic hemodilution

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.

SAS-Expander及其实现

SAS(Serial Attached SCSI)即串行SCSI技术,是一种磁盘连接技术.而Expander本质上就是SAS交换机,可以将多个SAS连接到有限数量的主机端口上.这里主要介绍了通过MAX-IM公司的VSC7154实现SAS-Expander磁盘阵列柜.此阵列柜机构部件依据SBB规范实现.

Expanders, Group Extensions, Hadamard Manifolds and Certain Banach Spaces

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.

A Class of Metric Spaces Which Do Not Coarsely Contain Expanders

In this paper, a class of metric spaces which include Hilbert spaces and Hadamard manifolds are defined. And the expanders cannot be coarsely embedded into this class of metric spaces are proved.