Lisboa, Isabel Neves Duarte;de Azevedo Macena, Monica Suela;da Conceicao Dias Fernandes, Maria Isabel;de Almeida Medeiros, Ana Beatriz;de Lima, Cyndi Fernandes;de Carvalho Lira, Ana Luisa Brandao
Asian Pacific Journal of Cancer Prevention
/
제17권7호
/
pp.3207-3211
/
2016
Background: Skin cancer has a remarkable importance given the high incidence in the population. In Brazil, it is estimated that there were 98,420 new cases of non-melanoma skin cancer among men and 83,710 new cases among women in 2014. Objectives: To verify signs and symptoms present in patients with skin neoplasms according to the literature and relate them to the nursing diagnoses of NANDA International. Materials and Methods: Integrative literature review carried out from March to May 2015 in the databases: Cumulative Index to Nursing and Allied Health Literature, SCOPUS, National Library of Medicine and Nattional Institutes of Health, Latin American and Caribbean Sciences of Health and Web of Science. The descriptors used were: 'Signs and Symptoms' and 'Skin Neoplasms'. Sixteen articles were identified as the final sample. After review, the signs and symptoms of skin cancer identified in the literature were related to the defining characteristics present in NANDA International, with the aim to trace possible nursing diagnoses. Results: The most prevalent signs and symptoms were: asymmetric and well circumscribed nodules with irregular borders; speckles with modified color aspect; ulcerations; blisters; pain; itching; and bleeding. The principal nursing diagnoses outlined were: risk for impaired skin integrity; impaired skin integrity; acute pain; risk of shock; and impaired comfort. Conclusions: The identification of signs and symptoms present in patients with skin cancer and the relationships of these with the nursing diagnoses of NANDA International provide a basis for qualified and systematized nursing care to this clientele.
Background: There are limited studies on oncoplastic breast conserving surgery in Asian women. We aimed to determine the applicability and safety of oncoplastic surgery, highlighting the specific circumstances when it will be most useful and compare our preferred technique with the worldwide practice of oncoplastic approaches. Materials and Methods: Breast cancer patients who underwent oncoplastic breast conserving surgery at a single institution from 1st May 2014-31st March 2015 were included. Data on patient demographics, tumor characteristics and the type of oncoplastic surgery performed were collected. Results: Nineteen breast cancer patients were identified. 42.1% of patients had grade I ptosis. The indications for surgery included a large tumor to breast size ratio (52.6%), multifocal/multicentric lesions (36.8%) and asymmetric breasts (10.6%), averting a mastectomy in 89.4%. Round block was the commonest technique in 63% of patients, in contrast to the inverted T pattern most frequently used in renowned institutions in the West. Mean and median tumor size and weight of specimen were 29.4/25mm (11 - 75mm) and 77g/64g (10 - 246g) respectively. Re-excision rate was 10.5%. Complete mastectomy was performed for one patient. One patient developed wound dehiscence which was treated conservatively. Cosmetic outcome was rated as excellent/good by 94.7% of patients. The patients remained clinically well after a median 16 months follow up. Conclusions: Oncoplastic breast conserving surgery is useful in a specific subgroup of Asian patients with a relatively small breast volume and minimal ptosis. Round block was the commonest technique in our series, in contrast to the worldwide utility of oncoplastic techniques. It is oncologically safe and has good cosmetic outcomes.
Purpose: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander. Methods: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction. Results: All patents were satisfied with the results and there occurred no specific complications. Conclusion: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.
Purpose: Gait is the most basic element when evaluating the quality of life with activities of daily living under ordinary life circumstances. Symmetrical use of the lower extremities requires complicated coordination of all limbs. Thus, this study examined asymmetry of muscle activity quadriceps femoris and tibialis anterior as a baseline for training during over-ground walking and stair walking of stroke patients. Methods: Subjects were 14 stroke patients included as one experimental group. Gait speed used in this study was determined by the subject. Low extremity paretic and non-paretic EMG was compared using the surface EMG system. Results: The low extremity EMG difference was statistically significant during over-ground walking and stair walking (p<0.05). The result of low extremity EMG substituted symmetry ratio formula was compared to EMG symmetry ratio in both legs during over-ground walking and stair walking. The average symmetry ratio of quadriceps femoris during over-ground walking was 0.65, and average symmetry ratio of quadriceps femoris during stair walking was 0.47, with significant difference (p<0.05). Conclusion: EMG data was higher in stair walking than over-ground walking. However, in the comparison of symmetry ratio, asymmetric EMG of quadriceps femoris was significantly increased during stair walking. These findings suggested that application of stair walking for strengthening of both legs can be positive, but the key factor is maintaining asymmetrical posture of both legs. Therefore, physical therapists should make an effort to reduce asymmetry of quadriceps femoris power during stair walking by stroke patients.
This article examines the scale effect of the flow characteristics, resistance and propulsion performance on a 317k VLCC. The turbulent flows around a ship in both towing and self-propulsion conditions are analyzed by solving the Reynolds-averaged Navier-Stokes equation together with the application of Reynolds stress turbulence model. The computations are carried out in both model- and full-scale. A double-body model is applied for the treatment of free surface. An asymmetric body-force propeller is used. The speed performances including resistance and propulsion factors are obtained from two kinds of methods. One is to analyze the computational results in model scale through the revised ITTC' 78 method. The other is directly to analyze the computational results in full scale. Based on the computational predictions, scale effects of the resistance and the self-propulsion factors including form factor, thrust deduction fraction, effective wake fraction and various efficiencies are investigated. Scale effects of the streamline pattern, hull pressure and local flow characteristics including x-constant sections, propeller and center plane, and transom region are also investigated. This study presents a useful tool to hull-form and propeller designers, and towing-tank experimenters to take the scale effect into consideration.
Purpose: Breast surgeons usually insert tissue expander or implant beneath the subpectoral - subglandular dual plane in breast reconstruction. But sometimes it happens unsatisfactory lower pole fullness, asymmetric inframammary fold and breast shape because there is implant migration due to the pectoralis major muscle contraction and gravity. To solve all the problem like these, we introduce implant breast reconstruction using AlloDerm$^{(R)}$(LifeCell Corp., Branchburg, N.J.) sling. Methods: The AlloDerm$^{(R)}$ sling was used in 13 patients and 18 breasts for implant breast reconstruction. After mastectomy, costal and lower sternal insertion of pectoralis major muscle was detached. Rehydrated AlloDerm$^{(R)}$ was sutured to the chest wall and serratus anterior fascia at the level of inframammary fold downward and to lower border of the pectoralis major muscle upward like crescent shape with tension free technique after implant insertion into the subpectoral - subAlloDerm dual pocket. Results: We make satisfactory lower pole fullness, symmetric inframammary fold and breast shape. In conclusion, patients obtain relatively natural breast shape. There was no complication except one case of capsular contracture and one case of breast cellulitis. Conclusion: Implant breast reconstruction using AlloDerm$^{(R)}$ sling makes easy to get natural breast shape through satisfactory lower pole fullness, symmetric inframammary fold and implant positioning.
Purpose: The pathophysiology of congenital muscular torticollis (CMT) is that the sternoclavicularmastoid (SCM) is shortened on the involved side by fibrosis, leading to an ipsilateral tilt and contralateral rotation of the face and chin. The aim of this study was to examine the effect of physical therapy and develop a mass diameter prediction model for infants with CMT. Methods: Fifty six patients were diagnosed with CMT between April 2003 and December 2008. Infants with neurological complications, and spasmodic and ocular torticollis were excluded. Physical therapy was applied to those masses in the SCM muscles of those infants after checking their physical findings and the diameter of the mass with ultrasonography. Their physical findings and mass diameter was reevaluated when their neck tilt was under $5^{\circ}$. Results: The mean age when physical therapy was started was 35 days. After a mean 90 days of treatment, the subjects showed improvement in the neck tilt. Subjects whose neck tilted above $15^{\circ}$ showed significant improvement in neck tilt decreased their mass diameter (p<0.01). Facial symmetric infants showed a shorter recovery duration than the facial asymmetric infants (p<0.05). A mass decreasing model based on the diameter of the mass, facial symmetry or not and the physical therapy start day after birth was developed by linear regression. Conclusion: Physical therapy is an effective treatment for CMT. The change in the diameter of the mass on the SCM muscles after treatment can be predicted.
Grunt (Stick-slip) noise happens between rear lining and drum on braking condition while vehicle is returning to steady position after nose-dive. The study presents a new testing and analysis methods for improving brake grunt noise on vehicle. Grunt noise is called a kind of stick slip noise with below 1kHz frequency that is caused by the surfaces alternating between sticking to each other and sliding over each other with a corresponding change in friction force. This noise is typically come from that the static friction coefficient of surfaces is much higher than the kinetic friction coefficient. For the identification of the excitation mechanism and improvement of grunt noise, it is necessary to study variable parameters of rear drum brake systems on vehicle and to implement CAE analysis with stick slip model of drum brake. The aim of this study has been to find solution parameters throughout test result on vehicle and dynamo test. As a result of this study, it is generated from stick slip between rear lining and rear drum and it can be solved to reduce contact angle of lining with asymmetric and is effected not only brake drum strength but also rear brake size and brake factor.
Organocatalysis is a relatively new and popular area within the field of chiral molecule synthesis. It is one of the main branches of enantioselective synthesis with enzymatic and organometallic catalysis. In recent years, immense high quality studies on catalysis by chiral secondary amines were reported. These progresses instantly led to different organocatalytic activation concepts, so thousands of researchers from academia and the chemical industry are currently involved in this field and new ideas, new approaches, and creative thinking have been rapidly emerged. Organocatalysts, some of which are natural products, appear to solve the problems of metal catalysts. Compared to metal-based catalysis, they have many advantages including savings in cost, time, and energy, easier experimental procedure, and reduction of chemical waste. These benefits originate from the following factors. First, organocatalysts are generally stable in oxygen and water in the atmosphere, there is no need for special equipments or experimental techniques to operate under anhydrous or anaerobic conditions. Second, organic reagents are naturally available from biological materials as single enantiomers that they are easy and cheap to prepare which makes them suitable for small-scale to industrial-scale reactions. Third, in terms of safety related catalysis, small organic molecules are non-toxic and environmentally friendly. Therefore, the purpose of this research is to develop novel synthetic methods and design for various organocatalyst. Furthermore, it is expected that these organocatalysts can be applied to a variety of asymmetric reactions and study the transition state of these reactions using a metal sulface. Here, we report the synthesis of unprecedented organocatalysts, proline and pyrrolidine derivatives with quaternary carbon center.
Tendon failures in bonded post-tensioned bridges over the last two decades have motivated ongoing investigations on various aspects of unbonded tendons and their monitoring methods. Recent research shows that change of strain distribution in anchor heads can be useful in detecting wire breakage in unbonded construction. Based on this strain variation, this paper develops a damage detection model that enables an automated tendon monitoring system to identify and locate wire breaks. The first part of this paper presents an experimental program conducted to study the strain variation in anchor heads by generating wire breaks using a mechanical device. The program comprised three sets of tests with fully populated 19-strand anchor head and evaluated the levels of strain variation with number of wire breaks in different strands. The sensitivity of strain variation with wire breaks in circumferential and radial directions of anchor head in addition to the axial direction (parallel to the strand) were investigated and the measured axial strains were found to be the most sensitive. The second part of the paper focuses on formulating the wire breakage detection framework. A finite element model of the anchorage assembly was created to demonstrate the algorithm as well as to investigate the asymmetric strain distribution observed in experimental results. In addition, as almost inevitably encountered during tendon stressing, the effects of differential wedge seating on the proposed model have been analyzed. A sensitivity analysis has been performed at the end to assess the robustness of the model with random measurement errors.
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