Synthetic polymers for simultaneous bacterial sequestration and quorum sense interference.

Double agents: dual-action polymers are able to sequester rapidly the marine organism Vibrio harveyi from suspension, while at the same time quenching bacterial quorum sense (QS) signals. The potency of the polymers is assessed by cell aggregation experiments and competitive binding assays against a QS signal precursor, and their effect on bacterial behavior is shown by means of bioluminescence.

Rejuvenation of the midface by elevating the malar fat pad: review of technique, cases, and complications.

The midface is an area where definite and consistent improvement is still hard to achieve. Vertical suspension of the malar fat pad is an effective midface lift that complements facial rejuvenation to obtain an overall appearance of youth and beauty while maintaining the personal features of the patient. To substantiate its effectiveness, the authors evaluated the complications and long-term results of the malar fat pad elevation proper and in conjunction with other facial procedures. A retrospective review of the medical records of 458 consecutive patients who underwent malar fat pad elevation by the senior author (B.C.D.) from January of 1994 to January of 2000 was conducted. Because 14 patients had their malar fat pad re-elevated, the number of midface lifts totaled 472. Of these, 437 had a combined superficial musculoaponeurotic system excision and tightening, 19 had a combined limited superficial musculoaponeurotic system plication/imbrication, and 16 had elevation of the malar fat pad only. Elevating the malar fat pad appears to be a sound, straightforward, and effective means of rendering a youthful midface. It consistently reshapes the malar eminence, softens the nasolabial fold, and rejuvenates the lower eyelid. This technique provides lasting results, with an acceptable complication rate. Facial nerve injury, in particular, was infrequent and temporary. In addition, the prehairline scar happened to be quite inconspicuous, especially in patients older than 55 years. This experience confirms that malar fat pad elevation is a safe and effective method to rejuvenate the central third of the face.

Endoscopic forehead lift: review of technique, cases, and complications.

Endoscopy has provided a significant improvement in the surgical rejuvenation of the upper face. It offers a minimally invasive alternative that avoids many of the undesirable effects associated with the coronal approach. The standard minimal access forehead endoscopic procedure consists of a subperiosteal undermining through three small triangular prehairline incisions. To successfully elevate the eyebrows, it is essential to release the periosteum at the level of the supraorbital rims and ablate the brow depressor muscles of the glabella. Until the periosteum reattaches itself, elevation is maintained by a temporary suspension suture between staples at the incision sites and 5 cm posterior to the hairline. The transverse closure of the triangular skin incisions achieves some additional elevation. The biplanar approach adds a partial subcutaneous undermining of the forehead to the endoscopic technique and allows plication of the frontalis muscle and excision of excess forehead skin. It is offered to patients with very ptotic eyebrows, deep transverse wrinkles, or a high forehead. The prehairline incision is a disadvantage but is tolerated quite well in older patients. The medical records of 393 consecutive patients who underwent endoscopic forehead lift from 1994 to 2000 were reviewed. Because seven patients had the endoscopic forehead lift repeated, the number of forehead endoscopies totaled 400. The complication rate was quite acceptable and did not markedly increase when a forehead lift was performed in combination with other facial procedures. The endoscopic forehead lift consistently attenuated the transverse forehead wrinkles, reduced the glabellar frown lines, and raised the eyebrows. It provided an appearance that was less tired and angry in addition to opening the area around the eyes. Long-term follow-up has shown that the endoscopic forehead lift produces lasting and predictable results.

Sugar synthesis in a protocellular model leads to a cell signalling response in bacteria.

The design of systems with life-like properties from simple chemical components may offer insights into biological processes, with the ultimate goal of creating an artificial chemical cell that would be considered to be alive. Most efforts to create artificial cells have concentrated on systems based on complex natural molecules such as DNA and RNA. Here we have constructed a lipid-bound protometabolism that synthesizes complex carbohydrates from simple feedstocks, which are capable of engaging the natural quorum sensing mechanism of the marine bacterium Vibrio harveyi and stimulating a proportional bioluminescent response. This encapsulated system may represent the first step towards the realization of a cellular 'mimic' and a starting point for 'bottom-up' designs of other chemical cells, which could perhaps display complex behaviours such as communication with natural cells.

Comorbidity trends in patients requiring sternectomy and reconstruction.

INTRODUCTION: The predisposing risk factors for sternal wound infection have been well delineated. However, the indications and comorbidity of patients who require cardiac surgery via the median sternotomy approach have changed over time and subsequently have changed the patient population presenting with sternal wound complications. These trends in cardiac surgery may require an adjustment of the plastic surgical approach and methods to optimize outcomes in the patient population. METHODS: A retrospective review was performed to identify patients who had undergone sternectomy or sternal debridement followed by flap coverage. A total of 93 cases performed between 1999 and 2004 examined to collect data about the initial presentation, operative procedure, and postoperative care of each patient. The data were then analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted (multivariable) measures of association with mortality. RESULTS: Results of the review indicated that 53% of the patients were male and 47% were female, with a median age of 62 years. Preoperative comorbidities included 64% of the patients were over age 60, 43% had diabetes, 51% had hypertension, 13% had renal insufficiency, and 6% were transplant recipients. The method of reconstruction varied, but the majority were pectoralis advancement flaps. Of the patients who underwent debridement and reconstruction, there was a 16% 30-day mortality. Among these mortalities, the distribution was 33% (5/15) male and 66% (10/15) female. CONCLUSIONS: Though the incidence of sternal wound problems is rare (about 1%-5%), there is a significant population of older, renal-insufficient, malnourished patients who present days or weeks after one would normally diagnose and treat a deep sternal wound infection who have a significant mortality rate. Appropriate identification of risk factors, preoperative management and timing for aggressive surgical treatment is required to maximize successful outcomes in this problematic patient population.

Retrospective review of the internal Doppler probe for intra- and postoperative microvascular surveillance.

The purpose of this review was to evaluate the utility of the 20 MHz microvascular implantable Doppler probe for free-tissue transfer, both intra- and postoperatively. Over a 15-month period, the Doppler probe was used in a total of 260 anastomoses, including 118 arterial and 142 venous microanastamoses. In these 260 anastomoses, there were six false positive results and eight true positives, resulting in one flap loss. The free flap success rate was 99 percent, the re-exploration rate was 8 percent, and the salvage rate was 83 percent. The internal Doppler offers an easy and reliable way to monitor microvascular free-tissue transfer both intra- and postoperatively. This study demonstrates the continued increase in survival, as well as salvage, of free-tissue transfer.

Clinical analysis of malar fat pad re-elevation.

Primary suture suspension of the malar fat pad has been described as a safe and simple component of global facial rejuvenation. This review evaluates the efficacy and indications for re-elevation of the malar fat pad elevation. A retrospective review of the medical records of patients who underwent malar fat pad elevation was performed between 1994 and 2000. Of 472 procedures, 14 involved re-elevation of the malar fat pad. These cases were examined for complications, risks, and results. Secondary midface elevation was performed using a subcutaneous approach to the malar fat pad through a pre-hairline incision and vertical suspension of the malar fat pad to the temporoparietal fascia. The indications for re-elevation of the malar fat pad included nasolabial asymmetry, malar fat pad malposition, and malar fat pad asymmetry. Primary elevation of the malar fat was performed in 472 patients. Fourteen of these patients had suboptimal results that necessitated re-elevation of their malar fat pads. Their average age was 57.5 years. Of the 14 malar fat pad elevations, 12 included SMAS procedures, nine were combined with platysmal plication/submental lipectomy, six with forehead lift, and three with eyelid procedures. The average interval between original malar fat pad elevation and the re-elevation was 40 months. Average follow-up was 15 months. Complications were seen in five patients, with the most significant being persistent eye irritation. Two patients had some minimal scar hypertrophy, which was self-limiting. Minor preauricular skin slough developed in one patient. Restoration of the youthful position of the deep structures in patients with a previous mid-facelift was successfully achieved by re-elevating the malar fat pad in a vertical direction. Re-elevation of the malar fat pad demonstrated effective and reliable long-term results. It is appropriate in the small number of patients who require revision or improvement of midface rejuvenation using the malar fat pad suspension technique.

Abdominoplasty repair for abdominal wall hernias.

The objectives of abdominal hernial repair are to reconstruct the structural integrity of the abdominal wall while minimizing morbidity. Current techniques include primary closure, staged repair, and the use of prosthetic materials. Techniques for abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. By incorporating these aspects into hernial repairs, the procedures are made safer and the results are improved. The medical records were reviewed of 123 consecutive patients who underwent hernial repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies using an abdominoplasty approach. This included using a transverse lower abdominal incision with or without extending it into an inverted-T incision. The hernial defect was then identified and isolated. Repair was obtained with primary fascial closure and plication, primary fascial approximation and reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with or without fascial approximation. Overall, 8 of 82 hernias recurred. Most complications were minor and could be managed with local wound care only. Major complications included one enterocutaneous fistula, one occurrence of skin flap necrosis requiring operative debridement and skin grafting, and one delayed permanent mesh extrusion 2 years after repair. The abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe with a low risk of complications and a low rate of recurrence. It is particularly helpful in obese patients, in patients with multiple hernias, and in those patients with recurrent hernias.