Complex fractures of the distal humerus in the elderly: Is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases

SummaryIntroductionDistal humerus fractures are fairly rare. But as our population ages, these fractures become more complex and the choice of treatment more delicate. Poor bone quality results in many technical problems and the fixation hardware stability remains at risk. The goal of this study was to evaluate the functional recovery and morbidity of complex distal humerus fractures in elderly patients when treated with elbow prosthesis.HypothesisGood functional recovery can be achieved with a total joint replacement.Patients and methodsThis series consisted of 20 patients (18 women and two men) having an average age of 80years (range 65–93, median 80). Based on the AO classification, there were two Type A2 fractures, two Type B fractures, 15 Type C fractures and one fracture that could not be classified because of previous rheumatoid disease history at this elbow. Two fractures were open. In two cases, the olecranon was also fractured. Treatment consisted of the implantation of a Coonrad-Morrey, hinge-type total elbow prosthesis (Zimmer®, Warsaw, IN, USA). The Mayo Clinic surgical approach was used 17 times and the transolecranon approach was used three times. Primary arthroplasty was performed in 19 cases and the surgery was performed after six weeks of conservative treatment (diagnostic delay) in one case. Unrestricted motion was allowed after surgery, but a maximum of 0.5kg could be carried during the first 3months; this was subsequently increased to 2.5kg.ResultsFifteen of the 20 patients were available for reevaluation with an average follow-up of 3.6years (range 1.7–5.5, median 3.4). Four patients had died and one was lost to follow-up. The average range of motion was 97° (range 60–130°), comprising an average flexion of 130° (range 110–140°) and average loss of extension of 33° (range 0–80°). Pronation and supination were normal. The average Mayo Elbow Performance Score (MEPS) was 83 (range 60–100, median 80). X-rays revealed seven cases of radiolucent lines, with two being progressive. There was no visible wear of the polyethylene bushings at the hinge. Six patients had moderate periarticular heterotopic ossification. The two cases of olecranon osteotomy and one case of olecranon fracture had healed. There were no surgical site infections but two cases of ulnar compression, one of which required neurolysis. There was one case of humeral component loosening after 6years, but the implant was not changed.DiscussionThe clinical range of motion results were comparable to published data. The functional scores were slightly lower, mainly because of the pain factor. The initial results were encouraging and consistent with published data as long as the indications were well-chosen. Based on this retrospective study, total elbow arthroplasty can be a valid alternative in the surgeon's treatment armamentarium for complex distal humerus fractures in elderly patients who have moderate functional demands. Our results support our hypothesis, since we found good functional recovery without associated morbidity.Level of evidenceLevel IV retrospective study without comparator

Global analysis of the TRAPPIST Ultra-Cool Dwarf Transit Survey

ABSTRACT We conducted a global analysis of the TRAPPIST Ultra-Cool Dwarf Transit Survey – a prototype of the SPECULOOS transit search conducted with the TRAPPIST-South robotic telescope in Chile from 2011 to 2017 – to estimate the occurrence rate of close-in planets such as TRAPPIST-1b orbiting ultra-cool dwarfs. For this purpose, the photometric data of 40 nearby ultra-cool dwarfs were reanalysed in a self-consistent and fully automated manner starting from the raw images. The pipeline developed specifically for this task generates differential light curves, removes non-planetary photometric features and stellar variability, and searches for transits. It identifies the transits of TRAPPIST-1b and TRAPPIST-1c without any human intervention. To test the pipeline and the potential output of similar surveys, we injected planetary transits into the light curves on a star-by-star basis and tested whether the pipeline is able to detect them. The achieved photometric precision enables us to identify Earth-sized planets orbiting ultra-cool dwarfs as validated by the injection tests. Our planet-injection simulation further suggests a lower limit of 10 per cent on the occurrence rate of planets similar to TRAPPIST-1b with a radius between 1 and 1.3 R⊕ and the orbital period between 1.4 and 1.8 d.</jats:p

The role of angiography in the congruence of cardiovascular measurements between autopsy and postmortem imaging.

Postmortem CT angiography is the method of choice for the postmortem imaging investigations of the cardiovascular (CV) system. However, autopsy still remains the gold standard for CV measurement. Nevertheless, there are not any studies on CV measurements on the multi-phase postmortem angiography (MPMCTA) which includes comparisons with autopsy. Therefore, the aim of this study is to compare CV measurements between the native CT scan and the three phases of the MPMCTA to find out which of these modalities correlate the best with autopsy measurements. For this study, we selected retrospectively 50 postmortem cases that underwent both MPMCTA and autopsy. A comparison was carried out between the CV measurements obtained with imaging (aorta; heart cavities and cardiac wall thicknesses; maximum cardiac diameter and cardiothoracic ratio) and at the autopsy (aorta; cardiac valves, ventricular thicknesses, and weight). Our results show that the dynamic phase displays an advantage for the measurement of the aortas. However, the MPMCTA is not accurate to measure the cardiac wall thicknesses. The measurements of the heart cavities show no correlation with the heart valves. The cardiothoracic ratio measured by the MPMCTA shows no correlation with the heart weight. Nevertheless, the maximum cardiac diameter exhibits a correlation with the latter on the venous and dynamic phase. These results show that only few CV parameters measured with imaging correlate with measurement obtained at the autopsy. These results indicate that in order to better estimate values obtained at the autopsy, we need to define new reference values for the CV measurement on MPMCTA

In search of lost hybridity: the French Daniel Deronda

Starting from a set of examples of borrowings from French in George Eliot’s Daniel Deronda, I explore the various ways in which the characters’ and narrator’s use of mixed English–French utterances generates inferences which make the transcending of their mono-cultural self possible. I go on to argue that in Jumeau’s recent French translation of the novel, the reader is not given access to those inferences, resulting in the erasing of an Anglo-European, cosmopolitan identity

TRAPPIST-1: Global results of the Spitzer Exploration Science Program Red Worlds

With more than 1000 hours of observation from Feb 2016 to Oct 2019, the Spitzer Exploration Program Red Worlds (ID: 13067, 13175 and 14223) exclusively targeted TRAPPIST-1, a nearby (12pc) ultracool dwarf star orbited by seven transiting Earth-sized planets, all well-suited for a detailed atmospheric characterization with the upcoming JWST. In this paper, we present the global results of the project. We analyzed 88 new transits and combined them with 100 previously analyzed transits, for a total of 188 transits observed at 3.6 or 4.5 $\mu$m. We also analyzed 29 occultations (secondary eclipses) of planet b and eight occultations of planet c observed at 4.5 $\mu$m to constrain the brightness temperatures of their daysides. We identify several orphan transit-like structures in our Spitzer photometry, but all of them are of low significance. We do not confirm any new transiting planets. We estimate for TRAPPIST-1 transit depth measurements mean noise floors of $\sim$35 and 25 ppm in channels 1 and 2 of Spitzer/IRAC, respectively. most of this noise floor is of instrumental origins and due to the large inter-pixel inhomogeneity of IRAC InSb arrays, and that the much better interpixel homogeneity of JWST instruments should result in noise floors as low as 10ppm, which is low enough to enable the atmospheric characterization of the planets by transit transmission spectroscopy. We construct updated broadband transmission spectra for all seven planets which show consistent transit depths between the two Spitzer channels. We identify and model five distinct high energy flares in the whole dataset, and discuss our results in the context of habitability. Finally, we fail to detect occultation signals of planets b and c at 4.5 $\mu$m, and can only set 3$\sigma$ upper limits on their dayside brightness temperatures (611K for b 586K for c)

Evidence for transit-timing variations of the 11 Myr exoplanet TOI-1227 b

TOI-1227 b is an 11 Myr old validated transiting planet in the middle of its contraction phase, with a current radius of 0.85 RJ. It orbits a low-mass pre-main sequence star (0.170 M⊙, 0.56 R⊙) every 27.4 days. The magnetic activity of its young host star induces radial velocity jitter and prevents good measurements of the planetary mass. We gathered additional transit observations of TOI-1227 b with space- and ground-based telescopes, and we detected highly significant transit-timing variations (TTVs). Their amplitude is about 40 minutes and their dominant timescale is longer than 3.7 years. Their most probable origin is dynamical interactions with additional planets in the system. We modeled the TTVs with inner and outer perturbers near first and second order resonances; several orbital configurations provide an acceptable fit. More data are needed to determine the actual orbital configuration and eventually measure the planetary masses. These TTVs and an updated transit chromaticity analysis reinforce the evidence that TOI-1227 b is a planet

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far