Distally based sural fasciomusculocutaneous flap for treatment of wounds of the distal third of the leg and ankle with exposed internal hardware

Soft tissue reconstruction of the distal third of the lower limb with exposure of the internal hardware is a challenging problem with several potential complications, such as exposure of the fracture line, fracture instability and bacterial contamination. The treatment of these lesions usually consists of substitution of the internal hardware with external fixation devices and further flap coverage. We propose a different reconstructive approach, characterized by harvesting a sural fasciomusculocutaneous flap on the exposed internal hardware once a sterile ground has been obtained. Four patients were retrospectively analyzed. Soft tissue reconstruction was achieved in all cases. In one case hardware removal was necessary for complete healing. The sural fasciomusculocutaneous flap is a safe alternative to other pedicled and free flaps. Moreover, it allows direct coverage of internal fixators, thus completing the reconstruction in less time. This flap fits best to the morphology of the wound and internal hardware, leaving the main vascular trunk of the leg intact and at the same time providing a reliable vascular supply

Relating Habitat and Climatic Niches in Birds

Predicting species' responses to the combined effects of habitat and climate changes has become a major challenge in ecology and conservation biology. However, the effects of climatic and habitat gradients on species distributions have generally been considered separately. Here, we explore the relationships between the habitat and thermal dimensions of the ecological niche in European common birds. Using data from the French Breeding Bird Survey, a large-scale bird monitoring program, we correlated the habitat and thermal positions and breadths of 74 bird species, controlling for life history traits and phylogeny. We found that cold climate species tend to have niche positions in closed habitats, as expected by the conjunction of the biogeographic history of birds' habitats, and their current continent-scale gradients. We also report a positive correlation between thermal and habitat niche breadths, a pattern consistent with macroecological predictions concerning the processes shaping species' distributions. Our results suggest that the relationships between the climatic and habitat components of the niche have to be taken into account to understand and predict changes in species' distributions

Commissioning the New CERN Beam Instrumentation Following the Upgrade of the LHC Injector Chain

The LHC injectors Upgrade (LIU) program has been fully implemented during the second long shutdown (LS2), which took place in 2019-20. In this context, new or upgraded beam instrumentation was developed to cope with H⁻ beam in LINAC4 and the new Proton Synchrotron Booster (PSB) injection systems which would provide high brightness proton beams in the rest of the injector complex. After a short overview of the newly installed diagnostics, the main focus of this paper will move to the instruments already commissioned with the beam. This will include LINAC4 diagnostics, the PSB H⁰/H⁻ monitor, the PSB Trajectory Measurement System, and the PS beam gas ionization monitor. In addition, particular emphasis will be given to the first operational experience with the new generation of fast wire scanners installed in all injector synchronous

Data from: Opportunistic records reveal Mediterranean reptiles’ scale‐dependent responses to anthropogenic land use

Although classified among the greatest threats to the world's biodiversity, the effects of land use and their scale dependency are left unexplored in many taxonomic groups. Reptiles are among the most data‐deficient vertebrates in this respect, although their ecological traits make them highly sensitive to habitat modifications. We tested whether land use gradients shape the distributions of Mediterranean reptiles at regional and local scales, and whether species’ ecological traits and phylogeny explain these patterns. Reptiles are generally rare and hard to survey through standardized protocols. We overcame these obstacles by modeling an original data set of 18164 opportunistic occurrence records for 14 reptile species with spatially‐explicit point process models incorporating known sources of sampling heterogeneity and spatially autocorrelated error. At a regional scale, reptiles favored open habitats and tended to avoid urban areas. At a local scale, the persistence of open habitats did better than forest resulting from land abandonment in maintaining reptiles within a heavily anthropogenic matrix. Contrary to our expectations, the absence of any clear trait or phylogenetic signals suggests that these responses are mediated by a complex interplay between species’ ecology and regional biogeographic history. These results demonstrate that reptile responses to land use are scale‐dependent and locally exacerbated when anthropogenic pressure is high. We further show that land abandonment is insufficient to preserve reptiles in the face of anthropogenic pressures unless patches of suitable habitat are effectively maintained. Eventually, our study further illustrates the effectiveness of volunteer‐based opportunistic sampling in testing hypotheses on the determinants of rare species’ distributions

Aspiration risk factors, microbiology, and empiric antibiotics for patients hospitalized with community-acquired pneumonia

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study design and methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P 50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage