The plant homeodomain (PHD) finger is found in many chromatin-associated proteins and functions to recruit effector proteins to chromatin through its ability to bind both methylated and unmethylated histone residues. Here, we show that the dual PHD fingers of Rco1, a member of the Rpd3S histone deacetylase complex recruited to transcribing genes, operate in a combinatorial manner in targeting the Rpd3S complex to histone H3 in chromatin. Although mutations in either the first or second PHD finger allow for Rpd3S complex formation, the assembled complexes from these mutants cannot recognize nucleosomes or function to maintain chromatin structure and prevent cryptic transcriptional initiation from within transcribed regions. Taken together, our findings establish a critical role of combinatorial readout in maintaining chromatin organization and in enforcing the transcriptional fidelity of genes.

The biocompatibility of prosthetic mesh is dependent on a number of physicochemical properties that ultimately incite an optimal foreign body response. The magnitude and character of the foreign body response directly affect the clinical success of the hernia repair, with too little scar resulting in bulge or hernia recurrence and too much scar causing mesh wrinkling and pain. Moreover, it is important to consider the effect of a sustained foreign body response and scar remodeling on the combined strength of the mesh-tissue construct over time. Understanding key elements that determine the foreign body response, such as implant porosity, surface area, and filament size, is critical to the performance of surgery. New absorbable materials introduce the additional variable of durability and persistence of the foreign body response after the foreign body itself has dissolved. In this review, we discuss the experimental and clinical literature relating the quality of the foreign body response to the physical attributes of implants in an effort to demystify prosthetic mesh selection.

Background Time spent under the microscope is often a limiting factor as plastic surgery residents work toward proficiency in microsurgery. This study describes and assesses a novel application of a digital microscope compatible with smart devices which can consistently and reliably magnify microsurgical fields. Methods A digital microscope was used to display an “operating” field on a tablet device. Two junior plastic surgery residents participated in multiple training sessions. During each session, residents completed two sessions of a knot-tying task and a chicken vessel anastomosis task. The sessions were recorded on the tablet, photographed, and graded by an experienced microsurgeon utilizing three standardized microsurgery training scales (OWOMSA, OSATS, and Global scale) for evaluation. Between sessions, the residents received feedback from the experienced microsurgeon. Results Statistically significant improvements (p < 0.05) in microsurgical technique were observed across 16 areas assessed by the standardized evaluation scales. Additionally, the residents' surveys suggest favorable attitudes toward the digital microscope and its value as a training device. Conclusion Traditional operating microscopes present considerable barriers for effective microsurgical training. The digital microscope analyzed in the present study provides solutions to several of these barriers: it is economical, lightweight, portable, and can be set up by the trainee on any flat surface; photographing and recording capabilities via the connected tablet device make the digital microscope setup optimized for education. Our study demonstrates measurable improvements in trainee's skills with use of—as well as favorable trainee attitudes toward—the digital microscope, which could present a valuable addition to plastic surgery education.

An operative construct employing a retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution can achieve significantly better outcomes across a spectrum of Ventral Hernia Working Group grade, risk-stratified patients compared to rates reported in the literature for current strategies that employ wide meshes with minimal fixation.

Background:Current ventral hernia repair risk estimation tools focus on patient comorbidities with the goal of improving clinical outcomes through improved patient selection. However, their predictive value remains unproven.Methods:Outcomes of patients who underwent midline ventral hernia repair with retrorectus placement of mid-weight soft polypropylene mesh between 2010 and 2015 were retrospectively reviewed and compared with predicted wound-related complication risk from 3 tools in the literature: Carolinas Equation for Determining Associated Risk, the Ventral Hernia Working Group (VHWG) grade, and a modified VHWG grade.Results:A total of 101 patients underwent hernia repair. Mean age was 56 years and mean body mass index was 29 m/kg2 (range, 18–51 m/kg2). We found no significant relationship between the risk estimated by Carolinas Equation for Determining Associated Risk (B = 1.45, P = 0.61) and actual wound-related complications. VHWG grades >1 were not statistically different with regard to rate of wound complication compared with VHWG grade 1 (grade 2: B = 0.05, P = 0.95; grade 3: B = −0.21, P = 0.86; grade 4: B = 2.57, P = 0.10). Modified VHWG grades >1 were not statistically different with regard to rate of wound complication compared with modified VHWG grade 1 (grade 2: B = 0.20, P = 0.80; grade 3: B = 1.03, P = 0.41).Conclusions:Current risk stratification tools overemphasize patient factors, ignoring the importance of technique in minimizing complications and recurrence. We attribute our low complication rate to retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution in contrast to current strategies that employ wide meshes with minimal fixation.