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This paper examines STRRIDE from its clinical perspectives and addresses practical and mechanistic questions about the relationships between doses and intensities of exercise that result in changes in glucose and lipid metabolism while controlling weight loss.

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Radiation therapy (RT) and intrathecal drug delivery systems (IDDS) are often used concurrently to optimize pain management in patients with cancer. Concern remains among clinicians regarding the potential for IDDS malfunction in the setting of RT. Here we assessed the frequency of IDDS malfunction in a large cohort of patients treated with RT. Cancer patients with IDDS and subsequent RT at our institution from 2011 to 2019 were eligible for this study. Patients were excluded in the rare event that their IDDS was managed by an outside clinic and follow‐up documentation was unavailable. Eighty‐eight patients aged 22–88 years old (43% female, 57% male) representing 106 separate courses of RT were retrospectively identified. Patients received varying levels of radiation for treatment of cancer and cumulative dose to the IDDS was calculated. IDDS interrogation was subsequently performed by a pain specialist. Malfunction was recorded as deviation from the expected drug volume and/or device errors reported upon interrogation as defined by the manufacturer. Total measured RT dose to the IDDS ranged from 0 to 18.0 Gy (median = 0.2 Gy) with median dose of 0.04 Gy/fraction (range, 0–3.2 Gy/fraction). Ten pumps received a total dose >2 Gy and three received ≥5 Gy. Eighty‐two percentage of patients had follow‐up with a pain specialist for IDDS interrogation and all patients underwent follow‐up with a healthcare provider following RT. There were zero incidences of IDDS malfunction related to RT. No patient had clinical evidence of radiation related pump malfunction at subsequent encounters. We found no evidence that RT in patients with IDDS led to device failure or dysfunction. While radiation oncologists and pain specialists should coordinate patient care, it does not appear that RT dose impacts the function of the IDDS to warrant significant clinical concern.

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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.02.022 Byline: David D. Rahn, Matthew D. Ruff, Spencer A. Brown, Harry F. Tibbals, R. Ann Word Keywords: elastic fiber; fibulin-5; pelvic organ prolapse; stress-strain; vaginal muscularis Abstract: The purpose of this study was to identify pregnancy-induced changes in biomechanical properties of the vaginal wall and to compare these with fibulin-5 knockout mice (Fbln5.sup.-/-) with and without prolapse. Author Affiliation: University of Texas Southwestern Medical Center, Dallas, TX. Article History: Received 1 August 2007; Revised 20 November 2007; Accepted 11 February 2008 Article Note: (footnote) This study was supported by National Institutes of Health grant AG028048., Cite this article as: Rahn DD, Ruff MD, Brown SA, Tibbals HF, Word RA. Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol 2008;198:590.e1-590.e6. , Reprints not available from the authors.

In a song on her latest album, pop queen Madonna earnestly declares, 'Selling out is not my thing.' The same might not be true of her record label, Warner Bros., [...]

The author examines the on-going battle between Microsoft Inc. and Sun Microsystems Inc. over the future web services. Topics include use of Microsoft's .NET, Sun Microsystem's Open Network Environment, and the advantages and disadvantages of both systems.

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In mammals, neuroepithelial cells play an essential role in embryonic neurogenesis, whereas glial stem cells are the principal source of neurons at postembryonic stages. By contrast, neuroepithelial‐like stem/progenitor (NE) cells have been shown to be present throughout life in teleosts. We used three‐dimensional (3D) reconstructions of cleared transgenic wdr12:GFP medaka brains to demonstrate that this cell type is widespread in juvenile and to identify new regions containing NE cells. We established the gene expression profile of optic tectum (OT) NE cells by cell sorting followed by RNA‐seq. Our results demonstrate that most OT NE cells are indeed active stem cells and that some of them exhibit long G2 phases. We identified several novel pathways (e.g., DNA repair pathways) potentially involved in NE cell homeostasis. In situ hybridization studies showed that all NE populations in the postembryonic medaka brain have a similar molecular signature. Our findings highlight the importance of NE progenitors in medaka and improve our understanding of NE‐cell biology. These cells are potentially useful not only for neural stem cell studies but also for improving the characterization of neurodevelopmental diseases, such as microcephaly. StemCells2017;35:1505–1518 We performed an enhancer screen in a locus composed of two medaka genes in tandem having a preferential expression in neuroepithelium. Thus, we isolated a driver for cells that we demonstrated to have cytological features of neuroepithelial cells. (A) Analysis of histological sections and 3D images from clarified brains of transgenic fish indicated that neuroepithelial‐based neurogenesis may be present in almost all the proliferation zones of the fish brain. Our study almost also points to the intriguing possibility that neuroepithelial cells exhibit long G2 phases. (B) RNA seq from optic tectum GFP+ sorted cells revealed neuroepithelium marker genes, some of which are orthologous to mammalian neuroepithelium markers. Many genes are associated to ribosome biogenesis, proliferation or DNA repair.

The triphasic birth control pill delivers the hormones progesterone and estrogen in dosages resembling the hormonal pattern of a normal menstrual cycle. That is, the hormone combination and dose is different in week one than in weeks two and three. Early studies on higher hormone dosage formulas described a relationship between pill use and heart disease, particularly heart attack and stroke. The effects of triphasic pills on blood lipid transport (elevated blood lipids increase the risk for heart disease) were studied in 150 nonsmoking women. Three different formulas were evaluated over a six-month period. There was an increase in blood triglycerides (28 to 52 percent) and apolipoprotein B levels (20 to 23 percent) in all groups. There were very slight increases in cholesterol (0 to 11 percent) and low-density lipoproteins (20 to 23 percent). Changes in the total high-density lipoproteins were insignificant. However, high-density lipoprotein 2, the HDL thought to be protective against heart disease, was increased by 29 to 33 percent. It is unclear how these blood lipid changes affect the probability of coronary heart disease in users of oral contraceptives. The results were similar in all three types of triphasic pills.

The article focuses on the success of Dartmouth Football Biggest Loser Competition by Dartmouth College in Hanover, New Hampshire that aims to educate student athletes on nutrition strategy, maintaining weight and living healthier.

The structural diversity of natural sulfated glycosaminoglycans (GAGs) presents major promise for discovery of chemical biology tools or therapeutic agents. Yet, few GAGs have been identified so far to exhibit this promise. We reasoned that a simple approach to identify such GAGs is to explore sequences containing rare residues, for example, 2-O-sulfonated glucuronic acid (GlcAp2S). Genetic algorithm-based computational docking and filtering suggested that GlcAp2S containing heparan sulfate (HS) may exhibit highly selective recognition of antithrombin, a key plasma clot regulator. HS containing only GlcAp2S and 2-N-sulfonated glucosamine residues, labeled as HS2S2S, was chemoenzymatically synthesized in just two steps and was found to preferentially bind antithrombin over heparin cofactor II, a closely related serpin. Likewise, HS2S2Sdirectly inhibited thrombin but not factor Xa, a closely related protease. The results show that a HS containing rare GlcAp2S residues exhibits the unusual property of selective antithrombin activation and direct thrombin inhibition. More importantly, HS2S2Sis also the first molecule to activate antithrombin nearly as well as the heparin pentasaccharide although being completely devoid of the critical 3-O-sulfonate group. Thus, this work shows that novel functions and mechanisms may be uncovered by studying rare GAG residues/sequences.

Apple chief Steve Jobs drew cheers last year when he demonstrated Macintosh computers running popular software faster than Windows-based machines that boasted a higher processor speed. He made his point [...]

The field of plastic surgery has been at the forefront of ideation and innovation. Surgeon scientists today continue to develop novel products that fulfill the needs of the medical community and patients. Part of this process requires the approval from various regulatory agencies and offices, including the U.S. Food and Drug Administration. Unfortunately, medical training does not include regulatory knowledge, and many surgeon scientists find the regulatory pathway and U.S. Food and Drug Administration perplexing, overly complicated, and insurmountable. The authors aim to clearly outline the path of the regulatory process as it pertains to the U.S. Food and Drug Administration and its various jurisdictions that may relate to the plastic surgeon.

Climate change, associated with increased aridity, and high grazing pressure by livestock results in the scarcity and loss of perennial Poaceae in arid ecosystems. The species threatened by this include Cenchrus ciliaris L., a native perennial grass of the tropical and sub-tropical arid rangelands of Africa and Western Asia and now introduced in Central and South America, and Australia. This species reproduces predominantly through aposporous apomixis although sexual individuals have been occasionally identified. Cenchrus ciliaris is characterised by a significant, heritable, phenotypic polymorphism and three ploidy levels including tetraploids (2n=4x=36), pentaploids (2n=5x=45) and hexaploids (2n=6x=54). Under water-deficit conditions, C. ciliaris shows plasticity in growth characteristics and aboveground biomass. This phenotypic plasticity has led to the identification of genotypic-associated responses conferring more productivity. This underlines the importance of conserving the genetic diversity of C. ciliaris in order to ensure the persistence of the vegetation cover in the arid ecosystems in which it occurs. Observations from cytogenetic and molecular data converge to underline the possibility of sexual reproduction, recombination and gene flow within and between populations of C. ciliaris. Genetic mechanisms, such as polyploidy, hybridisation between ploidy levels and apomixes, are generating and then maintaining the diversity of C. ciliaris. This review emphasises the role of polyploidy in the evolutionary development of C. ciliaris and how it may be a crucial factor for its conservation in some countries and its weedy nature in others.

To evaluate the integrity of 3 different types of sliding knots in a vaginal surgery model.

To evaluate if suture type and caliber or level of residency training affects strength and mode of failure of surgical knots.

This pilot study examined the efficacy of 5-bromo-2-deoxyuridine–labeled autologous adipose-derived stem cells seeded onto collagen scaffolds to augment andor regenerate the fat-enriched hypodermal tissue in an acute porcine wound model.

The use of knotless barbed sutures has shortened operation times for wound closure. In experimental models, their use in tendon surgery is still under investigation. This study looks at the use of barbed sutures in a porcine model for fascial repair when compared with traditional absorbable suture to further extend their clinical use.

Over the past 20 years, there has been a dramatic increase in the use of autologous fat grafting to treat volume and contour defects in aesthetic and reconstructive surgery. It is generally accepted that fat grafting is safe, with good patient satisfaction. However, there are many procedural variations, and in terms of objective clinical effectiveness, the major disadvantage of this technique remains the unpredictable fat resorption rates and subsequent adverse events. Because of the rapidly evolving nature of this procedure, this review article provides an update on previous reviews by looking at the current evidence base regarding fat graft techniques and their effect on clinical outcome.

Adipose-derived stem cells are multipotent cells that can easily be extracted from adipose tissue, are capable of expansion in vitro, and have the capacity to differentiate into multiple cell lineages, which have the potential for use in regenerative medicine. However, several issues need to be studied to determine safe human use. For example, there are questions related to isolation and purification of adipose-derived stem cells, their effect on tumor growth, and the enforcement of U.S. Food and Drug Administration regulations. Numerous studies have been published, with the interest in the potential for regenerative medicine continually growing. Several clinical trials using human adipose stem cell therapy are currently being performed around the world, and there has been a rapid evolution and expansion of their number. The purpose of this article was to review the current published basic science evidence and ongoing clinical trials involving the use of adipose-derived stem cells in plastic surgery and in regenerative medicine in general. The results of the studies and clinical trials using adipose-derived stem cells reported in this review seem to be promising not only in plastic surgery but also in a wide variety of other specialties. Nevertheless, those reported showed disparity in the way adipose-derived stem cells were used. Further basic science experimental studies with standardized protocols and larger randomized trials need to be performed to ensure safety and efficacy of adipose-derived stem cells use in accordance with U.S. Food and Drug Administration guidelines.

Abstract: Thirty-three populations belonging to the three Retama species, Retama monosperma, Retama raetam and Retama sphaerocarpa, were collected to study species differentiation using flow cytometry for 2C DNA assessment and molecular cytogenetics for karyotype organisation. All were 2n = 48. Genome size ranged from 1.76 to 1.97 pg and revealed significant intraspecific variation correlated to the geographic distribution of the populations. The number and position of the two ribosomal gene families 5S and 45S were determined by fluorescent in situ hybridization, revealing chromosome reorganisation between species. In R. raetam and R. monosperma, the minor 5S loci co-localised with 45S on the satellite chromosome pair. Fluorochrome banding identified GC- and AT-rich DNA regions. In R. monosperma a unique chromomycin positive GC-rich band was observed associated with the secondary constriction. In contrast, an original pattern showing two chromomycin positive bands localised at each side of the extended rDNA locus was observed in R. sphaerocarpa and R. raetam. The polymorphism revealed in our cytogenetic data allowed us to separate the group of R. raetam and R. monosperma from R. sphaerocarpa.

The superficial musculoaponeurotic system (SMAS) has inherent viscoelastic properties, although the optimal tension levels to minimize tissue relaxation have not been defined. This study evaluated the viscoelastic properties of the SMAS within the biomechanical parameters of the high-SMAS rhytidectomy.

Preservation or reconstruction of the middle nasal vault structure and internal nasal valve after dorsal reduction is challenging. The purpose of this study was to retrospectively analyze a series of 100 consecutive rhinoplasty cases with respect to preservation or restoration of the dorsal nasal lines following component dorsal reduction. A new quantitative mathematical application for subject digital images was performed.

The sartorius muscle is a superficial thigh muscle with specific anatomical characteristics in terms of shape and vascular supply. Few studies have assessed the vascular supply of the muscle and overlying skin paddle and its potential in reconstructive surgery. The study used three-dimensional, four-dimensional imaging to analyze the segmental vascularity of the muscle, as well as the overlying skin paddle, to define arcs of rotation based on its major pedicles.

This is a report of the secondary endpoints, Subject Global Evaluation (overall improvement) and Subject Satisfaction scores, from a study designed to examine the efficacy of injectable poly-l-lactic acid for the correction of nasolabial fold wrinkles over 25 months.

The recognition that fat contains stem cells has driven further examination into the potential uses of fat and adipose-derived stem cells in a wide number of clinical situations. New information about the harvesting, isolation, and subsequent differentiation properties of isolated adipose-derived stem cells has led to new research into novel tissue-engineered constructs and the transformation of adipose-derived stem cells to induced pluripotent stem cells. Clinically, use of fat grafts and adipose-derived stem cells worldwide and in the United States has dramatically increased in parallel to questions concerning the safety and efficacy of adipose-derived stem cell–based treatments. Currently, the U.S. Food and Drug Administration has not approved the use of isolated adipose-derived stem cells for medical indications.

Silicone gel breast implants are associated with long-term adverse events, including capsular contracture, with reported incidence rates as high as 50 percent. However, it is not clear how long the follow-up period should be and whether there is any association with estrogen or menopausal status. In addition, the placement of Baker grade II subjects in the majority of reports has been in data sets of controls instead of capsular contracture.

Regarding the perfusion of a deep inferior epigastric perforator (DIEP) flap, the classic Hartrampf zones II and III were demonstrated by Holm et al. to be reversed using fluorescent perfusion techniques, implying that blood flow from the pedicle travels to the ipsilateral side before crossing the midline. The authors' hypothesis is that the zones of perfusion and the vascular anatomy differ greatly between lateral row and medial row perforators.

Abstract: The subsection Asperae of genus Hydrangea L. (Hydrangeaceae) has been investigated for three reasons: several ambiguous classifications concerning Hydrangea aspera have been published, unexpected differences in genome size among seven accessions have been reported Cerbah et al. (Theor Appl Genet 103:45–51, 2001), and two atypical chromosome numbers (2n = 30 for Hydrangea involucrata and 2n = 34 for H. aspera) have been found when all other species of the genus present 2n = 36. Therefore, these two species and four subspecies of Hydrangea in all 29 accessions were analyzed for their genome size, chromosome number, and karyotype features. This investigation includes flow cytometric measurements of nuclear DNA content and bases composition (GC%), fluorochrome banding for detection of GC- and AT-rich DNA regions, and fluorescent in situ hybridisation (FISH) for chromosome mapping of 5 S and 18 S-5.8 S-26 S rDNA genes. In the H. aspera complex, the genome size ranged from 2.98 (subsp. sargentiana) to 4.67 pg/2C (subsp. aspera), an exceptional intraspecific variation of 1.57-fold. The mean base composition was 40.5% GC. Our report establishes the first karyotype for the species H. involucrata, and for the subspecies of H. aspera which indeed present different formulae, offering an element of discrimination. FISH and fluorochrome banding revealed the important differentiation between these two species (H. involucrata and H. aspera) and among four subspecies of the H. aspera complex. Our results are in agreement with the Chinese classification that places the groups Kawakami and Villosa as two different species: Hydrangea villosa Rehder and Hydrangea kawakami Hayata. This knowledge can contribute to effective germplasm management and horticultural use.

Periorbital rejuvenation has increasingly relied on augmentation with fillers. Numerous techniques have been described, including augmentation of the sub–orbicularis oculi fat. Cadaver studies initiated 2 years ago yielded presumptive evidence that sub–orbicularis oculi fat consists of two distinct regions. Knowledge of this anatomy is important for precision in facial rejuvenation.

There has been a lack of published bench and preclinical data supporting the safety and effectiveness of a noninvasive, nonthermal, focused ultrasound technology for body contouring.

The innovative technique of three- and four-dimensional computed tomographic angiography allows us to analyze the areas of perfusion in commonly used free abdominal flaps in breast reconstruction, such as pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, full TRAMs, muscle-sparing TRAMs, and deep inferior epigastric perforator (DIEP) flaps. The authors compared the vascular territories in these flaps.

Reports suggest that the anterolateral thigh flap can be reliably extended to include adjacent vascular territories. The vascular basis of this phenomenon is poorly understood. This study examines the three- and four-dimensional arterial and venous anatomy of the extended anterolateral thigh flap and reports the results of a clinical series of extended anterolateral thigh flaps.

Accurate preoperative planning combined with facial fat compartment augmentation can improve precision and balance in facial rejuvenation techniques. Understanding the concept of “facial shaping” with respect to symmetry and soft-tissue (fat) distribution preoperatively is critical to optimizing aesthetic outcomes in various face lift techniques.

Fractional photothermolysis is extremely popular in skin rejuvenation and remodeling procedures. However, the extent of thermal cellular injury beyond the borders of the coagulated microcolumns produced with fractional phototherapy is undefined.

There is a paucity of evidence within the plastic surgery literature concerning risk stratification and management of patients with respect to thromboembolic disease. A retrospective chart review was conducted to examine whether the Davison-Caprini risk-assessment model could stratify patients undergoing excisional body contouring surgery, allowing prophylaxis to be managed in an evidence-based manner.

This study uses three- and four-dimensional computed tomographic angiography and venography to evaluate the microvascular anatomy and perfusion of the deep inferior epigastric artery perforator (DIEP) and superficial inferior epigastric artery (SIEA) flaps.

This study presents a detailed three- and four-dimensional appraisal of the arterial and venous anatomy and perfusion of the anterolateral thigh flap using a novel computed tomographic technique.

The vascular anatomy of the thoracodorsal artery perforator flap, which has not previously been elucidated, was examined using three- and four-dimensional computed tomographic angiography and venography.

Two-dimensional contrast radiography is the current standard for investigating the vascular anatomy of surgical flaps. The microvascular anatomy of the perforator flap, however, is limited conceptually by representation in two dimensions. Static three-dimensional computed tomographic angiography enables vascular anatomy to be evaluated in the coronal, axial, and sagittal planes, and dynamic four-dimensional computed tomographic angiography allows the vascular filling of a perforator flap to be visualized over short time intervals in three dimensions.

The removal of unwanted body fat using a noninvasive technique is desirable to patients and physicians. The authors describe a controlled, multicenter, clinical trial assessing the safety and efficacy of a focused therapeutic ultrasound device for noninvasive body contouring.

Deep vein thrombosis is a known serious complication of surgical procedures and a significant cause of morbidity and mortality. Plastic surgeons’ management of the risk of deep vein thrombosis and current information regarding deep vein thrombosis incidence rates are limited. A survey was designed and mailed to plastic surgeons to collect data on the patterns of practice with regard to deep vein thrombosis in patients undergoing plastic surgery procedures.

Although much is written concerning breast augmentation, few authors have addressed preoperative chest wall analysis as it pertains to postoperative outcome. In the present study, 100 patients were randomly selected, underwent bilateral augmentation, and were examined retrospectively by four independent physicians using standardized preoperative photographs. Each patient was examined for ptosis and asymmetry of the nipples, breast mound, and chest wall. Results revealed significant asymmetries in all parameters. Nipple-areola complex asymmetry was present in 24 percent (nipple/areola size) and 53 percent (nipple position) of the women. Mound asymmetry was noted in 44 percent (volume), 29 percent (base constriction), and 30 percent (inframammary fold position) of the women, and finally, 29 percent of the women had grade I to III ptosis. Chest wall asymmetry was observed in 9 percent of the women. Overall, 88 percent of the women had some degree of asymmetry, and 65 percent of the women had more than one parameter of asymmetry. These findings underscore the importance of developing a systematic preoperative breast and chest wall analysis that can be individualized for each patient. The resulting asymmetries should then be discussed with the patient, along with the potential for continued or even more pronounced asymmetry postoperatively.

The purpose of this survey was to assess the current trends in mastopexy techniques and to compare satisfaction rates and complications associated with different techniques.

Superior gluteal artery perforator flaps are surgical options in breast and pressure sore reconstructions. Based on the recipient site, primary thinning of these flaps may be necessary for final optimal contour. As the thinning of a superior gluteal artery perforator flap should be based on the knowledge of perforator vascular territories to prevent vascular compromise, the authors performed an anatomical study to determine the number, location, and diameter of the perforators present in the superior gluteal artery perforator flap. Accompanying veins and acceptable locations for surgical incisions were also determined.

A prospective study was used to evaluate the efficacy of a commercially available platelet gel product as a sealant to decrease postsurgical drain fluid rates and volumes in patients who have undergone rhytidectomy procedures. Quantitative assessments of postoperative drain fluid outputs were compared in subjects who did and did not receive platelet gel treatment.