Long-term outcomes of operatively treated medial epicondyle fractures in pediatric and adolescent patients

PURPOSE: Medial epicondyle fractures are among the most common pediatric elbow injuries. The management of these fractures continues to be debated. To better understand patient results with operative fixation, we reviewed the outcomes of operatively treated medial epicondyle fractures. METHODS: A retrospective review was performed to identify all patients less than 18 years of age at the time of injury who were treated surgically for medial epicondyle fractures. Outcomes were assessed based on the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Pain Interference domains, Visual Analog Scale for pain, subjective range of motion, ulnar nerve function, and requirement for secondary surgery. RESULTS: We identified a cohort of 95 patients treated for a medial epicondyle fracture with open reduction and screw fixation. Of these, 39 patients with a mean age of 12.2 years (SD, 2.2 years; range, 7.6-16.0 years) at surgery were assessed for an average follow-up of 6.3 years (SD, 3.2 years; range, 2.2-13.9 years). Outcome measures and pain scores were excellent. The mean PROMIS Upper Extremity score was 56.9, the mean Pain Interference score was 38.5, and the mean Visual Analog Scale score was 0.4.Sixteen patients (41%) required secondary surgery for symptomatic hardware removal. Seven patients (18%) developed sensory complaints and 2 (5%) developed motor complaints consistent with ulnar nerve irritability. Three patients (8%) reported dissatisfaction with elbow range of motion. Patients who required secondary surgeries had higher (worse) PROMIS Pain Interference scores. CONCLUSIONS: At an average of 6.3 years after surgery, the clinical outcomes for medial epicondyle fracture were excellent. While operative treatment for medial epicondyle fractures in children leads to excellent clinical outcomes, patients and surgeons should be aware of high rates of hardware removal. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV

New results on solar neutrino fluxes from 192 days of Borexino data

We report the direct measurement of the ^7Be solar neutrino signal rate performed with the Borexino detector at the Laboratori Nazionali del Gran Sasso. The interaction rate of the 0.862 MeV ^7Be neutrinos is 49+-3(stat)+-4(syst) counts/(day * 100ton). The hypothesis of no oscillation for ^7Be solar neutrinos is inconsistent with our measurement at the 4sigma level. Our result is the first direct measurement of the survival probability for solar nu_e in the transition region between matter-enhanced and vacuum-driven oscillations. The measurement improves the experimental determination of the flux of ^7Be, pp, and CNO solar nu_e, and the limit on the magnetic moment of neutrinos

The Borexino detector at the Laboratori Nazionali del Gran Sasso

Borexino, a large volume detector for low energy neutrino spectroscopy, is currently running underground at the Laboratori Nazionali del Gran Sasso, Italy. The main goal of the experiment is the real-time measurement of sub MeV solar neutrinos, and particularly of the mono energetic (862 keV) Be7 electron capture neutrinos, via neutrino-electron scattering in an ultra-pure liquid scintillator. This paper is mostly devoted to the description of the detector structure, the photomultipliers, the electronics, and the trigger and calibration systems. The real performance of the detector, which always meets, and sometimes exceeds, design expectations, is also shown. Some important aspects of the Borexino project, i.e. the fluid handling plants, the purification techniques and the filling procedures, are not covered in this paper and are, or will be, published elsewhere (see Introduction and Bibliography).Comment: 37 pages, 43 figures, to be submitted to NI

New limits on nucleon decays into invisible channels with the BOREXINO Counting Test Facility

The results of background measurements with the second version of the BOREXINO Counting Test Facility (CTF-II), installed in the Gran Sasso Underground Laboratory, were used to obtain limits on the instability of nucleons, bounded in nuclei, for decays into invisible channels ($inv$): disappearance, decays to neutrinos, etc. The approach consisted of a search for decays of unstable nuclides resulting from $N$ and $NN$ decays of parents $^{12}$C, $^{13}$C and $^{16}$O nuclei in the liquid scintillator and the water shield of the CTF. Due to the extremely low background and the large mass (4.2 ton) of the CTF detector, the most stringent (or competitive) up-to-date experimental bounds have been established: $\tau(n \to inv) > 1.8 \cdot 10^{25}$ y, $\tau(p \to inv) > 1.1 \cdot 10^{26}$ y, $\tau(nn \to inv) > 4.9 \cdot 10^{25}$ y and $\tau(pp \to inv) > 5.0 \cdot 10^{25}$ y, all at 90% C.L.Comment: 22 pages, 3 figures,submitted to Phys.Lett.

Study of neutrino electromagnetic properties with the prototype of the Borexino detector

Abstract The results of background measurements with the prototype of the Borexino detector (CTF) have been used to obtain an upper bound on the neutrino magnetic moment, µ ν . The new upper limit for µ ν from pp and 7 Be solar neutrinos is (5.5 × 10 −10 )µ B (90% c.l.) in the Standard Solar Model scenario. This is the first limit on µ ν obtained using sub-MeV neutrinos. The sensitivity of the prototype to the neutrino charge radius and the neutrino radiative decay are also presented

Genetic differentiation of Artemia franciscana (Kellogg, 1906) in Kenyan coastal saltworks

The nature of genetic divergence between the Artemia population native to San Francisco Bay, (SFB) USA and those from the introductions of SFB material in the Kenyan coast two decades ago were investigated using the mitochondrial DNA (mtDNA) and heat shock protein 70 (Hsp70) gene molecular markers. The DNA was extracted from 80 single Artemia cysts using the Chelex protocol. The 1,500 bp fragment of the 12S - 16S region of the mtDNA and a 1,935 bp fragment of the Hsp70 gene were amplified through Polymerase Chain Reaction (PCR) followed by Restriction Fragment Length Polymorphism (RFLP) digestion using appropriate endonucleases. The mtDNA analysis indicated higher haplotype diversity (0.76 ± 0.07) in Artemia from Fundisha saltworks while the rest of the samples were monomorphic. A private haplotype (AAABBA) in Fundisha samples confirmed a molecular evidence of a systematic genetic differentiation albeit in an insignificant manner (P > 0.05). There was molecular evidence of coexistence of SFB and GSL Artemia strains in Fundisha saltworks. The monomorphic DNA fingerprint in Kensalt Artemia cysts was probably caused by non-sequential Artemia culture system and limited mtDNA fragment size analysed. The Hsp70 gene RFLP fingerprint did not show any unique gene signatures in the Kenyan Artemia samples suggesting that other factors other than Hsp70 were involved in their superior thermotolerance. Further genetical studies based on the larger mtDNA fragment using robust genetic markers are recommended. Ecological studies of the heat shock protein family and the stress response would be more relevant than the qualitative RFLP technique

L'Italia come modello per l'Europa e per il mondo nelle politiche sanitarie per il trattamento dell'epatite cronica da HCV

The World Health Organization foresees the elimination of HCV infection by 2030. In light of this and the curre nt, nearly worldwide, restriction in direct-acting agents (DAA) accessibility due to their high price, we aimed to evaluate the cost-effectiveness of two alternative DAA treatment policies: Policy 1 (universal): treat all patients, regardless of the fibrosis stage; Policy 2 (prioritized): treat only priori tized patients and delay treatment of the remaining patients until reaching stage F3. T he model was based on patient’s data from the PITER cohort. We demonstrated that extending HC V treatment of patients in any fibrosis stage improves health outcomes and is cost-effective

Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV