1. Free flap: SGAR (superior gluteal artery perforators)
-Take fat/skin over gluteus
-If you take the gluteus muscles, that's very morbid
-Vessels in the gluteal region tend to be flimsy and bleed frequently, and the fat quality is more fibrotic and harder to contour in comparison with abdominal fat.
2. Free flap: TUG/VUG (transverse upper gracilis/vertical upper gracilis) 
-Take gracilis muscle (leads to little functional defect)
-TUG vs VUG only differ by orientation of skin paddle
-The donor site isn't usually the best, unless they need a medial thigh lift anyways
-Good for small defects/small breasts.
3. Great article describing an algorithm for flap selection after breast reconstruction by the chief of plastics.
4. Recipient vessels in the breast: Internal mammary artery
-Advantages: reliably good vessel size, a good match for deep inf epigastric artery, reliable blood flow due to proximity to heart, medial flap placement leads to better cosmetic outcome.
-Disadvantages: you have to remove costal cartilage, the internal mammary vein is thin, she can never get a CABG with the internal mammary arteries.
-Article on using internal mammary perforators in order to spare the IMA for future cardiac surgery, but the perforators were really small (~0.5mm) and the success rate of anastomoses low (~30%)
5. Recipient vessels in the breast: Thoracodorsal. 
-Advantages: easy to find
-Disadvantages: they are in the field of radiation, also commonly cut during mastectomy. The arteries are smaller, you end up with a more lateral positioning of flap (worse cosmesis), you need a surgical assistant to complete the dissection, and if the flap goes down, you've lost the ability to do a latissimus flap because you've lost the thoracodorsal vessels.
6. Oncoplastic surgery:
-After a lumpectomy, rearranging the remaining breast tissue to fill the defect instead of using tissue transfers or implants.
-Difficult to spare the nipple in these cases.
7. How to restore anesthesia 
-if you think they are moving because they are too light (i.e. enough that they are being bothered by the ET tube) push propofol for fast sedation and increase gas %. You will need to increase your flow rate as well of carrier gas (i.e. O2) otherwise the gas will not enter. You can also add Desflurane as it is the fastest onset of the inhaled gases, and will work in 1-2 minutes.
-If you think they are moving because they are feeling some pain, propofol for fast sedation plus an opiate like fentanyl.
-Propofol will sedate someone fast (<30 seconds) but it has a tendency to drop people's blood pressure. If you give a small dose, the effect is small, but a big dose of propofol can drop someone's pressure by 20%, which may be dangerous in older, sicker people with little cardiopulmonary reserve.
8. Laparoscopic surgery & anaesthesia
-Young women tend to become bradycardic (ie to 30s) upon inflation (vasovagal?).
-The trendellenberg position makes it harder to ventilate, esp in overweight people; the fact that the gas being inflated is CO2 is worse, makes it even more important to ventilate well.
9. Crazy article in the NEJM about replicating CCR5 mutations in people already infected with HIV. They harvested CD4+ cells from the 12 patients, applied a zinc finger nuclease (zinc finger DNA binding domain selective for CCR5 + nuclease = gene-specific restriction enzyme). They infused back the autologous t-cells (only 11-28% of which were CCR5 deficient), and half were randomized to discontinue HAART. Safety was excellent. At 4 weeks, 13% of the patients' CD4+ cells were CCR5-. The mean half life of the modified T-cells was 48 weeks (!) which was actually longer than non-modified T-cells. For 1 out of the 4 patients that went off HAART, viral loads dropped to undetectable levels.
10. Ablation vs antiarrhythmics for initial management of a-fib {multicenter RCT, n=127, JAMA} 
Treatment group: treatment-naive a-fib patients
Outcome: (primary) time to the first documented atrial tachyarrhythmia of more than 30 seconds (symptomatic or asymptomatic AF, atrial flutter, or atrial tachycardia), (secondary) symptomatic a-fib, quality of life survey.
Results: 72% achieved outcome in antiarrhythmic meds group, 55% in ablation group. Recurrence of symptomatic a-fib at 2 years was 47% for ablation, 59% for drugs. No statistical difference for quality of life. 9% incidence of severe complications in ablation group- perforation leading to tamponade, stenosis of pulmonary veins, disrupted rhythm requiring pacemaker implantation. No strokes or deaths in either group.
Conclusion: Take the meds