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Breast cancer-related lymphedema is a major complication of breast cancer surgery. The lymphatic microsurgical preventive healing approach, a surgical technique that can prevent breast cancer-related lymphedema, creates a lymphovenous bypass between the damaged axillary lymphatics during axillary lymph node dissection and the axillary vein. We report a case using the unilateral lymphatic microsurgical preventive healing approach in a patient with bilateral breast cancer. A 58-year-old woman diagnosed with bilateral invasive ductal carcinoma underwent a bilateral nipple-sparing mastectomy. The lymphatic microsurgical preventive healing approach was performed on the left side after axillary lymph node dissection; the lymphatic microsurgical preventive healing approach was not performed after axillary sentinel lymph node biopsy on the right side. Six months after the surgery, MD Anderson Cancer Center stage 2 lymphedema was observed in the lymphography images of the right arm, where the lymphatic microsurgical preventive healing approach had not been performed.

Purpose: This study was performed to assess the effect of prophylactic lymphovenous anastomosis on the prevention of arm lymphedema after axillary lymph node dissection for breast cancer treatment.Methods: Among 69 women referred to undergo axillary lymph node dissection from January 2020 to June 2020, 21 were assigned to the treatment group and 48 to the control group. In the treatment group, 21 patients underwent prophylactic lymphovenous anastomosis for the prevention of breast cancer-related lymphedema. The other 48 patients in the control group did not undergo any preventive surgical treatment. Prophylactic lymphovenous anastomosis was performed at the same time as axillary lymph node dissection and breast cancer surgery. Postoperatively, all patients underwent circumferential measurements at 1, 3, and 6 months and lymphography at 6 months after the surgery. Results: None of the patients in the treatment group had lymphedema after the surgery (0%). In the control group, lymphedema occurred in nine patients (18.8%, p=0.049). No significant differences in the arm circumference were observed in the treatment group during follow-up (p>0.05), whereas the arm circumference in the control group showed a significant increase at 1, 3, and 6 months after axillary lymph node dissection (p0.05). Conclusion: Prophylactic lymphovenous anastomosis represents a valid super microsurgical technique for the primary prevention of breast cancer-related lymphedema.

Background During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients’ awareness of surgical treatment for secondary upper extremity lymphedema (UEL). Methods Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups. Results Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P Conclusions If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.

In this letter, we present a small pixel pitch image sensor optimized for high external quantum efficiency in short-wavelength infrared (SWIR). Thin-film photodiodes based on PbS colloidal quantum dot (CQD) absorber allow us to exceed the spectral limitations of silicon’s absorption while maintaining the benefits of CMOS technology. By monolithically integrating PbS CDQ thin films with CMOS readout arrays, high-pixel density SWIR image sensors can be achieved. To overcome the remaining disadvantages of the CQD-based image sensors over their bulk III-V semiconductor counterparts (lower sensitivity and reduced linearity), the thin-film photodiode stack is adapted towards the used readout circuit. A prototype image sensor with a $768\times 512$ resolution of 5- $\mu \text{m}$ pitch pixels is fabricated by using a modified 130 nm CMOS process for readout IC, together with the new CQD thin-film photodiode on top. Thanks to the optimized photodiode stack and co-integration process, the prototype image sensor shows less than 5% linearity error while having 40% external quantum efficiency in SWIR, which enables acquisition of high-quality images.

Purpose: The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.Methods: Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.Results: All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p

Background: To examine the correlation between lymphedema severity on lymphoscintigraphy and indocyanine green (ICG) lymphography in patients with secondary lower extremity lymphedema. Methods and ...

Image sensors are must-have components of most consumer electronics devices. They enable portable camera systems, which find their way into billions of devices annually. Such high volumes are possible thanks to the complementary metal-oxide semiconductor (CMOS) platform, leveraging wafer-scale manufacturing. Silicon photodiodes, at the core of CMOS image sensors, are perfectly suited to replicate human vision. Thin-film absorbers are an alternative family of photoactive materials, distinguished by the layer thickness comparable with or smaller than the wavelength of interest. They allow design of imagers with functionalities beyond Si-based sensors, such as transparency or detectivity at wavelengths above Si cutoff (e.g., short-wave infrared). Thin-film image sensors are an emerging device category. While intensive research is ongoing to achieve sufficient performance of thin-film photodetectors, to our best knowledge, there have been few complete studies on their integration into advanced systems. In this paper, we will describe several types of image sensors being developed at imec, based on organic, quantum dot, and perovskite photodiode and show their figures of merit. We also discuss the methodology for selecting the most appropriate sensor architecture (integration with thin-film transistor or CMOS). Application examples based on imec proof-of-concept sensors are demonstrated to showcase emerging use cases.

Summary Purpose To examine the correlation between lymphedema severity stages on lymphoscintigraphy and on indocyanine green (ICG) lymphography in patients with secondary lymphedema after breast cancer. Materials and Methods This retrospective study was conducted on patients who underwent both lymphoscintigraphy and ICG lymphography for the evaluation of secondary lymphedema after breast cancer. The images were classified into type I - V according to the Arm Dermal Backflow (ADB) stage and modified MD Anderson Cancer Center (MDACC) stage on ICG lymphography and lymphoscintigraphy images on the basis of how lymphatic flow was preserved and how dermal back flow was extended. The correlation between scales was analysed. Results A total of 47 patients were referred to our hospital for the evaluation of secondary lymphedema after breast cancer. There was no significant difference between lymphoscintigraphy severity scale and ADB stage (anterior and posterior). The lymphoscintigraphy severity scale and modified MDACC stage were significantly different. In the correlation analysis, lymphoscintigraphy and ADB (anterior) stage (r = 0.83), lymphoscintigraphy and ADB (posterior) stage (r = 0.86) and lymphoscintigraphy and modified MDACC stage (r = 0.85) exhibited very strong positive correlations. Intra-rater agreement between lymphoscintigraphy and ADB (anterior) stage and lymphoscintigraphy and ADB (posterior) was substantial (κ=0.62 and κ=0.69, respectively) and fair (κ = 0.36) between lymphoscintigraphy and modified MDACC stage. Conclusion Lymphoscintigraphy severity stage and ADB stage on ICG lymphography showed very strong positive correlation and substantial agreement. These two modalities can work synergistically to evaluate lymphedema severity.

Background: Negative-pressure wound therapy with instillation (NPWTi) is an adjunctive treatment modality for complex and infected wounds. However, commercial devices are expensive and not readily available in many countries. The objective of this study is to introduce an NPWTi method that is applicable where commercial NPWTi devices are not available and to report the clinical outcomes of the NPWTi method for the adjunctive treatment of complex wounds.Methods: This prospective clinical experimental study included 51 patients who had wounds on which operative debridement was performed between January 2017 and March 2019. A negative-pressure wound therapy (NPWT) device was applied with an intravenous (IV) line for continuous instillation of 0.9% normal saline plus 1% povidone-iodine solution for chronic wounds. The outcomes measured were the number of operating room visits, time to final surgical procedure, number of infected wounds, time to resolution of infection, type of reconstruction operation, and occurrence of complications.Results: The average number of operations performed was 2.5±0.8, and the time to final surgical procedure was 28.4±15.4 days. The number of infected wounds was 35 (68.6%), and the time to resolution of infection was 15.0±14.6 days. All wounds were closed or covered. Though partial graft failure occurred in two cases, they healed completely by secondary healing in 2 weeks.Conclusion: A continuous-instillation NPWT system using an IV line could be an adjunctive modality in treating complex wounds at institutions where commercial NPWTi systems are not readily available.

Background Pain caused by nasal pack removal after closed reduction of nasal bone fractures is a common problem. This study investigated the effect of infiltrating lidocaine into nasal packs on the pain caused by pack removal after closed reduction of nasal bone fractures. Methods Seventy-five patients who underwent closed reduction of nasal bone fractures between March 2016 and March 2018 were enrolled in this prospective, randomized, single-blind study. Merocel (hydroxylated polyvinyl acetate) packs were applied bilaterally and retained for 5 days. Twenty minutes before removal, both packs were rehydrated with 6 mL of 2% lidocaine in 26 patients and with 6 mL of saline in 24 patients; the packs were not rehydrated in 25 patients. Visual analog scale (VAS) scores for pain on removal were recorded. Results The mean VAS score was 5.3±2.0 in all patients, 3.8±1.5 in the lidocaine group, 5.8±1.4 in the saline group, and 6.3±2.1 in the non-rehydrated group. There was a significant difference in the pain score between the lidocaine and saline groups (P Conclusions Infiltration of lidocaine into Merocel packs reduced the pain caused by pack removal after closed reduction of nasal bone fractures.

This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is,1 hour (1 hour; n = 9) and over 1 hour (1 hour; n = 8). The patient's arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery (P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the 1 hour and 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.

Tissue engineering is a cutting-edge discipline in biomedicine. Cell culture techniques can be applied for regeneration of functional tissues and organs to replace diseased or damaged organs. Scaffolds are needed to facilitate the generation of three-dimensional organs or tissues using differentiated stem cells in vivo. In this report, we describe a novel method for developing vascularized scaffolds using decellularized rat kidneys. Eight-week-old Sprague-Dawley rats were used in this study, and heparin was injected into the heart to facilitate flow into the renal vessels, allowing heparin to perfuse into the renal vessels. The abdominal cavity was opened, and the left kidney was collected. The collected kidneys were perfused for 9 h using detergents, such as Triton X-100 and sodium dodecyl sulfate, to decellularize the tissue. Decellularized kidney scaffolds were then gently washed with 1% penicillin/streptomycin and heparin to remove cellular debris and chemical residues. Transplantation of stem cells with the decellularized vascular scaffolds is expected to facilitate the generation of new organs. Thus, the vascularized scaffolds may provide a foundation for tissue engineering of organ grafts in the future.

Background The dorsolateral branch of the posterior intercostal artery (DLBPI) can be easily found while harvesting a latissimus dorsi (LD) musculocutaneous flap for breast reconstruction. However, it remains unknown whether this branch can be used for a free flap and whether this branch alone can provide perfusion to the skin. We examined whether the DLBPI could be reliably found and whether it could provide sufficient perfusion. Methods We dissected 10 fresh cadavers and counted DLBPIs with a diameter larger than 2 mm. For each DLBPI, the following parameters were measured: distance from the lateral margin of the LD muscle, level of the intercostal space, distance from the spinal process, and distance from the inferior angle of the scapula. Results The DLBPI was easily found in all cadavers and was reliably located in the specified area. The average number of DLBPIs was 1.65. They were located between the seventh and eleventh intercostal spaces. The average length of the DLBPI between the intercostal space and the LD muscle was 4.82 cm. To assess the perfusion of the DLBPIs, a lead oxide mixture was injected through the branch and observed using X-rays, and it showed good perfusion. Conclusions The DLBPI can be used as a pedicle in free flaps for small defects. DLBPI flaps have some limitations, such as a short pedicle. However, an advantage of this branch is that it can be reliably located through simple dissection. For women, it has the advantage of concealing the donor scar underneath the bra band.

The materials of the dental barrier membranes (DBM), which is widely used for effective alveolar bone reconstruction, require high biocompatibility and additional functions. In this study, we prepared a chitosan/polyurethane (CSP) nanofibrous membrane incorporated silver nanoparticles (AgNPs) within the membrane. Characterization of CS-AgNP/polyurethane composite (AgCSP) nanofiber membranes showed that AgNPs were well embedded in chitosan membranes. In addition, biocompatibility and antibacterial effect against Porphyromonas gingivalis of the AgCSP was demonstrated by viability analysis and growth inhibition test. Collectively, AgCSP nanofiber membrane with antibacterial activity as well as biocompatibility may be useful in DBM and other tissue engineering applications.

Lens-free imaging (LFI) has become an important microscopy tool in many life science and industrial applications. Due to the absence of optical lenses (such as objectives) and accompanying lens aberrations (such as chromatic aberrations), the LFI modality is well suited for optical inspection of microscopic objects in a wide spectral range. However, the relatively restricted spectral sensitivity of CMOS imagers, i.e. from visible (~400 nm) up to near-infrared range (~900 nm), limits the wide spectral use of the technique. Many microscopic samples contain valuable information both in the visible and in the short wave infra-red (SWIR), sometimes in addition to visible (VIS) and near-infrared (NIR). With the recent emergence of cost-effective image sensor technologies such as quantum-dot and graphene-based image sensors with high quantum efficiency in SWIR, new lens-free imaging opportunities are emerging for wideband and high throughput microscopy. We demonstrate for the first time an LFI system based on a quantum-dot image sensor, capable of operating in both the visible and short-wave infrared range. The holograms of the samples are obtained through multiple partially coherent illumination sources in both visible and short-wave infrared (ranging from 405 nm to 1550 nm). The captured holograms are reconstructed to obtain images of the sample in focus. We demonstrate an optical resolution of 3.48 micron in a field of view of 9.6 mm2 over the whole spectral range. Our technique mitigates the need for bulky and expensive achromatic imaging optics and offers significant improvements in cost, field-of-view, scalability, and optical resolution to achieve microscopic imaging in both the visible and short-wave infrared spectral range with a simple imaging system. We present in this paper a performance analysis of the system and several potential applications and use cases.

As the smart mobile device market continues to grow and the number of cameras per device rapidly increases, demand for CMOS image sensors (CIS) also increases. Two major trends in mobile device cameras are: (1) adopting smaller pixels that enable greater pixel count at similar optical format, and (2) bigger pixels for higher image quality. To be more specific, front-facing cameras have a trend towards smaller pixels, while rear main cameras have a trend towards both smaller and bigger pixels. The optical format of front-facing cameras is especially limited due to existing bezel-less or border-less display designs, yet higher resolution still-shot and video (such as 4K UHD) recording is desired. To implement greater pixel count in a limited camera module size, scaling of pixel size is required. The main challenges are to maintain acceptable photodiode full-well capacity (FWC) and sensitivity, while suppressing optical crosstalk [1]. To completely eliminate both electrical and optical crosstalk, deep-trench isolation (DTI) has evolved from early BDTI (Back-side DTI) to current FDTI (Front-side DTI) technology, which is also called full-depth DTI. In this paper, a 44Mpixel CIS with 0.7µm pixels using full-depth DTI is demonstrated.

Paper description: The use of cryopreserved adipose tissue for soft tissue augmentation is common, but the unpredictability of fat graft viability remains a limitation. We demonstrated the effects of human adipose-derived stem cells (hADSC) plus sphingosylphosphorylcholine (SPC) on the survival of cryopreserved fat grafts in BALB/c male nude mice. The hADSC+SPC group showed higher survival rate in terms of weight and volume than the control or hADSC group. The hADSC+SPC treatment significantly increased the expression of angiogenic factors. These results point to the potential clinical benefit of hADSC+SPC. Abstract: The use of cryopreserved adipose tissue for soft-tissue augmentation is common, but the unpredictability of fat graft viability remains a limitation. Human adipose-derived stem cells (hADSC) have been introduced to enhance viability and improve the survival of transplanted fat tissue. Sphingosylphosphorylcholine (SPC) is a bioactive lipid molecule involved in various cellular responses. SPC stimulates the proliferation of various cell types such as hADSC. We demonstrated the effects of hADSC and SPC on the survival of cryopreserved fat grafts in nude mice. The cryopreserved fat grafts were treated with hADSC or hADSC+SPC, and a normal saline (control) mixture in BALB/c male nude mice. We examined the weight and volume of the mice in each group (n=11) at 8 weeks after transplantation to evaluate the survival of the fat tissue. The hADSC group showed increased weight and volume compared with the control group. The hADSC+SPC group showed a higher survival rate in terms of weight and volume than the control or hADSC group. In addition, the hADSC+SPC treatment significantly increased the expression of angiogenic factors. These results suggest the potential clinical utility of hADSC+SPC. https://doi.org/10.2298/ABS180220015B Received: February 20, 2018; Revised: April 12, 2018; Accepted: April 13, 2018; Published online: April 17, 2018 How to cite this article: Bae YC, Song JS, Nam KW, Kim JH, Nam SB. Effects of increased proliferation of human adipose tissue-derived mesenchymal stem cells by sphingosylphosphorylcholine on the survival of cryopreserved fat grafts. Arch Biol Sci. 2018;70(3):…

Angiosarcoma secondary to post-irradiation and lymphedema is rare, but it is aggressive with a poor prognosis. It is essential to understand these patients' clinical features and distinguish them from benign diseases or other malignant tumors.Three patients who had radiotherapy for cancer treatment and chronic lymphedema admitted to the hospital with specific skin lesions at upper or lower extremities.Excisional biopsies revealed prominent, highly atypical cells with a vasoformative area, composed of atypical, large epithelioid cells with vesicular nuclei, prominent nucleoli, and mitoses. Immunohistochemistry revealed diffuse expression of endothelial cell markers suggestive of angiosarcoma.One patient had shoulder disarticulation with wide excision with adjuvant radiotherapy and chemotherapy and other 2 discontinued the treatment.After the treatment, one patient was transferred to rehabilitation department for shoulder disarticulation prosthesis fitting without recurrence sign for 1 year. Two patient refused further treatment and was lost to follow-up.In cases of patients with irratiation and chronic lymphedema, clinical findings suggestive of angiosarcoma, biopsy and imaging studies should be performed as soon as possible.

We employed modified glass nanocapillaries to investigate interactions between the RNA-binding protein, known as cell carcinoma antigen recognized by T cells-3 (SART3), and the noncoding spliceosome component, U6 small nuclear RNA (snRNA), at the single-molecule level. We functionalized the nanocapillaries with U6 snRNA fragments, which were hybridized to DNA molecules and then covalently attached to the nanocapillary surface. When transported through the modified nanocapillaries, two different SART3-derived constructs, HAT-RRM1-RRM2 and RRM1-RRM2, exhibited resistive ionic current pulses with different dwell times, which represented their different binding affinities to tethered U6 snRNAs. The dissociation constants (KD), estimated from the bias voltage dependence of translocation events, were approximately 1.9 μM and 201 μM for HAT-RRM1-RRM2 and RRM1-RRM2, respectively. These values were comparable to corresponding values obtained with isothermal titration calorimetry, demonstrating that the modified gl...