Invited Discussion on: Global Prevalence and Preferences of Progressive Tension Suture Usage in Abdominoplasties.

The effectiveness of using quilting/progressive tension sutures in reducing seroma formation after abdominoplasties is well established in the literature, eliminating the use of drains regardless of the simultaneous performance of liposuction. However, despite being widely studied and advocated, the quilting/progressive tension sutures technique is still not widespread, and most surgeons still insist on the use of drains. The author provides a brief literature review on this subject and comments on the work carried out by Wen et al., analyzing divergences between literature data and those presented by Wen et al., and trying to identify the causes of low adherence to the evaluated technique.

Invited Discussion on: The Impact of Reconstructive Modality and Postoperative Complications on Decision Regret and Patient-Reported Outcomes following Breast Reconstruction.

One in eight women will have a lifetime diagnosis of confirmed breast cancer, and one in three of these women will undergo a mastectomy. About half of women undergoing mastectomies will opt for some type of breast reconstruction. Breast cancer itself and breast reconstruction bring physical changes that are accompanied by psychological changes of varying degrees. The decision process about cancer treatment and whether or not to perform breast reconstruction brings suffering. In the case of choosing to perform the reconstruction, deciding when to perform it and which surgical technique to choose from among several available is quite complex, and may result in regret. The author provides a brief literature review on this subject and comments on the work carried out by Cai and Momeni, comparing data and results.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Invited Discussion on: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and the Textured Implant Crisis.

The author discusses some important points about breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and adds new and updated information about the disease (ALCL). LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Invited Discussion on: Management of Expander and Implant Associated Infections in Breast Reconstruction.

The author presents an objective review on "Management of Expander and Implant Associated Infections in Breast Reconstruction," discussing different points related to this subject, such as infection definition, identification of risk factors, related microorganisms, surgical techniques, preventive measures, antibiotic prophylaxis and therapy. Flaws in methodologies are identified and points of discrepancy in data and treatment results from previously published studies are pointed out, with discussion of possible causes for these inconsistencies. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Human settlement history between Sunda and Sahul: a focus on East Timor (Timor-Leste) and the Pleistocenic mtDNA diversity.

BACKGROUND: Distinct, partly competing, "waves" have been proposed to explain human migration in(to) today's Island Southeast Asia and Australia based on genetic (and other) evidence. The paucity of high quality and high resolution data has impeded insights so far. In this study, one of the first in a forensic environment, we used the Ion Torrent Personal Genome Machine (PGM) for generating complete mitogenome sequences via stand-alone massively parallel sequencing and describe a standard data validation practice. RESULTS: In this first representative investigation on the mitochondrial DNA (mtDNA) variation of East Timor (Timor-Leste) population including >300 individuals, we put special emphasis on the reconstruction of the initial settlement, in particular on the previously poorly resolved haplogroup P1, an indigenous lineage of the Southwest Pacific region. Our results suggest a colonization of southern Sahul (Australia) >37 kya, limited subsequent exchange, and a parallel incubation of initial settlers in northern Sahul (New Guinea) followed by westward migrations <28 kya. CONCLUSIONS: The temporal proximity and possible coincidence of these latter dispersals, which encompassed autochthonous haplogroups, with the postulated "later" events of (South) East Asian origin pinpoints a highly dynamic migratory phase.

Genetic variation of 12 X-chromosomal STR loci in an East Timor sample.

East Timor (República Democrática de Timor Leste) is a country with a population around 1 million inhabitants located in Southeast Asia and composed of 13 districts, including the eastern half of the Timor Island, Ataúro and Jaco islands, and the coastal enclave of Oecusse-Ambeno located in West Timor. Examples of the importance of X-chromosomal short tandem repeats (STRs) analysis include parentage identification, namely in cases involving father/daughter relationships, paternity in close relative deficiency cases without access to the putative father, maternity testing, and in rape or incest cases. In this study, 149 saliva samples were collected from unrelated individuals from East Timor and 12 X-chromosomal STRs genotyped using Investigator® Argus X-12 kit (Qiagen). A total of 13 alleles not included in Investigator Argus X-12 allelic ladder (off-ladder alleles) were found, four of which never reported (alleles 34.1 and 38.1 at DXS10134, allele 17.2 at DXS10074, and allele 28.1 at DXS10146). Allele 27.3 at DXS10101 and alleles 26, 28, and 29 at DXS10148 have already been observed in other populations but their frequencies are considerably higher in East Timor population. Allele frequencies and population statistic parameters were calculated for East Timor population and data contextualized in Southeast Asia/Pacific Region.

Dereplication of calystegines in food plants and wild Solanum Brazilian fruits.

Calystegines are potent glycosidase inhibitors with therapeutic potential and are constituents of food and feed with potential toxic effects. This study aims to target calystegines and other nitrogenous substances in food plants. Hydroalcoholic extracts from Solanum tuberosum, Ipomoea batatas, S. lycocarpum, and fruit from S. lycopersicum, S. aethiopicum, S. paniculatum, S. crinitum, and S. acanthodes were analyzed by liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) using an acidic HILIC column. The dereplication approach included data processing using MZMine2, FBMN-GNPS, and structure elucidation and interpretation of the organized data. The calystegines A3, A5, B2, and C1 were identified, and several potential new calystegine analogues: three may correspond to new calystegines of the A-group, one glycosyl derivative of calystegine A3, and two glycosyl derivatives of the B-group. These findings help to direct the search for new calystegines. In addition, the dereplication approach enabled the annotation of 22 other nitrogen compounds.

Super giant squamous cell carcinomas.

Squamous cell carcinomas (SCCs) larger than 2 cm in diameter are associated with a greater risk for disfigurement, local recurrence, and metastasis. Giant SCCs are rare. They may develop near aesthetically and functionally important structures and infiltrate them. Treatment may be difficult with the need for large tissue resections and complex surgical reconstruction, with important repercussions on the quality of life of patients. We report 2 cases of super giant SCCs with long-standing evolution that were successfully treated with surgical excision and followed for 24 months posttreatment without signs of local recurrence and/or metastasis.

Increased intraoperative bleeding in patients undergoing abdominoplasty after gastroplasty is not due to coagulopathy.

BACKGROUND: Abdominoplasties carried out in patients previously underwent gastroplasty present high rates of complications, including increased bleeding in the intra- and postoperative periods. METHODS: This study evaluated bleeding, coagulation parameters (coagulogram, dosage of fibrinogen, FII, FV, FVII, FVIII, FIX, FX, and FXII), and thromboelastography in two groups of women who underwent abdominoplasties: a group with a history of gastroplasty by the Fobi-Capella technique (group I) and the other group without a history of obesity (group II). Analyses were performed before, during, and after each surgical procedure. Vitamins K and C were also dosed. Bleeding was measured by counting and weighing compresses at the end of each surgery, and the withdrawn surgical specimens were weighed. RESULTS: Statistically, group I patients had more bleeding than group II in all evaluated operative periods (p = 0.007). There was no significant change in the coagulogram or decrease in coagulation factors that could be associated with increased bleeding in any of the analyzed groups. Thromboelastography, which provides a comprehensive analysis of thrombin generation and of hemostasis in real time, did not differ between groups. Vitamin K was significantly increased in group I patients (p = 0.019). The weight of the surgical specimens removed was significantly higher in group I (p = 0.007) and there was correlation of the weight with the degree of bleeding. CONCLUSIONS: The results of this study demonstrate an increase of bleeding during the intraoperative period of abdominoplasty in patients with a history of gastroplasty that it is not due to changes in hemostasis. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Double-mesh technique for correction of abdominal hernia following mammary reconstruction carried out with bipedicled TRAM flap and the primary closing of the donor area by using a single polypropylene mesh.

BACKGROUND: Mammary reconstruction by using the transverse myocutaneous flap of the abdominal straight muscle (TRAM) is still an option well accepted in many parts of the world. However, bipedicled TRAM flaps are associated with greater morbidity of the abdominal donor area. The aim of this study was to describe an efficient technique for correcting the delayed defects of the abdominal wall following mammary reconstruction carried out with bipedicled TRAM flaps by using two polypropylene prostheses overlapped in different anatomical planes. METHODS: At Hospital Estadual Sumaré at Universidade Estadual de Campinas, 18 women who underwent unilateral mammary reconstruction with bipedicled TRAM flaps and immediate fixation of two rectangular flaps of polypropylene mesh on the donor area were assessed. Later on, three patients (16.7%) presented with deformity of the anterolateral abdominal wall in the donor area. Each of these herniations was corrected by fixing two polypropylene meshes in different anatomical planes: the first mesh, which was bigger and preperitoneal, was fixed from the costal borders until the pubis; the second mesh was fixed from the external oblique muscle to the contralateral external oblique muscle, remaking the median line. RESULTS: All patients were followed up for at least 18 months, without any signs of relapse, abdominal asymmetry, or chronic pain and with satisfactory functional results. CONCLUSION: The correction of delayed deformities of the abdominal wall after mammary reconstruction with bipedicled TRAM flaps using double mesh was carried out in an effective and secure way, providing an interesting surgical option for mastologists and plastic and general surgeons.

An unusual adverse event of botulinum toxin injection in the lower face.

BACKGROUND: In the lower third of the face, botulinum toxin A is used to obtain a more harmonious contour. The anatomical complexity of the face requires a more precise application of botulinum toxin. AIM: Describe the treatment of an unexpected effect after botulinum toxin A application in the lower third of the face. PATIENT/METHODS: A 51-year-old female patient presented to our clinic for application of botulin toxin aiming to improve facial wrinkles and contour. 50 U of botulinum toxin type A were applied to the upper third and 20 U to the lower third of the face. The patient returned after 10 days with a smile asymmetry and an excessive and unconscious lowering on the right side of the lower lip while laughing. So, 3 U of botulinum toxin were applied to the center of the depressor labii inferioris muscle on the right side. RESULTS: The patient returned with a satisfactory correction of the smile asymmetry. CONCLUSION: Although treatments with botulinum toxin A are considered safe, unexpected results can occur. In our case, it probably occurred due to medial injection or diffusion of botulinum toxin A into depressor anguli oris muscle on the left side that may lead to paralysis of the left depressor labii inferioris muscle and downward hyperfunction of the unaffected right lower lip. The correction was made with a new injection of botulinum toxin A in the depressor labii inferioris hyperactive muscle at the right side.

Correlation between mastitis occurrence and the count of microorganisms in bulk raw milk of bovine dairy herds in four selective culture media.

Milk is the normal secretion of the mammary gland, practically free of colostrum and obtained by the complete milking of one or more healthy animals. Mastitis is an inflammatory process of the mammary gland and it may cause alterations in the milk. The present work aimed to verify whether it is possible, by means of the counts of microorganism in the bulk raw milk in four selective culture media, to establish a correlation with the occurrence of mastitis and therefore, to monitor this disease in bovine dairy herds. The following selective culture media were used: KF Streptococcus Agar, Edwards Agar, Baird-Parker Agar, Blood Agar plus potassium tellurite. Spearman's correlation coefficient was calculated in order to compare the occurrence of mastitis (percentage) in each herd with respective selective culture media counts of microorganisms in bulk raw milk. Thirty-six possibilities were analysed (Tamis and CMT-positive rates were compared with the log-transformed count in four selective culture media) and there was a negative correlation between Tamis 3 and the Baird-Parker Agar plate count. The total results of microbiological tests showed that there were three correlations of the counts in selective culture media. Fifty-two possibilities were analysed and there was a negative correlation between no-bacterial-growth mastitis rates and log10 of KF Streptoccocus Agar plate count and there were two positive correlations between coagulase-positive staphylococci and log10 of Baird-Parker Agar plate count and Blood Agar plus potassium tellurite plate count.

Evaluation of mitogenome sequence concordance, heteroplasmy detection, and haplogrouping in a worldwide lineage study using the Precision ID mtDNA Whole Genome Panel.

The emergence of Massively Parallel Sequencing technologies enabled the analysis of full mitochondrial (mt)DNA sequences from forensically relevant samples that have, so far, only been typed in the control region or its hypervariable segments. In this study, we evaluated the performance of a commercially available multiplex-PCR-based assay, the Precision ID mtDNA Whole Genome Panel (Thermo Fisher Scientific), for the amplification and sequencing of the entire mitochondrial genome (mitogenome) from even degraded forensic specimens. For this purpose, more than 500 samples from 24 different populations were selected to cover the vast majority of established superhaplogroups. These are known to harbor different signature sequence motifs corresponding to their phylogenetic background that could have an effect on primer binding and, thus, could limit a broad application of this molecular genetic tool. The selected samples derived from various forensically relevant tissue sources and were DNA extracted using different methods. We evaluated sequence concordance and heteroplasmy detection and compared the findings to conventional Sanger sequencing as well as an orthogonal MPS platform. We discuss advantages and limitations of this approach with respect to forensic genetic workflow and analytical requirements.

Pinna synthetic mold for otoplasty techniques application.

INTRODUCTION: The ear deformity Tanzer type V, also known as prominent ears, is the most common genetic defect of the pinna. The surgery designed for its correction is known as otoplasty. This esthetic surgery can be performed using different techniques, which requires great skill of its operator. OBJECTIVE: The purpose of this work is the development of a new tool for otoplasty techniques training, aimed on the possibility to minimize errors during the otoplasty. METHODS: Synthetic molds of the external ear from patients with Tanzer type V deformity were made, using silicone material and rayon. RESULTS: The main procedures of otoplasty could be performed in the molds made of silicone and rayon with a good esthetic result. CONCLUSION: The elaborated molds had identical size and shape of a human ear and could be positioned in the same shape of the patient ears. Thus, the synthetic molds were presented as promising simulation tools for the training and surgical enhancement of otoplasty, especially for doctors beginners.

Lack of gene-language correlation due to reciprocal female but directional male admixture in Austronesians and non-Austronesians of East Timor.

Nusa Tenggara, including East Timor, located at the crossroad between Island Southeast Asia, Near Oceania, and Australia, are characterized by a complex cultural structure harbouring speakers from two different major linguistic groups of different geographic origins (Austronesian (AN) and non-Austronesian (NAN)). This provides suitable possibilities to study gene-language relationship; however, previous studies from other parts of Nusa Tenggara reported conflicting evidence about gene-language correlation in this region. Aiming to investigate gene-language relationships including sex-mediated aspects in East Timor, we analysed the paternally inherited non-recombining part of the Y chromosome (NRY) and the maternally inherited mitochondrial (mt) DNA in a representative collection of AN- and NAN-speaking groups. Y-SNP (single-nucleotide polymorphism) data were newly generated for 273 samples and combined with previously established Y-STR (short tandem repeat) data of the same samples, and with previously established mtDNA data of 290 different samples with, however, very similar representation of geographic and linguistic coverage of the country. We found NRY and mtDNA haplogroups of previously described putative East/Southeast Asian (E/SEA) and Near Oceanian (NO) origins in both AN and NAN speakers of East Timor, albeit in different proportions, suggesting reciprocal genetic admixture between both linguistic groups for females, but directional admixture for males. Our data underline the dual genetic origin of East Timorese in E/SEA and NO, and highlight that substantial genetic admixture between the two major linguistic groups had occurred, more so via women than men. Our study therefore provides another example where languages and genes do not conform due to sex-biased genetic admixture across major linguistic groups.

Model for human skin reconstructed in vitro composed of associated dermis and epidermis.

CONTEXT AND OBJECTIVE: The technique of obtaining human skin with dermis and epidermis reconstructed from cells isolated from patients can enable autologous skin grafting on patients with few donor sites. It also enables in vitro trials on chemicals and drugs. The objective of this work was to demonstrate a method for obtaining human skin composed of associated dermis and epidermis, reconstructed in vitro. DESIGN AND SETTING: Experimental laboratory study, in the Skin Cell Culture Laboratory of Faculdade de Ciências Médicas, Universidade Estadual de Campinas. METHODS: Cells from human fibroblast cultures are injected into bovine collagen type I matrix and kept immersed in specific culturing medium for fibroblasts. This enables human dermis reconstruction in vitro. On this, by culturing human keratinocytes and melanocytes, differentiated epidermis is formed, leading to the creation of human skin composed of associated dermis and epidermis, reconstructed in vitro. RESULTS: We showed that human skin composed of associated dermis and epidermis can be successfully reconstructed in vitro. It is histologically formed in the same way as human skin in vivo. Collagen tissue can be identified in the dermis, with cells and extracellular matrix organized in parallel to multilayer epidermis. CONCLUSIONS: It is possible to obtain completely differentiated human skin composed of associated dermis and epidermis, reconstructed in vitro, from injection of human fibroblasts into bovine collagen type I matrix and culturing of human keratinocytes and melanocytes on this matrix.

Pacifiplex: an ancestry-informative SNP panel centred on Australia and the Pacific region.

The analysis of human population variation is an area of considerable interest in the forensic, medical genetics and anthropological fields. Several forensic single nucleotide polymorphism (SNP) assays provide ancestry-informative genotypes in sensitive tests designed to work with limited DNA samples, including a 34-SNP multiplex differentiating African, European and East Asian ancestries. Although assays capable of differentiating Oceanian ancestry at a global scale have become available, this study describes markers compiled specifically for differentiation of Oceanian populations. A sensitive multiplex assay, termed Pacifiplex, was developed and optimized in a small-scale test applicable to forensic analyses. The Pacifiplex assay comprises 29 ancestry-informative marker SNPs (AIM-SNPs) selected to complement the 34-plex test, that in a combined set distinguish Africans, Europeans, East Asians and Oceanians. Nine Pacific region study populations were genotyped with both SNP assays, then compared to four reference population groups from the HGDP-CEPH human diversity panel. STRUCTURE analyses estimated population cluster membership proportions that aligned with the patterns of variation suggested for each study population's currently inferred demographic histories. Aboriginal Taiwanese and Philippine samples indicated high East Asian ancestry components, Papua New Guinean and Aboriginal Australians samples were predominantly Oceanian, while other populations displayed cluster patterns explained by the distribution of divergence amongst Melanesians, Polynesians and Micronesians. Genotype data from Pacifiplex and 34-plex tests is particularly well suited to analysis of Australian Aboriginal populations and when combined with Y and mitochondrial DNA variation will provide a powerful set of markers for ancestry inference applied to modern Australian demographic profiles. On a broader geographic scale, Pacifiplex adds highly informative data for inferring the ancestry of individuals from Oceanian populations. The sensitivity of Pacifiplex enabled successful genotyping of population samples from 50-year-old serum samples obtained from several Oceanian regions that would otherwise be unlikely to produce useful population data. This indicates tests primarily developed for forensic ancestry analysis also provide an important contribution to studies of populations where useful samples are in limited supply.

Escola e laço fraterno / Escuela y lazo fraterno / School and fraternal bond / L'école et le lien fraternel

Este artigo recupera algumas das características civilizatórias que marcaram o advento das sociedades da modernidade democrática e destaca aquele que seria o traço distintivo da escola republicana. A identificação desse traço permite confrontar as reivindicações de movimentos que atualmente afirmam a prioridade da educação familiar sobre a educação escolar e interrogar alguns dos pressupostos dos ideólogos de uma "educação para a sociabilidade democrática", que muitas vezes desconsideram que uma educação escolar comprometida com promoção da experiência democrática passa, antes de tudo, pela afirmação da escola como instituição implicada com a produção de uma filiação simbólica comum. É essa afirmação que nos permitirá vislumbrar, por fim, o limite da família no processo da transmissão simbólica que balizará o acontecimento de um sujeito interpelado na modernidade como indivíduo e como cidadão.

Este artículo busca recuperar algunas de las características civilizadoras que marcan el advenimiento de las sociedades de la modernidad democrática para, a partir de allí, rescatar el rasgo distintivo de la escuela republicana. La identificación de este rasgo que caracteriza a la escuela soñada por la modernidad democrática permite, en un segundo momento, confrontar el argumento en el que se basan los movimientos actuales que priorizan la educación familiar por sobre la escolar y, al mismo tiempo, cuestionar algunos de los presupuestos idealistas de una "educación para sociabilidad democrática" - que, muchas veces, desconocen que una educación escolar comprometida con la promoción de la experiencia democrática se basa, principalmente, en la consolidación de la escuela como institución implicada en la producción de una filiación simbólica común.

Starting with a brief consideration on the movements that presently claim the priority of family education over school education, and those that reclaim the possibility of an education fully ran in a home territory, this paper aims to recover some of the civilizatory characteristics that mark the advent of the societies of the democratic modernity to, from this point, retrieve what would be the distinctive trait of the Republican school. The identification of this trait that distinguishes the dreamed school in the advent of the democratic modernity allows us, at a second moment, to confront the argument that serves as a basis for these movements' claims. At the same time, it allows us to question some of the assumptions from the ideologues of an "education for the democratic sociability" - who, often, end for considering that a school education committed with the promotion of the democratic experience passes, first and foremost, through the affirmation of school as an institution implicated with the production of a common filiation.

Cet article vise à reprendre, en premier lieu, certains éléments civilisateurs caractérisant l'avènement des sociétés de la modernité démocratique afin d'en dégager celui qui serait le trait distinctif de l'école républicaine. D'une part, ce travail d'identification nous permet de confronter les propos des mouvements qui revendiquent, de nos jours, la priorité de l'éducation familiale par rapport à l'éducation scolaire. D'autre part, il est également nécessaire de remettre en cause quelques présupposés des théoriciens d'une « éducation pour la sociabilité démocratique ¼ d'autant plus qu'ils ne prennent pas assez souvent en compte certains aspects importants d'une éducation scolaire engagée à la promotion de l'expérience démocratique. Au terme de l'analyse, cette étude cherche à mettre en évidence que la scolarisation liée à la sociabilité démocratique passe, avant tout, par l'affirmation d'une école considérée comme une institution orientée envers la production d'une filiation commune.

Model of human epidermis reconstructed in vitro with keratinocytes and melanocytes on dead de-epidermized human dermis.

CONTEXT: Recent progress in the field of epithelial culture techniques has allowed the development of culture systems in which the reconstructed epidermis presents characteristics of morphological differentiation similar to those seen in vivo. Human epidermis reconstructed in vitro may be used as the best alternative for the in vitro testing of the toxicology and efficiency of products for topical use, as well as in the treatment of skin burns and chronic skin ulcers. OBJECTIVE: To demonstrate a method for obtaining human epidermis reconstructed in vitro, using keratinocytes and melanocytes cultivated on dead de-epidermized human dermis. TYPE OF STUDY: Experimental/laboratory. SETTING: Skin Cell Culture Laboratory of the Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PROCEDURE: Human keratinocytes and melanocytes cultured in vitro were grown on a biological matrix (dead de-epidermized human dermis) and the system was kept at an air-liquid interface, in a suitable culturing medium, until a stratified human epidermis was formed, maintaining the histological characteristics of the epidermis in vivo. RESULTS: It was histologically demonstrated that it is possible to reproduce a differentiated epidermis through keratinocytes and melanocytes cultured on dead de-epidermized human dermis, thus obtaining a correctly positioned human epidermis reconstructed in vitro with functional keratinocytes and melanocytes that is similar to in vivo epidermis. CONCLUSIONS: It is possible to obtain a completely differentiated human epidermis reconstructed in vitro from keratinocyte and melanocyte cultures on a dead de-epidermized human dermis.