A Single-center Comparison of Surgical Outcomes following Prepectoral and Subpectoral Implant-based Breast Reconstruction.

Background: Prepectoral implant placement continues to gain widespread acceptance as a safe and effective option for breast reconstruction. Current literature demonstrates comparable rates of complications and revisions between prepectoral and subpectoral placement; however, these studies are underpowered and lack long-term follow-up. Methods: We performed a retrospective cohort study of patients who underwent immediate two-staged tissue expander or direct-to-implant breast reconstruction at a single center from January 2017 to March 2021. Cases were divided into prepectoral and subpectoral cohorts. The primary outcomes were postoperative complications, aesthetic deformities, and secondary revisions. Descriptive statistics and multivariable regression models were performed to compare the demographic characteristics and outcomes between the two cohorts. Results: We identified 996 breasts (570 patients), which were divided into prepectoral (391 breasts) and subpectoral (605 breasts) cohorts. There was a higher rate of complications (P < 0.001) and aesthetic deformities (P = 0.02) with prepectoral breast reconstruction. Secondary revisions were comparable between the two cohorts. Multivariable regression analysis confirmed that prepectoral reconstruction was associated with an increased risk of complications (odds ratio 2.39, P < 0.001) and aesthetic deformities (odds ratio 1.62, P = 0.003). Conclusions: This study evaluated outcomes in patients undergoing prepectoral or subpectoral breast reconstruction from a single center with long-term follow-up. Prepectoral placement was shown to have an inferior complication and aesthetic profile compared with subpectoral placement, with no difference in secondary revisions. These findings require validation with a well-designed randomized controlled trial to establish best practice for implant-based breast reconstruction.

Anti-fouling rotating polymer-based heat exchanger for zero liquid discharge humidification-dehumidification desalination.

The objective of this investigation is to assess the performance of various heat exchangers for application in a novel solar-powered zero liquid discharge humidification-dehumidification desalination system. In this study four heat exchangers (HX) having two different flow configurations namely counter flow (cf), cross flow (cr) made up of three different materials namely high-density polyethylene (HDPE), aluminum (Al), and Polypropelyne (PP) were compared in terms of their effectiveness and overall heat transfer coefficient under varying salinity levels (up to 10%) and mixing ratios (0.22-0.45). At a mixing ratio of 0.22 and 0% salinity, PP-HXcr and Al-HXcf exhibited similar effectiveness (∼85%), surpassing that of HDPE-HXcf (∼65%). Despite PP-HXcr's lower thermal conductivity in comparison to Al-HXcf, comparable effectiveness was achieved due to the superior flow distribution in PP-HXcr. Further investigations focused on the impact of salinity on heat exchanger performance. At 3.5% salinity, all heat exchangers experienced a decline in effectiveness and heat transfer coefficient (HTC), with Al-HXcf experiencing a more pronounced decrease compared to PP-HXcr. The higher thermal conductivity of Al-HXcf led to greater salt accumulation, while PP-HXcr demonstrated minimal fouling. As the experiment progressed, fouling increased for all heat exchangers, with the Al-HXcf being practically ineffective at 10% salinity with an effectiveness below 10%. To address the issue of fouling, a rotating cross-flow heat exchanger (RPP-HXcr) was introduced. While the effectiveness of the PP-HXcr drops from 85% to approximately 60% with increasing salinity from 0% to 10%, the RPP-HXcr demonstrates only a marginal decline in effectiveness with increasing salinity. For instance, at mixing ratio of 0.22 when the salinity is increased from 0% to 10%, the effectiveness of RPP-HXcr only drops from 83% to 77%. This exceptional performance was attributed to the continuous contact between the rotating tubes and the incoming feed, effectively preventing fouling and ensuring sustained efficiency. Rotating cross-flow heat exchanger (RPP-HXcr) is introduced and validated as a potentially reliable solution for mitigating fouling, as it demonstrates sustained efficiency and minimal performance degradation across different salinity conditions.

Innovations in Skin and Soft Tissue Aging-A Systematic Literature Review and Market Analysis of Therapeutics and Associated Outcomes.

PURPOSE: Skin and soft tissue aging has been an important topic of discussion among plastic surgeons and their patients. While botulinum toxin, facial fillers, chemical peels, and surgical lifts preside as the mainstay of treatment to restore appearance of youth, emergent technologies, such as CRISPR-Cas9, proteostasis, flap biology, and stem cell therapies, have gained traction in addressing the aging process of skin and soft tissue. Several studies have introduced these advancements, but it remains unclear how safe and effective these therapeutics are in facial rejuvenation, and how they may fit in the existent treatment workflow for soft tissue aging. MATERIALS/METHODS: A systematic literature review was conducted to identify and assess therapeutics utilized in addressing skin and soft tissue aging. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes. In addition, we performed a market analysis of companies involved in promoting technologies and therapeutics within this space. PitchBook (Seattle, WA), a public market database, was utilized to classify companies, and record the amount of venture capital funding allocated to these categories. RESULTS: Initial review yielded four hundred and two papers. Of these, thirty-five were extracted after applying inclusion and exclusion criteria. Though previous literature regards CRISPR-Cas9 technology as the most favorable anti-aging innovation, after reviewing the current literature, stem cell therapies utilizing recipient chimerism appeared to be the superior skin anti-aging technique when accounting for possible disadvantages of various techniques. The psychosocial and cosmetic outcomes from using cell therapy to modulate allograft survival and tolerance may confer more long-term proposed benefits than the technologies in CRISPR-Cas9, flap biology innovations, and autologous platelet-rich plasma use. Market analysis yielded a total of 87 companies, which promoted innovations in technology, biotechnology, biopharmaceuticals, cell-based therapies, and genetic therapy. CONCLUSION: This review provides physicians and patients with relevant, usable information regarding how therapeutics can impact treatment regimen for facial aesthetics and skin rejuvenation. Furthermore, the goal of this research is to elucidate the varying therapeutics to restore appearance of youth, present associated outcomes, and in doing so, present plastic surgeons and their colleagues with greater insight on the role of these therapeutics and technologies in clinical practice. Future studies can further assess the safety and efficacy of these innovations and discuss how these may fit within surgical plans among patients seeking rejuvenation procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

National trends in the utilization of lumbar disc replacement for lumbar degenerative disc disease over a 10-year period, 2010 to 2019.

Background: Lumbar fusion (LF) is commonly performed to manage lumbar degenerative disc disease (LDDD) that has failed conservative measures. However, lumbar disc replacement (LDR) procedures are increasingly prevalent and designed to preserve motion in carefully selected patients. Methods: A retrospective cohort study was performed using the National Inpatient Sample (NIS), queried from 2010 to 2019 to identify patients undergoing single and double-level LF or LDR with a diagnosis of LDDD using International Classification of Diseases (ICD) 9th (ICD-9) and 10th (ICD-10) revision diagnostic and procedure codes. Propensity score matching (PSM) with a ratio of 2:1 was performed. All cost estimates reflect reported hospital costs adjusted to December 2019 United States Dollars. Results: A total of 1,129,121 LF cases (99.3%) and 8,049 LDR cases (0.7%) were identified, with 364,637 (32.3%) and 712 (8.8%) comprising two-level surgeries, respectively. 1,712 LDRs were performed in 2010 (1.27% of all), decreasing to 565 in 2013 (0.52%), and increased slightly to 870 in 2019 (0.74%). LDR patients were significantly more likely to be younger (mean age 41.2 vs. 57.1, P<0.001) and healthier (mean ECI 0.88 vs. 1.80, P<0.001). On matched analysis, LDR hospital costs were $4,529 less (P<0.001) and length of stay was 0.65 days shorter (P<0.001) than LF patients. LDR patients had lower rates of any complication (7.0% vs. 13.2%, P<0.001), neurologic complication (3.0% vs. 4.2%, P=0.006), and blood transfusion (3.1% vs. 8.1%, P<0.001) compared to LF patients. Conclusions: The prevalence of LDR procedures decreased from 2010-2017 but began to increase again in 2018 and 2019. Single-level LDR was associated with reduced costs and length of stay (LOS), and lower rates of blood transfusion compared to LF in patients with LDDD.

Fouling mechanism in airblast atomizers and its suppression for water desalination.

A detailed experimental study is presented on fouling behavior of the anti-clogging perforated plate atomizer designed for high salinity applications, and compared with a conventional (plain-jet) airblast atomizer. Low-pressure regions around fast moving air in the outer layer of spray (as in conventional atomizers: plain-jet and prefilming) due to Venturi suction were identified as the root cause of atomizer clogging, as they facilitate salt accumulation on the atomizer surface from spray. Accordingly, severe atomizer fouling, and fluctuations in spray cone angle were observed in the conventional airblast atomizer over 2 h at 100°C air and 50°C saline (44° to 76° at 35,000 ppm, and 44° to 91° at 100,000 ppm). In this regard, the perforated plate atomizer provides a novel liquid-film airblast atomization by maintaining a liquid-annulus film (around the air outlet) as the outer layer of spray. Doing so we achieved nearly complete suppression of fouling, and spray cone angle fluctuations (28° ± 1° at 35,000 ppm, and 30° ± 1° at 100,000 ppm). Later, novel liquid-film atomization was adopted in the conventional airblast atomizer. While, the conventional airblast atomization needed atomizer cleaning/maintenance after 35 min for 175°C air and 65°C saline at 100,000 ppm, the liquid-film atomization showed no sign of fouling over 14 h. Hence, current work establishes a benchmark liquid-film airblast atomization mechanism in the anti-clogging perforated plate atomizer for complete suppression of fouling in airblast atomization. This extends the application of airblast atomizers from high evaporation jet engines to ZLD-HDH desalination systems, spraying, powder metallurgy, pharmaceuticals and hospitals, and spray drying and cooling.

The importance of good history taking: a case report.

INTRODUCTION: Early comprehensive geriatric assessment (CGA) with good history-taking is essential in assessing the older adult. CASE PRESENTATION: Our patient, a 75-year-old Caucasian woman, was originally admitted to hospital for investigation of iron deficiency anemia. During admission, she developed pneumonia and new intermittent atrial fibrillation in association with a right-sided weakness, which was felt to be new at the time. Following this episode, she was treated for a further chest infection and, despite clinical improvement, her inflammatory markers failed to settle satisfactorily. She was transferred to her local hospital for a period of rehabilitation where further neurological findings made the diagnosis of solely stroke questionable; these findings prompted further history-taking, investigations and input from other disciplines, thereby helping to arrive at a working diagnosis of vasculitic neuropathy. CONCLUSIONS: The case aims to highlight the importance of taking a good history and performing an early comprehensive assessment in the older adult.