Osteoporoza – particularităţi de diagnostic clinic şi paraclinic

Considerând impactul osteoporozei ca nozologie, ne-am propus ca scop studierea unor aspecte clinice la pacientele cu osteoporoză de menopauză, inclusiv modificarea indicilor de laborator şi a valorilor parametrilor instrumentali

Менеджмент хирургического лечения переднего отдела стопы при ревматоидном артрите

USMF Nicolae Testemiţanu, Catedra Ortopedie şi Traumatologie, IMSP, Spitalul Clinic de Traumatologie şi Ortopedie, Catedra Medicină Internă nr. 5, Clinica universitară Reumatologie şi Nefrologie, SCRThis article describes the major forefoot deformities and problems ofen seen in patients with rheumatoid arthritis: hallux valgus, hallux extenzus, hallux flexus, hallux rigidus, quintus varus, subluxation and dorsiflection of the proximal phalanges of fingers II-V. Surgical intervention provides stability for the weight-bearing joints of the foot and reduces pain. Various types of surgical correction have been described in special literature.The aim of all of this is to lessen the pain and to correct the deformity. Consideration of these problems and an early intervention effort may help to prolong the ambulatory status of the patient with rheumatoid arthritis.Эта статья описывает основные деформации переднего отдела стопы и трудности, которые возникают у пациентов с ревматоидным артритом: вальгусной деформации первого пальца, hallux valgus, hallux extenzus, hallux flexus, hallux rigidus, quintus varus, подвывих и сгибание проксимальных фаланг II-V пальцев “в молоткообразной форме”. Хирургическое лечение дает возможность стабилизации сустава, подавляя болевой синдром и устраненяя деформацию. Различные виды хирургической коррекции были описаны в литературе. Все они направлены на устранение боли и деформации. Знание проблемы и ее решение своевременной операцией помогают продлить разумную и безболезненную ходьбу

Brain networks reorganization during maturation and healthy aging-emphases for resilience

Maturation and aging are important life periods that are linked to drastic brain reorganization processes which are essential for mental health. However, the development of generalized theories for delimiting physiological and pathological brain remodeling through life periods linked to healthy states and resilience on one side or mental dysfunction on the other remains a challenge. Furthermore, important processes of preservation and compensation of brain function occur continuously in the cerebral brain networks and drive physiological responses to life events. Here, we review research on brain reorganization processes across the lifespan, demonstrating brain circuits remodeling at the structural and functional level that support mental health and are parallelized by physiological trajectories during maturation and healthy aging. We show evidence that aberrations leading to mental disorders result from the specific alterations of cerebral networks and their pathological dynamics leading to distinct excitability patterns. We discuss how these series of large-scale responses of brain circuits can be viewed as protective or malfunctioning mechanisms for the maintenance of mental health and resilience

Epilepsia la pacienții cu tumori cerebrale

Tumorile cerebrale provoacă frecvent crize epileptice. Tratamentul antiepileptic medical are adesea un succes limitat. Farmacorezistența, interacțiunile medicamentoase și reacțiile adverse sunt probleme comune în timpul tratamentului cu medicația antiepileptică. Articolul se axează pe ambele aspecte clinice și de posibile mecanisme în epileptogeneză la pacienții cu tumori cerebrale. La moment mecanismele care stau la baza epileptogenezei la pacienții cu o tumoare cerebrală sunt insufi cient cunoscute. O înțelegere mai bună a modifi cărilor focale care sunt implicate în epileptogeneză poate oferi noi instrumente în tratamentul optim a convulsiilor. Conform datelor din literatură tratamentul pentru fiecare pacient cu o tumoră cerebrală asociată cu epilepsie ar trebui să urmărească în primul rând înlăturarea tumorii, precum și a focarului epileptic prin rezecție, combinată cu tratamentul antiepileptic postoperator

Neuroimaging and electrophysiology meet invasive neurostimulation for causal interrogations and modulations of brain states

Deep brain stimulation (DBS) has developed over the last twenty years into a highly effective evidenced-based treatment option for neuropsychiatric disorders. Moreover, it has become a fascinating tool to provide illustrative insights into the functioning of brain networks. New anatomical and pathophysiological models of DBS action have accelerated our understanding of neurological and psychiatric disorders and brain functioning. The description of the brain networks arose through the unique ability to illustrate long-range interactions between interconnected brain regions as derived from state-of-the-art neuroimaging (structural, diffusion, and functional MRI) and the opportunity to record local and large-scale brain activity at millisecond temporal resolution (microelectrode recordings, local field potential, electroencephalography, and magnetoencephalography). In the first part of this review, we describe how neuroimaging techniques have led to current understanding of DBS effects, by identifying and refining the DBS targets and illustrate the actual view on the relationships between electrode locations and clinical effects. One step further, we discuss how neuroimaging has shifted the view of localized DBS effects to a modulation of specific brain circuits, which has been possible from the combination of electrode location reconstructions with recently introduced network imaging methods. We highlight how these findings relate to clinical effects, thus postulating neuroimaging as a key factor to understand the mechanisms of DBS action on behavior and clinical effects. In the second part, we show how invasive electrophysiology techniques have been efficiently integrated into the DBS set-up to precisely localize the neuroanatomical targets of DBS based on distinct region-specific patterns of neural activity. Next, we show how multi-site electrophysiological recordings have granted a real-time window into the aberrant brain circuits within and beyond DBS targets to quantify and map the dynamic properties of rhythmic oscillations. We also discuss how DBS alters the transient synchrony states of oscillatory networks in temporal and spatial domains during resting, task-based and motion conditions, and how this modulation of brain states ultimately shapes the functional response. Finally, we show how a successful decoding and management of electrophysiological proxies (beta bursts, phase-amplitude coupling) of aberrant brain circuits was translated into adaptive DBS stimulation paradigms for a targeted and state-dependent invasive electrical neuromodulation

Metabolic and amyloid PET network reorganization in Alzheimer's disease: differential patterns and partial volume effects

Alzheimer’s disease (AD) is a neurodegenerative disorder, considered a disconnection syndrome with regional molecular pattern abnormalities quantifiable by the aid of PET imaging. Solutions for accurate quantification of network dysfunction are scarce. We evaluate the extent to which PET molecular markers reflect quantifiable network metrics derived through the graph theory framework and how partial volume effects (PVE)-correction (PVEc) affects these PET-derived metrics 75 AD patients and 126 cognitively normal older subjects (CN). Therefore our goal is twofold: 1) to evaluate the differential patterns of [18F]FDG- and [18F]AV45-PET data to depict AD pathology; and ii) to analyse the effects of PVEc on global uptake measures of [18F]FDG- and [18F]AV45-PET data and their derived covariance network reconstructions for differentiating between patients and normal older subjects. Network organization patterns were assessed using graph theory in terms of “degree”, “modularity”, and “efficiency”. PVEc evidenced effects on global uptake measures that are specific to either [18F]FDG- or [18F]AV45-PET, leading to increased statistical differences between the groups. PVEc was further shown to influence the topological characterization of PET-derived covariance brain networks, leading to an optimised characterization of network efficiency and modularisation. Partial-volume effects correction improves the interpretability of PET data in AD and leads to optimised characterization of network properties for organisation or disconnection

Intensity of respiratory cortical arousals is a distinct pathophysiologic feature and is associated with disease severity in obstructive sleep apnea patients

Background: We investigated whether the number, duration and intensity of respiratory arousals (RA) on C3-electroencephalographic (EEG) recordings correlate with polysomnography (PSG)-related disease severity in obstructive sleep apnea (OSA) patients. We also investigated if every patient might have an individual RA microstructure pattern, independent from OSA-severity. Methods: PSG recordings of 20 OSA patients (9 female; age 27–80 years) were analyzed retrospectively. Correlation coefficients were calculated between RA microstructure (duration, EEG-intensity) and RA number and respiratory disturbance index (RDI), oxygen desaturation index (ODI) and arousal index (AI). Intraclass correlations (ICC) for both RA duration and intensity were calculated. Sleep stage-specific and apnea- and hypopnea-specific analyses were also done. The probability distributions of duration and intensity were plotted, interpolated with a kernel which fits the distribution. A Bayesian posterior distribution analysis and pair-wise comparisons of each patient with all other 19 patients were performed. Results: Of the analyzed 2600 RA, strong positive correlations were found between average RA intensity and both RDI and AI. The number of PSG-recorded RA was strongly positively correlated with RDI. Significant correlations between average RA intensity in REM, NREM2 and NREM3 sleep stages and total ODI were identified. No sleep stage-specific correlations of arousal microstructure with age, sex, RDI or AI were identified. Although between-subjects ICC values were 0.7 (all p < 0.05). While apnea-related RA duration did not differ from hypopnea-related RA duration, RA intensity was significantly higher (p = 0.00135) in hypopneas than in apneas. A clear individual pattern of arousal duration for each patient was made distinct. For arousal intensity, a Gaussian distribution was identified in most patients. The Bayesian statistics regarding the arousal microstructure showed significant differences between each pair of patients. Conclusions: Each individual patient with OSA might have an individual pattern of RA intensity and duration indicating a distinct individual pathophysiological feature. Arousal intensity was significantly higher in hypopneic than in apneic events and may be related causally to the diminished (compared to apneas) respiratory distress associated with hypopneas. RA intensity in REM, NREM2 and NREM3 strongly correlated with ODI

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms

Corticoperipheral neuromuscular disconnection in obstructive sleep apnoea

The roles of central nervous mechanisms and cortical output in obstructive sleep apnea remain unclear. We addressed corticomuscular coupling between cortical sensorimotor areas and lower facial motor units as a mechanistic pathway and as a possible surrogate marker of cortico-peripheral motor control in obstructive sleep apnea. In this exploratory cross-sectional retrospective study we analysed EEG (C3- and C4-leads) and chin EMG from polysomnography recordings in 86 participants (22 females; age range: 26-81 years), 27 with mild (respiratory disturbance index = 5-15 events/hour), 21 with moderate (15-30 events/h) and 23 with severe obstructive sleep apnea (> 30 events/h) and 15 control subjects (<5 events/h). By computing C3-/C4-EEG- chin EMG coherence of signal dynamics in time and frequency domains we investigated corticomuscular coupling between cortical sensorimotor areas and lower facial motor units with increasing obstructive sleep apnea severity during the entire sleeping time, during different sleep stages and during obstructive respiratory events, including 5 seconds before (stable breathing) and after events (breathing resumption). Additionally, we studied a possible influence of body-mass-index and autonomic nervous system activation. We found that both average and respiratory event-specific corticomuscular coupling between cortical sensorimotor areas and lower facial motor units weakened significantly with increasing obstructive sleep apnea severity, was strongest during N3 and weakened in N1, N2 and rapid-eye-movement stages (in decreasing order). Coupling increases significantly during the obstructive respiratory events compared with coupling just before and following them. Results were independent of body-mass-index or autonomic nervous system activation. We conclude that obstructive respiratory events in obstructive sleep apnea are very strongly associated both quantitatively and temporally with the degree of disconnection within the cortical sensorimotor areas - lower facial motor units pathway. This quite coordinated activity pattern suggests a cortical sensorimotor area-driven obstructive respiratory event pattern generator and a central motor output disorder in obstructive sleep apnea