Background:Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage.Methods:This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection.Results:All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34).Conclusions:Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.

To improve understanding of the mechanisms of action of oral corticosteroids in asthma, we have conducted a double-blind, placebo-controlled study with prednisolone (20 mg for 2 wk followed by 10 mg for 4 wk) or placebo in 14 and 13 atopic corticosteroid-naive asthmatic subjects, respectively. Before and after treatment subjects underwent bronchoscopy with bronchoalveolar lavage (BAL) and bronchial biopsy. Treatment with prednisolone, but not placebo, significantly reduced asthma symptoms (from mean +/- SEM total weekly score of 34 +/- 6.2 to 15.7 +/- 3.2, p = 0.02) and albuterol usage (from mean +/- SEM number of puffs/wk of 29.7 +/- 6.2 to 18.2 +/- 3.7, p = 0.01) and significantly increased FEV1 (from 89.8 +/- 4.4% to 99.3 +/- 4.1% of predicted, p = 0.03). There were no significant changes in inflammatory or epithelial cell counts, levels of T-cell activation or albumin concentration in BAL. However, immunohistochemistry of bronchial biopsies showed that in the submucosa prednisolone significantly decreased numbers of mast cells by 62% (from median 45 to 17/mm2, p = 0.01), eosinophils by 81% (from median 30.1 to 5.7/mm2, p = 0.004), and CD4+ T-cells by 68% (from median 64.6 to 18.5/mm2, p = 0.02). In the epithelium only the reduction in the numbers of eosinophils was significant (from median 1.1 to 0/mm of epithelium, p = 0.02). There were no significant changes in any cell counts in the subjects receiving placebo, and comparison of the changes between the treatment groups identified a significant prednisolone-related reduction in submucosal eosinophil and mast cell counts (p = 0.003 and 0.03, respectively). The temporal association between the clinical and physiologic improvement, and the correlation between the magnitude of change in CD4+ T-cell counts in the submucosa and increase in PC20 methacholine (rs = 0.60, p = 0.049) suggests that the reduction in airways inflammatory cell numbers underlies the clinical efficacy of oral corticosteroids.

Abstract. A totally ordered monoid-or tomonoid , for short-is a commutative semigroup with identity S equipped with a total order ≤ S that is translation invariant, i.e., that satisfies: ∀x, y, z ∈ S x ≤ S y ⇒ x + z ≤ S y + z. We call a tomonoid that is a quotient of some totally ordered free commutative monoid formally integral. Our most significant results concern characterizations of this condition by means of constructions in the lattice Z n that are reminiscent of the geometric interpretation of the Buchberger algorithm that occurs in integer programming. In particular, we show that every two-generator tomonoid is formally integral. In addition, we give several (new) examples of tomonoids that are not formally integral, we present results on the structure of nil tomonoids and we show how a valuation-theoretic construction due to Hion reveals relationships between formally integral tomonoids and ordered commutative rings satisfying a condition introduced by Henriksen and Isbell. Introduction.In his 1976 survey of ordered semigroups [G], E. Ya. Gabovich identified several general research problems. The present work contains results that respond directly to at least three of these. First, Gabovich asked explicitly for criteria for formal integrality (and related properties in possibly non-commutative varieties of semigroups). Second, he posed the general problem of developing structure theories for classes of ordered semigroups. Third, he singled out Hion's work as a potentially useful way of describing the structure of totally ordered rings. We now comment on each of these topics in more detail.For clarity, we define a few terms that will be used in the introduction. A monoid is a set with an associative binary operation and an identity element. All monoids in this paper are commutative. The concept of a tomonoid is defined in the abstract. Let S be a tomonoid. We say S is positive if 0 S ≤ S x for all x ∈ S. If S is positive, we say S is archimedean if for any x, y ∈ S \ {0 S } there is a positive integer n such that x ≤ S ny. When we speak of a quotient of S, we always intend a congruence relation θ with convex classes, so the natural surjection S → → S/θ induces a translation-invariant total order on S/θ. We view S/θ as a tomonoid with this order. When we speak of a sub-tomonoid of S, we intend a sub-monoid with induced order.Problem 6 of [G] reads: In a variety (of semigroups) whose free semigroups are orderable, find necessary and sufficient conditions for a totally ordered semigroup to be a quotient of some totally ordered free semigroup. All free commutative monoids are orderableindeed the positive orders on finitely generated free commutative monoids are the so-called 1

We show that a locale possesses the localic analogue of the property of realcompactness if and only if it is regular Lindelöf. Thus, the localic version of the Hewitt real-compactification, originally defined by G.Reynolds using σ-frames, is the regular Lindelöf reflection. An immediate consequence is that a space is realcompact if and only if it is the point space of a regular Lindelöf local (3·2). We point out a nice analogy between a theorem of Reynolds and Stone's classical representation theorem for boolean algebras. Finally, we show that the quasi-F cover of a compact Hausdorff space is the Stone–čech compactifications of the smallest dense Lindelöf sublocale.