Augmented versus non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails for treating trochanteric fractures in patients over sixty-five years of age.

PURPOSE: Intramedullary nailing is a common treatment for pertrochanteric fractures. However, implant-related mechanical failures, such as cut-out and cut-through, lead to higher rates of revision surgery, loss of autonomy, and mortality. Cemented augmentation enhances the bone-implant interface. This study compared the frequency of mechanical failures between augmented and non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails. METHODS: This descriptive, retrospective study at a level 1 trauma centre included patients aged > 65 years with pertrochanteric fractures treated by a short augmented or non-augmented TFNA nail. The primary outcome was the comparison of cut-out or cut-through rates between groups at three and six months postoperatively. RESULTS: Of the 181 patients analysed, 103 had augmented TFNA nails and 78 had non-augmented TFNA nails. There were no statistically significant differences between groups in terms of demographic characteristics, AO/OTA classification, or quality of reduction. The failure rate was significantly lower in the augmented group than in the non-augmented group: 1 (0.97%) versus 9 (11.54%) (p = 0.005). At six months postoperatively, there was no significant difference between the two groups concerning functional recovery, as measured by the Parker and EuroQoL 5-Dimensions scores. CONCLUSIONS: For patients aged over 65 years, the use of the augmented TFNA nail may reduce the risk of fixation failures such as cut-out.

Epidemiology and characteristics of firearm injuries in a French level I trauma centre, 2009-2019.

BACKGROUND: Firearm injuries (FI) are an increasing problem in Europe but there have been few European epidemiological studies on civilian FI, particularly in France. This study investigated the epidemiology of FI at a French level I trauma centre. METHODS: A retrospective cohort study was conducted of all patients admitted to our centre with an FI between January 2009 and December 2019. We investigated the epidemiological trends of FI during the study period, and characterised the FI. RESULTS: A total of 162 patients were victims of FI. Prevalence was 0.11% and the mean annual incidence was 10.4 per 100 000 habs. A significant increase has been observed over the last 10 years, from 5 cases in 2009 (3.1%) to 30 in 2019 (18.5%). Of the 162 victims, 85 (52.5%) died as a direct result of the FI: 72 suicides (88.9%) and 9 victims of urban violence (11.1%) (armed public environment disorder). 95.3% of the patients died before reaching at the hospital. There were 95 cases (58.7%) of suicide and 33 cases (20.4%) of urban violence. The head was shot in 87 cases (48.9%), the thorax in 32 cases (18.5%) and the lower limbs in 24 cases (13.5%). A total of 106 surgeries were performed on 54 patients (33.3%). CONCLUSIONS: We identified 162 cases of FI with a mean annual incidence of 10.4 per 100 000 habs. A significant increase in FI was observed over the last 10 years. 52.2% of patients died, and the main context was suicide or attempted suicide.

Use of a Trochanteric Fixation Nail-Advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age.

PURPOSE: Intramedullary nailing is the standard treatment of trochanteric fractures. Mechanical failure such as cut-out and cut-through are associated with high rates of revision surgery, functional impairment, and mortality. The aim of the study was to evaluate the rate of mechanical failure of the cement augmented screws of Trochanteric Fixation Nail-Advanced (TFNA) nails. PATIENTS AND METHODS: A descriptive, retrospective, multi-operator, single-centre study was performed at our level 1 trauma centre between June 2019 and June 2020. Patients were included if they were > 65 years of age, presented with a trochanteric fracture treated with an augmented TFNA nail with 6 months of follow-up. The primary outcome was fixation failure rate (cut-out or cut-through) at three and six post-operative months. Secondary endpoints were intra-operative data, clinical scores, and radiographic analysis. RESULTS: Forty-five patients (38 women and 7 men) were analysed. The mean age was 82.84 years (65-102, 9.50). There were no instances of mechanical failure in our series, after either three or six months of follow-up. No patient exhibited cut-out or cut-through. The mean amount of cement injected was 4.72 mL (3-6; 1.05). The mean length of surgery was 37.59 min (25-55; 6.48), and the mean intra-operative radiation exposure was 91.47 cGycm2 (25.04-201.81; 51.40) for a mean duration of 43.11 s (17-86; 16.81). The mean duration of hospitalisation was 6.38 days (2-11; 2.27). CONCLUSIONS: Our clinical results suggest that cement-augmented TFNA screws can be successfully used in the management of trochanteric fractures in patients > 65 years of age.

Pathogen-mediated selection favours the maintenance of innate immunity gene polymorphism in a widespread wild ungulate.

Toll-like receptors (TLR) play a central role in recognition and host frontline defence against a wide range of pathogens. A number of recent studies have shown that TLR genes (Tlrs) often exhibit large polymorphism in natural populations. Yet, there is little knowledge on how this polymorphism is maintained and how it influences disease susceptibility in the wild. In previous work, we showed that some Tlrs exhibit similarly high levels of genetic diversity as genes of the Major Histocompatibility Complex (MHC), and signatures of contemporary balancing selection in roe deer (Capreolus capreolus), the most abundant cervid species in Europe. Here, we investigated the evolutionary mechanisms by which pathogen-mediated selection could shape this innate immunity genetic diversity by examining the relationships between Tlr (Tlr2, Tlr4 and Tlr5) genotypes (heterozygosity status and presence of specific alleles) and infections with Toxoplasma and Chlamydia, two widespread intracellular pathogens known to cause reproductive failure in ungulates. We showed that Toxoplasma and Chlamydia exposures vary significantly across years and landscape features with few co-infection events detected and that the two pathogens exert antagonistic selection on Tlr2 polymorphism. By contrast, we found limited support for Tlr heterozygote advantage. Our study confirmed the importance of looking beyond Mhc genes in wildlife immunogenetic studies. It also emphasized the necessity to consider multiple pathogen challenges and their spatiotemporal variation to improve our understanding of vertebrate defence evolution against pathogens.

Medial unilateral knee arthroplasty after high tibial osteotomy: A retrospective study of 41 cases.

INTRODUCTION: When medial knee osteoarthritis continues to get worse after a high tibial osteotomy (HTO) procedure, a subsequent total knee arthroplasty (TKA) is typically warranted. Medial unilateral knee arthroplasty (UKA) is not recommended. The aim of this study was to evaluate the outcomes of patients who underwent medial UKA after HTO. HYPOTHESIS: Good results can be obtained with this procedure, as long as the postoperative valgus is not excessive. MATERIALS AND METHODS: This was a retrospective, single-center study of patients operated between January 2005 and June 2019. The primary endpoint was the Oxford Knee Scale (OKS). The Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), range of motion and complications were the secondary endpoints. The average follow-up was 79 months. RESULTS: Forty-one knees in 38 patients were analyzed. Four revisions with implant exchange (10%) were needed. Thirty-seven knees had a mean OKS of 20/60±8 (12-39). The mean flexion and extension amplitude were 123°±8° (110-140) and -1.5°±4 (-15-0), respectively. Eight patients had flexion and/or extension contractures. DISCUSSION: Good functional and clinical outcomes in the medium term were achieved for the patients in this study who underwent UKA after HTO. These findings reinforce the good results reported in recent studies of UKA after HTO. LEVEL OF EVIDENCE: IV, Retrospective study.

Clinical audit: a useful tool for reducing severe postpartum haemorrhages?

OBJECTIVE: Reducing the rate of severe postpartum haemorrhage (PPH) is a major challenge in obstetrics today. One potentially effective tool for improving the quality of care is the clinical audit, that is, peer evaluation and comparison of actual practices against explicit criteria. Our objective was to assess the impact of regular criteria-based audits on the prevalence of severe PPH. DESIGN: Quasi-experimental before-and-after survey. SETTING: Two French maternity units in the Rhône-Alpes region, with different organization of care. PARTICIPANTS: All staff of both units. INTERVENTION: Quarterly clinical audit meetings at which a team of reviewers analysed all cases of severe PPH and provided feedback on quality of care and where all staff actively participated. MAIN OUTCOME MEASURES: The primary outcome was the prevalence of severe PPH. Secondary outcomes included the global quality of care for women with severe PPH, including the performance rate for each recommended procedure. Differences in these variables between 2005 and 2008 were tested. RESULTS: The prevalence of severe PPH declined significantly in both units, from 1.52 to 0.96% of deliveries in the level III hospital (P = 0.048) and from 2.08 to 0.57% in the level II hospital (P < 0.001). From 2005 to 2008, the proportion of deliveries with severe PPH that was managed consistently with the guidelines increased for all of its main components, in both units. CONCLUSION: Regular clinical audits of cases severe PPH were associated with a persistent reduction in the prevalence of severe PPH.

Impact of COVID-19 Lockdown on Short-Term Results After Laparoscopic Sleeve Gastrectomy.

BACKGROUND: The recent COVID-19 pandemic has led several countries worldwide to confine the population. Consequently, people's mobility and physical activity are limited in addition to a negative psychosocial effect. The aim of this study was to assess the impact of COVID-19 crisis on short-term weight loss and the remission of obesity-associated comorbidities in patients undergoing sleeve gastrectomy (SG). METHODS: A case-control study was conducted comparing percentage of total weight loss (%TWL), excess weight lost (%EWL), and the remission rate of obesity-related comorbidities at the first postoperative year between patients who underwent primary SG between June 2019 and October 2019 (1-year postoperative period affected by COVID-19 lockdown; COV-group), and a control group operated between June 2018 and October 2018 (1-year postoperative period not affected by COVID-19 lockdown; CONTROL-group). RESULTS: In total, 45 patients from COV-group were compared to 57 patients from CONTROL-group. Demographic data were similar between groups. The follow-up rate at 1 year was 100%. The mean %TWL and %EWL was lower at 28.2 ± 12.7% and 67.6 ± 23.5% in COV-group patients compared to 34.3 ± 14.1% and 78.3 ± 27.2% in CONTROL-group patients at 1 year from SG (p=0.025 and p=0.036, respectively). The remission rate of obesity-related comorbidities at 1 year from SG including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea syndrome was 57.1%, 60.0%, 71.4%, and 41.7% in COV-group and 66.7%, 72.4%, 85.3%, and 52.9% in CONTROL-group, respectively, without any statistically significant difference between groups. CONCLUSIONS: The COVID-19 lockdown had a negative effect on weight loss in the first year after SG. Larger studies are needed to confirm these results, and we are expecting for a longer follow-up to evaluate the long-term impact on weight loss and comorbidities.

A rare case of an irreducible Pipkin II fracture-dislocation of the femoral head in a young patient following low-energy trauma.

INTRODUCTION: Fractures-dislocations of the femoral head are rare, and irreducible dislocations are even rarer. The functional prognosis is poor. PRESENTATION OF CASE: We report the case of a 23-year-old male brought to the emergency room following low-energy trauma. X-rays and a computed tomography scan revealed a Pipkin II fracture-dislocation of the right femoral head. We attempted reduction with the patient under general anesthesia; this failed, so we proceeded to total hip arthroplasty (THA). DISCUSSION: A femoral head fracture has a poor prognosis; the principal complications are osteonecrosis, osteoarthritis, and heterotopic ossifications. No surgical treatment algorithm for a femoral head fracture (for fragment excision, followed by internal fixation or THA) is available, given the rarity of the injury and the lack of sufficient cases. CONCLUSIONS: We describe the mechanism of low-energy injury, as well as the controversial THA treatment chosen by this young patient.

Water restriction influences intra-pair vocal behavior and the acoustic structure of vocalisations in the opportunistically breeding zebra finch (Taeniopygia guttata).

Seasonally-breeding species experience significant and predictable shifts in vocal behaviour; however, it is unclear to what extent this is true for species that breed opportunistically. The Australian zebra finch is an opportunistically breeding species, which means individuals must time breeding bouts based on many environmental factors. Here we tested the effect of experimental water restriction, which suppresses reproductive readiness in zebra finches, on vocal behaviour of males and females. More specifically, we quantified the effect of water restriction on three parameters of vocal behaviour in pair-bonded zebra finches: vocal activity, patterns of vocal exchanges, and the acoustic structure of vocalisations (calls and male song). We found that water restriction caused a decrease in vocal output (both song and call rate). Additionally, water restriction affected the composition of male songs. However, there was no effect of water restriction on the patterns of calling exchanges for monogamous partners (temporal coordination and turn taking). Finally, water restriction had vocalisation- and sex-specific effects on the acoustic structure of song syllables and calls. Because the direction of these effects were vocalisation- and sex- specific, there may be different mechanisms underlying the effects of water restriction on acoustic structure depending on context. These results contribute to the growing body of research highlighting the rich communicative potential of bird calls. Our current results raise the hypothesis that zebra finches may use changes in vocal behaviour and/or the structure of vocalisations of their conspecifics when making breeding decisions.

When can obstetric risk be predicted?

OBJECTIVE: The aim of the study was to assess the chronology of the appearance of perpartum obstetric risk factors (POR) in order to define the best moment to evaluate the type of management to which women will be oriented. We have secondarily studied the extent to which inappropriate medical interventions play a role in the genesis of some complications in the deliveries of women who are in principle at low risk. MATERIALS AND METHODS: We conducted a prospective cohort study from January 1 to June 30, 2015 at the Croix-Rousse Hospital of Lyon, a level III maternity, and the Valence Hospital Center, a level II maternity, including all women giving birth at 24 to 42 weeks of gestation at hospital. The women were divided into two groups : one with no known perpartum obstetric risk (POR-) and the other with at least one obstetrical perpartum risk factor (POR+), defined at three different stages (at the last pregnancy monitoring consultation, at the onset of labor at the admission in the delivery room, and at the end of labor just before expulsive efforts). We observed medical interventions and foeto-maternal complications in each group. A non-simple delivery was a delivery involving a medical intervention, or a maternal or neonatal complication, or any combination of these. A secondary retrospective analysis of the practices and management was made for women initially considered POR- at the onset of labor but who had a non-simple delivery to assess adherence to current guidelines according to an audit schedule. RESULTS: Among 1975 women, we identified 32% women as POR- at end of pregnancy, 21% at start of labor and 20% at end of labor. Among the POR- women at start of labor, 16% had a non-simple delivery. 35% of these non-simple deliveries might perhaps have been avoided by closer adherence to current recommendations. Nonetheless 54% of these women still had an unpredictable and inevitable non-simple delivery that in some cases required an extremely rapid intervention. CONCLUSION: Determining and predicting pregnant women who will need additional resources in addition to the usual obstetric and neonatal care is difficult. This identification should be made at the admission for delivery and this risk should be reassessed during labor. There are no women at zero risk of intervention. Therefore, delivery in demedicalized units should not take place in isolated or distant free-standing facilities.

Rapid effects of sex steroids on zebra finch (Taeniopygia guttata) pair maintenance.

Although steroids are widely known to affect behavior through activation of nuclear/cytosolic receptors ("genomic" effects), steroids can also rapidly affect behavior via modulation of signal transduction pathways ("nongenomic," fast actions, or rapid effects). In zebra finches, there is evidence that sex steroids have context-specific effects on pair-maintenance behavior, on both acute and chronic timescales. Here, we quantified the effects of orally administered testosterone and 17ß-estradiol (E2) on pair-maintenance behavior. We show that E2 rapidly affects female, but not male, affiliative behavior profiles during a partner separation and reunion paradigm. More specifically, E2 rapidly (within 5-15 min of administration) increased females' spatial proximity to a partner. This effect was present regardless of breeding condition (water restriction or water ad libitum). Combined, these results contribute to a growing body of evidence implicating sex steroids in the regulation of prosocial behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Progress and Prospects in Gender Visibility at SMBE Annual Meetings.

Reduced visibility of women in science is thought to be one of the causes of their underrepresentation among scientists, in particular at senior positions. Visibility is achieved through publications, and through conference attendance and presentations. Here, we investigated gender differences in visibility at the annual meetings of the Society of Molecular Biology and Evolution. The analysis of meeting programs showed a regular increase in female speakers for the last 16 years. Data on abstract submission suggest that there are no gender-related preferences in the acceptance of contributed presentations at the most recent meetings. However, data collected on-site in 2015 and 2016 show that women asked only ∼25% of the questions, that is, much less than expected given the female attendance. Understanding the reasons for this pattern is necessary for the development of policies that aim to reduce imbalance in visibility.

Appraisal of unimodal cues during agonistic interactions in Maylandia zebra.

Communication is essential during social interactions including animal conflicts and it is often a complex process involving multiple sensory channels or modalities. To better understand how different modalities interact during communication, it is fundamental to study the behavioural responses to both the composite multimodal signal and each unimodal component with adequate experimental protocols. Here we test how an African cichlid, which communicates with multiple senses, responds to different sensory stimuli in a social relevant scenario. We tested Maylandia zebra males with isolated chemical (urine or holding water coming both from dominant males), visual (real opponent or video playback) and acoustic (agonistic sounds) cues during agonistic interactions. We showed that (1) these fish relied mostly on the visual modality, showing increased aggressiveness in response to the sight of a real contestant but no responses to urine or agonistic sounds presented separately, (2) video playback in our study did not appear appropriate to test the visual modality and needs more technical prospecting, (3) holding water provoked territorial behaviours and seems to be promising for the investigation into the role of the chemical channel in this species. Our findings suggest that unimodal signals are non-redundant but how different sensory modalities interplay during communication remains largely unknown in fish.

A New Semi-automated Method for Assessing Avian Acoustic Networks Reveals that Juvenile and Adult Zebra Finches Have Separate Calling Networks.

Social networks are often inferred from spatial associations, but other parameters like acoustic communication are likely to play a central role in within group interactions. However, it is currently difficult to determine which individual initiates vocalizations, or who responds to whom. To this aim, we designed a method that allows analyzing group vocal network while controlling for spatial networks, by positioning each group member in equidistant individual cages and analyzing continuous vocal interactions semi-automatically. We applied this method to two types of zebra finch groups, composed of either two adult females and two juveniles, or four young adults (juveniles from the first groups). Young often co-occur in the same social group as adults but are likely to have a different social role, which may be reflected in their vocal interactions. Therefore, we tested the hypothesis that the social structure of the group influences the parameters of the group vocal network. We found that groups including juveniles presented periods with higher level of activity than groups composed of young adults. Using two types of analyses (Markov analysis and cross-correlation), we showed that juveniles as well as adults were more likely to respond to individuals of their own age-class (i.e. to call one after another, in terms of turn-taking, and within a short time-window, in terms of time delay). When juveniles turned into adulthood, they showed adult characteristics of vocal patterns. Together our results suggest that vocal behavior changes during ontogeny, and individuals are more strongly connected with individuals of the same age-class within acoustic networks.

Low skin temperature impairs the cutaneous vasodilator response to local progressive pressure strain.

A pressure-induced vasodilation (PIV) was recently reported as a putative protective response in human skin. Therefore, we examined the influence of skin temperatures on cutaneous blood flow responses to local progressive pressure strain. Ten healthy volunteers were studied at different ambient temperatures leading to low (29.0 +/- 0.3 degrees C), intermediate (32.6 +/- 0.1 degrees C), high (33.9 +/- 0.1 degrees C) and very high (36.0 +/- 0.1 degrees C) skin temperatures. We measured cutaneous blood flow using laser Doppler flowmetry on the foot in response to a local progressive pressure increase of 5.0 mm Hg min(-1). Progressive pressure strain led to an almost linear cutaneous laser Doppler flow decrease at both low and intermediate skin temperatures (-40.1 +/- 6.6% and -31.2 +/- 6.5% from baseline at 30 +/- 1.25 mm Hg), whereas at both high and very high skin temperatures, subjects responded with a transient cutaneous vasodilation (+33.6 +/- 10.6% and +50.6 +/- 15.4% from baseline at 30 +/- 1.25 mm Hg). These findings suggest that high skin temperatures are required for the PIV to develop.