Buckling down on torus fractures: has evolving evidence affected practice?

PURPOSE: The purpose of this study was to evaluate the management of paediatric torus fractures of the distal forearm in current practice in light of growing evidence supporting a 'minimalist' approach with splint immobilization and limited follow-up. We hypothesized that 'traditional' cast-based management has persisted despite alternative evidence. METHODS: A retrospective review was performed of a consecutive series of paediatric patients diagnosed with torus fractures of the distal forearm between 2011 and 2014. Records were reviewed to abstract the type of immobilization (splint versus cast) prescribed at each visit, number of radiographic exams, duration of immobilization, number of clinical visits and complications. The primary outcome was the proportion of patients exclusively managed in splints. Injuries were grouped based on treatment into a cast group (CG) and a splint group (SG) for statistical analyses. Additionally, injuries were grouped by epoch of time to determine if immobilization usage patterns evolved. RESULTS: A total of 240 forty injuries met criteria for inclusion. Of these, 16 (6.7%) were exclusively splinted (SG). Relative to the CG, the SG had fewer clinical visits (p < 0.001), fewer radiographic exams (p < 0.001) and a shorter total encounter time (p = 0.015). No change in immobilization use occurred over the study period. In all, 21 (9.4%) of the CG experienced complications. No clinically significant displacements occurred in either group. CONCLUSION: Cast utilization and frequent radiographic follow-up remain prevalent at our institution in the management of paediatric torus fractures. Splint-only management was associated with fewer clinical visits, fewer radiographic exams and a shorter total encounter time. LEVEL OF EVIDENCE LEVEL III: Therapeutic retrospective cohort study.

Transit effects on fecal Escherichia coli O157 prevalence and coliform concentrations in feedlot cattle.

Our objectives were to evaluate the effects of transportation and lairage on fecal shedding of Escherichia coli O157 (E. coli O157), total Escherichia coli, and total coliforms in feedlot cattle, and the relationships between E. coli O157 prevalence and total E. coli population. The study was a randomized complete block design with a split-plot including 2 treatments: a nontransported group, which remained in its pen at all times, and a transported group, which was transported for 1 h in a trailer and subsequently unloaded in a different pen. The experiment was repeated on 3 different days (blocking factor) with 20 steers/d (10 steers/treatment, 60 total). Fecal samples were taken pretransport (h 0) and after 4 and 28 h, lairage from freshly voided fecal pats were taken from each animal. One gram of feces was transferred to a PBS tube, serially diluted, and plated onto Petrifilm for enumeration of total coliforms. Another sample (1 g) was added to gram-negative broth containing cefixime, cefsulodin, and vancomycin, and subjected to immunomagnetic separation. Resulting beads were plated onto MacConkey agar with sorbitol, cefixime, and tellurite. Nonsorbitol fermenting colonies were selected and tested for indole production and O157 antigen agglutination. Results were confirmed using an API 20E kit. Prevalence of E. coli O157 was transient across blocks. E. coli O157 prevalence revealed no treatment × sampling time interaction (P = 0.179) or sampling time effect (P = 0.937), but a tendency for a treatment effect (P = 0.092). Numbers of E. coli and other coliforms did not change across blocks. No effect of treatment (P > 0.7) was observed on total E. coli concentrations or total coliforms. However, tendencies for treatment × sampling time interactions were observed on both populations (P < 0.08), as well as a tendency for a sampling time effect on total E. coli (P = 0.087) and an effect on total coliforms (P = 0.004). Prevalence of E. coli O157 was not correlated with the concentration of total E. coli (P = 0.954). Results suggest that shedding of E. coli O157 and coliforms can vary within a period of 29 h. Greater statistical power and pathogen quantification, as well as hide sampling and stress-related measurements, are needed to be able to conclude on the effects of transport stress on E. coli O157 prevalence and the changes undergone in pathogen shedding patterns after transportation.

Occurrence of the transferable copper resistance gene tcrB among fecal enterococci of U.S. feedlot cattle fed copper-supplemented diets.

Copper, an essential micronutrient, is supplemented in the diet at elevated levels to reduce morbidity and mortality and to promote growth in feedlot cattle. Gut bacteria exposed to copper can acquire resistance, which among enterococci is conferred by a transferable copper resistance gene (tcrB) borne on a plasmid. The present study was undertaken to investigate whether the feeding of copper at levels sufficient to promote growth increases the prevalence of the tcrB gene among the fecal enterococci of feedlot cattle. The study was performed with 261 crossbred yearling heifers housed in 24 pens, with pens assigned randomly to a 2×2 factorial arrangement of treatments consisting of dietary copper and a commercial linseed meal-based energy protein supplement. A total of 22 isolates, each identified as Enterococcus faecium, were positive for tcrB with an overall prevalence of 3.8% (22/576). The prevalence was higher among the cattle fed diets supplemented with copper (6.9%) compared to normal copper levels (0.7%). The tcrB-positive isolates always contained both erm(B) and tet(M) genes. Median copper MICs for tcrB-positive and tcrB-negative enterococci were 22 and 4 mM, respectively. The transferability of the tcrB gene was demonstrated via a filter-mating assay. Multilocus variable number tandem repeat analysis revealed a genetically diverse population of enterococci. The finding of a strong association between the copper resistance gene and other antibiotic (tetracycline and tylosin) resistance determinants is significant because enterococci remain potential pathogens and have the propensity to transfer resistance genes to other bacteria in the gut.

Evaluation of the chemical composition of dry dogfoods commercialized in Chile used for growing dogs / Avaliação da composição química de rações comerciais no Chile, usadas para filhotes

The nutritional quality of dry dogfood commercialized in Chile for growing dogs was studied. Samples from at least three different batches of 26 dogfood brands were mixed. The resultant samples (n=26) were chemically analyzed to determine their concentrations of dry matter (DM), gross energy, fiber, ash, crude protein, essential amino acids, total fat, linoleic acid and minerals. The metabolizable energy (ME) content of each sample was estimated using modified atwater factors. The results from the chemical analyses were compared with the nutrient profiles published by the American Association of Feed Control Officials (AAFCO). Dogfoods that were found to contain an estimated ME of over 4,000kcal/kg DM were corrected for their high energy density before comparison. All of the dogfoods contained adequate levels of protein, total fat, linoleic acid, iron, copper, manganese and selenium. The concentration of tryptophan was adequate in 92.3 percent of the samples. All of the other essential amino acids were present in adequate quantities. However, the situation was different for many of the minerals. Only 92.3 percent of the dogfoods contained an adequate Ca:P ratio. A total of 96.2 percent of the dogfoods contained an adequate level of Ca, 96.2 percent for P, 96.2 percent for Mg, 92.3 percent for I, 88.5 percent for Cl, 80.8 percent for Na, 80.8 percent for Zn and only 34.6 percent were adequate for K content. Overall, only 23 percent of the dogfoods evaluated in this study fulfilled all of the requirements established by the AAFCO in terms of their content of crude protein, amino acids, total fat, linoleic acid, and minerals. It appears that the majority of the dogfoods evaluated in this study (77 percent) would not satisfy all nutritional requirements of the growing dog.

Determinou-se a qualidade nutricional de 26 rações para filhotes caninos comercializadas no Chile. As rações foram analisadas quimicamente e comparadas com as recomendações da American Association of Food Control Officials (AAFCO). Para as análises, utilizou-se uma amostra de cada ração, composta de pelo menos três lotes diferentes. Para cada amostra, foram determinados os conteúdos de matéria seca (MS), fibra, proteína bruta, aminoácidos essenciais, gordura, ácido linoléico e minerais. A energia metabolizável foi determinada mediante os fatores de conversão de Atwater e corrigida por sua densidade quando ultrapassava 4000kcal/kgMS. Todas as rações apresentaram conteúdos adequados de proteína, gordura, ácido linoléico, ferro, cobre, manganês e selênio. A concentração de triptofano foi adequada em 92,3 por cento das rações, e a dos demais aminoácidos essenciais foi maior que a mínima recomendada. As maiores irregularidades foram encontradas no conteúdo de minerais, 92,3 por cento das rações apresentaram uma adequada relação Ca:P. Foram observados níveis adequados de Ca, P e Mg em 96,2 por cento das rações, de I em 92,3 por cento, de Cl em 88,5 por cento, de Na e Zn em 80,8 por cento e de K em 34,6 por cento. Em relação às concentrações de proteína, aminoácidos, gordura, ácido linoléico e minerais, somente 23 por cento das rações apresentavam todas as especificações recomendadas pela AAFCO. A maioria das rações analisadas, (77 por cento) apresentavam concentrações de nutrientes inferiores ao requerimento de filhotes caninos.

Raman spectroscopy and multivariate analysis of serum samples from breast cancer patients.

Serum samples were studied using Raman spectroscopy and analyzed through the multivariate statistical methods of principal component analysis (PCA) and linear discriminant analysis (LDA). The blood samples were obtained from 11 patients who were clinically diagnosed with breast cancer and 12 healthy volunteer controls. The PCA allowed us to define the wavelength differences between the spectral bands of the control and patient groups. However, since the differences in the involved molecules were in their tertiary or quaternary structure, it was not possible to determine what molecule caused the observed differences in the spectra. The ratio of the corresponding band intensities were analyzed by calculating the p values and it was found that only seven of these band ratios were significant and corresponded to proteins, phospholipids, and polysaccharides. These specific bands might be helpful during screening for breast cancer using Raman Spectroscopy of serum samples. It is also shown that serum samples from patients with breast cancer and from the control group can be discriminated when the LDA is applied to their Raman spectra.