Post-traumatic humerus non-union treatment using fibular bone graft in a pediatric patient – case report

Clinica de Chirurgie și Ortopedie Pediatrică, Spitalul Clinic de Urgență pentru Copii ”Sfânta Maria”, Iași, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Pseudartroza de humerus prezintă o incidență de 8-12% în rândul populației pediatrice. Există o varietate largă de opțiuni terapeutice, principiile de tratament bazându-se pe reducere deschisă și osteosinteză sau utilizare de grefon osos, în funcție de caz. Material și metode: Pacientă în vârstă de 15 ani,victimă a unui accident rutier, s-a internat în urgență pentru traumatisme multiple, printre diagnosticele stabilite fiind fractura diafizei humerale stângi, pentru care s-a practicat reducere deschisă și osteosinteză cu placă și șuruburi. La un an postoperator s-a constatat pseudartroză la nivelul focarului de fractură. Rezultate obținute: S-au utilizat numeroase metode de tratament pentru cura pseudartrozei: montarea de fixator extern, injectare perilezională cu factori de creștere, o nouă osteosinteză cu placă și șuruburi și plombajul defectului osos cu ceramică bifazică. Întrucât pseudartroza a persistat, s-a optat pentru o nouă intervenție cu utilizarea grefonului osos peronier fixat centromedular la nivelul humerusului, evoluția postoperatorie fiind favorabilă. Concluzie: Pseudartroza de humerus rămâne una dintre cele mai dificile complicații ale fracturii de humerus din cauza frecvenței sale și a dificultăților de management terapeutic. În cazul de față, tratamentul chirurgical utilizând grefon osos autolog a avut rezultate optime, cu o rată bună de vindecare din punct de vedere anatomo-funcțional.Introduction: Humerus fracture non-union presents 8-12% of all the pediatric population. Treatment options are numerus and is generally based on open reduction with internal fixation or using bone graft depending on each case individually. Material and methods: 15 years old female patient, presented with road traffic crash, was admitted with multiple trauma. Left humerus shaft fracture was one of the established diagnosis, open reduction with internal fixation was performed using a plate and screws. 1 year postoperatively non-union was noticed on the check X-rays at the fracture site. Results: Multiple methods were used for non-union treatment: external fixator, growth factor hormone injection at fracture site, second open reduction with internal fixation attempt and biomaterial usage for bone loss. Fracture non-union persisted despite the usage of the mentioned methods. Decision was taken to use fibular bone graft as an intramedullary fixation of the humerus. Postoperative result and follow up were satisfactory. Conclusion: Humeral fracture non-union is one of the worse complications due to its frequency and difficult therapeutic management. In this presented case, surgical treatment using autologous bone graft reflected in optimal results, high anatomo-functional healing results

Balancing family with a successful career in neuroscience.

After years of hard work as a student and postdoc, stressful negotiations and restless nights of agony regarding your academic future, you managed to secure a Principal Investigator (PI) position and establish your own laboratory. And just when you thought you could relax a bit and enjoy some time with your family, or start a family, you find yourself facing massive levels of responsibility added to your research, that demand most of your time and energy. The challenge to balance a successful career with a happy family life is not a trivial one.The FENS‐Kavli Network of Excellence is supported by FENS, the Kavli Foundation, Alzheimer's Research UK, the European Molecular Biology Organization (EMBO) and Roche. P.P. acknowledges funding from the European Research Council (StG 311435 dEMORY). J.G. is supported by the European Research Council (StG 678832 REMOTE MEMORY TRACES), an MQ fellow award, the Swiss National Science Foundation, the National Competence Center for Research in Switzerland SYNAPSY, the SYNAPSIS Foundation, the Béatrice Ederer‐Weber Stiftung, the Alzheimer's Association as well as by an Independent Investigator Award from the Brain and Behavior Research Foundation. I.H.‐O. is supported by the ERC Consolidator Grant CoG 681577 PSYCHOCELL. D.B. is supported by the Wellcome Trust. G.L.‐B. is supported by the European Research Council, ERC‐2014‐CoG 647012 and the Spanish MINECO BFU2012‐34298 grant

Thalamic and Entorhinal Network Activity Differently Modulates the Functional Development of Prefrontal-Hippocampal Interactions.

Precise information flow during mnemonic and executive tasks requires the coactivation of adult prefrontal and hippocampal networks in oscillatory rhythms. This interplay emerges early in life, most likely as an anticipatory template of later cognitive performance. At neonatal age, hippocampal theta bursts drive the generation of prefrontal theta-gamma oscillations. In the absence of direct reciprocal interactions, the question arises of which feedback mechanisms control the early entrainment of prefrontal-hippocampal networks. Here, we demonstrate that prefrontal-hippocampal activity couples with discontinuous theta oscillations and neuronal firing in both lateral entorhinal cortex and ventral midline thalamic nuclei of neonatal rats. However, these two brain areas have different contributions to the neonatal long-range communication. The entorhinal cortex mainly modulates the hippocampal activity via direct axonal projections. In contrast, thalamic theta bursts are controlled by the prefrontal cortex via mutual projections and contribute to hippocampal activity. Thus, the neonatal prefrontal cortex modulates the level of hippocampal activation by directed interactions with the ventral midline thalamus. Similar to the adult task-related communication, theta-band activity ensures the feedback control of long-range coupling in the developing brain.Significance statementMemories are encoded by finely tuned interactions within large-scale neuronal networks. This cognitive performance is not inherited, but progressively matures in relationship with the establishment of long-range coupling in the immature brain. The hippocampus initiates and unidirectionally drives the oscillatory entrainment of neonatal prefrontal cortex, yet feedback interactions that precisely control this early communication are still unresolved. Here, we identified distinct roles of entorhinal cortex and ventral midline thalamus for the functional development of prefrontal-hippocampal interactions. While entorhinal oscillations modulate the hippocampal activity by timing the neuronal firing via monosynaptic afferents, thalamic nuclei act as a relay station routing prefrontal activation back to hippocampus. Understanding the mechanisms of network maturation represents the prerequisite for assessing circuit dysfunction in neurodevelopmental disorders

Mouse Embryonic Retina Delivers Information Controlling Cortical Neurogenesis

The relative contribution of extrinsic and intrinsic mechanisms to cortical development is an intensely debated issue and an outstanding question in neurobiology. Currently, the emerging view is that interplay between intrinsic genetic mechanisms and extrinsic information shape different stages of cortical development [1]. Yet, whereas the intrinsic program of early neocortical developmental events has been at least in part decoded [2], the exact nature and impact of extrinsic signaling are still elusive and controversial. We found that in the mouse developing visual system, acute pharmacological inhibition of spontaneous retinal activity (retinal waves-RWs) during embryonic stages increase the rate of corticogenesis (cell cycle withdrawal). Furthermore, early perturbation of retinal spontaneous activity leads to changes of cortical layer structure at a later time point. These data suggest that mouse embryonic retina delivers long-distance information capable of modulating cell genesis in the developing visual cortex and that spontaneous activity is the candidate long-distance acting extrinsic cue mediating this process. In addition, these data may support spontaneous activity to be a general signal coordinating neurogenesis in other developing sensory pathways or areas of the central nervous system

Gray matter injury associated with periventricular leukomalacia in the premature infant

Neuroimaging studies indicate reduced volumes of certain gray matter regions in survivors of prematurity with periventricular leukomalacia (PVL). We hypothesized that subacute and/or chronic gray matter lesions are increased in incidence and severity in PVL cases compared to non-PVL cases at autopsy. Forty-one cases of premature infants were divided based on cerebral white matter histology: PVL (n = 17) with cerebral white matter gliosis and focal periventricular necrosis; diffuse white matter gliosis (DWMG) (n = 17) without necrosis; and

An information-theoretic quantification of the content of communication between brain regions

Quantifying the amount, content and direction of communication between brain regions is key to understanding brain function. Traditional methods to analyze brain activity based on the Wiener-Granger causality principle quantify the overall information propagated by neural activity between simultaneously recorded brain regions, but do not reveal the information flow about specific features of interest (such as sensory stimuli). Here, we develop a new information theoretic measure termed Feature-specific Information Transfer (FIT), quantifying how much information about a specific feature flows between two regions. FIT merges the Wiener-Granger causality principle with information-content specificity. We first derive FIT and prove analytically its key properties. We then illustrate and test them with simulations of neural activity, demonstrating that FIT identifies, within the total information propagated between regions, the information that is transmitted about specific features. We then analyze three neural datasets obtained with different recording methods, magneto- and electro-encephalography, and spiking activity, to demonstrate the ability of FIT to uncover the content and direction of information flow between brain regions beyond what can be discerned with traditional analytical methods. FIT can improve our understanding of how brain regions communicate by uncovering previously unaddressed feature-specific information flow

Gray Matter Changes in Parkinson's and Alzheimer's Disease and Relation to Cognition

Purpose of Review We summarize structural (s)MRI findings of gray matter (GM) atrophy related to cognitive impairment in Alzheimer's disease (AD) and Parkinson's disease (PD) in light of new analytical approaches and recent longitudinal studies results. Recent Findings The hippocampus-to-cortex ratio seems to be the best sMRI biomarker to discriminate between various AD subtypes, following the spatial distribution of tau pathology, and predict rate of cognitive decline. PD is clinically far more variable than AD, with heterogeneous underlying brain pathology. Novel multivariate approaches have been used to describe patterns of early subcortical and cortical changes that relate to more malignant courses of PD. New emerging analytical approaches that combine structural MRI data with clinical and other biomarker outcomes hold promise for detecting specific GM changes in the early stages of PD and preclinical AD that may predict mild cognitive impairment and dementia conversion

Language development after cochlear implantation: an epigenetic model

Growing evidence supports the notion that dynamic gene expression, subject to epigenetic control, organizes multiple influences to enable a child to learn to listen and to talk. Here, we review neurobiological and genetic influences on spoken language development in the context of results of a longitudinal trial of cochlear implantation of young children with severe to profound sensorineural hearing loss in the Childhood Development after Cochlear Implantation study. We specifically examine the results of cochlear implantation in participants who were congenitally deaf (N = 116). Prior to intervention, these participants were subject to naturally imposed constraints in sensory (acoustic–phonologic) inputs during critical phases of development when spoken language skills are typically achieved rapidly. Their candidacy for a cochlear implant was prompted by delays (n = 20) or an essential absence of spoken language acquisition (n = 96). Observations thus present an opportunity to evaluate the impact of factors that influence the emergence of spoken language, particularly in the context of hearing restoration in sensitive periods for language acquisition. Outcomes demonstrate considerable variation in spoken language learning, although significant advantages exist for the congenitally deaf children implanted prior to 18 months of age. While age at implantation carries high predictive value in forecasting performance on measures of spoken language, several factors show significant association, particularly those related to parent–child interactions. Importantly, the significance of environmental variables in their predictive value for language development varies with age at implantation. These observations are considered in the context of an epigenetic model in which dynamic genomic expression can modulate aspects of auditory learning, offering insights into factors that can influence a child’s acquisition of spoken language after cochlear implantation. Increased understanding of these interactions could lead to targeted interventions that interact with the epigenome to influence language outcomes with intervention, particularly in periods in which development is subject to time-sensitive experience