False recognition in a mouse model of Alzheimer's disease: rescue with sensory restriction and memantine.

Alzheimer's disease is commonly regarded as a loss of memory for past events. However, patients with Alzheimer's disease seem not only to forget events but also to express false confidence in remembering events that have never happened. How and why false recognition occurs in such patients is currently unknown, and treatments targeting this specific mnemonic abnormality have not been attempted. Here, we used a modified object recognition paradigm to show that the tgCRND8 mouse-which overexpresses amyloid β and develops amyloid plaques similar to those in the brains of patients with Alzheimer's disease-exhibits false recognition. Furthermore, we found that false recognition did not occur when tgCRND8 mice were kept in a dark, quiet chamber during the delay, paralleling previous findings in patients with mild cognitive impairment, which is often considered to be prodromal Alzheimer's disease. Additionally, false recognition did not occur when mice were treated with the partial N-methyl-d-aspartic acid receptor antagonist memantine. In a subsequent experiment, we found abnormally enhanced N-methyl-d-aspartic acid receptor-dependent long-term depression in these mice, which could be normalized by treatment with memantine. We suggest that Alzheimer's disease typical amyloid β pathology leads to aberrant synaptic plasticity, thereby making memory representations more susceptible to interfering sensory input, thus increasing the likelihood of false recognition. Parallels between these findings and those from the literature on Alzheimer's disease and mild cognitive impairment suggest a mechanism underlying false recognition in these patients. The false recognition phenomenon may provide a novel paradigm for the discovery of potential therapies to treat the mnemonic dysfunction characteristic of this disease

Management of anterior cruciate ligament rupture in patients aged 40 years and older

The aim of anterior cruciate ligament (ACL) reconstruction is essentially to restore functional stability of the knee and to allow patients to return to their desired work and activities. While in the young and active population, surgery is often the best therapeutic option after an ACL tear, ACL reconstruction in middle-aged people is rather more controversial due to concerns about a higher complication rate. The purpose of our article is to establish, through a systematic review of the literature, useful decision-making criteria for the management of anterior cruciate ligament rupture in patients aged 40 years and older, guiding surgeons to the most appropriate therapeutic approach. Various reports have shown excellent results of ACL reconstruction in patients over the age of 40 in terms of subjective satisfaction, return to previous activity level, and reduced complication and failure rates. Some even document excellent outcomes in subjects of 50 years and older. Although there are limited high-level studies, data reported in the literature suggest that ACL reconstruction can be successful in appropriately selected, motivated older patients with symptomatic knee instability who want to return to participating in highly demanding sport and recreational activities. Deciding factors are based on occupation, sex, activity level of the subject, amount of time spent performing such highly demanding activities, and presence of associated knee lesions. Physiological age and activity level are more important than chronological age as deciding factors when considering ACL reconstruction

Reliability and Validity of the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Unicompartmental Knee Arthroplasty

BACKGROUND: The Knee Injury and Osteoarthritis Outcome Score (KOOS) was developed to document outcomes from knee injury, including the impact of osteoarthritis on knee function. The purpose of this study is to determine the reliability and validity of the KOOS subscales for evaluating outcomes following unicompartmental knee arthroplasty (UKA). METHODS: KOOS Pain, Activities of Daily Living (ADL), Sport, Symptoms, and Quality of Life (QoL) scores collected from 172 patients who underwent UKA were used in the analysis. KOOS subscales were tested for reliability and validity of scores through a Rasch model analysis. RESULTS: KOOS Sport, KOOS ADL, and KOOS QoL had good evidence of reliability with acceptable person reliability, person separation, and item reliability. For overall scale functioning, KOOS Pain, Symptoms, and ADL all had 1 question that did not have an acceptable value for infit or outfit mean square value. Questions in KOOS Sport and QoL all had acceptable values. There was a positive, linear relationship between the Short-Form 12 Physical Component Summary and the KOOS subscales which indicated good evidence of convergent validity. These associations were also seen when the cohort was separated in medial and lateral UKA. CONCLUSION: Two of the 5 KOOS subscales (KOOS Sport and KOOS QoL) were considered adequate in measuring outcomes, as well as reliability. The KOOS ADL had borderline values; however, it had adequate infit and outfit values. The KOOS Pain and Symptom score performed poorly in this analysis. For documenting outcomes following UKA, this study supports the use of KOOS ADL, Sport, and QoL

Tracking Microstructure Evolution in Complex Biaxial Strain Paths: A Bulge Test Methodology for the Scanning Electron Microscope

Abstract In this work, a novel method is presented to track site-specific microstructure evolution in metallic materials deformed biaxially along proportional and complex strain paths. A miniaturized bulge test setup featuring a removable sample holder was designed to enable incremental measurements to be performed in a scanning electron microscope, by probing the same position on the sample at different deformation levels, with electron backscatter diffraction (EBSD), electron channeling contrast imaging (ECCI) and other imaging modes. Validation experiments were performed at room temperature on samples prepared from commercial sheet metal (dual-phase steel) and foils (stainless steel). Local strain measurements with the digital image correlation technique confirmed that proportional strain paths with a strain ratio up to 5 can be investigated using elliptical dies in the bulge test holder. It is also shown how complex strain paths can be obtained using a combination of overlapping elliptical dies. Incremental EBSD and ECCI were conducted in configurations relevant for the multi-scale investigation of localized plasticity and damage mechanisms in dual-phase steel. Quantitative information regarding microstructure evolution (phase fractions, orientation fields, dislocation structures, etc.) and regarding local strain distributions could be successfully obtained. This type of data sheds light on underlying deformation mechanisms and provides opportunities to calibrate crystal plasticity models

Comparing Del Nido And Conventional Cardioplegia In Infants And Neonates In Congenital Heart Surgery

Background The aim of this study was to evaluate outcome measures after the use of del Nido (dN) cardioplegia compared with conventional multidose high-potassium (non-dN) cardioplegia in neonates and infants. Methods We retrospectively analyzed data in patients, aged younger than 1 year, undergoing cardiopulmonary bypass (CPB) from January 2012 to August 2015. We changed our cardioplegia protocol from non-dN to dN administered in a single or infrequently dosed strategy in September 2013. The outcomes of the dN group (n = 107) are compared with the non-dN group (n = 118). We analyzed variables for demographic, intraoperative, early postoperative, and discharge variables. Results The two groups were similar in age, weight, height, CPB, and cross-clamp time; preoperative and postoperative echocardiographic systolic functions; first 24-hour postoperative urine output and inotropic score; length of stay; and mortality rate. The Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) mortality category was significantly higher in the dN group (p = 0.03). The cardioplegia dosing interval was lower for the non-dN group (p \u3c 0.001). The volume and doses of cardioplegia per patient were significantly higher in the non-dN group (p \u3c 0.001). In a subanalysis, when the Norwood patients were excluded from both groups, the overall STAT mortality category difference was no longer significant. The demographic, early postoperative, and discharge variables still showed no significant difference when the two groups were compared. Conclusions Similar outcomes can be achieved with less frequent interruption of the operation and lower volume of cardioplegia when using dN cardioplegia solution compared with conventional cardioplegia. The dN cardioplegia with extended ischemic interval can be used as an alternative strategy in the neonatal and infant population during cardiac operations

Tracking microstructure evolution in complex biaxial strain paths:a bulge test methodology for the scanning electron microscope

\u3cp\u3eIn this work, a novel method is presented to track site-specific microstructure evolution in metallic materials deformed biaxially along proportional and complex strain paths. A miniaturized bulge test setup featuring a removable sample holder was designed to enable incremental measurements to be performed in a scanning electron microscope, by probing the same position on the sample at different deformation levels, with electron backscatter diffraction (EBSD), electron channeling contrast imaging (ECCI) and other imaging modes. Validation experiments were performed at room temperature on samples prepared from commercial sheet metal (dual-phase steel) and foils (stainless steel). Local strain measurements with the digital image correlation technique confirmed that proportional strain paths with a strain ratio up to 5 can be investigated using elliptical dies in the bulge test holder. It is also shown how complex strain paths can be obtained using a combination of overlapping elliptical dies. Incremental EBSD and ECCI were conducted in configurations relevant for the multi-scale investigation of localized plasticity and damage mechanisms in dual-phase steel. Quantitative information regarding microstructure evolution (phase fractions, orientation fields, dislocation structures, etc.) and regarding local strain distributions could be successfully obtained. This type of data sheds light on underlying deformation mechanisms and provides opportunities to calibrate crystal plasticity models.\u3c/p\u3

Immersive Episodic Memory Assessment with 360\ub0 Videos: The Protocol and a Case Study

Episodic memory has been conceptualized as the memory for personal events with specific spatiotemporal components. The assessment of episodic memory is usually conducted by means of verbal recall tasks, in which the individual is required to repeat what (s)he remembers from a previously presented verbal material (either single words or a brief story). However, the need of a more ecological approach to memory assessment led researchers to investigate the potential use of 360\ub0 videos as a suitable tool to present real life scenes to be remembered. The present study presents the protocol of the assessment of episodic memory employing five 360\ub0 video that represent interpersonal, emotional experiences known to be altered in psychopathological conditions. Furthermore, a case study in which the assessment protocol is applied to a patient with Borderline Personality Disorder is described. The results of the case study seem to indicate that our 360\ub0 videos are able to detect anomalies in remembering the behaviors displayed, the connected emotion together with details regarding the \u201cwhere\u201d and \u201cwhen\u201d components of the episodic recall

The Impact of Roller Pump vs. Centrifugal Pump on Homologous Blood Transfusion in Pediatric Cardiac Surgery

Centrifugal pumps are considered to be less destructive to blood elements(1) when compared to roller pumps. However, their large prime volumes render them unsuitable as arterial pumps in heart lung machine (HLM) circuitry for children. In November of 2014, the circuit at Arnold Palmer Hospital, a Biomedicus BP-50 with kinetic assist venous drainage (KAVD) and 1/4″ tubing was converted to a roller pump in the arterial position with gravity drainage. Vacuum-assisted venous drainage (VAVD) was mounted on the HLM as a backup, but not used. Tubing was changed to 3/16″ in the arterial line in patients <13 kg. A retrospective study with a total of 140 patients compared patients placed on cardiopulmonary bypass (CPB) with Biomedicus centrifugal pumps and KAVD (Centrifugal Group, n = 40) to those placed on CPB with roller pumps and gravity drainage (Roller Group, n = 100). Patients requiring extra-corporeal membrane oxygenation (ECMO)/cardio-pulmonary support (CPS) or undergoing a hybrid procedure were excluded. Re-operation or circulatory arrest patients were not excluded. Prime volumes decreased by 57% from 456 ± 34 mL in the Centrifugal Group to 197 ± 34 mL in the Roller Group (p < .001). There was a corresponding increase in hematocrit (HCT) of blood primes and also on CPB. Intraoperative homologous blood transfusions also decreased 55% from 422 mL in the Centrifugal Group to 231 mL in the Roller Group (p < .001). The Society of Thoracic Surgeons--European Association for Cardio-Thoracic Surgery (STAT) categorized intubation times and hospital length of stay (LOS) for all infants showed a trend toward reduction, but was not statistically significant. Overall mortality was 5% utilizing the centrifugal configuration and 0% in the roller pump cohort. We demonstrated that the transition to roller pumps in the arterial position of the HLM considerably reduced our priming volume and formed a basis for a comprehensive blood conservation program. By maintaining higher HCTs on CPB, we were able to reduce intraoperative homologous blood transfusions