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Supracondylar humeral fractures are the most common elbow fractures in children1, 2. Boys are affected more often than girls and the average age in which these fractures occur is 6 years3, 4, 5, 6, 7. The majority of supracondylar humeral fractures are extension?type injuries due to a fall onto the outstretched hand while the elbow is extended2. Complications after supracondylar humeral fractures include neurovascular lesions, decreased range of motion, malalignment, and nonunion8, 9, 10, 11, 12, 13, 14. Although this is a common fracture, controversy exists regarding treatment modalities. Percutaneous pinning is commonly used for displaced fractures. However, antegrade nailing with elastic stable intramedullary nails (ESIN) is a minimally invasive option, if a closed reduction is possible7, 10, 15, 16, 17, 18, 19, 20. While crossed pin placement is associated with the risk of ulnar nerve lesion8, there are reports that favor the application of ESIN due to its advantage of minimally invasively implanting the nail via a surgical access point that is located on the proximal humerus and far from the fracture site and the ulnar nerve10. However, to date, only a limited number of papers are available that report on the clinical application of ESIN in supracondylar humeral fractures17, 18.
The next factor to be considered is the mode of reduction. Usually, closed reduction remains the first approach for this type of fracture. Nevertheless, if open reduction is needed, controversy exists regarding whether it causes a decrease in range of motion and an increase in other complications15. Furthermore, the timing of the surgery and the effect of delaying operative treatment have been under investigation previously and have not led to any definite recommendations to date4, 21, 22, 23. In addition, the experience of the surgeon as well as the duration of the surgery may affect the outcome of the operation.
Therefore, it was the goal of our study to investigate whether these factors significantly change the outcome of the operation. We aimed to: (i) investigate whether the complication rate after osteosynthesis of supracondylar fractures is influenced by the mode of transportation (helicopter, ambulance, private car, or public transportation) as well as by the time period from trauma to surgery; (ii) focus on the question of whether the results of the surgery are the same or possibly even better if patients are operated on the following day as opposed to the day of the trauma; (iii) find out if the operation can be performed safely by young residents when an attending surgeon is present; and (iv) analyze the impact of the type of osteosynthesis on the results of the fracture treatment to guide the planning of the operation.
Prognostic Factors for the Outcome of Supracondylar Humeral Fractures in Children
Danielle S Wendling?Keim, MD,corresponding author 1 Marion Binder, MD, 1 Hans?Georg Dietz, MD, 1 and Markus Lehner, MD 1 , 2
A new large serrasalmid species of Tometes is described from the Tocantins-Araguaia River Basin. Tometes siderocarajensis sp. nov. is currently found in the rapids of the Itacai?nas River Basin, and formerly inhabited the lower Tocantins River. The new species can be distinguished from all congeners, except from T. ancylorhynchus, by the presence of lateral space between 1st and 2nd premaxillary teeth, and by the absence of lateral cusps in these two teeth. However, T. siderocarajensis sp. nov. can be differentiated from syntopic congener T. ancylorhynchus by an entirely black with mottled red body in live specimens, densely pigmented pelvic fins with a high concentration of dark chromatophores, and the presence of 39 to 41 rows of circumpeduncular scales (vs. silvery body coloration with slightly reddish overtones on middle flank during breeding period in live specimens, hyaline to slightly pale coloration on distalmost region of pelvic fins, and 30 to 36 rows of circumpeduncular scales). Additionally, molecular sequence shows that T. siderocarajensis sp. nov. is reciprocally monophyletic, and diagnosable from all congeners by having two autapomorphic molecular characters in the mitochondrial gene COI. The phylogenetic reconstruction still show that T. siderocarajensis sp. nov. is closely related to T. trilobatus. This is the first molecular study using an integrative taxonomic approach based on morphological and molecular sequence data for all described species of Tometes. These findings increase the number of formally described species of Tometes to seven. A key to the Tometes species is provided.
A new species of Tometes Valenciennes 1850 (Characiformes: Serrasalmidae) from Tocantins-Araguaia River Basin based on integrative analysis of molecular and morphological data
Marcelo C. Andrade,1,* Valeria N. Machado,2 Michel Jegu,3 Izeni P. Farias,2 and Tommaso Giarrizzo1 William Oki Wong, Editor
In 1997 the US Environmental Protection Agency (EPA) established the National Ambient Air Quality Standard (NAAQS) for fine particulate matter (PM2.5), largely because of its positive relationship to total mortality in the 1982 American Cancer Society Cancer Prevention Study (CPS II) cohort. Subsequently, EPA has used this relationship as the primary justification for many costly regulations, most recently the Clean Power Plan. An independent analysis of the CPS II data was conducted in order to test the validity of this relationship.
The original CPS II questionnaire data, including 1982 to 1988 mortality follow-up, were analyzed using Cox proportional hazards regression. Results were obtained for 292 277 participants in 85 counties with 1979-1983 EPA Inhalable Particulate Network PM2.5 measurements, as well as for 212 370 participants in the 50 counties used in the original 1995 analysis.
The 1982 to 1988 relative risk (RR) of death from all causes and 95% confidence interval adjusted for age, sex, race, education, and smoking status was 1.023 (0.997-1.049) for a 10 ?g/m3 increase in PM2.5 in 85 counties and 1.025 (0.990-1.061) in the 50 original counties. The fully adjusted RR was null in the western and eastern portions of the United States, including in areas with somewhat higher PM2.5 levels, particularly 5 Ohio Valley states and California.
No significant relationship between PM2.5 and total mortality in the CPS II cohort was found when the best available PM2.5 data were used. The original 1995 analysis found a positive relationship by selective use of CPS II and PM2.5 data. This independent analysis of underlying data raises serious doubts about the CPS II epidemiologic evidence supporting the PM2.5 NAAQS. These findings provide strong justification for further independent analysis of the CPS II data.
epidemiology, PM2.5, deaths, CPS II, reanalysis
Fine Particulate Matter and Total Mortality in Cancer Prevention Study Cohort Reanalysis
James E. Enstromcorresponding author1