Search

To assess the degree of pathological complete response (pCR), post-operative surgical complication rates and oncological outcomes in women with locally advanced (LABC) or high-risk breast cancers treated with neoadjuvant radiotherapy (NART).This retrospective multi-institutional review involved 138 clinically-staged patients with 140 breast cancers treated with NART between January 2014 and February 2021. Treatments involved sequential NACT and NART, followed by mastectomy with or without axillary surgery and immediate autologous breast reconstruction. Descriptive statistics were used to assess patient and disease features, treatment regimens, pathological response and factors affecting post-operative complications. Kaplan-Meier curves were performed to assess locoregional recurrence free, distant metastasis free and overall survival outcomes.Median age was 47 years (IQR 42-52). The median follow-up was 35.2 months (IQR 17.1-46.5). pCR was achieved in 36.4% (as defined by Chevallier Classification) or 42.1% (as defined by Miller-Payne scores) of patients. Higher pCR rates were achieved for HER2 positive (73.8%-85.7%) and triple negative phenotypes (47.6%-57.1%). There were 21 Grade 3 surgical complications including 10 Grade 3B breast events and 8 grade 3B donor-site events, where surgical reintervention was required. At 3-years follow-up, the locoregional recurrence free survival was 98.1%, distant metastasis free survival was 83.6% and overall survival was 95.3%%.NART is feasible to facilitate a single-stage mastectomy and immediate autologous breast reconstruction. This study demonstrated comparable rates of post-operative complication to standard of care, and high rates of pCR which translates to high rates of locoregional control, distant metastasis free survival and overall survival.

Introduction Neoadjuvant radiotherapy (NART) as part of a multi-modality approach for locally advanced breast cancer (LABC) requires further investigation. Importantly, this approach may allow for a single-staged surgical procedure, with mastectomy and immediate autologous reconstruction. Multiple other potential benefits of NART include improved pathological downstaging of breast disease, reduced overall treatment time, elimination of time period with breast tissue deficit and improved patient satisfaction. Methods This is a retrospective multi-institutional review of patients with LABC and high-risk breast disease undergoing NART. Eligible patients sequentially underwent neoadjuvant chemotherapy (NACT) with or without HER2-targeted therapy, NART, followed by mastectomy with immediate autologous breast reconstruction (BR) 4- to 6 weeks post-completion of radiotherapy. Patient and tumour characteristics were analysed using descriptive statistics. Surgical complications were assessed using the Clavien-Dindo Classification (Ann Surg 2004; 240: 205). Results From 3/2013 to 9/2019, 153 patients were treated with NART. The median age was 47 years (IQR 42-52), with median body mass index of 27. Eighteen patients experienced Grade 3 acute surgical complications. This included 13 Grade 3B breast-site events and 9 Grade 3B donor-site events, where further surgical intervention was required for management of wound infection, wound dehiscence, flap or mastectomy skin necrosis, haematoma and internal mammary venous anastomotic thrombosis. No autologous flap loss was observed. Conclusion Neoadjuvant radiotherapy facilitates a single-stage surgical procedure with mastectomy and immediate autologous BR, eliminating the delay to reconstructive surgery and thus shortening a woman's breast cancer journey. The findings of this review support the use of NART, with comparable rates of surgical complications to standard sequencing.

Introduction: The UK Government imposed a COVID19 lockdown (LD) restricting all but essential activities from 24th March 2020. Subsequently, there has been a significant reduction in casualty attendances nationwide including for ophthalmic emergencies. We aim to study the presentation of rhegmatogenous retinal detachments (RRD) and significant vitreous haemorrhage caused by posterior vitreous detachment (PVD-VH) in three tertiary centres covering most of the North West of England in the 6 weeks before and during the lockdown. Methods: A retrospective multicenter non-randomised consecutive case series study was designed to collect information on all cases of RRD and PVD-VH requiring surgery presenting to the vitreoretinal departments of Manchester Royal Eye Hospital, East Lancashire NHS Foundation Trust and the Lancashire NHS Foundation Trust from 11th February to 4th May 2020. Results: A total of 137 eyes of 137 patients were identified between the three centres of which 132 eyes were operated for RRD. Of these, 86 (64.7%) were operated pre-LD compared with 46 eyes (34.8%) during LD. Forty-five out of 86 eyes (52.3%) were macula-off pre-LD compared with 31 out of 46 eyes (67.3%) during LD ( p = 0.06). There was lower proportion of non-PVD related RRD during LD (11 pre-LD to 1 during LD, p = 0.05). PVR was present in four cases during LD compared to 2 before ( p = 0.19). Conclusion: There was a clinically significant reduction in the overall incidence of RRD in our centres with an increase in the proportion of macula-off and proliferative vitreoretinopathy during the LD period compared to a similar period before.

Purpose To evaluate a sequential approach of pneumatic displacement followed by vitrectomy (PPV) in failed cases to deal with submacular haemorrhage (SMH) of various aetiologies. Methods Retrospective, non-randomised interventional case series of consecutive patients with SMH of up to 2-weeks' duration, who were treated with a stepwise approach. Step 1 involved intravitreal injection of 0.3ml 100% C3F8 and rt-PA 50mcg/0.1ml. If unsuccessful, a prompt PPV with subretinal rt-PA 50mcg/0.1ml and 20% SF6 gas tamponade was carried out as a second attempt to displace the SMH. Results Thirty-one patients with SMH underwent pneumatic displacement; 24 (77.4%) had a successful outcome without further intervention. The mean presenting visual acuity (VA) of the 'successful cohort' was 1.34 logMAR (20/440 snellen), improving to 0.83 logMAR (20/135 snellen) 1-month after treatment. Five out of the 7 patients with failed pneumatic displacement underwent PPV with subretinal rt-PA at an average of 5 days post-step 1, with successful SMH displacement in 3 patients, giving an overall success of 87.1% for this treatment protocol. Conclusion A sequential approach of expansile gas injection followed by prompt PPV, aided by rt-PA at both steps, is a coherent, logical pathway to treat submacular haemorrhage with high anatomical and functional success.

The aim of this study was to analyse the volume and pattern of usage, media types and message contents of a smartphone group communication app within an acute surgical unit. WhatsApp® chatgroup history of a colorectal unit from August 2017 till January 2018 was analysed. The messages were categorised into text and multimedia messages, and further classified into groups based on contents, time of transmission and position of sender. 69% (11 of 16) of the participants were aged between 20-29 years old. 5,004 (4,498 clinical, 506 non-clinical) messages were transmitted over six months. 242 (5%) were multimedia messages or photographs. Of the clinical messages, 3,721 (83%) messages were relevant to patient care. There was significant after-hours communication (1,156, 23%). WhatsApp® usage peaked in December (1,555 messages). WhatsApp® meets the communication demands of clinical practice in a surgical unit. Its ability to support multimedia formats has significant advantage over traditional communication tools. Despite data security concerns, its usage had increased over time.

Phytobezoars are a rare cause of small bowel obstruction (SBO), which consists of vegetable matter such as seeds, skins, fibres of fruit and vegetables that have solidified. We present the case of a 61-year-old man with no previous surgery who presented with central abdominal pain, nausea and vomiting. An abdominal CT scan demonstrated SBO with a transition point in the left anterior abdomen. He proceeded to a laparoscopy, which revealed multiple perforations throughout the small bowel, from the proximal jejunum to the terminal ileum. Laparotomy was performed, and undigested chestnuts were milked out through the largest perforation and the perforations were oversewn. While obstruction due to phytobezoars is rare, this case demonstrates the importance of considering small bowel trauma and perforation due to phytobezoars and highlights the need for close inspection of the entire gastrointestinal tract for complications in the setting of phytobezoar-related bowel obstruction.

This report gives an overview of the Hoa (Chinese) community and its institutions in Phu Quoc, Vietnam. In particular it describes the linguistic landscape of the Hainanese, why the Hainanese language is maintained and the promotion of Mandarin has been difficult. The redevelopment of Chinese institutions, principally, the mutual aid association and the huiguan, helps to provide opportunities to maintain certain linguistic practices. However, without a linguistic market, the preservation of the Chinese school and the learning of Mandarin have not been easy.

A recent publication project entitled Asian Business Discourse(s) (Bargiela-Chiappini, 2005, 2006; Bargiela-Chiappini and Gotti, 2005) has brought to the attention of the international readership an original body of research on business discursive practices and organizational communication issues in a variety of Asian cultures. In this Forum, we discuss some of the topics highlighted by the project, which arise from the recent indigenous research in business discourse as a multidisciplinary field.

In the flip chip assembly process, no-flow underfill (NFU) has the advantage over traditional capillary-flow underfill because of the elimination of processing steps and the reduction of packaging cost. However, currently one of the major technical obstacles in applying no-flow underfill technology is the fillet cracking of no-flow underfill during the reflow after the moisture preconditioning. In this paper, comprehensive thermo-mechanical and hygroswelling models are established to study a larger die flip chip package with no flow underfill during reflow after moisture preconditioning. The adhesion strengths between no-flow underfill and die have been characterized. Based on the modelling results and the adhesion strength data, the reason why the crack on the no-flow underfill starts and propagates, leading to fillet cracking, is also explained. A series of parametric studies are also performed to eliminate or reduce the fillet crack. The results show that a lower coefficient of thermal expansion (CTE), a lower Young's modulus (E) and a higher cure temperature of no-flow underfill are desirable for the robustness of the package. The results also show that thinner die thickness is desirable for the robustness of the package. These findings form design guidelines for the design of larger die, copper pillar bump flip chip package with no-flow underfill.

Lexicographic evidence and oral translations of được in Vietnamese show its meanings as: “all right”, “agreed”, and “OK”. In reality, the undetermined range of probabilities in its meaning, imperceptible by non-native intuitions, are readily recognizable by natives. Not grasping what được means entails communication failures since to be told that something “can be done” induces a positive belief in English. This paper studies the meaning of được (can/OK) and compares it with chắc (là) được (probably can/OK) and chắc chắn được (certainly can/OK). It discusses the strategic and polite functions of được in business communication and shows that được is explorative as it sets the starting point for communication that could be furthered to reach a more conclusive result, explicitly lexicalized by chắc chắn được. It concludes that được is a non-committal “conflict-avoidance device” and “face-saver”. It is inconclusive that the farther the “distance” between the illocutors, the higher the degree of politeness, but supports the demand for ‘face’ over efficiency to a certain extent in the communicative style of the Vietnamese. Overall, it points to the need for long overdue analytic work on business discourse in cultural and social contexts, especially in lesser studied languages and cultures.

In the flip chip assembly process, no-flow underfill (NFU) has the advantage over traditional capillary-flow underfill because of the elimination of processing steps and the reduction of packaging cost. However, currently one of the major technical obstacles in applying no-flow underfill technology is the fillet cracking of no-flow underfill during the reflow after the moisture preconditioning. In this paper, comprehensive thermomechanical and hygroswelling models are established to study a larger die flip chip package with no flow underfill during reflow after moisture preconditioning. The adhesion strengths between no-flow underfill and die have been characterized. Based on the modelling results and the adhesion strength data, the reason why the crack on the no-flow underfill starts and propagates, leading to fillet cracking is also explained. A series of parametric studies are also performed to understand the package stresses. The results show that lower CTE & E of no-flow underfill and higher cure temperature of no-flow underfill are desirable for the robustness of the package. The results also show that thinner die thickness is desirable to the robustness of the package. These findings form design guidelines for the design of the larger die, copper pillar bump flip chip package with no-flow underfill

Children with Down syndrome have an increased risk of cryptorchidism, but the reported incidence is unclear. In a proportion of these children, the testes are within the scrotum at birth but later appear to have ascended to an ectopic position. Records of patients diagnosed with trisomy 21 who had surgery for undescended testes in two tertiary paediatric centres over a 10-year period were examined. Information on liveborn males with Down syndrome was obtained from the Victorian Genetic Registry, and then the incidence of congenital and acquired undescended testes was determined. The incidence of undescended testes in Down syndrome was found to be 6.52% (24/368), with 4.35% (16/368) being acquired undescended or ascending testes. In conclusion, there is an increased incidence of cryptorchidism in Down syndrome; in particular, there is a significant proportion of acquired undescended testes.