Background
TRAM breast reconstruction is commonly thought to be inadequate for underweight patients and LD flap with implant is usually recommended. However, it is often difficult to find an ...appropriate implant for thin Asian women with small breasts. The authors present the results of using TRAM flap alone for immediate breast reconstruction in underweight Asian patients.
Methods
Between September 2001 and October 2006, 564 patients underwent immediate TRAM flap-only breast reconstruction. Among these, 18 were underweight (BMI <18.5 kg/m
2
) and 317 were normal weight (18.5 kg/m
2
≤ BMI < 23.0 kg/m
2
). Complications were classified as systemic, breast, and donor site. Complication rate, oncologic outcome and overall satisfaction and recommendation were compared between two groups. Standardized postoperative photographs were also subject to a panel for cosmetic assessment.
Results
the overall complication rate was 22.2 % in underweight group and 27.1 % in normal weight group (
p
= 0.32). There was a tendency that the breast complication rate was higher in the normal weight group and the abdominal complication rate was higher in the underweight group. However, neither of these was statistically significant. Mean satisfaction was not statistically different, either (8.44 vs. 8.60,
p
= 0.54). Panel assessment for overall cosmesis, symmetry and scarring showed no significant between-group differences.
Conclusions
Immediate breast reconstruction using TRAM flap alone can be performed with acceptable complication rates and comparable patients’ satisfaction score in a well selected underweight Asian women as in a normal weight group.
A regional supplementary comparison, APMP.L-S4, was held in 2012 to demonstrate the equivalence of routine calibration services offered by NMIs to clients. Participants in this APMP.L-S4 comparison ...agreed to apply multi-step method for spidle error separation in order to yield the high precision roundness measurement. Eight laboratories from NMIs participated in this supplementary comparison; NIMT, NMIJ, NMIA, NIM, CMS/ITRI, KRISS, NMC/A*STAR and NMISA. This report describes the measurement results of 2 glass hemispheres and 2 softgauges. The calibrations of this comparison were carried out by participants during the period from March 2012 to May 2013. The results show that there is a degree of equivalence within 0.8 for all measurands. Hence, there is a close agreement between the measurements.
The isotropic, nonmagnetic doped BaBiO3 superconductors maintain some similarities to high-Tc cuprates, while also providing a cleaner system for isolating charge density wave (CDW) physics that ...commonly competes with superconductivity. Artificial layered superlattices offer the possibility of engineering the interaction between superconductivity and CDW. Here we stabilize a low-temperature, fluctuating short-range CDW order by using artificially layered epitaxial (BaPbO3)3m/(BaBiO3)m (m=1–10 unit cells) superlattices that are not present in the optimally doped BaPb0.75Bi0.25O3 alloy with the same overall chemical formula. Charge transfer from BaBiO3 to BaPbO3 effectively dopes the former and suppresses the long-range CDW; however, as the short-range CDW fluctuations strengthen at low temperatures charge appears to localize and superconductivity is weakened. The monolayer structural control demonstrated here provides compelling implications to access controllable, local density wave orders absent in bulk alloys and manipulate phase competition in unconventional superconductors.
We provide a rejoinder to a review (Rosen, 2015) of our original article “Making or breaking climate targets — the AMPERE study on staged accession scenarios for climate policy” (Kriegler et al., ...2015a). We have a substantial disagreement with the content of the review, and feel that it is plagued by a number of misconceptions about the nature of the AMPERE study and the integrated assessment modeling approach employed by it. We therefore see this rejoinder as an opportunity to clarify these misconceptions and advance the debate by providing a clearer understanding of the strengths, weaknesses, and ultimately the value of integrated assessment.
Background: Given the increasing incidence of multiple myeloma (MM) in Asian countries, effective treatment options for these patient (pt) populations are needed (Kim et al, Am J Hematol, 2014). The ...pivotal phase 3 FIRST trial investigated continuous treatment with lenalidomide plus low-dose dexamethasone until disease progression (Rd continuous) in pts with newly diagnosed MM (NDMM) who were ineligible for transplant from 18 countries, including China, South Korea, and Taiwan. Treatment with Rd continuous in the FIRST trial improved progression-free survival (PFS; hazard ratio HR = 0.72; P < .001) and overall survival (OS; HR = 0.78; P = .02) compared with melphalan-prednisone-thalidomide (MPT; Benboubker et al, N Engl J Med, 2014). This subanalysis of the FIRST trial examined the efficacy and safety of Rd continuous in the Asian population.
Methods: Pts with NDMM aged ≥ 65 years or ineligible for transplant were randomized to 3 treatment arms: Rd continuous, Rd for 18 cycles (Rd18; 72 weeks), or MPT for 12 cycles (72 weeks). The primary endpoint was PFS in pts treated with Rd continuous vs MPT (primary comparators). Secondary endpoints included OS, overall response rate (ORR), duration of response (DOR), and safety. Data cutoff was May 24, 2013; response and progression were assessed by an independent response adjudication committee. OS was assessed with extended follow-up at a data cutoff of March 3, 2014.
Results: Of the 114 pts enrolled in China, South Korea, and Taiwan, the median age (68 yrs range, 43-86 yrs) was similar across the Rd continuous (n = 36), Rd18 (n = 38), and MPT (n = 40) arms but was lower than that of the overall study population (73 yrs range, 40-92 yrs). Compared with the overall population, pts in Asia also had a higher rate of International Staging System stage III disease (45% in Asia vs 41% overall), a higher rate of Eastern Cooperative Oncology Group performance status ≥ 2 (28% in Asia vs 22% overall), and double the rate of severe renal insufficiency (creatinine clearance < 30 mL/min; 18% in Asia vs 9% overall), the latter of which was more frequent in the MPT (23%) and Rd18 (24%) arms vs the Rd continuous (8%) arm. There were more male than female pts (58% vs 42%) in the Asian population, with the exception of the MPT arm (50% each). The median treatment duration was 18.4 mos (range, 0.5-35.9 mos) for Rd continuous, 11.0 mos (range, 0.6-19.6 mos) for Rd18, and 11.1 mos (range, 0.3-19.1 mos) for MPT. Treatment with Rd continuous vs MPT resulted in a 39% reduction in the risk of progression or death (hazard ratio HR = 0.61; 95% CI, 0.33-1.14; Table). Rates of 2-year PFS were nearly doubled with Rd continuous (48%) vs MPT (25%). Rd continuous also resulted in a 48% reduced risk of death vs MPT (HR = 0.52; 95% CI, 0.24-1.13). Rates of 3-year OS were greater with Rd continuous (70%) vs MPT (56%). Similar improvements were observed for PFS and OS with Rd continuous vs Rd18. ORR was greater in the Rd continuous (78%) arm vs the Rd18 (66%) and MPT (58%) arms. Median DOR was not reached for Rd continuous and was 17.2 and 13.8 mos for Rd18 and MPT, respectively. The most frequent grade 3/4 adverse events with Rd continuous, Rd18, and MPT treatment were neutropenia (25%, 34%, 44%), anemia (19%, 5%, 15%), pneumonia (6%, 24%, 15%), and thrombocytopenia (14%, 5%, 5%). Deep vein thrombosis was reported in only 1 pt on the MPT arm, and pulmonary embolism was reported in 1 pt on each treatment arm. There were no reports of second primary malignancies in the Asian population.
Conclusions: Rd continuous treatment was associated with numerically larger PFS and OS benefits and higher response rates compared with MPT in the Asian subgroup of the FIRST trial, although pt numbers were small. Results from the Asian subgroup were consistent with that of the global population, with no unexpected safety signals observed, a low rate of thromboembolic events, and no second primary malignancies as of the data cutoff. These findings support the use of Rd continuous as standard treatment for pts with NDMM who are ineligible for stem cell transplant, including in Asian populations.
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Qiu:Celgene Corporation: Speakers Bureau; Johnson & Johnson: Speakers Bureau; Roche: Speakers Bureau. Yiu:Celgene Corporation: Employment, Equity Ownership. Chen:Celgene Corporation: Employment, Equity Ownership. Ervin Haynes:Celgene Corporation: Employment, Equity Ownership. Hulin:Celgene Corporation: Honoraria; Janssen: Honoraria; Amgen: Honoraria; Bristol Myers Squibb: Honoraria. Facon:Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Millenium: Membership on an entity's Board of Directors or advisory committees; Onyx: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Pierre Fabre: Membership on an entity's Board of Directors or advisory committees.
The electrostatic boundary-value problem of a slotted conducting wedge is solved by using the Mellin transform. Eigenfunction expansions are used to represent the fields, and boundary conditions are ...applied to constitute a set of simultaneous equations. Residue calculus is utilized to obtain a fast convergent series solution. The capacitance of a slotted conducting wedge is evaluated in terms of slot geometries.
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