Use of circumflex scapular vessels as a recipient pedicle for autologous breast reconstruction: a report of 40 consecutive cases

The use of the circumflex scapular pedicle as a recipient vessel for breast reconstruction in a series of 40 consecutive cases in 37 patients is reported. There were 3 bilateral reconstructions and 34 unilateral reconstructions. Twenty-one cases were immediate reconstructions, and 19 cases were secondary reconstructions. The diameter of the artery varied from 1.5 mm to 3 mm and systematically matched with the diameter of the epigastric artery. The artery was a branch of the subscapular system in 82.5 percent of cases (33 of 40). In 17.5 percent of cases (7 of 40), the artery was a direct branch of the axillary artery. The length of available pedicle between the axillary vessel and the distal part where it can be divided (on its division between scapular and parascapular artery) was of 76 +/- 13 mm for the artery and 72 +/- 12 mm for the vein. The vein was unique in 77.5 percent of cases. The diameter was similar to the artery diameter when unique. There was a dual venous system in 21 of 40 cases (52.5 percent) but in 15 cases (37.5 percent), one of the two veins was dominant. In the seven cases for which the veins were dual and of equivalent diameter, the epigastric veins were also dual and allowed a second anastomosis. Clinically, the anastomosis was always possible on the artery. In one case of reconstruction after Halstedt mastectomy, no vein could be found, because all the veins had been ligated previously. One venous thrombosis (2.5 percent) and one arterial thrombosis were experienced. Both were treated by revised anastomoses and did not compromise late results. The circumflex scapular pedicle is a reliable and simple recipient site for breast reconstruction. It allows a unique site of dissection in immediate reconstruction and avoids division of the thoracodorsal pedicle. The technique is now used exclusively at this institution.     

Toward a more International and Reputable Journal

Editors in 2004 In 2004 I, Hiroo Fukuda (University of Tokyo), was appointedto be the Editor-in-Chief of Plant and Cell Physiology (PCP).As my first task I have added four overseas and four domesticEditors: John Harada (University of California, Davis), FumihikoKatagiri (University of Minnesota, from July), Jiayang Li (ChineseAcademy of Science), Eberhard Schäfer (Freiburg University,from July), Ikuko Hara-Nishimura (Kyoto University), FumihikoSato (Kyoto University), Ichiro Terashima (Osaka University)and Hideyuki Takahashi (Tohoku University, from July). I would like to take     

Toward a more expansive conception of ecological science

There are two competing conceptions of the nature and domain of ecological science in the popular and academic literature, an orthodox conception and a more expansive conception. The orthodox conception conceives ecology as a natural biological science distinct from the human social sciences. The more expansive conception views ecology as a science whose domain properly spans both the natural and social sciences. On the more expansive conception, non-traditional ecological disciplines such as ecological psychology, ecological anthropology and ecological economics may legitimately be regarded as sub-disciplines of ecology, and the practitioners of such disciplines as ecologists. The orthodox-expansionist issue is significant both for the practice of ecology and for the self-identity of the philosophy of ecology. I argue in favour of the expansionist conception of ecology on general conceptual grounds, and by developing the case for one particular non-traditional ecological discipline, ecological psychology.     

A lengthened omental pedicle in facial reconstruction

The omentum continues to be a versatile reconstructive tool with increasing application, but its use for defects of the face or scalp has previously been limited to microvascular transfer. This case demonstrates the feasibility of using the omentum for facial reconstruction where microvascular techniques may not be suitable or available, thus making the omentum an even more valuable tool than we had previously appreciated.     

Immediate breast reconstruction: reducing the risks

One-hundred and sixty-five consecutive immediate breast reconstructions in 157 patients were reviewed. Reconstructions were performed with tissue expanders (53 percent) or immediate gel prostheses (47 percent). Immediate reconstruction was associated with an 18 percent rate of implant loss. Certain risk factors were identified at the p less than 0.05 level using immediate gel implants: failure to achieve complete muscle coverage of the implant, smoking at the time of surgery, initial gel implants of 400 ml or more volume, and age. Expander loss was increased by detaching the pectoralis major (p less than 0.05) and probably by lack of complete muscle coverage in general. Chemotherapy, history of previous smoking, and clinical stage of the carcinoma did not seem to affect reconstructive success. Smoking and patient age should be considered during patient selection for immediate reconstruction. Muscle coverage of the prosthesis should always be attempted. Muscle coverage is mandatory in the smoker. Gel implants of 400 ml or more volume are to be avoided at the initial operation. This approach should enable all surgeons to achieve lower rates of implant loss.     

CRISPR-Cas system: Toward a more efficient technology for genome editing and beyond

Genome engineering technology is of great interest for biomedical research that enables scientists to make specific manipulation in the DNA sequence. Early methods for introducing double-stranded DNA breaks relies on protein-based systems. These platforms have enabled fascinating advances, but all are costly and time-consuming to engineer, preventing these from gaining high-throughput applications. The CRISPR-Cas9 system, co-opted from bacteria, has generated considerable excitement in gene targeting. In this review, we describe gene targeting techniques with an emphasis on recent strategies to improve the specificities of CRISPR-Cas systems for nuclease and non-nuclease applications.     

Toward a more complete 3-D structure of the nuclear pore complex

The nuclear pore complex (NPC) is a large supramolecular assembly embedded in the double-membraned nuclear envelope (NE) that plays a pivotal role in the exchange of macromolecules and particles between the nucleus and the cytoplasm. Applying various methods of sample preparation to Xenopus laevis whole nuclei and isolated NEs in combination with conventional transmission electron microscopy and digital image processing, we have characterized several distinct components of the NPC, including massive cytoplasmic and more tenuous nuclear rings, NPCs devoid of their cytoplasmic or both rings, and prominent "knobs" that protrude from the periphery of the NPC proper into the lumen of the NE. Moreover, by quick freezing/freeze drying/rotary metal shadowing isolated NEs, we have visualized two distinct types of NPC-associated filaments: (1) eight short, highly twisted filaments that project from the cytoplasmic ring and sometimes collapse into short cylinders; and (2) eight long, thin filaments that protrude from the nuclear ring and whose ends join to form a distal ring centered above the NPC such that the assembly resembles a "fishtrap." These nuclear fishtraps are sensitive to divalent cations: removal unfolds them and addition reforms them. The significance of these various structural components in terms of current NPC models is discussed, and the emerging asymmetry of the NPC relative to its nuclear and cytoplasmic face is stressed.     

Toward a more accurate time scale for the human mitochondrial DNA tree

Several estimates of the time of occurrence of the most recent common mitochondrial DNA (mtDNA) ancestor of modern humans have been made. Estimates derived from noncoding regions based on a model that classifies sites into two categories (variable and invariable) have been consistently older than those derived from the third positions of codons. This discrepancy can be attributed to a violation of the assumption of rate homogeneity among variable sites when analyzing the noncoding regions. Additional data from the partial control region sequences allow us to take into account some of this further heterogeneity. By assigning the sites to three classes (highly variable, moderately variable, and invariable) and by assuming that the last common mtDNA ancestor of humans and chimpanzees lived 4 million years ago, the most recent common mtDNA ancestor of humans is estimated to have occurred 211,000 ±111,000 years ago (±1 SE), consistent with the estimate, 101,000 ± 52,000 years, made from third positions of codons and also with those proposed previously. We used the same technique to estimate when a putative expansion of modern humans out of Africa took place and estimated a time of 89,000 ± 69,000 years ago. Even though the standard errors of these estimates are large, they allow us to reject the multiregional hypothesis of modern human origin.Deceased July 21, 1991 Correspondence to: M. Hasegawa     

Immediate breast reconstruction with deepithelialized TRAM flaps: techniques for improving breast reconstruction

In selected patients with lower quadrant breast masses, large breasts, and sufficient abdominal tissue, standard techniques for breast reconstruction can be modified to improve overall results. The transverse abdominal island flap can be deepithelialized and mobilized to reconstruct unilateral or bilateral defects. Furthermore, skin markings prior to mastectomy that conform to a modified Wise pattern will allow for more aesthetic positioning of eventual scars. We present a case report of a patient who underwent immediate breast reconstruction with bilateral deepithelialized lower rectus abdominis myodermal flaps.