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Introduction The synovial wrist ganglion is a particularly common pathology of which the first "complication" is recidivism. The main objective of our study was to determine the rate of recurrence of this pathology in a series of arthroscopic patients. The secondary objective was to assess patient satisfaction well after the operation. Material and methods Our study was observational and retrospective and involved 30 patients (17 dorsal and 13 palmar cases) aged 41 years on average. The patients underwent an arthroscopic procedure for a palmar or dorsal ganglion of the wrist between March 2007 and April 2013. The data were collected by re-reading the files and conducting telephone interviews. Each patient answered a questionnaire about the operation, after-treatment, and their satisfaction well after the surgery. At the end of the interview, we calculated the Patient Rated Wrist Evaluation (PRWE) score. Results The mean follow-up was 4.6 years. A recurrence was noted in 4 (13%) cases, at an average delay of 9 months (6 months–1 year). There were only 2 patients (6.7%) that experienced the complication of complex regional pain syndrome type 1. Twenty-eight (93%) patients experienced improvement in postoperative pain. For 27 (90%) patients, firm-handed activities could be practised without limitation. The average time to resumption of activities of daily living was 27.1 days (1–240 days), resumption of firm-handed activities was 56 days (15–360 days), and return to work was 47.5 days (1–360 days). The mean PRWE score was 6.9/50 (0–34) for pain and 1.38/50 (0–8) for function. Conclusion The 13% recurrence rate is on the average of what is observed in the literature. Later satisfaction with the intervention is very good, and complications remain rare.Studies tend to show a lower rate of complications and recurrence following arthroscopic treatment, but to date, no randomized comparative series between the two methods has yet revealed any significant difference in these two points. A study of this type on a large scale could make it possible to highlight one of these treatment approaches.

Lateral epicondylitis is a condition whose pathophysiology is poorly understood and whose optimal treatment divides physicians. Arthroscopy has proven its worth, with results similar to or better than open surgery. The purpose of this study was to look for prognostic factors for the outcomes of arthroscopic treatment of lateral epicondylitis. This was a retrospective, single-center study involving 39 cases (36 patients). Patients were split into two groups based on the Mayo Elbow Performance score (MEPS). A good result was defined as a score of 75 or better. The variables of interest were gender, age, body mass index, smoking habits, recognition as an occupational disease, duration of absence from work, cartilage involvement, presence of a capsular lesion and length of follow-up. The mean follow-up at review was 37.2 months (± 17.4). The average MEPS was 77.44 (± 15.51). Smoking was statistically related to a poor result (P = 0.0422) and a longer follow-up was statistically related to a good result (P = 0.0396). We identified two prognostic factors for lateral epicondylitis treated by arthroscopy. Smoking has a negative effect and ideally, patients should quit before surgical treatment. Time has a positive effect; thus patients should be informed that it will take several months or even years for their ailment to improve. Taking these factors into consideration will improve the functional outcomes of this surgery.

Several techniques have been described for fusion of the distal interphalangeal joint. The intramedullary Lync

Hydraulic architecture imposes a fundamental control on water transport, underpinning plant productivity, and survival. The extent to which hydraulic architecture of mature trees acclimates to chronic drought is poorly understood, limiting accuracy in predictions of forest responses to future droughts. We measured seasonal shoot hydraulic performance for multiple years to assess xylem acclimation in mature piñon (Pinus edulis) and juniper (Juniperus monosperma) after 3+ years of precipitation manipulation. Our treatments consisted of water addition (+20% ambient precipitation), partial precipitation-exclusion (-45% ambient precipitation), and exclusion-structure control. Supplemental watering elevated leaf water potential, sapwood-area specific hydraulic conductivity, and leaf-area specific hydraulic conductivity relative to precipitation exclusion. Shifts in allocation of leaf area to sapwood area enhanced differences between irrigated and droughted K

Concentrations of atmospheric carbon dioxide (CO2) have continued to increase whereas atmospheric deposition of sulphur and nitrogen has declined in Europe and the USA during recent decades. Using time series of flux observations from 23 forests distributed throughout Europe and the USA, and generalised mixed models, we found that forest-level net ecosystem production and gross primary production have increased by 1% annually from 1995 to 2011. Statistical models indicated that increasing atmospheric CO2 was the most important factor driving the increasing strength of carbon sinks in these forests. We also found that the reduction of sulphur deposition in Europe and the USA lead to higher recovery in ecosystem respiration than in gross primary production, thus limiting the increase of carbon sequestration. By contrast, trends in climate and nitrogen deposition did not significantly contribute to changing carbon fluxes during the studied period. Our findings support the hypothesis of a general CO2-fertilization effect on vegetation growth and suggest that, so far unknown, sulphur deposition plays a significant role in the carbon balance of forests in industrialized regions. Our results show the need to include the effects of changing atmospheric composition, beyond CO2, to assess future dynamics of carbon-climate feedbacks not currently considered in earth system/climate modelling.

The partitioning of photosynthates toward biomass compartments plays a crucial role in the carbon (C) sink function of forests. Few studies have examined how carbon is allocated toward plant compartments in drought-prone forests. We analyzed the fate of gross primary production (GPP) in relation to yearly water deficit in an old evergreen Mediterranean Quercus ilex coppice severely affected by water limitations. Carbon fluxes between the ecosystem and the atmosphere were measured with an eddy covariance flux tower running continuously since 2001. Discrete measurements of litterfall, stem growth and fAPAR allowed us to derive annual productions of leaves, wood, flowers and acorns, and an isometric relationship between stem and belowground biomass has been used to estimate perennial belowground growth. By combining eddy covariance fluxes with annual net primary productions (NPP), we managed to close a C budget and derive values of autotrophic, heterotrophic respirations and carbon-use efficiency (CUE; the ratio between NPP and GPP). Average values of yearly net ecosystem production (NEP), GPP and Reco were 282, 1259 and 977 g C m−2. The corresponding aboveground net primary production (ANPP) components were 142.5, 26.4 and 69.6 g C m−2 for leaves, reproductive effort (flowers and fruits) and stems, respectively. NEP, GPP and Reco were affected by annual water deficit. Partitioning to the different plant compartments was also impacted by drought, with a hierarchy of responses going from the most affected – the stem growth – to the least affected – the leaf production. The average CUE was 0.40, which is well in the range for Mediterranean-type forest ecosystems. CUE tended to decrease less drastically in response to drought than GPP and NPP did, probably due to drought acclimation of autotrophic respiration. Overall, our results provide a baseline for modeling the inter-annual variations of carbon fluxes and allocation in this widespread Mediterranean ecosystem, and they highlight the value of maintaining continuous experimental measurements over the long term.

Trauma of the wrist is often responsible for multiple ligament injuries. We wanted to know if the association of a luno-triquetral ligament lesion and a triangular fibrocartilage disc lesion has a poor prognosis. We reviewed 32 patients with a traumatic injury of the triangular ligament, with a mean age of 35 years, and 32 months of follow up. The functional scores used were the Modified Mayo Wrist score, the Quick DASH score, and the Herzberg score. Patients were classified according to the severity of luno-triquetral lesions, in conformity with the Geissler's classification. Ten patients had a healthy ligament, 11 a stable lesion stage 1 and 11 an unstable lesion stage 2, 3 or 4. The joint mobility averages were 59.5° in flexion, 64.2° in extension, a pronation of 71.3°, a supination of 74.1°, an ulnar inclination of 33.8° and a radial inclination of 16.8°. The Modified Mayo Wrist score average was 75/100, the Herzberg score average was 81.5/100 and the average of the Quick DASH 8/100. The patients were all very satisfied or satisfied with their intervention. There was no statistically significant difference between the three groups studied regarding mobility and functional scores. In this study, an associated luno-triquetral ligament injury does not seem to worsen the functional outcome after surgery, provided appropriate treatment had been performed. However, a larger patient sample is needed to verify these findings.

Summary 1 Understanding the effect of water deficit on plant respiration and its temperature sensitivity at long time-scales is important for anticipating the shift in ecosystem dynamics that is expected to occur as a result of climate change. 2 We investigated seasonal variations of leaf dark respiration and sensitivity to temperature in the upper and lower canopy of Quercus ilex trees in a forest stand that had been exposed to either 33% throughfall reduction or normal rainfall for the preceding 6 years. 3 For upper and lower canopy leaves, light-saturated photosynthesis and respiration at a reference temperature of 15 °C (R15) had the lowest values in late summer, when both traits were lower in trees subjected to throughfall reduction than in those subject to control conditions. Respiration acclimated to seasonal shifts in temperature, more intensively through summer than winter and in throughfall-exclusion than control trees. Foliar concentration of soluble sugars was positively correlated with R15 across seasons. 4 As leaf respiration decreased with increasing water deficit, and the relationship between water status and respiration did not differ between trees that had been exposed to 7 years of enhanced drought when compared with controls, we suggest that drier conditions projected for the Mediterranean may attenuate the stimulation of leaf respiratory CO2 release by global warming in Q. ilex forests.

The medical art is more and more legally regulated. The case-law about civil medical liability has widely changed these past years. The reversal of the burden of proof regarding patient’s information, the presumption of responsibility in case of nosocomial infection, the medical liability without fault, the therapeutic risk and finally the law of 4 March 2002 are just a few examples of these changes. Regarding this judicial tendency of the medical practice, it appears interesting to study the contentious matters between doctors and patients in the orthopaedic and traumatologic surgery activity of a regional university hospital. Over a 20-year-period activity, at a rate of 3,000 patients per year, we found 20 files. The first complaints occurred 12 years after the medical event; they have become more frequent in the past 3 years. The most frequent reasons of complaint are the nosocomial infections and the lack of information to the patients. The rare medical errors could have had less effect if discussed beforehand with the patients. Nowadays fact sheets are available to the public and the committee for the prevention of nosocomial infection (CLIN) is positively involved. The complaints’ handling process is still slow, and therefore delays the compensation of victims. The increasing number of complaints made to the Regional commission for conciliation and compensation (CRCI) could be a solution to address those delays.

Resume Le CITH de Rennes a une double vocation d'innovation et d'evaluation des technologies pour la sante. Il s'inscrit, plus specifiquement, dans le cadre des systemes de surveillance multivaries de diagnostic et des protheses actives implantables permettant d'explorer, d'evaluer et de traiter les fonctions cardiovasculaire, nerveuse et respiratoire. Cet article decrit brievement sa genese, ses partenaires et quelques-unes des activites conduites depuis 2001.

In order to later make precise the operative technique of free vascularized elbow allograft transfer, the anatomic conditions necessary for the success of such an operation are reviewed. The exact topography of the nutrient foramina of the humerus, radius, and ulna has been specified on 102 dry bones. The osseous resection at the recipient will have to be carried out on these aspects: nutrient foramina of the three bones of the elbow (at 9 cm from medial epicondyle for the humerus; at 8 cm for the two bones of forearm) in order to preserve diaphysary vascularization of the recipient. A study of arterial and venous vascularization carried out on 18 anatomic specimens showed that the osseous ends were irrigated by a periosteal arterial network and were drained in the centromedullary cavities. Systematization of the arteriovenous blood supply of the distal end of the humerus and proximal ends of the two forearm bones is proposed after dissection of 18 anatomic specimens. Arterial periosteal territories are defined. The importance of each peri articular arteriole is estimated according to the surface of its respective section. A radial, constant, and musculoperiosteal collateral artery from the brachial artery is described. It accounts for 12% (+/- 3%) of the total contribution. The recurrent radial artery is the most significant: 31% (+/- 9%) of the total contribution. The profunda brachii artery is negligible: 4% (+/- 2%) of the total contribution. As well for vascular as mechanical reasons, osteosynthesis will have to be carried out using screwed plates, the optimal location of which is specified according to the arterial periosteal cartography. Ulnar and radial nerves and, to a lesser extent, the median nerve can be harvested "en bloc" preserving their vascular supply in order to make vascularized grafts of them. Free vascularized elbow allograft transfer is technically possible, if one respects these anatomic bases.

Aim: We present early optical spectroscopy of the afterglow of the gamma-ray burst GRB 060206 with the aim of determining the metallicity of the GRB absorber and the physical conditions in the circumburst medium. We also discuss how GRBs may be important complementary probes of cosmic chemical evolution. Method: Absorption line study of the GRB afterglow spectrum. Results: We determine the redshift of the GRB to be z=4.04795+/-0.00020. Based on the measurement of the neutral hydrogen column density from the damped Lyman-alpha line and the metal content from weak, unsaturated Sii lines we derive a metallicity of [S/H] =-0.84+/-0.10. This is one of the highest metallicities measured from absorption lines at z~4. From the very high column densities for the forbidden Siii*, Oi*, and Oi** lines we infer very high densities and low temperatures in the system. There is evidence for the presence of H$_2$ molecules with logN(H_2) ~ 17.0, translating into a molecular fraction of logf \~ -3.5 with f=2N(H_2)/(2N(H_2)+ N(Hi)). Even if GRBs are only formed by single massive stars with metallicities below ~0.3Z(solar), they could still be fairly unbiased tracers of the bulk of the star formation at z>2. Hence, metallicities as derived for GRB060206 here for a complete sample of GRB afterglows will directly show the distribution of metallicities for representative star-forming galaxies at these redshifts., 4 pages, 4 figures. Accepted for publication in A&A Letters

Purpose of the study We conducted this retrospective study to analyze outcome obtained in 58 cases of carpal scaphoid nonunion treated with a non-vascularized corticocancellous graft. Our objective was to search for factors influencing outcome and identify appropriate indications. Material and methods Between 1984 and 1999, 103 patients were treated with a non-vascularized corticocancellous graft. Fifty-seven patients (58 wrists) were retained for analysis (4 deaths, 30 not attending follow-up consultation far from their residence, and 12 lost to follow-up). Mean follow-up was 106 months (range 19-212). Mean age was 36 years (20-62). Mean time to diagnosis of fracture was 35 months (6-252); the fracture was not recognized initially in 45 patients. According to the Schernberg classification, fractures were localized in zone II (n = 11), zone III (n = 40), and zone IV (n = 7). Using the Alnot classification, nonunion was grade I (n = 13), grade IIA (n = 20), grade IIB (n = 22), grade IIIA (n = 2), and grade IIIB (n = 1). Mean immobilization after grafting was 2.7 months. Results At three months, bone healing was achieved in 42 wrists. Thirty-six patients were very satisfied, 18 satisfied and four not satisfied. Twenty-seven patients presented significant pain at the graft harvesting site which regressed in all. There were no harvesting sequelae. Compared with the healthy wrist, we noted reduced flexion (8.7 degrees on average), extension (12.8 degrees on average), and radial inclination (10.5 degrees on average). Other wrist motions were not affected, particularly pronation and supination. The index of carpal height was 0.54 on average (range 0.47-0.57); carpal height was diminished in nine wrists. The radiolunate angle was 4.8 degrees on average (-17 degrees to +27 degrees). Dorsal intercalated segmental instability (DISI) was noted in twenty wrists. Bone healing was not achieved in eleven wrists, seven of which presented initial necrosis of the proximal pole. Pain improved in all patients. Persistence of DISI favored osteoarthritic degeneration. Discussion With this technique, we achieved bone healing in 81% of the cases. Non-vascularized grafting cannot provide cure in the event of advanced osteoarthrtic degeneration. Correction of DISI appears to be an indispensable element for the prevention of osteoarthritis. This technique should not be proposed for patients with a necrotic proximal pole, a vascularized graft would be preferable.

Osteoid osteomas are often localised in long bones but only rarely in the carpus. This is a case report of an osteoid osteoma in the trapezoid. Diagnosis was difficult and established late, due to misleading initial symptoms. Radiological examination allowed localisation of the nidus. For osteoid osteoma localised in a carpal bone, we recommend total removal without bone-graft or arthrodesis.

Resume Introduction . – Nous avons mene une etude prospective de l’osteosynthese en vasque sur des fractures de l’extremite distale du radius. Le but etait d’etudier les possibilites de reduction des fractures complexes et la stabilite de ce montage dans le temps. Methode . – Il s’agissait de 12 patients âges en moyenne de 47,1 ans presentant des fractures articulaires de l’extremite distale du radius. Tous les patients ont ete vus a j0, j45, a j180 et a 36 mois avec un bilan clinique (score de Herzberg) et radiologique (mesure des inclinaisons radiales, sagittales et de la variance ulnaire). Resultats . – A 36 mois, nous avions 8 bons et excellents resultats, 3 moyens et 1 mauvais. L’osteosynthese en vasque a permis des reductions satisfaisantes mais n’a pas pu empecher les deplacements secondaires dans les fractures comminutives. Discussion . – Nous pensons que l’osteosynthese en vasque est une bonne technique d’osteosynthese mais elle ne permet pas le controle de la variance ulnaire. Elle devrait etre associee a un comblement de la perte de substance osseuse dans les fractures comminutives et a un vissage epiphysaire chaque fois que cela est possible.

We led a retrospective study to determine the causes of the tendon ruptures post-operating in the surgery of the wrist rheumatoid dorsal and to estimate the clinical result. At follow-up, we measured the extension lag and the rolling-up of fingers by the distance palm-pulps. Nine patients were so revised in the average of 40 months, average age was of 50.7 years. The tendon ruptures arose in 3 months in 67% of the cases. Seven times, a procedure on the distal radio-ulnar joint had been necessary (5 Sauve-Kapandji and 2 Darrach). Thirty tendons had been concerned in this study, that is 3.3 tendons on average (1-5). Two main causes were found: attrition on the stub ulnaire and great intra-tendinous synovitis (per operating observation). At the revision, the lag extension means was 23 degrees (0-40). Rolling-up of the long fingers was complete 4 times on 7. The best results were observed after tendinous grafting or index proprius transfer with a lateral suture. Tendinous adhesions had arisen 6 times and persisted still at 3 patients. Our study underlines the interest to stabilize the stub ulnaire to prevent the post-operating ruptures and proposes a transfer or a graft in front of tendons very weakened by the synovitis.

A case of ulnar artery aneurysm following repeated hand injury in a mountain biker, is reported. The patient underwent surgical aneurysm resection with venous graft end-to-end anastomosis. Complete relief of symptoms is observed at 3 years follow-up. A literature review is presented.

The partitioning of photosynthates toward biomass compartments has a crucial role in the carbon sink function of forests. Few studies have examined how carbon is allocated toward plant compartments in drought prone forests. We analyzed the fate of GPP in relation to yearly water deficit in an old evergreen Mediterranean Quercus ilex coppice severely affected by water limitations. Gross and net carbon fluxes between the ecosystem and the atmosphere were measured with an eddy-covariance flux tower running continuously since 2001. Discrete measurements of litterfall, stem growth and fAPAR allowed us to derive annual productions of leaves, wood, flowers and acorns and an isometric relationship between stem and belowground biomass has been used to estimate perennial belowground growth. By combining eddy-covariance fluxes with annual productions we managed to close a C budget and derive values of autotrophic and heterotrophic respirations, NPP and carbon use efficiency (CUE, the ratio between NPP and GPP). Average values of yearly NEP, GPP and Reco were 282, 1259 and 977 g C m−2. The corresponding ANPP components were 142.5, 26.4 and 69.6 g C m−2 for leaves, reproductive effort (flowers and fruits) and stems. Gross and net carbon exchange between the ecosystem and the atmosphere were affected by annual water deficit. Partitioning to the different plant compartments was also impacted by drought, with a hierarchy of responses going from the most affected, the stem growth, to the least affected, the leaf production. The average CUE was 0.40, which is well in the range for Mediterranean-type forest ecosystems. CUE tended to decrease more slightly in response to drought than GPP and NPP, probably due to drought-acclimation of autotrophic respiration. Overall, our results provide a baseline for modeling the inter-annual variations of carbon fluxes and allocation in this widespread Mediterranean ecosystem and highlight the value of maintaining continuous experimental measurements over the long term.

Constraints on the mass distribution in high-redshift clusters of galaxies are not currently very strong. We aim to constrain the mass profile, M(r), and dynamical status of the $z \sim 0.8$ LCDCS 0504 cluster of galaxies characterized by prominent giant gravitational arcs near its center. Our analysis is based on deep X-ray, optical, and infrared imaging, as well as optical spectroscopy. We model the mass distribution of the cluster with three different mass density profiles, whose parameters are constrained by the strong lensing features of the inner cluster region, by the X-ray emission from the intra-cluster medium, and by the kinematics of 71 cluster members. We obtain consistent M(r) determinations from three methods (dispersion-kurtosis, caustics and MAMPOSSt), out to the cluster virial radius and beyond. The mass profile inferred by the strong lensing analysis in the central cluster region is slightly above, but still consistent with, the kinematics estimate. On the other hand, the X-ray based M(r) is significantly below both the kinematics and strong lensing estimates. Theoretical predictions from $\Lambda$CDM cosmology for the concentration--mass relation are in agreement with our observational results, when taking into account the uncertainties in both the observational and theoretical estimates. There appears to be a central deficit in the intra-cluster gas mass fraction compared to nearby clusters. Despite the relaxed appearance of this cluster, the determinations of its mass profile by different probes show substantial discrepancies, the origin of which remains to be determined. The extension of a similar dynamical analysis to other clusters of the DAFT/FADA survey will allow to shed light on the possible systematics that affect the determination of mass profiles of high-z clusters, possibly related to our incomplete understanding of intracluster baryon physics., Comment: 13 pages, 14 figures, submitted to A&A, abstract shortened

Background: The incidence of atrial arrhythmia (AA) in a DDD paced population is high. Mode switch (MS) functions are today widely used to manage AA during dual chamber sequential pacing. Aim and method: This work aims to present the new MS function of the Chorum (ELA Medical). It is based on the diagnosis of the acceleration of the atrial rhythm to detect premature atrial contractions and on the statistical analysis of the atrial rhythm to diagnose sustained AA. It is fully automatic and independent from programmed parameters including upper rate limit. Results: A clinical evaluation with Holter recordings in 194 patients revealed a high sensitivity; due to the statistical approach of the atrial rhythm AA was appropriately detected even in the case of partial loss of atrial sensing. Additionally, a high specificity could be demonstrated due to the ability of the algorithm to discriminate between pathological atrial rate and normal sinus tachycardia on the basis of the rate acceleration. Still false-positive response of MS occurred, for example, due to oversensing of ventricular far-field signals which can be corrected by reprogramming the device. Specific memory functions allow the clinician to follow up the patient using stored MS episodes. Especially marker chains recorded during MS help to identify false-positive response of MS and to suggest reprogramming of the device.Conclusion: Thus, MS and associated memory function are complementary tools to optimize the functioning of the device and the patient's follow-up.

Contexte L’epicondylalgie laterale d’origine tendineuse reste a ce jour une pathologie « mysterieuse » dont la physiopathologie n’est pas clairement etablie et dont les differents traitements font debat. Depuis une dizaine d’annees, le traitement par arthroscopie a prouve son interet, procurant des resultats similaires voire superieurs a la technique classique a ciel ouvert et permettant un retour plus precoce aux activites professionnelles et sportives, sans toutefois apporter une guerison a la majorite des patients. Le but de cette etude etait de chercher des facteurs pronostiques du resultat du traitement arthroscopique des epicondylites. Methode Il s’agit d’une etude retrospective, monocentrique portant sur 39 arthroscopies (36 patients) realisees d’avril 2009 a janvier 2014. Le critere de jugement etait le score de la Mayo Clinic adapte au coude. Un bon resultat etait defini par un score superieur ou egal a 75. Les donnees etudiees etaient le sexe, l’indice de masse corporelle, l’atteinte du cote dominant, le tabagisme, la reconnaissance en maladie professionnelle, la duree de l’arret de travail, l’atteinte cartilagineuse constatee a l’arthroscopie, l’existence d’une lesion capsulaire laterale definie selon la classification de Baker et le recul. Les patients ont ete revus en consultation pour une evaluation clinique et fonctionnelle. Resultats Le recul moyen lors de la revision etait de 37,2 mois (± 17,4). Le score de la Mayo Clinic moyen etait de 77,44 (± 15,51). Les donnees liees statistiquement a un mauvais resultat etaient le tabagisme (p = 0,0422) et la duree de l’arret de travail (p = 0,01447). Un recul important etait statistiquement lie a un bon resultat (p = 0,03956). Conclusion Le tabagisme est finalement le seul facteur pronostique sur lequel peut agir le chirurgien. Il est indispensable, avant d’envisager le traitement chirurgical d’une epicondylite, de chercher un tabagisme actif, de chiffrer la consommation et d’evaluer la dependance nicotinique par le test de Fagerstrom dans le but d’obtenir un sevrage tabagique avant l’intervention qui ne saurait etre que benefique. Les dispositions concernant un eventuel reclassement professionnel ou un amenagement de poste doivent etre prises avant l’intervention, afin de favoriser une reprise la plus precoce possible des activites professionnelles. Enfin, les patients doivent etre clairement informes sur l’evolution attendue en postoperatoire, a savoir une amelioration s’etalant sur plusieurs mois a plusieurs annees avec une absence de guerison dans la plupart des cas.

Mast seeding, the synchronous, highly variable seed production among years, is very common in tree species, but there is no consensus about its main causes and the main environmental factors affecting it. In this study, we first analyze a long-term data set on reproductive and vegetative growth of Quercus ilex in a mediterranean woodland in order to identify the main environmental drivers of interannual variation in flower and seed production and contrast the impact of climate vs. adaptive factors as main causes of masting. Second, we conducted an experiment of rainfall exclusion to evaluate the effects of an increasing drought (simulating predictions of global change models) on both reproductive processes. The annual seed crop was always affected by environmental factors related to the precipitation pattern, these abiotic factors disrupting the fruiting process at different periods of time. Seed production was strongly dependent upon water availability for the plant at initial (spring) and advanced (summer) stages of the acorn maturation cycle, whereas the final step of seed development was negatively affected by the frequency of torrential-rain events. We also found clear evidence that seed masting in the study species is not only regulated by selective endogenous rhythms, but is mainly a physiological response to the variable environment. Our results from the rainfall exclusion experiment corroborated the conclusions obtained from the 26-year fruiting record and demonstrated that the high interannual variation in seed crop was mainly determined by the success in seed development rather than by the flowering effort. Under a global change scenario, it could be expected that the drier conditions predicted by climate models reinforce the negative effects of summer drought on seed production, leading to negative consequences for tree recruitment and forest dynamics.

(Abridged). We aim at bridging the gap between absorption selected and emission selected galaxies at z~3 by probing the faint end of the luminosity function of star-forming galaxies at z~3. We have performed narrow-band imaging in three fields with intervening QSO absorbers (a damped Ly$\alpha$ absorber and two Lyman-limit systems) using the VLT. We target Ly-alpha at redshifts 2.85, 3.15 and 3.20. We find a consistent surface density of about 10 Ly-alpha-emitters per square arcmin per unit redshift in all three fields down to our detection limit of about 3x10^41 ergs s^-1. The luminosity function is consistent with what has been found by other surveys at similar redshifts. About 85% of the sources are fainter than the canonical limit of R=25.5 for most Lyman-break galaxy surveys. In none of the three fields do we detect the emission counterparts of the QSO absorbers. In particular we do not detect the counterpart of the z=2.85 damped Ly-alpha absorber towards Q2138-4427. Narrow-band surveys for Ly-alpha emitters are excellent to probe the faint end of the luminosity function at z~3. There is a very high surface density of this class of objects. This is consistent with a very steep slope of the faint end of the luminosity function as has been inferred by other studies. This faint population of galaxies is playing a central role in the early Universe. There is evidence that this population is dominating the integrated star-formation activity, responsible for the bulk of the ionizing photons at z~3 and likely also responsible for the bulk of the enrichment of the intergalactic medium., Comment: 15 pages, 13 figures. Accepted for publication in A&A

ELTs (endless loop tachycardias) are a common occurrence associated with DDD pacing. In order to detect and treat ELTs, an innovative automatic pacemaker algorithm was devised and evaluated. The basic principle of the algorithm rests on the relative stability of the ventriculoatrial conduction time (VACT) during ELTs. ELTs are suspected when the VACT remains stable and adheres to certain programmable limits referred to as VACT stability (16 or 32 msec); it is confirmed when the VACT remains stable after a programmable shortening of the AV delay (AVD) value, referred to as AVD shortening (47 or 63 msec). Ninety-one patients, 54 males and 37 females, were implanted with such an algorithm-specific device between January 10 and September 9, 1989. The reasons for implantation were as follows: 55 patients were implanted for AV block, 31 for sinus node dysfunction, and 2 for carotid sinus syndrome. Pacing parameters were programmed to favor ELT initiation (long AVD, short postventricular atrial refractory period [PVARP] and high atrial sensitivity) followed by basic programming of the algorithm (VACT stability set at 16 msec and AVD shortening set at 47 msec. Once this was done, a 24-hour Holter recording was obtained. Eighty-eight patients were thus analyzed, three being excluded from the final report due to the poor quality of the Holter tracings. In 43.2% of the sampling (38 patients), multiple episodes of ELT were identified, exhibiting a mean rate of 120 beats/min. In 26 of 38 cases (68.4%), the rate of ELT was found to be slower than the upper rate limit (URL). A total of 1,816 episodes were encountered, representing a mean value of 47.8 ± 78.4 episodes per patient per day (2 to 330 episodes). In 31 patients (81.5%), the algorithm proved to work correctly. For eight patients, some episodes were not terminated by the basic programming. For two of these eight patients, reprogramming the algorithm's parameters (VACT stability to 31 msec and AVD shortening to 63 msec) resulted in a successful diagnosis and termination of ELT.

Introduction Le kyste synovial de poignet est une pathologie particulierement repandue. Le traitement de reference est chirurgical et deux techniques s’affrontent, ciel ouvert et sous arthroscopie. La premiere « complication » reste la recidive. L’objectif principal de notre etude etait de determiner sur une serie de patients operes sous arthroscopie le taux de recidive de cette pathologie. L’objectif secondaire etait d’evaluer la satisfaction des patients a distance de l’operation. Patients et methodes Notre etude etait observationnelle, retrospective, portant sur 30 patients (17 kystes dorsaux, 13 palmaires) de 41 ans d’âge moyen, operes sous arthroscopie entre mars 2007 et avril 2013 d’un kyste palmaire ou dorsal du poignet. Les donnees ont ete recueillies par relecture des dossiers, et par entretien telephonique. Chaque patient repondait a un questionnaire traitant de l’operation, des suites operatoires, et de leur satisfaction a distance de la chirurgie. En fin d’entretien, nous calculions le score Patient-Rated Wrist Evaluation (PRWE). Resultats Le recul moyen etait de 4,6 ans. Une recidive a ete notee dans 4 (13 %) cas, a un delai moyen de 9 mois. Les seules complications etaient 2 (6,7 %) syndromes douloureux regionaux complexes de type 1. Vingt-huit (93 %) patients ont ressenti une amelioration sur la douleur en postoperatoire. Sur le resultat esthetique, 24 (80 %) etaient tres satisfaits, 6 (20 %) satisfaits. Vingt-huit (93 %) patients conseilleraient l’intervention a un membre de leur entourage. Pour 27 (90 %) patients, les activites avec poigne ont pu etre reprises sans limitation. Le delai moyen de reprise des activites de la vie quotidienne etait de 27,1 jours, la reprise des activites avec poigne de 56 jours, la reprise du travail de 47,5 jours. Le score PRWE moyen etait de 6,9/50 pour la douleur, 1,38/50 pour la fonction. Discussion Le taux de recidive a 13 % se situe dans la moyenne de ce qui est observe dans la litterature. La resection arthroscopique du kyste a apporte une reelle amelioration sur les symptomes pour la quasi-totalite des patients. La satisfaction a distance de l’intervention est tres bonne, et les complications restent rares. Conclusion Nos resultats sont proches de ceux observes dans plusieurs series « sous arthroscopie », mais aussi « ciel ouvert ». Des etudes tendent a montrer un plus faible taux de complication et de recidive suite au traitement arthroscopique, sans resultat significatif. Une serie comparative randomisee a grande echelle serait necessaire pour le confirmer.

The authors evaluated an algorithm present in the DDD pacemaker Chorus 6003 (Ela Medical) able to detect and treat the pacemaker-mediated tachycardia (PMT) and able to reprogram automatically some parameters to prevent new episodes of tachycardia. Ten patients were implanted with Chorus 6003 and submitted to 24-hour Holter monitoring to evaluate the algorithm performance. PMTs were revealed in 7/10 patients, and a total of 261 episodes were detected. All episodes were terminated, although 71 episodes were interrupted during detection and confirmation phases. In 3 patients closely coupled PMT episodes activated the autoreprogram function. In the study, the algorithm showed a high sensitivity and specificity. >

Software was developed to pilot an injection pump, easily adaptable to each type of drug and equipment. A computerized infusion system was utilized during pacemaker implantation. The study was performed in five patients. Hypnomidate was infused via a Baxter Flo-Gard 8000 volumetric pump driven by a Toshiba-3200 PC. Theoretical concentration is compared with blood sample dosages. Target concentration in blood samples during injection was 0.401 ug/ml+or-0.165 (0.588-0.217). The mean correlation was 0.86+or-0.12. >

Before programming a dual-chamber pacemaker (PM), the physician must take into account the patient's (pt) clinical profile. Such software is now included in the PM programmer software, supported by a PC computer. It allows direct programming of the PM. This software is now under clinical evaluation. Ninety-four pts were enrolled in the study: 40 women, 54 men (71+or-9 years old, 20-91). EP pathologies at implant were: 61 atrioventricular blocks (65%), 33 sinoatrial blocks (35%). At the end of the 1.2+or-1.7 months follow-up 85.1% of programming proposals have been accepted.

Cardiac papillary fibroelastoma (CPF) is a rare and histologically benign tumor, but may have a malignant propensity for life-threatening complications; thus, surgical removal is justified. Case histories were reviewed of four patients who underwent surgical management after diagnosis of CPF located on aortic (n = 2) or mitral (n = 2) valves. Our aim was to provide explanations for the clinical diversity of the lesions and, using histological and immunohistochemical methods, to hypothesize the genesis of these tumors.Among four patients with a diagnosis of valvular CPF, two had previous and recent history of neurological embolic symptoms with small echographically located tumors attached to the ventricular side of aortic cusps. Two other patients (one with paroxysmal atrial fibrillation, one with no neurological or rhythmically related stroke) had CPFs located on the posterior or anterior mitral leaflets.Surgical excision was performed with a conservative valve-sparing approach. Histological and specific immunohistochemical (IHC) studies were conducted on all samples. The postoperative course was uneventful, and histological analysis confirmed the diagnosis of CPF with typical fronds characterized by three successive layers. In the first two patients there was correlation between neurological events and the presence of thrombus aggregated on the injured superficial endothelial layer. In the other patients, no endothelial damage or thrombus was found. IHC studies showed dysfunction of the superficial endothelium, a centrifugal mesenchymal cellular migration arising from the central layer to the superficial layer with differentiation steps, the presence of dendritic cells in the intermediate layer, and remnants of cytomegalovirus (CMV) in the intermediate layer.Despite their benign histological aspect, and independent of their size, CPFs justify surgical excision because of their high potential to systemic embolization. In most cases, valve sparing management is possible with no observed recurrence after complete excision. The presence of dendritic cells and CMV strongly suggests the possibility of a virus-induced tumor, therefore evoking the concept of a chronic form of viral endocarditis.

Constant rapid pacing may suppress arrhythmias, but it is usually poorly tolerated in the long term. We report a pilot study of a new pacing algorithm for overdrive suppression of atrial premature complexes (APCs) and atrial fibrillation (AF), which prevents postextrasystolic pauses and varies the pacing rate in response to the frequency of APCs. The algorithm was tested in a multiple crossover study for 24 hours in dual chamber pacemakers implanted in 70 patients. Comparison was made on ambulatory recordings between the number of atrial arrhythmias commencing with the algorithm active and inactive. In all cases, the algorithm functioned as designed. No patient was aware of its operation, and no malignant arrhythmias were induced. The 36 recordings that showed atrial arrhythmia were included for analysis. The effects of the algorithm were: APCs (estimated from pacemaker statistics) reduced in 18 patients, increased in 8 (P = 0.02); atrial salvos reduced in 12, increased in 4 (P = 0.041); and AF reduced in 11, increased in 8 (P = NS). In all patients with frequent AF (5 episodes in total), fewer episodes occurred when the algorithm was active. We conclude that the algorithm is safe and well tolerated, reduces atrial ectopic activity, and may reduce the frequency of sustained atrial fibrillation.

The methods used for preventing endless-loop tachycardias (ELTs) most often consist of initiating a long postventricular atrial refractory period (PVARP) with the sensing of every event likely to induce ELTs, such as sensed premature ventricular contractions (PVCs). A new fallback function may be useful to prevent the initiation of ELTs. A window of atrial rate acceleration detection (WARAD) is initiated with the sensing of every sinus event and equals 75% of the preceding PP interval. If an atrial event is sensed during this period, as are premature atrial contractions (PACs), no atrioventricular (AV) delay is initiated, but an atrial pulse output is delivered and a subsequent 31-msec AV delay is started. Theoretically retrograde P waves are premature compared to sinus rhythm. They are therefore detected as PACs, and do not initiate AV delay, thus prohibiting the induction of ELTs. This function was tested in six patients, using external or implanted Chorus 2 pacemakers. Short PVARP (203 msec) and high atrial sensibility were programmed. Retrograde conduction was induced either by inefficient atrial pacing or a long programmed AV delay. Two different dual chamber settings were tested: dual chamber pacing with the fallback function On or Off. In every situation, the function proved effective in preventing ELTs: the number of tachycardia episodes went from 124 with the function programmed Off to 5 with the function programmed On for comparable durations. More than 75 ELTs effectively prevented by fallback have been recorded.

Les allogreffes non vascularisees du coude presentent une deterioration progressive avec le temps. Une des causes pourrait etre l’absence de revascularisation. Cette etude precise la vascularisation peri-articulaire et permet de decrire la technique chirurgicale de greffe vascularisee du coude. Les vaisseaux de 12 membres superieurs dont 10 frais ont ete injectes au latex. Les vaisseaux periostes ont ete disseques, mesures, dessines et photographies La capsule ne doit pas etre exposee. La partie antero-mediale de l’extremite distale de l’humerus, la zone situee en regard de la fossette olecrânienne doit etre respectee. La face antero-mediale de l’ulna, le col du radius doivent etre egalement respectes. Par un abord anterieur, les vaisseaux sont disseques et lies a des niveaux precis : l’artere brachiale 12 cm au-dessus de l’epicondyle medial, les arteres radiale et ulnaire 10 cm en dessous. Les tendons sont coupes a un niveau permettant leur suture a ceux du receveur. Quelques muscles profonds sont conserves car ils protegent le reseau perioste. Les niveaux de section osseuse sont definis en fonction des zones de vascularisation et de la topographie des foramens nourriciers : 9 cm au-dessus de l’epicondyle medial pour l’humerus, 7 cm au-dessous pour les deux os de l’avant-bras. Il est possible de prelever simultanement le nerf ulnaire et/ou le nerf radial vascularise(s). Une osteosynthese solide est appliquee sur les zones de moindre importance vasculaire. L’allogreffe vascularisee est techniquement possible et pourrait donner des survies de l’articulation transplantee sans degradation mecanique ulterieure.

We present a joint optical/X-ray analysis of the massive galaxy cluster Abell 2744 (z=0.308). Our strong- and weak-lensing analysis within the central region of the cluster, i.e., at R, Submitted to MNRAS -- 19 pages, 8 figures, 6 tables