bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Acellular Dermal Matrix in Expander-Implant Breast Reconstruction after Total Skin-Sparing Mastectomy
Authors: Peled Anne Warren , Foster Robert D. , Garwood Elisabeth R. , Moore Dan H. , Ewing Cheryl A. , Alvarado Michael , Hwang E. Shelley , Esserman Laura J.
Published: January 2013

Background:

Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular dermal matrix nor a strategy for optimal acellular dermal matrix selection criteria has been well described.

Methods:

Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular dermal matrix) comprised 90 cases in which acellular dermal matrix was not used. Cohort 2 (consecutive acellular dermal matrix) included the next 100 consecutive cases, which all received acellular dermal matrix. Cohort 3 (selective acellular dermal matrix) consisted of the next 260 cases, in which acellular dermal matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis.

Results:

The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no–acellular dermal matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular dermal matrix in irradiated patients.

Conclusions:

Acellular dermal matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Bone Biology and Physiology
Authors: Buck Donald W. , Dumanian Gregory A.
Published: January 2013

The principles of bone biology and physiology permeate all subspecialty practices in plastic and reconstructive surgery from hand surgery to aesthetic surgery. Despite its importance in our practices, the biology of bone healing and bone physiology rarely surfaces within textbooks, literature reviews, or residency curricula. In this article, the authors present the first of a two-part series reviewing the important concepts of bone biology and bone physiology relevant to plastic surgery in an effort to ameliorate this educational gap.
An Analysis of the Experiences of 62 Patients with Moderate Complications after Full-Face Fat Injection for Augmentation
Authors: Kim Sung Min , Kim Young Seok , Hong Jong Won , Roh Tai Suk , Rah Dong Kyun
Published: January 2013

Background:

Recently, fat injection has been performed across the globe and has several advantages. However, there have not been many studies regarding the relationship between complications and contributing factors. The authors analyzed factors present when complications occurred during fat injections into the face.

Methods:

A retrospective chart review was performed for 62 patients who had moderate complications among the 1261 persons who had received full-face fat injection between April of 2004 and July of 2008. Complications included chronic edema, calcification, fibrosis, acne, headache, dysesthesia, drooping, and irregularity.

Results:

There were no differences among the first, second, and third injection groups regarding age, body weight, height, or body mass index. However, there were statistically significant differences in injection amount and complication occurrence time (p < 0.0001). There were statistically significant differences in injection amount and complication occurrence time between the fresh and frozen fat (p < 0.0001). There were statistically significant differences regarding age, injection amount, and complication occurrence time according to the complication groups (p < 0.0001). There was also a difference between timing of the injection and the complication frequency (Fisher's exact test, p < 0.0001) and between fat status and the complication frequency (Fisher's exact test, p = 0.005).

Conclusions:

Chronic edema, calcification, fibrosis, acne, headache, dysesthesia, drooping, and irregularity after full-face fat injection were observed as moderate complications. Although further study will be needed for the effective analysis of complications according to the number of injection or fat status, the authors found significant differences in age, complication occurrence time, and injection amount between some complication groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Current Surgical Management of Bilateral Cleft Lip in North America
Authors: Tan Stephan P. K. , Greene Arin K. , Mulliken John B.
Published: January 2013

Background:

This study was undertaken to determine contemporary surgical management of bilateral cleft lip.

Methods:

A survey was sent to North American cleft surgeons. Variables included number of bilateral cleft lip repairs per year, surgical specialty, and methods of nasolabial correction. The authors analyzed possible relationships between surgical specialty/volume and operative techniques.

Results:

The response rate was 40 percent (241 of 600). Annual bilateral nasolabial repairs per surgeon were as follows: zero to two, 30 percent; three to five, 46 percent; and six or more, 25 percent. For bilateral complete cleft lip, dentofacial orthopedics was used by 71 percent of respondents; synchronous closure was most commonly performed (88 percent); infrequent techniques were preliminary labial adhesions (11 percent) and staged labial closure (1 percent); and 50 percent undertook primary nasal repair. One half of respondents used nostril splinting following primary or secondary nasal correction. For bilateral incomplete cleft lip, 90 percent of surgeons performed synchronous labial repair and 36 percent did primary nasal correction. For both complete and incomplete bilateral cleft lips, high-volume surgeons were more likely to excise prolabial vermilion and use lateral vermilion-mucosal flaps to form the median tubercle. For bilateral asymmetrical cleft lip, 85 percent of surgeons practiced synchronous labial repair and 54 percent used dentofacial orthopedics on the complete side.

Conclusions:

Synchronous repair was the most frequent method for bilateral cleft lip; one-half of surgeons practiced primary nasal correction. There were no associations between surgical specialty/volume and operative principles or techniques for bilateral nasolabial repair, except for construction of the median tubercle.
Robotic Latissimus Dorsi Muscle Harvest
Authors: Selber Jesse C. , Baumann Donald P. , Holsinger F. Chistopher
Published: January 2013

Background:

The latissimus dorsi muscle is a workhorse of reconstructive surgery. Traditional harvest technique requires a long, posterior donor-site incision. Endoscopic harvest is limited by technical challenges. Robotic technology permits a simpler, minimally invasive harvest technique.

Methods:

Seven consecutive robotic latissimus dorsi muscle harvests were performed by a single surgeon. Two were used as free flaps for scalp reconstruction and the remaining five as pedicled flaps for breast reconstruction; three were for immediate, implant-based reconstruction with nipple-areola complex–sparing mastectomies, and two were for radiated breasts when the expander was exchanged for an implant. Harvest technique employed a short, axillary incision for pedicle dissection and two to three additional ports for robotic instrumentation.

Results:

All seven muscle flaps were harvested without converting to an open technique. Both free flaps were successfully transferred. All pedicled flaps resulted in successful breast reconstructions. Flap harvest complications included a single, temporary radial nerve palsy in the contralateral extremity, likely from positioning. There were no donor-site hematomas, seromas, or cutaneous thermal injuries. Robotic harvest time decreased from over 2 hours to about an hour over the study period.

Conclusions:

Robotic harvest of the latissimus dorsi is a novel and effective method of muscle harvest. It offers technical advantages over endoscopic harvest and aesthetic advantages over the open technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Body Contouring
Authors: Shermak Michele A.
Published: January 2013

Learning Objectives:

After studying this article, the participant should be able to: 1. List patient selection factors for body lift surgery. 2. Describe operative approaches for brachioplasty, upper body lift, abdominoplasty, lower body lift, and thigh lift. 3. Identify complications and pitfalls related to body lifting and describe how to avoid them.

The author discusses the preoperative assessment, surgical treatment plan, postoperative management, outcomes, and possible complications for a comprehensive spectrum of body-contouring surgical procedures. Preoperative planning includes medical history and physical examination, along with an open discussion with the patient. Surgical procedures for brachioplasty, upper back lift, abdominoplasty, lower back lift, gluteal augmentation and thigh lift are discussed. Postoperative management pearls are shared, as well as pitfalls to be avoided.
Assessing Strength of Evidence in Diagnostic Tests
Authors: Aliu Oluseyi , Chung Kevin C.
Published: January 2013

Clinical encounters between clinicians and patients begin with an attempt at diagnosis, a foundational element in determining a patient's ultimate outcome. Diagnosis that is expedient and accurate will result in a treatment that is expedient, appropriate, and cost-effective. In essence, evidence-based diagnosis is as vital as evidence-based intervention and treatment. If surgeons are committed to making expedient and accurate diagnoses, they must strive to apply diagnostic tests not just on the basis of ease, novelty, or availability but for the soundness of evidence behind them. In the scopes of both aesthetic and reconstructive surgery, advocating evidence-driven diagnostic test use is relevant. A pertinent example of how this relates to plastic surgery is the U.S. Food and Drug Administration recommendation to screen asymptomatic women with silicone breast implants with magnetic resonance imaging. For an important recommendation such as this that has tremendous cost implications to patients, sound study design and rigorous evaluation of the accuracy of magnetic resonance imaging as a screening tool has important health policy implications. The authors demonstrate how to determine the accuracy of diagnostic tests and, more importantly, illustrate the essential qualities of any study to establish the accuracy of a diagnostic test.
Complications in Surgery
Authors: Chung Kevin C. , Kotsis Sandra V.
Published: January 2013

Patients expect to receive quality medical care by relying on the concepts of evidence-based medicine. This quality care is expected to be provided at decreased costs for payors, some of whom have stopped reimbursement for cases involving “reasonably preventable” surgical complications. The purpose of this article is to introduce root cause analysis as a tool for identifying the causes of surgical complications. The authors also discuss preventive measures, such as improved communication, checklists, reporting systems, and the use of evidence-based medicine, that have been implemented to decrease surgical complications. These preventive measures can be used alone or together to decrease complications and improve overall patient care.
Benchmarking Academic Plastic Surgery Services in the United States
Authors: Song Elaine Horibe , Shirazian Afshin , Binns Brian , Fleming Yuedi , Ferreira Lydia Masako , Rohrich Rod J. , Azari Kodi
Published: January 2013

Rising health care costs and increasingly demanding patients are only some of the challenges faced by academic plastic surgery services in their pursuit of excellence in education, research, and patient care. Benchmarking, when correctly applied, is a powerful tool that can help services learn from each other's experiences. This study aimed at creating the first benchmarking report summarizing performance indicators and management practices of some of the most complete academic plastic surgery units in the United States. Results provide an opportunity for plastic surgery leaders to benchmark against their own units, identify eventual gaps, and improve their performance as needed.
Teaching Plastic Surgery from Different Perspectives
Authors: Cable Christian , Chong Tae , Pratt Daniel D.
Published: January 2013

Just as everyone has a different learning style, teachers too approach the task from different perspectives. There are five basic teaching perspectives or styles: transmission, apprenticeship, developmental, nurturing, and social justice. The acronym BIAS is useful to describe the beliefs, intentions, assessments, and strategies associated with each perspective. The authors present a hypothetical 1-week rotation in plastic and reconstructive surgery in which a student encounters instructors who embody the five basic teaching perspectives. By presenting these perspectives, the authors introduce valuable teaching techniques that can benefit all those charged with the education of learners along the spectrum from premedical to continuing education venues. Educational objectives include the following: (1) explain and illustrate different approaches to effective teaching in plastic surgery; (2) introduce readers to the Teaching Perspectives Inventory as a means of determining their primary teaching style; and (3) argue for a “plurality of the good” in teaching.
The Battle of Words and the Reality of Never Events in Breast Reconstruction
Authors: Adetayo Oluwaseun A. , Salcedo Samuel E. , Biskup Nataliya I. , Gupta Subhas C.
Published: January 2013

Background:

The Centers for Medicare and Medicaid Services has a list of 10 hospital-acquired conditions for which hospitals and physicians will not be reimbursed because it deems such conditions are preventable and should be considered “never events.” To evaluate the validity of this premise, the authors conducted a real-life analysis of the incidence and categories of never events occurring in a breast reconstruction cohort of a multisurgeon plastic surgery practice. Cost analysis of estimated revenue loss and risk factors associated with the development of never events are enumerated.

Methods:

A retrospective chart review of postmastectomy patients undergoing breast reconstruction from 2008 to August of 2010 was conducted. A total of 297 patients were identified and International Classification of Diseases, Ninth Revision codes corresponding to the never events of interest were applied to the study population.

Results:

Of the 297 patients, 24 (8.08 percent) developed never events in two categories: surgical-site infections (7.74 percent) and catheter-related urinary tract infections (0.34 percent). There were no complications in the remaining eight categories. Overweight body mass index and diabetes were strong independent risk factors for the development of never events (p < 0.0001). Cost estimates of associated revenue loss and economic analysis reveal substantial financial burdens to physicians and hospitals as a result of nonreimbursement.

Conclusions:

The “one-size-fits-all” approach of the Centers for Medicare and Medicaid Services may be misplaced and misleading. Certain risk factors are independent predictors of developing a never event, making it impossible to classify certain outcomes as “never” occurrences. The never events pendulum may have swung immensely to the left, and it is time to attain a much-needed equilibrium.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Abdominal Wall Stability and Flap Complications after Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Ochoa Oscar , Chrysopoulo Minas , Nastala Chet , Ledoux Peter , Pisano Steven
Published: January 2013

Background:

Promoted by reports of decreased donor-site morbidity, deep inferior epigastric perforator (DIEP) flaps have gained significant popularity. Increasing body mass index is associated with poor outcomes in breast reconstruction using traditional techniques. The authors aimed to define complications with increasing body mass index among patients undergoing DIEP flap breast reconstruction.

Methods:

A retrospective analysis of 639 DIEP flaps in 418 patients was performed. Patients were stratified into five groups based on body mass index. Data regarding medical comorbidities, adjuvant therapies, timing of reconstruction, active tobacco use, and surgical history were collected. Primary outcomes were compared among groups.

Results:

The average body mass index for the entire population was 28.3 (range, 17 to 42). Increasing body mass index was associated with increased incidence of hypertension, previous abdominal operations, and length of follow-up. Flap complications stratified by group demonstrated significantly increased delayed wound healing complications in severely obese patients compared with lower body mass index groups. Donor-site complications stratified by body mass index demonstrated significantly increased delayed wound healing and overall complications among morbidly obese patients compared with other groups. Incidence of abdominal wall bulging and hernia formation was not significantly different among groups.

Conclusions:

Increasing body mass index predisposes patients to delayed wound healing complications in both flap and donor-site locations. Nevertheless, overall flap complications remain similar across all body mass index groups. Abdominal wall stability was maintained. Given a similar flap complication profile and maintenance of abdominal stability, DIEP flaps are recommended in patients with increased body mass index.

CLINICAL QUESTION/LEVEL OF EVDENCE:

Risk, II.
Inverted-T Skin-Reducing Mastectomy with Immediate Implant Reconstruction Using the Submuscular-Subfascial Pocket
Authors: Salgarello Marzia , Visconti Giuseppe , Barone-Adesi Liliana , Franceschini Gianluca , Magno Stefano , Terribile Daniela , Masetti Riccardo
Published: January 2013

Background:

The inverted-T skin-reducing mastectomy with implant reconstruction represents a very effective reconstructive and cosmetic option in patients with macromastia. However, in this subset of patients, the risk of skin flap necrosis, especially at the T-junction, is significant. In this setting, complete implant coverage with viable tissue beneath the mastectomy skin flaps is essential to reduce morbidity. In this article, the authors retrospectively review their series of 16 skin-reducing mastectomy and immediate one-stage implant reconstructions using the submuscular-subfascial pocket, analyzing the reconstructive issues and cosmetic outcomes.

Methods:

Between June of 2008 and August of 2010, 14 women underwent skin-reducing mastectomy with immediate implant reconstruction using definitive anatomical gel implants, totalling 16 breasts. Reconstructive evaluation methods were clinically and photography-based assessment. The BREAST-Q was used to quantify patient satisfaction.

Results:

The average follow-up time was 18.6 months (range, 6 to 36 months). The average implant volume was 416.5 cc (range, 300 to 500 cc). The reconstructive outcomes were excellent to good, with patient satisfaction ranking high to very high, except in two patients who experienced skin necrosis (14.3 percent).

Conclusions:

The authors' series suggests that skin-reducing mastectomy with immediate implant reconstruction can be easily and safely performed when an appropriate conservative skin-reducing mastectomy pattern is designed, providing complete autologous implant coverage with the submuscular-subfascial pocket. However, further studies are needed to enhance patient selection and reduce the complication rate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Vascularized Bone Marrow Allotransplantation and Low-Dose Cyclosporine Prolong the Survival of Adipose Tissue Allografts
Authors: Hsieh Yu-Hsuan , Chen Wei-Fan , Huang Jung-Ju , Wu Chih-Wei , Engel Holger , Cheng Ming-Huei
Published: January 2013

Background:

Composite tissue allotransplantation holds promise in reconstructive surgery, but its application is limited by the need for long-term immunosuppression. The objective of this study was to investigate the feasibility of low-dose cyclosporine and vascularized bone allotransplantation in prolonging the survival of vascularized adipose tissue allograft.

Methods:

In the adipose tissue allograft model, adipose tissue allografts based on superficial epigastric vessels from Lewis-Brown-Norway rats were allotransplanted into Lewis rats. In the adipose tissue and bone marrow allograft model, combined vascularized bone marrow and adipose tissues were allografted from Brown Norway rats into Lewis rats. The graft survival, the onset and progression of rejection, and the effects of cyclosporine at different dosages and treatment durations were recorded. A rejection grading system was created based on gross observation and was correlated with histologic examinations.

Results:

Even at a low dose of 2 mg/kg/day, cyclosporine continued to provide effective allograft protection. Tolerance was not observed in either model. Adipose tissue survival after discontinuation of cyclosporine was independent of treatment duration. The inclusion of vascularized bone to the adipose tissue allograft provided an additional protective effect. This effect was synergistic with concomitant use of immunosuppressant.

Conclusions:

Adipose tissue allotransplantation is a potential reconstructive option that requires only minimal use of immunosuppressants. Its survival can be further prolonged with simultaneous bone marrow allotransplantation.
Keystone Island Flap Reconstruction of Parotid Defects
Authors: Behan Felix C. , Lo Cheng H. , Sizeland Andrew , Pham Toan , Findlay Michael
Published: January 2013

Background:

Skin cancers of the face and scalp have a propensity to metastasize to the parotid group of lymph nodes. The resection of these secondary tumors and other primary tumors in the parotid region often results in defects requiring flap reconstruction. Pectoralis major flaps are reliable and free flaps are arguably the criterion standard. However, we have found keystone island flaps to be a simple and robust alternative, with low donor-site and patient morbidity. The aim of this article is to share our surgical technique, experience, and outcomes of reconstructing parotid defects with keystone island flaps.

Methods:

The authors retrospectively reviewed 62 patients who had 63 parotid defect reconstructions at a single institution from 2004 to 2009 (5-year period).

Results:

The diseases involved were squamous cell carcinoma (52 cases), melanoma (five cases), basal cell carcinoma (four cases), and others (two cases). Nine patients presented with a previous history of radiotherapy and 33 patients required adjuvant radiotherapy. Seven patients (11 percent) suffered postoperative complications necessitating a return to the operating room.

Conclusions:

Keystone island perforator-based flaps present an alternative to free tissue transfer. From the series presented, it can be seen that reliable and reproducible results are achievable.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
An Evolution of Communication in Postoperative Free Flap Monitoring
Authors: Hee Hwang Jin , Mun Goo-Hyun
Published: January 2013

For more precise and rapid notification of free flap status between staff members after surgery, the authors used a smartphone and mobile messenger application including multimedia during the initial postoperative period and analyzed the influence of this method for the re-exploration time and survival rate of the flap before and after use. From April of 2010 to September of 2011, 123 consecutive free flaps were reviewed. The authors increased the flap survival rate from 96.2 to 100 percent and increased the threatened flap salvage rate from 50 to 100 percent with this method. The time interval between the first notification of flap compromise and the start of re-exploration was significantly shortened (4.0 versus 1.4 hours). This method not only provided better communication and comprehensive information but also allowed early diagnosis of flap compromise to be actualized at early re-exploration, ultimately increasing flap survival.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Magnitude of Effect of Cosmetic Breast Augmentation on Patient Satisfaction and Health-Related Quality of Life
Authors: McCarthy Colleen M. , Cano Stefan J. , Klassen Anne F. , Scott Amie , Van Laeken Nancy , Lennox Peter A. , Cordeiro Peter G. , Pusic Andrea L.
Published: January 2013

Background:

The objective of this study was to gain a better understanding of the magnitude of clinical change in health-related quality of life and patient satisfaction brought about by cosmetic breast augmentation.

Methods:

A prospective, longitudinal study was performed. Women undergoing cosmetic breast augmentation were asked to complete the BREAST-Q Augmentation module both before and after augmentation. Before and after group-level comparisons included paired t tests and effect size statistics. The responsiveness of the BREAST-Q scales was also compared at the individual person level by computing, for each and every person, the significance of her own change in measurement.

Results:

A total of 41 patients completed the BREAST-Q before and after augmentation. Patients reported that “satisfaction with breasts,” “psychosocial well-being,” and “sexual well-being” were significantly higher following augmentation compared with preoperative levels (p = 0.00, p = 0.00, and p = 0.00, respectively). These statistically significant change scores were associated with large effect sizes (d = 2.4, 1.7, and 1.9, respectively). Significant improvements in satisfaction with breasts, psychosocial well-being, and sexual functioning were seen in 38 (83 percent), 36 (88 percent), and 33 (81 percent) of individuals, respectively.

Conclusions:

These findings suggest that the BREAST-Q Augmentation module detected significant benefits of breast augmentation surgery, as assessed by both group-level and individual-level responsiveness indices. Importantly, this finding strongly supports the hypothesis that cosmetic breast augmentation can have a significant and profound positive impact on a woman's satisfaction with her breasts and her psychosocial and sexual well-being.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Complete Septal Extension Grafts Using Porous High-Density Polyethylene Sheets for the Westernization of the Asian Nose
Authors: Han Kihwan , Jeong Jin Wook , Kim Jun Hyung , Son Daegu , Kim Sukwha , Park Sang Woo , Choi Jaehoon , Choi Tae Hyun
Published: January 2013

Background:

In Asian rhinoplasty, most patients need correction of the nasal tip and columella along with dorsal augmentation. A complete septal extension graft can effectively and concomitantly correct less projected tips, retracted columellar bases, and acute columella-labial angles. However, the amount of septal cartilage is not sufficient as a source for the graft; therefore, the authors used porous high-density polyethylene sheets as their graft material.

Methods:

Fifty-eight patients were enrolled in the study between April of 1994 and July of 2001. The authors evaluated a total of 11 measurement items (three for nasal tip, three for columella, two for alar shape or flaring, one for nostril shape, and two for symmetry of the alae and columella) by photogrammetry using standardized clinical photogrammetric techniques.

Results:

Nasal tip projection, nasal bridge length, height of nose, and columella-labial angle increased significantly during an average follow-up period of 21 months, but nostril axis inclination, columellar length (Rt-Lt), and alar length (Rt-Lt) decreased significantly during the same study period. Implant exposure was noted in two cases, which was resolved by trimming the implants. Minor complications were stiffness of the columella (12 patients), buckling of the implant (nine patients), and excessive columellar show (two patients).

Conclusions:

A complete septal extension graft resulted in a more projected and caudally lengthened nasal tip; in addition, retracted columella and the acute columella-labial angle were improved aesthetically. Most complications were lower risk and preventable. Therefore, with careful use of porous high-density polyethylene, the authors could modify Asian noses into more Westernized noses.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Inferiorly Based Parenchymal Flap Mammaplasty
Authors: Bonomi Stefano , Salval André , Settembrini Fernanda , Gregorelli Chiara , Musumarra Gaetano , Rapisarda Vincenzo
Published: January 2013

Background:

Breast reduction and mastopexy are among the most frequent procedures in aesthetic breast surgery. Many approaches have been described, and various types of dermaglandular pedicles for the nipple-areola complex have been used. The authors present a technique suitable for either mastopexy or breast reduction whereby the superior or superomedial pedicle supplying the nipple-areola complex is combined with an inferior dermaglandular flap to restore the upper pole fullness, thereby improving breast shape and projection.

Methods:

From January of 2008 to January of 2010, 83 patients underwent inferiorly based parenchymal flap mammaplasty. Patients' ages ranged from 23 to 65 years. The mean follow-up period was 27 months. The inferior breast tissue that is usually removed in a superior/superomedial pedicle technique is spared and shaped as a small implant and stitched to the pectoralis major muscle. The superior/superomedial pedicle is used for the nipple-areola complex.

Results:

All the procedures were successful. No major complications were reported. All the patients were very satisfied with the shape, size, projection, and upper pole fullness of their breast postoperatively as reported by the questionnaire. Comparative evaluation test scores of a four-member jury were significantly higher regarding breast shape (p = 0.007), projection (p = 0.0041), and upper pole fullness (p = 0.0028).

Conclusions:

The inferiorly based parenchymal flap mammaplasty is a safe, versatile, and reproducible technique. It demonstrates ease of pedicle shaping and breast remodeling in patients undergoing mastopexy and breast reduction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Trophic indicators in fisheries: a call for re-evaluation
Authors: Hornborg Sara , Belgrano Andrea , Bartolino Valerio , Valentinsson Daniel , Ziegler Friederike
Published: January 2013

Mean trophic level (MTL) of landings and primary production required (PPR) by fisheries are increasingly used in the assessment of sustainability in fisheries. However, in their present form, MTL and PPR are prone to misinterpretation. We show that it is important to account for actual catch data, define an appropriate historical and spatial domain, and carefully consider the effects of fisheries management, based on results from a case study of Swedish fisheries during the past century.
Reverse Genetics by Loss-of-Function Mosaic Analysis in Drosophila
Authors: Kao Chih-Fei , Lee Tzumin
Published: January 2013

Genetic mosaics in Drosophila typically involve derivation of homozygous daughter cells from heterozygous precursors through mitotic recombination. MARCM (mosaic analysis with a repressible cell marker) couples loss of heterozygosity with derepression of a marker gene, permitting unique labeling of specific homozygous daughter cells. The generation of GAL80-minus homozygous daughter cells in otherwise heterozygous tissues allows GAL4-dependent activation of upstream activation sequence (UAS)-reporter specifically in the homozygous cells of interest. To make MARCM clones, organisms must carry at least five genetic elements (flippase [FLP], flippase recognition targets [FRTs], tubP-GAL80, GAL4, and UAS-marker) in specific configurations. One major application of MARCM, as described here, is to study cell-autonomous function(s) of a gene within single cells or a group of cells in otherwise unperturbed organisms. A mutation of interest distal to one FRT site is put in trans to a tubP-GAL80-containing chromosome arm that carries the same FRT. The resulting MARCM clones, which are negative for tubP-GAL80 and thus specifically marked, will become homozygous for the mutation in otherwise heterozygous organisms. By including a UAS-transgene, one can perform rescue experiments in the mutant MARCM clones. Conversely, if the mutation is placed on the same chromosome arm as tubP-GAL80, MARCM-labeled cells will be homozygous wild-type and may lie adjacent to sister cells that are homozygous mutant. This variant, called reverse MARCM, allows one to determine non-cell-autonomous effects of a mutation.
In Vitro Imaging of Retinal Whole Mounts
Authors: Williams Philip R. , Morgan Joshua L. , Kerschensteiner Daniel , Wong Rachel O.L.
Published: January 2013

Neuronal circuits of the vertebrate retina are organized into stereotyped laminae. This orderly arrangement makes the retina an ideal model system for imaging studies aimed at understanding how circuits assemble during development. In particular, live-cell imaging techniques are readily applied to the developing retina to monitor dynamic changes over time in cell structure and connectivity. Such imaging studies have collectively revealed novel strategies by which retinal neurons contact their presynaptic and postsynaptic partners to establish synaptic connections. We describe here the procedures developed in our laboratory for confocal and multiphoton live-cell imaging of the developing retina using in vitro retinal explants. Retinas can be removed from the eye and kept in culture conditions for several days with limited disruption to the retinal circuit. The explanted retina is amenable to a variety of labeling techniques and provides a large, flat, unobstructed surface that is ideal for optical imaging experiments. This protocol describes procedures for mounting and imaging the isolated mouse retina. The same general procedure, with only minor modification (composition of culture medium), has been used to image retinas from a variety of vertebrates (e.g., chick, ferret, and rabbit).
Investigating Ion Channel Distribution Using a Combination of Spatially Limited Photolysis, Ca2+ Imaging, and Patch Clamp Recording
Authors: Almassy Janos , Yule David I.
Published: January 2013

The production of saliva by parotid acinar cells is stimulated by Ca2+ activation of Cl− and K+ channels located in the apical plasma membrane of these polarized cells. Here, we utilize a combination of spatially limited flash photolysis, Ca2+ imaging, and electrophysiological recording to investigate the distinct distribution of Ca2+-dependent ion channels in the plasma membrane (PM) of enzymatically isolated murine parotid acinar cells. In these experiments, the aim of photolysis is to selectively target and modify the activity of ion channels, thereby revealing membrane-domain-specific differences in distribution. Specifically, the relative distribution of channels to either apical or basal PM can be investigated. Since there is substantial evidence that Ca2+-dependent Cl− channels are exclusively localized to the apical membrane of acinar cells, this provides an important electrophysiological verification that a particular membrane has been specifically targeted.
ATP‐dependent/‐independent enzymatic ring reductions involved in the anaerobic catabolism of naphthalene
Authors: Eberlein Christian , Johannes Jörg , Mouttaki Housna , Sadeghi Masih , Golding Bernard T. , Boll Matthias , Meckenstock Rainer U.
Published: January 2013

Polycyclic aromatic hydrocarbons are among the most hazardous environmental pollutants. However, in contrast to aerobic degradation, the respective degradation pathways in anaerobes are greatly unknown which has so far prohibited many environmental investigations. In this work, we studied the enzymatic dearomatization reactions involved in the degradation of the PAH model compounds naphthalene and 2‐methylnaphthalene in the sulfate‐reducing enrichment culture N47. Cell extracts of N47 grown on naphthalene catalysed the sodium dithionite‐dependent four‐electron reduction of the key intermediate 2‐naphthoyl‐coenzyme A (NCoA) to 5,6,7,8‐tetrahydro‐2‐naphthoyl‐CoA (THNCoA). The NCoA reductase activity was independent of ATP and was, surprisingly, not sensitive to oxygen. In cell extracts in the presence of various electron donors the product THNCoA was further reduced by a two‐electron reaction to most likely a conjugated hexahydro‐2‐naphthoyl‐CoA isomer (HHNCoA). The reaction assigned to THNCoA reductase strictly depended on ATP and was oxygen‐sensitive with a half‐life time between 30 s and 1 min when exposed to air. The rate was highest with NADH as electron donor. The results indicate that two novel and completely different dearomatizing ring reductases are involved in anaerobic naphthalene degradation. While the THNCoA reducing activity shows some properties of ATP‐dependent class I benzoyl‐CoA reductases, NCoA reduction appears to be catalysed by a previously unknown class of dearomatizing aryl‐carboxyl‐CoA reductases.
The hydrocarbon‐degrading marine bacteriumCobetiasp. strainMM1IDA2H‐1 produces a biosurfactant that interferes with quorum sensing of fish pathogens by signal hijacking
Authors: Ibacache‐Quiroga C. , Ojeda J. , Espinoza‐Vergara G. , Olivero P. , Cuellar M. , Dinamarca M. A.
Published: January 2013

Biosurfactants are produced by hydrocarbon‐degrading marine bacteria in response to the presence of water‐insoluble hydrocarbons. This is believed to facilitate the uptake of hydrocarbons by bacteria. However, these diffusible amphiphilic surface‐active molecules are involved in several other biological functions such as microbial competition and intra‐ or inter‐species communication. We report the isolation and characterization of a marine bacterial strain identified asCobetiasp.MM1IDA2H‐1, which can grow using the sulfur‐containing heterocyclic aromatic hydrocarbon dibenzothiophene (DBT). As withDBT, when the isolated strain is grown in the presence of a microbial competitor, it produces a biosurfactant. Because the obtained biosurfactant was formed by hydroxy fatty acids and extracellular lipidic structures were observed during bacterial growth, we investigated whether the biosurfactant at its critical micelle concentration can interfere with bacterial communication systems such as quorum sensing. We focused onAeromonas salmonicidasubsp.salmonicida, a fish pathogen whose virulence relies on quorum sensing signals. Using biosensors for quorum sensing based onChromobacterium violaceumandVibrio anguillarum, we showed that when the purified biosurfactant was mixed withN‐acyl homoserine lactones produced byA. salmonicida, quorum sensing was inhibited, although bacterial growth was not affected. In addition, the transcriptional activities ofA. salmonicidavirulence genes that are controlled by quorum sensing were repressed by both the purified biosurfactant and the growth in the presence ofCobetiasp.MM1IDA2H‐1. We propose that the biosurfactant, or the lipid structures interact with theN‐acyl homoserine lactones, inhibiting their function. This could be used as a strategy to interfere with the quorum sensing systems of bacterial fish pathogens, which represents an attractive alternative to classical antimicrobial therapies in fish aquaculture.
Niches and neutrality: community ecology for entomologists
Authors: Kitching Roger L
Published: January 2013

The study of interacting sets of species within ecosystems – community ecology – is generally less familiar to entomologists than the more species‐centric studies of population and behavioural ecology. Here, I review some key areas of community ecology that should be of interest and concern to entomologists. The contrasting current models of community assembly – based, on the one hand, on ideas of neutral replacement and, on the other, of resource‐based niche partitioning – are discussed. A synthetic version that identifies a stochastic/deterministic switch point based on a characteristic spatial scale for each community studied is presented as a possible way of combining these two approaches.
Managing contradictions of corporate social responsibility: the sustainability of diversity in a frontrunner firm
Authors: Bjerregaard Toke , Lauring Jakob
Published: January 2013

Corporate social responsibility (CSR) has attracted increasing attention in business and research. Studies have documented how management concepts such as diversity management are translated and adapted to differential local sociocultural contexts outside their countries of origin. More research is needed concerning how CSR concepts are translated and practiced locally within particular organizations. This research is based on an organizational ethnography of the management of multiple social, ethical and business logics of CSR in a Danish frontrunner firm. The study contributes with insights into the ongoing organizational management of potentially opposing logics in CSR. Findings show that managing contradictions of CSR is an ongoing challenge and accomplishment influencing whether ethical, social and business logics collide or reinforce each other. The study shows that when ethics are framed as means to economic ends, some social responsibilities have a tendency to be disregarded in practice.
Doing research inclusively: bridges to multiple possibilities in inclusive research
Authors: Nind Melanie , Vinha Hilra
Published: January 2013

Accessible summary

This article is about the ways people do research together.

We talked with people doing inclusive research about their views and experiences.

We found out about different ways people work together and how power is important.

People talked about how inclusive research can change people's lives.

We discuss why we think research can be performed inclusively in a variety of ways and why keeping this variety is important.

This article reports on a study of how people do research that matters to people with learning disabilities and that involves them and their views and experiences. The study was an attempt to bring together people doing inclusive research so that, collectively, we could take stock of our practices. This would add to the individual reports and reflections on approaches that are already available. In particular, we wanted to explore what quality means in inclusive research and how we might best achieve this. We used focus groups to share and generate knowledge, and we recorded, transcribed and analysed the dialogue, looking for themes and answers to core questions. We found that there are many different ways of doing research inclusively, and we propose a model to describe this. Reflecting on the findings, we argue that it is important to keep a flexible vision of inclusive research and to keep learning and talking together.
Addressing health inequities: coronary heart disease training within learning disabilities services
Authors: Holly Deirdre , Sharp John
Published: January 2013

Accessible summary

People with a learning disability have a special risk of developing certain problems with their health. Heart disease can also happen to people with a learning disability.

We do not know how we should help people with a learning disability stay healthy and not develop heart disease.

We trained staff using a programme designed to improve what they know about heart disease. This programme also helps staff learn ways to help people improve their health.

After training, staff knew a lot more about heart disease and felt more confident about being able to improve the health of people with a learning disability.

People with learning disabilities are at increased risk of coronary heart disease (CHD). Research suggests this may be due to inequalities in health status and inequities in the way health services respond to need. Little is known about the most effective way to improve health outcomes for people with learning disabilities. A previously developed CHD educational resource was piloted within residential community support organisations working closely with adults with complex learning disabilities. Following the training, improvements in knowledge of CHD‐related topics were noted. Improvements were also seen in skills and confidence relating to working with others. Participant satisfaction with the training was demonstrated in terms of the acceptability and effectiveness of the training. Systematic training of this nature could lead to increased awareness of and attention to the cardiac health requirements of individuals, thereby improving the health outcomes, health literacy and ultimately self‐management of people with learning disabilities.
Ecological tree line history and palaeoclimate – review of megafossil evidence from the Swedish Scandes
Authors: Kullman Leif
Published: January 2013

The postglacial tree line and climate history in the Swedish Scandes have been inferred from megafossil tree remains. Investigated species are mountain birch (Betula pubescens ssp. czerepanovii), Scots pine (Pinus sylvestris) and grey alder (Alnus incana). Betula and Pinus first appeared on early deglaciated nunataks during the Lateglacial. Their tree lines peaked between 9600 and 9000 cal. a BP, almost 600 m higher than present‐day elevations. This implies (adjusted for land uplift) that early Holocene summer temperatures may have been 2.3°C above modern ones. Elevational tree line retreat characterized the Holocene tree line evolution. For short periods, excursions from this trend have occurred. Between c. 12 000 and 10 000 cal. a BP, a pine‐dominated subalpine belt prevailed. A first major episode of descent occurred c. 8200 cal. a BP, possibly forced by cooling and an associated shift to a deeper and more persistent snow pack. Thereafter, the subalpine birch forest belt gradually evolved at the expense of the prior pine‐dominated tree line ecotone. A second episode of pine descent took place c. 4800 cal. a BP. Historical tree line positions are viewed in relation to early 21st century equivalents, and indicate that tree line elevations attained during the past century and in association with modern climate warming are highly unusual, but not unique, phenomena from the perspective of the past 4800 years. Prior to that, the pine tree line (and summer temperatures) was consistently higher than present, as it was also during the Roman and Medieval periods, c. 1900 and 1000 cal. a BP, respectively.