Plate fixation of clavicle fractures:comparison between early and delayed surgery

Background: The optimal treatment strategy for clavicle fractures remains a topic of debate. We evaluated our step-wise treatment protocol for patients with clavicle fractures to determine our success rate of conservative treatment. In addition, we evaluated the incidence of complications after clavicle plate fixation in patients undergoing acute surgery vs. delayed surgery. Methods: This was a retrospective analysis in which we registered all patients aged 14 years or older with a clavicle fracture between January 2010 and May 2018 and at least 6 weeks' follow-up. Patients who underwent surgery were included from a prospectively maintained database. Functional outcomes were measured by Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores 6 weeks after surgery. Results: Conservative treatment was successful in 1627 of 1748 patients (93%). Primary fixation was performed in 73 patients (61%) and delayed fixation in 48 (39%). In 8 patients (6.6%), radiologic widening of the acromioclavicular (AC) joint was present after surgery, suggestive of AC injury. The incidence of complications was significantly higher among patients who underwent delayed fixation vs. those who underwent primary fixation: 15 of 48 patients (31.3%) vs. 9 of 73 patients (12.3%). Conclusion: Most patients with clavicle fractures have an excellent outcome using conservative management. Acute surgery can be performed in high-demand patients, resulting in high performance scores. Delayed surgery is associated with a higher risk of complications, although the outcome is generally good. Associated AC joint dislocation found on postoperative radiographs does not influence outcomes. Shared decision making is key, and patients should be well aware of the potential risks and benefits of surgery

Comparison of Octopus dofleini hemocyanin paralogues and evidence for recent divergence

Presented here is an in depth comparison of the Octopus dofleini hemocyanin paralogues, designated A and G. The protein sequences coded by these genes are each comprised of seven oxygen-binding units, or functional units (FU-a to FU-g). Each FU is approximately 400 amino acids in length and a linker region separates each of them. Within every linker, a phase one intron (found between the first and second base of an amino acid codon) was found which varies from 100-910 base pairs in length. Three FUs are split by internal introns, dividing FU-b, FU-e, and FU-f into two exons. These internal introns show no phase pattern like the linker introns and appear to represent later insertion events. The intron within FU-e houses a microsatellite region that contains di- and tetra- nucleotide tandem repeats. Variation between the two Octopus paralogues is greatest in this microsatellite region, however the similarity is still striking. Given the higher rate of mutation for microsatellites, due mainly to slippage, this similarity either lends support to the recent divergence of these two paralogues or implies some kind of secondary-structure related function that has slowed the divergence of these microsatellites. The high degree of similarity in the coding regions, as well as the non-coding regions, of this gene is evidence that suggests these paralogues have recently diverged. Comparisons between the two Octopus sequences and comparisons to related hemocyanins will help uncover the evolutionary origins of this gene

Cost-Effectiveness of Newborn Screening for Spinal Muscular Atrophy in The Netherlands

Objectives: Spinal muscular atrophy (SMA) is a rare genetic disorder that causes progressive muscle weakness and paralysis. In its most common and severe form, the majority of untreated infants die before 2 years of age. Early detection and treatment, ideally before symptom onset, maximize survival and achievement of age-appropriate motor milestones, with potentially substantial impact on health-related quality of life. Therefore, SMA is an ideal candidate for inclusion in newborn screening (NBS) programs. We evaluated the cost-effectiveness of including SMA in the NBS program in The Netherlands. Methods: We developed a cost-utility model to estimate lifetime health effects and costs of NBS for SMA and subsequent treatment versus a treatment pathway without NBS (ie, diagnosis and treatment after presentation with overt symptoms). Model inputs were based on literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and validity of results. Results: After detection of SMA by NBS in 17 patients, the number of quality-adjusted life-years gained per annual birth cohort was estimated at 320 with NBS followed by treatment compared with treatment after clinical SMA diagnosis. Total healthcare costs, including screening, diagnostics, treatment, and other healthcare resource use, were estimated to be €12 014 949 lower for patients identified by NBS. Conclusions: NBS for early identification and treatment of SMA versus later symptomatic treatment after clinical diagnosis improves health outcomes and is less costly and, therefore, is a cost-effective use of resources. Results were robust in sensitivity and scenario analyses

Augmenting solute clearance in peritoneal dialysis

Augmenting solute clearance in peritoneal dialysis.BackgroundThe removal of low molecular weight solutes by peritoneal dialysis is less than by hemodialysis. The targets for Kt/Vurea and creatinine clearance formulated in the Dialysis Outcome Quality Initiative are unlikely to be achieved in a substantial portion of peritoneal dialysis patients. Possibilities to increase small solute clearances have therefore been subject to many investigations.MethodsA review of the literature and of recent new data on determinants of solute removal, such as residual renal function, the role of drained dialysate volume and manipulation of the diffusive capacity of the peritoneum are presented.ResultsThe contribution of residual GFR is more important for the clearance of creatinine than for Kt/Vurea. It is even more important for the removal of organic acids that are removed from the body by tubular secretion. High dosages of furosemide increase the urinary volume and the fractional Na+ excretion, but have no effect on the magnitude of residual GFR, renal creatinine clearance, renal urea clearance, and peritoneal transport characteristics. The drained dialysate volume per day is the main determinant of the peritoneal removal of urea. Its effect decreases the higher the molecular weight of a solute. It can be augmented by using large instillation volumes, by the application of more exchanges, and by increasing peritoneal ultrafiltration. A large exchange volume is especially effective in patients with an average transport state, but in those with high solute transport rates, Kt/Vurea is especially influenced by the number of exchanges. Possibilities to increase ultrafiltration are discussed. The diffusive capacity of the peritoneum can be augmented by using low dosages of intraperitoneally administered nitroprusside. This increases solute transport most markedly when it is applied in combination with icodextrin as osmotic agent.ConclusionsSmall solutes clearances cannot be increased by furosemide. Increasing the instilled volume of dialysis fluid and the number of exchanges both affect solute clearance. Studies are necessary on long-term effects of manipulation of the peritoneal membrane with nitroprusside

Words matter: a systematic review of communication in non-native aquatic species literature

How scientists communicate can influence public viewpoints on invasive species. In the scientific litera-ture, some invasion biologists adopt neutral language, while others use more loaded language, for example by emphasizing the devastating impacts of invasive species and outlining consequences for policy and practice. An evaluation of the use of language in the invasion biology literature does not exist, preventing us from understanding which frames are used and whether there are correlations between message framing in scientific papers and local environmental impacts associated with invasive species. Thus, we conducted a systematic literature review of 278 peer-reviewed articles published from 2008-2018 to understand communication styles adopted by social and natural scientists while reporting on aquatic non-native spe-cies research. Species-centered frames (45%) and human-centered frames (55%) were adopted to nearly equal degrees. Negative valence was dominant in that 81.3% of articles highlighted the negative risks and impacts of invasive species. Additionally, the use of terminology was found to broadly align with the stage of invasion, in that "invasive" was most commonly used except when the research was conducted at early stages of invasion, when "non-native" was most commonly used. Terminology use therefore enables readers of scientific papers to infer the status and severity of ongoing invasions. Given that science communication within the peer-reviewed literature affects public understanding of research outcomes, these findings provide an important point of reflection for researchers

Automated Directional Measurement System for the Acquisition of Thermal Radiative Measurements of Vegetative Canopies

The potential for directional optical and thermal imagery is very large. Field measurements have been performed with a goniometer on which thermal instruments were attached. In order to reduce dynamical effects the goniometer was adjusted to run in automated mode, for zenith and azimuthal direction. Directional measurements were performed over various crops with increasing heterogeneity. The improvements to the goniometer proved successful. For all the crops, except the vineyard, the acquisition of the directional thermal brightness temperatures of the crops went successfully. The large scale heterogeneity of the vineyard proved to be larger then the goniometer was capable of. The potential of directional thermal brightness temperatures has been proven