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

Bilateral thalamic volume loss in patients with pharmacoresistant temporal lobe epilepsy with and without hippocampal sclerosis [Abstract]

Purpose There is growing evidence of extratemporal volume changes associated with pharmacoresistant temporal lobe epilepsy (TLE). The aim of the present study was to characterize the volume changes of thalamus in patients with pharmacoresistant TLE in comparison with healthy controls. Further dependencies of thalamic volumes, seizure focus and duration of epilepsy will be studied. Method T1-weighted images (repetition time [TR] = 2,000 ms, echo time [TE] = 9 ms, 4 mm – slice thickness, flip angle = 150°) were acquired by 3T Magnetic Resonance Imaging (MRI) in 15 patients (mean age ± standard deviation [SD] 25 ± 1.8 years, 9 male) with pharmacoresistant TLE (disease duration 15.2 ± 8.8 years). Nine patients (60 %) presented on MRI signs of hippocampal sclerosis (HS). Thalamic volumes were extracted from Freesurfer analytical pipeline and compared with a group of 15 controls (mean age 27.9 ± 4.0 years, 7 male). There was no difference between the groups regarding age (p > 0.1) and sex (p = 0.46). Volumes of thalami were correlated with duration of epilepsy. Results Patients with TLE presented significantly smaller thalamic volumes both ipsilateral to the seizure focus (7362.1 ± 848.3 mm3, p = 0.00005) and contralaterally (7,186 ± 848.3 mm3, p = 0.0037) in comparison with healthy controls (right thalamus 8088.7 ± 683 mm3, left thalamus 9360.5 ± 1,382 mm3). We found a negative correlation between the duration of pharmacoresistant TLE and the volume of ipsilateral thalamus (r = - 0.12, p < 0.05) and contralateral thalamus (r = - 0.13, p < 0.05). There was no correlation between age and thalamic volumes both in patients and controls. Conclusion Our data show a bilateral thalamic atrophy in patients with pharmacoresistant TLE, that correlates with the disease duration. The present study provides insight into alterations of extrahippocampal morphology induced by recurrent seizures of pharmacoresistant TLE

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

Translational model of cortical premotor-motor networks

Deciphering the physiological patterns of motor network connectivity is a prerequisite to elucidate aberrant oscillatory transformations and elaborate robust translational models of movement disorders. In the proposed translational approach, we studied the connectivity between premotor (PMC) and primary motor cortex (M1) by recording high-density electroencephalography in humans and between caudal (CFA) and rostral forelimb (RFA) areas by recording multi-site extracellular activity in mice to obtain spectral power, functional and effective connectivity. We identified a significantly higher spectral power in β- and γ-bands in M1compared to PMC and similarly in mice CFA layers (L) 2/3 and 5 compared to RFA. We found a strong functional β-band connectivity between PMC and M1 in humans and between CFA L6 and RFA L5 in mice. We observed that in both humans and mice the direction of information flow mediated by β- and γ-band oscillations was predominantly from PMC toward M1 and from RFA to CFA, respectively. Combining spectral power, functional and effective connectivity, we revealed clear similarities between human PMC-M1 connections and mice RFA-CFA network. We propose that reciprocal connectivity of mice RFA-CFA circuitry presents a suitable model for analysis of motor control and physiological PMC-M1 functioning or pathological transformations within this network

Differences of subcortical structures in patients with nocturnal, diurnal and mixed seizures [Poster Abstract]

Volumetric changes of subcortical grey matter structures in epilepsy patients with different circadian profiles of seizure presentation

Locating the STN-DBS electrodes and resolving their subsequent networks using coherent source analysis on EEG

The deep brain stimulation (DBS) of the subthalamic nucleus (STN) is the most effective surgical therapy for Parkinson's disease (PD). The first aim of the study was to locate the STN-DBS electrode by applying source analysis on EEG. Secondly, to identify tremor related areas which are associated with the STN. The Dynamic imaging of coherent sources (DICS) was used to find the coherent sources in the brain. The capability of the source analysis to detect deep sources like STN in the brain using EEG data was tested with two model dipole simulations. The simulations were concentrated on two aspects, the angle of the dipole orientation and the disturbance of the cortical areas on locating subcortical regions. In all the DBS treated Parkinsonian tremor patients the power spectrum showed a clear peak at the stimulated frequency and followed by there harmonics. The DBS stimulated frequency constituted a network of primary sensory motor cortex, supplementary motor area, prefrontal cortex, diencephalon, cerebellum and brainstem. Thus the STN was located in the region of the diencephalon. The resolved network may give better understanding to the pathophysiology of the effected tremor network in PD patients with STN-DBS

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