Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by ...constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.
Introduction Bioelectrical impedance analysis (BIA) is the most used tool in clinical practice to evaluate body composition in patients with obesity. The skeletal muscle index (SMI) defined by BIA ...has been proposed for the identification of sarcopenia, but there are currently no univocal cutoffs for this condition. In this study, we aimed: 1) to determine the prevalence of sarcopenia in patients with severe obesity using the current cutoffs of SMI; 2) to define new specific cutoffs; 3) to validate the new cutoffs; and 4) to re-determine the prevalence of sarcopenia. Methods A total of 300 patients, 74% women and 26% men (mean age = 42.6 ±; 9 years), with morbid obesity (mean BMI = 46.7 ±; 6.5 kg/m 2 ) followed by the Unit of Endocrinology from January 2014 to December 2020 were retrospectively evaluated. SMI was calculated as the skeletal muscle mass normalized for squared height through the BIA equation by Janssen et al. Results The prevalence of sarcopenic obesity calculated using the cutoff points reported by De Rosa et al. (7.3 kg/h 2 for women and 9.5 kg/h 2 for men) was 2.3%. The prevalence of sarcopenia was calculated using the new cutoffs: with the cutoff obtained from the standard deviation method (8.2 kg/h 2 for women and 10.2 kg/h 2 for men), a prevalence of 14.7% was observed, whereas the prevalence reached 47.6% when using the cutoff calculated through the K -means unsupervised cluster (9.2 kg/h 2 for women and 11.3 kg/h 2 for men). The new cutoffs were validated with a second sample consisting of 300 patients with morbid obesity (BMI = 44.9 ±; 6.7 kg/m 2 ): the rate of sarcopenic patients was still higher than that observed in the training cohort (56%). After the matching procedure (by BMI and age), the rates of sarcopenic patients were similar in both groups (50.2% in the validation group and 53% in the training group, p = 0.6). Conclusion The new cutoffs calculated with cluster analysis could better identify sarcopenia in morbidly obese patients. However, further studies are needed to validate these cutoffs in different patient cohorts.
The mass migration of East European Jews and their resettlement in cities
throughout Europe, the United States, Argentina, the Middle East and Australia in
the late 19th and early 20th centuries not ...only transformed the demographic and
cultural centers of world Jewry, it also reshaped Jews' understanding and
performance of their diasporic identities. Rebecca Kobrin's study of the dispersal
of Jews from one city in Poland -- Bialystok -- demonstrates how the act of
migration set in motion a wide range of transformations that led the migrants to
imagine themselves as exiles not only from the mythic Land of Israel but most
immediately from their east European homeland. Kobrin explores the organizations,
institutions, newspapers, and philanthropies that the Bialystokers created around
the world and that reshaped their perceptions of exile and diaspora.
Breast implant–associated anaplastic large-cell lymphoma is a rare disease with a favourable prognosis if adequately treated. Same staged patients have usually a similar prognosis and outcomes, but ...in our experience, IIA-staged patients have a wider prognosis with outcomes that vary from complete disease response to death. This study aimed to understand and identify all the factors that could influence the prognosis of this group of patients and verify if their prognosis matches the stage they belong to.
Patients in stage IIA have been divided into two subgroups: IIAb with lymphoma extension towards the glandular tissue and IIAcw with tumour extension towards the chest-wall. The overall survival (OS) and event-free survival (EFS) of 64 BIA-ALCL cases were evaluated for each staged group.
Significant differences of OS and EFS between IIAb and IIAcw patients (log-rank p = 0.046 and log-rank p = 0.018, respectively) were observed and poor prognosis joined IIAcw- and IV-staged patients.
Chest-wall infiltration is a critical prognostic factor in BIA-ALCL patients as it influences the possibility of performing a surgical radical tumour extirpation. Our results could represent valid assistance for the physicians in choosing the most appropriate BIA-ALCL prognostic category and treatment and could promote further wider studies to provide stronger evidence on a possible revision of the MDA TNM classification.
•IIA BIA-ALCL-staged patients have a wide variability of prognosis and outcomes.•Overall survival analysis shows a different behaviour of IIA-staged BIA-ALCL patients.•Chest wall infiltration worsens the prognosis in IIA-staged BIA-ALCL patients.
This year, 2021, marks the “coming of age” for JoEB with its indexing in PubMed Central. It is also a century since some of the earliest studies on tissue impedance. This editorial briefly reviews ...the time-line of research in the field to mark this occasion.
Background: Body composition is frequently measured in women athletes to evaluate training changes, assist in dietary planning, and avoid the female athlete triad. Measurements to monitor %fat and ...fat-free mass (FFM) can provide valuable information for coaches and athletes throughout the training process. However, questions remain concerning the accuracy of various methods used to measure %fat. The purpose of this study was to assess the accuracy of bioelectric impedance analysis (BIA) devices to estimate %fat and FFM compared to dual-energy X-ray absorptiometry (DXA) in college women athletes.
Methods: A cross-section design was employed to assess %fat and FFM among college women athletes. Fiftyseven athletes (age = 20.0 1.4 yrs, height = 179.2 6.0 cm, weight = 74.3 4.4 kg) from soccer (n = 29), basketball (n = 15), and swimming (n = 13) had %fat estimated from four single-frequency BIA devices. Two BIA devices had general population equations (BIA1 and BIA2) and two had athletespecific equations (BIA3 and BIA4). Each device had proprietary equations for estimating %fat and was not capable of being updated. Each device had a 2-point electrode contact with either hands or feet. DXA %fat served as the criterion measurement. Percent fat was estimated directly by each device, and FFM was calculated as body mass minus fat mass. All measures were completed in single sessions for each athletic group with different sports groups being measured at the onset of their competitive season. Athletes were measured between 1400 and 1600 hours in a rested stated with hydration assumed and after voiding the bladder. A repeated-measures one-way analysis of variance (ANOVA) with Bonferroni post hoc testing was used to evaluate differences among measurement techniques with significance set at p<0.05.
Results: Three arm-to-arm BIA devices (BIA1, BIA2, and BIA3) were not significantly different in %fat estimates (23.1 ± 5.0%, 23.7 ± 4.7%, and 23.6 ± 4.3%, respectively) but were significantly lower than DXA (29.5 ± 5.1%). The leg-to-leg athletic BIA (BIA4) had a significantly higher %fat estimate (24.6 ± 5.7%) than BIA1 but was not significantly different from BIA2 and BIA3. The correlation of DXA %fat with BIA1 (r = 0.84), BIA2 (r = 0.85), and BIA3 (r = 0.85) were significant but not statistically different across the 3 devices. BIA4 had a significantly lower correlation (r = 0.66) with DXA %fat. The lower estimates in %fat resulted in significantly higher calculated FFM values for BIA1 (51.1 ± 5.5 kg), BIA2 (50.8 ± 59 kg), BIA3 (50.9 ± 6.9 kg), and BIA4 (50.1 ± 5.8 kg) than for DXA (47.5 ± 5.9 kg). However, all BIA estimates of FFM were highly correlated with DXA FFM (r = 0.90-0.93). Limits of agreement analysis indicatedthe average bias ranged from 2.2 kg (BIA4) to 3.4 kg (BIA1).
Conclusion: Single-frequency BIA devices utilized in this study tend to underestimate %fat and overestimate FFM compared to DXA in college women athletes. However, high correlations between predicted and actual FFM values indicate that single-frequency BIA devices may be useful for tracking changes in women athletes across seasons.
Summary
The work presented in this paper is inspired by the user grouping approach of topological blind interference alignment (top‐BIA), which is a semi‐blind IA scheme and the fact that the ...partially connected networks can be advantageous in terms of degree of freedom (DoF) and sum rate. The hybrid‐BIA scheme proposed in the paper uses top‐BIA to group users that are randomly distributed in a dense small‐cell network and aims to reduce the supersymbol length and overcome the DoF loss of the state‐of‐the‐art hierarchical BIA (h‐BIA) technique. The proposed scheme is very suitable for channels where coherence time is limited and also could attain a good DoF over a small number of symbol extensions. Both the sum‐DoF and the network throughput for hybrid‐BIA is greater than that of h‐BIA. By varying the number of user groups, the paper shows that h‐BIA constitutes a special case of hybrid‐BIA. Finally, the paper demonstrates the effect of changing the number of transmit antennas and number of small cells on the sum‐DoF gain of hybrid‐BIA over that of h‐BIA.
The proposed hybrid blind interference alignment (hybrid‐BIA) scheme first uses the topological information for users and base station (BSs) in a partially connected network to group the users that can be served at the same time. Afterwards, the state‐of‐the‐art hierarchical BIA technique is applied on the grouped users to reduced the supersymbol length and overcome the DoF loss of the hierarchical BIA.
Summary
Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL) is an uncommon T‐cell non‐Hodgkin Lymphoma (NHL) associated with breast implants. Raising awareness of the possibility of ...BIA‐ALCL in anyone with breast implants and new breast symptoms is crucial to early diagnosis. The tumour begins on the inner aspect of the peri‐implant capsule causing an effusion, or less commonly a tissue mass to form within the capsule, which may spread locally or to more distant sites in the body. Diagnosis is usually made by cytological, immunohistochemical and immunophenotypic evaluation of the aspirated peri‐implant fluid: pleomorphic lymphocytes are characteristically anaplastic lymphoma kinase (ALK)‐negative and strongly positive for CD30. BIA‐ALCL is indolent in most patients but can progress rapidly. Surgical removal of the implant with the intact surrounding capsule (total en‐bloc capsulectomy) is usually curative. Late diagnosis may require more radical surgery and systemic therapies and although these are usually successful, poor outcomes and deaths have been reported. By adopting a structured approach, as suggested in these guidelines, early diagnosis and successful treatment will minimise the need for systemic treatments, reduce morbidity and the risk of poor outcomes.
Introduction and purpose: Recently, the topic of the incidence of breast implant-associated anaplastic large cell lymphoma has become very popular. The aetiology of the disease is not fully ...understood. Many women worldwide have undergone breast implant surgery, so raising awareness about the possibility of developing BIA-ALCL is crucial for early diagnosis. The aim of this article is to review and compile the currently available knowledge regarding the association of anaplastic large cell lymphoma with breast implants in patients who have undergone implant plastic surgery. Brief description of the state of knowledge: Literature data indicate a multifactorial aetiology of BIA-ALCL. Textured surface breast implants are suspected to be a significant risk factor, as they may lead to the development of chronic inflammation. The most common symptoms of BIA-ALCL include the accumulation of serous fluid around the breast implant, pain, swelling or breast asymmetry. A proper diagnostic and therapeutic process improves the prognosis. Material and methods: A comprehensive literature review was conducted using PubMed and Google Scholar databases. The search strategy was based on the following terms: BIA-ALCL; lymphoma; breast implants; textured implants. Conclusions: Although BIA-ALCL is a rare disease, it is important to know the risk factors and clinical signs that may suggest the disease. A proper diagnostic process allows the disease to be detected at an early stage and treated effectively. Knowledge of the occurrence of potential complications of implant surgery allows patients to take informed consent and increases vigilance on the part of clinicians.
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