Effectiveness and cost-effectiveness of surgery versus casting for elderly patients with Displaced intra-Articular type C distal Radius fractures: protocol of a randomised controlled Trial with economic evaluation (the DART study).

INTRODUCTION: Current literature is inconclusive about the optimal treatment of elderly patients with displaced intra-articular distal radius fractures. Cast treatment is less invasive and less expensive than surgical treatment. Nevertheless, surgery is often the preferred treatment for this common type of distal radius fracture. Patients with a non-acceptable position after closed reduction are more likely to benefit from surgery than patients with an acceptable position after closed reduction. Therefore, this study aims to assess non-inferiority of functional outcomes after casting versus surgery in elderly patients with a non-acceptable position following a distal radius fracture. METHODS AND ANALYSIS: This study is a multicentre randomised controlled trial (RCT) with a non-inferiority design and an economic evaluation alongside. The population consists of patients aged 65 years and older with a displaced intra-articular distal radius fracture with non-acceptable radiological characteristics following either inadequate reduction or redisplacement after adequate reduction. Patients will be randomised between surgical treatment (open reduction and internal fixation) and non-operative treatment (closed reduction followed by cast treatment). We will use two age strata (65-75 and >75 years of age) and a web-based mixed block randomisation. A total of 154 patients will be enrolled and evaluated with the patient-rated wrist evaluation as the primary outcome at 1-year follow-up. Secondary outcomes include the Disabilities of the Arm, Shoulder and Hand questionnaire, quality of life (measured by the EQ-5D), wrist range of motion, grip strength and adverse events. In addition, we will perform a cost-effectiveness and cost-utility analysis from a societal and healthcare perspective. Incremental cost-effectiveness ratios, cost-effectiveness planes and cost-effectiveness acceptability curves will be presented. ETHICS AND DISSEMINATION: The Research and Ethics Committee approved this RCT (NL56858.100.16). The results of this study will be reported in a peer-reviewed journal. We will present the results of this study at (inter)national conferences and disseminate the results through guideline committees. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov (NCT03009890). Dutch Trial Registry (NTR6365).

Animal mortality and illegal poison bait use in Greece.

The present study describes the use of poison baits against so-called pest species in Greece and explores various aspects of this illegal practice. Data were collected from 2000 to 2016, and a total of 1015 poisoning incidents in rural areas causing the death of 3248 animals were examined. In 58.7% of investigated cases, the motives remained unknown; in the remaining cases, human-wildlife conflicts and retaliatory actions among stakeholders (e.g., hunters vs. livestock breeders) were found to be the main reasons for poison bait use. The target animals for these actions were mainly mammalian carnivores, and stray canids, all of which were blamed for livestock and game losses. Avian scavengers were the wildlife species most affected by secondary poisoning (30% of the wildlife fatalities), whereas shepherd dogs accounted for 66.4% of domestic animal losses. Toxicological analyses showed that a wide range of chemical substances were used, mostly legal or banned pesticides (e.g., carbamates, organophosphates, and organochlorines) and potassium cyanide. Furthermore, the widespread trafficking of black marketed insecticides was also recorded, with methomyl (in powder form) and carbofuran being most common. The majority of poisoning events (72%) took place outside protected areas, while in approximately 73.4% of them, no official reporting to the competent authorities was made. Overall, the study highlights the significant impact of illegal poison bait use on wildlife in Greece and addresses its extreme socioeconomic complexity. The need for an integrated national anti-poison strategy is discussed.

Identification of TCE and PCE sorption and biodegradation parameters in a sandy aquifer for fate and transport modelling: batch and column studies.

The main aim of this study was to determine the sorption and biodegradation parameters of trichloroethene (TCE) and tetrachloroethene (PCE) as input data required for their fate and transport modelling in a Quaternary sandy aquifer. Sorption was determined based on batch and column experiments, while biodegradation was investigated using the compound-specific isotope analysis (CSIA). The aquifer materials medium (soil 1) to fine (soil 2) sands and groundwater samples came from the representative profile of the contaminated site (south-east Poland). The sorption isotherms were approximately linear (TCE, soil 1, K d = 0.0016; PCE, soil 1, K d = 0.0051; PCE, soil 2, K d = 0.0069) except for one case in which the best fitting was for the Langmuir isotherm (TCE, soil 2, K f = 0.6493 and S max = 0.0145). The results indicate low retardation coefficients (R) of TCE and PCE; however, somewhat lower values were obtained in batch compared to column experiments. In the column experiments with the presence of both contaminants, TCE influenced sorption of PCE, so that the R values for both compounds were almost two times higher. Non-significant differences in isotope compositions of TCE and PCE measured in the observation points (δ(13)C values within the range of -23.6 ÷ -24.3‰ and -26.3 ÷-27.7‰, respectively) indicate that biodegradation apparently is not an important process contributing to the natural attenuation of these contaminants in the studied sandy aquifer.

[Comparative evaluation of various methods for feeding children with pyloric stenosis]. / Sravnitel'naia otsenka razlichnykh sposobov pitania detei pilorostenozom.

Pylorostenosis is still the most frequently encountered type of congenital intestinal obstruction. A severe course of the disease with a fatal outcome is observed today. Successful treatment is linked in many respects with adequate feeding of the patient. The authors examined and performed operations on 90 children. According to the type of feeding they were divided into 3 groups. Group 1 consisted of patients given the generally accepted oral diet in portions, group 2 was made up of infants fed according to a "forced" schedule (the physiological requirements were supplied by the natural way by the 3rd-4th postoperative day), and group 3 received enteral feeding through a tube. The tube was introduced by means of an endoscope before or during the operation. It was found that in feeding through a tube children with pylorostenosis could be given 2-3 times more milk before the operation and in the first days after it. Regurgitation and the phenomena of esophagitis and jaundice are arrested in this case. The gain in weight is 3 times that in children of group 1. The authors consider this type of feeding to be justified in gravely ill patients. The "forced" schedule is used in an uncomplicated course of the disease. Feeding of infants with pylorostenosis by the generally accepted method was found to be unsatisfactory and the authors rejected it.