Oncoplastic surgery for breast cancer: Global perspectives and trends.

Oncoplastic surgery (OPS) is a form of breast conservation that combines definitive oncologic resection with optimal aesthetic outcomes. Various definitions exist, with most focusing on volume displacement techniques to close the lumpectomy defect and redistribute the remaining breast volume over the preserved breast. Although its oncologic safety has been well demonstrated, uptake into practice varies globally. This article details the definition, safety, training opportunities, and practice patterns of OPS on a global scale.

Genomic insights into rapid speciation within the world's largest tree genus Syzygium.

Species radiations, despite immense phenotypic variation, can be difficult to resolve phylogenetically when genetic change poorly matches the rapidity of diversification. Genomic potential furnished by palaeopolyploidy, and relative roles for adaptation, random drift and hybridisation in the apportionment of genetic variation, remain poorly understood factors. Here, we study these aspects in a model radiation, Syzygium, the most species-rich tree genus worldwide. Genomes of 182 distinct species and 58 unidentified taxa are compared against a chromosome-level reference genome of the sea apple, Syzygium grande. We show that while Syzygium shares an ancient genome doubling event with other Myrtales, little evidence exists for recent polyploidy events. Phylogenomics confirms that Syzygium originated in Australia-New Guinea and diversified in multiple migrations, eastward to the Pacific and westward to India and Africa, in bursts of speciation visible as poorly resolved branches on phylogenies. Furthermore, some sublineages demonstrate genomic clines that recapitulate cladogenetic events, suggesting that stepwise geographic speciation, a neutral process, has been important in Syzygium diversification.

A human rights-based approach to improve access to insulin and other aspects of diabetes care.

Many nations struggle to provide adequate diabetes care. Legal as well as moral obligations may facilitate access. International human rights law places obligations on governments to ensure the accessibility and affordability of insulin (a World Health Organization essential medicine), and other components of diabetes care. Despite this obligation, the global reality is that access remains deficient. A human rights approach facilitating the improvement of diabetes services and equitable access to insulin provides a strong framework, theoretically and practically, for advocacy and policymaking changes. This approach links governments to their international obligations, fosters the ideal of, and adherence to, national essential medicine lists, complements the pursuit of international goals in non-communicable diseases, and should influence the actions of pharmaceutical and device companies. This approach empowers patients, families, and communities living with diabetes, and grounds actions by governments, clinicians, and non-government organisations in the principles of dignity, non-discrimination, and equity of access.

Perrottetiataronensis B.M.Barthol. & K.Armstr., sp. nov. (Dipentodontaceae), a new species from northwestern Yunnan Province, China and northern Kachin State, Myanmar and a re-examination of the Asian and Australasian taxa of Perrottetia.

Perrottetiataronensis from the Dulong Jiang valley in northwestern Yunnan Province, China and the Babulongtan mountain range in northern Kachin State, Myanmar is here described as a new species of the Dipentodontaceae. It is the third species of the genus to be recognized for China and the first to be reported for Myanmar. It is similar to P.alpestris s.s. but differs by characters of its leaf margins, inflorescences, and fruit. The three subspecies of P.alpestris recognized by Hou in "Flora Malesiana" are here recognized as three distinct species, i.e., P.alpestris, P.moluccana, and P.philippinensis on the basis of differences in diagnostic characters and distribution. The report in the "Flora of China" of the Taiwan species P.arisanensis from Yunnan is determined to be incorrect due to misidentification of two specimens at KUN.

We All Have a Role to Play: Redressing Inequities for Children Living with CAH and Other Chronic Health Conditions of Childhood in Resource-Poor Settings.

CLAN (Caring and Living as Neighbours) is an Australian-based non-governmental organisation (NGO) committed to equity for children living with chronic health conditions in resource-poor settings. Since 2004, CLAN has collaborated with a broad range of partners across the Asia Pacific region to improve quality of life for children living with congenital adrenal hyperplasia (CAH). This exploratory case study uses the Knowledge to Action (KTA) framework to analyse CLAN's activities for children living with CAH in the Asia Pacific. The seven stages of the KTA action cycle inform a systematic examination of comprehensive, collaborative, sustained actions to address a complex health challenge. The KTA framework demonstrates the "how" of CLAN's approach to knowledge creation and exchange, and the centrality of community development to multisectoral collaborative action across a range of conditions, cultures and countries to redressing child health inequities. This includes a commitment to: affordable access to essential medicines and equipment; education, research and advocacy; optimisation of medical management; encouragement of family support groups; efforts to reduce financial burdens; and ethical, transparent program management as critical components of success. Improvements in quality of life and health outcomes are achievable for children living with CAH and other chronic health conditions in resource-poor settings. CLAN's strategic framework for action offers a model for those committed to #LeaveNoChildBehind.

Corrigendum: Patterns of diversification amongst tropical regions compared: a case study in Sapotaceae.

[This corrects the article on p. 362 in vol. 5, PMID: 25520736.].

Patterns of diversification amongst tropical regions compared: a case study in Sapotaceae.

Species diversity is unequally distributed across the globe, with the greatest concentration occurring in the tropics. Even within the tropics, there are significant differences in the numbers of taxa found in each continental region. Manilkara is a pantropical genus of trees in the Sapotaceae comprising c. 78 species. Its distribution allows for biogeographic investigation and testing of whether rates of diversification differ amongst tropical regions. The age and geographical origin of Manilkara are inferred to determine whether Gondwanan break-up, boreotropical migration or long distance dispersal have shaped its current disjunct distribution. Diversification rates through time are also analyzed to determine whether the timing and tempo of speciation on each continent coincides with geoclimatic events. Bayesian analyses of nuclear (ITS) and plastid (rpl32-trnL, rps16-trnK, and trnS-trnFM) sequences were used to reconstruct a species level phylogeny of Manilkara and related genera in the tribe Mimusopeae. Analyses of the nuclear data using a fossil-calibrated relaxed molecular clock indicate that Manilkara evolved 32-29 million years ago (Mya) in Africa. Lineages within the genus dispersed to the Neotropics 26-18 Mya and to Asia 28-15 Mya. Higher speciation rates are found in the Neotropical Manilkara clade than in either African or Asian clades. Dating of regional diversification correlates with known palaeoclimatic events. In South America, the divergence between Atlantic coastal forest and Amazonian clades coincides with the formation of drier Cerrado and Caatinga habitats between them. In Africa diversification coincides with Tertiary cycles of aridification and uplift of the east African plateaux. In Southeast Asia dispersal may have been limited by the relatively recent emergence of land in New Guinea and islands further east c. 10 Mya.

Glycaemic control in children with neonatal diabetes and type 1 diabetes in Vietnam.

Childhood diabetes care may be suboptimal in resource-poor countries. A cross-sectional study of youths with diabetes aged ≤19 years attending the three major paediatric centres in Vietnam was performed. Diabetes management was documented by questionnaire. Glycated haemoglobin (HbA1c) was measured with a fingerprick blood sample. Multiple linear regression analysis was used to examine factors associated with glycaemic control. In total, 105 patients participated, comprising 93 with type 1 diabetes and 12 with neonatal diabetes. The median age was 11.5 years [interquartile range (IQR) 6.4-14.5 years] and the median duration of diabetes was 2.6 years (IQR 1.5-6.1 years). Patients with type 1 diabetes performed few blood glucose tests per month (median 8, IQR 4-30). Mean HbA1c was higher in patients with type 1 diabetes compared with neonatal diabetes (9.9% vs. 7.5%; P = 0.01). In type 1 diabetes using multivariate analysis, higher HbA1c was associated with older age (ß = 0.3, 95% CI 0.2-0.4; P < 0.001), lower frequency of blood glucose monitoring (ß = -0.06, 95% CI -0.10 to 0.12; P = 0.01) and use of pre-mixed insulin (ß = -1.7, 95% CI -3.4 to 0.0; P = 0.05). In conclusion, international glycaemic control targets for childhood diabetes (HbA1c <7.5%) are not being achieved in Vietnam, and intensive diabetes management is rare. There is an urgent need to address barriers to achieving optimal control in this population.