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Incisional negative pressure wound therapy (iNPWT) has shown effectiveness in the treatment of high-risk surgical wounds. Especially patients with diabetes-induced peripheral arterial disease undergoing major limb amputation have a high intrinsic risk for post-surgical wound infections. While normal gauze wound dressings do not cause stimulation of microvasculature, iNPWT might improve wound healing and reduce wound complications. The purpose of this study was to systematically review the literature for rates of wound complications and readmissions, as well as post-surgical 30-day mortality.We conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were the modified Coleman methodology Score >60, non-traumatic major limb amputation, and adult patients. Traumatic amputations and animal studies were excluded. Relevant articles were reviewed independently by referring to the title and abstract. In a meta-analysis, we compared 3 studies and 457 patients.A significantly overall lower rate of postoperative complications is associated with usage of iNPWT (odds ratio (OR) = 0.52; 95% CI: 0.30–0.89; P = 0.02). There was no significant improvement for 30-day mortality, when iNPWT was used (OR= 081; 95% CI: 0.46 – 1.45; P = 0.48). Nevertheless, we did not noteasignificant difference in the readmission rate or revision surgery between the two groups.Overall, the usage of iNPWT may reduce the risk of postoperative wound complications in major lower limb amputations but does not improve 30-day mortality rates significantly. However, to anticipate surgical-site infection, iNPWT has shown effectiveness and thus should be used whenever applicable.

High resolution spectra with UVES/VLT of SN 1987A from December 2000 until November 2005 show a number of high ionization lines from gas with velocities of ~ $\pm 350~\rm km\,s^{-1}$, emerging from the shocked gas formed by the ejecta–ring collision. These include coronal lines from [Fe X], [Fe XI] and [Fe XIV] which have increased by a factor of ~ 20 during the observed period. The evolution of the lines is similar to that of the soft X-rays, indicating that they arise in the same component. The line ratios are consistent with those expected from radiative shocks with velocity $310{-}390~\rm km\,s^{-1}$, corresponding to a shock temperature of $(1.6{-}2.5)\times 10^{6}$K. A fraction of the coronal emission may, however, originate in higher velocity adiabatic shocks.

The X-ray emission from the circumstellar interaction in type II supernovae with a dense circumstellar medium is calculated. In type IIL and type IIn supernovae, mass loss rates are generally high enough for the region behind the reverse shock to be radiative, producing strong radiation, particularly in X-rays. We present a model for the emission from the cooling region in the case of a radiative reverse shock. Under the assumption of a stationary flow, a hydrodynamic model is combined with a time-dependent ionization balance and multilevel calculations. The applicability of the steady state approximation is discussed for various values of the ejecta density gradient and different sets of chemical composition. We show how the emerging spectrum strongly depends on the reverse shock velocity and the composition of the shocked gas. We discuss differences between a spectrum produced by this model and a single-temperature spectrum. Large differences are found especially for the line emission, which can seriously affect abundance estimates. We also illustrate the effects of absorption in the cool shocked ejecta. The applicability of our model to various types of supernovae is discussed.

Aims. We investigate the effects of radiative shocks on the observed X-ray emission from the type?II supernova?SN?1993J. To this end, the X-ray emission is modeled as a result of the interaction between the supernova ejecta and a dense circumstellar medium at an age of 8?years.Methods. The circumstances under which the reverse shock is radiative are discussed and the observed X-ray emission is analyzed using the numerical code described in Nymark et?al. (2006, A&A, 449, 171). We argue that the original analysis of the X-ray observations suffered from the lack of self-consistent models for cooling shocks with high density and velocity, leading to questionable conclusions about the temperatures and elemental abundances. We reanalyze the spectra with our numerical model, and discuss the expected spectra for different explosion models for the progenitors.Results. We find that the spectra of SN?1993J are compatible with a CNO-enriched composition and that the X-ray flux is dominated by the reverse shock.

In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twice as often in the TGN group compared with the DHS group, however they were not statistically significant. Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors and not by highly specialized hip/trauma surgeons. The TGN may have advantages in selected intertrochanteric fractures.