Is Using Closed Incision Negative Pressure Therapy in Reconstructive and Oncoplastic Breast Surgery Helpful in Reducing Skin Necrosis?

Introduction Skin necrosis is a major concern of morbidity in patients undergoing reconstructive and oncoplastic breast surgery (ROBS) as it may lead to a poor aesthetic outcome, necessitate further surgery, and delay adjuvant chemotherapy and radiotherapy if required postoperatively. Some studies have reported that closed incision negative pressure therapy (ciNPT) immediately after surgery can reduce the incidence of wound complications. Our study aimed to investigate the effect of ciNPT on skin necrosis rate after ROBS. Methods Our study included 82 patients in a single center who underwent 121 ROBS procedures. We used conventional dressing in 42 patients (62 procedures, group A), while we used ciNPT in 40 patients (59 procedures, group B). When ciNPT dressing was introduced in our breast unit, 40 patients with 59 ROBS procedures who had ciNPT dressing were studied prospectively. The risk factors recorded were age, body mass index (BMI), history of previous radiotherapy, history of smoking, type of incision, type of operation, breast tissue specimen weight, use of neoadjuvant chemotherapy, and implant size. Skin necrosis was classified as "minor" if it was managed conservatively with regular dressings and "major" if surgical debridement in theater and/or exchange or implant removal was necessary. Results The incidence of overall skin necrosis in the conventional dressing group was 17.7% (11/62), while in the ciNPT group, it was higher at 25.4% (15/59), although this was not statistically significant (p = 0.51). ciNPT also did not show a statistically significant difference from the conventional dressing in the rate of minor necrosis (18.6% versus 11.2%, respectively; p = 0.44) and major necrosis (6.7% versus 6.4%, respectively; p = 1.00) Conclusion Our data has shown no superiority of ciNPT in reducing skin necrosis rate in a patient undergoing reconstructive and oncoplastic breast surgery, contrary to many other published reports. However, it may have reduced rates of other wound complications such as wound dehiscence, wound infection, and hypertrophic scar formation, which were not studied in our cohort. Further studies are needed to confirm its benefits, especially in high-risk patients.

Comparative Efficacy and Safety Study of Darbepoetin Alfa versus Epoetin Alfa in Management of Anemia Associated with ESRD in Egyptian Hemodialysis Patients.

BACKGROUND: Anemia is one of the most common complications of Chronic Kidney Disease (CKD). The vast majority of Egyptian CKD patients are interchangeably treated with Darbepoetin Alfa (DPA) and Epoetin Alfa (EPA) to achieve and maintain target hemoglobin levels. Our study aimed to compare the efficacy and safety of DPA versus EPA for managing anemia amongst Egyptian patients with CKD undergoing dialysis. METHODS: A multicenter, open label, randomized, prospective, parallel study was conducted. Patients with CKD undergoing dialysis with Hb level < 10 g/dl were enrolled. The primary efficacy endpoint was the change in hemoglobin concentration at the evaluation period (weeks 20-24). Prespecified adverse events of interest following administration, including blood transfusions requirement, blood pressure and hemoglobin excursions, the relationship between C - Reactive Protein (CRP) and hemoglobin, were assessed. RESULTS: Only 98 of 104 enrolled patients completed the study, fifty patients received EPA, and 48 patients received DPA. Our results showed that a significantly higher percentage of patients who achieved target Hb level ≥ 11 g/dL in DPA treated group vs. EPA as well as the meantime to achieve Hb level ≥ 10 g/dL was shorter in DPA treated group. Safety profiles of both treatments were similar. A negative correlation was observed between serum CRP and hemoglobin level in hemodialysis patients. CONCLUSION: Our study showed that DPA was more effective and well tolerated in achieving and maintaining Hb levels with lower dosing frequency compared to EPA. Furthermore, CRP is recommended to be routinely measured where patients with higher CRP require high ESA doses.

Outcome of complete acellular dermal matrix wrap with polyurethane implant in immediate prepectoral breast reconstruction.

BACKGROUND: Polyurethane implants have been used on and off in breast reconstruction since 1991 while prepectoral breast reconstruction has gained popularity in recent times. In this study, we present our outcomes from the use of acellular dermal matrix (ADM) complete wrap with polyurethane implants in prepectoral breast reconstruction. METHODS: This is a retrospective review of prospectively maintained database from 41 patients receiving complete ADM wrap with prepectoral polyurethane implants over a 3-year period. Selection criteria were adapted from a previous study (4135 Trust Clinical Audit Database) evaluating prepectoral reconstruction with Braxon matrices. Patient demographics, operative data, surgical complications, and outcomes were collected and analyzed. RESULTS: A total of 52 implant reconstructions were performed in 41 patients with a mean follow-up of 14.3 months (range, 6-36 months). The overall reported complication rates including early (less than 6 weeks) and late complications. Early complications included two patients (4.9%) with wound dehiscence. One of which had an implant loss that was salvageable. Another patient (2%) developed red-breast syndrome and two women (4.9%) developed with seroma treated conservatively. Late complications included one patient (2%) with grade II capsular contraction, 12 patients with grade I-II rippling and two patients (4.9%) with grade III rippling. CONCLUSIONS: We present our experience of prepectoral polyurethane implant using complete ADM wrap. This is one of the few papers to report on the outcome of the prepectoral use of polyurethane in immediate implant-based breast reconstruction. Our early observational series show satisfactory outcome and long-term results are warranted by a large multicenter study.

Management based on grading of animation deformity following implant-based subpectoral breast reconstruction.

Subpectoral breast reconstruction using implants and meshes have been used widely in Europe, the United States and the United Kingdom. Although this technique has several advantages, animation deformity is a well-documented problem. We propose a new grading system to classify breast animation in patients undergoing subpectoral implant based breast reconstruction. We also discuss different techniques to avoid and correct animation deformity.

Feeling blue, going green and finding other attractive alternatives: a case of biphasic anaphylaxis to patent blue and a literature review of alternative sentinel node localisation methods.

Patent blue dye is used for sentinel lymph node localisation in order to stage the axilla in patients with breast cancer. Patent blue is one of the most common dyes used across the UK, however, the incidence of adverse effects seems to be increasing. This case highlights our experience of a biphasic anaphylactic reaction to patent blue dye, and we conduct a brief literature review of alternative and more novel methods to adequately visualise the lymphatics for sentinel lymph node biopsy.

An integrated open-cavity system for magnetic bead separation and manipulation.

Superparamagnetic beads are generally used in biomedical assays to manipulate, maneuver, separate, and transport bio-materials. We present a low-cost integrated system designed in bulk 0.5 µm process to automate the manipulation and separation process of magnetic beads. The system consists of an 8 × 8 coil-array suitable for a single bead manipulation, or collaborative manipulation using pseudoparallel executions. The size of a single coil is 30 µm × 30 µm and the driver DC current source supports 8 different levels up to 1.5 mA. The total power consumption of the entire system is 9 mW when running at full power and it occupies an area of 248 µm × 248 µm.

Integrated CMOS electronic system-on-chip for medical sensors and actuators.

We present an overview of an integrated low-power, lightweight, compact computing platform dedicated to addressing specific needs in sensing and actuation. The architecture includes an adaptive computing electronic design (Chip) that supersedes the capabilities of present microcomputing paradigms (micro-processors, micro-controllers, and DSPs) in the application domains of process identification, modeling, prediction, and real-time control. In particular, a domain of prominent applications is biological and medical measurements and stimulation.

Sensing and feedback stimulation via the wireless ZigBee protocol.

The aim of this work is to implement a feedback sensing and control mechanism via wireless sensor nodes for medical sensing and actuation. To that end, we employ the Zigbee protocol in sensing and precisely commanding an analog signal to a probe. We employ a user application upon the layer available in the Zigbee stack to achieve our goal. Signal transmission delays, packet losses, and energy consumption are major challenges, we present strategies to minimize or solve these challenges. We also introduce strategies to enable sensor nodes to acquire and command (electrical current) signals from/to sensing/actuating platforms. Finally, we implement algorithms allowing the sensor node to compute and to regulate command signal on line.

Blind information-theoretic multiuser detection algorithms for DS-CDMA and WCDMA downlink systems.

Code division multiple access (CDMA) is based on the spread-spectrum technology and is a dominant air interface for 2.5G, 3G, and future wireless networks. For the CDMA downlink, the transmitted CDMA signals from the base station (BS) propagate through a noisy multipath fading communication channel before arriving at the receiver of the user equipment/mobile station (UE/MS). Classical CDMA single-user detection (SUD) algorithms implemented in the UE/MS receiver do not provide the required performance for modern high data-rate applications. In contrast, multi-user detection (MUD) approaches require a lot of a priori information not available to the UE/MS. In this paper, three promising adaptive Riemannian contra-variant (or natural) gradient based user detection approaches, capable of handling the highly dynamic wireless environments, are proposed. The first approach, blind multiuser detection (BMUD), is the process of simultaneously estimating multiple symbol sequences associated with all the users in the downlink of a CDMA communication system using only the received wireless data and without any knowledge of the user spreading codes. This approach is applicable to CDMA systems with relatively short spreading codes but becomes impractical for systems using long spreading codes. We also propose two other adaptive approaches, namely, RAKE -blind source recovery (RAKE-BSR) and RAKE-principal component analysis (RAKE-PCA) that fuse an adaptive stage into a standard RAKE receiver. This adaptation results in robust user detection algorithms with performance exceeding the linear minimum mean squared error (LMMSE) detectors for both Direct Sequence CDMA (DS-CDMA) and wide-band CDMA (WCDMA) systems under conditions of congestion, imprecise channel estimation and unmodeled multiple access interference (MAI).