Medial Area Research Articles

Post-traumatic Telecanthus Induced by a Missed Diagnosis of Avulsion Fracture of the Medial Canthal Tendon.

Telecanthus is commonly accompanied by severe naso-orbito-ethmoid fractures. If there is only an avulsion fracture of the medial canthal tendon (MCT), the initial diagnosis may be missed, and post-traumatic telecanthus may follow. To avoid misdiagnosis of post-traumatic telecanthus, the following should be considered: avulsion fracture of the MCT should be suspected in the presence of an injury or edema of the medial canthal area; the facial computed tomography images should be carefully analyzed to confirm the presence of bone segment caused by the avulsion fracture of the MCT; physical examinations, such as the bowstring test and bimanual palpation, also provide essential data for early diagnosis. And even if early diagnosis is delayed, post-traumatic telecanthus can be improved through aggressive surgical correction.

Effectiveness of Rex shunt for improving the abnormal portal hemodynamics and portal venous pathology in EHPVO animal model.

To investigate the feasibility of the re-patent EHPVO (r-EHPVO) as an animal model of Rex shunt and the effectiveness of Rex shunt in improving abnormal portal hemodynamics and portal venous pathology of EHPVO. A total of 18 New Zealand white rabbits were randomly divided into three groups: normal control (NC) group, extrahepatic portal venous obstruction (EHPVO) group, and r-EHPVO group. The main portal vein was dissected only in the NC group. The main portal vein was narrowed by a cannula in the EHPVO group. The cannula narrowing the main portal vein was removed to restore the portal blood flow into the liver on day 14 in the r-EHPVO group. The portal pressure, splenic size, blood flow velocity, and diameter of the portal vein were measured on days 14 and 28. The shear stress (SS) and circumferential stress (CS) of the portal vein were calculated. The proximal end of the main portal vein was collected on day 28 for further pathological analysis, and the thickness and area of the intima and media were measured by Image J software. The portal pressure, splenic size, SS, CS, intima and media thickness, the ratio of intimal to medial area (I/M), and the ratio of intimal area to the sum of intimal and medial area (I/I + M) were compared among the three groups. The correlation between SS and intimal thickness and between CS and medial thickness were analyzed. On day 28, the portal pressure of the EHPVO group was significantly higher than that of the NC and r-EHPVO groups, but no significant difference was detected in the portal pressure between r-EHPVO and NC groups. The length and thickness of the spleen in the EHPVO and r-EHPVO groups were significantly higher than those in the NC group (P < 0.01) but were significantly lower in the r-EHPVO group than those in the EHPVO group (P < 0.05). The SS was significantly lower in the EHPVO group than in NC and r-EHPVO groups (P < 0.05) but was significantly higher in the NC group than in the r-EHPVO group (P = 0.003). The CS was significantly higher in the EHPVO and r-EHPVO groups than that in the NC group (P < 0.05) but was significantly lower in the r-EHPVO group than that in the EHPVO group (P < 0.001). The intimal thickness, I/M, and I/I + M of the EHPVO group were significantly higher than those of the NC and r-EHPVO groups (P < 0.05), but no significant difference was observed between the NC and r-EHPVO groups (P > 0.05). The SS is negatively related to intimal thickness (r = - 0.799, P < 0.001). The r-EHPVO model is feasible as an animal model of the Rex shunt. The Rex shunt could be beneficial to improving the abnormal portal hemodynamic and portal venous intimal hyperplasia by restoring the portal blood flow into the liver.

Abstract 273: Smooth Muscle Cell Specific Beclin-1 Deficiency Accelerates Aortic Aneurysms In Male And Female Normolipidemic And Hypercholesterolemic Mice

Background and Objective: Ascending and abdominal aortic aneurysms (AAs) are permanent dilations of the aorta with 80% mortality after rupture. Vascular smooth muscle cell (SMC)-rich aortic media is disrupted in AAs. Autophagy is a process by which cell recycles their cytoplasmic materials for energy purposes under stress. Recent clinical studies highlighted that Beclin-1, an autophagy induction gene, is upregulated in AA tissues from patients. Using Angiotensin II (AngII) infusion model of AAs, we examined the functional role of SMC-derived Beclin-1 during AA development in normolipidemic and hypercholesterolemic mice. Methods and Results: Mice with inducible deletion of Beclin-1 in SMCs were produced by breeding male Acta2-Cre ERT2 hemizygous mice female Beclin-1 floxed mice in normolipidemic and hypercholesterolemic (LDLR-/-) background. At 8 weeks of age, Beclin-1 x Acta2-Cre ERT2 (Cre+) and non-Cre littermates (Cre-) mice were injected with tamoxifen (75 mg/kg, i.p.) for 5 days. After 2 weeks, Western blot analyses showed depletion of Beclin-1 protein in the aortic media from Cre+ mice compared to Cre- littermates. To study the role of SMC-Beclin-1, normolipidemic or hypercholesterolemic male Cre+ and Cre- (N=7 per group) mice were fed either chow or fat-enriched diet (21% fat; 0.15% cholesterol) for 5 weeks. After 1 week of diet feeding, mice were infused with saline or low dose of AngII (500 ng/kg/min) by osmotic mini-pumps for 4 weeks. SMC-Beclin-1 deficiency in either normolipidemic or hypercholesterolemic mice spontaneously but significantly accelerated ascending (Cre-: 1.2 ± 0.07 vs Cre+: 1.8 ± 0.04 mm; P &lt;0.001), arch (Cre-: 1.1 ± 0.04 vs Cre+: 1.8 ± 0.03 mm; P &lt;0.001), descending (Cre-: 1.1 ± 0.04 vs Cre+: 1.5 ± 0.04 mm; P &lt;0.001), and abdominal (Cre-: 1.0 ± 0.02 vs Cre+: 1.5 ± 0.14 mm; P &lt;0.001) aortic expansion. AngII-infusion had no additional influence on SMC-Beclin-1 deficiency accelerated aortic expansion. In addition, SMC-Beclin-1 deficiency significantly increased aortic medial hypertrophy and elastin breaks (P&lt;0.001 Cre- vs Cre+) associated with complete loss of medial alpha-SMC actin positive area. Conclusion: These findings demonstrate that SMC-Beclin-1 plays a critical role in suppressing aortic aneurysmal formation in mice.

Investigating the Co-administration of Ghrelin and Nicotine into the Medial Septum and Its Influencing on Morphine Amnestic Effect

Introduction: Evidence indicates that medial septum nicotinic receptors regulate cognitive processes. Ghrelin is a gut hormone that regulates energy homeostasis. Ghrelin is also produced in the brain and is involved in cognitive function. This study aims to evaluate the effects of medial septal administration of ghrelin on the amnestic effect of morphine in rats.In addition, the possible relationship between the medial septal ghrelin and acetylcholine nicotinic receptors on the amnestic effect of morphine is evaluated. Methods: The rats were implanted at the medial septum area and were microinjected with ghrelin and nicotinic receptor agents. The step-through type inhibitory avoidance apparatus was used for memory retrieval assessment. Results: The results showed that the administration of morphine after the training phase impaired memory consolidation. Post-training intra-septal injection of the same doses of either ghrelin or nicotine did not change memory performance; however, their co-application with morphine (significant dose: 7.5 mg/kg subcutaneous injection) increased the step-through latency and improved memory consolidation. Moreover, post-training co-application of low doses of the two agonists could not affect morphine-induced memory impairment. Conclusion: These results indicated no interaction between medial septal ghrelin and nicotinic receptors on the amnestic effect of morphine in rats.

Knee kinetics and the medial femoral cartilage cross-sectional area response to loading in indviduals with anterior cruciate ligament reconstruction

BackgroundUltrasonography is capable of detecting morphological changes in femoral articular cartilage cross-sectional area in response to an acute bout of walking; yet, the response of femoral cartilage cross-sectional area varies between individuals. It is hypothesized that differences in joint kinetics may influence the response of cartilage to a standardized walking protocol. Therefore, the study purpose was to compare internal knee abduction and extension moments between individuals with anterior cruciate ligament reconstruction who demonstrate an acute increase, decrease, or unchanged medial femoral cross-sectional area response following 3000 steps. MethodsThe medial femoral cartilage in the anterior cruciate ligament reconstructed limb was assessed with ultrasonography before and immediately following 3000 steps of treadmill walking. Knee joint moments were calculated in the anterior cruciate ligament reconstructed limb and compared between groups throughout the stance phase of gait using linear regression and functional, mixed effects waveform analyses. FindingsNo associations between peak knee joint moments and the cross-sectional area response were observed. The group that demonstrated an acute cross-sectional area increase exhibited 1) lower knee abduction moments in early stance in comparison to the group that exhibited a decreased cross-sectional area response; and 2) greater knee extension moments in early stance in comparison to the group with an unchanged cross-sectional area response. InterpretationThe propensity of femoral cartilage to acutely increase cross-sectional area in response to walking is consistent with less-dynamic knee abduction and knee extension moment profiles.

Superimposition Study to Determine the Angular Arterial Distribution and Its Clinical Application.

The purpose of this study was to determine the distribution of the angular artery (AA) in the medial canthal area with the aim of defining an arterial course to prevent AA injury during facial surgery in this region. The authors dissected 36 hemifaces of 18 cadavers. The horizontal distance from the vertical level through the medial canthus to the AAs was measured. The AA course of each specimen was then recorded, and all of them were then superimposed to determine the AA course. The diameter and depth of the AA around the medial canthal area were also investigated using ultrasonography on living subjects. The horizontal distances from the medial canthus level and 2 cm below the medial canthus were 9.0 ± 2.0 mm (mean ± SD) and 1.9 ± 2.4 mm, respectively. The superimposed image demonstrated that most of the AAs were present inside the vertical line through the medial canthus. Ultrasonography indicated that the AA was 2.3 ± 0.9 mm below the skin and 1.7 ± 0.3 mm in diameter. The AA course was relatively constant along the nasojugal fold. The AAs were most often present between the middle of the medial canthus and the facial midline, but were very scarce in both the medial and lateral thirds. Knowledge of the detailed course of the AA may help surgeons to avoid arterial injury and decrease the risk of surgical morbidities around the nasal root and medial canthal area.

Optogenetic activation of basal forebrain cholinergic neurons improves interval timing performance in rodents (P1-6.009)

<h3>Objective:</h3> To study the effect of basal forebrain optogenetic cholinergic activation in an interval timing task in freely behaving animals. <h3>Background:</h3> Cholinergic deficit is a major feature in patients with Alzheimer’s disease, Parkinson’s disease dementia and dementia with Lewy bodies. Parkinson’s and Alzheimer’s patients can have impairments in interval timing, or the ability to control movements in time. Timing is preserved across mammalian species, and timing tasks require subjects to estimate an interval of several seconds. These tasks require attention to time and working memory for temporal rules. Mice receiving scopolamine, a cholinergic inhibitor, perform poorly during timing tasks. Interval timing involves medial prefrontal cortical areas that receive prominent cholinergic input; our recent work showed that scopolamine impairs interval timing through disrupting stimulus-processing rather than temporal processing in the medial prefrontal cortex. However, it is unclear whether basal forebrain cholinergic neuron activation could improve timing performance. <h3>Design/Methods:</h3> ChAT-Cre transgenic mice were trained on a 12s interval timing task before bilateral basal forebrain stereotactic AAV-DIO-ChR2 injection and optic canulae implantation (AP −0.7, ML +/−1.8, DV AAV injection at −4.0 and −5.0, with optic canulae at −3.5). Laser (473nm) stimulation was assigned on/off randomly across trials, and interval timing tasks were performed 30 min after intraperitoneal scopolamine (1mg/kg) or normal saline injections. <h3>Results:</h3> Scopolamine induced interval-timing deficits were partially reversed by optogenetic activation of basal forebrain cholinergic neurons with 20Hz stimulation but not 4 Hz. <h3>Conclusions:</h3> Optogenetic activation of the basal forebrain cholinergic neurons improves interval timing performance. These data may have relevance for our understanding of cholinergic function in human diseases such as Parkinson’s disease and Alzheimer’s disease. <b>Disclosure:</b> Dr. Zhang has nothing to disclose. Mr. Kirkpatrick has nothing to disclose. Dr. Narayanan has nothing to disclose.

Fronto-amygdala resting state functional connectivity is associated with anxiety symptoms among adolescent girls more advanced in pubertal maturation

Early adolescence, with the onset of puberty, is an important period when sex differences in anxiety emerge, with girls reporting significantly higher anxiety symptoms than boys. This study examined the role of puberty on fronto-amygdala functional connectivity and risk of anxiety symptoms in 70 girls (age 11–13) who completed a resting state fMRI scan, self-report measures of anxiety symptoms and pubertal status, and provided basal testosterone levels (64 girls). Resting state fMRI data were preprocessed using fMRIPrep and connectivity indices were extracted from ventromedial prefrontal cortex (vmPFC) and amygdala regions-of-interest. We tested moderated mediation models and hypothesized that vmPFC-amygdala would mediate the relation between three indices of puberty (testosterone and adrenarcheal/gonadarcheal development) and anxiety, with puberty moderating the relation between connectivity and anxiety. Results showed a significant moderation effect of testosterone and adrenarcheal development in the right amygdala and a rostral/dorsal area of the vmPFC and of gonadarcheal development in the left amygdala and a medial area of the vmPFC on anxiety symptoms. Simple slope analyses showed that vmPFC-amygdala connectivity was negatively associated with anxiety only in girls more advanced in puberty suggesting that sensitivity to the effects of puberty on fronto-amygdala function could contribute to risk for anxiety disorders among adolescent girls.

Joint-embeddings reveal functional differences in default-mode network architecture between marmosets and humans

The default-mode network (DMN) is a distributed functional brain system integral for social and higher-order cognition in humans with implications in a myriad of neuropsychological disorders. In this study, we compared the functional architecture of the DMN between humans and marmosets to assess their similarities and differences using joint gradients. This approach permits simultaneous large-scale mapping of functional systems across the cortex of humans and marmosets, revealing evidence of putative homologies between them. In doing so, we find that the DMN architecture of the marmoset exhibits differences along its anterolateral-posterior axis. Specifically, the anterolateral node of the DMN (dorsolateral prefrontal cortex) displayed weak connections and inconsistent connection topographies as compared to its posterior DMN-nodes (posterior cingulate and posterior parietal cortices). We also present evidence that the marmoset medial prefrontal cortex and temporal lobe areas correspond to other macroscopical distributed functional systems that are not part of the DMN. Given the importance of the marmoset as a pre-clinical primate model for higher-order cognitive functioning and the DMN's relevance to cognition, our results suggest that the marmoset may lack the capacity to integrate neural information to subserve cortical dynamics that are necessary for supporting diverse cognitive demands.

Structural covariances of prefrontal subregions selectively associate with dopamine-related gene coexpression and schizophrenia.

Evidence highlights that dopamine (DA) system dysregulation and prefrontal cortex (PFC) dysfunction may underlie the pathophysiology of schizophrenia. However, the associations among DA genes, PFC morphometry, and schizophrenia have not yet been fully clarified. Based on the brain gene expression dataset from Allen Human Brain Atlas and structural magnetic resonance imaging data (NDIS = 1727, NREP = 408), we first identified 10 out of 22 PFC subregions whose gray matter volume (GMV) covariance profiles were reliably associated with their DA genes coexpression profiles, then four out of the identified 10 PFC subregions demonstrated abnormally increased GMV covariance with the hippocampus, insula, and medial frontal areas in schizophrenia patients (NCASE = 100; NCONTROL=102). Moreover, based on a schizophrenia postmortem expression dataset, we found that the DA genes coexpression of schizophrenia was significantly reduced between the middle frontal gyrus and hippocampus, in which 21 DA genes showed significantly unsynchronized expression changes, and the 21 genes' brain expression were enriched in brain activity invoked by working memory, reward, speech production, and episodic memory. Our findings indicate the DA genes selectively regulate the structural covariance of PFC subregions by their coexpression profiles, which may underlie the disrupted GMV covariance and impaired cognitive functions in schizophrenia.

A Rare Cause of Orbital Cellulitis: Eikenella corrodens.

To The Editors: Eikenella corrodens is a small, nonmotile Gram-negative rod and is a member of the ordinary flora of the oral mucosa. Eikenella species can cause a wide variety of head and neck infections, such as sinusitis, preseptal cellulitis and orbital cellulitis in immunocompromised patients as well as in hosts with normal immunity.1,2 In the literature, there are few cases of orbital cellulitis caused by E. corrodens. We herein report 2 cases of orbital cellulitis due to Eikenella spp. as the complication of untreated sinusitis in previously healthy girls. The first case, a previously healthy 15-year-old girl, was admitted to the pediatric emergency department (PED) complaining of new-onset left eyelid swelling, painful eye movements and chemosis. On physical examination, her eye movements were limited and painful. Significant chemosis and ectropion were observed. Laboratory results were notable for leukocytosis (16000 cells/mm3) and increased C-reactive protein (CRP) (176 mg/L) levels. Orbital computed tomography (CT) revealed orbital cellulitis and subperiosteal abscess as a complication of sinusitis in the left orbit (Fig. 1). The treatment was administered as intravenous (IV) cefotaxime (300 mg/kg/day), vancomycin (60 mg/kg/day) and metronidazole (30 mg/kg/day). Orbital decompression and subperiosteal abscess drainage were performed. Abscess culture grew E. corrodens that was susceptible to penicillin (MIC:0.023), cefuroxime (MIC:1.00) and cefotaxime (MIC:0.064). Vancomycin and metronidazole were discontinued on day 3. After 14 days of IV cefotaxime treatment, she was discharged with oral cefuroxime, and the total treatment period was completed in 21 days.FIGURE 1.: The arrow marks show abcess and the stars show sinusitis in both pictures. A: The orbital CT reveal orbital cellulitis of the left eye and ethmoid sinusitis. B: Orbital CT represents the subperiosteal abscess in the medial extraconal area of the left orbita.The second case, a previously healthy 9-year-old girl, presented to the PED with a 4-day history of painful eye movements. On physical examination, eye movements were painful, and there was proptosis in her left eye. In the laboratory, acute phase reactants were normal (CRP:26 mg/L, procalcitonin:<0.06 µg/L) without leukocytosis (WBC:11500 cells/mm3). Orbital CT showed diffuse sinusitis and subperiosteal abscess in the left orbital medial extraconal region (Fig. 1). Treatment was arranged as IV cefotaxime, vancomycin and metronidazole. Orbital decompression and subperiosteal abscess drainage were performed. E. corrodens grew in abscess culture, which was susceptible to ampicillin (MIC:0,064), cefotaxime (MIC:0,16), clindamycin (MIC:0,75) and meropenem (MIC:0,16). Her treatment was continued with IV ampicillin-sulbactam (300 mg/kg/day) for 10 days. She was discharged with amoxicillin/clavulanic acid, and the total treatment was completed in 21 days. Acute sinusitis is a common condition that can cause severe complications due to expanding to the surrounding structures, including the eye and the brain.3 Orbital cellulitis is a rare but important complication of acute sinusitis, as it may result in vision loss.4 Although Streptococcus and Staphylococcus spp. are the most common, other less frequent oral flora members, including anaerobes and facultative anaerobic agents such as E. corrodens, may also cause the same clinical presentations. In routine culture, E. corrodens was challenging to detect due to growth in 72 hours in an atmosphere of 5%–15% CO2, 35–37 °C and 100% humidity.5E. corrodens is usually susceptible to penicillin, second- and third-generation cephalosporins, and carbapenem but is resistant to clindamycin, macrolide, metronidazole and aminoglycoside.2 Antibiotic susceptibility tests are important in terms of guiding for appropriate treatment. In summary, we present 2 previously healthy children who developed orbital cellulitis due to Eikenella corrodens. Early diagnosis, appropriate surgical drainage, and targeted medical treatment due to antibiotic susceptibility will improve the outcomes.

Infrared Thermography in Symptomatic Knee Osteoarthritis: Joint Temperature Differs Based on Patient and Pain Characteristics.

The aim of this study was to evaluate osteoarthritis (OA) patients with infrared thermography to investigate imaging patterns as well as demographic and clinical characteristics that influence knee inflammation. Forty patients with one-sided symptomatic knee OA were included and evaluated through knee-specific PROMs and the PainDETECT Questionnaire for neuropathic pain evaluation. Thermograms were captured using a thermographic camera FLIR-T1020 and temperatures were extracted using the software ResearchIR for the overall knee and the five ROIs: medial, lateral, medial patella, lateral patella, and suprapatellar. The mean temperature of the total knee was 31.9 ± 1.6 °C. It negatively correlated with age (rho = -0.380, p = 0.016) and positively correlated with BMI (rho = 0.421, p = 0.007) and the IKDC objective score (tau = 0.294, p = 0.016). Men had higher temperatures in the knee medial, lateral, and suprapatellar areas (p = 0.017, p = 0.019, p = 0.025, respectively). Patients with neuropathic pain had a lower temperature of the medial knee area (31.5 ± 1.0 vs. 32.3 ± 1.1, p = 0.042), with the total knee negatively correlating with PainDETECT (p = 0.045). This study demonstrated that the skin temperature of OA symptomatic knees is influenced by demographic and clinical characteristics of patients, with higher joint temperatures in younger male patients with higher BMI and worst objective knee scores and lower temperatures in patients affected by neuropathic pain.

Decoding human spontaneous spiking activity in medial temporal lobe from scalp EEG

Linking scalp electroencephalography (EEG) signals and spontaneous firing activity from deep nuclei in humans is not trivial. To examine this, we analyzed simultaneous recordings of scalp EEG and unit activity in deeply located sites recorded overnight from patients undergoing pre-surgical invasive monitoring. We focused on modeling the within-subject average unit activity of two medial temporal lobe areas: amygdala and hippocampus. Linear regression model correlates the units' average firing activity to spectral features extracted from the EEG during wakefulness or non-REM sleep. We show that changes in mean firing activity in both areas and states can be estimated from EEG (Pearson r>0.2, p≪0.001). Region specificity was shown with respect to other areas. Both short- and long-term fluctuations in firing rates contributed to the model accuracy. This demonstrates that scalp EEG frequency modulations can predict changes in neuronal firing rates, opening a new horizon for non-invasive neurological and psychiatric interventions.

Changes in Distributed Motor Network Connectivity Correlates With Functional Outcome After Surgical Resection of Brain Tumors

BACKGROUND: In patients with brain tumors around the motor cortices, deterioration of motor performance may be observed even if the integrity of the cortical output is maintained. Especially, resection of medial premotor area (PM) can cause postoperative deterioration called supplementary motor area syndrome. OBJECTIVE: To clarify the neuronal mechanisms underlying postsurgical deterioration with a case-control study. METHODS: Twelve patients with brain tumors underwent preoperative and postoperative sessions consisting of motor performance evaluation and 3T-magnetic resonance imaging data acquisition. Based on additional postsurgical motor deficits, 6 patients were classified into “deficit group,” and 6 others were into “no deficit group.” Using resting-state functional magnetic resonance imaging (fMRI), the integrity of functional connectivity was evaluated by placing a seed in the ipsilesional primary motor area (M1). With motor task fMRI, hand and foot representations were identified in the M1 and lateral and medial PMs. Probabilistic tractography assessed anatomic connectivity in the cortico-cortical and corticofugal networks. RESULTS: Functional connectivity among M1 and lateral and medial PMs during resting-state fMRI was reduced postoperatively in the deficit group (P < .05, corrected) and preserved in the no deficit group. The deficit was unlikely to be attributable to surgical resection of specific anatomic connectivity. The amplitude of motor-evoked potential was maintained in available cases. These intraoperative observations agree with imaging findings suggesting preserved anatomic connectivity of the estimated corticofugal pathway. CONCLUSION: The present findings suggest that supplementary motor area syndrome is caused by disorganization of functional connectivity among cortical motor networks rather than resection of anatomic connectivity of corticofugal pathway.

MULTI-VOXEL PATTERN ANALYSIS OF fMRI DATA DURING SELF- AND OTHER-REFERENTIAL PROCESSING

The study of brain activity in the processing of self-referential information, as compared to the processing of information related to other people, is based on the application of mass-univariate analysis, based on the assumption that activity in one region is independent of activity in other regions. Recently, there has been a growing interest in neuroimaging to investigate spatially distributed information using multivariate approaches such as multivoxel pattern analysis (MVPA). In this paper, we used MVPA to analyze fMRI data recorded during self-evaluation and evaluation of other people of varying proximity. In all pairwise classifications tested, the number of correct identifications was significantly higher than the level of random matches. Predictively significant structures were widely distributed over different brain regions and included areas of the visual, lateral prefrontal, and many other cortical areas in addition to the cortical midline structures that contributed the most. In the self-other classification, ventral areas of the medial prefrontal and cingulate cortex were the most informative for the self condition, whereas parietal and occipital medial areas were the most informative for the other condition. The combination of brain structures, which included the anterior cingulate cortex and both amygdalae, revealed by principal component analysis, correlated positively with the psychometric scale of sensitivity to reward, and negatively with neuroticism scales. Overall, the results show the fruitfulness of using machine learning methods to analyze data from such kinds of experiments.

A meta-analysis of the neural substrates of monetary reward anticipation and outcome in alcohol use disorder.

The capacity to anticipate and detect rewarding outcomes is fundamental for the development of adaptive decision-making and goal-oriented behavior. Delineating the neural correlates of different stages of reward processing is imperative for understanding the neurobiological mechanism underlying alcohol use disorder (AUD). To examine the neural correlates of monetary anticipation and outcome in AUD patients, we performed two separate voxel-wise meta-analyses of functional neuroimaging studies, including 12 studies investigating reward anticipation and 7 studies investigating reward outcome using the monetary incentive delay task. During the anticipation stage, AUD patients displayed decreased activation in response to monetary cues in mesocortical-limbic circuits and sensory areas, including the ventral striatum (VS), insula, hippocampus, inferior occipital gyrus, supramarginal gyrus, lingual gyrus and fusiform gyrus. During the outcome stage, AUD patients exhibited reduced activation in the dorsal striatum, VS and insula, and increased activation in the orbital frontal cortex and medial temporal area. Our findings suggest that different activation patterns are associated with nondrug rewards during different reward processing stages, potentially reflecting a changed sensitivity to monetary reward in AUD.

Larger Medial Contact Area and More Anterior Contact Position in Medial-Pivot than Posterior-Stabilized Total Knee Arthroplasty during In-Vivo Lunge Activity

This study aimed to compare the in-vivo kinematics and articular contact status between medial-pivot total knee arthroplasty (MP-TKA) and posterior stabilized (PS) TKA during weight-bearing single-leg lunge. 16 MP-TKA and 12 PS-TKA patients performed bilateral single-leg lunges under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The closest point between the surface models of the femoral condyle and the polyethylene insert was used to determine the contact position and area. The nonparametric statistics analysis was performed to test the symmetry of the kinematics between MP-TKA and PS-TKA. PS-TKA demonstrated a significantly greater range of AP translation than MP-TKA during high flexion (p = 0.0002). Both groups showed a significantly greater range of lateral compartment posterior translation with medial pivot rotation. The contact points of PS-TKA were located significantly more posterior than MP-TKA in both medial (10°-100°) and lateral (5°-40°, 55°-100°) compartments (p < 0.0500). MP-TKA had a significantly larger contact area in the medial compartment than in the lateral compartment. In contrast, no significant differences were observed in PS-TKA. The present study revealed no significant differences in clinical outcomes between the MP and PS groups. The PS-TKA demonstrated significantly more posterior translations than MP-TKA at high flexion. The contact points are located more posteriorly in PS-TKA compared with MP-TKA. A larger contact area and medial pivot pattern during high flexion in MP-TKA indicated that MP-TKA provides enhanced medial pivot rotation.

Intraparietal stimulation disrupts negative distractor effects in human multi-alternative decision-making.

There has been debate about whether addition of an irrelevant distractor option to an otherwise binary decision influences which of the two choices is taken. We show that disparate views on this question are reconciled if distractors exert two opposing but not mutually exclusive effects. Each effect predominates in a different part of decision space: (1) a positive distractor effect predicts high-value distractors improve decision-making; (2) a negative distractor effect, of the type associated with divisive normalisation models, entails decreased accuracy with increased distractor values. Here, we demonstrate both distractor effects coexist in human decision making but in different parts of a decision space defined by the choice values. We show disruption of the medial intraparietal area (MIP) by transcranial magnetic stimulation (TMS) increases positive distractor effects at the expense of negative distractor effects. Furthermore, individuals with larger MIP volumes are also less susceptible to the disruption induced by TMS. These findings also demonstrate a causal link between MIP and the impact of distractors on decision-making via divisive normalisation.

Effect of photodynamic therapy on choroid of the medial area from optic disc in patients with central serous chorioretinopathy.

To explore the effect of photodynamic therapy (PDT) on the choroid of medial area from optic disc and factors correlated with treatment outcomes, we evaluated choroidal changes using ultra-widefield optical coherence tomography (UWF-OCT) after PDT for central serous chorioretinopathy (CSC). In this retrospective case-series, we included CSC patients who received a standard-dose of full-fluence PDT. UWF-OCT were examined at baseline and 3 months after treatment. We measured choroidal thickness (CT), classified into central, middle, and peripheral sectors. We examined CT changes after PDT by sectors and treatment outcome. Twenty-two eyes of 21 patients (20 males; mean age 58.7 ± 12.3 years) were included. CT reduction after PDT was significant in all sectors, including peripheral areas: supratemporal, 330.5 ± 90.6 μm vs. 237.0 ± 53.2 μm; infratemporal, 240.0 ± 89.4 μm vs. 209.9 ± 55.1 μm; supranasal, 237.7 ± 59.8 vs 209.3 ± 69.3 μm; infranasal, 172.6 ± 47.2 μm vs. 155.1 ± 38.2 μm (P < 0.001, for all). In patients with retinal fluid resolution, despite no apparent difference in baseline CT, there was more significant reduction after PDT in supratemporal and supranasal peripheral sectors, compared with patients without resolution: supratemporal, 41.9 ± 30.3 μm vs. -1.6 ± 22.7 μm; supranasal, 24.7 ± 15.3 μm vs. 8.5 ± 3.6 μm (P < 0.019, for both). Whole CT decreased after PDT, including in medial areas from optic disc. This may be associated with the treatment response of PDT for CSC.

Use of a biological scaffold in the cleavage area in complex revision breast augmentation: A surgical technique and case series

BackgroundBilateral breast augmentation has been the top surgical procedure performed worldwide by plastic surgeons for the past 5 years. Complex breast revision patients are challenging, with the cleavage area being one of the most difficult areas to navigate. We present a novel technique for using biological scaffolds in revision breast augmentation surgery. MethodsA step-by-step surgical technique is presented, combined with a series of 11 cases where either SurgiMend® acellular dermal matrix (ADM) or GalaFLEX mesh was used specifically in the medial cleavage area to correct a difficult to manage soft tissue contour deformity. ResultsEleven patients underwent revision breast augmentation with the use of the biological scaffolds in the medial cleavage area. The mean age was 43 years with a range of 29–68 years. All replacement breast implants were anatomical-shaped, medium profile, polyurethane-coated implants. GalaFLEX® mesh was used in six patients; five patients received SurgiMend® ADM. Mastopexy was performed in 8/11 patients. There were two complications in the same patient in this series, one emergency return to theater for bleeding and one minor scar revision. ConclusionsRevision breast augmentation surgery includes a smorgasbord of options that can be used individually or in combination, such as full or partial capsulectomy, removal alone or replacement of the implant, change to the tissue plane of where the implant sits, mastopexy, and fat transfer. In addition to these recognized treatments, we would like to advocate the option of a biological scaffold for extra support of the cleavage area in complex revision cases.