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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Monteggia-like fractures are rare but complex injuries to the elbow joint, accounting for 2-5% of proximal forearm fractures. Even for experienced surgeons, their treatment can be challenging. The objective of this retrospective study was to analyze the short-term results after surgical treatment of Monteggia-like fractures in adults.Methods: All patients who sustained a Monteggia-like fracture over a period of 3 years (2014-2016) and underwent surgical treatment in the authors' institution were followed-up. Pain level (visual analogue scale, VAS), range of motion (ROM), Broberg and Morrey Score (BMS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) Score, and subjective elbow score (SEV) were recorded.Results: Of 14 adult patients who sustained a Monteggia-like lesion during a 3-year period, 13 were available for follow-up after a mean time of 21.9 months (7 to 44 months). According to the BMS, 3 patients (15%) showed excellent, 7 (54%) good, 2 (15%) fair, and 2 (15%) poor results. A total of 3 patients (23%) needed revision surgery other than implant removal. Mean BMS was 79 (23 to 100), mean MEPS was 82 (35 to 100), mean DASH score was 23.6 (0 to 61), mean SEV was 66% (20 to 90), and mean VAS was 2.6 (0-8).Conclusion: Good short-term results can be achieved if the injury is classified correctly and a standardized surgical treatment of all injury components is performed. The results are comparable with data from the literature. Patients with Monteggia-like fractures should be informed about the risk of potential functional deficits and the possible need of further surgery.Level of evidence: This study is evidence level IV. [ABSTRACT FROM AUTHOR]

Background: The prevalence of patellar tendinopathy is elevated in elite soccer compared to less explosive sports. While the burden of training hours and load is comparably high in youth elite players (age < 23 years), little is known about the prevalence of patellar tendinopathy at this age. There is only little data available on the influence of age, the amount of training, the position on the field, as well as muscular strength, range of motion, or sonographical findings in this age group. The purpose of the present study was to examine the above-mentioned parameters in all age groups of a German youth elite soccer academy.Methods: One hundred nineteen male youth soccer players (age 15,97 ± 2,24 years, height 174, 60 ± 10,16 cm, BMI 21, 24 ± 2,65) of the U-13 to U-23 teams were part of the study. Data acquisition included sport specific parameters such as footwear, amount of training hours, leg dominance, history of tendon pathologies, and clinical examination for palpatory pain, indurations, muscular circumference, and range of motion. Subjective complaints were measured with the Victorian Institute of Sport Assessment Patellar (VISA-P) Score. Furthermore, sonographical examinations (Aplio SSA-770A/80; Toshiba, Tokyo, Japan) with 12-MHz multifrequency linear transducers (8-14 MHz) of both patellar tendons were performed with special emphasis on hyper- and hypo echogenic areas, diameter and neovascularization.Results: The prevalence of patellar tendinopathies was 13.4%. Seventy-five percent of the players complained of pain of their dominant leg with onset of pain at training in 87.5%. The injured players showed a medium amount of 10.34 ± 3.85 training hours and a medium duration of symptoms of 11.94 ± 18.75 weeks. Two thirds of players with patellar tendinopathy were at the age of 15-17 (Odds ratio 1.89) while no differences between players of the national or regional league were observed. In case of patellar tendinopathy, VISA-P was significantly lower in comparison to healthy players (mean ± SD 76.80 ± 28.56 points vs. 95.85 ± 10.37). The clinical examination revealed local pain at the distal patella, pain at stretching, and thickening of the patellar tendon (p = 0.02). The mean tendon diameter measured 2 cm distally to the patella was 4.10 ± 0.68 mm with a significantly increased diameter of 0.15 mm in case of an underlying tendinopathy (p = 0.00). The incidence of hypo-echogenic areas and neovascularizations was significantly elevated in players with patellar tendon syndrome (PTS) (p = 0.05).Conclusion: The prevalence of patellar tendinopathy in youth elite soccer is relatively high in comparison to available data of adult players. Especially players at the age of 15 to 17 are at considerable risk. Tendon thickening, hypo-echogenic areas, and neovascularization are more common in tendons affected by PTS. [ABSTRACT FROM AUTHOR]

Background: Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with meta-analysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis.Methods: A systematic search of the Ovid database was performed in December 2016 to identify all published articles reporting outcome and return to preinjury sport-level after conservative or operative treatment of avulsion fractures of the pelvis in adolescent patients. Included studies were abstracted regarding study characteristics, patient demographics and outcome measures. The methodological quality of the studies was assessed with the Coleman Methodology Score (CMS).Results: Fourteen studies with a total of 596 patients met the inclusion criteria. The mean patient age was 14.3 ± 0.6 years and 75.5% of patients were male. Affected were the anterior inferior iliac spine (33.2%), ischial tuberosity (29.7%), anterior superior iliac spine (27.9%), iliac crest (6.7%) lesser trochanter (1.8%) and superior corner of the pubic symphysis (1.2%). Mean follow-up was 12.4 ± 11.7 months and most of the patients underwent a conservative treatment (89.6%). The overall success rate was higher in the patients receiving surgery (88%) compared to the patients receiving conservative treatment (79%) (p = 0,09). The rate of return to sports was 80% in conservative and 92% in operative treated patients (p = 0,03). Overall, the methodological quality of the included studies was low, with a mean CMS of 41.2.Conclusion: On the basis of the present meta-analysis, the overall success and return to sports rate was higher in the patients receiving surgery. Especially in patients with fragment displacement greater 15 mm and high functional demands, surgical treatment should be considered. [ABSTRACT FROM AUTHOR]

Background: The proteasome is a multisubunit enzyme complex involved in protein degradation, which is essential for many cellular processes. During inflammation, the constitutive subunits are replaced by their inducible counterparts, resulting in the formation of the immunoproteasome.Methods: We investigated the expression pattern of constitutive (β1, β5) and immunoproteasome (β1i, β5i) subunits using immunohistochemistry in malformations of cortical development (MCD; focal cortical dysplasia (FCD) IIa and b, cortical tubers from patients with tuberous sclerosis complex (TSC), and mild MCD (mMCD)). Glial cells in culture were used to elucidate the mechanisms regulating immunoproteasome subunit expression.Results: Increased expression was observed in both FCD II and TSC; β1, β1i, β5, and β5i were detected (within cytosol and nucleus) in dysmorphic neurons, balloon/giant cells, and reactive astrocytes. Glial and neuronal nuclear expression positively correlated with seizure frequency. Positive correlation was also observed between the glial expression of constitutive and immunoproteasome subunits and IL-1β. Accordingly, the proteasome subunit expression was modulated by IL-1β in human astrocytes in vitro. Expression of both constitutive and immunoproteasome subunits in FCD II-derived astroglial cultures was negatively regulated by treatment with the immunomodulatory drug rapamycin (inhibitor of the mammalian target of rapamycin (mTOR) pathway, which is activated in both TSC and FCD II).Conclusions: These observations support the dysregulation of the proteasome system in both FCD and TSC and provide new insights on the mechanism of regulation the (immuno)proteasome in astrocytes and the molecular links between inflammation, mTOR activation, and epilepsy. [ABSTRACT FROM AUTHOR]

Objectives: Empirical mode decomposition (EMD) is a frequently used signal processing approach which adaptively decomposes a signal into a set of narrow-band components known as intrinsic mode functions (IMFs). For multi-trial, multivariate (multiple simultaneous recordings), and multi-subject analyses the number and signal properties of the IMFs can deviate from each other between trials, channels and subjects. A further processing of IMFs, e.g. a simple ensemble averaging, should determine which IMFs of one signal correspond to IMFs from another signal. When the signal properties have similar characteristics, the IMFs are assigned to each other. This problem is known as correspondence problem.Methods: From the mathematical point of view, in some cases the correspondence problem can be transformed into an assignment problem which can be solved e.g. by the Kuhn-Munkres algorithm (KMA) by which a minimal cost matching can be found. We use the KMA for solving classic assignment problems, i.e. the pairwise correspondence between two sets of IMFs of equal cardinalities, and for pairwise correspondences between two sets of IMFs with different cardinalities representing an unbalanced assignment problem which is a special case of the k-cardinality assignment problem.Results: A KMA-based approach to solve the correspondence problem was tested by using simulated, heart rate variability (HRV), and EEG data. The KMA-based results of HRV decomposition are compared with those obtained from a hierarchical cluster analysis (state-of-the-art). The major difference between the two approaches is that there is a more consistent assignment pattern using KMA. Integrating KMA into complex analysis concepts enables a comprehensive exploitation of the key advantages of the EMD. This can be demonstrated by non-linear analysis of HRV-related IMFs and by an EMD-based cross-frequency coupling analysis of the EEG data.Conclusions: The successful application to HRV and EEG analysis demonstrates that our solutions can be used for automated EMD-based processing concepts for biomedical signals. [ABSTRACT FROM AUTHOR]

The chemotherapeutic agent mitoxantrone is approved for the treatment of aggressive multiple sclerosis (MS) in adults, Its use, however, is limited by the risk of severe adverse events including cardiotoxicity, myelosuppression, liver toxicity and secondary leukemia. The aim of this retrospective study is to present data on the safety, tolerability and efficacy of mitoxantrone in a small cohort of children with MS. 4 pediatric MS patients with a high relapse rate or severe, disabling relapses were treated with mitoxantrone and followed for 3.8-18 years. The cumulative dose of mitoxantrone was 36, 68, 84 and 120 mg/m2, respectively. The frequency and severity of relapses as well as disability scores, decreased in the year after treatment onset. Short-term adverse events were transient in all cases. Cardiac monitoring by transthoracic echocardiography (IrE) showed asymptomatic left ventricular dysfunction during treatment in I patient, which was again normal at the next assessment. Long-term adverse events, including late-onset mitox-antrone-induced cardiotoxicity or secondary leukemia did not occur during the follow-up period. In our cohort of pediatric MS patients, mitoxantrone showed short-term reduction of disease activity and no long-term adverse events on follow-up. However, the risk of mitoxantrone-induced cardiotoxicity or toxic leukemia remains a life-long threat. [ABSTRACT FROM AUTHOR]

One-channel routine recordings of the scalp electroencephalogram (EEG) from unmedicated children strictly classified as unprovoked typical (3 c/s) absence seizures were selected. The dynamics of spike-and-wave discharges (SWD) were then examined by means of autocorrelation, correlation dimension, averaged pointwise dimension and largest Lyapunov exponent. For one EEG signal with pronounced spike-and-wave (SW) patterns, these measures were used complementary to a surrogate data method, a nonlinear (SETAR) modeling approach, and a SW simulation procedure providing five types of SW test signals. The SETAR model exhibited stationary SW dynamics, visually very similar to the EEG target signal, and with clear nonlinear structure. According to the results, the EEG episodes investigated represent low-dimensional dynamics, possibly recorded during nonstationary periods. Arguments that justify the assumption of deterministic chaos in our EEG signals were not obtained with the current methods. From the results one may conclude that two global oscillatory modes are present for the model, and three modes are active during the EEG recording period. [ABSTRACT FROM AUTHOR]

Objective Hippocampal Sclerosis (HS) is widely recognized as a significant underlying cause of drug-resistant temporal lobe epilepsy (TLE) in adults. In contrast, HS is a rare finding in paediatric surgical series and data on this patient group are scarce. Methods We studied 34 children and adolescents with drug-resistant TLE and MTS who had epilepsy surgery at our centre with regard to electroclinical characteristics, MRI features and histopathology. Special focus was set on 15 children in whom histopathology was consistent with Focal Cortical Dysplasia (FCD) Type IIIa. Results Clinical characteristics associated with this highly selective subset of patients were: the presence of febrile seizures during infancy, a shorter duration of active epilepsy, a lower age at epilepsy surgery, extended EEG changes as well as excellent outcomes after anterior temporo-polar resection. However, we were unable to detect any significant association with either specific features on neuroimaging or neuropathological subtyping of the hippocampal sclerosis. Conclusion Data on HS in children with temporal lobe epilepsy is scarce and available data sets limitied. In the light of this perspective we present the first detailed description and comprehensive data analysis of children with the novel entity of FCD Type IIIa. [ABSTRACT FROM AUTHOR]

We present an 11 months old girl with Sturge Weber syndrom (SWS) and infantile spasms, refractory to treatment; The child was delivered in the 36th week of gestation. On prenatal ultrasound the obstetrician noticed an enlargement of the right ventricle. Postnatal, the MRI showed at first indications for an early SWS; hypertrophy of the right hemisphere with reduced gyration, T1 hyperintense and Tw2 hypointense signal alterations in the right periventricular white matter; proliferation of superficial vessels after administration of contrast agent and on SWI sequences, and a dysplastic corpus callosum. From day 1 onwards the child presented with a severe muscular hypotonia and daily series of complex partial and focal seizures occurred. The EEG was concordant with continuous epileptic discharges over the right hemisphere. The establishment of several AEDs did not yield any seizure control. Extensive diagnostics were carried out and in the light of these results the suspicious diagnosis of a type III SWS with an isolated leptomeningeal-brain angiom, was raised. In the combination of the diagnostics and the patients poor general condition, the indication for epilepsy surgery was met. At the age of 7 months a functional hemispherotomy was performed. Since the surgery the patient is seizure-free and there is a significant improvement of motor skills, despite the expected left-sided hemiparesis. Neurohistopathological assessment of the resected tissue showed severe meningoangiomatosis associated with classical 4-layered polymicrogyria, although no mosaic mutation in the GNAQ gene was found. Detailed immunohistological analysis presented small immature neurons in a 4-layered cortical organization as well as various sizes of malformed bloodvessels within the meninges. In addition, a hyperactivation of the (PI3K)-AKT3-mTOR pathway (pS6, pAkt Ser 473) could be detected. Our case highlights the importance of thorough clinical assessment and the effect of epilepsy surgery also in highly complex malformations of cortical development. [ABSTRACT FROM AUTHOR]

Objective Neonatal seizures are the most common neurological emergency in newborns. Up to date, phenobarbitone (Pb) is the recommended first-line antiepileptic drug (AED), although animal and human studies have reported neuronal damage (apoptosis and even cell death) and consecutive impairment after its use. Levetiracetam (LEV) seems to have a more favorable profile, but only few data are available concerning its use in newborns. Methods We retrospectively analyzed data from all neonates treated with LEV at our institution 2009–2014 as second line treatment following treatment with Pb. Response was defined as being seizure free (SF) or ≥50% reduction in seizure frequency (SR). Results Data from 35 neonates (21 males) were analyzed. The mean gestational age at birth was 37+1 weeks, birth weight 3060 g. LEV was administered at a mean postnatal age of 16 days. Etiologies were vascular insults in 20 (57.1%), brain malformation in 9 (25.7%), genetic/metabolic disorders in 5 (14.3%) and CNS infections in 1 (2.9%) patients. Duration of LEV treatment was <1 week in 9 (25.7%), up to 1 month in 10 (28.6%), up to 3 months in 7 (20%) and ≥3 months in 9 (25.7%) patients. Complete data sets were only available in 23 patients. 17 (73.9%) responded within the first 24 hours (11 patients SF, 6 patients SR). 2 more patients (8.7%) responded within 30 days after treatment initiation (1 patient SF, 1 patient SR). One patient developed agitation and LEV was therefore withdrawn. No other relevant side effects were observed. Conclusion Our results illustrate that treatment with LEV is effective and safe in newborn infants. Prospective controlled studies and long-term evaluation of developmental outcome are warranted to further assess efficacy and safety of LEV in newborn infants. [ABSTRACT FROM AUTHOR]

Objective The prognosis of infantile spasms (IS) is usually unfavorable with respect to treatment and developmental outcomes. The antiepileptic drugs (AEDs) most likely to be effective in the short-term management (complete cessation of spasm and EEG normalization) are ACTH and Vigabatrin, but there is insufficient evidence that these drugs also improve long-term outcomes. Both drugs have shown serious (irreversible and in part lethal) side effects. The ketogenic diet (KD) is licensed for drug-resistant epilepsy including IS as second-line treatment. Aim of this randomized, prospective study was to evaluate the efficacy and tolerability of the KD compared with ACTH. Methods All infants with IS referred to the Medical University of Vienna between June 2008 and September 2014 who were eligible for both treatments were included and randomized to either ACTH or the KD (liquid formula) after informed consent. When failure to the first treatment occurred (seizures and/or persistent hypsarrhyhtmia), patients were switched to the alternative treatment. Seizure and developmental outcomes as well as side effects were evaluated at 12 months after treatment initiation. Results 32 children were randomized (16 ACTH/16 KD). 9/16 randomized to the KD became seizure free (56%), with recurrence of seizures in 3 (18%) after 6 months. 7 (44%) did not respond. 10 non-responders were then switched to ACTH and further 4 children became seizure free (40%). The KD was well tolerated. 10/16 patients randomized to ACTH (62%) became seizure free and 3 (18%) relapsed, 6 (38%) did not respond. 6 patients were then switched to the KD and one child became seizure free (16%). 14/16 children on ACTH children showed severe side effects. Conclusion No differences in responder rates or in efficacy were observed between the KD and ACTH. However, compliance was better in the KD group and no severe side effects were observed. [ABSTRACT FROM AUTHOR]