Isolated olecranon fractures in children affected by osteogenesis imperfecta type I treated with single screw or tension band wiring system: outcomes and pitfalls in relation to bone mineral density

The purpose of this study is to compare the results of 2 techniques, tension band wiring (TBW) and fixation with screws, in olecranon fractures in children affected with osteogenesis imperfecta (OI) type I. Between 2010 and 2014, 21 olecranon fractures in 18 children with OI (average age: 12 years old) were treated surgically. Ten patients were treated with the screw fixation and 11 with TBW. A total of 65% of olecranon fractures occurred as a result of a spontaneous avulsion of the olecranon during the contraction of the triceps muscle. The average follow-up was 36 months. Among the children treated with 1 screw, 5 patients needed a surgical revision with TBW due to a mobilization of the screw. In this group, the satisfactory results were 50%. In patients treated with TBW, the satisfactory results were 100% of the cases. The average Z-score, the last one recorded in the patients before the trauma, was -2.53 in patients treated with screw fixation and -2.04 in those treated with TBW. TBW represents the safest surgical treatment for patients suffering from OI type I, as it helps to prevent the rigidity of the elbow through an earlier recovery of the range of motion, and there was no loosening of the implant. In analyzing the average Z-score before any fracture, the fixation with screws has an increased risk of failure in combination with low bone mineral density

Classification of lower extremity movement patterns based on visual assessment: reliability and correlation with 2-dimensional video analysis

CONTEXT: Abnormal movement patterns have been implicated in lower extremity injury. Reliable, valid, and easily implemented assessment methods are needed to examine existing musculoskeletal disorders and investigate predictive factors for lower extremity injury. OBJECTIVE: To determine the reliability of experienced and novice testers in making visual assessments of lower extremity movement patterns and to characterize the construct validity of the visual assessments. DESIGN: Cross-sectional study. SETTING: University athletic department and research laboratory. PATIENTS OR OTHER PARTICIPANTS: Convenience sample of 30 undergraduate and graduate students who regularly participate in athletics (age = 19.3 ± 4.5 years). Testers were 2 experienced physical therapists and 1 novice postdoctoral fellow (nonclinician). MAIN OUTCOME MEASURE(S): We took videos of 30 athletes performing the single-legged squat. Three testers observed the videos on 2 occasions and classified the lower extremity movement as dynamic valgus, no change, or dynamic varus. The classification was based on the estimated change in frontal-plane projection angle (FPPA) of the knee from single-legged stance to maximum single-legged squat depth. The actual FPPA change was measured quantitatively. We used percentage agreement and weighted κ to examine tester reliability and to determine construct validity of the visual assessment. RESULTS: The κ values for intratester and intertester reliability ranged from 0.75 to 0.90, indicating substantial to excellent reliability. Percentage agreement between the visual assessment and the quantitative FPPA change category was 90%, with a κ value of 0.85. CONCLUSIONS: Visual assessments were made reliably by experienced and novice testers. Additionally, movement-pattern categories based on visual assessments were in excellent agreement with objective methods to measure FPPA change. Therefore, visual assessments can be used in the clinic to assess movement patterns associated with musculoskeletal disorders and in large epidemiologic studies to assess the association between lower extremity movement patterns and musculoskeletal injury

Choice of three different intramedullary nails in the treatment of trochanteric fractures: outcome, analysis and consideration in midterm

paragone di 3 differenti impianti per frattura pertrocanterica femoreThe purpose of this study is to compare the results obtained using three different systems of osteosynthesis, developed for the surgical treatment of fractures of the trochanteric region of the femur, based on the principle intramedullary nailing: the Gamma nail, the Affixus nail and the ZNN nail. This is a retrospective study: 72 trochanteric fractures treated with the Gamma nail, 68 treated with the Affixus nail and 69 treated with the ZNN nail, between the years 2012 and 2014, with the prerequisite of a minimum follow-up of 18 months. The fractures were classified according to the AO system; the most commonly reported subtype was the A2 fracture. Clinical and radiographic examinations were performed, both at hospital admission and post-operatively, at 1, 3, 6, 12 and 18 months. Of the 209 patients, 171 were women and 38 were men. The average age was 83.12 years old. All three systems guaranteed an early mobilization and ambulation in most of the patients. There were no significant differences in the use of the three nails in terms of recovery of previous functional capacity, or in terms of the time required for the fracture to heal. There were no advantages encountered with the use of one intramedullary nail over another and, in particular, when observing the complications and patient outcome, there were no statistically significant differences detected

First outbreak of Pepper vein yellows virus infecting sweet pepper in Italy

Sweet pepper (Capsicum annum) is an economically important crop worldwide, including Sicily where about 4,000 hectares are grown each year. In October 2015, severe symptoms not previously reported by growers in the horticultural area of the province of Trapani (Sicily, Italy) were observed on sweet pepper plants in eight different greenhouses. Symptoms included upward leaf curling, internodal shortening and interveinal yellowing. Symptoms were more evident in the upper part of the plants. These symptoms were reminiscent of those caused by poleroviruses. In the greenhouse, symptoms were evident in about 35% of the plants. Three samples per greenhouse (24 in total) were collected for analysis

Lethal Mutagenesis of Poliovirus Mediated by a Mutagenic Pyrimidine Analogue

Lethal mutagenesis is the mechanism of action of ribavirin against poliovirus (PV) and numerous other RNA viruses. However, there is still considerable debate regarding the mechanism of action of ribavirin against a variety of RNA viruses. Here we show by using T7 RNA polymerase mediated production of PV genomic RNA, PV polymerase-catalyzed primer extension and cell-free PV synthesis that a pyrimidine ribonucleoside triphosphate analogue (rPTP) with ambiguous basepairing capacity is an efficient mutagen of the PV genome. The in vitro incorporation properties of rPTP are superior to ribavirin triphosphate. We observed a log-linear relationship between virus titer reduction and the number of rPMP molecules incorporated. A PV genome encoding a high-fidelity polymerase was more sensitive to rPMP incorporation, consistent with diminished mutational robustness of high-fidelity PV. The nucleoside (rP) did not exhibit antiviral activity in cell culture owing to the inability of rP to be converted to rPMP by cellular nucleotide kinases. rP was also a poor substrate for herpes simplex virus thymidine kinase. The block to nucleoside phosphorylation could be bypassed by treatment with the P nucleobase, which exhibited both antiviral activity and mutagenesis, presumably a reflection of rP nucleotide formation by a nucleotide salvage pathway. These studies provide additional support for lethal mutagenesis as an antiviral strategy, suggest that rPMP prodrugs may be highly efficacious antiviral agents, and provide a new tool to determine the sensitivity of RNA virus genomes to mutagenesis as well as interrogation of the impact of mutational load on the population dynamics of these viruses

The signalling effect of eco-labels in modern coastal tourism

As the demand for environmentally sustainable tourism grows, eco-labels are becoming increasingly popular as a signal of environmental quality. However, the existence of a causal link between awarding a seaside eco-label and the increase in tourism flows is still under discussion in the literature. In this article, we gauge the signalling impact of a specific eco-label, the Blue Flag award, using detailed data on tourism flows to seaside Italian destinations during the period 2008-2012. We adopt a recent econometric modelling strategy - the synthetic control method - in shaping estimation results and testing the sensitivity and robustness of our results. We find that being awarded the Blue Flag increases the flow of domestic tourists for up to three seasons after assignment. However, we find no effect for the flow of international tourists. Investigating the mechanisms driving the results, we find that the award of a Blue Flag only positively affects the flow of domestic tourists when it is used as a driver of organisation, coordination and integrated management of the tourism supply

Barriers and solutions for improving pain management practices at regional hospitals in South Albania

Having access to pain management is a human right. We can’t assure a life without any kind of pain but we certainly can do much to reduce physical pain. Based on literature review, acute pain management in Albania differs from that of developed countries, in pharmacological and non-pharmacological management. Taking into account the entire Albanian background, this research had two objectives; first, Identification of barriers and solutions on the Albanian Health Care System in terms of Acute Pain Assessment and Non-pharmacological Management of Pain; second, experimentation of the Italian procedure “Procedura Monitoraggio del Dolore” for the acute pain management in the Surgery and OBGYN units. Methods This is a mixed cross-sectional and experimental, quantitative and qualitative study. It was developed in three phases. The first phase was observation, the second phase was training of nursing staff, and the third phase was the experimentation. The population of this study consisted of all nurses and all patients of Surgery and OBGYN Units in the public regional hospitals of Gjirokastër, Vlorë, and Fier. It wasn’t applied any filter of gender, age, ethnicity, or socio-economic factors on the target population of nurses. Meanwhile, the target population of patients was all adults, conscious and responsible, without any cognitive deficiency or impairment, and collaborative. In the first phase, the sample of the study consisted of 73 nurses and 453 patients. In the third phase, the sample of the study consisted of 68 nurses and 380 patients. The instruments used were interviews, observation, and a questionnaire. Data analysis The data were processed with the statistical program SPSS-23. For the qualitative data, a tabular method was used, as well as pie and column charts to better reflect the phenomena in the study. The Chi-square probability indicator was used to see the significant statistical differences between the qualitative variables. For the quantitative variables, the indicators of average, standard deviation, and confidence intervals were calculated. To verify the distribution of the values of the continuous variables, the Shapiro-Wilk test was used. For variables with normal distribution, the ANOVA method was used to verify the differences between groups with different evaluation points. For the variables, for which the values do not have a normal distribution, the non-parametric methods Mann-Whitney u test, and Kruskal-Wallis test were applied. The Hypothesis Control method was used to verify the hypotheses of this research. Linear Regression was used to analyze the relationship between the variables. Results Of the patients assisted by the trained group, to 89.3% of them the objective evaluation of pain was done, 98% of them used non-pharmacological methods for pain relief, and 96.7% of them received health education. The patients that were assisted by the trained group had a higher average of patient satisfaction, Mean=8.7; and a higher average of pain relief, Mean=83.7%. The patient satisfaction was higher in the regional hospital of Fier, Mean=8.92; and the regional Memorial Hospital of Fier, Mean=8.85. The lowest score for the patient’s satisfaction was at the regional hospital of Gjirokastër, Mean=7.24. Patient satisfaction was higher in the Surgery Unit, Mean=8.36. Patient’s perception of pain management quality was highest in the regional Memorial Hospital of Fier, Mean=5.748; and lowest at the regional hospital of Gjirokastër, Mean=4.827. It was also higher in the patients who received health education, Mean=5.653; higher in the patients who used non-pharmacological methods for pain relief, Mean=5.647; and higher in the patients who were assisted by the trained group, Mean=5.696. The number of days spent with pain was higher in the Surgery Unit, Mean=2.31; lower in the patients assisted by the trained group, Mean=2.07; higher in the regional hospital of Gjirokastër, Mean=2.3; lower in highly educated patients, Mean=1.73; lower in female patients, Mean=1.98, and lower in younger patients 18-29 years old, Mean=1.74. Conclusions Pain management improved after nursing staff was trained with an Italian procedure on pain assessment, and non-pharmacological methods for pain relief. The use of non-pharmacological methods for pain relief is strongly correlated to the improvement of patient’s quality of life during hospitalization, the increase of patient satisfaction, and the increase of pain relief from the pain management received. The barriers to improving non-pharmacological management of pain were identified and possible solutions were addressed. The first hypothesis was confirmed, the experimentation of an Italian procedure for pain evaluation and monitoration increased patient satisfaction. The second hypothesis was confirmed, applying non-pharmacological methods for pain relief improves the patient’s quality of life during hospitalization by reducing the impact of pain in the patient’s activities, and in the patient’s mood and emotions, but didn’t impact pain severity. The third hypothesis was not confirmed, applying non-pharmacological methods for pain relief didn’t decrease the number of days spent with pain. The training was successful and is statistically proven to be useful in improving the quality of health care, improving patient’s quality of life during hospitalization, and increasing patient’s satisfaction with the pain management received