Search

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture >2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate >15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax < 15 ml/s, stricture on RGU and any post-operative urethral intervention. Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7% Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

Brain stem abscesses are rare entities that predominantly affect the pons. A wide variety of microorganisms may be implied, depending on the focus of dissemination. We present the case of a female patient with multiple comorbidities who developed multi-lobar pneumonia due to influenza A(H1N1)pdm09 virus during the postoperative period after an emergent cholecystectomy, requiring mechanical ventilation (MV). Following clinical improvement and withdrawal of MV, the patient did not recover consciousness. Forty-eight hours later, imaging exams showed an abscess in the left pontine dorsolateral tegmentum –a region recently associated with coma-. Despite the administration of broad-spectrum antibiotics, the patient died five days later. This case illustrates the importance of considering pontine abscesses as a cause of poor neurological course in critically ill patients, as well as the need for doing imaging exams to rule out intracranial lesions, particularly in coma-associated areas.

We report an 87-year-old woman with right dorsolateral medullary hemorrhage. She did not show all of the usual symptoms of Wallenberg syndrome and her main symptom was severe dysphagia. Dorsolateral medullary hemorrhage may be overlooked, because it is rare and does not exhibit the typical Wallenberg syndrome presentation usually seen in patients with infarction at the dorsolateral medulla.

The prefrontal lobe has been considered to be closely related to depression. This study examined the relationship between depression and three prefronto-thalamic tract (PF-TT) regions (the dorsolateral prefronto-thalamic tract [DLPF-TT], ventrolateral prefronto-thalamic tract [VLPF-TT], and the orbitofronto-thalamic tract [OF-TT]) in patients with mild traumatic brain injury (TBI), using diffusion tensor tractography (DTT). Thirty-seven patients with depression following mild TBI were recruited based on Beck Depression Inventory-II (BDI-II) scores. Thirty-one normal control subjects were also recruited. The three regions of the PF-TTs were reconstructed using probabilistic tractography and DTT parameters for each of the three PF-TT regions were determined. The tract volume of the DLPF-TT and OF-TT in the patient group showed a significant decrease compared to that of the control group (p r = − 0.33) and left (r = − 0.41) DLPF-TT (p p > 0.05). Using DTT, depression was found to be closely related to a DLPF-TT injury in patients with mild TBI. We believe that evaluation of the DLPF-TT using DTT would be helpful when assessing patients with depression following mild TBI. These results can provide useful information regarding the proper application of neuromodulation in the management of depression.

This randomized crossover study investigated whether anodal transcranial direct current stimulation (tDCS) over the dorsolateral prefontal cortex (dlPFC) modulates memory-guided finger isometric maintenance during single motor and dual cognitive-motor tasks, based on electroencephalogram (EEG) signals. Twenty-three healthy participants (14 female; M age = 29.130 years, SD = 10.918) underwent both sham and 2-mA stimulation sessions over the dlPFC for 20 minutes, with a minimum washout period of seven days. We analyzed finger-force isometric maintenance and event-related spectral perturbation (ERSP) of the EEG during early and later phases of both tasks. We observed a significant motor accuracy improvement ( p = .014) and significant variation of force output ( p = .027) with significant decrease in ERSP on the dorsomedial prefrontal cortex (dmPFC) (early phase, p = .027; later phase, p = .023) only after 2 mA stimulation. Thus, anodal tDCS over the dlPFC may improve memory-guided force control during cognitive-motor dual tasks.

Sinus tarsi syndrome is the clinical syndrome of lateral heel pain with local tenderness at the sinus tarsi and is frequently associated with a history of inversion sprain to the ankle. The lateral heel pain can be due to the capsule-ligamentous structures lateral to the axis of the anterior and posterior subtalar joints. Anterior and posterior subtalar arthroscopies are needed to detect and treat the disorders of both joints. In this Technical Note, we describe the details of a 2-portal arthroscopic approach to both anterior and posterior subtalar joints. This allows complete examination of all the possible sources of lateral heel pain in sinus tarsi syndrome.

Objective: Despite effective psychological and pharmacological treatments, there is a large unmet burden of illness in post-traumatic stress disorder (PTSD). Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive intervention and a putative treatment strategy for PTSD. The evidence base to date suggests that rTMS targeting the dorsolateral prefrontal cortex (DLPFC), in particular the right DLPFC, leads to improvements in PTSD symptoms. However, optimal stimulation parameters have yet to be determined. In this study, we examine the efficacy of high- and low-frequency rTMS of the right DLPFC using a randomized, double-blind, sham-controlled design in civilian PTSD. Methods: We conducted a 2-week single-site randomized sham-controlled trial of rTMS targeting the right DLPFC. We recruited civilians aged 19 to 70 with PTSD and randomized subjects with allocation concealment to daily 1-Hz rTMS, 10-Hz rTMS, or sham rTMS. The primary outcome was improvement in Clinician Administered PTSD Scale–IV (CAPS-IV). Secondary outcomes included change in depressive and anxiety symptoms. Results: We recruited 31 civilians with PTSD. One 1-Hz-treated patient developed transient suicidal ideation. Analyses revealed significant improvement in CAPS-IV symptoms in the 1-Hz group relative to sham (Hedges’ g = −1.07) but not in the 10-Hz group. This was not attributable to changes in anxious or depressive symptomatology. Ten-Hz stimulation appeared to improve depressive symptoms compared to sham. Conclusion: Low-frequency rTMS is efficacious in the treatment of civilian PTSD. Our data suggest that high-frequency rTMS of the right DLPFC is worthy of additional investigation for the treatment of depressive symptoms comorbid with PTSD.

Background: Deep-brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for motor symptoms of advanced Parkinson's disease (PD). Due to a lack of detailed somatotopic organization in STN, the clinically most effective part of the STN for stimulation has already become one of the hot research focuses. At present, there are some reports about topographic distribution for different depths within the STN, but few about a mediolateral topography in this area.Objective: The objective was to investigate the local field potential (LFP) distribution patterns in dorsomedial and dorsolateral subparts of STN.Methods: In total, 18 PD patients eventually enrolled in this study. The DBS electrodes were initially located on the lateral portion of dorsolateral STN. Because of internal capsule side effects presented at low threshold (below 1.5 mA), the electrode was reimplanted more medially to the dorsomedial STN. In this process, intraoperative LFPs from dorsomedial and dorsolateral STN were recorded from the inserted electrode. Both beta power and gamma power of the LFPs were calculated using the power spectral density (PSD) for each DBS contact pair. Furthermore, coherence between any two pairs of contacts was computed in the dorsomedial and dorsolateral parts of STN, respectively. Meanwhile, the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) was monitored prior to surgery and at the 6-month follow-up.Results: Compared to the dorsolateral part of STN, gamma oscillations (p < 0.01) and coherence (p < 0.05) were all weaker in the dorsomedial part. However, no obvious differences in beta oscillations and coherence were observed between the two groups (p > 0.05). Moreover, it should be noted that DBS of the dorsomedial STN resulted in significant improvement in the UPDRS-III in PD patients. There was a 61.50 ± 21.30% improvement in UPDRS-III scores in Med-off/Stim-on state relative to the Med-off state at baseline (from 15.44 ± 6.84 to 43.94 ± 15.79, p < 0.01).Conclusions: The specific features of gamma activity may be used to differentiate STN subregions. Moreover, the dorsomedial part of STN might be a potential target for DBS in PD.

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for refractory major depressive disorder, yet no studies have characterized trajectories of rTMS response. The aim of this study was to characterize response trajectories for patients with major depression undergoing left dorsolateral prefrontal cortex rTMS and to determine associated baseline clinical characteristics.This was a secondary analysis of a randomized noninferiority trial (N=388) comparing conventional 10-Hz rTMS and intermittent theta burst stimulation (iTBS) rTMS. Participants were adult outpatients who had a primary diagnosis of major depressive disorder, had a score ≥18 on the 17-item Hamilton Depression Rating Scale (HAM-D), and did not respond to one to three adequate antidepressant trials. Treatment was either conventional 10-Hz rTMS or iTBS rTMS applied to the dorsolateral prefrontal cortex, 5 days/week over 4-6 weeks (20-30 sessions). Group-based trajectory modeling was applied to identify HAM-D response trajectories, and regression techniques were used to identify associated characteristics.Four trajectories were identified: nonresponse (N=43, 11%); rapid response (N=73, 19%); higher baseline symptoms, linear response (N=118, 30%); and lower baseline symptoms, linear response (N=154, 40%). Significant differences in response and remission rates between trajectories were detectable by week 1. There was no association between treatment protocol and response trajectory. Higher baseline scores on the HAM-D and the Quick Inventory of Depression Symptomatology-Self-Report (QIDS-SR) were associated with the nonresponse trajectory, and older age, lower QIDS-SR score, and lack of benzodiazepine use were associated with the rapid response trajectory.Major depression shows distinct response trajectories to rTMS, which are associated with baseline clinical characteristics but not treatment protocol. These response trajectories with differential response to rTMS raise the possibility of developing individualized treatment protocols.

The dorsolateral subluxation index of the femoral head is a good proxy of hip dysplasia in dogs. An exploratory, prospective, descriptive study was carried out in order to assess whether the dorsolateral subluxation index may also be useful to improve diagnosis of hip dysplasia in cats. The dorsolateral subluxation index was determined by CT scans simulating the loading position, and compared with measurements of the Norberg-Olsson angle. A total of 82 cats were subjected to radiographic examination of the pelvis, in the standard ventro-dorsal projection, and to CT scans of the pelvis and hips. The Norberg-Olsson angle of each hip was calculated radiographically, while the dorsolateral subluxation index of the femur was calculated on CT images according to a technique recently developed for evaluation of hip dysplasia in dogs. Using the Norberg-Olsson angle a total of 52 hips (31,7%) were diagnosed as dysplastic, 74 (45,1%) as non-dysplastic, and 38 (23,1%) as borderline. Using the dorsolateral subluxation index, values ranged from a minimum of 34.6% to a maximum of 66.6% and four distribution classes were proposed. Findings indicated that the dorsolateral subluxation index previously described as method for quantifying hip dysplasia in dogs is also a feasible method for quantifying hip dysplasia in cats. Future studies are needed to more definitively determine the diagnostic sensitivity of this method.

Background: Alzheimer's disease (AD) animal models have shown a reduced gamma power in several brain areas, and induction of these oscillations by non-invasive methods has been shown to modify several pathogenic mechanisms of AD. In humans, the application of low-intensity magnetic fields has shown to be able to produce neural entrainment at the magnetic pulse frequency, making it useful to induce gamma frequencies.Objective: The aim of this study was to assess if the application of fast gamma magnetic stimulation (FGMS) over the left prefrontal dorsolateral cortex would be a safe and well-tolerated intervention that could potentially improve cognitive scores in subjects with mild cognitive impairment and mild AD.Methods: In these randomized, double-blind, sham-controlled study, participants were assigned to either receive daily sessions two times a day of active or sham FGMS for 6 months. Afterward, measurements of adverse effects, cognition, functionality, and depression were taken.Results: Thirty-four patients, 17 in each group, were analyzed for the primary outcome. FGMS was adequately tolerated by most of the subjects. Only four patients from the active FGMS group (23.52%) and one patient from the sham FGMS group (5.88%) presented any kind of adverse effects, showing no significant difference between groups. Nevertheless, FGMS did not significantly change cognitive, functionality, or depressive evaluations.Conclusion: FGMS over the left prefrontal dorsolateral cortex applied twice a day for 6 months resulted to be a viable intervention that can be applied safely directly from home without supervision of a healthcare provider. However, no statistically significant changes in cognitive, functionality, or depression scores compared to sham stimulation were observed.Clinical Trial Registration:www.ClinicalTrials.gov, Identifier: NCT03983655, URL: https://clinicaltrials.gov/ct2/show/NCT03983655.

Relapse is one of the most perplexing problems of addiction. The dorsolateral prefrontal cortex is crucially involved in numerous cognitive and affective processes that are implicated in the phenotypes of both substance use disorders and other neuropsychiatric diseases and has become the principal site to deliver transcranial magnetic stimulation for their treatment. However, the dorsolateral prefrontal cortex is an anatomically large and functionally heterogeneous region, and the specific dorsolateral prefrontal cortex locus and dorsolateral prefrontal cortex-based functional circuits that contribute to drug relapse and/or treatment outcome remain unknown. We systematically investigated the relationship of cocaine relapse with functional circuits from 98 dorsolateral prefrontal cortex regions-of-interest defined by evenly sampling the entire surface of bilateral dorsolateral prefrontal cortex in a cohort of cocaine dependent patients (n = 43, 5 Fr) following a psychosocial treatment intervention. Cox regression models were utilized to predict relapse likelihood based on dorsolateral prefrontal cortex functional connectivity strength. Functional connectivity from only 3 of the 98 dorsolateral prefrontal cortex loci, one in the left and two in the right hemisphere, significantly predicted cocaine relapse with an accuracy of 83.9%, 84.6% and 85.4%, respectively. Combining all three loci significantly improved prediction validity to 87.5%. Protective and risk circuits related to these dorsolateral prefrontal cortex loci were identified that have previously been implicated to support ‘bottom up’ drive to use drug and ‘top down’ control over behaviour together with social emotional, learning and memory processing. Three dorsolateral prefrontal cortex-centric circuits were identified that predict relapse to cocaine use with high accuracy. These functionally distinct dorsolateral prefrontal cortex-based circuits provide insights into the multiple roles played by the dorsolateral prefrontal cortex in cognitive and affective functioning that affects treatment outcome. The identified dorsolateral prefrontal cortex loci may serve as potential neuromodulation targets to be tested in subsequent clinical studies for addiction treatment and as clinically relevant biomarkers of its efficacy. Zhai et al. identify three dorsolateral prefrontal cortex (dlPFC)-centric circuits that predict cocaine relapse with high accuracy, providing insights into the multiple roles of the dlPFC in brain functioning that affects treatment outcome and suggesting the dlPFC loci as potential neuromodulation targets for addiction treatment., Graphical Abstract Graphical Abstract

Background Recent studies advocate a connectivity pattern wider than previously believed of the uncinate fasciculus that extends to the ventrolateral and dorsolateral prefrontal cortices. These new percepts on the connectivity of the tract suggest a more expansive role for the uncinate fasciculus. Our aim was to shed light on this controversy through fiber dissections. Methods Twenty normal adult human formalin-fixed cerebral hemispheres were used. Focused dissections on the insular, orbitofrontal, ventromedial, ventrolateral, and dorsolateral prefrontal areas were performed to record the topography of the frontal terminations of the uncinate fasciculus. Results Three discrete fiber layers were consistently disclosed: the first layer was recorded to terminate at the posterior orbital gyrus and pars orbitalis, the second layer at the posterior two thirds of the gyrus rectus, and the last layer at the posterior one third of the paraolfactory gyrus. The insular apex was documented as a crucial landmark regarding the topographic differentiation of the uncinate and occipitofrontal fasciculi (i.e., fibers that travel ventrally belong to the uncinate fasciculus whereas those traveling dorsally are occipitofrontal fibers). Conclusions The frontal terminations of the uncinate fasciculus were consistently documented to project to the posterior orbitofrontal area. The area of the insular apex is introduced for the first time as a crucial surface landmark to effectively distinguish the stems of the uncinate and occipitofrontal fasciculi. This finding could refine the spatial resolution of awake subcortical mapping, especially for insular lesions, and improve the accuracy of in vivo diffusion tensor imaging protocols.

Observation of others’ painful heat stimulation involves spinal cord responses that are distinct from sensory processing., Observing others’ aversive experiences is central to know what is dangerous for ourselves. Hence, observation often elicits behavioral and physiological responses comparable to first-hand aversive experiences and engages overlapping brain activation. While brain activation to first-hand aversive experiences relies on connections to the spinal cord, it is unresolved whether merely observing aversive stimulation also involves responses in the spinal cord. Here, we show that observation of others receiving painful heat stimulation involves neural responses in the spinal cord, located in the same cervical segment as first-hand heat pain. However, while first-hand painful experiences are coded within dorsolateral regions of the spinal cord, observation of others’ painful heat stimulation involves medial regions. Dorsolateral areas that process first-hand pain exhibit negative responses when observing pain in others. Our results suggest a distinct processing between self and others’ pain in the spinal cord when integrating social information.

Introduction This study aimed to evaluate the clinical outcomes of 16 patients with capitellum and trochlea fractures that were treated using isolated headless compression screws or a combination of dorsolateral locking plates and anterior-to-posterior screws. We also investigated the presence of lateral epicondyle fragments because this fragment is especially important when making decisions regarding the surgical approach and implants. Materials and methods We conducted a retrospective analysis of 16 patients with capitellum and trochlea fractures. Clinical, radiographic (based on CT scans), and elbow-specific outcomes, including the Mayo Elbow Performance Index (MEPI), were evaluated at a mean of 23.5 months postoperatively. Results The average MEPI scores in patients with Dubberley type A (non-posterior comminution) and type B (posterior comminution) fractures were 88 and 78, respectively (p=0.08). Headless compression screws were used in 10 cases of type A fracture and one case of type B fracture. A combination of dorsolateral locking plates and anterior-to-posterior screws was used in five cases of type B fracture. Hardware loosening was seen in one case of type B fracture with isolated screw fixation. The presence of a lateral epicondyle fragment was significantly associated with the type B group (6/6 patients; 100%). In contrast, patients in the type A group rarely had posterior comminution of the lateral epicondyle fragment (2/10 patients; 20%). Conclusions Capitellum and trochlea fractures with posterior comminution, which typically presented with lateral epicondylar fragments, were safely and effectively treated with a combination of dorsolateral locking plates and anterior-to-posterior screws through lateral approaches. Cases without posterior comminution were treated with headless compression screws with no complications. The Dubberley classification system provides helpful information to determine the fixation strategy.

Background Dorsolateral medullary infarction is a typical cerebral infarction which is characterized by Wallenberg’s syndrome. Neurotrophic keratopathy is an uncommon consequence of dorsolateral medullary infarction. At present, the protocol is aimed to study the dynamic changes in corneal innervation and the ocular surface environment after dorsolateral medullary infarction. Methods This study will involve consecutive data from all medical records of patients within 7 days of acute dorsolateral medullary infarction onset at the Departments of Neurology from 10 collaborating stroke centers. Eligible patients will mainly be characterized based on detailed physical examinations, multimodal imaging, and corneal related examinations and patients will be followed-up for 2 years. Neurotrophic keratopathy after dorsolateral medullary infarction is the primary endpoint. The dynamic histological corneal innervation and ocular surface environment after dorsolateral medullary infarction will be observed during the follow-up period. Discussion This multicentric, prospective registry is the first to identify and characterize the dynamic changes of corneal innervation and the ocular surface environment after acute dorsolateral medullary infarction. The significance of the study is to emphasize that the curative effect is based on the doctors’ identification of the disease in the earliest stage before irreversible damage occurs to the cornea. Trial registration The registry was registered (ChiCTR-OPC-17,011,625) on June 11, 2017.

The present study had three main aims: (1) to explore the possible relationships between the two dimensions of negative symptoms (NS) with the three frontal behavioral syndromes (dorsolateral, orbitofrontal and the anterior or mesial cingulate circuit) in patients with schizophrenia, (2) to determine the influence of sociodemographic and clinical variables on the severity of the two dimensions of NS (expressive deficits and disordered relationships/avolition), and (3) to explore the possible relationships between the two dimensions of NS and social functioning. We evaluated a group of 33 patients with schizophrenia with a predominance of NS using the self-reported version of the Frontal System Behavior scale. To quantify the severity of NS, the Assessment of Negative Symptoms (SANS) scale was used. The results revealed that the two dimensions of NS correlate positively with the behavioral syndrome of dorsolateral prefrontal origin. Regarding the influence of sociodemographic and clinical variables, in patients with a long evolution the NS of the expressive deficits dimension were less severe than in patients with a short evolution. A negative correlation was found between the severity of NS of the disordered relationships/avolition dimension and perceived social functioning. Our results show the importance of differentiating between the two dimensions of NS to characterize better their possible frontal etiology and impact on clinical course and social functioning.

Chronic cigarette smoking is associated with regional metabolite abnormalities in choline-containing compounds, creatine-containing compounds, glutamate, and N-acetylaspartate. The effects of cigarette smoking on anterior frontal cortical gamma-aminobutyric acid (GABA) concentration is unknown. This study compared chronic smokers (n=33) and non-smokers (n=31) on anterior cingulate cortex (ACC) and right dorsolateral prefrontal cortex (DLPFC) GABA+ (the sum of GABA and co-edited macromolecules) concentrations and associations of GABA+ levels in these regions with neurocognition in seven different domains of functioning, decision-making and impulsivity measures. Smokers had significantly lower right DLPFC GABA+ concentration than non-smokers, but groups were equivalent on ACC GABA+ level. Across groups, greater number of days since end of menstrual cycle were related to higher GABA+ level in the ACC, but not right DLPFC GABA+ concentration. In exploratory correlation analyses, higher ACC and right DLPFC GABA+ levels were associated with faster processing speed and better auditory-verbal memory, respectively in the combined group of smokers and non-smokers; in smokers only, higher ACC GABA+ was related to better decision-making and auditory-verbal learning. This study contributes additional novel data on the adverse effects of chronic cigarette smoking on the adult human brain and demonstrated ACC and DLPFC GABA+ concentrations were associated with neurocognition and decision-making/impulsivity in active cigarette smokers. Longitudinal studies on the effects of smoking cessation on regional brain GABA levels, with a greater number of female participants, are required to determine if the observed metabolite abnormalities are persistent or normalize with smoking cessation.

Resumen Objetivo: Evaluar clínicamente a pacientes con lesiones distales combinadas del pulgar tratados mediante colgajo dorsolateral o colgajo en isla mediopalmar radial. Materiales y Métodos: Se comparó retrospectivamente a 20 pacientes (14 hombres y 6 mujeres; promedio de edad 35 años) con lesiones traumáticas combinadas distales del pulgar, operados por dos cirujanos, con técnicas diferentes. Los pacientes no tenían antecedentes quirúrgicos y el seguimiento mínimo fue de 24 meses. Se evaluaron el resultado subjetivo usando el índice de satisfacción, la escala analógica visual para dolor y el puntaje QuickDASH, y el resultado objetivo mediante el test de discriminación de 2 puntos, el tiempo quirúrgico promedio y la necesidad de reeducación espacial digital. Resultados: La media desde el ingreso hasta el alta laboral fue de 7 semanas (rango 6-8). Resultados promedio posoperatorios: escala analógica visual 01/10, ambos grupos. Grupo con colgajo dorsolateral: índice de satisfacción 97%, test de discrimi-nación de 2 puntos 4 mm, puntaje QuickDASH 2,5; tiempo quirúrgico 45 min, sin necesidad de reeducación espacial digital. Grupo con colgajo en isla mediopalmar radial: índice de satisfacción 92%, test de discriminación de 2 puntos 6 mm, puntaje QuickDASH 8, tiempo quirúrgico 60 min; 4 pacientes requirieron reeducación espacial digital. Conclusión: Los colgajos dorsolateral y en isla mediopalmar radial resultaron eficaces en el tratamiento de lesiones traumáticas distales del pulgar, aunque el colgajo dorsolateral tuvo mejores puntajes de evaluación objetiva y requirió menos tiempo quirúrgico. Abstract Objective: To clinically evaluate patients with combined distal thumb lesions treated by a dorsolateral flap or radial midpalmar island flap. Materials and Methods: We retrospectively compared 20 patients (14 males and 6 females, averaging 35 years) with combined distal thumb traumatic lesions, who were operated on by two surgeons using different techniques. Patients had no pre-vious surgical history and a minimum follow-up period of 24 months. Subjective outcome was evaluated by satisfaction index (SI), visual analogue scale (VAS), and QuickDASH score. Objective outcome was evaluated by two-point discrimination test (TPDT), average surgical time (ST), and need for digital spatial reeducation (DSR). Results: Time from admission to medical discharge averaged 7 weeks (range, 6-8). Average postoperative results: VAS for pain, 01/10 (both groups); IS, 97% vs. 92% (dorsolateral flap group vs. radial midpalmar island flap); TPDT, 4 mm vs. 6 mm; QuickDASH, 2.5 vs. 8; ST, 45 minutes vs. 60 minutes; need for DSR, 0 vs. 4 cases. Conclusion: Both the dorsolateral flap and the radial midpalmar island flap techniques were effective in the treatment of distal thumb traumatic lesions, although the dorsolateral flap achieved better objective evaluation scores and required less ST.

Background: In this study we evaluated the impact of location of deep brain stimulation electrode active contact in different parts of the subthalamic nucleus on improvement of non-motor symptoms in patients with Parkinson's disease. Methods: The subthalamic nucleus was divided into two (dorsolateral/ventromedial) and three (dorsolateral, medial, ventromedial) parts. 37 deep brain stimulation electrodes were divided according to their active contact location. Correlation between change in non-motor symptoms before and one and four months after deep brain stimulation electrode implantation and the location of active contact was made. Results: In dividing the subthalamic nucleus into three parts, no electrode active contact was placed ventromedially, 28 active contacts were located in the medial part and 9 contacts were placed dorsolaterally. After one and four months, no significant difference was found between medial and dorsolateral positions. In the division of the subthalamic nucleus into two parts, 13 contacts were located in the ventromedial part and 24 contacts were placed in the dorsolateral part. After one month, significantly greater improvement in the Non-motor Symptoms Scale for Parkinson's disease (P=0.045) was found on dorsolateral left-sided stimulation, but no significant differences between the ventromedial and dorsolateral positions were found on the right side. Conclusion: This study demonstrated the relationship between improvement of non-motor symptoms and the side (hemisphere, left/right) of the deep brain stimulation electrode active contact, rather than its precise location within specific parts of the subthalamic nucleus in patients treated for advanced Parkinson's disease.

Objective: To compare the effects of anodal trans-cranial direct current stimulation (a-tDCS) over primary motor and dorsolateral prefrontal cortices on Fatigue Severity Scale and its lasting effect on fatigue reduction and improvement in quality of life in patients with multiple sclerosis. Design: A randomized, double-blinded, sham-controlled parallel clinical trial study. Setting: Neurological physiotherapy clinics. Subjects: Thirty-nine participants were randomly assigned to three groups: dorsolateral prefrontal cortex a-tDCS, primary motor a-tDCS (experimental groups) and sham a-tDCS. Finally, 36 participants completed the whole study ( n = 12 in each group). Interventions: Participants in the experimental groups received six-session a-tDCS (1.5 mA, 20 minutes) during two weeks (three sessions per week). The sham group received six sessions of 20-minute sham stimulation. Main measures: The Fatigue Severity Scale and quality of life were assessed before, immediately and four weeks after the intervention. Results: Findings indicated a significant reduction in the Fatigue Severity Scale and a significant increase in the quality of life in both experimental groups, immediately after the intervention ( P 0.05). In addition, improvement of the variables remained four weeks after the intervention in dorsolateral prefrontal cortex a-tDCS (mean differences (95% confidence interval): 0.03 (−0.63 to 0.68) as compared to primary motor (−0.62 (−0.11 to −1.14) and sham a-tDCS groups (−0.47 (−1.37 to 0.43)). Conclusion: Both primary motor and dorsolateral prefrontal cortex a-tDCS as compared to sham intervention can immediately improve fatigue and quality of life. However, the effects last up to four weeks only by the dorsolateral prefrontal cortex a-tDCS.

Opalski syndrome is a rare variation of lateral medullary syndrome (LMS) accompanied by ipsilateral hemiparesis. Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) is a rare headache syndrome which belongs to the trigeminal autonomic cephalalgias. SUNCT syndrome has been previously described in association with LMS. We here describe a case of SUNCT syndrome with Opalski syndrome caused by dorsolateral medullary infarction.

Increased anticholinergic activity resulting from pharmacotherapies used to treat schizophrenia is associated with poorer cognition. However the neural mechanisms underlying this effect are unknown. In this study of 39 early course schizophrenia outpatients, we demonstrate that increased serum anticholinergic activity is associated with reduced activation across the prefrontal cortex, including the dorsolateral, anterior, and medial prefrontal cortices, during two tasks of cognitive control. Lower activation in the dorsolateral and anterior prefrontal cortices mediated the association between increased anticholinergicity and poorer neurocognitive function. Such findings provide preliminary insight into how anticholinergic medications may impact cognition through reduced prefrontal cortical function in schizophrenia.

Background The human motor system consists of several divisions in the frontal lobes. The physiological function of projections from the dorsolateral prefrontal cortex (DLPFC) to the primary motor cortex (M1) remains elusive. Here, we introduce theta burst stimulation (TBS)-based protocols to target inhibitory and facilitatory connections in the DLPFC-M1 network. Methods Intermittent and continuous TBS with 600 pulses (iTBS600/cTBS600) were applied to the left DLPFC. Resting motor threshold (RMT), motor-evoked potential (MEP), and short-interval intracortical inhibition (SICI) were measured with transcranial magnetic stimulation to the ipsilateral M1. Results iTBS600 to the DLPFC decreased MEP amplitude in M1. Conversely, cTBS600 to the DLPFC increased MEP amplitude in M1. The peak decrease in MEP amplitude after iTBS600 was negatively correlated with the peak increase in MEP amplitude after cTBS600. There were no significant effects in the control group with the sham stimulation. Discussion These results provide insight into the regulation of inhibitory and facilitatory balance from the local DLPFC to M1. TBS modulation in one brain region will induce interactions within other remote cortical areas. Our results enable better understanding of how cognitive resources are allocated to achieve optimal control of motor output.

KEY POINTS Some cortical areas are believed to transmit a descending signal in association with motor intention and/or effort that regulates the cardiovascular system during exercise (termed central command). However, there was no evidence for the specific cortical area responding prior to arbitrary motor execution and in proportion to the motor effort. Using a multichannel near-infrared spectroscopy system, we found that the oxygenation of the dorsolateral and ventrolateral prefrontal cortices on the right side increases in a feedforward- and motor effort-dependent manner during voluntary one-armed cranking with the right arm. This finding may suggest a role of the dorsolateral and ventrolateral prefrontal cortices in triggering off central command and may help us to understand impaired regulation of the cardiovascular system in association with lesion of the prefrontal cortex. ABSTRACT Output from higher brain centres (termed central command) regulates the cardiovascular system during exercise in a feedforward- and motor effort-dependent manner. This study aimed to determine a cortical area responding prior to arbitrarily started exercise and in proportion to the effort during exercise. The oxygenation responses in the frontal and frontoparietal areas during one-armed cranking with the right arm were measured using multichannel near-infrared spectroscopy, as indexes of regional blood flow responses, in 20 subjects. The intensity of voluntary exercise was 30% and 60% of the maximal voluntary effort (MVE). At the start period of both voluntary cranking tasks, the oxygenation increased (P

Obsessive-compulsive symptoms and/or obsessive-compulsive disorders (OCD) are frequently comorbid with schizophrenia, though the exact clinical and etiological relationship between them is poorly understood. Here we describe a case that, to the best of our knowledge, is the first report of new-onset OCD in a patient who was receiving high-frequency repetitive transcranial magnetic stimulation over left dorsolateral pre-frontal cortex as an adjuvant therapy for negative symptoms of schizophrenia. Thisreport supports our understanding of OCD as a brain disorder involving hyper-activity of pre-frontal cortex and cortico-striatal-thalamo-cortical circuit dysfunction.

Deep brain stimulation has become an option for advanced Parkinson's disease treatment since the 1990s, but the first reports are from Benabid's team, a French neurosurgeon, in the 1980s. The subthalamic nucleus (STN), more specifically its dorsolateral portion, is the most commonly stimulated brain area. One of the major aspects for a good surgical result is the accurate location of this target. Therefore, the present article aimed to identify landmarks that facilitate and refine the location of the STN using nuclear magnetic resonance imaging (NMRI) of the skull. In order to achieve this goal, a search for articles was performed using the PubMed and Science Direct online databases, and articles regarding the use of NMRI to target STN were included. The precise location of the dorsolateral portion of the STN is fundamental to achieve the best possible effect on motor symptoms and to minimize side effects. One of the most used location methods is the NMRI, associated or not with tomography or ventriculography. The location strategies can be classified as direct and indirect. Landmarks are among the indirect strategies, and the most important ones (red nucleus, Sukeroku sign, dent internal capsule sign, supramammillary commissure, mammillothalamic tract, and interpeduncular cistern) are described in the present article. The various landmarks can be combined to locate with more accuracy the dorsolateral portion of the STN and the ideal position of the electrodes to achieve the best possible clinical result.

Background: The standard management of urethral strictures involving the anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischemia of the urethra in addition to chordee. In this research, we managed the anterior urethral stricture, applying a dorsolateral onlay urethroplasty.Methodology: This prospective study was conducted in the Department of Urology, BIRDEM General Hospital& some private hospitals from July 2009 to June 2015, the outcomes of a total cases of 103 of one sided anterior dorsolateral onlay OMG Urethroplastywere assess and compared. Patients with anterior and recurrent urethral stricture more than 1 cm were included as study population. Urethrogram and Uroflowmetry were the mainstay of assessment. Success was defined as a maximum flow rate of>20 ml/sec., normal RGU, and/or urethroscopy. Poor outcomes were defined as the presence of obstructive urinary tract symptoms, Qmax

Background Dorsolateral nigral hyperintensity on iron-sensitive magnetic resonance imaging (MRI) sequences seems to be a typical finding in Parkinson's disease (PD), but most studies have involved small samples and have had heterogeneous control populations. Objectives The objective of this study was to perform a meta-analysis on dorsolateral nigral hyperintensity as an imaging marker for PD. Methods The methods included a systematic literature search and a hierarchical summary receiver operating characteristics curve approach. Results Of the 16 identified studies, 10 were suitable for analysis, including 364 PD and 231 control cases. The meta-analysis showed an overall sensitivity and specificity of the absence of dorsolateral nigral hyperintensity for PD versus controls of 97.7% and 94.6% (3 and 7 Tesla) and of 94.6% and 94.4% (3 Tesla only). Descriptive analysis among the 4 studies including patients with non-PD parkinsonism showed that dorsolateral nigral hyperintensity was absent in 89.4% of cases with atypical parkinsonian disorders (n = 74), but only in 21.7% of cases with non-neurodegenerative parkinsonism (n = 69). Moreover, in 2 of these studies, the absence of dorsolateral nigral hyperintensity predicted ipsilateral dopamine-transporter deficiency with 87.5% sensitivity and 83.6% specificity. Conclusions Visual assessment of dorsolateral nigral hyperintensity on iron-sensitive MRI sequences provides excellent diagnostic accuracy for PD versus controls. Moreover, its loss appears to be a marker of nigral pathology and holds the potential for the differentiation of neurodegenerative from non-neurodegenerative parkinsonian disorders. © 2017 International Parkinson and Movement Disorder Society

Foville syndrome is a well‐recognised clinical entity and is defined as a caudal dorsolateral pontine syndrome with the following ipsilateral clinical findings: facial hemi‐hypoesthesia, ocular abd...

The prefrontal cortex (PFC) is enormously important in suicide and major depressive disorder (MDD). However, little is known about the structural alterations in the brains of people with MDD and suicidal ideation. We examined the gray matter volume (GMV) of the PFC of individuals with MDD and suicidal ideation to determine if PFC volumetric differences contribute to suicidal ideation in patients with MDD. Thirty-five subjects with MDD and suicidal ideation, 38 subjects with MDD but without suicidal ideation, and 43 age- and gender-matched healthy control (HC) subjects underwent T1-weighted imaging. A voxel-based morphometric analysis was conducted to compare the PFC GMVs of the three groups. Further GMV reductions in the left and right dorsolateral PFC (DLPFC) and right ventrolateral PFC (VLPFC) were detected in the MDD with suicidal ideation group compared with those in the HC group and the MDD without suicidal ideation group, whereas the MDD without suicidal ideation group only exhibited significant differences in the left DLPFC relative to the HC group. Our findings demonstrated that left DLPFC reductions were associated with MDD and suicidal ideation, and diminished GMV reductions in the right DLPFC and right VLPFC were only associated with suicidal ideation. These results help us better understand the neuropathological changes in MDD with suicidal ideation.

Summary Background Reconstruction of finger-pulp defects remains a challenge, although the treatment varies widely. The homodigital island flap based on dorsal branches of the proper digital artery (PDA) is one of the most popular methods for repair of finger-pulp defects. The aim of this study was to introduce our experiences of using modified dorsolateral proximal phalangeal island flaps for reconstruction of finger-pulp defects. Methods From July 2016 to November 2018, 16 modified dorsolateral proximal phalangeal (MDPP) island flaps were performed for finger-pulp reconstruction. The comparison group included 11 patients treated with homodigital dorsal perforator (HDP) flaps. Flap survivals were assessed and active range of motion (ROM) of the joints, time to return to work, static 2-point discrimination and hand performance were analysed at final follow-up. Results Both the Group MDPP and the Group HDP had similar satisfactory flap survival. There were no differences in static 2-point discrimination, time to return to work and the ROM of the injured fingers. However, the Michigan Hand Outcomes Questionnaire (MHQ) summary scores of the satisfaction and aesthetics were much better in Group MDPP. Conclusions The modified homodigital dorsolateral proximal phalangeal island flap is a reliable alternative for finger-pulp reconstruction with good functional and cosmetic outcome.

Transcranial magnetic stimulation (TMS) of the human lateral prefrontal cortex, particularly the ventral region, often causes considerable discomfort to subjects. To date, in contrast to abundant literature on stimulations to the dorsolateral prefrontal cortex, the ventrolateral prefrontal cortex has been less frequently stimulated, partly because some subjects are intolerable of stimulation to the ventrolateral prefrontal cortex. To predict the additional number of subjects required for the stimulation of the dorsolateral and ventrolateral prefrontal cortices, 20 young healthy subjects reported two evaluation scores: the discomfort caused by TMS and the resulting intolerability to complete the TMS experiments. Single-pulse stimulation (SPS) or theta-burst stimulation (TBS) was administered to the lateral prefrontal cortex. The high-resolution extended 10-20 system was used to provide accurate estimation of the voxelwise scores. The discomfort ratings with the SPS and TBS were relatively higher in the ventrolateral prefrontal cortex than those in the dorsolateral prefrontal cortex. Both the SPS and TBS elicited maximal discomfort at the stimulation position F8. The SPS and TBS to F8 under the standard TMS protocols were intolerable for approximately one half (11 and 10, respectively) of the subjects. The intolerability was further calculated for all voxels in the lateral prefrontal cortex, which enabled us to estimate the additional number of subjects required for specific target areas. These results suggest that prior knowledge of subjects' discomfort during stimulation of the lateral prefrontal cortex can be of practical use in the experimental planning of the appropriate number of recruited subjects and provide the database for the probability of intolerability that can be used to predict the additional number of subjects.

Exposure to stressful conditions induces long-lasting neurobiological changes in selected brain areas, which could be associated with the emergence of negative emotional responses. Moreover, the interaction of a stressful experience and the retrieval of an established fear memory trace enhance both fear expression and fear retention. Related to this, the stimulation of the dorsolateral part of the mesencephalic periaqueductal gray matter (dlPAG) prior to retrieval potentiates a fear memory trace previously acquired. Therefore, the question that arises is whether the dlPAG mediates the increased fear expression and fear retention after retrieval. Rats were subjected to a contextual fear conditioning paradigm using a single footshock, and 1 day later, rats were subjected to a stressful situation. As previously reported, there was an increase of freezing response only in those rodents that were re-exposed to the associated context at 1 and 5 days after stress exposure. Muscimol intra-dlPAG prior to the restraint event prevented such increase. Conversely, Muscimol intra-dlPAG infusion immediately after the stress experience had no effect on the resulting fear memory. When the neuroendocrine response to stress was explored, intra-dlPAG infusion of muscimol prior to stress decreased Fos expression in the paraventricular nucleus and serum corticosterone levels. Moreover, this treatment prevented the enhancement of the density of hippocampal "mature" spines associated with fear memory. In conclusion, the present results suggest that the dlPAG is a key neural site for the negative valence instruction necessary to modulate the promoting influence of stress on fear memory.

Chordomas are rare midline tumors of the central nervous system which arise from the remnants of the primitive notochord and have unique diagnostic and management challenges. Although recommended treatment for chordoma is radical resection, this may require extended skull base approaches. We report a case of low clival chordoma in a teenage patient which was successfully treated by dorsolateral suboccipital transcondylar approach.

Pleomorphic adenoma is most common benign neoplasm of the major salivary glands that predominantly affects the superficial lobe of the parotid gland and rarely minor salivary glands. These tumors commonly occur in the fourth, fifth and sixth decades with increased predilection towards females and clinically manifests as unilateral, slow growing, firm and painless mass. Their occurrence on the tongue has been very rarely reported in the literature. This case report describes a rarest case of pleomorphic adenoma involving the right dorsolateral surface of tongue in a 28 year old male patient.