Does surgical fixation improve pain and quality of life in patients with non-flail rib fractures? A best evidence topic review.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'does surgical stabilization of rib fractures improve pain and quality of life in patients with non-flail rib fractures?'. Altogether >300 papers were found using the reported search, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Whilst several non-randomized cohort studies demonstrate superior pain and quality of life outcomes with surgical fixation as compared to conservative management, this is not replicated by the findings of a recent randomized trial which found worse pain, but early return to work in those treated with surgical stabilization of rib fractures. Given this, clinicians will need to carefully consider the indications for treating painful non-flail rib fractures as surgical fixation represents a reasonable treatment option in only appropriately selected candidates.

Farmers' knowledge, perception and management of mango mealy bug, Drosicha mangiferae Green (Hemiptera: Monophlebidae), on Mangifera indica in Punjab, Pakistan.

In 2004-05, during the December to February about 141 mango farmers were interviewed during peak activity of mango mealy bug in southern Punjab, Pakistan. The objective was to know the farmers' knowledge, perceptions and practices in the management of mango mealy bug. Most of the farmers (94.33%) reported that Chaunsa variety (king of all mango varieties) was susceptible to mango and irrigation water was the major source of flare up of this pest. Basudin and Supracide were the most commonly used insecticides as 72.92 and 51.77 percent farmers gave positive response and grease bands were applied for the control of mango mealy bug by the majority of the respondents. Hundred percent yield losses was told by 22.7 percent respondents whereas 75 percent, 50 percent and 25 percent losses were reported by 39.7, 31.9 and 14.2 insecticidal spray did not show satisfaction to the respondents for the control of fertilized females of mango mealy bug coming down from the trees. Lack of knowledge about the pest, lack of money, adulterated and shortage of pesticides, lack of unity amongst farmers Further the growers' views were tested in the field for confirmation and small land holdings were the main constraints for the control of mango mealy bug.

Endovascular Neuromodulation: Safety Profile and Future Directions.

Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the StentrodeTM, a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the StentrodeTM has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients. Although technical precedence for venous sinus stenting already exists in the setting of idiopathic intracranial hypertension, long term implantation of a lead within the intracranial veins has never been previously achieved. Contrastingly, transvenous leads have been successfully employed for decades in the setting of implantable cardiac pacemakers and defibrillators. In the current absence of human data on the StentrodeTM, the literature on these structurally comparable devices provides valuable lessons that can be translated to the setting of endovascular neuromodulation. This review will explore this literature in order to understand the potential risks of the StentrodeTM and define avenues where further research and development are necessary in order to optimize this device for human application.