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Successful monitoring of technological processes using control of vibro-acoustic (VA) signals largely depends on the clarity of physical phenomena that determine the correlation between the functional parameters of the technological process and the diagnostic signs of vibration parameters. This article discusses such a relationship between vibration parameters and temperature in the core of technological processes. The experiments showed a stable pattern of changes in the parameters of VA signals with a change in the state of cutting tools in various technological processes associated with blade processing of workpieces. As such a parameter (Kf), the article considers the ratio of effective amplitudes in two frequency ranges: high-frequency and low-frequency. The most informative combination of frequency ranges is selected experimentally and depends on the dynamic characteristics of a particular elastic system. The paper gives examples of Kf changes for turning and grinding processes. To identify the nature of this phenomenon, experiments with the action of laser pulses on a steel plate with parallel recording of VA signals are considered. As a result, it is concluded that the Kf change is associated with a temperature increase in the frictional contact of the tool and the part when the cutting ability of the tool blade deteriorates. The work emphasizes that in the implementation of technological processes there are conditions that violate the described regularity. As such an example, the article shows an example of intense self-oscillations that changes the temperature regime in the contact zone. At the end of the work, it was shown that even during electric discharge machining, by changing the parameter Kf, it is possible to prevent short circuits and breaks in wire electrodes.

The rapid development of new technologies employing laser, electron beam, electroerosion and other processes as the working ones requires new approaches to developing systems controlling operations being performed. However, these processes do not lend themselves to visual observation and do not allow the introduction of any sensors into the working process zone, which suggests that vibroacoustic diagnostics methods should be used. The article discusses obtaining information from a vacuum chamber under electron-beam action on thin films of reinforcing coatings. It is shown that the parameters of vibroacoustic signals accompanying the formation of new structures can be recorded with the help of flexible waveguides in the form of a wire drawn from a vacuum chamber to a plate with an accelerometer. The article presents and discusses monitoring the formation of intermetallic compounds under the influence of a pulsed electron beam on an aluminum plate covered with a thin film of a heat-resistant nickel alloy.

Cystic neutrophilic granulomatous mastitis (CNGM) is an uncommon but increasingly recognised cause of mastitis, often associated with Corynebacterium ssp. infection. We studied the histopathological and clinical features of CNGM in a Canadian setting, and the work-up required to identify pathogenic microorganisms.A retrospective search for breast specimens with abscess, acute, chronic and/or granulomatous inflammation from 1998 to 2018 was performed. Haematoxylin and eosin slides were reviewed for typical histological features of CNGM. Histochemically stained slides for microorganisms were also reviewed. Repeat Gram stains were performed if initially negative. Electronic medical records were abstracted for microbiology results and relevant clinical data. Twelve cases were identified. All were female, aged 25-57 years, mainly Caucasian, with one Venezuelan and two of Chinese ethnicity. Most were parous (10 of 12); five of 12 had an endocrinopathy. Bacteria were identified in one or more specimens from eight of 12 patients; additional Gram stains revealed organisms in four of 12 cases. Of four bacterial cultures, one grew Corynebacterium kroppenstedtii. 16S polymerase chain reaction for three samples was negative. Two patients had multiple breast biopsies, showing early palisaded granulomas followed by classic features of CNGM. The patients had various management approaches, including surgery and antimicrobials.CNGM may present as palisaded granulomatous inflammation, without the expected 'cystic' pattern, suggesting that there is an evolution of histomorphology with this infection. Most patients with CNGM are parous, and there may be an association with endocrinopathies. Application of multiple Gram stains increases the yield of microorganism identification. Recognition of CNGM in breast biopsies and collaborative communications are essential to direct appropriate therapy.

Synthesis of intermetallic phases of AlNi system using surface alloying technology on the surface of aluminum alloy products is not highly stable, so it seems appropriate to use diagnostic systems. In such cases, the method of vibroacoustic signal registration can be used, since it allows to control the kinetics of the process and phase transformations associated with the change in volume. Under the action of a low-energy high-current electron beam, the appearance of a vibroacoustic wave is due to the effect of thermoelasticity in a thin surface layer capable of providing a reaction of self-propagating high-temperature synthesis between a thin film of a titanium or nickel alloy and an aluminum substrate. Tracking changes in the effective value of the vibroacoustic signal make it possible to clearly state the formation of the intermetallic phase and select rational modes of irradiation.

Breast reduction is a common procedure used to improve physical and aesthetic factors associated with breast hypertrophy. This study investigated how surgical technique alone affects the risk factors for complications and profiled differences between techniques. Complications were assessed by the use of time-to-event methods.Patient information was extracted from a cohort of 283 patients. Demographic, surgical, and follow-up information was analyzed for patients undergoing surgical procedures using the inferior pedicle Wise pattern (IPWP) and modified Hall-Findlay (MHF) techniques. The patients managed with the IPWP technique were considered control subjects. The failure rates were described using the Kaplan-Meier failure estimator to provide a true estimate of the experienced complication rates.Overall, few differences were noted between the groups except for total tissue removed. The overall failure (complication) rate at 6 months was 18.8%, with 9% of all the patients experiencing a major complication that required operative intervention/revision. As expected, the period with the greatest risk of complication was the first month after surgery. Surgical technique, total tissue removed, and age were nonpredictive of complications. Overall, the IPWP group had significantly more total tissue removed than the MHF group (median difference, 227 g; P=0.002). There was no evidence of a learning curve when an experienced surgeon moved from the one technique to the other.At 6 months after surgery, 19% of patients are expected to have experienced a complication. There appears to be few differences in outcomes between the techniques of breast reductions used, and the success or otherwise almost certainly relates to factors independent of surgical technique and includes patient selection, operative skill, and experience. Time-to-event analysis provides a precise assessment and description of the complication profile.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 at www.springer.com/00266.

Background: Differences in receptor status between primary and metastatic breast cancer are well recognized. We have previous demonstrated substantial receptor discordance rates resulting in a change in management in 14% of patients. However, while retrospective studies suggest that discordance can be associated with a worse patient prognosis, there are currently no prospective data assessing the impact of such discordance on survival outcomes. Methods: A single-center prospective biopsy study was performed. Patients with either recurrent or progressive disease underwent biopsy of their metastases. Subsequent treatment choices were modified according to the results and patients were followed up for progression or death. To account for the differing times at which patients entered the study, progression-free survival (PFS) was calculated as the duration between biopsy and either progression or death. Overall survival (OS) was defined as the duration from diagnosis of metastatic disease to death. A Cox propotional hazards model accounting for duration of metastatic disease and visceral versus non-visceral metastatic disease was utilized. Results: 121 biopsies were completed and 38% of cases showed discordance between the primary and the recurrence. Survival data were available from 96 patients. After a median follow-up of 11 months, 76 patients (79%) had progressed and 38 (40%) had died. There was no difference in median PFS between concordant and discordance cases (5.9 vs. 6.5 months, HR 0.89, p=0.61). There was a non-significant trend towards worse OS in discordant cases (50.6 vs. 57.8 months, HR 0.77, p=0.47). When compared with the primary tumour a gain of HER2 was associated with a poor survival, while loss of HER2 was associated with improved outcome. Metastatic biopsies showed a trend towards better prediction of response to endocrine therapy with tumors losing progesterone receptor expression between primary and metastatic disease having worse DFS on endocrine therapy. Conclusion: We have previously shown that performing metastatic biopsies is associated with a substantial rate of receptor discordance between primary and metastatic disease. The current analysis demonstrates that this discordance is associated with a trend towards worse OS, but not PFS. Knowledge of the receptor status of metastatic disease allows better prognostication between HER2-postive and HER2-negative disease and also allows for improved prediction of response to endocrine therapy. Metastatic biopsies should therefore be considered in patients with recurrent breast cancer. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD10-05.

Introduction:Struma ovarii is a rare, monodermal, ovarian teratoma. The common presentation is abdominal, with pelvic mass and pain, traditionally managed by gynaecologists. The malignant form is extremely rare and consists of differentiated thyroid cancer. It is rare for struma ovarii to present with features of hyperthyroidism. We present two unusual cases of struma ovarii and discuss the role of the thyroid surgeon in their management.Methods and results:The first case involved a 40-year-old woman with a two-month history of swelling in the lower abdomen. Investigations revealed a mass arising from the left ovary. Surgery revealed a follicular carcinoma arising in a struma ovarii. She underwent a total thyroidectomy prior to radio-iodine therapy. The second case involved a 60-year-old woman who underwent thyroidectomy for thyrotoxicosis. Three months post-operatively, she remained thyrotoxic despite stopping thyroxine. A whole body radio-iodine scan revealed high uptake in the left ovary. Histological analysis of the resected ovary showed benign struma ovarii.Conclusion:These two cases highlight the diagnostic and therapeutic role of thyroid surgeons in the management of benign and malignant forms of struma ovarii.

The objective of this work was to observe the various thermal-induced optical changes that occur in the near-infrared (NIR) during drilling in dentin and enamel with the laser and the high-speed dental handpiece. Tooth sections of ~ 3 mm-thickness were prepared from extracted human incisors (N=60). Samples were ablated with a mechanically scanned CO(2) laser operating at a wavelength of 9.3-µm, a 300-Hz laser pulse repetition rate, and a laser pulse duration of 10-20 µs. An InGaAs imaging camera was used to acquire real-time NIR images at 1300-nm of thermal and mechanical changes (cracks). Enamel was rapidly removed by the CO(2) laser without peripheral thermal damage by mechanically scanning the laser beam while a water spray was used to cool the sample. Comparison of the peripheral thermal and mechanical changes produced while cutting with the laser and the high-speed hand-piece suggest that enamel and dentin can be removed at high speed by the CO(2) laser without excessive peripheral thermal or mechanical damage. Only 2 of the 15 samples ablated with the laser showed the formation of small cracks while 9 out of 15 samples exhibited crack formation with the dental hand-piece. The first indication of thermal change is a decrease in transparency due to loss of the mobile water from pores in the enamel which increase light-scattering. To test the hypothesis that peripheral thermal changes were caused by loss of mobile water in the enamel, thermal changes were intentionally induced by heating the surface. The mean attenuation coefficient of enamel increased significantly from 2.12 ± 0.82 to 5.08 ± 0.98 with loss of mobile water due to heating.

The objective of this work was to observe the various thermal-induced optical changes that occur in the near-infrared (NIR) during drilling in dentin and enamel with the laser and the high-speed dental handpiece. Tooth sections of ~ 3 mm-thickness were prepared from extracted human incisors (N=60). Samples were ablated with a mechanically scanned CO(2) laser operating at a wavelength of 9.3-µm, a 300-Hz laser pulse repetition rate, and a laser pulse duration of 10-20 µs. An InGaAs imaging camera was used to acquire real-time NIR images at 1300-nm of thermal and mechanical changes (cracks). Enamel was rapidly removed by the CO(2) laser without peripheral thermal damage by mechanically scanning the laser beam while a water spray was used to cool the sample. Comparison of the peripheral thermal and mechanical changes produced while cutting with the laser and the high-speed hand-piece suggest that enamel and dentin can be removed at high speed by the CO(2) laser without excessive peripheral thermal or mechanical damage. Only 2 of the 15 samples ablated with the laser showed the formation of small cracks while 9 out of 15 samples exhibited crack formation with the dental hand-piece. The first indication of thermal change is a decrease in transparency due to loss of the mobile water from pores in the enamel which increase light-scattering. To test the hypothesis that peripheral thermal changes were caused by loss of mobile water in the enamel, thermal changes were intentionally induced by heating the surface. The mean attenuation coefficient of enamel increased significantly from 2.12 ± 0.82 to 5.08 ± 0.98 with loss of mobile water due to heating.

Post-thyroidectomy patients often complain of globus pharyngeus type symptoms. One of the organic pathologies recognized as causing globus pattern symptoms is goitre. We conducted a prospective questionnaire-based study in the thyroid clinic at Hull Royal Infirmary to examine the relationship between goitre, thyroidectomy and globus pattern symptoms by using the Glasgow–Edinburgh Throat Scale. A questionnaire-based study in which 41 consecutive patients due to undergo thyroidectomy prospectively completed the questionnaire pre-operatively and 12 months post-operatively. A subset of 25 randomly selected patients also completed the questionnaire three months post-operatively. Globus symptoms were not worsened by thyroidectomy at three or 12 months. Indeed two of the questioned parameters were significantly improved at three months, and six at one year (p < 0.023). In conclusion, thyroidectomy does not exacerbate globus pharyngeus symptoms. Indeed, in the absence of other clinical causes, when a patient has a World Health Organization (WHO) 2 goitre or greater, thyroidectomy may improve them.

In the absence of a healthcare budget enabling the import of ready-made aural grommets, Myanmar ENT surgeons have devised an ingenious ‘home-grown’ solution. We describe how grommets are made from raw materials bought from the local market.

The Salin subbasin of Myanmar (part of the larger Central basin) is a fore-arc/back-arc basin couplet situated between an oblique subduction zone to the west and a major right-lateral strike-slip fault to the east. Surface and subsurface expressions of folds and faults suggest that the basin experienced north-northwest-directed extensional deformation in the Miocene followed by east-northeast-directed Pliocene-Pleistocene transpressional deformation, resulting in a variety of structural styles, including thrust faults, oblique-reverse faults, strike-slip faults, and normal faults. Fault-propagation folds cored by west-dipping thrust faults in the basin center are located above steps in the top-of-basement surface (most likely fault controlled). Unconformities at the base of and within the Pliocene-Pleistocene synorogenic section indicate that the thrust faults were active during the Pliocene-Pleistocene. The southeastern region contains broad, north-northwest- trending uplifts and east-northeast-striking normal faults associated with thickened Miocene synorogenic deposits. Pliocene-Pleistocene sedimentary rocks lie unconformably above the Miocene section and are folded above the uplifts, reflecting Pliocene-Pleistocene compression. In the southern part of the basin, Miocene sedimentary rocks thicken dramatically over the 20°N uplift and the Yedwet uplift, suggesting that the north-northwest-striking faults that bound them represent Pliocene- Pleistocene inversion of Miocene normal faults. During the Miocene, the Burma plate acted as a fore-arc sliver coupled with the India plate, subducting obliquely underneath it, and moved northward relative to Asia along the Sagaing fault. Normal faulting and local basin formation took place at this time. When the northern part of the Burma plate collided with eastern Asia in the Pliocene, transpressional deformation predominated, creating thrust and reverse faults, positive flower structures, and inverted basins.

Excisions of neck lesions under local anaesthesia are made technically more difficult by the injection of anaesthetic agent, causing the lesion to become less palpable. Pen marking the lesion can circumvent the problem; however, this marking often disappears after skin preparation. We describe a technique which abolishes this problem.

Bone mineral density and bone remodelling markers osteocalcin and alkaline phosphatase in patients with Stage IV breast cancer F. Lumachi*, V. Camozzi, G. Luisetto, R. Orlando, S.M.M. Basso, A. Brunello, U. Basso Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, 35128 Padova, Italy Department of Medical and Surgical Sciences, University of Padua, School of Medicine, 35128 Padova, Italy UO Chirurgia 1, S Maria degli Angeli Hospital, 33170 Pordenone, Italy Istituto Oncologico Veneto (IOV) IRCCS, 35128 Padova, Italy

Purpose: Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and HER2/neu status of the primary tumour. This study prospectively investigated concordance in receptor status between primary tumour and distant metastases at various stages of progression and assessed the impact of any discordance on patient management.Methods: Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and HER2/neu. Receptor status of metastases was compared to the primary tumour. The treating physician completed questionnaires before and after biopsy to determine whether the biopsy result lead to a change in treatment plan.Results: One hundred and sixteen women were enrolled and 102 underwent biopsy. Of these 52 (51%) were newly diagnosed with metastatic disease, 17 (17%) had received one line of metastatic treatment and 35 (34%) had received 2 or more lines of treatment in the metastatic setting. 86/102 (84%) of samples were sufficient analysis; of these 5/86 biopsies (6%) showed benign disease and one biopsy (1%) confirmed a different malignancy (indolent lymphoma). Changes in hormone receptor status were observed in 33%. Among these, ER discordance was seen in 11%, PgR discordance in 27% and discordance in both ER and PgR in 5%. Loss of PgR was the most common change in hormone receptor status (25%). HER2/neu showed 4% discordance. Three patients (3%) gained and one patient (1%) lost HER2/neu expression. Biopsy results led to a change of management in 12% of patients. Patients with newly diagnosed metastatic disease were more likely to show discordance than those previously treated in the metastatic setting. Among triple negative primary tumours, no changes in receptor expression of metastases were seen.Conclusions: This is the largest prospective biopsy study we are aware of. Results demonstrate the presence of substantial discordance in receptor status between primary tumour and metastases. The number needed to biopsy to alter immediate management was 8.5, although biopsy information could also be useful in planning subsequent treatments. Tissue confirmation should therefore, be considered in all patients with suspicion of metastatic recurrence or progression. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2023.

Individual ZnO nanowires grown on a Pt tip were exposed to O2 and H2 in the course of field emission. O2 exposure was found to suppress field emission, while H2 reduced the turn-on voltage and increased the emission current. Upon UV (250?400?nm) illumination, the emission current increased almost immediately by about two orders of magnitude, but takes a much longer period, depending on the vacuum level, to fall to its original value following illumination. These phenomena can be accounted for with reference to mechanisms responsible for the sensitivity of metal oxides to oxidizing and reducing gases.