Background: Skin- (SSM) and nipple-sparing (NSM) mastectomies are frequently performed surgeries with a considerable risk for post-operative hematoma or seroma. Tranexamic acid (TXA) is a potent antifibrinolytic drug commonly used in many surgical fields but rather novel in plastic and specifically breast surgery. This study investigates the influence of TXA in patients undergoing SSM or NSM with expander-based reconstruction (EbR) on post-operative outcomes. Methodology: A retrospective study was conducted on 132 patients undergoing uni- or bilateral SSM or NSM with EbR between May 2015 and March 2022. Patients receiving systemic TXA treatment for 48 hours following a standardized protocol were compared to those who received no treatment. Multivariable linear regression was performed to identify influencing factors and quantify their effect on drainage volume, duration of drain placement, length of hospital stay, post-operative bleeding, and seroma formation. Results: 132 patients underwent a total of 155 mastectomies (72 in the TXA group, 83 in the control group). TXA significantly reduced drainage volume (-22.3ml, P=0.011). Duration of drain placement and length of hospital stay were significantly shorter in the TXA group (P<0.001 and P=0.001). No significant side effects were reported. Conclusion: TXA is a safe drug if administered respecting the well-defined contraindications. Systemic TXA administration significantly reduces drainage volume in patients undergoing SSM or NSM and should encourage surgeons to reconsider using drains in post-operative protocols. Duration of drain placement and length of hospital stay were significantly reduced in the TXA group but other factors like resection weight might have a more substantial impact.

This work presents an innovative tri-generation system for the simultaneous production of desalinated water, electrical energy, and cooling, aimed at addressing the growing challenges of water scarcity and climate change. The system integrates an 8-stage MSF process and a 6-effect MED process, along with an expander-generator that improves cycle efficiency by utilizing and reintroducing steam within the desalination stages. A parametric study was conducted using ASPEN PLUS to evaluate the system’s performance. The analysis showed that the system operates over a broader pressure and temperature range than conventional MED systems, from 28.3 to 0.8 kPa and from 68 to 4°C, thanks to a dual ejector-condensation process. In cogeneration mode, the system achieves a PR of 12.06 and an RR of 54%0.54, producing 67,219.2 L/day of desalinated water and reducing electrical consumption by 12.03%. In tri-generation mode, it achieves a PR of 17.81 and an RR of 0.80%, with a cooling capacity of 1225 kW (COP of 3.278), producing 99,273.6 L/day of desalinated water while reducing electrical consumption by 3.69%. This system offers an efficient solution to meet the growing water and energy needs of coastal communities, combining water desalination, energy production, and cooling in a single integrated process.

The ever-growing concerns about global warming and the rapid depletion of fossil fuels have triggered a rising interest in research for cleaner, more efficient and cost-effective energy generation. Organic Rankine cycle systems have immense potential to become a strong alternative to conventional methods of energy generation. However, such systems’ efficiency is limited by the performance of the incorporated gas expanders or prime movers. Conventional gas expanders often utilize ports or cam-operated valves. Ported expanders offer limited efficiency and controllability, and produce high emissions causing a large amount of heated and compressed gas to be wasted. Cam-operated valves, in contrast, increase expansion performance compared to ported expanders, however, they have no variability and adaptability to changes in system parameters such as gas pressure, temperature, dryness fraction, and load variation to name a few. On a positive note, this issue can be addressed by adopting a variable timing and fast-operating, control valve with an accurate and adaptive control mechanism at the expander inlet. A properly designed and controlled valve can greatly improve the system performance of gas expanders and pave the way for an efficient low-cost alternative energy generation. This manuscript provides a comparative review of recent progress on the design, modeling, optimization, and control aspects of valves for gas expanders. A clear pathway on the scope of further development is also drawn based on the present state of the art.

Introduction The placement of implants is often hindered by a severely atrophic mandibular edentulous ridge. A sufficient volume of bone graft is crucial for successful implant restoration. The required bone graft volume directly correlates with the deficiency present in the edentulous ridge. If the residual crestal bone height is so low that the distance between the crestal ridge and the inferior alveolar nerve is less than 2 mm, a significant bone augmentation procedure is necessary. This procedure must ensure the implants are surrounded by a sufficient margin of bone, aiming for a final height of more than 8 mm and a width of more than 7 mm. Achieving primary closure with adequate soft tissue is vital for the success of the bone graft procedure. The key to successful bone grafting lies in the effective management of the soft tissue covering. Case Report This case report details the treatment of a patient with severely atrophic edentulous ridges on both sides, addressed using Self Inflating Tissue Expanders (SITEs) to facilitate bone grafting and implant placement. Following soft tissue expansion, bone grafting and implant placement were successfully performed. The implants supported a fixed restoration, which remained stable and complication-free over a seven-year observation period. Conclusion The SITE (Self-Inflating Tissue Expander) proved effective in obtaining a substantial amount of bone graft needed for implant installation. A seven-year follow-up confirmed the implants were well-functioning with stable bone support, healthy soft tissue coverage, and adequate vestibular depth.

The aim of this paper was to evaluate the changes in the mean bone density values of the midpalatal suture in 392 young patients treated with the Rapid Palatal Expander appliance according to sex, gender, vertical and sagittal skeletal patterns. Materials and Methods. The evaluations were performed using the low-dose protocol cone-beam computed tomography scans at t0 (preoperatively) and t1 (1 year after the beginning of the therapy). The region of interest was used to calculate bone density in Hounsfield units (HU) in the area between the maxillary incisors. Results. CBCT scan data of 196 females and 196 males (mean age of 11,7 years) showed homogeneous and similar density values of the MPS at T0 (547.59 HU - 565.85 HU) and T1 (542.31 - 554.20 HU). Class III skeletal individuals showed a significant higher BD than the II class group at T0, but not at T1. Females showed significantly higher BD than males at t0 and t1. No significant differences were found between the other groups and between two-time points in terms of bone density values of the MPS. Conclusions. Females and III class groups showed significantly higher bone density values than males and II class, respectively. No statistically significant differences were found from T0 to T1 in any groups, suggesting that a similar rate of suture reorganization occurs after the use of the RPE, following reorganization and bone deposition along with the MPS.