Radial Head and Neck Allograft for Comminute Irreparable Fracture-Dislocations of the Elbow

Fracture-dislocations of the elbow can be difficult to treat, with unsatisfactory results in some cases. In general, it is preferable to preserve the fractured radial head when possible, but some patients present a unique treatment challenge because of extremely comminuted fractures and bone loss. In these cases, the only options available are radial head prosthesis or allograft. The authors present a case of a 45-year-old man with a fracture-dislocation of the left elbow that was treated with an allograft of the radial head and neck because of extreme comminution of the fracture. There have been a few reports about osteochondral allograft transplantation of the radial head, and they all included traumatic or posttraumatic cases treated with a frozen allograft. To the best of the authors' knowledge, this is the first report on the use of osteochondral allograft in the acute setting for the treatment of a comminuted fracture of the radius involving the whole head and neck. The clinical results were satisfactory at the final follow-up, although mild degenerative changes were present, the screws were coming loose, and the radial head had a slight valgus deformity. Radial head allograft can be an option in selected cases of acute fractures with severe comminution and bone loss that are not amenable to a stable internal fixation; for the young and active patient, who is not the best candidate for radial head resection; or in cases in which radial head arthroplasty is not feasible because of severe bone loss. [Orthopedics. 201x; xx(x):xx-xx.]

A Declarative Goal-oriented Framework for Smart Environments with LPaaS

Smart environments powered by the Internet of Things aim at improving our daily lives by automatically tuning ambient parameters (e.g. temperature, interior light) and by achieving energy savings through self-managing cyber-physical systems. Commercial solutions, however, only permit setting simple target goals on those parameters and do not consider mediating conflicting goals among different users and/or system administrators, and feature limited compatibility across different IoT verticals. In this article, we propose a declarative framework to represent smart environments, user-set goals and customisable mediation policies to reconcile contrasting goals encompassing multiple IoT systems. An open-source Prolog prototype of the framework is showcased over two lifelike motivating examples

Histological Study of Discoid Lateral Meniscus in Children and Adolescents: Morphogenetic Considerations

: Background  Discoid lateral meniscus is the most frequent variant of the meniscus. Few studies have focused on the histology of discoid menisci. The aim of the present study was to report the histological findings of discoid lateral meniscus in children and adolescents, after arthroscopic partial resection, to give a possible explanation of its developmental etiology. Methods  Five patients aged 9, 10, 13, 15, and 17 years were operated on for a 1-piece excision of a discoid lateral meniscus, and the specimens were histologically examined. Results  The extracellular matrix showed a different distribution and characteristics depending on the different side of the meniscus. Irregularly oriented collagen fibers in discoid lateral meniscus were found. Cells of different shapes were observed depending on the surficial or deep location in the tissue. There were no blood vessels in the inner part of discoid lateral meniscus. Conclusion  The findings of the current study seem to confirm that discoid lateral meniscus arises from variant morphogenesis. Furthermore, the altered distribution and shape of the cells and disorganization of collagen fibers (irrespectively of the age of the patients) may predispose discoid lateral meniscus to degeneration, damage, and tear in young patients also. Level of Evidence  Level of evidence 4 (case series)

Continuous QoS-compliant Orchestration in the Cloud-Edge Continuum

The problem of managing multi-service applications on top of Cloud-Edge networks in a QoS-aware manner has been thoroughly studied in recent years from a decision-making perspective. However, only a few studies addressed the problem of actively enforcing such decisions while orchestrating multi-service applications and considering infrastructure and application variations. In this article, we propose a next-gen orchestrator prototype based on Docker to achieve the continuous and QoS-compliant management of multiservice applications on top of geographically distributed Cloud-Edge resources, in continuity with CI/CD pipelines and infrastructure monitoring tools. Finally, we assess our proposal over a geographically distributed testbed across Italy.Comment: 25 pages, 8 figure

Effects of lack of microRNA-34 on the neural circuitry underlying the stress response and anxiety

Stress-related psychiatric disorders, including anxiety, are complex diseases that have genetic, and environmental causes. Stressful experiences increase the release of prefrontal amygdala neurotransmitters, a response that is relevant to cognitive, emotional, and behavioral coping. Moreover, exposure to stress elicits anxiety-like behavior and dendritic remodeling in the amygdala. Members of the miR-34 family have been suggested to regulate synaptic plasticity and neurotransmission processes, which mediate stress-related disorders. Using mice that harbored targeted deletions of all 3 members of the miR-34-family (miR-34-TKO), we evaluated acute stress-induced basolateral amygdala (BLA)-GABAergic and medial prefrontal cortex (mpFC) aminergic outflow by intracerebral in vivo microdialysis. Moreover, we also examined fear conditioning/extinction, stress-induced anxiety, and dendritic remodeling in the BLA of stress-exposed TKO mice. We found that TKO mice showed resilience to stress-induced anxiety and facilitation in fear extinction. Accordingly, no significant increase was evident in aminergic prefrontal or amygdala GABA release, and no significant acute stress-induced amygdalar dendritic remodeling was observed in TKO mice. Differential GRM7, 5-HT2C, and CRFR1 mRNA expressionwas noted in the mpFC and BLA between TKO andWT mice. Our data demonstrate that the miR-34 has a critical function in regulating the behavioral and neurochemical response to acute stress and in inducing stress-related amygdala neuroplasticity

Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques.

Background: a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruct ion. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. Methods: two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT- 1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). Results: the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. Conclusions: the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. Level of evidence III. Treatment study: Case-control study

Simultaneous Bilateral Flexion-Type Salter-Harris II Fractures of the Proximal Tibia: A Case Report and Review of the Literature

A rare case is reported of bilateral physeal lesions of the proximal tibia classified as Salter-Harris type II, which occurred simultaneously after a “flexion type” injury in a 14-year-old boy. Treatment was conservative on the nondisplaced side and surgical, by closed reduction and internal fixation, on the displaced side. There was no previous diagnosis of Osgood-Schlatter disease. After reviewing all the cases described previously, which occurred either consecutively or simultaneously, we conclude that less resistance of the growth plate, typical of late adolescence, likely represents the cause of this type of lesion

Resolvin D1 Halts Remote Neuroinflammation and Improves Functional Recovery after Focal Brain Damage Via ALX/FPR2 Receptor-Regulated MicroRNAs

Remote damage is a secondary phenomenon that usually occurs after a primary brain damage in regions that are distant, yet functionally connected, and that is critical for determining the outcomes of several CNS pathologies, including traumatic brain and spinal cord injuries. The understanding of remote damage-associated mechanisms has been mostly achieved in several models of focal brain injury such as the hemicerebellectomy (HCb) experimental paradigm, which helped to identify the involvement of many key players, such as inflammation, oxidative stress, apoptosis and autophagy. Currently, few interventions have been shown to successfully limit the progression of secondary damage events and there is still an unmet need for new therapeutic options. Given the emergence of the novel concept of resolution of inflammation, mediated by the newly identified ω3-derived specialized pro-resolving lipid mediators, such as resolvins, we reported a reduced ability of HCb-injured animals to produce resolvin D1 (RvD1) and an increased expression of its target receptor ALX/FPR2 in remote brain regions. The in vivo administration of RvD1 promoted functional recovery and neuroprotection by reducing the activation of Iba-1+ microglia and GFAP+ astrocytes as well as by impairing inflammatory-induced neuronal cell death in remote regions. These effects were counteracted by intracerebroventricular neutralization of ALX/FPR2, whose activation by RvD1 also down-regulated miR-146b and miR-219a-1-dependent inflammatory markers. In conclusion, we propose that innovative therapies based on RvD1-ALX/ FPR2 axis could be exploited to curtail remote damage and enable neuroprotective effects after acute focal brain damage

Isolated Paralysis of the Adductor Pollicis: A Case Report

We report a case of isolated paralysis of the right adductor pollicis in a 30-year-old woman. Electromyographic study showed involvement of the deep motor branch of the ulnar nerve. A ganglion and an anomalous muscle were both ruled out clinically and by MRI as a possible cause of the paralysis. At surgical exploration, we found a fibrous band joining the pisiform and the hook of the hamate bone that compressed the deep motor branch of the ulnar nerve. The fibrous band was excised, and a neurolysis of the motor branch of the ulnar nerve was performed. At followup, eight months later, the patient had fully recovered strength of the adductor muscle