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Background Reports of synchronous bilateral giant (>10 cm) phyllodes tumors of the breast are scant in the literature. Reconstruction of the two large defects created after bilateral mastectomies is a challenge. Our patient, a 45-year-old woman, had a borderline phyllodes tumor measuring 15.5×15×7.3 cm in the right breast and a malignant phyllodes tumor measuring 16×10×9.8 cm in the left breast. After bilateral mastectomy, the following two huge defects remained: a 15×15 cm defect in the right breast and a 18×15-cm defect in the left breast. Methods We used one donor site with two separated deep inferior epigastric perforator flaps for postmastectomy breast reconstruction. This is the first case of bilateral giant phyllodes tumor in which mastectomy was followed immediately by autologous tissue reconstruction. Results Large flap reconstruction conferred adequate leverage for wide excision of giant phyllodes tumors, and no local recurrence or distal metastatic lesions were observed over a follow-up period of 4 years. Conclusions This method caused less donor site morbidity than did methods involving other types of flaps, and good functional and cosmetic results were achieved.

BACKGROUND This study is a retrospective review to compare combining progressive tension sutures, closed drain, and fibrin sealant effects on seroma formation, postoperative drainage volume, and hospital stay for abdominoplasty after deep inferior epigastric artery perforator (DIEP) flap. We ever published a 0% seroma rate in abdominoplasty after DIEP flap using progressive tension sutures and closed drain. Massive abdominal wound drainage caused delayed drain removal and increased hospital stay and medical costs. METHODS We retrospectively evaluated 54 abdominoplasty patients between December 2013 and September 2017; 43 patients used fibrin glue and 11 used progressive tension sutures and closed drain. RESULTS Abdominal drainage for the first 3 postoperative days was 84.65 ± 52.95 mL in the fibrin group, with total drainage of 127.70 ± 125.50 mL and 214.45 ± 104.35 mL in the no fibrin group, with total drainage of 350.45 ± 213.58 mL. Drains were removed on postoperative day 6.21 ± 1.44 in the fibrin group and day 9.64 ± 1.96 in the no fibrin group. The association of the first 3 days and total drainage volumes with the drain removal day significantly differed in the fibrin and no fibrin groups. Hospital stay was 9.88 ± 3.55 and 12.45 ± 5.22 days in the fibrin and no fibrin group, respectively, with borderline significant differences. CONCLUSIONS Donor site abdominoplasty after DIEP flap combining progressive tension sutures, closed drainage, and fibrin glue can prevent seroma occurrence, reduce postoperative abdominal drainage and need for blood transfusion, and achieve early removal of the abdominal drain, shorter hospital stay, and lower medical cost.

Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P > .05). There was a trend of higher drainage (P = .251) and shorter time to incision healing (P = .067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post‐surgery in the ciNPT group compared with control (P

We report a rare case that after rapid recurrence there was pathological transition from a fibroadenoma and benign phyllodes tumor to borderline and malignant phyllodes tumor. Another rare finding included tumor dissemination in the pleural cavity via reconstructed deep inferior epigastric perforator flap edge and internal mammary vessel bundle. Hence, we eliminated the use of internal mammary vessel bundle as the recipient vessel for free-flap reconstruction to avoid recurrence in the pleural cavity. Remarkably, we achieved successful reconstruction of 2 huge defects (reconstruction of breast following mastectomy and that of chest wall following en bloc excision of recurrence) using 2 different free flaps.

Drowsiness of driver is one of the common causes resulting in road crashes. According to the research, there have been twenty percent of the road accidents which are related to the drowsiness of drivers. Nowadays, with the development technology, various approaches are introduced to detect the drowsiness of drivers. In this paper, we propose a multi-model fusion system which is composed of the three models to capture driver’s face and detect drowsiness in the real-time for telemetric robotics tracking applications. The sensor device we used is an RGB camera which is mounted in front of driver to obtain the facial image. Then, we combine the results based on the state of the eye blink, yawn and head deviation to determine whether the driver is drowsy. We test our models to obtain the weighting factors in drowsy value. In the experiment, we show that our system has the high accuracy of detection.

The objective of this paper is to develop a modular Robot Operating System (ROS) based autonomous mobile industrial robot system for automated intelligent manufacturing applications. We propose a finite state machine based method to integrate and manage various modular functions on the mobile manipulator which makes it have a great talent on mobility and manipulation. For mobility, we perform simultaneous localization and mapping (SLAM) on our robot to build a map and locate itself. We also develop navigation and collision avoidance strategies, so that it can navigate to anywhere it plans in the indoor environment. For manipulation, we use an RGB-D camera on the end effector to perform eye-in-hand system which given an image and point cloud, leveraging the learning-based object detection and shape-based grasping pose estimation to achieve flexible manipulation capabilities. In the experiments, we have developed an Autonomous Mobile Industrial Robot (AMIR) with a carefully designed mechanism and a fully modular ROS environment in our robotics lab at NTU. In the experiments, we construct an intelligent industrial scenario: collecting materials and delivering products from one place to another. Using our ROS based architecture to control the data/command flow between functions, we have successfully completed the demonstration of the system and proved the stability of the system.

Facebook was applied to investigate correlation between psychological symptoms.Belief in dangerous virtual community is correlated to social anxiety.Increase in social anxiety increases the continuance intention.Increase in general social anxiety increases the online social anxiety. Despite increased understanding regarding the effects of individual and contextual factors on continuance intention, this study investigated individuals' beliefs in dangerous virtual communities as a predictor of the related psychological symptoms, general and online social anxiety, in relation to individuals' continuance intention to sustain participation in the social network of Facebook. Confirmatory factor analysis was applied to 230 effective questionnaires and the results revealed that belief in dangerous virtual communities was positively correlated to both general and online social anxiety, which results in a negative correlation with continuance intention. The implication was that if participants experienced high levels of both types of social anxieties, then they exhibited a low level of continuance intention. In conjunction with a number of studies, the findings suggested that belief in a dangerous virtual community serves as the antecedent of general and online social anxiety. In addition, recommendations for future research are provided by the study.

Background First rib fractures and traumatic Horner's syndrome are both quite rare, which can make it difficult to properly diagnose the combination of these 2 conditions in the emergency department. These conditions may be associated with severe medical emergencies, such as ongoing carotid dissection. Case Report We present the case of a 33-year-old man who sustained fractures to his right second, third, and fourth ribs and a delay in the diagnosis of left Horner's syndrome after he was involved in a traffic accident. Left Horner's syndrome was caused by a left transverse fracture of the first rib. This fracture was not detected on chest radiographs and required a 3-dimensional reconstructed neck computed tomography scan for detection. Why Should an Emergency Physician Be Aware of This? In the diagnosis of carotid artery dissection, conventional angiography is the criterion standard but is considered invasive. CTA is less invasive, time-saving, and can show more anatomic structures in the neck in addition to the carotid arteries. It is a good screening diagnostic modality in the traumatology department. Although the treatments for Horner's syndrome and first rib fracture are conservative, the early diagnosis of both conditions can resolve the anxiety and uncertainty experienced by both doctors and patients.

Phyllodes tumors of the breast are the rarest of all breast neoplasms. Giant phyllodes tumors (>10 cm) of the breast have been less discussed in the literature. Reconstruction of the large defect created after wide excision (safety margin >1 cm) is a challenge in these patients. We present one technique using a bi-pedicled deep inferior epigastric perforator flap for post-mastectomy breast reconstruction for giant phyllodes tumors. We treated three patients with giant phyllodes tumors between 2013 and 2016. The histological characteristics were benign and borderline; tumor sizes were 18 × 13 × 12, 20 × 16 × 9.5, and 18 × 15 × 9 cm. Immediate post-mastectomy reconstruction was performed using bi-pedicled deep inferior epigastric perforator flaps. Flap sizes measured 30 × 11, 28 × 12, and 28 × 13 cm. Total operative time, including that for mastectomy, was 285, 425, and 410 min. The duration of hospital stay was 12, 13, and 9 days. No local recurrence or distant metastasis occurred in the first two patients over a follow-up period of 3 years and in the third patient over a follow-up period of 6 months. A higher local recurrence rate was associated with positive margins, histological grade, tumor size, and necrosis. Immediate post-mastectomy breast reconstruction may become the preferred option for treatment of giant phyllodes tumors. A bi-pedicled deep inferior epigastric perforator flap conferred adequate leverage for wide excision and resolved scar contracture of the axilla. Good functional and cosmetic results were achieved. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The difference in gender is often affected by the politics and the environment. A number of recent researches try to explore the impact of gender difference. As the internet becomes popularized, the way people learn is changed; many now learn through the internet. The present study unveiled the different types of video guitar learning lessons’influence on impulsive behavior, instrument learning self-efficacy, applicability, learning interest and user satisfaction. Online surveys were distributed through a guitar learning website, and a data of 177 containing 75 males and 42 females was obtained. Previous researches show that females have an overall higher satisfaction and learning interest than males.However, the results of the present study showed that there was no gender difference in impulsive behavior, instrument learning self-efficacy and applicability when learning through video guitar learning lessons. In addition, the male user satisfaction and learning interest were significantly higher than that of the female. Keywords-gender difference; self-efficacy; impulsive behavior; learning interest; user satisfaction

This paper proposes a region-based color correction method that corrects color-shifted images based on a reference image with a standard background. When correcting images without foreground objects, i.e., objects not in the reference image, both the reference image and the color-shifted image are segmented into several regions. A color correction process based on principal component analysis (PCA) is performed between the corresponding regions on the reference image and color-shifted image. The key concept of the color correction process is to align the color distribution of regions on the color-shifted image with the corresponding ones on the reference image by an Affine transform. The proposed color correction is also applicable to those images with foreground objects. In the experiments, the effectiveness of the proposed method is verified by testing some simple images and real-world images with and without foreground objects. Particularly, the proposed method effectively improves the skin-color area identification in a face detector, which is an important issue in many computer vision applications