Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora

The labia minora or nymphae of the vulva are two cutaneous-mucosal refolds located between the labia majora, the internal aspect of which is separated by the interlabial cleft. The enlargement of the labia minora may be attributable to several factors, most commonly congenital. Although some women require surgical reduction for functional reasons, most seek reduction of their labia minora because of psychological concerns. The authors describe a modified plastic surgery procedure for functional and aesthetic reduction of the labia minora.     

Medial pedicle reduction mammaplasty for severe mammary hypertrophy

Current options in reduction mammaplasty for severe mammary hypertrophy include amputation with free-nipple graft as well as the inferior pedicle and bipedicle techniques. Complications of these procedures include nipple-areola necrosis, insensitivity, and hypopigmentation. The purpose of this study was to determine whether medial pedicle reduction mammaplasty can minimize these complications. Twenty-three patients with severe mammary hypertrophy were studied. The medial pedicle successfully transposed the nipple-areola complex in 44 of 45 breasts (98 percent). Mean change in nipple position was 17.1 cm, and mean weight of tissue removed was 1604 g per breast. Nipple-areola sensation was retained in 43 of 44 breasts (98 percent) using a medial pedicle. Hypopigmentation was not observed, and central breast projection was restored in all patients. This study has demonstrated that medial pedicle reduction mammaplasty is a safe and reliable technique and should be given primary consideration in cases of severe mammary hypertrophy.     

Morphology of the petal inAconitum

The petals ofAconitum were classified into six types. Type I: the labium tubular at the base and no appendage inside. Type II: a lambda (A)-shaped enation present inside the limb. The upper part of the enation is situated at the lower edge of the spur mouth and both wings of the enation extend to margins of the labium. Type III resembles type II but both wings do not extend to the margins. Type IV: a small flap attached at the lower edge of the spur mouth. Type V: two auriculate appendages present on both lateral walls of the labium. Type VI: without inside appendage. Most species of sect.Lycoctonum have type I petal and those of sect.Aconitum have type V petal. Type I is distinctly cup-shaped or peltate with a well developed cross zone or adaxial wall and type II is a modification of type I. Type VI is distinctly flat or epeltate without the cross zone. Others are intermediate between cup-shaped and flat or peltate and epeltate types. Based on the observation of petal ontogeny onA. pterocaule var.glabrescens, A. vulparia andA. japonicum var.eizanense, the relation among these types was explained by the partial or total reduction of the adaxial meristematic regions.     

Simplifying the vertical reduction mammaplasty

The vertical reduction mammaplasty is an evolving technique. Its proponents report significantly decreased scarring, better breast shape, and more stable results compared with the standard inverted-T method, but the learning curve is long and cosmetic outcomes can be inconsistent. Many surgeons have experimented with the vertical closure before returning to methods more familiar to them. The authors present their modifications to the vertical reduction mammaplasty. Their changes simplify the preoperative markings and the intraoperative technique to shorten the learning curve while maintaining reliable aesthetic results. With the patient standing, only four preoperative marks are made: (1) the inframammary fold; (2) the breast axis; (3) the apex of the new nipple-areola complex; and (4) the medial and lateral limbs of the vertical incision. In the operating room, a medial or a superomedial pedicle is developed. Excess breast skin is resected with the inferior and lateral parenchyma as a C-shaped wedge. The lateral skin-adipose flap is redraped inferomedially and sutured to the chest wall. The inferior aspect of the breast is aggressively debulked and a gathering subcuticular stitch is started 2 cm below the nadir of the nipple-areola complex. Finally, a 38-mm to 42-mm nipple-areola complex marker is used to create a circular defect that is offset 0.5 cm medial to the vertical axis of the breast. In their series, 56 patients were treated and no major complications were noted. The median follow-up period was 17 months. The average reduction was 554.5 g per breast; however, the reduction was greater than 1000 g per breast in eight patients. The authors found that (1) chest wall anchoring improves lateral contour and minimizes axillary fullness; (2) aggressive debulking inferiorly avoids the persistent inferior bulge; and (3) starting the subcuticular gathering suture 2 cm below the nipple-areola complex followed by placement of a nipple-areola complex marker at the conclusion of the case prevents lateral deviation and corrects the nipple-areola complex teardrop deformity. These innovations accelerate the learning curve by simplifying the preoperative markings and lead to more consistent postoperative results and an improved cosmetic outcome. In conclusion, these modifications yield a simple, easily learned vertical reduction mammaplasty with aesthetically reliable results.     

The reduction of putidaredoxin reductase by reduced pyridine nucleotides

Putidaredoxin reductase (PdR), an FAD-containing protein, mediates the transfer of electrons from NADH to putidaredoxin in the cytochrome P-450cam-dependent oxidation of camphor. Using stopped-flow spectrophotometry, reduction of putidaredoxin reductase by NADH (70 microM) at 4 degrees C appeared to be a pseudo-first-order process with a rate constant in excess of 600 s-1. The reduction of putidaredoxin reductase by NADPH was much slower with a second-order rate constant of 530 s-1 M-1 at 4 degrees C. The reduction of the enzyme was monitored at several wavelengths: 455 nm to follow flavin reduction; 700 nm to follow the appearance of the long-wavelength charge-transfer complex; and 513 nm to detect the presence of a semiquinone form of the flavoprotein. There was no apparent semiquinone formation observed during reduction. The charge-transfer complex can be formed in the presence of NAD+, whereas, no charge-transfer band could be detected when PdR was reduced with NADPH. The titration of chemically or NADPH-reduced putidaredoxin reductase with either a stoichiometric or an excess amount of NAD+ resulted in the formation of a charge-transfer complex, indicating that the reduced form of PdR has a high affinity for NAD+ regardless of the method of reduction. The data presented indicate that putidaredoxin reductase is reduced without the formation of semiquinone intermediate and, upon reduction, forms a tight complex with NAD+. The Keq for the reduction of PdR by NADPH is 1.1 and the midpoint potential for this reaction is -317 +/- 5 mV.     

Repeat reduction mammaplasty

Repeat reduction mammaplasty is an uncommonly performed procedure. Currently, no clear operative guidelines of management exist. Sixteen patients (28 breasts) with a mean age of 29 years (range, 13 to 52 years) underwent repeat breast reduction over an 11-year period. Before the first reduction, the mean notch to nipple distance was 29.6 cm (range, 24 to 38 cm) and mean nipple to inframammary crease distance was 15.5 cm (range, 12 to 18 cm). The mean mass of tissue excised was 615 g per breast. A number of different pedicles were used (six inferior, five superior, four superomedial, one unknown). All patients subsequently developed pseudoptosis. The nipple to inframammary crease distance was a mean of 11.4 cm (having initially been set at 7 cm) before the second procedure. At the second operation, two patients (three breasts) had their initial pedicles transected and the nipple-areola complex moved, and both patients developed vascular compromise of the nipple-areola complex (two breasts). Where the same pedicle was used in the second operation (five patients, 10 breasts), one patient developed unilateral nipple-areola complex necrosis. In eight patients, because of the development of pseudoptosis, the nipple was in a satisfactory position, and therefore only an inferior wedge of tissue required excision. This was performed without nipple-areola complex compromise, irrespective of the initial pedicle. The mean mass of tissue excised in the second operation was 325 g per breast (range, 120 to 620 g). Fourteen patients were available for follow-up after a mean of 5.1 years (range, 3 months to 11.7 years) following the repeat reduction mammaplasty. In the repeat breast reduction, where nipple-areola complex transposition is planned, the initial pedicle should be reused to maintain nipple-areola complex perfusion. Where the initial pedicle is not known, a free nipple graft may be the safest option. In patients with pseudoptosis, in whom the nipple does not require transposition, an inferior wedge of tissue can be safely excised, irrespective of the initial pedicle.     

Convolutional Virtual Electric Field for Image Segmentation Using Active Contours

Gradient vector flow (GVF) is an effective external force for active contours; however, it suffers from heavy computation load. The virtual electric field (VEF) model, which can be implemented in real time using fast Fourier transform (FFT), has been proposed later as a remedy for the GVF model. In this work, we present an extension of the VEF model, which is referred to as CONvolutional Virtual Electric Field, CONVEF for short. This proposed CONVEF model takes the VEF model as a convolution operation and employs a modified distance in the convolution kernel. The CONVEF model is also closely related to the vector field convolution (VFC) model. Compared with the GVF, VEF and VFC models, the CONVEF model possesses not only some desirable properties of these models, such as enlarged capture range, u-shape concavity convergence, subject contour convergence and initialization insensitivity, but also some other interesting properties such as G-shape concavity convergence, neighboring objects separation, and noise suppression and simultaneously weak edge preserving. Meanwhile, the CONVEF model can also be implemented in real-time by using FFT. Experimental results illustrate these advantages of the CONVEF model on both synthetic and natural images.     

Tip-to-tip interaction in the crystal packing of PACSIN 2 is important in regulating tabulation activity

The F-BAR domain containing proteins PACSINs are cytoplasmic phosphoproteins involved in various membrane deformations, such as actin reorganization, vesicle transport and microtubule movement. Our previous study shows that all PACSINs are composed of crescent shaped dimers with two wedge loops, and the wedge loopmediated lateral interaction between neighboring dimmers is important for protein packing and tubulation activity. Here, from the crystal packing of PACSIN 2, we observed a tight tip-to-tip interaction, in addition to the wedge loopmediated lateral interaction. With this tip-to-tip interaction, the whole packing of PACSIN 2 shows a spiral-like assembly with a central hole from the top view. Elimination of this tip-to-tip connection inhibited the tubulation function of PACSIN 2, indicating that tip-to-tip interaction plays an important role in membrane deformation activity. Together with our previous study, we proposed a packing model for the assembly of PACSIN 2 on membrane, where the proteins are connected by tip-to-tip and wedge loop-mediated lateral interactions on the surface of membrane to generate various diameter tubules.     

Glio-neuronal and glio-glial syncytial cytoplasmic connections in peripheral nerve trunks of the crayfish Astacus leptodactylus

The paper considers various aspects of glial sheaths of neuritis in the crayfish peripheral nerve trunks and roots. There are revealed dotted glio-neurite tight junctions and a varicose deformation of the intercellular glio-neurite cleft. Rupture of membranes in the area of contact leads to formation of the glio-neurite pore (less than 10 nm) that is enlarged and forms wide (up to 240 nm) syncytial perforations. At the edge of perforation, either remnants of tight junctions are present or damaged membranes that fuse and are rounding. The lumen of perforations always contains residual membranous bodies in the form of vesicles. Their deviation from the median line can indicate a mutual translocation of substances of the glio- and neuroplasm. In the adjacent layers of the multilayer glial sheath there is noted a similar phenomenon of formation of the glio-glial syncytial connection terminating by fusion of neighbor glial layers, which is terminated by fusion of neighbor glial layers into the single lamina. The process begins from the varicose deformation of interglial clefts, which appears as a result of massive formation of dotted and expanded tight membranous contacts. As a result of transformation of ellipsoid varicose deformations into the spherical ones, syncytial pores (less than 10 nm) between them are formed, which are enlarged and break the paired gliolemmas into fragments. As a result, the adjacent glial layers are united. Since this process in intact animals occurs on the background of undamaged nerve structures, a suggestion is put forward about its reversibility and the functional nature.     

Beta edge strands in protein structure prediction and aggregation

It is well established that recognition between exposed edges of beta-sheets is an important mode of protein-protein interaction and can have pathological consequences; for instance, it has been linked to the aggregation of proteins into a fibrillar structure, which is associated with a number of predominantly neurodegenerative disorders. A number of protective mechanisms have evolved in the edge strands of beta-sheets, preventing the aggregation and insolubility of most natural beta-sheet proteins. Such mechanisms are unfavorable in the interior of a beta-sheet. The problem of distinguishing edge strands from central strands based on sequence information alone is important in predicting residues and mutations likely to be involved in aggregation, and is also a first step in predicting folding topology. Here we report support vector machine (SVM) and decision tree methods developed to classify edge strands from central strands in a representative set of protein domains. Interestingly, rules generated by the decision tree method are in close agreement with our knowledge of protein structure and are potentially useful in a number of different biological applications. When trained on strands from proteins of known structure, using structure-based (Dictionary of Secondary Structure in Proteins) strand assignments, both methods achieved mean cross-validated, prediction accuracies of approximately 78%. These accuracies were reduced when strand assignments from secondary structure prediction were used. Further investigation of this effect revealed that it could be explained by a significant reduction in the accuracy of standard secondary structure prediction methods for edge strands, in comparison with central strands.     

Glio-neuronal and glio-glial syncytial cytoplasmic connections in peripheral nerve trunks of the crayfish <Emphasis Type="Italic">Astacus leptodactylus</Emphasis>

The paper considers various aspects of glial sheaths of neurites in the crayfish peripheral nerve trunks and roots. There are revealed dotted glio-neuritic tight junctions and a varicose deformation of the intercellular glio-neuritic cleft. Rupture of membranes in the area of contact leads to formation of the glio-neuritic pore (less than 10 nm) that is enlarged and forms wide (up to 240 nm) syncytial perforations. At the edge of perforation, either remnants of tight junctions are present or damaged membranes that fuse and become rounded. The lumen of perforations always contains residual membranous bodies in the form of vesicles. Their deviation from the median line can indicate a mutual translocation of substances of the glio- and neuroplasm. In the adjacent layers of the multilayer glial sheath there is noted a similar phenomenon of formation of the glio-glial syncytial connection terminating by fusion of neighbor glial layers, which is terminated by fusion of neighbor glial layers into the single lamina. The process begins from the varicose deformation of interglial clefts, which appears as a result of massive formation of dotted and expanded tight membranous contacts. As a result of transformation of ellipsoid varicose deformations into the spherical ones, syncytial pores (less than 10 nm) between them are formed, which are enlarged and break the paired gliolemmae into fragments. As a result, the adjacent glial layers are united. Since this process in intact animals occurs on the background of undamaged nerve structures, a suggestion is put forward about its reversibility and the functional nature.     

Voltametric monitoring of enzyme-mediated indigo reduction in the presence of various fibre materials

A comparative study of enzyme-mediated indigo reduction is presented as an environmentally-friendly alternative to alkaline sodium dithionite reduction. The effect of the mediator 1,8-dihydroxy-9,10-anthraquinone in enzymatic reduction was studied by means of voltammetry, both in the presence and absence of different textile materials (polyamide 6, polyamide 6,6 and cotton), and compared to chemically reduced indigo. It was observed that bio-catalytic formation of leuco indigo and its exhaustion on substrates is inversely proportional to the pH within the range of 7–11. Additionally, substrate coloration was strongly influenced by the mediator, resulting in in situ formation of leuco indigo. This effect was most pronounced for polyamide substrates. The reuse of an enzyme-mediated reduction bath for dyeing was assessed showing that the levelness of the obtained shade was either excellent or good at pH 9 and 11, respectively. The wash, perspiration, and light color fastness properties of all textile materials dyed with enzymatically-reduced indigo were comparable or even better than those obtained with chemically reduced indigo. The use of enzyme-mediated reduction of indigo combined with potential reuse of the reduction bath represents a cost effective and environmentally-friendly dyeing process that can be applied for the dyeing of natural cellulosic and synthetic polyamide fibres.     

Periareolar reduction mammaplasty

This paper examines the technique of periareolar reduction mammaplasty. Periareolar reduction mammaplasty is a less aggressive procedure than traditional techniques. It preserves a greater number of central glandular lobules, as well as the papillary artery and nerve. It can be performed under local anesthesia, and the area to be anesthetized is smaller because the amount of breast tissue to be resected is reduced. The sutures required number less than a third of those used for conventional techniques, and operative time is shorter. The greatest advantage is the inconspicuous periareolar scar left, combined with an acceptable result for both surgeon and patient.     

Selective modulation of NMDA responses by reduction and oxidation

Electrophysiological responses to the glutamate analog N-methyl-D-aspartate (NMDA) measured in three different central neuronal preparations are subject to a novel modulatory mechanism: they are substantially potentiated after exposure to the disulfide reducing agent dithiothreitol, while oxidation with 5-5-dithiobis-2-nitrobenzoic acid decreases the magnitude of the response. Modification of the NMDA response by either oxidation or reduction does not appear to affect the pharmacological properties of the receptor-channel complex. Since we observe that the redox state of the native receptor-channel complex varies widely among neurons, an in vivo mechanism that can strongly regulate NMDA-activated functions by either reduction or oxidation may exist. In addition, these results suggest that it may be possible to design specific redox agents for characterizing the NMDA receptor-channel complex.     

The Recognition and Management of Peripheral Arterial Injuries

Early recognition of limb ischemia may allow prompt, effective therapy for peripheral arterial injuries. A review of cases of peripheral arterial trauma at the Toronto General Hospital since 1953 revealed that 50% of the injuries were not immediately recognized. An expanding hematoma, pulsatile hemorrhage or the onset of a bruit and thrill signifies arterial damage in penetrating wounds. Ischemia may be difficult to recognize in patients with soft tissue or skeletal trauma, but the presence of distal pallor, coolness, paresis, cyanosis, anesthesia, poor capillary refill and disproportionate pain indicates significant arterial damage and necessitates surgical exploration. The diagnosis of arterial “spasm” in such instances is untenable and can only be made after direct inspection, or on the return of pulses after reduction of a fracture or release of a tight cast. Restoration of arterial continuity by end-to-end anastomosis is the recommended technique for all arterial injuries, since after ligation of even minor vessels, ischemia may ensue, and amputation may occasionally be necessary.     

Effect of compliance on haptic perception of curvature

The haptic sense of geometric properties such as the curvature of a contour is derived from somatosensory cues about the motions and forces experienced during exploratory actions. This study addressed the question of whether compliance, the relationship between force and displacement, influences haptic perception of curvature. Subjects traced a curved 30 cm long compliant contour by grasping the handle of a manipulandum and reported whether the contour curved towards or away from them. The contour at which there was equal probability of responding either way was taken to represent one that was sensed as being straight. The compliance of the contour was varied, being constant, greatest in the middle or greatest at the ends. Subjects exhibited a bias in what they sensed to be a straight edge. However, the actual handpath that was judged to be straight did not vary across the three compliance profiles. Our results rule out a hypothetical strategy in which an intended motion is planned and the actual trajectory is then inferred by sensing force feedback. Another strategy in which the force against the contour is controlled and the handpath is inferred from proprioceptive feedback is more consistent with the observations.     

Effect of compliance on haptic perception of curvature

The haptic sense of geometric properties such as the curvature of a contour is derived from somatosensory cues about the motions and forces experienced during exploratory actions. This study addressed the question of whether compliance, the relationship between force and displacement, influences haptic perception of curvature. Subjects traced a curved 30?cm long compliant contour by grasping the handle of a manipulandum and reported whether the contour curved towards or away from them. The contour at which there was equal probability of responding either way was taken to represent one that was sensed as being straight. The compliance of the contour was varied, being constant, greatest in the middle or greatest at the ends. Subjects exhibited a bias in what they sensed to be a straight edge. However, the actual handpath that was judged to be straight did not vary across the three compliance profiles. Our results rule out a hypothetical strategy in which an intended motion is planned and the actual trajectory is then inferred by sensing force feedback. Another strategy in which the force against the contour is controlled and the handpath is inferred from proprioceptive feedback is more consistent with the observations.     

Ultrastructure and function of the adhesion–capture apparatus of Stenus species (Coleoptera, Staphylinidae)

 The elongated labium of rove beetles of the genus Stenus forms an adhesion–capture apparatus that enables the animal to catch fast fleeing prey, for example, collemboles. Structural details of this labium have been reinvestigated by using transmission electron microscopy, and the functional model of the capture mechanism has been refined. The openings of glandular ductules have been found to be located at the outer margin of the sticky cushions formed by the paraglossae. These cushions can be expanded by hemolymph pressure and are compressed when the tip of the protrusible labium hits the prey. Endocuticular fibers stabilize the cushions internally and determine the shape of the cushions in both the expanded and the compressed state. Within the membranous connecting tube that connects the prementum with the head capsule, the existence of an extra inner membrane has been confirmed. It is formed by a portion of the epidermis that has become detached from the cuticle. The most important part of the functional model of the protrusion of the labium is that the membranous connecting tube turns itself inside out distally, but the extra inner membrane does so proximally. During protrusion of the labium by hemolymph pressure, the prementum is accelerated during the initial phase of the process, and the nerves, muscles, tracheae, and glandular ductules that are attached to it are passively drawn into the labium. The mechanoreceptive function of setae at the distal end of the prementum has been confirmed on the basis of their ultrastructural characteristics. Accepted: 4 September 1998