bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Summary:
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.
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

SummaryPolycyclic 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

SummaryBiosurfactants 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

AbstractThe 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.
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.

SummaryThis 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.

SummaryPeople 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.