Clinical and financial impacts of flexible intramedullary nailing in pediatric diaphyseal forearm fractures: A case–control study

Purpose:Flexible intramedullary nailing is regularly applied for pediatric displaced unstable forearm fractures. When compared to closed reduction and casting (orthopedic treatment), flexible intramedullary nailing decreases malalignment, shortens immobilization time, and should decrease follow-up controls. Comparing flexible intramedullary nailing and orthopedic treatment in the clinical, radiological, and financial managements of these fractures was performed.Methods:Retrospective 5 years study of pediatric cases in two pediatric orthopedic university departments. Treatment method, post-operative course, and radiological follow-up were reviewed. Number of radiographs, follow-up controls, type and duration of immobilization, final bone angulation, and reported complications were compared. Extensive financial analysis was completed.Results:Of 73 girls and 168 boys included in the study, 150 were treated by flexible intramedullary nailing and 91 by orthopedic treatment. No difference was noted with regard to total number of radiographs (7.3 vs 7.2, respectively). Total number of follow-ups was 6.4 and 5.5, respectively. Malalignment occurred in two flexible intramedullary nailing and sixteen orthopedic treatments. The least expensive cost was ambulatory orthopedic treatment.Conclusion:Flexible intramedullary nailing treated children had similar numbers of radiographs or follow-up consultation, but less malunion when compared to orthopedic treatment. Orthopedic management was systematically cheaper than flexible intramedullary nailing. Unless post-operative management guidelines decreasing the number of radiographs and follow-ups are implemented, flexible intramedullary nailing will remain a costly procedure when compared to conventional orthopedic treatment.Level of evidence:level III case–control retrospective study.     

The use of time‐of‐flight camera to assess respiratory rates and thoracoabdominal depths in patients with chronic respiratory disease

IntroductionOver the last 5 years, the analysis of respiratory patterns presents a growing usage in clinical and research purposes, but there is still currently a lack of easy‐to‐use and affordable devices to perform such kind of evaluation.ObjectivesThe aim of this study is to validate a new specifically developed method, based on Kinect sensor, to assess respiratory patterns against spirometry under various conditions.MethodsOne hundred and one participants took parts in one of the three validations studies. Twenty‐five chronic respiratory disease patients (14 with chronic obstructive pulmonary disease (COPD) [65 ± 10 years old, FEV₁ = 37 (15% predicted value), VC = 62 (20% predicted value)], and 11 with lung fibrosis (LF) [64 ± 14 years old, FEV₁ = 55 (19% predicted value), VC = 62 (20% predicted value)]) and 76 healthy controls (HC) were recruited. The correlations between the signal of the Kinect (depth and respiratory rate) and the spirometer (tidal volume and respiratory rate) were computed in part 1. We then included 66 HC to test the ability of the system to detect modifications of respiratory patterns induced by various conditions known to modify respiratory pattern (cognitive load, inspiratory load and combination) in parts 2 and 3.ResultsThere is a strong correlation between the depth recorded by the Kinect and the tidal volume recorded by the spirometer: r = 0.973 for COPD patients, r = 0.989 for LF patients and r = 0.984 for HC. The Kinect is able to detect changes in breathing patterns induced by different respiratory disturbance conditions, gender and oral task.ConclusionsMeasurements performed with the Kinect sensors are highly correlated with the spirometer in HC and patients with COPD and LF. Kinect is also able to assess respiratory patterns under various loads and disturbances. This method is affordable, easy to use, fully automated and could be used in the current clinical context.Respiratory patterns are important to assess in daily clinics. However, there is currently no affordable and easy‐to‐use tool to evaluate these parameters in clinics. We validated a new system to assess respiratory patterns using the Kinect sensor in patients with chronic respiratory diseases.     

Beitr?ge zur Kenntnis der Nervenendigungen im Epithel der S?ugetiere

Ohne ZusammenfassungMit 8 Textabbildungen.     

Early detection of thrombin activity in neuroinflammatory disease

Although multiple sclerosis (MS) has been associated with the coagulation system, the temporal and spatial regulation of coagulation activity in neuroinflammatory lesions is unknown. Using a novel molecular probe, we characterized the activity pattern of thrombin, the central protease of the coagulation cascade, in experimental autoimmune encephalomyelitis. Thrombin activity preceded onset of neurological signs, increased at disease peak, and correlated with fibrin deposition, microglial activation, demyelination, axonal damage, and clinical severity. Mice with a genetic deficit in prothrombin confirmed the specificity of the thrombin probe. Thrombin activity might be exploited for developing sensitive probes for preclinical detection and monitoring of neuroinflammation and MS progression. Ann Neurol 2014;75:303–308     

Review of surgical implant procedures for male incontinence after radical prostatectomy according to IDEAL framework

Most aspects of surgical therapy for stress urinary incontinence (SUI) after radical prostatectomy (RP) are under debate or poorly studied. A systematic review was conducted and a literature search was carried out through PubMed database for articles on the surgical procedures for male SUI after RP published from Jan 2010 to Nov 2016. The efficacy results (pad count, 24 h pad test), complications, and quality of life (QoL) were reported. The included studies were categorized in accordance with the IDEAL framework of surgical innovation. Only Stage 0–2 IDEAL studies were revealed by systematic review of the literature. Randomized and long-term trials are missing. The current evidence on male SUI therapy is low. IDEAL-conform evaluation of new therapies should be applied in the future.