Male fertility advantage within and between seasons in the perennial androdioecious plant Phillyrea angustifolia.

BACKGROUND AND AIMS: Androdioecy, the co-occurrence of males and hermaphrodites, is a rare reproductive system. Males can be maintained if they benefit from a higher male fitness than hermaphrodites, referred to as male advantage. Male advantage can emerge from increased fertility owing to resource reallocation. However, empirical studies usually compare sexual phenotypes over a single flowering season, thus ignoring potential cumulative effects over successive seasons in perennials. In this study, we quantify various components of male fertility advantage, both within and between seasons, in the long-lived perennial shrub Phillyrea angustifolia (Oleaceae). Although, owing to a peculiar diallelic self-incompatibility system and female sterility mutation strictly associated with a breakdown of incompatibility, males do not need fertility advantage to persist in this species, this advantage remains an important determinant of their equilibrium frequency. METHODS: A survey of >1000 full-sib plants allowed us to compare males and hermaphrodites for several components of male fertility. Individuals were characterized for proxies of pollen production and vegetative growth. By analysing maternal progeny, we compared the siring success of males and hermaphrodites. Finally, using a multistate capture-recapture model we assessed, for each sexual morph, how the intensity of flowering in one year impacts next-year growth and reproduction. KEY RESULTS: Males benefitted from a greater vegetative growth and flowering intensity. Within one season, males sired twice as many seeds as equidistant, compatible hermaphroditic competitors. In addition, males more often maintained intense flowering over successive years. Finally, investment in male reproductive function appeared to differ between the two incompatibility groups of hermaphrodites. CONCLUSION: Males, by sparing the cost of female reproduction, have a higher flowering frequency and vegetative growth, both of which contribute to male advantage over an individual lifetime. This suggests that studies analysing sexual phenotypes during only single reproductive periods are likely to provide inadequate estimates of male advantage in perennials.

Separation of congenital embryonic syndactylies in children: dorsal or volar flap? About a comparative retrospective series.

Congenital syndactylies account for 1 to 2 out of 2000 birth defects. Although several types of syndactylies exist, we only studied embryonic syndactylies. The goal of our study was to compare 2 types of coverage flap for the reconstruction of the finger web spaces: a volar flap described by Blauth and a dorsal flap described by Gilbert. Between 1993 and 2015, children affected by simple and complex syndactylies (partial or complete) were treated in 2 french pediatric hospitals and were selected for our analytic, comparative, retrospective review. The 2 hospitals used different surgical techniques: one used a volar flap described by Blauth and the other a dorsal flap described by Gilbert. The children were followed up to look for signs according to the stages of the Classification of Withey and to evaluate a global result according to the score of Withey. Our secondary criteria of judgement were the aspect of the surgical scar according to the VSS (Vancouver Scar Scale) and the satisfaction of the parents and children. The age of the children, need for a surgical revision and time of last follow- up were also studied. We found statistically significant differences between group I (volar flap) and group II (dorsal flap) in favor of the volar flap: higher scores of Withey (even when the number of commissures was increasing) and better VSS (regardless of the number of web spaces treated). There was no statistically significant difference between the 2 groups in terms of age, follow-up, or rate of surgical revision. All in all, the volar flap presented less sequelae in terms of scar retraction. Regardless of the flap used, the cosmetic results of the full-thickness skin graft used impacted the result both on the receiving site (dyschromia, hairiness) and the donor site.

Comparison between isotropic linear-elastic law and isotropic hyperelastic law in the finite element modeling of the brachial plexus.

Augmented reality could help the identification of nerve structures in brachial plexus surgery. The goal of this study was to determine which law of mechanical behavior was more adapted by comparing the results of Hooke's isotropic linear elastic law to those of Ogden's isotropic hyperelastic law, applied to a biomechanical model of the brachial plexus. A model of finite elements was created using the ABAQUS® from a 3D model of the brachial plexus acquired by segmentation and meshing of MRI images at 0°, 45° and 135° of shoulder abduction of a healthy subject. The offset between the reconstructed model and the deformed model was evaluated quantitatively by the Hausdorff distance and qualitatively by the identification of 3 anatomical landmarks. In every case the Hausdorff distance was shorter with Ogden's law compared to Hooke's law. On a qualitative aspect, the model deformed by Ogden's law followed the concavity of the reconstructed model whereas the model deformed by Hooke's law remained convex. In conclusion, the results of this study demonstrate that the behavior of Ogden's isotropic hyperelastic mechanical model was more adapted to the modeling of the deformations of the brachial plexus.

Analysis of the modifications of MRI signal of the brachial plexus of rats: Comparative study before and after freezing/thawing.

The aim of this study was to compare the MRI signal of the brachial plexus and surrounding muscles before and after freezing/thawing on a murine model. A first MRI going through the brachial plexuses of 5 healthy Wistar rats was performed immediately post-mortem. A second MRI was performed after freezing at -30°C and then thawing at 20°C for 24hours. All MRI images were segmented to make nerve and muscular structures appear and calculate the average intensity of the MRI signal using the program ImageJ. The average nerve and muscular MRI signals were compared before and after freezing/thawing and rated in grayscale units between 0 and 255. The average intensity of the MRI signal of nerve structures was 40.315 grayscale units before freezing and 31.943 after freezing/thawing. The average intensity of the MRI signal of muscular structures was 25.44 grayscale units before freezing and 35.710 after freezing/thawing. Our results have shown that the intensity of the MRI signal of the brachial plexus was higher before freezing/thawing. The intensity of the MRI signal of muscles was lower than the intensity of the brachial plexus before freezing/thawing and higher after freezing/thawing in muscles than in brachial plexus. The MRI could be used in clinical practice to monitor the reinnervation after frozen nerve allografts.

Technical feasibility of robot-assisted minimally-invasive neurolysis of the lateral cutaneous nerve of thigh: About a case.

To limit the risk of iatrogenic neuroma and recurrence after surgical treatment of meralgia paresthetica, some authors have recently developed a technique of endoscopic neurolysis of the lateral cutaneous nerve of thigh (LCNT) below the level of the inguinal ligament. We report the case of a robot-assisted endoscopic technique underneath the inguinal ligament. A 62-year-old patient suffering of idiopathic meralgia paresthetica for the past 18 months received a Da Vinci robot-assisted minimally-invasive 10cm long neurolysis, of which 1/3 was situated above the level of the inguinal ligament and 2/3 below it. The patient was discharged the following day without complications. At 6-months follow-up the pain was rated 0/10 compared to 5/10 pre-operatively. Robot-assisted endoscopic neurolysis of the LCNT retains the advantages of conventional endoscopy and enables to approach the nerve in the most frequently compressed zone underneath the inguinal ligament. The three-dimensional view offered by robotic surgery facilitates the dissection. The superiority of this technique remains to be demonstrated by comparing it to conventional techniques.

A one-locus model of androdioecy with two homomorphic self-incompatibility groups: expected vs. observed male frequencies.

Androdioecy, the occurrence of males and hermaphrodites in a single population, is a rare breeding system because the conditions for maintenance of males are restrictive. In the androdioecious shrub Phillyrea angustifolia, high male frequencies are observed in some populations. The species has a sporophytic self-incompatibility (SI) system with two self-incompatibility groups, which ensures that two groups of hermaphrodites can each mate only with the other group, whereas males can fertilize hermaphrodites of both groups. Here, we analyse a population genetic model to investigate the dynamics of such an androdioecious species, assuming that self-incompatibility and sex phenotypes are determined by a single locus. Our model confirms a previous prediction that a slight reproductive advantage of males relative to hermaphrodites allows the maintenance of males at high equilibrium frequencies. The model predicts different equilibria between hermaphrodites of the two SI groups and males, depending on the male advantage, the initial composition of the population and the population size, whose effect is studied through stochastic simulations. Although the model can generate high male frequencies, observed frequencies are considerably higher than the model predicts. We finally discuss how this model may help explain the large male frequency variation observed in other androdioecious species of Oleaceae: some species show only androdioecious populations, as P. angustifolia, whereas others show populations either completely hermaphrodite or androdioecious.

Organization of outpatient consultations at a hand surgery department in a French university hospital during the COVID-19 lockdown.

The COVID-19 health crisis has greatly impacted the organization of outpatient consultations, especially in hand surgery. Five reorganization stages were described during the crisis (from week 11 to week 21 in 2020): preparatory stage, 1st organizational stage, wait-and-see stage, 2nd organizational stage, and progressive return stage. The number of patients seen on-site decreased 64% in 2020 compared to 2019, while 78% of consultations were canceled. The logistics (teleconsultation, dedicated COVID-19 patient pathways) and human resources (sick leave, telework, reassignment to other departments) were adapted to ensure that patients who are usually seen in our hand surgery department received adequate care.

Does spinal fusion influence vestibular information in scoliosis patients? Unstable equilibrium analysis.

BACKGROUND: Idiopathic scoliosis is described as the most common postural deformity to affect adolescents. These patients demonstrate vestibular system perturbations. Scoliosis can be treated through spinal fusion. Does spinal fusion coupled to rehabilitation program present significant effect of dynamic equilibrium? METHODS: An unstable platform was used to analyze dynamic equilibrium in patients with idiopathic scoliosis (before and one year after spinal fusion) against a population of asymptomatic subjects. RESULTS: A significant group and condition effect was observed on Center of Mass. CONCLUSION: In relation to vestibular system, spinal fusion coupled to rehabilitation program is associated to better dynamic equilibrium.

Flexor tendon complications in distal radius fractures treated with volar rim locking plates.

Volar locking plates used for treating distal radius fractures can damage the flexor tendon. Fractures distal to the watershed line can be fixed using volar rim locking plates. The aim of our study was to report the incidence of flexor tendon lesions when using these plates. Our case series included 15 patients (7 women, 8 men), aged 59 years on average (23-88) who underwent distal radius fixation using a volar rim plate (Extradistale®, Newclip Technics™, Haute Goulaine, France). Eight patients had complications: seven cases of synovitis treated by synovectomy with a satisfactory final outcome, 10 cases of partial tendon ruptures treated by synovectomy and tendon repair in two cases, and five cases of complete rupture that were not repaired at the patient's requests. Our working hypothesis was not verified as we found flexor tendon complications in half our patients. When the fracture is distal to the watershed line, we recommend removing the plate after bone healing, never after the 3rd month postoperative.

Arthrodesis of the thumb metacarpophalangeal joint: Conventional open technique with a locking plate or compression pins versus minimally invasive technique with compression pins or screws.

Arthrodesis of the thumb metacarpophalangeal (MCP) joint usually leads to satisfying results when performed with an open technique. The main complication is adhesion of the extensor tendons that sometimes requires hardware removal associated with tenolysis. The goal of this study was to assess whether a minimally invasive technique could reduce the risk of this complication. Arthrodesis of the thumb MCP was performed using an open technique with a locking plate or compression pins in 12 cases (group I) and using a minimally invasive technique with compression pins or screws in 12 cases, for a total of 24 patients aged 48.9 years on average, among which 15 were women. At the last follow-up, the average pain level was rated at 2/10 in group I and 2.3/10 in group II. The QuickDASH was 40.70/100 in group I and 36.24 in group II, grip strength was 79% of the contralateral side in group I and 51% in group II. Pinch strength was 81% of the contralateral side in group I and 45% in group II. Fusion was achieved in all cases in group I and in 7 of 12 cases in group II. Surgical revision for non-union was needed in 5 cases in group II, with hardware removal and tenolysis performed in 2 cases. The non-unions were observed in non-rheumatoid cases. While the two groups were not identical, arthrodesis of the thumb MCP using a minimally invasive technique with compression pins or screws seems to give satisfying results for rheumatoid cases in which no cartilage remains.

Designing a minimally-invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique: a cadaver study.

The goal of this study was to develop a minimally-invasive, ultrasound-guided percutaneous flexor tendon sheath lavage technique on cadaver model. Two catheters were inserted using ultrasound guidance at the proximal and distal ends of the tendon sheath in 20 fingers from cadaveric forearms. Percutaneous injection of a saline solution colored with methylene blue resulted in anterograde lavage of the flexor tendon sheath. The technique was successful in 13 out of 20 cases. The proximal catheter was in the correct position in 17 cases and the distal catheter was correctly positioned in 15 cases. The flexor tendons were continuous in all cases and had puncture wounds in 9 cases. Based on our study, this minimally-invasive, ultrasound-guided percutaneous lavage of the flexor tendon sheath was effective in 65% of cases and safe in 100% of cases in the index, middle and ring fingers. If this percutaneous lavage fails, it is always possible to switch to a conventional open technique.

Distal radius fracture fixation with a volar locking plate and endoscopic carpal tunnel release using a single 15mm approach: Feasibility study.

Distal radius fractures (DRF) may trigger, reveal or decompensate acute carpal tunnel syndrome (CTS) in 0.5-21% of cases. Internal fixation and median nerve release must then be carried out urgently. Less invasive approaches have been described for both the median nerve release using an endoscopic device and for the DRF fixation using a volar locking plate. We assessed the feasibility of DRF fixation and median nerve release through a single, minimally-invasive 15mm approach on a series of 10 cases. We reviewed retrospectively 10 consecutive cases of DRF associated with symptomatic CTS in 8 women and 2 men, aged 57 years on average. CTS was diagnosed clinically. All patients were treated during outpatient surgery with a volar locking plate and endoscopic carpal tunnel release using a single 15mm minimally-invasive approach. In one case, arthroscopic scapholunate repair was also required. Six months after the procedure, all patients were reviewed with a clinical examination and a radiological evaluation. The average values for the clinical and radiological outcomes were as follows: pain on VAS 1.5/10; QuickDASH 14.3/100; flexion 90%; extension 90.6%; pronation 95.6%; supination 87.9%; grip strength 90.1%; 2PD test 5.2mm (4-8mm). Five complications occurred: two cases of temporary dysesthesia in the territory of the median nerve and one case of temporary hypoesthesia of the palmar branch of the median nerve, which had all completely recovered; two cases of complex regional pain syndrome type I, which were still active at 6 months. Despite its methodological weaknesses, our study is the only one to describe the technical feasibility of a single 15mm minimally-invasive approach for both internal fixation using a volar locking plate and endoscopic nerve release, with no serious complications. This technique should be added to the surgical toolbox of minimally-invasive procedures for the hand and wrist.

Relevance of intraoperative ultrasound imaging for detecting foreign bodies in the hand: A series of 19 cases.

Radiolucent foreign bodies of the hand are frequent and may lead to pain, infection, hematoma and/or migration. Their diagnosis and removal can be difficult. The goal of this study was to assess the usefulness of intraoperative ultrasound imaging for detecting translucent foreign bodies in the hand to facilitate their removal. Our single-center retrospective study included 19 patients with preoperatively radiolucent but echogenic foreign bodies. An intraoperative ultrasound was performed to assist with and confirm the removal of the foreign body. The foreign bodies were vegetal in 15 cases, made of glass in 2 cases, rock in 1 case and undetermined in 1 case. The average length was 4.65 mm (min 1, max 16) and the average width 1.02 mm. All foreign bodies were visible during the intraoperative ultrasound and were no longer visible after their removal. Because intraoperative ultrasound imaging was able to guide the removal of all radiolucent foreign bodies in our study, it can be a useful tool for the removal of radiolucent foreign bodies.

Learning of supermicrosurgical vascular anastomosis: MicroChirSim® procedural simulator versus Anastomosis Training Kit® procedural simulator.

Many biological and non-biological simulators have been developed to reduce the length of the learning curve for supermicrosurgery. All of them have disadvantages. The goal of this study was to evaluate the feasibility of the new MicrochirSim® (0.5mm) non-biological procedural simulator by comparing it to the Anastomosis Training Kit® (2mm). After viewing a video of end-to-end anastomosis of a rat-tail artery, 10 residents in surgery reproduced the same technique on a procedural simulator: 5 on the MicroChirSim® (group 1) and 5 on the Anastomosis Training Kit® (group 2). The 10 residents then each performed five end-to-end anastomoses of the rat-tail artery on which they were evaluated. The average length of the procedure was 33minutes in group 1 and 45minutes in group 2. The average number of suture points was 3.7 in group 1 and 5.4 in group 2, which suggests training with a 0.5mm simulator improves suturing. The anastomosis was patent in 25 cases in group 1 and in 22 cases in group 2. The anastomosis was free of leaks in 25 cases in group 1 and in 19 cases in group 2. In conclusion, the MicroChirSim® procedural simulator accelerates the learning curve for vascular supermicrosurgery.

Comparison of proximal interphalangeal arthroplasty outcomes with Swanson implant performed by volar versus dorsal approach.

No study has compared the QuickDASH score after Swanson implant arthroplasty performed by dorsal versus volar approaches. This study compared the outcomes of PIP arthroplasties through a volar approach as described by Schneider versus a dorsal approach as described by Chamay by determining the QuickDASH score, pain and range of motion. Our series included 21 Swanson implant arthroplasty cases in 17 patients aged 62 years on average, among which 12 were females. A volar approach was performed in 9 cases (group I) and a dorsal approach was performed in 12 cases (group II). The difference between the average QuickDASH score preoperatively and at the last follow-up was strong (group I: -16.584; group II: -1.444), the difference between the average pain level preoperatively and at the last follow up was very strong (group I: -2.098; group II: -4.506), the difference in average PIP extension was not different from 0 (group: I -5.805; group II: -11.332), the difference in average PIP flexion was very strong (group I: -2.716; group II: -2.007). There were four recurrences of swan neck deformity (3 in group, 1 in group II) and one implant fracture in each group. For Swanson implant arthroplasty, the volar approach leads to better QuickDASH scores and PIP flexion compared to the dorsal approach. The volar approach did not improve PIP extension, or pain, and did not lead to dysesthesia.

Identification of sperm antigens as a first step towards the generation of a contraceptive vaccine to decrease fossorial water vole Arvicola terrestris Scherman proliferations.

Immunocontraceptive strategies have proved to be efficient in controlling fertility of various mammalian species. In the present study we have made the first steps towards the identification of Arvicola terrestris sperm antigens that could be used as targets in the development of a contraceptive vaccine to limit the proliferations of this pest rodent. Rabbit-raised polyclonal antisera directed against complete A. terrestris spermatozoa were used to identify and characterize on 2D-gels coupled with a MALDI-TOF mass spectrometry analysis A. terrestris sperm proteins. Amongst the proteins pinpointed by this approach some were further investigated based on their tissue- and/or sperm-specific expression, and their relevance to fertility or sperm/egg interaction. In parallel, three proteins that have been already reported in the literature to be appropriate targets for the development of contraceptive vaccines in other mammalian species have also been looked for in A. terrestris. With the selected protein targets, a reverse-PCR approach using degenerate primers was employed to amplify corresponding A. terrestris cDNAs. After conceptual translation and sequence alignment, different proteins were studied to determine zones with sufficient sequence divergence and of antigenic/immunogenic nature that could be used in future assays to immunize animals.

Minimally invasive hardware removal after minimally invasive distal radius plate osteosynthesis (MIPO): Feasibility study in a 388 case series.

HYPOTHESIS: The aim of the present study was to assess the technical feasibility of minimally invasive volar plate removal following distal radius fracture. MATERIAL AND METHODS: Three hundred and eighty-eight plates removed from 387 patients (357 females: mean age, 50 years) were assessed retrospectively. The incision used the primary minimally invasive approach and was closed after plate removal by intradermal continuous suture, without drainage or immobilization. RESULTS: Mean scar size was 22.2mm preoperatively, and the incision was 19.8mm at start and 21.4mm at end of procedure, these differences being non-significant. The scar was enlarged by accidental skin tear in 13 cases and intentionally by lancet in 11 cases. There were 29 screw-related complications, 1 bone crack without clinical impact, and 1 plate fracture. There were no postoperative complications. DISCUSSION: The present results demonstrate the feasibility of removing a volar plate on the distal radius via a 20-mm approach. These findings should be confirmed on a future study comparing minimally invasive plate ablation and conventional approaches.

Is there a relevance of suction drainage in non-septic wrist surgery?

INTRODUCTION: No rational argument leads to conclude to the benefit or the innocuousness of drainage in non-septic wrist surgery. HYPOTHESIS: The goal of this study was to validate the hypothesis that for those indications drainage is unnecessary. MATERIAL AND METHOD: We reviewed 1001 consecutive cases, concerning 885 patients, 58 years old in average. RESULTS: Out of 1001 procedures, 9 patients were operated on both sides, 145 were operated twice of which 130 for the implantation and then the removal of surgical material. None were reoperated for hematomas. Three patients were initially treated for an osteosynthesis using an anterior plate of distal radius and secondarily reoperated due to sepsis, one of them twice. The material was removed from two patients. The average time of tourniquet for those 3 osteosynthesis was significantly superior (84.33min) to the average time for the 595 other anterior distal radius plates (45.35min). CONCLUSION: The results of our study show that suction drainage in non-septic wrist surgery is unnecessary. LEVEL OF EVIDENCE: III descriptive retrospective study.

Development of a clinical path for the emergency care of hand bite injuries without signs of infection.

HYPOTHESIS: The care of bite injuries has not currently reached a consensus, including in our department. The goal of this study was to evaluate our current care of bite injuries by an assessment of professional practices (APP), then formulate and validate a flowchart to standardize our practices. MATERIAL AND METHODS: During a first round of file reviewing, 30 files were randomly selected and then evaluated using a 15 item auditing form (group 1). A flowchart was then designed to standardize the care of hand bite injuries and released in our department. Six months later, 30 new files were randomly selected and evaluated using the same auditing form (group 2). RESULTS: When comparing the results of the 15 items before and after the release of the flowchart, 7 items reached 100% in group 2. The wounds were described more precisely, signs of severity were systematically researched and the antibiotic treatment was standardized. Two items decreased but did not reach 0%: systematic prescription of bacteriologic swabs and X-rays. Using these results the flowchart was improved. DISCUSSION AND CONCLUSION: Our results showed an improvement of the care of hand bites for 11 items, including 5 that were statistically significant. This flowchart enabled to standardize our practices and could be used in other emergency departments.

Results of conservative treatment of volar plate sprains of the proximal interphalangeal joint with and without avulsion fracture.

The prognosis of isolated volar plate sprains of the proximal interphalangeal (PIP) joint is related to the extension deficit. Some consider an associated avulsion fracture as a sign of severity. The goal of this study was to find out whether the outcomes of conservative treatment in PIP volar plate injury was impacted by the presence of an avulsion fracture. Our series included 75 patients, 27 years old on average, of which 58 were men. All sprains were stable. The X-rays were normal in 52 cases (group 1); an avulsion fracture was found in 23 cases (group 2). The patients were treated by buddy taping during the day and a straight finger splint at night for 3 weeks. At the last follow-up, no significant difference was found between the two groups regarding pain, extension/flexion range of motion or edema. The results of this study show that the prognosis of conservative treatment of PIP volar plate injuries does not depend on the presence of an avulsion fracture.