Sulfide lithium argyrodites are a key materials family that are studied as solid electrolytes in commercial all-solid-state batteries (ASSBs), while their oxide analogues remain relatively unexplored. This study presents the discovery of Li7TiO5X (X = Cl-, Br-), the first lithium argyrodite materials in which a transition metal is used as the framework-forming cation, expanding the chemical space that is accessible for oxide argyrodites. Incorporation of Ti4+ enables the lithium content to be maximized to 7 Li+ per formula unit. Interestingly, even with the high lithium content, Li7TiO5Cl retains a Li+ site disordered cubic F4̅3m structure at room temperature with Li+ occupancy of the T5, T5a, and T3 positions, and exhibits an ionic conductivity of 2.2(2) × 10-6 S cm-1 with the lowest reported activation energy (0.36(2) eV) for bulk Li+ ion transport in an oxide argyrodite. Conversely, Li7TiO5Br adopts the same F4̅3m symmetry at room temperature but with an ordered arrangement of Li+ positions via full occupancy of the T5a and T3 positions, and thus has an ionic conductivity that is 3 orders of magnitude lower (∼10-9 S cm-1) and a much higher activation energy (0.58(2) eV) than Li7TiO5Cl. Order-disorder behavior is observed below 250 K in Li7TiO5Cl, where a Li+ site ordering pattern is observed that is distinct from Li7TiO5Br and all sulfide argyrodites, yielding a tetragonal symmetry (I4̅) for only the second time to date in the argyrodite structure type. This unique order-disorder behavior, alongside the ability to incorporate transition metal cations within this material family emphasizes the potential to access much greater structural diversity via the expansive chemical space that is available for exploration in oxide argyrodites.

BACKGROUND:Nipple-sparing mastectomy (NSMs) and the deep inferior epigastric perforator (DIEP) flap for breast reconstruction represent the latest evolutions of breast and reconstructive surgery, with resemblance to the aesthetics and feel of the natural breast without needing additional nipple reconstruction or tattooing. Despite clinical adoption of these advances, current literature of autologous reconstruction after NSM remains limited. Herein, we classify the incidence and predictors for the most common complications in patients undergoing NSM and DIEP flap reconstruction over a 10-year period. METHODS:This is a retrospective review of all patients receiving uni- or bilateral NSMs with DIEP flap breast reconstruction by the senior author between July 2013 and November 2022. Complications included flap issues, infection, hematoma, and wound healing problems within 90 days. RESULTS:Two hundred fourteen patients had post-NSM DIEP reconstruction for 380 breasts. The average age at reconstruction was 49.98 (SD 10.0). Sixteen (4.2%) flaps required a reoperation during the same admission: 13 were due to a hematoma, 2 were due to flap thrombosis, and 1 was due to venous congestion. No flaps were lost. On multivariate analysis, body mass index > 25 kg/m2 and tobacco use were associated with breast and abdominal complications. Delayed-immediate reconstruction was protective against breast complications (odds ratio 0.16, P = 0.001). CONCLUSION:In our series of 380 DIEP flaps after NSM, we present a major donor site complication rate of 5.9% and a major recipient site complication rate of 16.3%. Body mass index and tobacco use are associated with breast and abdominal complications. Delayed-immediate reconstruction has a protective effect on breast complications.

BACKGROUND:Spinal degeneration and deformities affect more than 27% of US adults, and $14.1 billion is spent annually on spinal fusion to address these pathologies. Wound closure using local muscle flaps has been associated with reduced complication rates, including infection and reoperation. The high prevalence of degenerative deformities and health care expenditures highlight the need for resource utilization studies to inform decision-makers on best operative practices. METHODS:A retrospective review was performed on adult patients who underwent posterior spinal fusion for degenerative or deformity indications at the authors' institution between 2019 and 2022. Patients were stratified by the prophylactic use of muscle flap closure, and outcomes were compared between groups. Costs were applied to consumed resources, and univariate and multivariable regression analyses were performed to measure the impact of muscle flaps on overall costs. RESULTS:Of 520 included patients, 240 received muscle flap closures. These patients had significantly fewer readmissions (odds ratio [OR], 0.49 [95% CI, 0.29, 0.84]), reoperations (OR, 0.49 [95% CI, 0.26, 0.89]), and hardware failures (OR, 0.09 [95% CI, 0.00, 0.45]), but greater odds of seroma (OR, 5.22 [95% CI, 2.12, 15.7]). They also had shorter hospital stays (5.4 versus 6.5 days [ P = 0.033]), but operative time did not vary by closure type. Multivariable regression revealed that muscle flap closure was associated with a $7152 reduction in overall costs per patient ( P < 0.03). CONCLUSIONS:Muscle flap closure correlates with reduced complication rates and decreased overall costs per patient. These findings support the use of prophylactic muscle flap closure from safety and health economics perspectives.

BACKGROUND:Sternal wound infection (SWI) is a serious and life-threatening complication of open cardiac surgery. Debridement and flap reconstruction has become standard of care, but data on national practice patterns are limited. METHODS:We queried the National Inpatient Sample from 2016-2018 for patients with SWI who underwent coronary artery bypass grafting (CABG). The outcomes of interest were reception of flap reconstruction and in-hospital mortality. Sociodemographic and clinical variables that differed significantly (p<0.20) on univariate analysis were incorporated into binary logistic regression (p<0.05). RESULTS:In total, 120,440 patients who underwent CABG procedures were initially identified, of which 1399 (1.2%) were diagnosed with SWI. Among these SWI patients, 113 (8.1%) patients were treated with a flap procedure during their stay, and 134 (9.6%) patients died during admission. Female sex (odds ratio [OR]: 0.68, 95% confidence interval [CI]: 0.55-0.84, p<0.001) and rural (OR: 0.32, 95% CI: 0.13-0.79, p=0.013) or urban nonteaching (OR: 0.39, 95% CI: 0.27-0.56, p<0.001) hospital status predicted lower probability of flap reconstruction, whereas older age (OR: 1.028, 95% CI: 1.019-1.037, p<0.001) and higher comorbidity burden (OR: 1.026, 95% CI: 1.021-1.030, p<0.001) predicted higher risk of in-hospital mortality. CONCLUSION:The rate of flap reconstruction is significantly lower than expected for management of SWI in some demographic groups. Our analysis highlights variations in practice patterns for SWI management depending on both patient demographics and hospital characteristics.

Magnesium batteries offer a promising alternative to lithium-ion systems, but suitable electrodes remain limited. Covalent organic frameworks (COFs) are attractive candidates due to their structural tunability and open channels for ion transport. We report a pyrene- 4,5,9,10-tetraone COF composite with carbon nanotubes as a Mg electrode, delivering 70 mAh g-1 at 200 mA g-1 and operating at 1.3 V. In situ Raman spectroscopy confirms carbonyl-centered redox on pyrene tetraone, supporting a Mg2+-driven carbonyl reduction. Compared with Li+, only partial carbonyl utilization occurs, attributed to steric and electrostatic constraints of divalent Mg2+. This incomplete conversion to magnesium-enolate inspires future work toward structural optimization.

OBJECTIVE:Spinal fusion is associated with risks of surgical site infection and wound dehiscence. Muscle flap reconstruction during surgery may mitigate these risks. While the benefits of muscle flap reconstruction have been established, sociodemographic and hospital-level influences on access to this procedure remain unexplored. This study identifies sociodemographic predictors of muscle flap reconstruction after spinal fusion surgeries using a nationwide database. METHODS:Patients who underwent spinal fusion of two or more vertebral levels (n = 606,408) were identified from the 2012-2020 National Inpatient Sample database. The primary investigated outcome was utilization of muscle flap reconstruction. Cases without and with muscle flap reconstruction were 2:1 propensity score matched based on covariates for clinical severity and surgical complexity. Binary logistic regression identified significant sociodemographic and hospital-level predictors of receiving muscle flap reconstruction (p < 0.05). RESULTS:Of 606,408 discharges with spinal fusion cases, 1991 (0.3%) included muscle flap reconstruction. After matching (n = 5973), patient-level factors including private insurance status, residence in large metropolitan counties, and high median zip code income quartile, and hospital-level factors including urban teaching hospital status, higher institutional plastic surgery case volume, and private not-for-profit hospital ownership, all predicted a higher likelihood of muscle flap reconstruction (p < 0.05). CONCLUSIONS:Multiple sociodemographic variables predict use of muscle flap reconstruction after spinal fusion surgery. These disparities may stem from multiple underlying factors, including lack of access to specialized plastic surgery care and centralization of more complex cases at quaternary care hospitals. A better understanding of these factors may help inform further efforts to increase access to muscle flap reconstruction, thereby reducing the risk of wound healing complications.

BACKGROUND:Use of the absorbable deep dermal stapler in wound closure has become more common in plastic surgery because of its possible reduction in operative times and subsequent decrease in operative room costs. In this study, we examine the effects of this stapler on operative times and postoperative complications in bilateral reduction mammaplasties. METHODS:A retrospective, observational cohort study was conducted via electronic chart review on patients who underwent bilateral reduction mammaplasties. Patients were stratified by wound closure method. One group was closed with sutures only, and in the other group, deep dermal staples were used during closure of the inframammary fold incision. Incidences of patient comorbidities and postoperative complications were compared. In addition, a financial cost analysis was performed. RESULTS:The final patient cohort included 62 patients. Operative time was reduced by an average of 21.8 minutes when using deep dermal staples during closure, compared with when closing solely with sutures (P = 0.032). When controlling for mass of breast tissue removed and type of pedicle, deep dermal staple closure still predicted a reduction of 26.5 (SE, 9.9) minutes in operative time (P = 0.010). Postoperative complications were not affected by wound closure method (odds ratio, 4.36; 95% confidence interval, 0.91-31.7, P = 0.087). Though not statistically significant, financial charge was decreased with usage of deep dermal staples (P = 0.34). CONCLUSIONS:Use of absorbable deep dermal staples produces a significant decrease in operative time for reduction mammaplasties with no increase in postoperative complication rates.

Magnesium batteries attract interest as alternative energy-storage devices because of elemental abundance and potential for high energy density. Development is limited by the absence of suitable cathodes, associated with poor diffusion kinetics resulting from strong interactions between Mg 2+ and the host structure. V 2 PS 10 is reported as a positive electrode material for rechargeable magnesium batteries. Cyclable capacity of 100 mAh g −1 is achieved with fast Mg 2+ diffusion of 7.2 10 −11 –4 10 −14  cm 2  s −1 . The fast insertion mechanism results from combined cationic redox on the V site and anionic redox on the (S 2 ) 2− site; enabled by reversible cleavage of S−S bonds, identified by X-ray photoelectron and X-ray absorption spectroscopy. Detailed structural characterisation with maximum entropy method analysis, supported by density functional theory and projected density of states analysis, reveals that the sulphur species involved in anion redox are not connected to the transition metal centres, spatially separating the two redox processes. This facilitates fast and reversible Mg insertion in which the nature of the redox process depends on the cation insertion site, creating a synergy between the occupancy of specific Mg sites and the location of the electrons transferred.

V2Se9 displays facile electrochemical insertion of up to 1.6 Mg2+ per unit formula with fast diffusion (coefficients of 10-10-10-12 cm2 s-1) surpassing best-in-class materials like Mo6S8. Detailed structural characterization of synchrotron X-ray diffraction data with ab initio Maximum Entropy Method analysis reveals Mg2+ insertion into octahedral sites within the large vdW space between [V4Se18]infinity chains. Fast rate performance is attributed to low structural perturbation and low diffusion barriers, calculated by bond valence pathway analysis, resulting from the low charge-per-size of anionic selenium. X-ray photoelectron spectroscopy and X-ray absorption spectroscopy reveal that reversible insertion of Mg2+ is facilitated by V5+/V3+ redox. V2Se9 demonstrates that selenides, despite their larger molecular weight, offer potential as fast-rate positive electrode materials for magnesium batteries over well-explored oxides and sulfides.

Two compounds were discovered in the well-studied BaO-Y2O3-SiO2 phase field. Two different experimental routines were used for the exploration of this system due to the differences of synthetic conditions and competition with a glass field. The first phase Ba5Y13[SiO4]8O8.5 was isolated through a combination of energy dispersive X-ray spectroscopy analysis and diffraction techniques which guided the exploration. The second phase Ba3Y2[Si2O7]2 was located using iterative algorithmic identification of target compositions. The structure solution of the new compounds was aided by continuous rotation electron diffraction, and the structures were refined against combined synchrotron and neutron time-of-flight powder diffraction. Ba5Y13[SiO4]8O8.5 crystallizes in I4̄2m, a = 18.92732(1), c = 5.357307(6) Å and represents its own structure type which combines elements of structures of known silicates embedded in columns of interconnected yttrium-centred polyhedra characteristic of high-pressure phases. Ba3Y2[Si2O7]2 has P21 symmetry with a pseudo-tetragonal cell (a = 16.47640(4), b = 9.04150(5), c = 9.04114(7) Å, β = 90.0122(9)°) and is a direct superstructure of the Ca3BaBi[P2O7]2 structure. Despite the lower symmetry, the structure of Ba3Y2[Si2O7]2 retains disorder in both Ba/Y sites and disilicate network, thus presenting a superposition of possible locally-ordered fragments. Ba5Y13[SiO4]8O8.5 has low thermal conductivity of 1.04(5) W m-1 K-1 at room temperature. The two discovered phases provide a rich structural platform for further functional material design. The interplay of automated unknown phase composition identification with multiple diffraction methods offers acceleration of the time-consuming exploration of high-dimensional chemical spaces for new structures.

PURPOSE: Rates of spinal degenerative deformities and spondylosis have a prevalence of over 60% in elderly patients. An estimated $34 billion is spent annually on posterior spinal fusions (PSFs) and subsequent postoperative complications, which affect upwards of 20% of patients. Wound closure involving local muscle flaps has been associated with reduced rates of complications compared to primary closure. The rise in PSF rates and health expenditures underscores the need for healthcare utilization studies to inform decision-makers on best operative protocols. METHODS: A retrospective review was performed on adult patients who underwent PSF due to degenerative deformity or spondylosis. Health and economic outcomes were compared between PSF procedures with local muscle flap closure vs. primary closure. Patient-level costs were calculated using standard unit cost estimates derived from CMS Medicare fee schedules. RESULTS: 200 patients met our study criteria; 100 received prophylactic muscle flap closure by plastic surgery. The groups did not differ significantly in terms of gender, race, insurance status, surgical indication, or number of vertebrae fused. Patients who received muscle flaps had significantly fewer post-operative infections and readmissions, and more seromas. Use of muscle flaps did not increase operative time, length of stay, or outpatient resource utilization. Reductions in postoperative resource utilization without statistically significant increases in peri-operative costs resulted in an average cost reduction of $2,760 per patient. CONCLUSION: In this study, those who received muscle flap closure had fewer complications without the burden of increased resource utilization, providing useful information for stakeholders when deciding to implement this technique.

BACKGROUND: Spinal degenerative deformities have a prevalence of over 27% in US adults.1 $34 billion is spent annually on spinal instrumentation and fusion to address these deformities.2 Wound closure after fusion using paraspinal muscle flaps has been associated with reduced rates of complications, including infection and reoperation.3 However, no study has addressed the cost effectiveness of this added intervention. The high prevalence of degenerative deformities and subsequent healthcare expenditures highlights the need for resource utilization studies to inform decision-makers on best operative practices. METHODS: A retrospective review was performed on adult patients at our institution who underwent posterior spinal fusion due to degenerative deformity between 2019 and 2022. Patients with infection, spinal tumor, or connective tissue disease were excluded. Patients were stratified by the prophylactic use of muscle flap closure following fusion, and outcomes were compared between groups using chi-square tests and odds ratios (OR) with an alpha of 0.05. Costs were applied to operative, inpatient, and outpatient resources, and univariate and multivariate regression were performed to measure the impact of muscle flaps on costs. RESULTS: 520 patients were included in this study. Diagnoses included 319 patients (61%) with spondylosis, 142 (27%) with scoliosis, 47 (9%) with discopathy, and 12 (2%) with other musculoskeletal pathologies. 240 patients received muscle flap closure and 280 underwent primary closure. These cohorts were similar in terms of sex, race, ethnicity, BMI, and length of fusion. The flap group was statistically younger (mean age 57.7 vs 61.4 years) and more likely to have had prior spine surgery (63% vs 54%). Flap closure patients had significantly fewer readmissions (10% vs. 17%, OR 0.56), reoperations (8% vs 14%, OR 0.56), and hardware failures (0.4% vs. 4%, OR 0.10), and more seromas (10% vs. 2%, OR 6.11) than the control group. There were no differences in infection, hematoma, or wound dehiscence rates. Operative time, hospital length of stay, and subacute rehabilitation use did not vary between groups. In the multivariate regression, when controlling for independently significant factors like age, diagnosis, comorbidities, and length of fusion, muscle flap closure remained a significant predictor of costs, and was associated with a $7,376 reduction in overall costs per patient. CONCLUSIONS: This resource utilization study shows that muscle flap closures correlate with improved outcomes by reducing complication rates, while also leading to decreased costs per patient. These findings support the use of prophylactic muscle flap closures following posterior spinal fusion from patient safety and health economics perspectives. References: 1. Parenteau CS, Lau EC, Campbell IC, Courtney A. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Sci Rep. 2021;11(1):5389. doi:10.1038/S41598-021-84724-6 2. Rajaee S, Bae H, Kanim L, Delamarter R. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37(1):67-76. doi:10.1097/BRS.0B013E31820CCCFB 3. Wright MA, Weinstein AL, Bernstein JL, et al. Muscle flap closure following complex spine surgery: A decade of experience. Plast Reconstr Surg. Published online 2020:642E-650E. doi:10.1097/PRS.0000000000007274

Whole-brain fluorescence images require several stages of computational processing to fully reveal the neuron morphology and connectivity information they contain. However, these computational tools are rarely part of an integrated pipeline. Here we present BrainLine, an open-source pipeline that interfaces with existing software to provide registration, axon segmentation, soma detection, visualization and analysis of results. By implementing a feedback based training paradigm with BrainLine, we were able to use a single learning algorithm to accurately process a diverse set of whole-brain images generated by light-sheet microscopy. BrainLine is available as part of our Python package brainlit:http://brainlit.neurodata.io/.

RESULTS: A total of 7,311,656 patients were identified with isolated LE trauma in both databases; 25,818 received amputation (88.7%) while 3,304 underwent FFR (11.3%). Out of 130,610 patients treated at the top volume quartile of centers performing FFR, 806 received FFR (36%) while 1,422 received amputation (64%). Annual rates of amputation decreased from 2015-2019 (P<0.001) while FFRs increased over the decade (P=0.001). Patients who were in higher income percentiles and treated at large teaching hospitals were more likely to receive FFR, while older, publicly insured, multimorbid, and more severely injured patients were less likely. Patients with FFR were not associated with increased overall costs (USD $841.00 [95% CI: $-2,618.31-$4,300.81], P=0.634) compared to the amputation cohort after controlling for patientand hospital-level confounders.

Introduction: Capsular contracture remains the most common complication following device-based breast reconstruction, occurring in up to 50% of women who also undergo adjuvant radiotherapy either before or after device-based reconstruction. While certain risk factors for capsular contracture have been identified, there remains no clinically effective method of prevention. The purpose of the present study is to determine the effect of coating the implant with the novel small molecule Met-Z2-Y12, with and without delayed, targeted radiotherapy, on capsule thickness and morphologic change around smooth silicone implants placed under the latissimus dorsi in a rodent model. Methods: Twenty-four female Sprague Dawley rats each had 2 mL smooth round silicone breast implants implanted bilaterally under the latissimus dorsi muscle. Twelve received uncoated implants and twelve received implants coated with Met-Z2-Y12. Half of the an-imals from each group received targeted radiotherapy (20 Gray) on postoperative day ten. At three and 6 months after implantation, the tissue surrounding the implants was har-vested for analysis of capsular histology including capsule thickness. Additionally, microCT scans were qualitatively analyzed for morphologic change. Results: Capsules surrounding Met-Z2-Y12-coated implants were significantly thinner (P 1/4 0.006). The greatest difference in capsule thickness was seen in the irradiated 6-month groups, where mean capsule thickness was 79.1 & PLUSMN; 27.3 mm for uncoated versus 50.9 & PLUSMN; 9.6 mm for Met-Z2-Y12-coated implants (P 1/4 0.038). At the time of explant, there were no capsular morphologic differences between the groups either grossly or per microCT. Conclusions: Met-Z2-Y12 coating of smooth silicone breast implants significantly reduces capsule thickness in a rodent model of submuscular breast reconstruction with delayed radiotherapy.& COPY; 2023 Elsevier Inc. All rights reserved.

The application of machine learning models to predict material properties is determined by the availability of high-quality data. We present an expert-curated dataset of lithium ion conductors and associated lithium ion conductivities measured by a.c. impedance spectroscopy. This dataset has 820 entries collected from 214 sources; entries contain a chemical composition, an expert-assigned structural label, and ionic conductivity at a specific temperature (from 5 to 873 °C). There are 403 unique chemical compositions with an associated ionic conductivity near room temperature (15–35 °C). The materials contained in this dataset are placed in the context of compounds reported in the Inorganic Crystal Structure Database with unsupervised machine learning and the Element Movers Distance. This dataset is used to train a CrabNet-based classifier to estimate whether a chemical composition has high or low ionic conductivity. This classifier is a practical tool to aid experimentalists in prioritizing candidates for further investigation as lithium ion conductors.

Abstract Patients with Fanconi anemia (FA) are at increased risk for head and neck cancers that often necessitate extensive reconstructions. Such patients have multiple comorbidities including anemia and thrombocytopenia frequently requiring bone marrow transplant, and they are at an increased risk of cancer recurrence and need for further extirpation. in the present study, charts from 3 patients with FA who underwent microvascular free tissue transfer by the senior author were retrospectively reviewed for pertinent pre- and peri-operative details in addition to functional and cosmetic outcomes. Two of these patients ultimately required metachronous free flap reconstructions for recurrence. All patients had acceptable functional and cosmetic outcomes following each instance of free flap reconstruction, thereby demonstrating the utility of microvas- cular free tissue transfer in patients with FA. The authors herein present each patient's clinical history in addition to a discussion of the current literature and an outline of our approach to these challenging cases.