Effectiveness of extended antibiotic prophylaxis in implant-based breast reconstruction surgery: A meta-analysis.

INTRODUCTION: Considerable research has been carried out on the postoperative benefits of extended antibiotic prophylaxis (EAP) in different surgical contexts, generating various results regarding its effectiveness. Some studies indicate positive outcomes, whereas others indicate no significant advantages. Our approach involves conducting a comprehensive systematic review and meta-analysis to provide a more nuanced understanding of the role of extended antibiotic use because of the lack of a consistent consensus. METHODS: A thorough search of the Cochrane Library, Embase, and MEDLINE electronic databases was conducted to identify relevant studies. The metafor package in R software was used for meta-analysis. We collected risk ratios (RRs) for surgical site infection (SSI) in the EAP versus non-EAP groups from the included studies to assess the effects of EAP on reducing the risk of SSI. The meta-analysis used a random-effects model, and effect sizes were presented with their corresponding 95% confidence intervals (CIs). RESULTS: Fourteen studies, involving 12,572 patients who underwent implant-based reconstruction postmastectomy, were included. Pooling the results of the studies that used EAP until drain removal revealed no protective effect of EAP against SSI risk (RR = 0.84; 95% CI: 0.60-1.18). Similarly, our analysis revealed no significant benefit of EAP in studies where EAP was not contingent on drain removal (RR = 0.70; 95% CI: 0.46-1.07). CONCLUSIONS: EAP administration did not decrease the incidence of SSI in individuals undergoing implant-based breast reconstruction surgery postmastectomy.

The Reconstruction of Bi 2 Te 4 O 11 Nanorods for Efficient and pH-universal Electrochemical CO 2 Reduction.

The practical application of electrochemical CO2 reduction reaction (CO2RR) is hindered by the competing CO production, hydrogen evolution reaction (HER), and the lack of pH-universal catalysts. Here, Te-modified Bi nanorods (Te-Bi NRs) were synthesized through in situ reconstruction of Bi2Te4O11 NRs under the CO2RR condition. Our study illustrates that the complex reconstruction process of Bi2Te4O11 NRs during CO2RR could be decoupled into three distinct steps, i.e., the destruction of Bi2Te4O11, the formation of Te/Bi phases, and the dissolution of Te. The thus-obtained Te-Bi NRs exhibit remarkably high performance in CO2RR towards formate production, showing high activity, selectivity, and stability across all pH conditions (acidic, neutral, and alkaline). In a flow cell reactor under neutral, alkaline, or acidic conditions, the catalysts achieved HCOOH Faradaic efficiencies of up to 94.3%, 96.4%, and 91.0%, respectively, at a high current density of 300 mA cm-2. DFT calculations, along with operando spectral measurements, reveal that Te manipulates the Bi sites to an electron-deficient state, enhancing the adsorption strength of the *OCHO intermediate, and significantly suppressing the competing HER and CO production. This study highlights the substantial influence of catalyst reconstruction under operational conditions and offers insights into designing highly active and stable electrocatalysts towards CO2RR.

Multiphase Reconstruction of Heterogeneous Materials Using Machine Learning and Quality of Connection Function.

Establishing accurate structure-property linkages and precise phase volume accuracy in 3D microstructure reconstruction of materials remains challenging, particularly with limited samples. This paper presents an optimized method for reconstructing 3D microstructures of various materials, including isotropic and anisotropic types with two and three phases, using convolutional occupancy networks and point clouds from inner layers of the microstructure. The method emphasizes precise phase representation and compatibility with point cloud data. A stage within the Quality of Connection Function (QCF) repetition loop optimizes the weights of the convolutional occupancy networks model to minimize error between the microstructure's statistical properties and the reconstructive model. This model successfully reconstructs 3D representations from initial 2D serial images. Comparisons with screened Poisson surface reconstruction and local implicit grid methods demonstrate the model's efficacy. The developed model proves suitable for high-quality 3D microstructure reconstruction, aiding in structure-property linkages and finite element analysis.

Rate of graft retear is higher in over-the-top superior capsular reconstruction for massive posterosuperior rotator cuff tears with subscapularis tear.

PURPOSE: To compare side-to-side superior capsular reconstruction (SCR) with over-the-top SCR in terms of functional outcomes, pain relief and allograft survival rates. METHODS: Patients who had undergone arthroscopic dermal allograft SCR for massive irreparable rotator cuff tears and clinical follow-up for ≥2 years were recruited. All patients underwent postoperative assessment with routine radiographic analysis for acromiohumeral distances, ultrasound imaging 1 and 3 months after SCR and magnetic resonance imaging (MRI) at least 12 months after SCR. The outcome measures were visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant and Single Assessment Numeric Evaluation (SANE) scores. RESULTS: SCR was performed in 56 patients including side-to-side SCR in 32 and over-the-top SCR in 24. Postoperative MRI showed that the grafts were intact in 46 patients (82.1%; 26 who underwent side-to-side SCR and 20 who underwent over-the-top SCR). The proportion of nonhealing grafts in the over-the-top group was significantly higher with concomitant subscapularis tears (60% vs. 5.3%; p = 0.02). VAS scores and functional outcomes improved postoperatively in both groups and postoperative VAS (1.4 vs. 1.7; n.s.), Constant (74.8 vs. 76.0; n.s.), mean ASES (87.4 vs. 89.1; n.s.) and mean SANE (81.7 vs. 84.3; n.s.) scores did not differ significantly. CONCLUSION: For massive rotator cuff tears, over-the-top and side-to-side SCR achieve similar pain relief and functional improvement, and the rate of healing allografts is high. However, over-the-top SCR is not recommended for massive posterosuperior rotator cuff tears with repairable subscapularis tendon tears due to a higher nonhealing rate. LEVEL OF EVIDENCE: Level III.

Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes.

PURPOSE: This study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra-articular knee ligament reconstructions in elite athletes by reporting return-to-play (RTP) rates and levels, career longevity and complications. METHODS: A consecutive series of all extra-articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy-six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTP was defined as competing at professional level or national/international level in amateur sport. RESULTS: There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty-two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty-six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP. CONCLUSION: Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications. LEVEL OF EVIDENCE: Level IV.

Pareto optimization of SPECT acquisition and reconstruction settings for 177Lu activity quantification.

BACKGROUND: The aim was to investigate the noise and bias properties of quantitative 177Lu-SPECT with respect to the number of projection angles, and the number of subsets and iterations in the OS-EM reconstruction, for different total acquisition times. METHODS: Experimental SPECT acquisition of six spheres in a NEMA body phantom filled with 177Lu was performed, using medium-energy collimators and 120 projections with 180 s per projection. Bootstrapping was applied to generate data sets representing acquisitions with 20 to 120 projections for 10 min, 20 min, and 40 min, with 32 noise realizations per setting. Monte Carlo simulations were performed of 177Lu-DOTA-TATE in an anthropomorphic computer phantom with three tumours (2.8 mL to 40.0 mL). Projections representing 24 h and 168 h post administration were simulated, each with 32 noise realizations. Images were reconstructed using OS-EM with compensation for attenuation, scatter, and distance-dependent resolution. The number of subsets and iterations were varied within a constrained range of the product number of iterations × number of projections ≤ 2400 . Volumes-of-interest were defined following the physical size of the spheres and tumours, the mean activity-concentrations estimated, and the absolute mean relative error and coefficient of variation (CV) over noise realizations calculated. Pareto fronts were established by analysis of CV versus mean relative error. RESULTS: Points at the Pareto fronts with low CV and high mean error resulted from using a low number of subsets, whilst points at the Pareto fronts associated with high CV but low mean error resulted from reconstructions with a high number of subsets. The number of projection angles had limited impact. CONCLUSIONS: For accurate estimation of the 177Lu activity-concentration from SPECT images, the number of projection angles has limited importance, whilst the total acquisition time and the number of subsets and iterations are parameters of importance.

Arthroscopic debridement and antibiotic-loaded cement for treatment of chronic infected tibial tunnel post-ACL reconstruction: A case report.

INTRODUCTION AND IMPORTANCE: Chronic extra-articular infections of the tibial tunnel are rare, and there are only a few cases reported in the literature, so the diagnosis and management of these infections are still unclear. CASE PRESENTATION: We report a 36-year-old patient with chronic infection of the tibial tunnel after ACL reconstruction surgery. The patient was treated with arthroscopic debridement of the tibial tunnel and antibiotic cement filling. Seven months postoperative, there were no signs of infection at the surgical site and the knee joint. The patient has no pain, no joint instability, no limitation of range of motion, and no limitation in daily activities. CLINICAL DISCUSSION: The definitive diagnosis of chronic infection of the tibial tunnel should be carefully based on clinical signs, blood tests, and imaging to rule out combined intra-articular infections. The arthroscopic technique can be a favorable method to control and debride the inflammatory tissue of the tibial tunnel, limiting the recurrence rate postoperatively. CONCLUSION: Arthroscopic debridement and antibiotic-loaded cement can be considered an alternative to traditional surgical methods in the treatment of chronic infection of the tibial bone tunnel after ACL reconstruction. LEVEL OF EVIDENCE: A case report.

Joint diffusion: mutual consistency-driven diffusion model for PET-MRI co-reconstruction.

OBJECTIVE: Positron Emission Tomography and Magnetic Resonance Imaging (PET-MRI) systems can obtain functional and anatomical scans. But PET suffers from a low signal-to-noise ratio, while MRI are time-consuming. To address time-consuming, an effective strategy involves reducing k-space data collection, albeit at the cost of lowering image quality. This study aims to leverage the inherent complementarity within PET-MRI data to enhance the image quality of PET-MRI. Apporach: A novel PET-MRI joint reconstruction model, termed MC-Diffusion, is proposed in the Bayesian framework. The joint reconstruction problem is transformed into a joint regularization problem, where data fidelity terms of PET and MRI are expressed independently. The regular term, the derivative of the logarithm of the joint probability distribution of PET and MRI, employs a joint score-based diffusion model for learning. The diffusion model involves the forward diffusion process and the reverse diffusion process. The forward diffusion process adds noise to transform a complex joint data distribution into a known joint prior distribution for PET and MRI simultaneously, resembling a denoiser. The reverse diffusion process removes noise using a denoiser to revert the joint prior distribution to the original joint data distribution, effectively utilizing joint probability distribution to describe the correlations of PET and MRI for improved quality of joint reconstruction. MAIN RESULTS: Qualitative and quantitative improvements are observed with the MC-Diffusion model. Comparative analysis against LPLS and Joint ISAT-net on the ADNI dataset demonstrates superior performance by exploiting complementary information between PET and MRI. The MC-Diffusion model effectively enhances the quality of PET and MRI images. SIGNIFICANCE: This study employs the MC-Diffusion model to enhance the quality of PET-MRI images by integrating the fundamental principles of PET and MRI modalities and their inherent complementarity. The MC-Diffusion model facilitates a more profound comprehension of the priors obtained through deep learning.

Chronic Rhinosinusitis Risk after Maxillectomy with Microvascular Reconstruction.

INTRODUCTION: Chronic rhinosinusitis (CRS) can be associated with tumors involving the maxillary sinus, but outcomes after undergoing maxillectomy with free flap reconstruction remain unclear. METHODS: A retrospective analysis of medical records was performed to evaluate evidence of CRS in patients who underwent maxillectomy with free flap reconstruction at a single tertiary care academic institution from 2013 through 2020. RESULTS: Eighty-four patients were assessed. Nineteen (22.6%) patients were diagnosed with CRS after surgery, 23 (27.4%) patients were treated for sinus symptoms, and 49 (58.3%) had radiographic evidence of sinus inflammation for more than 6 months. Risk factors for requiring sinus treatment included adjuvant or neoadjuvant chemotherapy (p = 0.002) and pre-operative use of sinus medication (p < 0.001). Radiographic evidence of sinusitis 6 months after surgery is also closely associated with sinusitis treatment (p = 0.051). CONCLUSIONS: CRS may be underdiagnosed in patients undergoing maxillectomy with microvascular reconstruction. Further evaluation into patient sinus disease and symptoms following neoplastic surgery may lead to a higher quality of life in some long-term survivors.

Assessment of image quality and diagnostic accuracy for cervical spondylosis using T2w-STIR sequence with a deep learning-based reconstruction approach.

OBJECTIVES: To investigate potential of enhancing image quality, maintaining interobserver consensus, and elevating disease diagnostic efficacy through the implementation of deep learning-based reconstruction (DLR) processing in 3.0 T cervical spine fast magnetic resonance imaging (MRI) images, compared with conventional images. METHODS: The 3.0 T cervical spine MRI images of 71 volunteers were categorized into two groups: sagittal T2-weighted short T1 inversion recovery without DLR (Sag T2w-STIR) and with DLR (Sag T2w-STIR-DLR). The assessment covered artifacts, perceptual signal-to-noise ratio, clearness of tissue interfaces, fat suppression, overall image quality, and the delineation of spinal cord, vertebrae, discs, dopamine, and joints. Spanning canal stenosis, neural foraminal stenosis, herniated discs, annular fissures, hypertrophy of the ligamentum flavum or vertebral facet joints, and intervertebral disc degeneration were evaluated by three impartial readers. RESULTS: Sag T2w-STIR-DLR images exhibited markedly superior performance across quality indicators (median = 4 or 5) compared to Sag T2w-STIR sequences (median = 3 or 4) (p < 0.001). No statistically significant differences were observed between the two sequences in terms of diagnosis and grading (p > 0.05). The interobserver agreement for Sag T2w-STIR-DLR images (0.604-0.931) was higher than the other (0.545-0.853), Sag T2w-STIR-DLR (0.747-1.000) demonstrated increased concordance between reader 1 and reader 3 in comparison to Sag T2w-STIR (0.508-1.000). Acquisition time diminished from 364 to 197 s through the DLR scheme. CONCLUSIONS: Our investigation establishes that 3.0 T fast MRI images subjected to DLR processing present heightened image quality, bolstered diagnostic performance, and reduced scanning durations for cervical spine MRI compared with conventional sequences.

A contemporary view on vascular resections and reconstruction during hepatectomies.

Oncological hepatic surgery carries the possibility to perform vascular reconstructions for advanced tumours with vessel invasion since surgery often represents the only potentially curative approach for these tumours. An extended review was conducted in an attempt to understand and clarify the latest trends in hepatectomies with vascular resections. We searched bibliographic databases including PubMed, Scopus, references from bibliographies and Cochrane Library. Information and outcomes from worldwide clinical trials were collected from qualified institutions performing hepatectomies with vascular resection and reconstruction. Careful patient selection and thorough preoperative imaging remain crucial for correct and safe surgical planning. A literature analysis shows that vascular resections carry different indications in different diseases. Despite significant advances made in imaging techniques and technical skills, reports of hepatectomies with vascular resections are still associated with high postoperative morbidity and mortality. The trend of complex liver resection with vascular resection is constantly on the increase, but more profound knowledge as well as further trials are required. Recent technological developments in multiple fields could surely provide novel approaches and enhance a new era of digital imaging and intelligent hepatic surgery.

Research on Three-Dimensional Reconstruction of Ribs Based on Point Cloud Adaptive Smoothing Denoising.

The traditional methods for 3D reconstruction mainly involve using image processing techniques or deep learning segmentation models for rib extraction. After post-processing, voxel-based rib reconstruction is achieved. However, these methods suffer from limited reconstruction accuracy and low computational efficiency. To overcome these limitations, this paper proposes a 3D rib reconstruction method based on point cloud adaptive smoothing and denoising. We converted voxel data from CT images to multi-attribute point cloud data. Then, we applied point cloud adaptive smoothing and denoising methods to eliminate noise and non-rib points in the point cloud. Additionally, efficient 3D reconstruction and post-processing techniques were employed to achieve high-accuracy and comprehensive 3D rib reconstruction results. Experimental calculations demonstrated that compared to voxel-based 3D rib reconstruction methods, the 3D rib models generated by the proposed method achieved a 40% improvement in reconstruction accuracy and were twice as efficient as the former.

Neural Colour Correction for Indoor 3D Reconstruction Using RGB-D Data.

With the rise in popularity of different human-centred applications using 3D reconstruction data, the problem of generating photo-realistic models has become an important task. In a multiview acquisition system, particularly for large indoor scenes, the acquisition conditions will differ along the environment, causing colour differences between captures and unappealing visual artefacts in the produced models. We propose a novel neural-based approach to colour correction for indoor 3D reconstruction. It is a lightweight and efficient approach that can be used to harmonize colour from sparse captures over complex indoor scenes. Our approach uses a fully connected deep neural network to learn an implicit representation of the colour in 3D space, while capturing camera-dependent effects. We then leverage this continuous function as reference data to estimate the required transformations to regenerate pixels in each capture. Experiments to evaluate the proposed method on several scenes of the MP3D dataset show that it outperforms other relevant state-of-the-art approaches.

Multi-Tracking Sensor Architectures for Reconstructing Autonomous Vehicle Crashes: An Exploratory Study.

With the continuous development of new sensor features and tracking algorithms for object tracking, researchers have opportunities to experiment using different combinations. However, there is no standard or agreed method for selecting an appropriate architecture for autonomous vehicle (AV) crash reconstruction using multi-sensor-based sensor fusion. This study proposes a novel simulation method for tracking performance evaluation (SMTPE) to solve this problem. The SMTPE helps select the best tracking architecture for AV crash reconstruction. This study reveals that a radar-camera-based centralized tracking architecture of multi-sensor fusion performed the best among three different architectures tested with varying sensor setups, sampling rates, and vehicle crash scenarios. We provide a brief guideline for the best practices in selecting appropriate sensor fusion and tracking architecture arrangements, which can be helpful for future vehicle crash reconstruction and other AV improvement research.

An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction.

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

Underwater Single-Photon 3D Reconstruction Algorithm Based on K-Nearest Neighbor.

The high sensitivity and picosecond time resolution of single-photon avalanche diodes (SPADs) can improve the operational range and imaging accuracy of underwater detection systems. When an underwater SPAD imaging system is used to detect targets, backward-scattering caused by particles in water often results in the poor quality of the reconstructed underwater image. Although methods such as simple pixel accumulation have been proven to be effective for time-photon histogram reconstruction, they perform unsatisfactorily in a highly scattering environment. Therefore, new reconstruction methods are necessary for underwater SPAD detection to obtain high-resolution images. In this paper, we propose an algorithm that reconstructs high-resolution depth profiles of underwater targets from a time-photon histogram by employing the K-nearest neighbor (KNN) to classify multiple targets and the background. The results contribute to the performance of pixel accumulation and depth estimation algorithms such as pixel cross-correlation and ManiPoP. We use public experimental data sets and underwater simulation data to verify the effectiveness of the proposed algorithm. The results of our algorithm show that the root mean square errors (RMSEs) of land targets and simulated underwater targets are reduced by 57.12% and 23.45%, respectively, achieving high-resolution single-photon depth profile reconstruction.

Technological Advances in SPECT and SPECT/CT Imaging.

Single photon emission tomography/computed tomography (SPECT/CT) is a mature imaging technology with a dynamic role in the diagnosis and monitoring of a wide array of diseases. This paper reviews the technological advances, clinical impact, and future directions of SPECT and SPECT/CT imaging. The focus of this review is on signal amplifier devices, detector materials, camera head and collimator designs, image reconstruction techniques, and quantitative methods. Bulky photomultiplier tubes (PMTs) are being replaced by position-sensitive PMTs (PSPMTs), avalanche photodiodes (APDs), and silicon PMs to achieve higher detection efficiency and improved energy resolution and spatial resolution. Most recently, new SPECT cameras have been designed for cardiac imaging. The new design involves using specialised collimators in conjunction with conventional sodium iodide detectors (NaI(Tl)) or an L-shaped camera head, which utilises semiconductor detector materials such as CdZnTe (CZT: cadmium-zinc-telluride). The clinical benefits of the new design include shorter scanning times, improved image quality, enhanced patient comfort, reduced claustrophobic effects, and decreased overall size, particularly in specialised clinical centres. These noticeable improvements are also attributed to the implementation of resolution-recovery iterative reconstructions. Immense efforts have been made to establish SPECT and SPECT/CT imaging as quantitative tools by incorporating camera-specific modelling. Moreover, this review includes clinical examples in oncology, neurology, cardiology, musculoskeletal, and infection, demonstrating the impact of these advancements on clinical practice in radiology and molecular imaging departments.

Cell State Transition Models Stratify Breast Cancer Cell Phenotypes and Reveal New Therapeutic Targets.

Understanding signaling patterns of transformation and controlling cell phenotypes is a challenge of current biology. Here we applied a cell State Transition Assessment and Regulation (cSTAR) approach to a perturbation dataset of single cell phosphoproteomic patterns of multiple breast cancer (BC) and normal breast tissue-derived cell lines. Following a separation of luminal, basal, and normal cell states, we identified signaling nodes within core control networks, delineated causal connections, and determined the primary drivers underlying oncogenic transformation and transitions across distinct BC subtypes. Whereas cell lines within the same BC subtype have different mutational and expression profiles, the architecture of the core network was similar for all luminal BC cells, and mTOR was a main oncogenic driver. In contrast, core networks of basal BC were heterogeneous and segregated into roughly four major subclasses with distinct oncogenic and BC subtype drivers. Likewise, normal breast tissue cells were separated into two different subclasses. Based on the data and quantified network topologies, we derived mechanistic cSTAR models that serve as digital cell twins and allow the deliberate control of cell movements within a Waddington landscape across different cell states. These cSTAR models suggested strategies of normalizing phosphorylation networks of BC cell lines using small molecule inhibitors.

A Multi-Center Retrospective Observational Analysis of Three-Year Experience of Our Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction.

BACKGROUND: With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients. AIMS: The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures. METHODS AND RESULTS: We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%. CONCLUSION: After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders.

Cr-doping promoted surface reconstruction of Ni3N electrocatalysts toward efficient overall water splitting.

Understanding and utilizing the dynamic changes of electrocatalysts under working conditions are important for advancing the sustainable hydrogen production. Here, we for the first time report that Cr-doping can promote the in situ reconstruction of a self-supported Ni3N electrocatalyst (Cr-Ni3N/NF) during oxygen and hydrogen evolution reactions (OER and HER), and therefore improve the electrocatalytic water splitting performance. As identified by in situ measurements and theoretical calculations, Cr-doping enhances OH- adsorption during OER at anode and thereby boosts the transformation of Ni3N pre-catalysts to defect-rich nickel oxyhydroxide (NiOOH) active species. Meanwhile, it facilitates the generation of Ni3N/Ni(OH)2 at cathodes due to effective H2O activation, leading to the fast HER kinetics on the Ni3N/Ni(OH)2 interfaces. Notably, the optimal Cr-Ni3N/NF displays good OER and HER performance in 1.0 M KOH electrolytes, with low overpotentials of 316 and 188 mV to achieve the current density of ± 100 mA cm-2, respectively. Benefiting from its bi-functionality and self-supporting property, an alkaline electrolyzer equipped with Cr-Ni3N/NF as both anode and cathode affords a small voltage of 1.72 V at 100 mA cm-2, along with 100 h operation stability. Elucidating that Cr-doping can boost in situ reconfiguration and consequently the electrocatalytic activity, this work would shed new light on the rational design and synthesis of electrocatalysts via directional reconstructions.