Comparison of Functional Outcomes,Femoral Rollback and Sagittal Stability of Anterior-Stabilized Versus Posterior-Stabilized Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials

PurposeTotal knee arthroplasty (TKA) has improved leaps and bounds in terms of design to improve clinical outcomes and achieve better rehabilitation of the patients. Ultra-congruent inserts (UC) were designed to replace the need for posterior stabilized (PS) implants. The purpose of this review was to evaluate clinical outcomes, femoral rollback, functional scores, range of motion, sagittal laxity, complication rates, and isokinetic performance between UC and PS TKA among RCTsMethodsElectronic databases such as PubMed, Scopus, opengrey, and Cochrane were searched from date of inception up to mid-April 2021, and meta-analysis was performed following PRISMA guidelines. This study analyzed outcomes, femoral rollback, tibial sagittal laxity and isokinetic performance.ResultsTen RCTs identified 852 knees, of which 420 underwent UC TKAs and 432 underwent PS TKA. Compared to UC TKA, a significantly better sagittal stability (p = 0.17) and femoral rollback (p < 0.00001) in PS TKAs was noted, although no statistically significant difference was found in the assessment of the range of motion (p = 0.19) and functional scores. Both the groups had similar isokinetic performance with extensor torque (p = 0.97) and flexor torque (p = 0.37).ConclusionsWe conclude with the current meta-analysis that there are no added benefits for UC over PS inserts and these inserts have a higher sagittal laxity and less femoral roll back in cruciate sacrificing UC knee. But since there are no long-term wear data, UC inserts with CS technique should be used cautiously and may be used only when the PCL cannot be balanced adequately. There is no evidence or only a few to support the superiority of the AS TKA in terms of clinical outcomes or isokinetic performance or femoral external rotation over PS TKA.Level of EvidenceLevel I, Systematic review and meta-analysis of RCTs.     

The anatomical basis for modulatory convergence in the antennal lobe of Manduca sexta

The release of neuromodulators by widely projecting neurons often allows sensory systems to alter how they process information based on the physiological state of an animal. Neuromodulators alter network function by changing the biophysical properties of individual neurons and the synaptic efficacy with which individual neurons communicate. However, most, if not all, sensory networks receive multiple neuromodulatory inputs, and the mechanisms by which sensory networks integrate multiple modulatory inputs are not well understood. Here we characterized the relative glomerular distribution of two extrinsic neuromodulators associated with distinct physiological states, serotonin (5‐HT) and dopamine (DA), in the antennal lobe (AL) of the moth Manduca sexta. By using immunocytochemistry and mass dye fills, we characterized the innervation patterns of both 5‐HT‐ and tyrosine hydroxylase‐immunoreactive processes relative to each other, to olfactory receptor neurons (ORNs), to projection neurons (PNs), and to several subsets of local interneurons (LNs). 5‐HT immunoreactivity had nearly complete overlap with PNs and LNs, yet no overlap with ORNs, suggesting that 5‐HT may modulate PNs and LNs directly but not ORNs. TH immunoreactivity overlapped with PNs, LNs, and ORNs, suggesting that dopamine has the potential to modulate all three cell types. Furthermore, the branching density of each neuromodulator differed, with 5‐HT exhibiting denser arborizations and TH‐ir processes being sparser. Our results suggest that 5‐HT and DA extrinsic neurons target partially overlapping glomerular regions, yet DA extends further into the region occupied by ORNs. J. Comp. Neurol. 524:1859–1875, 2016. © 2015 Wiley Periodicals, Inc.     

Mechanisms of Flushing Due to Niacin and Abolition of These Effects

There are many factors that increase the risk of cardiovascular disease, and a prominent factor among these is dyslipidemia. The following literature review focuses on the use of niacin therapy in order to treat dyslipidemia and how to control the associated niacin flush. The associated studies gathered are reviews and randomized control trials. They were obtained by using electronic searches. Certain keywords took precedence, and articles focusing on niacin therapy were chosen. Recent research has found promising insight into more effective prevention of the niacin-mediated flush through a selective antagonist for the prostaglandin D2 receptor, laropiprant. Aspirin (or NSAIDs) also provide some prevention for flushing, although recent studies have shown that it is not as effective as laropiprant. There is a need for further research in order to come to a clear conclusion regarding combined therapies of aspirin and laropiprant pretreatment, as well as exact dosage requirements.     

Parkinsonism as a late presentation of lymphomatosis cerebri following high-dose chemotherapy with autologous stem cell transplantation for primary central nervous system lymphoma

Journal of Neurology - Primary central nervous system lymphoma is an aggressive form of non-Hodgkin lymphoma arising in the eyes, meninges, spinal cord, or brain. Treatment of primary CNS lymphoma...     

Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge,attitudes, and practices

Journal of Neurology - To report the understanding and decision-making of neuroimmunologists and their treatment of patients with multiple sclerosis (MS) during the early stages of the SARS-CoV-2...     

Unique deficit in embodied simulation in autism: An fMRI study comparing autism and developmental coordination disorder

A deficit in pre‐cognitively mirroring other people''s actions and experiences may be related to the social impairments observed in autism spectrum disorder (ASD). However, it is unclear whether such embodied simulation deficits are unique to ASD or instead are related to motor impairment, which is commonly comorbid with ASD. Here we aim to disentangle how, neurologically, motor impairments contribute to simulation deficits and identify unique neural signatures of ASD. We compare children with ASD (N = 30) to children with Developmental Coordination Disorder (DCD; N = 23) as well as a typically developing group (N = 33) during fMRI tasks in which children observe, imitate, and mentalize about other people''s actions. Results indicate a unique neural signature in ASD: during action observation, only the ASD group shows hypoactivity in a region important for simulation (inferior frontal gyrus, pars opercularis, IFGop). However, during a motor production task (imitation), the IFGop is hypoactive for both ASD and DCD groups. For all tasks, we find correlations across groups with motor ability, even after controlling for age, IQ, and social impairment. Conversely, across groups, mentalizing ability is correlated with activity in the dorsomedial prefrontal cortex when controlling for motor ability. These findings help identify the unique neurobiological basis of ASD for aspects of social processing. Furthermore, as no previous fMRI studies correlated brain activity with motor impairment in ASD, these findings help explain prior conflicting reports in these simulation networks.     

Key changes in denervated muscles and their impact on regeneration and reinnervation

The neuromuscular junction becomes progressively less receptive to regenerating axons if nerve repair is delayed for a long period of time. It is difficult to ascertain the denervated muscle＇s residual receptivity by time alone. Other sensitive markers that closely correlate with the extent of denervation should be found. After a denervated muscle develops a fibrillation potential, muscle fiber conduction velocity, muscle fiber diameter, muscle wet weight, and maximal isometric force all decrease; remodeling increases neuromuscular junction fragmentation and plantar area, and expression of myogenesis-related genes is initially up-regulated and then down-regulated. All these changes correlate with both the time course and degree of denervation. The nature and time course of these denervation changes in muscle are reviewed from the literature to explore their roles in assessing both the degree of detrimental changes and the potential success of a nerve repair. Fibrillation potential amplitude, muscle fiber conduction velocity, muscle fiber diameter, mRNA expression levels of myogenic regulatory factors and nicotinic acetylcholine receptor could all reflect the severity and length of denervation and the receptiveness of denervated muscle to regenerating axons, which could possibly offer an important clue for surgical choices and predict the outcomes of delayed nerve repair.