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We present a case of a transwoman taking hormonal feminisation therapy for over 20 years, who underwent surgical excision of a benign phyllodes tumour of the breast. Hormones progesterone and oestrogen act on breast epithelium to increase proliferation. For ciswomen, endogenous and exogenous oestrogen exposure over a lifetime is associated with increased risk for certain benign and malignant breast pathologies. Transwomen taking hormonal therapy may also be at an increased risk of breast disease., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

This paper presents an innovative approach to the integration of thermoelectric microgenerators (μTEGs) based on thick-film thermopiles of planar constantan-silver (CuNi-Ag) and calcium cobaltite oxide-silver (Ca 3 Co 4 O 9 -Ag) thick-film thermopiles with radio frequency identification (RFID) technology. The goal was to consider using the TEG for an active or semi-passive RFID tag. The proposed implementation would allow the communication distance to be increased or even operated without changing batteries. This article discusses the principles of planar thermoelectric microgenerators (μTEGs), focusing on their ability to convert the temperature difference into electrical energy. The concept of integration with active or semi-passive tags is presented, as well as the results of energy efficiency tests, considering various environmental conditions. On the basis of the measurements, the parameters of thermopiles consisting of more thermocouples were simulated to provide the required voltage and power for cooperation with RFID tags. The conclusions of the research indicate promising prospects for the integration of planar thermoelectric microgenerators with RFID technology, opening the way to more sustainable and efficient monitoring and identification systems. Our work provides the theoretical basis and practical experimental data for the further development and implementation of this innovative technology.

Breast necrotising soft tissue infections (NSTIs) are rare surgical emergencies with limited cases described in the literature. Here, we discuss a unique case of a woman in her 70s who presented with newly diagnosed diabetes and a neglected right breast cancer associated with breast erythema, skin necrosis, crepitus on examination and breast soft tissue gas seen on CT requiring emergent total mastectomy with partial pectoralis muscle excision. Pathology revealed a 15 cm invasive mucinous adenocarcinoma and necrotising polymicrobial cellulitis with a large abscess cavity. She recovered from her surgery with strict glycaemic control and a 10-day course of antibiotics. Multidisciplinary tumour board recommended adjuvant anastrozole, abemaciclib and postmastectomy radiation to complete her oncological treatment. Although exceedingly rare, it is important that clinicians be aware of, promptly recognise and properly treat NSTIs of the breast, as correct care can be life-saving from both infection and malignancy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Polycrystalline samples of NaCo 2-x Cu x O 4 (x = 0, 0.01, 0.03, 0.05) were obtained from powder precursors synthesized by a mechanochemically assisted solid-state reaction method (MASSR) and a citric acid complex method (CAC). Ceramic samples were prepared by pressing into disc-shaped pellets and subsequently sintering at 880 °C in an argon atmosphere. Effects of low concentrations of Cu doping and the above-mentioned synthesis procedures on the thermoelectric and mechanical properties were observed. The electrical resistivity ( ρ ), the thermal conductivity ( κ ) and the Seebeck coefficient ( S ) were measured simultaneously in the temperature gradient (Δ T ) between the hot and cold side of the sample, and the figure of merit ( ZT ) was subsequently calculated. The ZT of the CAC samples was higher compared with the MASSR samples. The highest ZT value of 0.061 at Δ T = 473 K was obtained for the sample with 5 mol% of Cu prepared by the CAC method. The CAC samples showed better mechanical properties compared to the MASSR samples due to the higher hardness of the CAC samples which is a consequence of homogeneous microstructure and higher density obtained during sintering of these samples. The results confirmed that, besides the concentration of Cu, the synthesis procedure considerably affected the thermoelectric and mechanical properties of NaCo 2 O 4 (NCO) ceramics.

The nonlinear response of a material to an external stimulus is vital in fundamental science and technical applications. The power-law current-voltage relationship of a varistor is one such example. An excellent example of such behavior is the power-law current-voltage relationship exhibited by Bi 2 O 3 -doped ZnO varistor ceramics, which are the cornerstone of commercial varistor materials for overvoltage protection. Here, we report on a sustainable, ZnO-based varistor ceramic, without the volatile Bi 2 O 3 , that is based on Cr 2 O 3 as the varistor former and oxides of Ca, Co, and Sb as the performance enhancers. The material has an ultrahigh α of up to 219, a low I L of less than 0.2 μA/cm 2 , and a high E b of up to 925 V/mm, making it superior to state-of-the-art varistor ceramics. The results provide insights into the design of materials with specific characteristics by tailoring states at the grain boundaries. The discovery of this ZnO-Cr 2 O 3 -type varistor ceramic represents a major breakthrough in the field of varistors for overvoltage protection and could drastically affect the world market for overvoltage protection.

In the present pilot study, we evaluated different supplemental therapies using autologous multipotent mesenchymal stromal cells (MMSCs) for the treatment of cranial cruciate ligament defects in dogs. We used tibial tuberosity advancement (TTA) and augmented it by supportive therapy with MMSCs in three patient groups. In the first patient group, the dogs were injected with MMSCs directly into the treated stifle one month after surgery. In the second group, MMSCs were delivered in a silk fibroin scaffold which was placed in the osteotomy gap during surgery. In the third group, MMSCs were first mixed with bone tissue and blood from the patient and delivered into the osteotomy gap during surgery. In the control group, patients underwent the TTA procedure but did not receive MMSC treatment. In the group of patients who received cells in the silk fibroin scaffold during surgery, the osteotomy gap did not heal, presumably due to the low absorption of silk fibroin. Patients who received MMSCs mixed with bone tissue and blood during surgery into the osteotomy gap recovered clinically faster and had better healing of the osteotomy gap than dogs from the other two treated groups and from the control group, as assessed by clinical examination and quantification of radiographs. In conclusion, dogs that received stem cells directly into the osteotomy gap (Group 3) recovered faster compared to dogs from Groups 1 (MMSCs injected into the joint one month after surgery), 2 (cells implanted into the osteotomy gap in a silk fibroin scaffold), and the control group that did not receive additional MMSCs treatment.

In/ZnO bulk compounds have been synthesized using a simple solid-state process. In this study, both the structural features and thermoelectric properties of the Zn 1-x In x O series with ultralow indium content (0 ≤ x ≤ 0.02) have been studied. High-angle annular dark-field scanning transmission electron microscopy analyses highlight that indium has the ability to create multiple basal plane and pyramidal defects that produce ZnO domains with inverted polarity starting from dopant concentrations as low as 0.25 atom %. Interestingly, the formation of parallel inversion boundaries consisting of InO 6 octahedra in the ZnO 4 tetrahedra matrix is responsible for phonon scattering while increasing electrical conductivity, thereby enhancing the thermoelectric properties. This effect of multiple extended two-dimensional defects on the thermoelectric properties of ZnO is reported for the first time with such low indium doping. On the chemistry side, the present results point toward a lack of In solubility in the ZnO structure. Moreover, this study is a step forward to the synthesis of other thermoelectric compounds where dopant-induced planar defects in bulk transition metal compounds have the potential to enhance both phonon scattering and electronic conductivity.

We investigated the high-temperature thermoelectric properties of Ga:ZnO bulk compounds, synthesized using a simple and scalable solid-state process. The effects of a low gallium content (x ≤ 0.04 in Zn 1-x Ga x O 1+x/2 ) on the structural features and electrical/thermal properties are reviewed. Transmission electron microscopy analyses showed that 2D, nonperiodic defects had formed from a doping content as low as x = 0.01 Ga. The structural description of these nanoscale interfaces is, for the first time, carefully investigated in such low-Ga-content samples by HAADF-STEM analyses combined with structural modeling. It was found that the formation of head-to-head inversion twin (h-IT) boundaries and tail-to tail inversion boundaries (t-IB) in the bulk compounds is responsible for strong phonon scattering, while maintaining relatively good electrical conductivity and thereby enhancing the thermoelectric properties. The absolute value of the Seebeck coefficient decreases abruptly from 475 μV/K for x = 0 down to 60 μV/K for x = 0.005 at 350 K. At the same time, the electrical resistivity drops from 1 ohm cm for x = 0 to 1.7 × 10 -3 ohm cm for x = 0.005. For higher Ga additions (x > 0.01), the increase in electrical resistivity is likely linked to the formation of interface defects at a larger extent in the wurtzite structure. The thermal conductivity also drops sharply with the increase in the Ga content from ∼33 W/m K for x = 0 to ∼8 for x = 0.04 at 350 K. This study is progress toward the synthesis of other thermoelectric materials where nanoscale interfaces in bulk compounds provide tremendous opportunities for further enhancing both the phonon scattering and the overall figure of merit.

Zinc oxide nanopowders were synthesized by the sol-gel method from an ethanol solution of zinc acetate dihydrate. Detailed structural and microstructural investigations were carried out using x-ray diffraction, Raman spectroscopy, thermogravimetric and differential thermal analyses, as well as high-resolution transmission electron microscopy (TEM) and field-emission scanning electron microscopy. The intermediate compound of the reaction was layered zinc hydroxide acetate that further transforms into hexagonally shaped ZnO crystalline nanoplates (d(m) = 4 nm), which aggregate into larger spherical particles. According to the TEM analysis the ZnO nanoparticles were self-assembled into larger particles with the same orientation, i.e. aligned lattice planes of the particles. A further solvothermal treatment resulted in hexagonal, prismatic ZnO mesocrystals.

In this paper, changes of microstructural characteristics of disperse systems during mechanical activation of zinc oxide (ZnO) have been investigated. ZnO powder was activated by grinding in a planetary ball mill in a continuous regime in air during 300 min at the basic disc rotation speed of 320 rpm and rotation speed of bowls of 400 rpm but with various balls-to-powder mass ratios. During ball milling in a planetary ball mill, initial ZnO powder suffered high-energy impacts. These impacts are very strong, and large amounts of microstructural and structural defects were introduced in the milled powders. The morphology and dispersivity of particles and agglomerates of all powders were investigated by scanning electron microscopy and scanning transmission electron microscopy. The specific surface area of initial ZnO powder was determined as 3.60 m(2) g(-1) and it increased to 4.42 m(2) g(-1) in mechanically activated powders. An increase of the ball-to-powder mass ratio led to a decrease of particle dimensions as well as increased the tendency for joining into quite compact agglomerates, that is aggregates, compared with the very loose, soft initial agglomerates. The obtained results pointed out that activation of ZnO powders produces a highly disperse, nano-scaled mixture of small particles, that is crystallites with sizes in the range of 10-40 nm. Most of these particles are in the form of aggregates with dimensions of 0.3-0.1 mum. The crystallite and aggregate size strongly depend on milling conditions, that is ball-to-powder mass ratio, as shown in this investigation.

The diagnostic power of an integrated positron emission tomography/computed tomography (PET/CT) system for whole-body 2-fluoro-2-deoxy-d-glucose (FDG) imaging is clearly demonstrated in this case report. The precise anatomic localization of FDG uptake with CT in a PET/CT scan of a patient with known breast carcinoma helped identify a contralateral breast tumor with axillary lymph node metastasis despite the presence of extensive physiologic brown fat FDG uptake. Accordingly, the patient received appropriate surgical management and pathologic confirmation of the disease.

Background: Intracavitary brachytherapy with the MammoSite applicator as the sole radiation treatment in breast-conserving therapy is an option for women with early-stage breast cancer; we evaluated the acute toxicities associated with this treatment method., Methods: Thirty-one patients with 32 stage I or II breast carcinomas underwent breast-conserving therapy, which included lumpectomy with negative margins, sentinel node biopsy, or axillary dissection, followed by brachytherapy with the MammoSite applicator. Acute radiation skin complications were graded on the day of radiotherapy completion and at weeks 2, 4, 6, and 12 after radiation treatment. Cosmesis was graded on the Harvard Scale at all follow-ups., Results: The median follow-up was 11 months (range, 4-15 months). Twenty-seven of the 31 patients were treated with the device as the sole method of radiotherapy. No acute toxicities occurred during the 5 days of treatment. Nineteen patients (68%) had no to mild acute skin reactions, and 25% developed bright erythema and patchy moist desquamation. Two patients (7%) developed confluent moist desquamation within the first 4 weeks (grade 3); this healed by week 12. All skin reactions were localized to the area overlying the balloon. Sixteen percent (5 of 32) of all breasts with implants developed infection. Cosmesis was good to excellent in 86% of cases., Conclusions: Most acute skin toxicities were mild. Our infection rate was higher than in prior studies that used interstitial brachytherapy. Cosmesis was good to excellent in most patients. Breast brachytherapy with the MammoSite catheter was well tolerated; further investigations of breast brachytherapy with this system are warranted.

The purpose of this study was to examine the short-term effects of 75, 100 and 150 mg of acarbose mixed in 100 g standard laboratory chow on specific intestinal disaccharidase activities and on hyperglycaemia in diabetic CBA strain mice on standard diet. The small intestine was excised and divided into three segments, from pylorus to duodenum, and two equal lengths of the jejunum and ileum of control and diabetic mice with or without added acarbose. Specific maltase and sucrase activities were determined using maltose and sucrose as substrates respectively. Increased specific activities of maltase and sucrase were detected in the intestines of CBA mice on standard laboratory diet seven days after alloxan-induced diabetes. Feeding for 7 days with 75, 100 or 150 mg acarbose uniformly mixed in 100 g standard laboratory chow, induced a decrease in the specific maltase and sucrase activities, compared with diabetic mice on standard laboratory diet. Feeding with 75 mg acarbose mixed in 100 g standard laboratory chow caused a statistically significant decrease of maltase in the duodenum and of sucrase in duodenum and jejunum, without a antihyperglycaemic effect. Feeding with 100 or 150 mg caused statistically significant decreases in specific maltase and sucrase activities in duodenum, jejunum and ileum. An antihyperglycaemic effect was observed only in the group of diabetic mice fed with 100 mg acarbose. This indicates that the antihyperglycaemic effect of acarbose involves factors other than these, related only to its inhibitory effect on disaccharidase activities.

Unlabelled: Multicentric or multifocal breast cancer is considered as one of the limitations for sentinel lymph node (SLN) localization. We did a retrospective analysis to evaluate the success rate, sensitivity, accuracy, and negative predictive values of SLN localization in multicentric or multifocal breast lesions., Methods: Fifty-nine patients with multifocal or multicentric breast lesions proven by either fine-needle aspiration (19/59), core biopsy (39/59), or lumpectomy (8/59) underwent SLN localization. Of these patients, 46 had SLN localization by both radiocolloid and blue dye, and 13 had SLN localization by radiocolloid alone. Approximately 10 MBq (99m)Tc-labeled unfiltered sulfur colloid in 0.3-0.4 mL were injected intradermally over the 1 or 2 breast tumor locations 2-4 h before surgery. During surgery, vital blue dye was injected intraparenchymally in 4-6 places around the tumor. All lymph nodes with counts of >10 times that of the background counts, whether or not blue dye positive, and all blue dye-positive lymph nodes, whether or not radiocolloid positive, were excised and labeled accordingly. All lymph nodes underwent frozen sectioning and were examined by hematoxylin and eosin and immunohistologic (cytokeratin) staining., Results: Of the 59 patients, 48 had axillary lymph node dissection irrespective of the results of pathologic examination of the SLN. The success rate, sensitivity, negative predictive value, and accuracy were 93%, 100%, 100%, and 100% using the radiocolloid probe, 87%, 100%, 100%, and 100% using blue dye, and 93.5%, 100%, 100%, and 100% using combined methods, respectively. Concordance between blue dye and radiocolloid was 91% (the incidence of the number of sentinel nodes detected was 37.5%, 30.3%, 10.7%, and 21.4% for 1, 2, 3, and 4 or more lymph nodes, respectively). Metastatic lymph node involvement was found in 39.5% of patients., Conclusion: The sentinel node localization approach showed a high negative predictive value in breast cancer patients with multifocal or multicentric lesions, contrary to the common belief of significant false-negative results in these patients.

Ectopic supernumerary kidney is a rare congenital urinary tract abnormality. Because of the scarcity of published cases and atypical presenting symptomatology this entity frequently causes a diagnostic as well as therapeutic dilemma. We report a case of an unusually symptomatic supernumerary kidney that presented as back pain. Noncontrast CT scan showed a suspicious left-sided para-aortic mass, which prompted a percutaneous biopsy. Intravenous contrast CT scan revealed an anatomically and functionally free supernumerary kidney. The approach to diagnosis as well as management of supernumerary kidneys is discussed herein.

Patients with advanced or recurrent gastric cancer affecting the upper and lower gastrointestinal tract usually experience obstructive symptoms, causing a severe compromise in their quality of life. Surgery may not be feasible because of the patient's precarious medical condition and multilevel tumor infiltration. When faced with these circumstances, surgeons have few options. Parenteral nutrition and comfort measures are utilized when surgical bypass is not a tenable option. We herein describe a unique case of multilevel upper and lower gastrointestinal obstruction secondary to recurrent gastric cancer. The patient was treated palliatively through a combined surgical, radiological, and endoscopic approach by implanting a series of self-expanding metallic stents. To our knowledge, there are no previous reports of successful management of simultaneous strictures of the upper and lower gastrointestinal tract using this technique.

A replication-deficient recombinant vaccinia virus, NYVAC, was developed by deleting 18 open reading frames in the vaccinia virus genome. Recombinant NYVAC, encoding the murine T cell co-stimulatory gene B7.1 (CD 80) (NYVAC-B7.1) and the murine interleukin-2 gene (NYVAC-IL-2), were prepared and the expression of B7.1 and the secretion of IL-2 were respectively confirmed in vitro. The use of these viruses to prepare a potent tumor cell vaccine was studied in a syngeneic murine CC-36 colon adenocarcinoma model. Mice were immunized on days 1 and 8 with 10(6) irradiated CC-36 cells that were infected with 10(7) plaque-forming units of either NYVAC-B7.1, NYVAC-IL-2 or a control virus, NYVAC-HR, which encodes a vaccinia virus host-range gene. These mice were then challenged with 10(8) viable CC-36 tumor cells on day 15. All mice (10/10) in a group that had received no vaccination and all mice (20/20) in a group that had received a control vaccine of CC-36/NYVAC-HR developed tumor 4-weeks after tumor cell challenge. Interestingly, only 16/20 mice in a group that had received CC-36/ NYVAC-B7.1 showed the development of tumor after the same interval. The protection against tumor development and the reduction in tumor burden (as mean tumor diameter, 4 weeks after tumor challenge) were significant in this group when compared to groups that were either unvaccinated or vaccinated with CC-36/NYVAC-HR (mean tumor diameter = 6.51+/-3.2 mm compared to 26.5+/-0.9 mm or 26.2+/-1.8 mm respectively) (P = < 0.05). The protection against tumor in a group of mice that received CC-36/ NYVAC-IL-2 vaccination was similar to that in the unvaccinated group or the group receiving a CC-36/NYVAC-HR control vaccination. However, in a survival experiment, mice that received either CC36/NYVAC-B7.1 or CC-36/ NYVAC-IL-2 vaccination on the day of tumor transplantation survived significantly longer than mice that had not been vaccinated (median survival 60+ days, 60+ days or 23.5 days respectively) (P = < 0.05). Interestingly, when a therapeutic tumor vaccination was performed on day 4 after tumor transplantation, mice that had been vaccinated with either CC36/NYVAC-B7.1 or CC-36/NYVAC-IL-2 did not show an improved survival when compared to mice in the control that had not been vaccinated (median survival 28 days compared to 26 days or 25 days respectively). However, mice that had received a therapeutic vaccination with CC-36 cells infected with both NYVAC-B7.1 and NYVAC-IL-2, 4 days after tumor transplantation, survived significantly longer than control mice that had not received any vaccination (median survival 29.5 days compared to 25 days respectively) (P<0.05). These results suggest that a replication-deficient recombinant NYVAC encoding the B7.1 gene and NYVAC encoding the IL-2 gene can be used to produce an effective vaccinia-virus-augmented tumor cell vaccine.

Gestational breast cancer is occurring with increasing incidence because more women are delaying childbirth into their thirties and forties. Although breast cancer during pregnancy or within the first year postpartum is occurring more often, there is still some confusion regarding its treatment. Although breast conservation therapy has evolved as the major treatment in breast cancer, it has been thought that pregnancy was a contraindication for this type of breast cancer therapy due to risks imposed on the fetus by chemotherapy and radiation. However, recent studies have shown that the use of chemotherapeutics during the second and third trimesters is possible. Also, if chemotherapy is initiated after a lumpectomy, radiation can be withheld until after the birth of the baby when the cancer is detected in the second or third trimester.

A retrospective study was conducted to determine the influence of the acquired immunodeficiency syndrome (AIDS) epidemic on the incidence, clinical presentation, and outcome of primary gastrointestinal lymphoma (stages I and II) over a 20-year period at a single institution. Between 1971 and 1981, there were seven cases. Fifty-eight patients were diagnosed between 1983 and 1993, and 81 per cent were AIDS-related. The mean age overall was 50 years; 81 per cent were male, and 35 per cent presented with acute complications. All tumors were high or intermediate grade B cell lymphomas, and 48 per cent had bulky or advanced disease at presentation. The overall actuarial 5-year survival was 9 per cent. Human immunodeficiency virus status and stage were significant independent prognostic factors. The AIDS-related subgroup had a mean age of 43 years, and 91 per cent were male. Tumor resection was performed in 38 per cent, and the 5-year survival was 2 per cent. The mean age for the non-AIDS-related subgroup was 71 years, and 55 per cent were male. Resection was performed in 39 per cent, and 5-year survival was 28 per cent. AIDS-related disease accounted for the dramatic increase in incidence of primary gastrointestinal lymphoma since 1983. The prognosis for these patients is poor and is dominated by the underlying immunocompromise.

Background: Although a wealth of information is available on adjuvant immunotherapy for melanoma, little is known about adjuvant immunotherapy for head and neck melanoma. Interestingly, a few immunotherapy clinical trials report the observation of clinical responses in a subset of patients with head and neck melanoma., Method: An up-to-date literature search was performed to identify the current information on adjuvant immunotherapy for patients with melanoma, including head and neck melanoma. Moreover, a retrospective analysis of a subset of primary head and neck melanoma was performed using data from a phase III, randomized, double-blind, multi-institutinal, vaccinia melanoma oncolysate adjuvant immunotherapy trial that was performed in our laboratory for patients with stage III (AJCC) melanoma., Results: In a passive immunotherapy trial with an antibody to melanoma ganglioside antigen GM2, a complete regression was observed in one patient with lesions of the right cheek. In three active specific immunotherapy trials, including our phase III trial, a subset of patients with head and neck primary melanoma showed a longer disease-free and overall survival with immunotherapy. Moreover, these clinical responses were correlated to the induction of immune response, delayed-type hypersensitivity response and melanoma-specific antibody response., Conclusions: The above results therefore suggest that patients with head and neck melanoma clinically respond to immunotherapy. However, these results need to be confirmed in a prospectively randomized trial for patients with head and neck melanoma.