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Objective To evaluate the role of disease-modifying anti-rheumatic drugs (DMARDs) on wound healing outcomes of patients with autoimmune disease at our tertiary wound care center. Approach Retrospective review of patients presenting to our wound care center between 2014 and 2018 with both chronic wounds and a history of inflammatory disease. Patient demographics, comorbid conditions, and progression to complete wound healing were compared between those taking DMARDs or not at the time of wound onset. The study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results 58 patients with a total of 296 wounds were retrospectively reviewed. Patients were taking at least one DMARD at wound onset in 217 (73.3%) of these wounds. The average number of DMARDs at wound onset was 1.5 (SD 1.2). 210 wounds progressed to heal (70.9%) with a median time to healing of 229.5 days (IQR 71.0-490.0). Of the 210 wounds that healed, patients taking at least one DMARD had a significantly shorter time to healing relative to patients who were not on any DMARDs (median 190.5 vs 340.0 days, p=0.0156). Innovation Characterizing wound healing outcomes at a tertiary hospital with a dedicated wound care center and analyzing the role of DMARDs in wound healing progression. Conclusions Chronic wounds are notoriously challenging to treat in the setting of autoimmune disease. The median time to healing in the studied cohort was 229.5 days, which is alarming when compared to patients with non-infected diabetic foot ulcers, who take a median time to heal of 30.8 days at our institution.10.

This study aimed to assess whether raised baseline plasma tHcy concentrations increased the risks of major adverse cardiovascular events (MACE) and all-cause death outcomes in older patients with obstructive sleep apnea (OSA).A multicenter, prospective, observational study.Beijing, Shandong Province, Gansu Province of China.A total of 1, 290 OSA patients aged 60 to 96 years from sleep centers of six hospitals in China consecutively recruited between January 2015 and October 2017.Cox proportional models assessed the association between tHcy and the risk of new-onset all events among Chinese older OSA patients.The final analysis (60.1% male; median age, 66 years) used data from 1, 100 subjects during a median follow-up of 42 months, a total of 105 (9.5%) patients developed MACE and 42 (3.8%) patients died. Multivariable Cox regression analysis showed higher adjusted hazard ratios (aHRs) of MACE, myocardial infarction (MI), hospitalization for unstable angina, and composite of all events with tHcy levels in the 4th quartile (HR=5.93, 95% CI: 2.79-12.59; HR=4.72, 95% CI:1.36-4.61; HR=4.26, 95% CI:1.62-5.71; HR=4.17, 95% CI:2.23-7.81) and the 3rd quartile (HR=3.79, 95% CI:1.76-8.20; HR=3.65, 95% CI:1.04-2.98; HR=2.75, 95% CI:1.08-3.76; HR=2.51, 95% CI:1.31-4.83) compared to reference tHcy levels in quartile 1, respectively, while the aHRs (95% CIs) of all-cause death showed significantly higher only in the highest tHcy level quartile than in the lowest quartile (HR=3.20, 95% CI=1.16-8.84, P=0.025) with no significant differences in risks of cardiovascular death and hospitalisation for heart failure among groups (P0.05).tHcy, a marker of prognosis for older OSA patients, was significantly associated with the increased risk of MACE and all-cause death in this population independent of BMI, smoking status, and other potential risk factors, but not all clinical components events of MACE. New therapeutic approaches for older patients with OSA should mitigate tHcy-associated risks of MACE, and even all-cause death.

Background. Triple-antibiotic irrigation of breast implant pockets is a mainstay of infection prophylaxis in breast reconstruction and augmentation. The recall of bacitracin for injection due to risk of anaphylaxis and nephrotoxicity in January 2020, a staple component of the irrigation solution, has raised concern for worsened postoperative sequelae. This study aimed to investigate pre- and post-recall implant-based breast surgery to analyze the impact of bacitracin in irrigation solutions on infection rates. Methods. All implant-based breast reconstruction or augmentation surgeries from January 2019 to February 2021 were retrospectively reviewed. In a regression discontinuity study design, patients were divided into pre- and post-recall groups. Patient demographics, surgical details, and outcomes including infection rates were collected. Differences in complication rates were compared between groups and with surgical and patient factors. Results. 254 implants in 143 patients met inclusion criteria for this study, with 172 implants placed before recall and 82 placed after recall. Patients in each cohort did not differ in age, BMI, smoking status, or history of breast radiation or capsular contracture ( p > 0.05 ). All breast pockets were irrigated with antibiotic solution, most commonly bacitracin, cefazolin, gentamycin, and povidone-iodine before recall (116,67.4%) and cefazolin, gentamycin, and povidone-iodine after recall (59,72.0%). There was no difference in incidence of infection (6.4% vs. 8.5%, p = 0.551 ) or cellulitis (3.5% vs. 3.7%, p = 0.959 ) before and after recall. Implant infection was associated with smoking history ( p < 0.001 ) and increased surgical time ( p = 0.003 ). Conclusions. Despite the recent recall of bacitracin from inclusion in breast pocket irrigation solutions, our study demonstrated no detrimental impact on immediate complication rates. This shift in irrigation protocols calls for additional investigations into optimizing antibiotic combinations in solution, as bacitracin is no longer a viable option, to improve surgical outcomes and long-term benefits.

Five-year mortality rates after lower extremity amputation in the chronic wound population have long been regarded as high and inevitable. We theorize that function-based surgical technique and multidisciplinary care improve mortality and assess our institution's mortality rates after major lower extremity amputation (MLEA).We performed a retrospective review of patients who underwent primary nontraumatic MLEA at our institution from 2010 to 2013. Major amputations included below knee amputation, through knee amputation, and above knee amputation. Our function-based surgical approach to MLEA is guided by 4 tenets: (1) optimization of limb biomechanics, (2) maximal soft tissue preservation, (3) multidisciplinary team approach, and (4) addressing nerves during primary amputation to prevent postamputation pain. Kaplan-Meier analysis and Cox regression were performed to estimate cumulative 5-year mortality and to identify predictors of 5-year mortality, respectively.A total of 188 patients underwent MLEA. Median Charlson Comorbidity Index was 4. Estimated 5-year mortality was 40% overall and 43% for diabetic patients. When stratified by amputation level, 5-year mortalities were 36.3% for below knee amputation, 60.9% for through knee amputation, and 44.0% for above knee amputation. Charlson Comorbidity Index (hazard ratio 1.24, p0.001) and end-stage renal disease (hazard ratio 3.38, p0.001) were the strongest predictors of 5-year mortality.We demonstrate the lowest mortality rate reported for MLEA. Improved functional and mortality outcomes can be achieved with a function-based surgical approach to MLEA and close follow-up by a multidisciplinary team. Future studies, using standardized reporting of mortality data and incorporating patient-reported outcomes, are warranted to correlate return to function and mortality.

After the cessation of all in-person visiting rotations during the coronavirus 2019 pandemic, many programs developed virtual rotations as an alternative for the recruitment and education of prospective applicants. In this study, we developed a consortium of three institutions each with a unique virtual subinternship and prospectively surveyed participating students in order to reflect and improve upon future rotations. All students participating in virtual subinternships at three institutions were administered the same pre subinternship and post subinternship electronic surveys. Subinternship curricula were developed independently at each respective institution. Fifty-two students completed both surveys, for an overall response rate of 77.6%. Students' primary objectives were to evaluate their fit with the program (94.2%), interact with residents (94.2%), gain faculty mentorship (88.5%), and improve didactic knowledge (82.7%). Postrotation surveys revealed that over 73% of students reported having met all of these objectives over the course of the rotation. On average, students ranked programs 5% higher overall after the rotation (P = 0.024). Postrotation results showed that the majority (71.2%) of students perceived the virtual subinternship as slightly less valuable than in-person subinternships but that all students would participate in a virtual subinternship again. Student objectives can be successfully met using the virtual format for subinternships. The virtual format is also effective in enhancing the overall perception of a program and its residents. Although students still prefer in-person subinternships, our results suggest that virtual rotations are more accessible and very capable of meeting student goals.

Patients who decline blood transfusions, including members of the Jehovah's Witness faith, often face challenges when they require or desire prolonged operations such as free tissue transfer (FTT). This study aims to outline our institution's experience with treating bloodless medicine patients and offers the first anatomically comprehensive evaluation of FTT in this population. All patients undergoing FTT from 2017 to 2020 at a single institution were retrospectively reviewed. Patients who declined blood products were selected. Outcomes of interest include flap success, operative complications, and changes to hemoglobin measurements. Ten patients undergoing 11 FTT procedures were identified. Average age was 62.4 years (SD 7.6). Most patients were female (n = 9) and Black (n = 8). Average body mass index was 31.3 (SD 5.6), American Society of Anesthesiologists Physical Status was 2.9 (SD 0.5), and Charlson Comorbidity Index was 3.8 (SD 1.1). Sites of FTT reconstruction were breast (6), lower extremity (3), and scalp (2). Average operative time was 390 min (SD 85.1), with an average estimated blood loss of 170 mL (SD 100.4). The difference between preoperative hemoglobin to first postoperative hemoglobin measurement averaged 2.2 g/dL (SD 1.4). Average patient follow-up was 12 months (SD 7.8). Flap success occurred in 10 cases. One patient with flap failure was successfully reconstructed with a second procedure. Despite a small, heterogeneous cohort, our success rate in this highly comorbid population indicates that FTT can be performed effectively for patients who cannot use blood products. Bloodless medicine protocols are beneficial to providers serving patients with transfusion restrictions and systems that strive to limit transfusion volume and risk.

We report TeV gamma-ray observations of the ultra-high-energy source MGRO J1908+06 using data from the High Altitude Water Cherenkov (HAWC) Observatory. This source is one of the highest-energy known gamma-ray sources, with emission extending past 200 TeV. Modeling suggests that the bulk of the TeV gamma-ray emission is leptonic in nature, driven by the energetic radio-faint pulsar PSR J1907+0602. Depending on what assumptions are included in the model, a hadronic component may also be allowed. Using the results of the modeling, we discuss implications for detection prospects by multi-messenger campaigns., Comment: accepted by ApJ, in press

Antiplatelet agents are typically withheld perioperatively because of bleeding concerns. Dual antiplatelet therapy, such as aspirin and clopidogrel, has significant morbidity and mortality benefits in patients with ischemic heart disease or peripheral vascular disease. This study aims to evaluate the impact of perioperative dual antiplatelet therapy in the lower extremity free tissue transfer population.Lower extremity free tissue transfers performed by the senior author (K.K.E.) from 2011 to 2019 were retrospectively reviewed. Demographics, comorbidities, perioperative dual antiplatelet therapy, and free tissue transfer characteristics were recorded. Outcomes of interest included flap success, hematoma formation, blood transfusion requirements, and cardiac event occurrence.One hundred ninety-five free tissue transfers were included. Median age at the time of free tissue transfer was 56.5 years. Median Charlson Comorbidity Index was 3. Thirty-four patients were on clopidogrel, which was either withheld (n = 20) or continued (n = 14) on the day of free tissue transfer. Incidence of blood transfusion was significantly higher in both the withheld and continued versus nonclopidogrel groups. Flap success was statistically equivalent between groups (withheld, 90.0 percent; continued, 92.9 percent; nonclopidogrel, 95.0 percent; p = 0.346). Cardiac events occurred most often in the continued group (21.4 percent) compared to the withheld (5.0 percent) and nonclopidogrel (0.6 percent) groups. On multivariate analysis, holding clopidogrel remained significant for increased odds of postoperative transfusion. The clopidogrel group was no longer significant for intraoperative transfusion.Despite increases in volume of blood products transfused, free tissue transfer can be performed safely with perioperative dual antiplatelet therapy. Withholding dual antiplatelet therapy on the day of free tissue transfer was not associated with decreased intraoperative transfusion; thus, dual antiplatelet therapy can safely be continued throughout the operative course to minimize cardiovascular risk.Therapeutic, III.

We present the results of dark matter (DM) searches in a sample of 31 dwarf irregular (dIrr) galaxies within the field of view of the HAWC Observatory. dIrr galaxies are DM dominated objects, which astrophysical gamma-ray emission is estimated to be negligible with respect to the secondary gamma-ray flux expected by annihilation or decay of Weakly Interacting Massive Particles (WIMPs). While we do not see any statistically significant DM signal in dIrr galaxies, we present the exclusion limits ($95\%~\text{C.L.}$) for annihilation cross-section and decay lifetime for WIMP candidates with masses between $1$ and $100~\text{TeV}$. Exclusion limits from dIrr galaxies are relevant and complementary to benchmark dwarf Spheroidal (dSph) galaxies. In fact, dIrr galaxies are targets kinematically different from benchmark dSph, preserving the footprints of different evolution histories. We compare the limits from dIrr galaxies to those from ultrafaint and classical dSph galaxies previously observed with HAWC. We find that the contraints are comparable to the limits from classical dSph galaxies and $\thicksim2$ orders of magnitude weaker than the ultrafaint dSph limits., Comment: 22 pages, 11 figures, 3 tables

Previous studies have demonstrated that methyl ester-based biodiesels produce significantly less soot compared to petroleum diesel in standard diffusion flames. However, the roles of the oxygen content and the degrees of unsaturation (DoU) of the biodiesels on their sooting propensity have not been independently analysed. In the present study, the relationship between soot yield of biodiesels and the DoU of the fuel is systematically analysed in laminar pool flames and pre-vaporised diffusion flames. The spatial distribution of soot volume fraction of the flames fuelled with four biodiesel fuels, two methyl esters and their blends with diesel are quantitatively measured using laser induced incandescence. All six biofuels have different DoU but similar oxygen mass fractions, so that the effect of the DoU on soot formation could be separately considered. The soot yield using biodiesels was measured to be lower than that of diesel fuel by a factor up to 7.5 in pool flames and by a factor of 4.0 in vapour flames. In both flame setups, the soot reduction effect of biodiesels ranks in order of DoU. The more saturated the fuel molecule is, the lower the soot yield. The soot reduction effect of the blending ratio with biodiesel was found to be non-linear, and different in pool and vapour flames. The morphology, size, and number density of soot particles were analysed using scanning electronic microscopy. The results suggest that the shape of primary soot particles is close to spherical and the structure of the point-contact aggregates is similar in all cases. Biofuels not only produce smaller particle sizes, but also fewer particles compared to diesel. Chemical kinetic simulations suggest that blending of biodiesels reduces the soot yield primarily by slowing the soot surface growth process, and secondarily by prohibiting the soot nucleation and inception. Both the nucleation (C3H3 and benzene) and growth species (C2H2) for soot formation take place more quickly and intensely for the combustion of more unsaturated fuels, which results in the correspondingly larger soot yield.

Extended very-high-energy (VHE; 0.1–100 TeV) γ-ray emission has been observed around several middle-aged pulsars and referred to as “TeV halos.” Their formation mechanism remains under debate. It is also unknown whether they are ubiquitous or related to a certain subgroup of pulsars. With 2321 days of observation, the High Altitude Water Cherenkov (HAWC) Gamma-Ray Observatory detected VHE γ-ray emission at the location of the radio-quiet pulsar PSR J0359+5414 with >6σ significance. By performing likelihood tests with different spectral and spatial models and comparing the TeV spectrum with multiwavelength observations of nearby sources, we show that this excess is consistent with a TeV halo associated with PSR J0359+5414, though future observation of HAWC and multiwavelength follow-ups are needed to confirm this nature. This new halo candidate is located in a noncrowded region in the outer galaxy. It shares similar properties to the other halos but its pulsar is younger and radio-quiet. Our observation implies that TeV halos could commonly exist around pulsars and their formation does not depend on the configuration of the pulsar magnetosphere.

In the quest for high-energy neutrino sources, the Astrophysical Multimessenger Observatory Network has implemented a new search by combining data from the High Altitude Water Cherenkov (HAWC) Observatory and the Astronomy with a Neutrino Telescope and Abyss environmental RESearch (ANTARES) neutrino telescope. Using the same analysis strategy as in a previous detector combination of HAWC and IceCube data, we perform a search for coincidences in HAWC and ANTARES events that are below the threshold for sending public alerts in each individual detector. Data were collected between 2015 July and 2020 February with a live time of 4.39 yr. Over this time period, three coincident events with an estimated false-alarm rate of, The National Science Foundation under grants PHY-1708146, PHY-1806854, The Institute for Gravitation and the Cosmos of the Pennsylvania State University, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’énergie atomique et aux énergies alternatives (CEA), Commission Européenne (FEDER fund and Marie Curie Program), Institut Universitaire de France (IUF), LabEx UnivEarthS (ANR-10-LABX-0023 and ANR-18-IDEX-0001), Région Île-de-France (DIM-ACAV), Région Alsace (contrat CPER), Région Provence-Alpes-Côte d’Azur, Département du Var and Ville de La Seyne-sur-Mer, Bundesministerium für Bildung und Forschung (BMBF), Istituto Nazionale di Fisica Nucleare (INFN), Nederlandse organisatie voor Wetenschappelijk Onderzoek (NWO), Executive Unit for Financing Higher Education, Research, Development and Innovation (UEFISCDI), Romania; Ministerio de Ciencia, Innovación, Investigación y Universidades (MCIU), Programa Estatal de Generación de Conocimiento (refs. PGC2018- 096663-B-C41, -A-C42, B-C43, B-C44, PID2021- 124591NB-C41, C42, C43, (MCIU/FEDER), Generalitat Valenciana, Prometeo (PROMETEO/2020/019), Grisolía (refs. GRISOLIA/2018/119, /2021/192), GenT (refs. /2019/043, /2020/049, /2021/023) programs, Junta de Andalucía (ref. A-FQM-053-UGR18), La Caixa Foundation (ref. LCF/BQ/IN17/11620019), MSC program (ref. 101025085), Spain; Ministry of Higher Education, Scientific Research and Innovation, The Arab Fund for Economic and Social Development, Kuwait, US National Science Foundation (NSF), The US Department of Energy Office of High-Energy Physics, Laboratory Directed Research and Development (LDRD) program of Los Alamos National Laboratory, Consejo Nacional de Ciencia y Tecnología (CONACyT), México, grants 271051, 232656, 260378, 179588, 254964, 258865, 243290, 132197, A1-S-46288, A1- S-22784, Cátedras 873, 1563, 341, 323, Red HAWC, México, DGAPA-UNAM grants IG101320, IN111716-3, IN111419, IA102019, IN110621, IN110521, VIEP-BUAP, PIFI 2012, PROFOCIE 2014, 2015, the University of Wisconsin Alumni Research Foundation, The Institute of Geophysics, Planetary Physics, Signatures at Los Alamos National Laboratory, Polish Science Centre grant, DEC-2017/27/B/ ST9/02272, Coordinación de la Investigación Científica de la Universidad Michoacana; Royal Society—Newton Advanced Fellowship 180385, Generalitat Valenciana, grant CIDEGENT/ 2018/034, The Program Management Unit for Human Resources & Institutional Development, Research and Innovation, NXPO (grant No. B16F630069), Coordinación General Académica e Innovación (CGAI-UdeG), PRODEP-SEP UDGCA- 499; Institute of Cosmic Ray Research (ICRR), University of Tokyo, NASA under award number 80GSFC21M0002

We analyse the molecular and atomic emission lines of 71 bright Herschel-selected galaxies between redshifts 1.4 to 4.6 detected by the Atacama Large Millimetre/submillimetre Array. These lines include a total of 156 CO, [C I], and H2O emission lines. For 46 galaxies, we detect two transitions of CO lines, and for these galaxies we find gas properties similar to those of other dusty star-forming galaxy (DSFG) samples. A comparison to photo-dissociation models suggests that most of Herschel-selected galaxies have similar interstellar medium conditions as local infrared-luminous galaxies and high-redshift DSFGs, although with denser gas and more intense far-ultraviolet radiation fields than normal star-forming galaxies. The line luminosities agree with the luminosity scaling relations across five orders of magnitude, although the star-formation and gas surface density distributions (i.e., Schmidt-Kennicutt relation) suggest a different star-formation phase in our galaxies (and other DSFGs) compared to local and low-redshift gas-rich, normal star-forming systems. The gas-to-dust ratios of these galaxies are similar to Milky Way values, with no apparent redshift evolution. Four of 46 sources appear to have CO line ratios in excess of the expected maximum (thermalized) profile, suggesting a rare phase in the evolution of DSFGs. Finally, we create a deep stacked spectrum over a wide rest-frame frequency (220-890 GHz) that reveals faint transitions from HCN and CH, in line with previous stacking experiments., Comment: 30 pages, 17 figures, accepted for publication in Monthly Notices of the Royal Astronomical Society Main Journal. Comments are warmly welcomed

Introduction With mobile technologies becoming more advanced and accessible, mobile health (mHealth) has been incorporated in delivering timely and convenient breastfeeding support. However, its feasibility and potential efficacy remain to be examined. Therefore, the primary objective of this study is to assess the feasibility and acceptability of an online instant messaging peer support group for breastfeeding. The secondary objective is to evaluate the effect of the intervention on breastfeeding outcomes. Methods A pilot randomized controlled trial was conducted. A total of 33 primiparous women were recruited in the antenatal clinic at a public hospital in Hong Kong between March and April 2021. They were randomized to receive either standard care (n = 18) or standard care and receive peer-group support in an online instant messaging app (n = 15). Participants received telephone follow-up for up to six months postpartum or until they stopped breastfeeding. After completing the study, six participants in the intervention group were interviewed to understand their perceptions of the intervention. Results This pilot study shows that online messaging peer support group is feasible and acceptable to women. In total, 54.4% of the eligible women agreed to participate, and 97.0% completed the follow-up. Participants perceived that providing peer support through instant messaging app is appropriate. It serves as a channel for the participants to ask questions and obtain information. Furthermore, meetings of the peer supporters and group members can be held to enhance the effectiveness of the intervention. In addition, no significant differences were found in any and exclusive breastfeeding rates, breastfeeding attitude, and breastfeeding self-efficacy between the two groups. Conclusions This study shows that online messaging peer support group is feasible and acceptable. A full-scale study should be conducted to understand the effect of the online instant messaging peer support group on breastfeeding outcomes. Trial Registration: The study protocol is registered on Clinicaltrial.gov (NCT04826796) on 1 April 2021

Soybean (Glycine max L.) is an important oil, food and economic crop in the world. High salinity severely affects the growth and yield of soybean. Overexpressing a specific anti-retroviral transcription factor by biotechnology is an effective way to cultivate new stress-tolerant varieties of soybean. TGA transcription factor is a subfamily of bZIP and plays an important role in abiotic stress responses. A TGA subfamily gene GmTGA13 was cloned and the gene expression, subcellular localization and transcriptional activity were measured. Through the Ag. tumefaciens mediated flower dip method and the Ag. rhizogenes mediated transformation of soybean hairy roots, the transgenic Arabidopsis and the 'combination' soybean plants of overexpressing GmTGA13 were obtained. The two types of transgenic plants were treated with salt stress respectively, and the related physiological indexes were determined. Furthermore, the expression levels of five abiotic stress responsive genes were analyzed in GmTGA13 overexpression hairy roots. GmTGA13 gene was highly expressed in roots and significantly induced by saline stress in soybean. GmTGA13 encoded a nuclear localization protein and had transcriptional activation activity. Overexpression of GmTGA13 enhanced the saline stress tolerance of transgenic Arabidopsis and the 'combination' soybean plants. Furthermore, overexpression of GmTGA13 enhanced the expression of the stress responsive genes in transgenic soybean hairy roots. In conclusion, overexpression of GmTGA13 is beneficial to the absorption of K+ and Ca2+ by the cell, thereby regulating the ion homeostasis in the cell balance. GmTGA13 enhanced salt resistance of plants by regulating the expression of many stress-responsive genes.

By analyzing 4.48 × 108 ψ(3686) events collected with the BESIII detector, we observe the decays χ cJ → nK S 0 Λ ¯ $$ {nK}_S^0\overline{\Lambda} $$ + c.c. (J = 0, 1, 2) for the first time, via the radiative transition ψ(3686) → γχ cJ . The branching fractions are determined to be (6.65 ± 0.26stat ± 0.41syst) × 10 −4, (1.66 ± 0.12stat ± 0.12syst) × 10 −4, and (3.58 ± 0.16stat ± 0.23syst) × 10 −4 for J = 0, 1, and 2, respectively.

Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4–23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

Inter-individual variance in 6-mercaptopurine (6-MP) dose intensity is common in patients with acute lymphoblastic leukemia (ALL). We aimed to evaluate the association of common variants of ABCC4, ...