Predictors of Unplanned Reoperation after Gender-affirming Mastectomy: An Analysis of the NSQIP Database.

Background: Gender-affirming mastectomy (GAM) is a gender-affirmation surgery designed to remove or reduce breast tissue, with or without nipple reconstruction. GAM is the most commonly performed gender-affirmation surgery and risk factors associated with unplanned return to the operating room and reoperation continue to be investigated. This is the largest study of transgender and nonbinary patients undergoing GAM to determine predictors of unplanned reoperation. Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing GAM from 2012 to 2020. The primary outcome was the incidence of unplanned reoperation within 30 days postoperatively. The secondary outcome was the indication for unplanned reoperation within this period. Descriptive statistics were calculated. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of reoperation after GAM. Results: A total of 2316 patients underwent GAM, of whom 2.2% (n = 51) underwent unplanned reoperation of the chest. The most common indication for unplanned reoperation was hematoma (n = 41, 71.9%) followed by abscess (n = 5, 8.8%). Significant predictors of reoperation were corticosteroid use [adjusted odds ratio (aOR) 95% confidence interval (CI) 5.07 (1.07-23.89)] and diabetes [aOR (CI) 10.98 (3.0-40.33)]. Hispanic/Latinx ethnicity [aOR (CI) 3.19 (1.22-8.33)] and corticosteroid use [aOR (CI) 6.81 (1.45-31.98)] were significant predictors of unplanned reoperation for hematoma evacuation after GAM. Conclusions: Diabetes mellitus and corticosteroid use were associated with unplanned reoperation after GAM. Ethnic correlations remain to be better elucidated as well as the effect of intersectionality. These findings can be used to guide patient selection and surgical decision-making.

Craniofacial Cleft: A Case of Tessier 10 Cleft With a Novel Method to Repair Large Bilateral Colobomas.

OBJECTIVE: To describe a reliable method utilizing large, rotation flaps to reconstruct a number 10 Tessier cleft. DESIGN: This is a descriptive clinical case report. SETTING: Pediatric teaching hospital affiliated with a university. PATIENTS, PARTICIPANTS: One participant in this clinical case report. INTERVENTIONS: Full-thickness excision of the clefted eyelid, brow, and forehead tissue was performed bilaterally to develop medial and lateral eyebrow and forehead flaps. Right: the forehead/brow flap was rotated caudally to reapproximate the eyebrow and an eyelid rotation flap was also used to reapproximate the lid margin. Left: forehead/brow rotation flap allowed realignment of the eyebrow and a series of Z-plasties were used in the eyelid to reapproximate the lid margin and to lengthen the eyelid. MAIN OUTCOME MEASURE(S): Develop and construct a reliable reconstruction with full-eyelid closure and minimal donor site morbidity. RESULTS: Complete eyelid closure bilaterally was achieved intraoperatively, and was maintained at 6-month follow-up with no evidence of ocular pathology. CONCLUSIONS: Large, bilateral upper eyelid colobomas require repair to prevent blindness. Although free tarsomarginal grafts and lid-sharing procedures have been described, we demonstrate that large rotation flaps designed along the cleft margin can provide a reliable reconstruction and minimize donor-site morbidity.

Seasonal variations in outcomes after kidney transplantation: UNOS review of 336,330 transplants.

INTRODUCTION: The "July effect" is a widely discussed phenomenon of worse patient outcomes at teaching hospitals in July due to inexperienced house staff. METHODS: We conducted a retrospective review of Organ Procurement and Transplantation Network data from Oct 1, 1987 to June 30, 2011, including longitudinal censored data of 360,330 transplantations. Demographic and comorbid variables for donors and recipients were collected. Primary outcomes were graft loss, patient death, and delayed graft function. Secondary outcomes were surgical complications, length of stay, and graft rejection. We compared survival indicators (1-month, 1-, 3-, and 5-year survival and median survival times) for both grafts and patients. We also analyzed death-censored graft survival. RESULTS: There were fewer July donors with diabetes (p = 0.003), hypertension (p = 0.000), and extended criteria (p<0.0001). Graft survival (p = 0.000), death-censored graft survival (p = 0.001), and patient survival (p = 0.002) were statistically higher in July. After adjusting the Cox model for extended criteria donors, there was no difference in outcomes (p>0.05 for graft, death-censored graft survival, and patient survival). CONCLUSION: We conclude that there is no July effect. Initially identified, superior outcomes in July may be attributed to more conservative allografts selection in the beginning of the academic year.

Clothing polymer fibers with well-aligned and high-aspect ratio carbon nanotubes.

It is believed that the crucial step towards preparation of electrical conductive polymer-carbon nanotube (CNT) composites is dispersing CNTs with a high length-to-diameter aspect ratio in a well-aligned manner. However, this process is extremely challenging when dealing with long and entangled CNTs. Here in this study, a new approach is demonstrated to fabricate conductive polymer-CNT composite fibers without involving any dispersion process. Well-aligned CNT films were firstly drawn from CNT arrays, and then directly coated on polycaprolactone fibers to form polymer-CNT composite fibers. The conductivity of these composite fibers can be as high as 285 S m(-1) with only 2.5 wt% CNT loading, and reach 1549 S m(-1) when CNT loading is 13.4 wt%. As-prepared composite fibers also exhibit 82% retention of conductivity at a strain of 7%, and have improved mechanical properties.

Ultra-sensitive and wide-dynamic-range sensors based on dense arrays of carbon nanotube tips.

Electrochemical electrodes based on dense and vertically aligned arrays of multi-walled carbon nanotubes (MWCNTs) were produced. The open tips of individual hollow nanotubes are exposed as active sites while the entangled nanotube stems encapsulated in epoxy collectively provide multiplexed and highly conductive pathways for charge transport. This unique structure together with the extraordinary electrical and electrochemical properties of MWCNTs offers a high signal-to-noise ratio (thus high sensitivity) and a large detection range, compared with other carbon-based electrodes. Our electrodes can detect K(3)FeCN(6) and dopamine at concentrations as low as 5 nM and 10 nM, respectively, and are responsive in a large dynamic range that spans almost 5 orders of magnitude.

Detection of stent fractures: a comparison of 64-slice CT, conventional cine-angiography, and intravascular ultrasonography.

RATIONAL AND OBJECTIVES: We evaluated the ability of 64-slice computed tomography (CT), conventional cine-angiography, and intravascular ultrasound (IVUS) to detect stent fractures under ideal conditions. Coronary stent fracture has been implicated as one of the mechanisms of stent thrombosis and, perhaps, in-stent restenosis. However, the preferred imaging modality in detecting fractures in coronary stents has not been well established. MATERIALS AND METHODS: Four different types of commonly used coronary stents (Cypher, Taxus, Vision, Hepacoat) each with three strut fractures (Cypher, 5; Taxus, 5; Vision, 4; Hepacoat, 5) were nominally deployed in polyurethane tubes and imaged with 64-slice CT, conventional cine-angiography, and IVUS. For each stent type, an unfractured control stent was also imaged. RESULTS: Overall accuracy (84.1% vs. 73.9%), sensitivity (80.7 vs. 77.2%), and specificity (100% vs. 58.3%) for stent fracture detection was higher with 64 multislice CT compared to conventional cine-angiography. Stent fractures were not accurately detected by IVUS. Fracture detection by multislice CT was best when the stents were imaged at 45 degrees to the z-axis. CONCLUSIONS: Under ideal in vitro conditions, CT has a high accuracy when used to evaluate coronary stent fractures. The overall accuracy, sensitivity, and specificity of detecting stent fractures are lower by conventional cine-angiography. Stent fractures were not detected using IVUS.

Nanoscale deformation measurement of microscale interconnection assemblies by a digital image correlation technique.

The continuous miniaturization of microelectronic devices and interconnections demand more and more experimental strain/stress analysis of micro- and nanoscale components for material characterization and structure reliability analysis. The digital image correlation (DIC) technique, with the aid of scanning probe microscopes, has become a very promising tool to meet this demand. In this study, an atomic force microscope (AFM) was used to scan and digitally image micro-interconnection assemblies in a micro-thermoelectric cooler. AFM images of the scan region of interest were obtained separately when the microelectronic device was operated before and after the cooling and heating stages. The AFM images were then used to obtain the in-plane deformation fields in the observed region of the micro-assembly. AFM image correlation is performed for nanoscale deformation analysis using the authors' AFM-DIC program. The results show that the observed region was subjected to cyclic strains when the device worked between its cooling and heating stages, and cyclic strain in the vertical direction was found to be a significant deformation mode. The thermally induced deformation behavior of the micro-assembly device was modeled by finite element analysis (FEA). Both thermal-electric analysis and thermal stress analysis were conducted on a 3D finite element model of the device. It is shown that the experimental results were able to validate the finite element analysis results.

AFM image reconstruction for deformation measurements by digital image correlation.

The scanner drift of the atomic force microscope (AFM) is a great disadvantage to the application of digital image correlation to micro/nano-scale deformation measurements. This paper has addressed the image distortion induced by the scanner drifts and developed a method to reconstruct AFM images for the successful use of AFM image correlation. It presents such a method, that is to generate a corrected image from two correlated AFM images scanned at the angle of 0° and 90° respectively. The proposed method has been validated by the zero-deformation test. A buckling test of a thin plate under AFM has also been demonstrated. The in-plane displacement field at the centre point of the buckling plate has been successfully characterized by the application of the image correlation technique on reconstructed AFM images.

Finite element formulation for a digital image correlation method.

A finite element formulation for a digital image correlation method is presented that will determine directly the complete, two-dimensional displacement field during the image correlation process on digital images. The entire interested image area is discretized into finite elements that are involved in the common image correlation process by use of our algorithms. This image correlation method with finite element formulation has an advantage over subset-based image correlation methods because it satisfies the requirements of displacement continuity and derivative continuity among elements on images. Numerical studies and a real experiment are used to verify the proposed formulation. Results have shown that the image correlation with the finite element formulation is computationally efficient, accurate, and robust.