Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study

BackgroundThe optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population.MethodsAn international prospective comparative study was conducted in fifteen European centres, involving patients aged ≥55 years with type II/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52 weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52 weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics.ResultsThe study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P = 0.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) −11 (2.4) vs. −14 (1.8), P = 0.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97–5.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) −13 (2.0) vs. −12 (2.8), P = 0.78). There was no difference for any of the secondary outcomes or subgroups.ConclusionsClinical outcome and fracture healing at 52 weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.Analysis and support of clinical decision makin

Ensaios sobre a metodologia do estudo da influência de três herbicidas em Spirodela punctata (G.F.W. Meyer) Thompson (Lemnaceae)

O presente trabalho visa conhecer a taxa de multiplicação e o índice de mortalidade de S. punctata a diversas concentrações do butaclora, propanila e glifosato bem como comparar dois métodos diferentes de investigações (ensaio 1 e 2). Os dados indicaram que no ensaio 1 as concentrações foram pouco tóxicas provocando baixos índices de mortalidade embora tenha ocorrido inibição do crescimento nas concentrações mais fortes. O ensaio 2 mostrou que a butaclora e a propanila são mais tóxicas que o glifosato, com valores de mortalidade de 100% em apenas 48 horas. A taxa de multiplicação, neste ensaio, somente foi determinada para o glifosato, pois os demais herbicidas foram altamente tóxicos para a espécie. Verificou-se, na comparação dos dois métodos diferentes, que os recipientes utilizados no ensaio 2 foram mais adequados ao cultivo da espécie e que os efeitos tóxicos devem ser observados em frondes consideradas individualmente e não em plantas inteiras.The present work looks for a knowledge of multiplícate rate and mortality index of. S. punctata to several concentrations of butachlor, propanil and gliphosate as well as to compare two different methods. On essay 1 the concentrations were a little toxic provoking low index of mortality in spite of it has occured inhibition of increasing on stronger concentrations. The essay 2 showed what, the butachlor and the propanil are more toxics than the gliphosate, with values of mortality of 100% in only 48 hours. The multiplícate rate, on this essay, was only determinated to the gliphosate, because the other herbicides were highly toxic to the species. It was checked on the comparation of the two different methods the posts used on essay 2 were more appropriate to the cultive specie and the toxic effects must be observated on considered individualy and not on whole plants