Basis for choice of treatment of patients with fracture of the proximal humeral

In the article reported the results of analysis of the treatment of 531 patients with fracture of the proximal humeral. As part of the study it was shown that using of the external osteosyntesis provides good results, which are not depend on bone mineral density. The results of the conservative treatment depend on premorbid condition of the osseous tissue. Whence external osteosyntesis is more convenient, the method of intramedullary fixation provides better results, and conservative treatment is reasonable for elder year class with normal bone mineral density

The analisis of the standards for decision of surgical treatment proximal humeral. Anatomical research

The article provides information about habits of the routes to the proximal humeral for people with different constitution. The clinical studies were made on 55 corpses, which were put in order of constitution, body mass and shoulder-elbow length. Results of studies have shown us that for people with normal body mass better to use anterior approach in a case of fracture with breaking of the proximal humerus, transdeltoid rout for people with transvers fractures of collum and low bone mineral density. As for people with subnormal body an anterior approach is more convenient than transdeltoid rout, and for patients with overweight and lipotrophy of the I degree selection of the rout depends on character of the fracture and optimal method of the osteosynthesis

Management and outcome of mechanically ventilated patients after cardiac arrest

Introduction: The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Methods: We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission. Results: Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (V T ) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO 2 <60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher V T , and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective mechanical ventilation with lower V T and higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest

Genetics and Genomics of Carrot Biotic Stress

International audienceCarrot (Daucus carota ssp. sativus) production can be affected by a wide range of pests and pathogens. At least five diseases of carrot are caused by bacterial pathogens, 36 by fungal and oomycete pathogens, two by phytoplasmas, and 13 by viruses; and seven genera of nematodes and two genera of parasitic plants affect carrot. In addition, numerous insect and mite pests can cause losses. There have been extensive efforts to select carrot cultivars with partial or complete resistance to many of these pathogens and pests, and to identify wild species with resistance to specific biotic stresses for introgression into breeding populations and commercial cultivars. For some pathogens and pests, significant advances have been made at identifying resistance and mapping that resistance to the carrot genome. For others, resistance has been identified, but the genetic basis is yet to be determined. For a majority of these diverse stresses, however, there has been little success at identifying highly effective resistance and understanding the genetic basis of resistance. The diversity of stresses as well as interactions among these pests and pathogens can complicate efforts to develop cultivars with resistance to all key biotic stresses in a region that also meet market and consumer expectations. New approaches to identifying resistant material and speeding traditional breeding are being developed with molecular breeding tools, including simple sequence repeat markers and deep-coverage libraries of the carrot genome. These valuable genomic resources will enhance efforts to identify and breed for resistance to carrot pests and pathogens