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Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

Burst suppression (BS) is an electroencephalogram (EEG) pattern in which signals alternates between high-amplitude slow waves (burst waves) and nearly flat low-amplitude waves (suppression waves). In this study, we used wide-field (8.32 mm × 8.32 mm) fluorescent calcium imaging to record the activity of glutamatergic neurons in the parietal and occipital cortex, in conjunction with EEG recordings under BS induced by different anesthetics (sevoflurane, isoflurane, and propofol), to investigate the spatiotemporal pattern of neural activity under BS. The calcium signal of all observed cortices was decreased during the phase of EEG suppression. However, during the phase of EEG burst, the calcium signal in areas of the medial cortex, such as the secondary motor and retrosplenial area, was excited, whereas the signal in areas of the lateral cortex, such as the hindlimb cortex, forelimb cortex, barrel field, and primary visual area, was still suppressed or only weakly excited. Correlation analysis showed a strong correlation between the EEG signal and the calcium signal in the medial cortex under BS (except for propofol induced signals). As the burst-suppression ratio (BSR) increased, the regions with strong correlation coefficients became smaller, but strong correlation coefficients were still noted in the medial cortex. Taken together, our results reveal the landscape of cortical activity underlying BS.

Comminuted inter-trochanteric fractures are unstable and treated with conventional anatomic reduction and internal Fixation stability may not be restored due to significant cortical defect present postero-medially. Several surgical methods of treatment for comminuted and unstable inter-trochanteric fracture is described. In this study we performed oblique valgus osteotomy (Augusto Sarmiento) technique in fixing unstable comminuted inter-trochanteric fractures using a short Smith Petersen (SP Nail) and Mclaughlin plate system has been used to achieve union.Materials and Methods: A prospective study was carried out on 20 hips of 20 patients are treated with oblique valgus osteotomy (Augusto Sarmiento) technique and fixed with short Smith Petersen Nail and Mclaughlin Plate was used, the patients were evaluated at a mean of 10 months to 62 months average (26 months) for union, leg equalisation, clinical outcomes.Results: Mean time of union was 12.5 +_ (range 10 – 22 weeks). NO intra-operative instability of the osteotomy site was encountered.Conclusions: Comminuted unstable inter -trochanteric fracture treated by valgus osteotomy (Sarmiento technique) and medial displacement of the distal fragment with accurate approximation of the medial cortex of the two major fragments greatly enhances the efficiency of fixation.

This study aimed to evaluate the results of surgical treatment for proximal humeral fractures using a locking plate in patients aged > 70 years. Between September 2010 and March 2018, we retrospectively analyzed the clinical and radiological outcomes of 56 patients aged > 70 years who underwent locking plate fixation for proximal humeral fractures. We analyzed bone union, neck-shaft angle, University of California Los Angeles (UCLA) score, range of motion (compared to that of the opposite side), and complications. Further, clinical and radiological results of unstable medial column fractures were investigated. Fifty-four patients (96.2%) achieved bone union. The mean time to bone union was 14.7 ± 1.2 weeks, and the mean neck-shaft angle was 126.4° ± 14.2°. The mean UCLA shoulder score was 22.4 ± 6.5. The mean forward flexion, abduction, and external rotation angles were 129.2° ± 19.4°, 112.3° ± 14.8°, and 44.2° ± 18.5°, respectively, with internal rotation to L2/3 (S-T11). The range of motion was significantly different from that in the opposite shoulder motion. Unstable medial column fractures led to a significant loss in the neck-shaft angle compared with fractures with an intact medial cortex. For the surgical treatment of proximal humeral fractures in patients aged > 70 years, using a locking plate helped achieve a high bone union rate with relatively satisfactory results. However, the prevalence of unstable medial column fracture was high. Clinical and radiological outcomes were poor in these patients. Therefore, it is necessary to accurately understand the fracture pattern prior to surgery, and various surgical methods, including conservative treatment, should be considered.

Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

This study used hydrogen proton magnetic resonance imaging to detect the changes of white matter and the medial cortex in the prefrontal cortex of patients with type 2 diabetes, analyzed its relationship with cognitive function and blood glucose level, and discussed the recognition of patients with type 2 diabetes from the perspective of brain metabolism. We discuss the neural mechanisms affected by the disorder. The experiment recruited 65 volunteers, including 32 control subjects and 33 patients with type 2 diabetes. All volunteers underwent clinical cognitive function and psychological evaluation, including a simple intelligent mental state examination scale, digital breadth test, Raven intelligence test, Flanker paradigm experiment, connection test, auditory word learning test, depression self-evaluation scale, and anxiety self-rating scale. All subjects underwent multivoxel proton magnetic resonance scanning, and the spectral data were processed and metabolite concentration analysis was completed by Functool software. The detected regions of interest included the bilateral prefrontal white matter and bilateral prefrontal cortex. This study found that the N-acetylaspartate (NAA) and NAA/myo-inositol (MI) of the right prefrontal cortex were reduced, the right prefrontal white matter choline-containing compounds increased, and the MI of the bilateral prefrontal cortex increased in the type 2 diabetes group compared with the control group. The NAA value of the right prefrontal cortex in the type 2 diabetes group was negatively correlated with the glycated hemoglobin concentration. The study found that the right prefrontal cortex NAA value of patients with type 2 diabetes was negatively correlated with the glycated hemoglobin concentration, reflecting that recent blood glucose levels can affect the changes of brain metabolites, and reasonable control of blood glucose can effectively delay brain neurons caused by diabetes.

After experiencing the same episode, some people can recall certain details about it, whereas others cannot. We investigate how common (intersubject) neural patterns during memory encoding influence whether an episode will be subsequently remembered, and how divergence from a common organization is associated with encoding failure. Using functional magnetic resonance imaging with intersubject multivariate analyses, we measured brain activity as people viewed episodes within wildlife videos and then assessed their memory for these episodes. During encoding, greater neural similarity was observed between the people who later remembered an episode (compared with those who did not) within the regions of the declarative memory network (hippocampus, posterior medial cortex [PMC], and dorsal Default Mode Network [dDMN]). The intersubject similarity of the PMC and dDMN was episode-specific. Hippocampal encoding patterns were also more similar between subjects for memory success that was defined after one day, compared with immediately after retrieval. The neural encoding patterns were sufficiently robust and generalizable to train machine learning classifiers to predict future recall success in held-out subjects, and a subset of decodable regions formed a network of shared classifier predictions of subsequent memory success. This work suggests that common neural patterns reflect successful, rather than unsuccessful, encoding across individuals.

Highlights • Dedifferentiated chondrosarcomas are rare, difficult to treat and survival is poor. • Chemotherapy and radiation are currently controversial. • Wide resection with adequate margins is essential. • Reconstruction with an articular sparing hemicortical allograft is a viable option. • Functional shoulder scores are acceptable and improve over time., Introduction Dedifferentiated chondrosarcomas are rare and highly malignant tumors that require wide surgical resection. Survival is extremely poor without adequate surgical margins. We present a case of articular sparing surgery of the shoulder for dedifferentiated chondrosarcoma with excellent functional outcomes and no evidence of disease after fifty-six months. Presentation of case A 29-year-old male was found to have a non-metastatic right proximal humerus dedifferentiated chondrosarcoma. He underwent resection with clear one centimeter margins sparing the medial cortex and the articular surface. Reconstruction of the bone was accomplished using a hemicortical allograft. A dermal allograft was used to help reconstruct the rotator cuff to the allograft bone. At fifty-six months after surgery he has excellent functional range of motion. His current MSTS, Quick Dash, and Constant Shoulder scores are 29, 2.3, and 80, respectively. He has remained free of disease, is back to work without restrictions and is active in outdoor activities. Discussion Dedifferentiated chondrosarcoma has high recurrence and poor survival rates. Adequate surgical resection is vital for its treatment. Previously described reconstructive techniques have consisted of articular replacement with a prosthesis, allograft, or allograft-prosthetic composites. To our knowledge, this is the first report of an articular sparing reconstruction for dedifferentiated chondrosarcoma with fifty-six month survival and functional outcomes. When possible, sparing the articular surface can provide good functional outcomes that improve over time. Conclusion If adequate surgical margins can be obtained, an articular surface sparing reconstruction of the shoulder can provide effective functional outcomes and an alternative to joint replacement.

Highlights • Author got reliable fixation with double plating in situation, could not get secure stability by unilateral lateral plating. • Authors used medial parapatella approach for placing an additional plate on the medial side of distal femur. • Parapatella approach for additional plating can check screw length, femoral component stability and rotation, and polyethylene insert wear., Introduction Recently, good results of locking compression plate (LCP) have been reported in the case of fixation using plate, but when fractures extend too distal over the proximal border of femoral component, operations are highly challenging. Presentation of case Author reports two cases that couldn't get reliable fixation by LCP alone because of poor bone quality with chronic infection and far juxta-fracture of prosthesis. Fractures were fixed to the medial and lateral sides of the distal femur with LCPs and were healed successfully. Discussion Indirect healing (endochondral bone formation) using anatomical alignment and bridge plating using LCP is usually used rather than direct healing (intramembranous) through anatomical reduction and rigidly stable fixation for periprosthetic distal femoral fracture. Proper flexible fixation is helpful for indirect bone healing through the callus formation, but too flexible fixation cannot maintain fracture fragments until the callus formation provides sufficient stability. Medial parapatella approach for additional medial side plating have many advantages that it can confirm the screw length which not penetrate intercondylar box or medial cortex, and can check component stability, rotation, wear of the polyethylene insert. Conclusion Bilateral plate fixation through additional medial parapatella approach is useful method for obtaining secure fixation to poor bone quality or extremely distal femoral periprosthetic fracture.

Current theory and empirical studies suggest that humans segment continuous experiences into events based on the mismatch between predicted and actual sensory inputs; detection of these “event boundaries” evokes transient neural responses. However, boundaries can also occur at transitions between internal mental states, without relevant external input changes. To what extent do such “internal boundaries” share neural response properties with externally-driven boundaries? We conducted an fMRI experiment where subjects watched a series of short movies and then verbally recalled the movies, unprompted, in the order of their choosing. During recall, transitions between movies thus constituted major boundaries between internal mental contexts, generated purely by subjects’ unguided thoughts. Following the offset of each recalled movie, we observed stereotyped spatial activation patterns in the default mode network, especially the posterior medial cortex, consistent across different movie contents and even across the different tasks of movie watching and recall. Surprisingly, the between-movie boundary patterns did not resemble patterns at boundaries between events within a movie. Thus, major transitions between mental contexts elicit neural phenomena shared across internal and external modes and distinct from within-context event boundary detection, potentially reflecting a cognitive state related to the flushing and reconfiguration of situation models.

Malrotation after nailing of femoral shaft fractures occurs in about 25% of cases. It can cause substantial functional problems. The lesser trochanter (LT) profile has been used to assess rotational alignment. However, the extent to which the LT profile is symmetrical between limbs, whether the LT profile varies as a function of age or sex, and the efficacy of the LT profile technique remain unknown. The purpose of this study was to determine if there was a significant side-to-side length difference in the LT profile (LTD) according to age and sex.We attempted to determine the amount of medial prominence of the lesser trochanter relative to the medial cortex of the femoral shaft (the LT profile) using 3-dimensional computed tomography (3D-CT) images of normal femora obtained bilaterally (366 subjects) in anatomic positions. We also compared the left and right sides to determine the amount of natural asymmetry by age and sex. In addition, we compared the side-to-side difference in the LT version with the LTD to determine whether the LTD represented the difference in femoral rotation.The LTD was4 mm (meaning an LT version difference of10°) in 83% of the subjects, but was ≥4 mm (an LT version difference of ≥10°) in 17%. Subset analysis demonstrated that the differences were greatest in women70 years of age. The largest LTD (both sexes) was observed in individuals over 70 years of age (2.62 ± 1.37 mm, compared with55 years: 1.55 ± 1.36 mm and 55 to 70 years: 2.27 ± 1.70 mm). There was no significant difference between sexes in the under-70 age groups. However, the LTD was significantly greater in women over 70 years than in men over 70 years (3.10 ± 1.42 versus 2.41 ± 1.30 mm).Since the LTD demonstrated side-to-side symmetry within 4 mm, or 10° of rotation, in 83% of all subjects, we consider the LT profile to be useful as a guide to assess rotational reduction clinically. However, surgeons should recognize that, in 17% of cases, using this technique could result in malrotation of ≥10°. The rate of malrotation may be even higher in women over 70, for whom supplemental techniques to ensure correct rotation may be appropriate.

When making a turn at a familiar intersection, we know what items and landmarks will come into view. These perceptual expectations, or predictions, come from our knowledge of the context; however, it is unclear how memory and perceptual systems interact to support the prediction and reactivation of sensory details in cortex. To address this, human participants learned the spatial layout of animals positioned in a cross maze. During fMRI, participants of both sexes navigated between animals to reach a target, and in the process saw a predictable sequence of five animal images. Critically, to isolate activity patterns related to item predictions, rather than bottom-up inputs, one-fourth of trials ended early, with a blank screen presented instead. Using multivariate pattern similarity analysis, we reveal that activity patterns in early visual cortex, posterior medial regions, and the posterior hippocampus showed greater similarity when seeing the same item compared with different items. Further, item effects in posterior hippocampus were specific to the sequence context. Critically, activity patterns associated with seeing an item in visual cortex and posterior medial cortex, were also related to activity patterns when an item was expected, but omitted, suggesting sequence predictions were reinstated in these regions. Finally, multivariate connectivity showed that patterns in the posterior hippocampus at one position in the sequence were related to patterns in early visual cortex and posterior medial cortex at a later position. Together, our results support the idea that hippocampal representations facilitate sensory processing by modulating visual cortical activity in anticipation of expected items.SIGNIFICANCE STATEMENT Our visual world is a series of connected events, where we can predict what we might see next based on our recent past. Understanding the neural circuitry and mechanisms of the perceptual and memory systems that support these expectations is fundamental to revealing how we perceive and act in our world. Using brain imaging, we studied what happens when we expect to see specific visual items, and how such expectations relate to top-down memory signals. We find both visual and memory systems reflect item predictions, and moreover, we show that hippocampal activity supports predictions of future expected items. This demonstrates that the hippocampus acts to predict upcoming items, and reinstates such predictions in cortex.

Engaging with narratives involves a complex array of cognitive and affective processes. These processes make stories persuasive in ways that standard arguments are not, though the underlying reasons for this remain unclear. Transportation theory proposes a potential explanation for this: narratives are processed in a way which makes individuals feel immersed in the world of a story, which in turn leads people to resonate emotionally with the events of the story. Recent fMRI studies have shown that the posterior medial cortex (PMC) and anterior insula (AI) play important roles in understanding the meaning of stories and experiencing the feelings they produce. In this study, we aimed to explore the AI’s and PMC’s role in narrative processing by measuring their functional connectivity with the rest of the brain during story listening, and how connectivity changes as a function of narrative transportation and the persuasiveness of the story. We analyzed data from 36 right-handed subjects who listened to two stories, obtained from podcasts, inside the fMRI scanner. After the scan, subjects were asked a series of questions, including a measure of how transported into the story they felt, how likely they would be to donate to causes related to the messages of the stories. We used searchlight multivariate pattern analysis (MVPA) to classify functional connectivity maps using seeds in both the AI and PMC and to compare these maps between participants who differed in transportation and prosocial intention. We found that connectivity to various regions successfully distinguished between high and low ratings on each of these behavioral measures with accuracies over 75%. However, only one pattern of connectivity was consistent across both stories: PMC-inferior frontal gyrus connectivity successfully distinguished high and low ratings of narrative transportation in both stories. All other findings were not consistent across stories. Instead, we found that patterns of connectivity may relate more to the specific content of the story rather than to a universal way in which narratives are processed.

Background The anterior cortical window technique was developed to facilitate stem removal in revision total hip arthroplasty (THA). In this technique, only the anterior cortex of the proximal femur is osteomized; the trochanter, lateral cortex, and medial cortex remain intact. Therefore, a new stem can be press-fitted into the femur and mediolateral stability can be obtained. However, the long-term results of revision THA using this technique are unknown. We report the outcome and survivorship at a minimum of 10-year follow-up. Methods From May 2003 to April 2006, 69 patients (75 hips) underwent revision THA using an anterior cortical window and a cementless distal interlocking stem. Of these, 50 patients (56 hips) were followed up for 10 to 13 years (mean, 11.5 years). There were 26 men (29 hips) and 24 women (27 hips) with a mean age of 51.2 years (range, 29 to 82 years) at the time of revision arthroplasty. We evaluated radiographs, Harris hip score, University of California at Los Angeles (UCLA) activity score, Koval category, and survivorship. Results Nonunion of the osteotomy occurred in one hip (2%). Five stems (8.9%) subsided 5 mm or more. At the final evaluation, the mean Harris hip score, UCLA activity score, and the Koval category were 82.5, 4.6, and 1.5, respectively. Survivorship with any operations as the end point was 80.4% and that with stem-revision as the end point was 91.1%. Conclusions With use of an anterior cortical window, a well-fixed stem can be easily removed, and a new stem can be inserted with firm mediolateral stability in the proximal femur in revision THA. We recommend using this technique instead of the extended trochanteric osteotomy in revision THA.

To evaluate the correlation between avascular necrosis (AVN) and the amount (severity) and direction (translation and angulation) of initial displacement of pediatric femoral neck fractures. We retrospectively reviewed 108 pediatric patients (mean age 10.3 ± 4.1 years) with femoral neck fractures. The amount of initial translation (T) and angulation (A) was measured on anteroposterior (AP; TAP% and AAP) and lateral (TL% and AL) radiographs. The direction of translation was determined on AP (medial or lateral) and lateral radiographs (anterior or posterior). Furthermore, the presence of a comminuted medial cortex on the AP pelvis radiograph was also recorded. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, student’s t tests, and chi-square tests were used to evaluate the correlation between AVN and the severity and direction of displacement. Twenty-eight out of 108 hips (25.9%) developed AVN of the femoral head. Logistical regression analysis indicated that TAP%, TL%, AAP, and AL were risk factors for AVN (P < 0.05). The analysis of ROC curves found that TAP% over 37.4% and TL% over 29% were the cut-off values for an increased incidence of AVN; similarly, AAP over 8° and AL over 18.6° were the cut-off values for an increased incidence of AVN. The amount of initial translation is a better predictor of AVN than angulation is; fractures with posterior translation (P = 0.002) and/or medial comminution had a significantly higher incidence of AVN (P = 0.005). The mean diagnostic accuracy of translation (74–75%) was significantly higher than that of angulation (65–66%). Displacement severity and direction are important radiological parameters to be assessed in children with femoral neck fractures. Initial translation better predicts AVN than angulation does. Posterior translation and medial comminution are associated with an increased risk of AVN.

In the context of total hip arthroplasty (THA), there are several reasons that have motivated the development of short stems. It has been postulated that short stems allow a better conservation of the bone stock if compared to conventional stems. As far as we have knowledge, the quantitative loss of diaphyseal bone stock in patients with standard femoral stems has not been fully described. The aim of this study was to provide evidences about the thickness of the cortical bone at the diaphysis in patients who have undergone unilateral THA with Furlong® stems with a minimum follow-up of 18 years. A retrospective study of patients who underwent THA in a single hospital was performed. The inclusion criteria were patients who had undergone a non-cemented elective THA with a Furlong® stem, minimum follow-up of 18 years, and contralateral femur and hip without history of previous surgical procedures. The follow-up analysis was performed by means of radiological examinations performed at the last follow-up visit. Data related to the sex, age at surgery and adverse events registered during the follow-up were gathered. The cortical thickness index (CTI) and cortical thickness (CT) assessed at the last follow-up visit in anteroposterior pelvic X-rays were analyzed, both in the operated hip and in the non-operated hip (which was used as control). Calibration of the measurements was done by means of using the circumference of the head of the THA. The total number of patients who met the inclusion criteria was 22. There were 14 women and eight men. There were 12 left hips. The mean age at the time of surgery was 59.32 ± 6.83 (range 50–70) years. The mean follow-up was 20.86 ± 1.90 (range 18–24) years. The CTI was found to be 11.93% greater in the non-operated hips. The CT measured at 3 cm and 6 cm from lesser trochanter, and at 9 cm from the greater trochanter, was found to be 21.64%, 15.33% and 18.73% greater in the non-operated hips, respectively. After a minimum of 18 years from the implantation of a Furlong® stem, the bone density that surrounds the implant seems to involve a cortical bone ten percent less thick than the cortical bone of the non-operated contralateral side. With this stem, the cortical zones with less CT seem to be the lateral cortex at 9 cm from the greater trochanter, and the medial cortex at 3 and 6 cm from the lesser trochanter. III, retrospective case–control study.

Purpose Brain positron emission tomography using 18F-fluorodeoxyglucose (18FDG-PET) provides a metabolic assessment of brain function that is useful for differential diagnosis among several neurodegenerative diseases manifested by cognitive impairment (CI) [1] , [2] , [3] . The purpose of the study is to describe the pattern of 18FDG-PET abnormalities in patients with CI related to alcohol use disorder. Methods Patients admitted to the addiction medicine department of a university hospital in Paris between January 2017 and October 2018 with a confirmed diagnosis of alcohol-related cognitive impairment (ARCI) or Wernicke encephalopathy (WE) were included. Brain 18FDG-PET uptake was measured after at least one month of monitored abstinence from alcohol. Standardized uptake values (SUV) were obtained for 13 regions of interest (ROI) and normalized to the pons. Individual patients’ ROI Z-scores were calculated from healthy sex- and age-matched controls provided by Cortex ID software. A principal component analysis (PCA) on the subjects’ ROIs SUV ratios was conducted. Results Twenty-five patients were included in the analysis (20 males and 5 females; mean age 57.6 years [45 – 76 years old]). The group consisted of 19 ARCI and 6 WE cases. The mean hypometabolism was most severe in the prefrontal medial cortex (PFM) (−2.80 [± 1.30]), the prefrontal lateral cortex (−2.20 [± 1.35]), and the anterior cingulate cortex (ACC) (−2.24 [± 1.19]). Hypometabolism (Z-score Table 1 ). Other regions were also affected (with 5.32/13 hypometabolic ROIs on average [SD = 4.16, range 0 – 13]). The Z-scores in the 13 ROIs did not differ significantly between the ARCI and WE patients (P ≥ 0.05). The PCA identified two principal components. The first principal component explains 59.49% of the variance and it is formed by the clustering of six specific ROIs: sensorimotor cortex, parietal superior cortex, parietal inferior cortex, precuneus, occipital lateral cortex and primary visual cortex. The second explains 14.52% of the variance and it is formed by three ROIs: the PFM, ACC and temporal mesial cortex. Conclusions Predominant prefrontal and cingulate cortex hypometabolism was the most frequent brain 18FDG-PET pattern in our sample of patients with ARCI and WE. We believe that brain 18FDG-PET could be a potential imaging biomarker of ARCI, and predictive values for both differential diagnosis and prognosis should be prospectively tested.

The cingulum is the major fiber system connecting the cingulate and surrounding medial cortex and medial temporal lobe internally and with other brain areas. It is important for social and emotional functions related to core symptomatology in autism spectrum disorders (ASDs). While the cingulum has been examined in autism, the extensive system of cingulate U‐fibers has not been studied. Using probabilistic tractography, we investigated white matter fibers of the cingulate cortex by distinguishing its deep intra‐cingulate bundle (cingulum proper) and short rostral anterior, caudal anterior, posterior, and isthmus cingulate U‐fibers in 61 ASD and 54 typically developing children and adolescents. Increased mean and radial diffusivity of the left cingulum proper was observed in the ASD group, replicating previous findings on the cingulum. For cingulate U‐fibers, an atypical age‐related decline in right posterior cingulate U‐fiber volume was found in the ASD group, which appeared to be driven by an abnormally large volume in younger children. History of repetitive and restrictive behavior was negatively associated with right caudal anterior cingulate U‐fiber volume, linking cingulate motor areas with neighboring gyri. Aberrant development in U‐fiber volume of the right posterior cingulate gyrus may underlie functional abnormalities found in this region, such as in the default mode network.

Skilled visual object and pattern recognition form the basis of many everyday behaviours. The game of chess has often been used as a model case for studying how long-term experience aides in perceiving objects and their spatio-functional interrelations. Earlier research revealed two brain regions, posterior middle temporal gyrus (pMTG) and collateral sulcus (CoS), to be linked to chess experts' superior object and pattern recognition, respectively. Here we elucidated the brain networks these two expertise-related regions are embedded in, employing resting-state functional connectivity analysis and meta-analytic connectivity modelling with the BrainMap database. pMTG was preferentially connected with dorsal visual stream areas and a parieto-prefrontal network for action planning, while CoS was preferentially connected with posterior medial cortex and hippocampus, linked to scene perception, perspective-taking and navigation. Functional profiling using BrainMap meta-data revealed that pMTG was linked to semantic processing as well as inhibition and attention, while CoS was linked to face and shape perception as well as passive viewing. Our findings suggest that pMTG subserves skilled object recognition by mediating the link between object identity and object affordances, while CoS subserves skilled pattern recognition by linking the position of individual objects with typical spatio-functional layouts of their environment stored in memory.

Popliteal artery injury is a rare but devastating complication of open-wedge high tibial osteotomy (OWHTO). The objectives of this study were: to document the location of the artery in the virtual osteotomy plane (VOP), to measure the minimal distance between the popliteal artery and three virtual saw-progression lines (VSLs), and to present a safe sawing technique for OWHTO. In total, 45 computed tomography angiographies were reconstructed and virtual osteotomy was simulated using 3D image-processing software. The VOP was defined as an inclined plane commencing 3.5 cm below the articular plane towards the fibular head. VSLs were defined as saw-progression guidelines that lie on the VOP: “VSL-mid” runs from the midpoint of the tibial medial cortex towards the fibular head; “VSL-ant” starts from the same point as VSL-mid, but runs 10° anterior to the fibular head; and “VSL-post” runs 10° posterior to the fibular head. The distances between the popliteal artery and the three VSLs were measured, and the risk of injury was assessed. The popliteal artery was located 20.7° posterior to VSL-mid and 51 mm from the starting point. The minimum distance between the popliteal artery and VSL-mid was 18 mm (99% confidence interval 9–27 mm). When the saw was moved along VSL-mid, 42% of the arteries were susceptible to injury. However, when it followed VSL-ant, there was no risk of injury. Sawing toward the fibular head carries a risk of popliteal artery injury and should not be performed. When sawing in OWHTO, the recommended target should be 10° anterior to the fibular head. This technique eliminates the risk of popliteal artery injury.

Background The purpose of this study was to evaluate the quantitative association between the degree of reduction and the position of the blade of the proximal femoral nail antirotation (PFNA) in intertrochanteric hip fractures. Methods From March 2009 to April 2015, 530 patients treated with PFNA for intertrochanteric hip fractures were retrospectively reviewed. Patients were divided into a valgus reduced group (group 1) and a non-valgus reduced group (group 2), and the "valgus reduced" was defined as valgus reduction over 5°. We compared the calcar referenced tip-apex distance (calTAD) and the area between the blade of PFNA and the medial cortex of the femoral neck between the two groups. Results The calTAD was measured as 22.5 ± 4.1 mm in group 1 and 24.8 ± 3.8 mm in group 2 (p < 0.05). The area between the blade and the medial femoral neck was measured as 135.5 ± 49.8 mm2 in group 1 and 145.1 ± 54.8 mm2 in group 2 (p = 0.074). The area corrected for the length difference in the femoral neck was 0.55 ± 0.16 in group 1 and 0.79 ± 0.19 in group 2 (p < 0.05). Conclusions Valgus reduction resulted in less calTAD and inferior position of the blade at the femoral neck in the treatment of intertrochanteric hip fractures with PFNA.

Objective: The aim of this study was to compare clinical and radiological outcomes of elder and younger patients with comminuted proximal humerus fracture treated with osteosynthesis with locking plate. Methods: A total of 70 patients (30 males and 40 females; mean age 65.4 years) operated on for Neer 3- or 4-part proximal humeral fractures between 2010 and 2016 and followed for at least one-year were included in the study. The reduction was achieved through intraosseous window to minimize soft tissue stripping in all patients and structural allograft at metaphyseal diaphyseal junction was used aggressively to resist varus force. Group 1 consisted of 32 patients aged 70 or older (14 males and 18 females; mean age: 77.8 ± 5.1), while Group 2 consisted of 38 patients younger than 70 (16 males and 22 females; mean age: 58.2 ± 9.3). The groups were compared for their clinical and radiological outcomes. Results: There was no significant difference in clinical outcomes by Oxford score (54.8 ± 2.7 vs 56.6 ± 3.4, p = 0.13) and ASES score (89.7 ± 5.7 vs 90.8 ± 8.2, p = 0.68). Two groups had similar radiological outcomes regarding neck shaft angle, greater tip height and offset. However, group 2 had better final shoulder forward elevation (162.6 ± 8.7 vs 135.4 ± 14.7ß, p

Background The conserved NDR-family kinase Sid2p localizes to the contractile ring during fission yeast cytokinesis to promote ring constriction, septation, and completion of cell division. Previous studies have found that the Type 2 interphase node proteins Blt1p and Gef2p contribute to localization of Sid2p and its regulatory protein Mob1p at the division site. However, their relative contributions and whether they operate in the same or parallel pathways has been unclear. In this study, we quantify the respective roles of Blt1p and Gef2p in Sid2p/Mob1p recruitment and characterize the effect of single and double deletion mutants on contractile ring dynamics and completion of cell division. Results Using quantitative confocal fluorescence microscopy, we measured Sid2p and Mob1p recruitment to the division site in blt1∆, gef2∆, and blt1∆/gef2∆ mutant cells. We observed an equivalent decrease in Sid2p/Mob1p localization for both single and double mutants. Though assembly of the contractile ring is normal in these mutants, the reduction in Sid2p/Mob1p at the division site delayed the onset of contractile ring constriction and completion of division. We quantified localization of Blt1p and Gef2p at the medial cortex throughout the cell cycle and found that Blt1p localization to interphase nodes and the contractile ring is independent of Gef2p. However, Gef2p localization to the contractile ring is decreased in blt1∆ mutants. Conclusions Blt1p and Gef2p work in the same pathway, rather than in parallel, to localize the NDR-family kinase Sid2p and its regulatory partner Mob1p to the division site, thereby promoting timely completion of cell division. Future studies are necessary to understand how additional fission yeast cytokinesis proteins work with these Type 2 interphase node components to promote Sid2p/Mob1p recruitment. Electronic supplementary material The online version of this article (10.1186/s12860-018-0182-z) contains supplementary material, which is available to authorized users.

Background: Femoral neck shortening can occur in young patients receiving closed reduction and internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after closed reduction and internal fixation with parallel partially threaded cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.Methods: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. These patients were followed (average follow-up: 12 months). And the chi-square test or t test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion：Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after closed reduction and internal fixation with parallel, partially threaded, cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.BMD and BMI may be also risk factors.

The abnormal cortices of autism spectrum disorder (ASD) brains are uncertain. However, the pathological alterations of ASD brains are distributed throughout interconnected cortical systems. Functional connections (FCs) methodology identifies cooperation and separation characteristics of information process in macroscopic cortical activity patterns under the context of network neuroscience. Embracing the graph theory concepts, this paper introduces eigenvector centrality index (EC score) ground on the FCs, and further develops a new framework for researching the dysfunctional cortex of ASD in holism significance. The important process is to uncover noticeable regions and subsystems endowed with antagonistic stance in EC-scores of 26 ASD boys and 28 matched healthy controls (HCs). For whole brain regional EC scores of ASD boys, orbitofrontal superior medial cortex, insula R, posterior cingulate gyrus L, and cerebellum 9 L are endowed with different EC scores significantly. In the brain subsystems level, EC scores of DMN, prefrontal lobe, and cerebellum are aberrant in the ASD boys. Generally, the EC scores display widespread distribution of diseased regions in ASD brains. Meanwhile, the discovered regions and subsystems, such as MPFC, AMYG, INS, prefrontal lobe, and DMN, are engaged in social processing. Meanwhile, the CBCL externalizing problem scores are associated with EC scores.

Background The purpose of the current study was to retrospectively clarify the anatomic character and evaluate the mid-term operative outcomes for vertical medial malleolar fractures (MMFs). Methods A total of 53 patients with supination adduction (SAD) type II MMFs treated with open reduction and internal fixation (ORIF) between March 2009 and June 2013 were included. We reviewed the patients' preoperative X-ray and computed tomography (CT) to determine the pathoanatomic characteristics of medial malleolus fractures. Buttress plate lag screws fixation had been applied. Complications and treatment failures were recorded; the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Results For the 53 patients, only 39.6% cases with simple vertical MMFs. The mean distal tibial articular surface (DTAS) involvement in the MMF was 16.5%±11.6% (range, 0-47%). The mean follow up time was 62.4±14.1 [44-91] months. There were 7 cases of traumatic osteoarthritis (TOA), and 3 cases of failure were reported in the screw fixation group. The mean AOFAS score was 80.6±15.8 points, and the mean VAS score was 2.1±1.7 points, with a good to excellent rate (GTE) of 81.1%. No significant difference was found in comparing the AOFAS, VAS, GTE, incision relative complication rate, infection rate, loss of reduction (LoR) rate, and TOA rate between groups (P>0.05). The participants in the buttress plate group reached a shorter mean full weight-bearing (FWB) time (P=0.04). Conclusions More than 60% vertical MMFs are with one or more characteristics of medial cortex comminuted fractures, or die-punch fragments, or medial joint compression. And patients with die-punch fragment, medial joint compression, LoR, large DTAS involvement and small fracture line angle (FLA) were positively correlated with the fair to poor results. Lag screw fixation should be cautiously used in vertical MMF patients with comminuted medial cortex.