bluuebunny/crossref_metadata_2025 huggingface dataset:
Cranial Bone Grafting
Authors: Vyas Raj M.
Published: July 2019

This chapter provides a summary of calvarial bone graft utilization and technique. The authors provide a brief review of the anatomy, graft type selection, and procedural steps. The needs of the recipient site dominate decision-making regarding the calvarial graft. These needs include structural integrity, size, shape, and fixation of the graft. Autogenous calvarial grafting is a valuable technique for any surgeon working in craniofacial surgery. With proper consideration of recipient site needs and harvest technique, autogenous calvarial grafting is a useful procedure with benefits outweighing the inherent surgical risks. Also discussed is virtual surgical planning (VSP), which has contributed an additional option for calvarial defect reconstruction by broadening the treatment options to include custom three-dimensional printed polyether ether ketone (PEEK) inlays.
Basic Techniques in Septorhinoplasty
Authors: Kosins Aaron M. , Daniel Rollin , Nguyen Dananh
Published: July 2019

Indications for septorhinoplasty include both cosmetic and/or functional issues. Common cosmetic complaints include a hump, bulbous tip, wide dorsum and/or base, plunging tip, and asymmetry. Functional issues can be due to the nasal septum and turbinates as well as to the internal and external nasal valves. During initial assessment, it is very important for the plastic surgeon to discuss the patient’s individual wishes and concerns. Realistic expectations are paramount. This chapter will discuss the basic aspects of septorhinoplasty including preoperative analysis, surgical planning and operative technique.
Abdominoplasty
Authors: Paul Malcolm D.
Published: July 2019

The evolution of abdominal contouring began with excision of skin and subcutaneous tissue more than 100 years ago. This evolved into proper lower abdominal horizontal incision placement and fascial repair along with dermo-lipectomy. The introduction of liposuction was a sentinel event in body contouring, applicable as well to the entire abdomen. Taken further, abdominoplasty matured with targeted fat removal, fat grafting, and high-definition lipo-contouring. Limited undermining combined with targeted liposuction created an aesthetically pleasing abdominal contour while safely preserving the blood supply to the undermined flap. The introduction of barbed sutures for fascial repair and for wound closure, the use of basting sutures, and lateral to medial flap advancement moved modern abdominoplasty to a safer procedure with impressive aesthetic results. While producing an impressive aesthetic improvement was always the primary goal, increasing attention that focused on decreasing the risks of adverse events and sequelae was an important goal.
Body Contouring After Weight Loss
Authors: Amar Dalit , Rubin J. Peter
Published: July 2019

The goal of this chapter is to provide a comprehensive approach to management of massive weight loss (MWL) patients seeking plastic surgical reconstruction. The topics covered include the medical impact of obesity and the rise in bariatric surgical procedures that has increased the demand for plastic surgical reconstruction after MWL, critical factors for consideration in the preoperative evaluation of the MWL patient presenting for body contouring surgery, essential elements of intraoperative patient management, and a framework for deciding when to combine multiple procedures and when to perform them in separate stages. Preoperative evaluation of this unique cohort must take into account complex medical and psychosocial issues associated with obesity and operative planning requires unique strategies.
Skin Optimization Strategies in Plastic Surgery
Authors: Karamanoukian Raffy , Evans Gregory R. D.
Published: July 2019

Skin aging is a multivariate phenomenon that is influenced by an interdependent and patient-specific footprint of biologic and chronologic aging processes. The most common patterns of aging include degenerative changes to the skin, muscle, muscle fascia, and adipocyte. The interplay of these four variables is a fundamental focus of a modern plastic surgery practice. Plastic surgeons must be proficient in skin aging pathophysiology and the mechanisms to optimize skin with topical dermatologic monotherapy alone, or as a prelude to surgery or laser. The focus of this chapter is to highlight the importance of skin aging in the global assessment of the cosmetic patient and to elucidate the role of skin optimization in the management of the patient requesting rejuvenative cosmetic surgery.
Rhytidectomy
Authors: Paul Malcolm D.
Published: July 2019

Current concepts in rejuvenating the aging face and neck have evolved from simple undermining of the skin resulting in skin tension-based closure to various techniques that utilize the superficial musculoaponeurotic system (SMAS) as a supporting layer with no tension on the skin. The evolution of techniques regarding the manipulation of the SMAS began with an understanding of the anatomy of the facial nerve and sub-SMAS anatomy. Both volume-based and vector-based corrections are required. The selection of the appropriate technique is based on the clinical examination and the surgical options that the surgeon possesses. A safely performed procedure that provides impressive rejuvenation of the aging face and neck is always the goal.
Nasal Fractures
Authors: Lee Christine J. , Vyas Raj M.
Published: July 2019

The nose has several vital functions, including respiration and olfaction. The nose, as the leading point of the face, is without protective covering and is the least resistant of the facial bones to the application of a directional mechanical force. The management of isolated nasal fractures, therefore, requires a systematic approach to diagnosis, treatment, and follow-up care to ensure optimal functional and aesthetic results while minimizing complications. Good results can usually be obtained from a closed reduction of most nasal fractures in appropriately selected patients. Open reduction and wire or plate fixation should be considered in very displaced and severely comminuted fractures or when accompanied by adjacent facial fractures. Proper early operative management minimizes the need for secondary surgical revision.
Repair of Lip Defects with the Abbe and Estlander Flaps
Authors: Langstein Howard N. , Kroll Stephen S.
Published: July 2019

Repair of lip defects with Abbe and Estlander flaps requires a thorough knowledge of lip anatomy and physiology in order to achieve a successful outcome. Both the Abbe and Estlander flaps are unipedicled lip flaps that transfer tissue from one lip to the other. The Abbe flap is extremely useful for repairing moderately sized defects of either lip but requires a second stage to divide the vascular pedicle. The Estlander flap is a “terminal” Abbe flap at either commissure and does not require a second stage. This chapter will discuss the technical details for the performance of these lip flaps.
The Radial Forearm Flap
Authors: Evans Brogan G. A. , Evans Gregory R. D.
Published: July 2019

Radial forearm free-flaps (RFFF) offer great utility in the reconstruction of intraoral soft tissue defects. The use of a free tissue transfer with the radial forearm flap can obviate poor wound healing and replace previously irradiated tissue with well-perfused normal fascia and skin. Considerable care must be taken by the surgeon to preserve adequate function of speech and swallow, as well as to obtain good cosmesis. Knowledge of proper anatomical orientation and preoperative marking provide keys to a successful flap dissection and intraoral reconstruction. After reading this chapter, the reader should have an understanding of the assessment of intraoral defects, indications for RFFF, intraoperative techniques, and marking, as well as postoperative patient management.
ALT Flaps
Authors: Zelken Jonathan A. , Cheng Ming-Huei
Published: July 2019

The anterolateral thigh (ALT) flap is one of the most versatile and reliable of the thigh-based free flaps. The ALT flap is indicated for reconstruction of a diverse range of defects of various surface area and depths; it can be used as a “ultra-thin” flap for resurfacing, rolled up for filling in dead space, or taken with muscle to obliterate spaces or provide bulk. The flap has been used in trauma salvage as a flow-through flap, as a tissue carrier to “piggy back” additional flaps. The flap can be raised as a pedicled (proximally or distally) or a free flap, either supra- or subfascia with or without muscle or additional tissue components.
Latissimus Dorsi Free Flaps
Authors: Song David H. , Shenaq Deana S. , Smith Jesse
Published: July 2019

The latissimus dorsi myocutaneous flap for free tissue transfer has been and continues to be a workhorse for head and neck reconstruction. This chapter provides the indications and contraindications for its use and serves also to provide knowledge of its anatomy and dissection schema. The use of this flap for head and neck reconstruction allows for composite tissue transfers and lends well to a chimeric reconstruction where multiple different types of tissues (bone, skin, muscle, fascia) can be carried via a single pedicle. It also serves a role in functional restoration in facial reanimation.
The Free Fibula Flap
Authors: Houdek Matthew T. , Moran Steven L.
Published: July 2019

The free vascularized fibula flap has become the most common microvascular flap option for long bone and mandibular reconstruction following trauma and tumor extirpation. The free fibula flap can provide up to 26 cm of straight, cortical bone and has acceptable donor site morbidity. Published series have noted high rates of reconstructive success, with primary bony union rates of up to 80% and overall union of 97% following supplemental nonvascularized bone grafting. It is a true workhorse flap and one that all reconstructive plastic surgeons need to be familiar.
The Evolution of the Iliac Crest Flap
Authors: Yu Peirong , Schaverien Mark V.
Published: July 2019

The iliac crest free flap, although the gold standard for many years for mandibular reconstruction, remains an important option in the armamentarium for mandibular reconstruction. With the increasing popularity of the fibula osteocutaneous flap, which allows for more refined reconstruction and permits multiple osteotomies, the iliac crest flap is typically reserved for where the fibula flap is contraindicated, including in those with peripheral vascular disease, peroneal magnum, history of fibula fractures, and with previous bilateral fibular flaps. The many limitations of the traditional osteomusculocutaneous flap have been overcome by modified approaches to harvest, including the split iliac crest based on the inner cortex to preserve the thigh muscle attachments and reduce donor site morbidity, and the deep circumflex iliac artery perforator flap that does not include the bulky abdominal wall musculature and allows greater freedom of movement of the skin paddle. This chapter reviews the indications, anatomy, surgical techniques, and postoperative management for the free iliac crest flap.
Microtia Repair
Authors: Kanack Melissa , Tsai Catherine , Gosman Amanda
Published: July 2019

Microtia may occur as an isolated finding or in conjunction with other associated anomalies or a genetic syndrome. Ear reconstruction for these patients is typically performed no earlier than 6 years of age. In this chapter, a staged autogenous method of ear reconstruction is described using costal cartilage. In the first stage, a costal cartilage graft is harvested and placed. The next stages involve lobule transposition, detachment of the auricle with placement of a posterior skin graft, and further refinement of the external ear landmarks with tragus creation and definition of the conchal bowl and ear canal.
Cleft Lip Repair
Authors: Lance Samuel , Tsai Catherine , Gosman Amanda
Published: July 2019

Understanding the anatomy and surgical technique for repair of the unilateral and bilateral cleft lip remain essential to the practice of plastic surgery. This chapter summarizes the relevant anatomy, clinical evaluation, surgical technique, and postoperative care of the cleft lip patient. Step-by-step surgical descriptions and illustrations are provided along with commentary regarding common pitfalls encountered with these techniques. The surgical techniques described are a modified Millard rotation advancement technique for repair of the unilateral cleft lip and a modified Byrd repair for correction of the bilateral cleft lip.
Pharyngeal Flap
Authors: Yvas Raj , Patty Lauren D. , Mowlds Donald S.
Published: July 2019

Closure of the velopharyngeal sphincter is necessary for the correct phonation of vowels and most consonants. Dysfunction of the velopharyngeal sphincter allows excess air passage into the nasal cavity, resulting in altered speech. Surgeons rely on a handful of diagnostic modalities as well as perceptual speech analysis by cleft-trained speech-language pathologists for proper evaluation of the underlying abnormality causing velopharyngeal dysfunction and for determination of subsequent treatment options. Pharyngeal flap surgery is considered in patients whose dysfunction occurs due to velopharyngeal insufficiency from a large anteroposterior central gap during closure of the velum and pharynx. The pharyngeal flap creates a static central obstruction while maintaining two patent lateral airway openings, ultimately aiding in improved phonation of oral consonants.
Reconstruction of Orbital Defects
Authors: Ellis Marco F. , Cohen Mimis N.
Published: July 2019

Traumatic injuries and oncologic defects of the orbit can present several challenges to the reconstructive surgeon. Fracture care has evolved over the past 20 years, and emphasis is placed on both rigid fixation and minimizing postoperative complications related to surgical exposure. Computed tomography data can now be reformatted to create three-dimensional representations that improve our diagnosis and interpretation of common fracture patterns. In cases of tumor invasion, a multidisciplinary approach will optimize outcomes for the patient. The primary objective after enucleation is to maintain soft tissue and bony orbital volume, which will facilitate use of a prosthesis. Exenteration requires circumferential orbit resurfacing, especially in cases of concomitant craniotomy and partial maxillectomy. The ultimate priority in orbit reconstruction, regardless of etiology, is to provide aesthetic and functional reconstruction.
Naso-orbito-ethmoidal Complex Injuries
Authors: AlQattan Husain T. , Nugent Ajani , Thaller Seth
Published: July 2019

Comprehensive reconstruction of naso-orbito-ethmoidal fractures remains among the most challenging clinical problems for plastic surgeons. Successful repair centers on accurate diagnosis through a comprehensive history and physical examination and diagnostic imaging. Once this foundation is achieved, accurate anatomic reconstruction requires a stepwise approach and an intimate knowledge of the normal bony and soft tissue anatomy. The cornerstone remains the precise repositioning of the medial canthal tendon. Once this foundation is successfully reconstructed, the remaining bony framework can be anatomically, repositioned, reinforced, replaced with bone grafts &stabilized with rigid internal fixation.
Axillary Dissection
Authors: Shaterian Ashkaun , Lin Erin
Published: July 2019

Axillary dissection represents an evaluation of the axillary lymph node basin to provide prognostic and therapeutic value for cancer patients. Axillary lymph node dissection (ALND) is most commonly utilized in breast cancer but has applications in the treatment of other malignant neoplasms that may drain to the axillary lymphatics. ALND offers pathologic staging of cancer, therapeutic removal of clinically apparent axillary disease, and the removal of lymph nodes with possible subclinical disease following sentinel lymph node biopsy. The anatomy of the axillary space and technique of axillary dissection are discussed in detail in the chapter text.
Breast Reconstruction with Implants and Tissue Expanders
Authors: Barta Ruth J. , Adepoju Omotinuwe , Cunningham Bruce
Published: July 2019

This chapter details breast reconstruction following breast surgery. Over the past decade the number of women choosing reconstruction with tissue expanders and implants has steadily increased, while the percentage of women having autologous reconstruction has plateaued or fallen off. The authors explain the use of tissue expanders and implants and detail the advancements made in the ability to evaluate tissue in real-time intervals. Additional advances in technique, implant design, acellular dermal matrix, and fat grafting have improved the aesthetic results of breast reconstruction even further, and these techniques are discussed in detail. The authors address patient-specific indications and contraindications, the use of acellular dermal matrix, the assessment of the defect and perfusion, patient markings, room setup, and operative technique.
Posterior Thigh Flap for Pressure Sores
Authors: Ellstrom Christopher L. , Evans Gregory R. D.
Published: July 2019

Management of pressure ulcers requires a multifaceted approach for both prevention and treatment. The posterior thigh flap is one option for definitive surgical management. Treatment is initiated optimizing factors for wound healing and minimizing risk factors for recurrence. Obtaining adequate pressure offloading, moisture control, decreased wound contamination, and correction of any malnutrition should be addressed before considering surgery. The arc of rotation allows for potential closure of defects of the upper gluteal region, lower sacrum, greater trochanter, pubis, or perineum. Ischial ulcers treated with the posterior thigh flap can have a high rate of wound healing complications, but total flap loss and other serious complications are relatively rare. Partial loss or recurrence can often be treated with flap readvancement. Patient selection and preparation are keys to success.
Surgical Treatment of Postmastectomy Lymphedema
Authors: Teven Chad M. , Chang David W.
Published: July 2019

Secondary lymphedema is a common complication of cancer treatment, particularly in breast cancer patients. Its prevalence has been reported at up to 28% of patients after lumpectomy and up to 49% of patients who have undergone mastectomy. Currently, the most widely used procedures for treatment of lymphedema consist of variations using microsurgical technique. This chapter will highlight surgical treatment options for postmastectomy lymphedema, with a focus on vascularized lymph node transfer and lymphovenous bypass. In most cases, microsurgical techniques do not cure lymphedema. However, they do improve severity, reduce the number of complications associated with lymphedema, and improve quality of life.
Sentinel Lymph Node Dissection
Authors: Lalezari Shadi , Le-Tran Vivian V. , Lane Karen T.
Published: July 2019

Regional lymph node status is an important prognostic factor for patients with breast cancer and melanoma. Sentinel lymph node dissection (SLND) is used to determine lymph node status in the surgical staging of the clinically negative axilla in patients with clinical stage I, stage IIA, stage IIB, or stage IIIA T3, N1, M0 breast cancer. SLND is also indicated in patients with melanoma with Breslow depth > 1 mm. For breast cancer and melanoma patients in need of surgical staging of regional lymph nodes, SLND has significantly lowered the rates of surgical complications and morbidity compared to the more invasive complete lymph node dissection.
DIEP and Muscle Sparing Breast Free Flap
Authors: Nahabedian Maurice Y.
Published: July 2019

The deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flaps are arguably the most common flaps used for autologous breast reconstruction. The benefit of these flaps is that very little to no donor site muscle is harvested. The decision to use one or the other is occasionally made preoperatively based on body habitus but often intraoperatively based on the quality of the perforating vessels. The technical aspects of the operation are similar except for the actual dissection around the perforating vessels. Studies have demonstrated no significant differences in outcome when comparing the DIEP and MS free TRAM flaps.
Rectus Abdominis Flap for Perineal and Vaginal Reconstruction
Authors: Evans Brogan G. A. , Evans Gregory R. D.
Published: July 2019

Reconstruction of the vagina is usually performed in patients undergoing abdominal-perineal resection or pelvic exenteration for carcinoma of the cervix, vagina, or rectum. Vaginal reconstruction is indicated for both psychological rehabilitation and perineal wound healing. Immediate reconstruction after partial or total vaginal resection facilitates primary healing of the perineal defect, decreases fluid loss from the pelvis, reduces infection rate, prevents herniation of abdominal contents into the perineum, and decreases nutritional demands. Additionally, flap closure provides neovascularization of the remaining pelvic tissue, which is particularly important in successful wound healing for patients who have either had radiation to the area or who are having postoperative radiation therapy. Moreover, even in the sexually inactive patient, this surgery provides patients with faster healing and overall enhanced self-esteem
Gracilis Flap for Vaginal Reconstruction
Authors: Barton Natalie , Evans Gregory R. D.
Published: July 2019

Reconstruction of the vagina is performed for patients undergoing abdominoperineal resection, pelvic exenteration for cancer involving the cervix, vagina, or rectum, and other causes of acquired pelvic defects. Immediate reconstruction after partial or total vaginal resection facilitates primary healing of the perineal defect, decreases fluid loss from the pelvis, reduces infection rate, and decreases nutritional demands. The gracilis flap is one of the most commonly used flaps for reconstruction of these challenging pelvic defects because it is versatile, has minimal donor side morbidity, and often lies outside the field of radiation. This chapter provides a detailed account of patient assessment and operative techniques.
Pudendal Artery Flap (Singapore) for Perineal Reconstruction
Authors: Evans Gregory R. D.
Published: July 2019

Resection of the perineal area is challenging. Not only is there a component of loss of skin and muscle, but one must also consider reconstruction in an immediate or delayed fashion; whether a vaginal resection will result in partial or a total defect; and, if partial, whether the vaginal loss will be on the anterior, posterior, or distal vaginal wall. The pudendal flap may not be the best option for some of these defects. Loss of the vaginal introitus as well as part of the vault requires careful planning to provide a flap design with adequate length and width to prevent stenosis. Fraught with bacterial contamination, limitation of tissue advancement, and often tissues subjected to previous adjuvant therapy, perineal reconstruction is frequently accompanied by complications. Knowledge of the appropriate anatomy reduces morbidity. This chapter will focus on the pudendal (Singapore) artery flap for reconstruction. At the end of the chapter, readers should be able to understand the anatomy, design of the flap, and management of potential complications
Soleus Flap for Lower Leg Reconstruction
Authors: Friedman Jeffrey D. , Ruff Eric S.
Published: July 2019

Open wounds in the middle third of the lower leg often require soft tissue reconstruction to allow for primary wound healing. The soleus muscle flap is uniquely suited for this purpose and is used primarily as a muscle flap without the accompanying overlying skin. This muscle has a blood supply that is segmental in nature, arising from multiple perforators from the posterior tibial vessels. Given that that this blood supply is primarily located in the proximal third of the leg, the soleus muscle flap is generally based proximally to allow for coverage of middle-third defects. While the muscle has a clear intermuscular septum which separates the medial head from the lateral segment, the use of a so-called hemi-soleus flap is less reliable and thus used on an infrequent basis. The soleus muscle flap can also be based distally in the leg for small distal-third defects; however, this flap can often be unreliable due to a paucity of sufficient perforators located in this area.
Gracilis and Rectus Abdominis Flaps for Leg and Foot Reconstruction
Authors: Cusano Alessandro G. , Pu Lee L. Q. , Wong Michael S.
Published: July 2019

Distal third wounds of the lower extremity are challenging to reconstruct because vital structures are frequently exposed and local options are often limited. Free tissue transfer is regarded as the reconstructive gold standard for defects of the distal leg, ankle, and foot. The gracilis and rectus abdominis muscle flaps have proved reliable for free flap reconstruction of the distal lower extremity. This chapter provides a general approach to lower extremity reconstruction and highlights the role of the gracilis and rectus abdominis muscles and musculocutaneous flaps in the reconstruction of the distal lower extremity. Each flap is reviewed with special attention given to its indications, contraindications, anatomy, preoperative preparation, room setup, flap design, and harvest, as well as to donor site management. Considerations for flap inset and anastomosis as well as postoperative care are also discussed. Four case examples are also provided.
Nail Bed Injury
Authors: Mattison Gennaya L. , Leis Amber R.
Published: July 2019

This chapter provides a summary of nailbed injuries and outlines reconstructive algorithms and options for repair. Fingertip injuries, which are often associated with nail bed damage, are one of the most common injuries to the upper extremity. Successful treatment of such injuries requires an understanding of the anatomy, function, injury extent, and mechanism, as well as of the techniques available for reconstruction. Surgical judgment also comes into play, incorporating factors such as medical history, occupation, age, hand dominance, and expected outcome for the degree of damage.
The authors provide tips for efficient set up and management of fingertip and nailbed injuries in the emergency room.
Excision of Ganglion Cysts
Authors: Johnson Shepard P. , Chung Kevin C.
Published: July 2019

A ganglion cyst is a common reason for an outpatient hand surgery consultation. Clinically, a ganglion presents as a visible and palpable rubbery subcutaneous mass that is mobile and tethered to an underlying structure. Although commonly asymptomatic, patients may present with pain on activity and palpation, decreased range of motion and grip strength, paraesthesia from local nerve compression, or fears of malignancy. However, this benign soft-tissue mass is often asymptomatic, and it most frequently occurs on the dorsal wrist between the third and fourth extensor compartment. Excision is warranted for patients with recalcitrant pain, aesthetic concern, associated nerve entrapment, or to rule out an alternative etiology. Although recurrence is high, surgical excision is most effective when the synovial stalk communicating the ganglia with the underlying joint capsule is removed.
Palmar Fasciectomy and Fasciotomy for Dupuytren Disease
Authors: Johnson Shepard P. , Chung Kevin C.
Published: July 2019

Dupuytren disease is a connective tissue disorder of the palmodigital fascia that most commonly afflicts middle-aged males. Although the etiology is unknown, this fibroproliferative disorder results in the formation of nodules and cords that result in joint contractures that inhibit hand function. Minimally invasive treatment options include needle fasciotomy and collagenase injections to separate offending Dupuytren cords. If the latter are ineffective, open fasciotomy or fasciectomy is indicated. Dupuytren disease can be aggressive and therefore treatment success is predicated on an understanding of the pathophysiology and a thoughtful surgical approach.
Written by the Body: Evolutions of Embodiment in Maxine Hong Kingston’s The Woman Warrior and I Love a Broad Margin to My Life
Authors: Ng Audrey
Published: July 2019

While much has been written on embodiment and autobiographical narrative strategies in Maxine Hong Kingston's The Woman Warrior (1975), little critical attention has been given to these aspects in her latest foray into poetry, I Love a Broad Margin to My Life (2011). The materiality of bodies in her characters No Name Woman and Fa Mu Lan are altered across the two works in ways that reflect and engender a change in cultural necessities for peace. The female avenger's body evolves from a weapon that addresses wrongs through violence to the embodiment of Kingston's striving for a happy ending, on the page and also in reality, thus implicating her work with war veterans. No Name Woman's suicide changes from an embodiment of vengeful female subjectivity that is concomitant with biological destiny to an occasion of communal reconciliation. In tandem, Kingston's reappropriation of her portrayal of the swordswoman Fa Mu Lan in The Woman Warrior shows a progression from a soldier's aggressive filiality to patriarchal norms to a woman's act of self-violence that addresses the reality of post-traumatic stress disorder (PTSD) prevalent among war veterans. If life writing, as narrative psychologist Jerome Bruner argues, is capable of constituting identity and shaping future reality, Kingston's work of intersubjective remembering and community building through autobiographical narratives that constantly position the body at the intersection of public and personal identities has positive implications for her peace project.
Migrant votes ‘here’ and ‘there’: Transnational electoral behavior of Turks in the Netherlands
Authors: Mügge Liza , Kranendonk Maria , Vermeulen Floris , Aydemir Nermin
Published: July 2019

Whether there is a trade-off between ‘here’ (country of settlement) and ‘there’ (the country of origin) is one of the key political questions and concerns regarding political attitudes and behaviors of immigrant minorities. We take this issue by the horns and study three components of political attitudes and behavior within a transnational framework among Dutch-Turkish citizens in the Netherlands: turnout, political trust and interest, and party choice. The empirical data draws on original exit polls held during the Turkish presidential and parliamentary elections at a polling station in 2014 (n = 791) and in 2015 (n = 456). We find that that gender and country of birth influence electoral participation; social class (working class background as labor migrants) influences voting behavior. While there is a trade-off for political trust and voting behavior, there is no trade-off for political interest. These findings call for a more nuanced approach to transnational political behavior that is attentive to processes of convergence between ‘here’ and ‘there’ and the diversity within migrant groups.
Single-molecule visualization reveals the damage search mechanism for the human NER protein XPC-RAD23B
Authors: Cheon Na Young , Kim Hyun-Suk , Yeo Jung-Eun , Schärer Orlando D , Lee Ja Yil
Published: July 2019

DNA repair is critical for maintaining genomic integrity. Finding DNA lesions initiates the entire repair process. In human nucleotide excision repair (NER), XPC-RAD23B recognizes DNA lesions and recruits downstream factors. Although previous studies revealed the molecular features of damage identification by the yeast orthologs Rad4-Rad23, the dynamic mechanisms by which human XPC-RAD23B recognizes DNA defects have remained elusive. Here, we directly visualized the motion of XPC-RAD23B on undamaged and lesion-containing DNA using high-throughput single-molecule imaging. We observed three types of one-dimensional motion of XPC-RAD23B along DNA: diffusive, immobile and constrained. We found that consecutive AT-tracks led to increase in proteins with constrained motion. The diffusion coefficient dramatically increased according to ionic strength, suggesting that XPC-RAD23B diffuses along DNA via hopping, allowing XPC-RAD23B to bypass protein obstacles during the search for DNA damage. We also examined how XPC-RAD23B identifies cyclobutane pyrimidine dimers (CPDs) during diffusion. XPC-RAD23B makes futile attempts to bind to CPDs, consistent with low CPD recognition efficiency. Moreover, XPC-RAD23B binds CPDs in biphasic states, stable for lesion recognition and transient for lesion interrogation. Taken together, our results provide new insight into how XPC-RAD23B searches for DNA lesions in billions of base pairs in human genome.
Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments: a prospective cohort study
Authors: Thomas Alvin G , Ruck Jessica M , Chu Nadia M , Agoons Dayawa , Shaffer Ashton A , Haugen Christine E , Swenor Bonnielin , Norman Silas P , Garonzik-Wang Jacqueline , Segev Dorry L , McAdams-DeMarco Mara
Published: July 2019

Background

Disability in general has been associated with poor outcomes in kidney transplant (KT) recipients. However, disability can be derived from various components, specifically visual, hearing, physical and walking impairments. Different impairments may compromise the patient through different mechanisms and might impact different aspects of KT outcomes.

Methods

In our prospective cohort study (June 2013–June 2017), 465 recipients reported hearing, visual, physical and walking impairments before KT. We used hybrid registry-augmented Cox regression, adjusting for confounders using the US KT population (Scientific Registry of Transplant Recipients, N = 66 891), to assess the independent association between impairments and post-KT outcomes [death-censored graft failure (DCGF) and mortality].

Results

In our cohort of 465 recipients, 31.6% reported one or more impairments (hearing 9.3%, visual 16.6%, physical 9.1%, walking 12.1%). Visual impairment was associated with a 3.36-fold [95% confidence interval (CI) 1.17–9.65] higher DCGF risk, however, hearing [2.77 (95% CI 0.78–9.82)], physical [0.67 (95% CI 0.08–3.35)] and walking [0.50 (95% CI 0.06–3.89)] impairments were not. Walking impairment was associated with a 3.13-fold (95% CI 1.32–7.48) higher mortality risk, however, visual [1.20 (95% CI 0.48–2.98)], hearing [1.01 (95% CI 0.29–3.47)] and physical [1.16 (95% CI 0.34–3.94)] impairments were not.

Conclusions

Impairments are common among KT recipients, yet only visual impairment and walking impairment are associated with adverse post-KT outcomes. Referring nephrologists and KT centers should identify recipients with visual and walking impairments who might benefit from targeted interventions pre-KT, additional supportive care and close post-KT monitoring.
Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study
Authors: Kalkhoran Sara , Chang Yuchiao , Rigotti Nancy A
Published: July 2019

Introduction

Electronic cigarettes (e-cigarettes) could benefit public health if they help current smokers to stop smoking long term, but evidence that they do so is limited. We aimed to determine the association between e-cigarette use and subsequent smoking cessation in a nationally representative cohort of US smokers followed for 2 years.

Methods

We analyzed data from adult cigarette smokers in Waves 1 through 3 of the Population Assessment of Tobacco and Health study. The primary exposure was e-cigarette use at Wave 1. The primary outcome was prolonged cigarette abstinence, defined as past 30-day cigarette abstinence at Waves 2 and 3 (1- and 2-year follow-up).

Results

Among Wave 1 cigarette smokers, 3.6% were current daily e-cigarette users, 18% were current non-daily e-cigarette users, and 78% reported no current e-cigarette use. In multivariable-adjusted analyses, daily e-cigarette use at Wave 1 was associated with higher odds of prolonged cigarette smoking abstinence at Waves 2 and 3 compared to nonuse of e-cigarettes (11% vs. 6%, adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.08 to 2.89). Non-daily e-cigarette use was not associated with prolonged cigarette smoking abstinence. Among Wave 1 daily e-cigarette users who were abstinent from cigarette smoking at Wave 3, 63% were using e-cigarettes at Wave 3.

Conclusions

In this longitudinal cohort study of US adult cigarette smokers, daily but not non-daily e-cigarette use was associated with higher odds of prolonged cigarette smoking abstinence over 2 years, compared to no e-cigarette use. Daily use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.

Implications

In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years. Regular use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.
Collecting the golden water: Quality assessment on approach of diagnosing urinary tract infections in 0 to 36 months old children
Authors: Hamid Muhammad Akhter , Afroz Ruqiya , Ahmed Uqba Nawaz , Nanthakumar Arrutran , Arulchelvan Atchaya , Salim Asim
Published: July 2019

Objective

The study aimed to assess current practices of a community hospital for collection of urine sample when diagnosis of urinary tract infection (UTI) is suspected in children aged 0 to 36 months old.

Methods

An analysis of paediatric patients aged 0 to 36 months old was performed in two separate audits to assess the quality of urine sampling. The first, retrospective analysis comprised of urine collections techniques in a community hospital for diagnosis of UTI followed by an education intervention in which the hospital staff was briefed regarding the Canadian Paediatric Society (CPS) position statement for diagnosis and management of UTI. CPS recommendations were transposed using PowerPoint presentations, reminders at unit huddles, and other educational forums. Second audit was a prospective analysis which was conducted 6 months after the educations intervention.

Results

Bagged sampling had higher sensitivity and lower specificity due to sample contamination, versus transurethral bladder catheterization and suprapubic aspiration. The first audit showed that while 66% of culture-positive urine sampling was performed via the bagging, only 26% those positive cultures were repeated before treatment. In the second audit, after educational intervention, 33% of culture-positive urine collection was done via the bagging method and repeat testing was done in 83% of positive results on a bagged sample before initiating treatment. The false-positive rate for the diagnosis of UTIs in the first and second audit was 65.7 and 60%, respectively.

Conclusion

Our study recognizes the flaws in community hospital practices in the diagnosis of UTI in children and validates the significance of educational intervention in improving health care.
Effects of Transcranial Direct Current Stimulation for Treatment of Primary Dysmenorrhea: Preliminary Results of a Randomized Sham-Controlled Trial
Authors: Pegado Rodrigo , Silva Luana Karyne , da Silva Dantas Hégila , Andrade Câmara Hialison , Andrade Mescouto Karime , Silva-Filho Edson Meneses , Lopes Johnnatas Mikael , Micussi Maria Thereza Albuquerque Barbosa Cabral , Correia Grasiéla Nascimento
Published: July 2019

Objective

The aim of this trial was to investigate the effects of five consecutive sessions of anodal transcranial direct current stimulation (tDCS) over the motor cortex (M1) on pain, mood, and physical performance in patients with primary dysmenorrhea (PDM).

Design

This is a double-blind randomized controlled trial.

Subjects

Twenty-two participants with PDM according to the No. 345-PDM Consensus Guideline were included.

Methods

Eleven active treatment and 11 sham stimulation patients received five applications over a one-week period. The primary outcome measures were pain evaluated by numeric rating scale (NRS) and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule (PANAS), Hamilton Anxiety Scale (HAM-A), grip strength, and six-minute walk test (6MWT). Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected.

Results

The intervention provided significant improvements on NRS in active tDCS, shown as an interaction between group intervention vs pre/postintervention vs days of menstrual cycle (Wald x2 = 10.54, P = 0.005), main effect of days of menstrual cycle (Wald x2 = 25.42, P < 0.001), and pre/postintervention (Wald x2 = 6.97, P = 0.008). McGill showed an interaction effect between pre/postintervention and group of stimulation (Wald x2 = 18.45, P = 0.001), with a large reduction in active tDCS (P < 0.001, d = 0.75). Psychological and functional outcomes did not differ between groups or pre/postintervention.

Conclusions

tDCS could provide pain relief in subjects with PDM. These results provide some preliminary evidence for the potential role of tDCS as a contributor to the management of symptoms of PDM.
Free-energy landscape of molecular interactions between endothelin 1 and human endothelin type B receptor: fly-casting mechanism
Authors: Higo Junichi , Kasahara Kota , Wada Mitsuhito , Dasgupta Bhaskar , Kamiya Narutoshi , Hayami Tomonori , Fukuda Ikuo , Fukunishi Yoshifumi , Nakamura Haruki
Published: July 2019

The free-energy landscape of interaction between a medium-sized peptide, endothelin 1 (ET1), and its receptor, human endothelin type B receptor (hETB), was computed using multidimensional virtual-system coupled molecular dynamics, which controls the system’s motions by introducing multiple reaction coordinates. The hETB embedded in lipid bilayer was immersed in explicit solvent. All molecules were expressed as all-atom models. The resultant free-energy landscape had five ranges with decreasing ET1–hETB distance: completely dissociative, outside-gate, gate, binding pocket, and genuine-bound ranges. In the completely dissociative range, no ET1–hETB interaction appeared. In the outside-gate range, an ET1–hETB attractive interaction was the fly-casting mechanism. In the gate range, the ET1 orientational variety decreased rapidly. In the binding pocket range, ET1 was in a narrow pathway with a steep free-energy slope. In the genuine-bound range, ET1 was in a stable free-energy basin. A G-protein-coupled receptor (GPCR) might capture its ligand from a distant place.
Hepatotropic viruses (hepatitis A, B, C, D and E) in a rural Brazilian population: prevalence, genotypes, risk factors and vaccination
Authors: Caetano Karlla A A , Bergamaschi Fabiana P R , Carneiro Megmar A S , Pinheiro Raquel S , Araújo Lyriane A , Matos Marcos A , Carvalho Paulie M R S , de Souza Márcia M , de Matos Márcia A D , Del-Rios Nativa Helena A , Martins Regina M B , Motta-Castro Ana Rita C , Soares Caroline C , Cook Robert L , Teles Sheila A
Published: July 2019

Background

People living in settlement projects represent an emergent rural population in Brazil. Data on their health is scarce and there are no data on viral hepatitis in this population. This study investigated the epidemiology of viral hepatitis A-E in residents of settlement projects in central Brazil.

Methods

During 2011 and 2012, 923 people living in rural settlements in central Brazil were interviewed and tested to estimate the prevalence of exposure to viral hepatitis A-E, to identify the circulating hepatitis B virus (HBV)/hepatitis C virus (HCV) genotypes and risk factors for HBV exposure and to evaluate adherence to the hepatitis B vaccination series.

Results

Overall, 85.9, 3.9, 0.4 and 17.3% of individuals showed evidence of exposure to hepatitis A virus (HAV), hepatitis E virus, HCV and HBV, respectively. Among HBV-DNA positive samples (n=8), subgenotypes A1 (n=3) and A2 (n=1) and genotype D/subgenotype D3 (n=4) were identified. Hepatitis D virus superinfection was detected in 0/16 HBsAg-positive participants. A total of 229 individuals showed serological evidence of HBV vaccination. In total, 442 settlers were eligible for vaccination, but only 150 individuals completed the vaccine series. All anti-HCV-positive samples (n=4) were also HCV-RNA positive and identified as subtype 1a.

Conclusions

The intermediate endemicity of HAV, the higher prevalence of HBV exposure compared with urban areas and the low compliance with HBV vaccination requires preventive measures focused on rural populations, emphasizing the need for HAV and HBV vaccination.
Acibenzolar-S-Methyl Restricts Infection ofNicotiana benthamianaby Plantago Asiatica Mosaic Virus at Two Distinct Stages
Authors: Matsuo Yuki , Novianti Fawzia , Takehara Miki , Fukuhara Toshiyuki , Arie Tsutomu , Komatsu Ken
Published: July 2019

Plant activators, including acibenzolar-S-methyl (ASM), are chemical compounds that stimulate plant defense responses to pathogens. ASM treatment inhibits infection by a variety of plant viruses, however, the mechanisms of this broad-spectrum and strong effect remain poorly understood. We employed green fluorescent protein (GFP)-expressing viruses and Nicotiana benthamiana plants to identify the infection stages that are restricted by ASM. ASM suppressed infection by three viral species, plantago asiatica mosaic virus (PlAMV), potato virus X (PVX), and turnip mosaic virus (TuMV), in inoculated cells. Furthermore, ASM delayed the long-distance movement of PlAMV and PVX, and the cell-to-cell (short range) movement of TuMV. The ASM-mediated delay of long-distance movement of PlAMV was not due to the suppression of viral accumulation in the inoculated leaves, indicating that ASM restricts PlAMV infection in at least two independent steps. We used Arabidopsis thaliana mutants to show that the ASM-mediated restriction of PlAMV infection requires the NPR1 gene but was independent of the dicer-like genes essential for RNA silencing. Furthermore, experiments using protoplasts showed that ASM treatment inhibited PlAMV replication without cell death. Our approach, using GFP-expressing viruses, will be useful for the analysis of mechanisms underlying plant activator–mediated virus restriction.
Diagnostic qPCR Assay to Detect Fusarium brasiliense, a Causal Agent of Soybean Sudden Death Syndrome and Root Rot of Dry Bean
Authors: Roth Mitchell G. , Oudman Kjersten A. , Griffin Amanda , Jacobs Janette L. , Sang Hyunkyu , Chilvers Martin I.
Published: July 2019

Species within clade 2 of the Fusarium solani species complex (FSSC) are significant pathogens of dry bean (Phaseolus vulgaris) and soybean (Glycine max), causing root rot and/or sudden death syndrome (SDS). These species are morphologically difficult to distinguish and often require molecular tools for proper diagnosis to a species level. Here, a TaqMan probe-based quantitative PCR (qPCR) assay was developed to distinguish Fusarium brasiliense from other closely related species within clade 2 of the FSSC. The assay displays high specificity against close relatives and high sensitivity, with a detection limit of 100 fg. This assay was able to detect F. brasiliense from purified mycelia, infected dry bean roots, and soil samples throughout Michigan. When multiplexed with an existing qPCR assay specific to Fusarium virguliforme, accurate quantification of both F. brasiliense and F. virguliforme was obtained, which can facilitate accurate diagnoses and identify coinfections with a single reaction. The assay is compatible with multiple qPCR thermal cycling platforms and will be helpful in providing accurate detection of F. brasiliense. Management of root rot and SDS pathogens in clade 2 of the FSSC is challenging and must be done proactively, because no midseason management strategies currently exist. However, accurate detection can facilitate management decisions for subsequent growing seasons to successfully manage these pathogens.