Hiperostosis cortical congénita: una causa infrecuente de llanto inconsolable del lactante. Presentación de caso clínico / Congenital cortical hyperostosis: a rare cause of inconsolable crying in a baby. Clinical case report

Se presenta el caso de un lactante de 2 meses que fue llevado a consulta varias veces por llanto problemático, inicialmente interpretado como de causa gastrointestinal. Dado que el síntoma persistía, se sospechó de una fractura debido a su asociación con la movilización de los miembros y la palpación de una tumoración en la cara anterior de la tibia derecha. Las radiografías mostraron compromiso poliostótico diafisario y lesiones compatibles con compromiso cortical de huesos largos. Se realizó el diagnóstico operativo de síndrome de Caffey-De Toni-Silverman y se inició el tratamiento con antiinflamatorios no esteroideos, lo que resultó en una remisión sintomática. Posteriormente, se confirmó el diagnóstico mediante la identificación de la variante patogénica COL1A1 en estado heterocigota. Se trata de una patología rara de la cual se estima una incidencia de 48/100 000 y hay menos de 150 casos descritos al momento.

Here we describe the case of a 2-month-old infant who consulted several times due to excessive crying, initially interpreted as having a gastrointestinal cause. Since the symptom persisted, a fracture was suspected due to its association with mobilization of the limbs and palpation of a mass on the anterior aspect of the right tibia. X-rays showed diaphyseal polyostotic involvement and lesions compatible with cortical involvement of long bones. Caffey-De Toni-Silverman syndrome was diagnosed and treatment with nonsteroidal anti-inflammatory drugs was initiated, resulting in symptom remission. Subsequently, the diagnosis was confirmed by the identification of the pathogenic heterozygous variant COL1A1. This is a rare condition with an estimated incidence of 48/100 000 individuals, and less than 150 cases have been described to date.

The contribution of Alois Alzheimer and Oskar Fischer to the understanding of Pick's complex - (Historical Note) / A contribuição de Alois Alzheimer e Oskar Fischer para a compreensão do complexo de Pick - (Nota Histórica)

Arnold Pick described a series of cases with progressive aphasia, behavioural disorders, and dementia. The post-mortem examination revealed on macroscopy, beside diffuse brain atrophy, also circumscribed (lobar) atrophy of the temporal and/or frontal lobes. The histopathology was not provided. Such kind of cases were soon named after the author, being known for a time as 'Pick's disease', coming to constitute a new nosological group. A time later after the original description, Alois Alzheimer and Oskar Fischer completed microscopic examination of similar cases, where the first author found, on silver impregnation, spheric neuronal inclusions, he named 'argentophilic ball' inclusions, while the second one identified complex cortical changes he named 'spongiform cortical wasting', and additionally a type of swollen cell that was named 'ballooned neuron'. Such microscopic changes became the first histopathological markers of this group of diseases.

Arnold Pick descreveu uma série de casos apresentando, de modo progressivo, afasia, transtornos de comportamento e demência. O exame pós-morte revelou à macroscopia, além de atrofia cerebral difusa, também atrofia circunscrita (lobar) dos lobos temporais e/ou frontais. A histopatologia não foi fornecida. Tal tipo de casos foi logo denominado segundo o autor, sendo conhecido por um período como 'doença de Pick', vindo a constituir um novo grupo nosológico. Algum tempo após a discrição original, Alois Alzheimer e Oskar Fischer perfizeram exame microscópio de casos semelhantes, onde o primeiro autor encontrou inclusões neuronais esféricas à impregnação pela prata, que denominou de 'bola argirofílica', enquanto o segundo identificou alterações corticais complexas às quais denominou 'perda cortical espongiforme', além de um tipo de célula tumefeita que chamou de 'neurônio balonizado'. Tais alterações microscópicas tornaram-se os primeiros marcadores histopatológicos desse grupo de doenças.

Bases neurobiológicas de la epilepsia neonatal y sus comorbilidades / Neurobiological basis of neonatal epilepsy and its co morbilities

Resumen La aparición de convulsiones es frecuente durante el periodo neonatal debido a las características de inma durez funcional del cerebro es este periodo. La aparición de estas convulsiones puede llevar a un diagnóstico de epilepsia neonatal, que suele estar asociado a alteracio nes estructurales del cerebro durante el neurodesarrollo. Aproximadamente el 50% de las personas con epilepsia activa padecen al menos un trastorno médico comórbi do, y esto hace que cambie la evolución de la epilepsia. La presencia de trastornos neurológicos que preceden a la aparición de la epilepsia indica que alteraciones es tructurales y/o funcionales del cerebro subyacentes pue den ser causa de la predisposición a padecer epilepsia y de los procesos comórbidos de manera independiente. En esta revisión describimos los procesos cerebrales estructurales y funcionales que subyacen a la aparición de epilepsia neonatal y sus comorbilidades.

Abstract The occurrence of seizures is frequent during the neonatal period due to the functional immaturity of the brain.The presence of these seizures may lead to a diagnosis of neonatal epilepsy, which is usually as sociated with structural alterations of the brain during neurodevelopment. Approximately 50% of people with active epilepsy have at least one comorbid medical di sorder, and the existence of a comorbid process changes the course of the epilepsy. The presence of neurologic disorders preceding the onset of epilepsy indicates that underlying neurobiological alterations may indepen dently cause the predisposition to epilepsy and comor bid processes. In this review we describe the structural and functional brain processes underlying the onset of neonatal epilepsy and its comorbidities.

Enfermedad de Caffey después del primer año de vida: caso clínico / Caffey disease after the first year of life: clinical case

Objetivo: La enfermedad de Caffey o hiperostosis cor- tical infantil es una enfermedad rara que afecta uno o más huesos en los primeros meses de vida y debido a su baja inci- dencia está subdiagnosticada, y por tanto se aplican procedi- mientos invasivos innecesarios en su estudio y tratamiento. Se presenta un caso clínico atípico de enfermedad de Caffey en una paciente mayor de 1 año de edad y su resolución. Caso clínico: El servicio de Cirugía Maxilofacial del Hospital Provincial Pediátrico Eduardo Agramonte Piña de Camagüey, Cuba, atiende a una niña de 1 año y 10 meses que se encontraba hospitalizada por presentar una inflamación alarmante en la región facial y cervical precedida de un cua- dro febril y dificultad para alimentarse. Se indicaron los estu- dios apropiados, cuyos resultados, junto a las características clínicas, permitieron diagnosticar la enfermedad de Caffey. Aunque sea una enfermedad rara, es importante estudiarla para realizar un correcto análisis de cada caso y diferenciarla de otras enfermedades que requieren de conductas terapéuti- cas agresivas (AU)

Aim: Caffey's disease or infantile cortical hyperostosis is a rare disease that affects one or more bones in the first months of life and due to its low incidence, it is underdiag- nosed, and therefore unnecessary invasive procedures are applied in its study and treatment. An atypical clinical case of Caffey's disease in a patient older than 1 year and its reso- lution is presented. Case report: The Maxillofacial Surgery service of the Eduardo Agramonte Piña Provincial Pediatric Hospital in Camagüey, Cuba, takes the case of a 1 year and 10-month-old female patient who was hospitalized for an alarming inflam- mation in the facial and cervical region, preceded by a fever and difficulty to eat. The appropriate studies were indicated, which results, together with the clinical characteristics, al- lowed the diagnosis of Caffey's disease. Although it is a rare entity, it is important to study it to carry out a correct analysis of each case and differentiate it from other diseases that re- quire aggressive therapeutic behaviors (AU)

Diagnóstico de malformación del desarrollo cortical en embarazo gemelar monocorial: reporte de caso / Diagnosis of malformation of the cortical development in a monochorial twin pregnancy: case report

Introducción: Las malformaciones del desarrollo cortical se deben a alteraciones en la migración del neuroblasto durante la formación de la corteza cerebral. Se desconoce su frecuencia en embarazos monocoriales. Objetivo: Reportar el caso de un embarazo monocorial con diagnóstico de malformación del desarrollo cortical en uno de los fetos y revisar la literatura referente a su diagnóstico y pronóstico. Método: Mujer de 19 años, embarazo monocorial biamniótico de 26 semanas, que acudió con estudio ecográfico y resonancia fetal que evidenció en uno de los fetos asimetría de los hemisferios cerebrales, hipoplasia de la cisura de Silvio izquierda con simplificación del patrón giral por focos de paquigiria y polimicrogiria, con confirmación posnatal de alteración en la migración neuronal asociada a hipoplasia vermiana. Resultados: Se encontraron en la literatura tres casos de embarazo múltiple monocorial con trastorno de la migración neuronal con recién nacidos vivos. Los hallazgos más comunes fueron microcefalia, lisencefalia e hipoplasia cerebelosa. Conclusiones: El diagnóstico prenatal del trastorno de la migración neuronal se realiza con ecografía y resonancia fetal. La más frecuente es la alteración de la migración neuronal tipo II. El pronóstico depende del tipo de alteración; sin embargo, la mayoría de los casos presentan trastornos epileptiformes con alteraciones del neurodesarrollo.

Introduction: Malformations of cortical development are the result from alterations in the neuroblast migration during the cerebral cortex formation. Its frequency in monochorial multiple pregnancies remains unknown. Objective: To report a case of monochorial multiple pregnancy with diagnosis of malformation of the cortical development in one of the fetuses. In addition, to review the literature regarding the diagnosis and prognosis of this entity. Method: A 19-year-old female with a monochorial diamniotic pregnancy of 26 weeks gestation, arrived with an ultrasound anatomy scan visit, and fetal magnetic resonance imaging, we detected asymmetry in the cerebral hemispheres one of the fetuses, hypoplasia of the left sulcus of Sylvius with simplification of the gyrus pattern due to clusters of pachygyria and polymicrogyria. Those findings were confirmed afterbirth, with a definite diagnosis of neuronal migration disorder associated with vermian hypoplasia. Results: Three cases of monochorial pregnancy with neuronal migration disorder with live newborn, common findings like microcephaly, lissencephaly and vermian hypoplasia. Conclusions: Prenatal diagnosis with neuronal migration disorder is done via ultrasound and magnetic resonance imaging. Neuronal migration disorders type II are the most common of them. Prognosis depends on the type of disorder; however, most patients have epileptiform activity and neurodevelopment impairment.

Acupuncture for generalized anxiety disorder: a study protocol for a randomized controlled trial

During the COVID-19 outbreak, there was a sharp increase in generalized anxiety disorder (GAD). Acupuncture therapy has the advantages of accurate clinical efficacy, safety and reliability, few adverse reactions, and no dependence, and is gradually becoming one of the emerging therapies for treating GAD. We present a study protocol for a randomized clinical trial with the aim of exploring the mechanism of brain plasticity in patients with GAD and evaluate the effectiveness and reliability of acupuncture treatment. Transcranial magnetic stimulation (TMS) will be used to assess cortical excitability in GAD patients and healthy people. Sixty-six GAD patients meeting the inclusion criteria will be randomly divided into two groups: TA group, (treatment with acupuncture and basic western medicine treatment) and SA group (sham acupuncture and basic western medicine treatment). Twenty healthy people will be recruited as the control group (HC). The parameters that will be evaluated are amplitude of motor evoked potentials (MEPs), cortical resting period (CSP), resting motor threshold (RMT), and Hamilton Anxiety Scale (HAMA) score. Secondary results will include blood analysis of γ-aminobutyric acid (GABA), glutamate (Glu), glutamine (Gln), serotonin (5-HT), and brain-derived nerve growth factor (BDNF). Outcomes will be assessed at baseline and after the intervention (week 8). This study protocol is the first clinical trial designed to detect differences in cerebral cortical excitability between healthy subjects and patients with GAD, and the comparison of clinical efficacy and reliability before and after acupuncture intervention is also one of the main contents of the protocol. We hope to find a suitable non-pharmacological alternative treatment for patients with GAD.

Effect of locking plate combined with cortical screw internal fixation on ankle function and quality of life in patients with ankle fracture combined with inferior tibiofibular separation / 临床外科杂志

Objective To investigate the effect of locking plate combined with cortical screw internal fixation on ankle function and quality of life in patients with ankle fracture with tibiofibular separation.Methods A total of 120 patients with ankle fracture and distal tibiofibular separation treated in our hospital from May 2020 to December 2021 were selected and divided into control group and observation group according to random number table method,with 60 patients/group.The control group was treated with cortical screw fixation alone,and the observation group was treated with locking plate combined with cortical screw internal fixation.Before surgery and 6 months after surgery,the recovery function of the two groups was compared.X-ray,operation duration,healing time,intraoperative blood loss,postoperative complications were compared,and the living ability of the two groups of patients was evaluated.Results Before treatment,there was no difference in joint function between the two groups(P＞0.05).After treatment,the longest walking of the control group(15.89±0.85),foot alignment(15.06±0.71),pain response(29.03±4.48)and ground walking(15.65±0.59).The longest walking distance(16.19±0.87),foot alignment(15.29±0.76),pain response(31.24±4.55)and ground walking(15.96±0.68)in the observation group,which were higher than those in control group(P＜0.05).Compared with the control group,the intraoperative blood loss and healing time in the observation group were lower(P＜0.05).BI index of the two groups before treatment had no difference(P＞0.05);After treatment,BI index of observation group was higher than that of control group(P＜0.05).There was no difference in the total complication rate between the two groups(P＞0.05).Conclusion Locking plate combined with cortical screw internal fixation has a good therapeutic effect on improving ankle function,reducing intraoperative blood loss,promoting healing and improving behavioral ability in the treatment of ankle fracture combined with hypotibiofibular syndesmosis injury.

Three-dimensional finite element analysis of the distribution pattern of stress in bone tissues with different characteristics / 中国组织工程研究

BACKGROUND:Less is reported on the influence of cortical bone thickness on displacement and equivalent stress. OBJECTIVE:To analyze the influence of cortical bone thickness on the maximum displacement and equivalent stress at the implant-bone interface through a three-dimensional finite element method,thereby providing some suggestions for oral implantation. METHODS:In this experiment,we selected the cone-shaped CT image data of a patient who was scheduled for mandibular first molar implant restoration.First,we established a mandibular model in Mimics13 software,and then imported it into Solid works 2022 software.According to the related product information,we drew the cone-shaped implant(4.1 mm×10 mm)and the upper prosthesis model.Cortical bone models were obtained according to different cortical bone thicknesses(2.5,2.0,1.5,1.0 mm)and named D1,D2,D3,and D4,respectively.All the models were imported into ANSYS Workbench 2021 software and cross-combined.Finally,we applied vertical and oblique loads to the four groups of models,and analyzed the stress of the models in each group. RESULTS AND CONCLUSION:The peak equivalent stress is lowest in the cancellous bone and highest in the upper prosthesis,that is,at the abutment-implant junction.The peak stress increases with the decrease of cortical bone thickness.The peak stress of the abutment increases with the decrease of cortical bone thickness,and a similar explanation can also be applied to the other implant restoration components.The peak stress in bone tissue and implants increases with the increase of cortical bone thickness.In models D1,D2,D3,the peak stress in implants is higher than that in bone tissue,but the results are reversed in D4.

Fracture accuracy on cortical bone structure under bending load using different numerical methods / 中国组织工程研究

BACKGROUND:Current fracture simulation for cortical bone structure is mainly based on three numerical methods:the element instantaneous failure,continuum damage mechanics,and extended finite element methods.Although many studies focus on cortical bone fracture simulation,few have compared the differences in prediction accuracy using the three numerical methods. OBJECTIVE:To probe the accuracy and applicability of the three numerical methods in simulating cortical bone fracture under bending load. METHODS:The rat femur samples were primarily used to perform the three-point bending experiment.The rat femoral finite element models were established based on the micro-CT images of the femur samples and the three numerical methods were used to conduct the fracture simulations under three-point bending loads.The predicted fracture loads and fracture patterns were compared with the experimental data to determine the accuracy of various numerical methods in simulating cortical bone fracture. RESULTS AND CONCLUSION:(1)The discernible differences in the failure processes could be observed in the same finite element model under the three numerical simulations due to different element failure strategies.(2)The simulation results showed that the fracture simulation using the continuum damage mechanics method was in better agreement with the experimental results.(3)The numerical method that was suitable for simulating cortical bone fracture under bending load could be determined by comparing it with experimental results.The variations in the fracture parameters were observed,and the reason for the differences in the predicted results using different numerical methods was also discussed,which aided in determining the range of applicability of structural fracture simulation for each numerical method and then improving the simulation accuracy.

Effects of transcranial magneto-acoustical stimulation on beta oscillations in neural circuits of healthy and Parkinson's disease rats / 中国组织工程研究

BACKGROUND:Transcranial magneto-acoustical electrical stimulation(TMAES)is a non-invasive,high-precision neurofocused stimulation method based on magneto-acoustic coupling electrical effect,which can regulate the rhythmic oscillation of nerve activity,thereby affecting the brain's movement,cognition and other functions. OBJECTIVE:To explore the effect of TMAES on beta oscillations in the neural circuits of healthy rats and Parkinson's rats. METHODS:(1)Animal experiments:Twenty-four Wistar rats were randomly divided into four groups(n=6 per group).The rats in the normal control group received no intervention,while those in the normal stimulation group received TMAES(the average spatial peak pulse intensity:13.33 W/cm2,fundamental frequency:0.4 MHz,the number of fundamental wave cycles:1000,and pulse frequency:200 Hz).The model control group and model stimulation group were established by intraperitoneal injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine.After successful modeling,the rats in the model control group received sham TMAES stimulation in the prefrontal cortex,and those in the model stimulation group received TMAES in the prefrontal cortex,and the duration of stimulation was 2.0 minutes per day.After an interval of 8-10 minutes,the local field potential signals of rats were collected during the execution of T-maze test and the correct rate of behavior was recorded at the same time to compare and analyze the time-frequency distribution of local field potential signals and behavioral differences among the groups.The stimulation experiment and T-maze test were stopped when the correct rate of rats was higher than 80%for 3 consecutive days.(2)Modeling and simulation experiments:The cortical-basal ganglion circuit model under TMAES was established,and the ultrasonic emission period(5,10,20 ms),ultrasonic emission duty cycle(30%,50%,90%)and induced current density(20,50,100 μA/cm2)were changed respectively to compare the power spectral density values of beta oscillations in healthy rats and Parkinson's rats under different stimulation parameters. RESULTS AND CONCLUSION:(1)Animal experiments:The spatial learning ability of the rats in the normal control group was stronger than that of the model control group(P＜0.001),the spatial learning ability of the rats in the normal stimulation group was stronger than that of the normal control group(P＜0.05),and the spatial learning ability of the rats in the model stimulation group was stronger than that of the model control group(P＜0.01).The distribution of beta oscillation energy in the normal control group was more concentrated,and the beta oscillation signal energy was reduced in the normal stimulation group compared with the normal control group.The beta oscillation energy was widely distributed and the energy value was significantly higher in the model control group and the model stimulation group than the normal control and normal stimulation groups.Moreover,the beta oscillation signal energy in the model stimulation group was significantly lower than that in the model control group.(2)Modeling and simulation experiments:the peak power spectral density of the beta band of healthy rats without stimulation(30 dB)was significantly lower than that of Parkinson's rats(55 dB).The power spectral density value generally decreased after stimulation.The peak power spectral density in the beta band was positively correlated with the ultrasonic emission period and negatively correlated with the induced current density.In addition,the peak power spectral density value was the lowest when the duty cycle of ultrasonic emission was 50%.These findings indicate that TMAES suppresses beta oscillations in healthy and Parkinson's disease rats,thereby improving motor function and decision-making cognitive function in rats.

Mechanical analysis of cortical bone trajectory screw placement in lumbar revision / 中国组织工程研究

BACKGROUND:At present,there are shortcomings and risks in the surgical revision of vertebral bodies that failed to be fixed in clinical practice.To avoid the risks of conventional revision surgery,the cortical bone trajectory technique is used to perform revision surgery on vertebral bodies that failed to be fixed.However,the mechanical properties of cortical bone trajectory technique screws in revision surgery are not clear. OBJECTIVE:The mechanical properties of cortical bone trajectory in lumbar revision surgery were analyzed by the finite element method to provide a theoretical basis for the clinical application of cortical bone trajectory in revision surgery. METHODS:CT scan data of the osteoporotic vertebral body were obtained and the L4 vertebral body model was established.The initial cortical bone trajectory placement and traditional pedicle screw in the L4 vertebral body model were completed,respectively,and their mechanical data were taken as the baseline standard for later evaluation of revision surgical performance.The traditional pedicle screw was removed and the screw path was retained.The cortical bone trajectory screw was used for secondary screw placement on the vertebral body to achieve lumbar refixation.The axial pull-out force,stability,and lumbar motion range of the revised screw were analyzed by the finite element method. RESULTS AND CONCLUSION:(1)The screw axial pull-out force of the cortical bone trajectory revision group was 25.6%higher than that of the traditional pedicle initial group.(2)In the lower,left,and right working conditions,the load-displacement ratio of screws in the cortical bone trajectory revision group increased by 18.5%,41.3%,and 35.0%,respectively,compared with the traditional pedicle initial group.The load-displacement ratio of screws in the cortical bone trajectory revision group was slightly higher than that in the traditional pedicle initial group under the above condition,but there was no statistically significant difference(P>0.05).(3)In anterior and posterior flexion conditions,lumbar motion range in the cortical bone trajectory revision group was increased by 45.5%and 36.1%compared with the traditional pedicle initial group,but there was no statistically significant difference in left bend,right bend,and axial rotation conditions(P>0.05).(4)There were no statistically significant differences in screw axial pull-out force,screw load-displacement ratio,and lumbar motion range between the cortical bone trajectory revision group and cortical bone trajectory initial group(P>0.05).(5)The mechanical data exhibited that although the revised nail track bone was damaged or lost to a certain extent,the mechanical properties of the cortical bone trajectory revision group were still better than those of the traditional pedicle initial group to a certain extent.Moreover,there was no significant difference in the mechanical properties between the cortical bone trajectory revision group and the cortical bone trajectory initial group.It provides a reference for revision surgery of lumbar internal fixation with cortical bone trajectory technique in patients with failed traditional pedicle fixation.

Prediction of critical energy release rate for cortical bone structure under different failure modes / 中国组织工程研究

BACKGROUND:Critical energy release rate is a global fracture parameter that could be measured during the failing process,and its value may change under different failure modes even in the same structure. OBJECTIVE:To propose an approach to predict the critical energy release rate in the femoral cortical bone structure under different failure modes. METHODS:Three-point bending and axial compression experiments and the corresponding fracture simulations were performed on the rat femoral cortical bone structures.Different critical energy release rates were repeatedly assigned to the models to perform fracture simulation,and the predicted load-displacement curves in each simulation were compared with the experimental data to back-calculate the critical energy release rate.The successful fit was that the differences in the fracture parameters between the predicted and experimental results were less than 5%. RESULTS AND CONCLUSION:(1)The results showed that the cortical bone structure occurred tensile open failure under three-point bending load,and the predicted critical energy release rate was 0.16 N/mm.(2)The same cortical bone structure occurred shear open failure under axial compression load,and the predicted critical energy release rate was 0.12 N/mm,which indicates that the critical energy release rate of the same cortical bone structure under different failure modes was different.(3)A comprehensive analysis from the perspectives of material mechanical properties and damage mechanism was conducted to reveal the reasons for the differences in the critical energy release rate in the cortical bone structure under different failure modes,which provided a theoretical basis for the measurement of the energy release rate and the accurate fracture simulation.

Effects of Different Running Speeds on Tissue-Level Failure Strain in Rat Femoral Cortical Bone / 医用生物力学

Objective To predict the tissue-level failure strain of the cortical bone and discuss the effects of different running speeds on the mechanical properties of rat femoral cortical bone.Methods The threshold for cortical bone tissue-level failure strain was assigned,and fracture simulation under three-point bending was performed on a rat femoral finite element model.The predicted load-displacement curves in each simulation were compared and fitted with the experimental data to back-calculate the tissue-level failure strain.Results The cortical bone tissue-level failure strains at different running speeds were statistically different,which indicated that different running speeds had certain impacts on the micromechanical properties of the cortical bone structures.At a running speed of 12 m/min,the cortical bone structure expressed the greatest tissue-level failure strain,and at a running speed of 20 m/min,the cortical bone structure expressed the lowest tissue-level failure strain.Conclusions Based on the changing trends of tissue-level failure strain and in combination with the changes in macro-level failure load and tissue-level elastic modulus of cortical bone structures,the effects of different running speeds on the mechanical properties of cortical bone structures were discussed in this study.The appropriate running speed for improving the mechanical properties of the cortical bone was explored,thereby providing a theoretical basis for improving bone strength through running exercises.

Design of a Novel Variable-Diameter Cortical Threaded Screw and its Application in Improving Cortical Bone Trajectory in Lumbar Spine / 医用生物力学

Objective A novel variable-diameter cortical threaded screw used in a modified cortical bone trajectory(MCBT)was designed to verify its mechanical properties using the MCBT technique.Methods According to MCBT technology,the screw pitch was fixed at 2 mm,the total length was 45 mm,the diameter of the thick rod was 5.5 mm,the diameter of the thin rod was 4.0-4.5 mm,and the length of variable-diameter position connecting the thick rod and the thin rod was 2 mm.The parameters were set based on three aspects:variable-diameter position,thread depth,and thread type.Three-factor and three-level L9 tests were conducted and screw models were established.The torsion and the bending and pull-out force of the designed screws were calculated based on the finite element method,the results were analyzed using range analysis,and then the screw models were determined.The three-dimensional(3D)model of L4 vertebral body in osteoporosis specimens was established and screws were placed according to the MCBT technique.The pull-out force of the novel variable-diameter cortical threaded screw was compared with that of a conventional non-variable-diameter cortical threaded screw.Results Range analysis showed that screw No.6(variable-diameter position:24 mm from the screw head,thread depth:0.7 mm,45° symmetrical thread)was the optimal screw.The anti-pull-out force of the No.6 variable-diameter cortical threaded screw was 13.1%higher than that of the 4.5 mm conventional non-variable-diameter cortical threaded screw,and no statistical difference in anti-pull-out force was found between the No.6 variable-diameter cortical threaded screw and the 5.5 mm conventional non-variable-diameter cortical threaded screw.Conclusions The variable-diameter position has the smallest influence on pull-out force of the screw,the thread type has the largest influence on pull-out force,and the thread depth has the largest influence on torsion and bending.Compared with that of the conventional non-variable-diameter cortical threaded screw,the variable-diameter cortical threaded screw had a smaller front end,which prevented splitting at the entrance point of the screw.The screw has a large diameter at rear end,thereby showing improved pull-out performance.The results provide a new theoretical basis for the clinical application of MCBT technology.

Diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/CT and MRI in focal cortical dysplasia complicated with refractory epilepsy / 中华神经科杂志

Objective:To investigate the diagnostic value and imaging characteristics of MRI combined with 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/CT in focal cortical dysplasia (FCD) complicated with refractory epilepsy. Methods:A retrospective analysis was performed on 42 patients with FCD complicated with refractory epilepsy who were admitted to the Affiliated Hospital of Jining Medical University from January 2017 to December 2022. All patients underwent preoperative MRI and 18F-FDG PET/CT, and PET/MRI fusion was performed on the images. Chi-square test and Kappa consistency test were used to compare the localization diagnostic efficacy of PET/CT, MRI and PET/MRI fusion for epileptic foci. The patients were categorized based on gender, lesion location, pathological type, seizure type, and efficacy. Independent sample t-test and analysis of variance were used to compare maximum standardized uptake (SUVmax) values and asymmetry index (AI) of the patients between different groups. Results:Among the 42 patients, the positive rates of MRI, PET/CT, PET/MRI fusion examinations were 85.7%(36/42), 95.2%(40/42), 100.0%(42/42), the lateral localization rates were 71.4%(30/42), 92.9%(39/42), 95.2%(40/42), and the localization rates were 57.1%(24/42), 81.0%(34/42), 88.1%(37/42), respectively. There were significant differences in the lateral localization rates and localization rates of epileptogenic foci between MRI and PET/CT (χ 2=6.574, P=0.010; χ 2=5.570, P=0.018). There were significant differences in the positive rates of lesions, the lateral localization rates and the localization rates of epileptogenic foci between MRI and PET/MRI fusion (χ 2=6.385, P=0.012; χ 2=8.571, P=0.003; χ 2=10.118, P=0.001). There were no significant differences in the positive rates of lesions between MRI and PET/CT, and in the positive rates of lesions, the lateral localization rates and localization rates of epileptogenic foci between PET/CT and PET/MRI fusion (χ 2=2.184, P=0.139; χ 2=2.024, P=0.155; χ 2=0.210, P=0.647; χ 2=0.819, P=0.365). The Kappa consistency test of PET/CT and PET/MRI fusion imaging was performed for the location of epileptogenic foci, and the Kappa=0.721 was obtained, indicating that they were consistent in the location of epileptogenic foci. The SUVmax values of patients with temporal lobe epilepsy were lower, and the AI values were higher than that of patients with extra temporal lobe epilepsy (7.4±1.3 vs 9.6±1.6, 15.5±2.6 vs 12.9±2.4; t=5.154, 6.083; P=0.001, 0.001). The SUVmax values of patients with good efficacy (according to the Engel efficacy grading system, grades Ⅰ-Ⅱ indicating good efficacy) were higher, and the AI values were lower than that of patients with poor efficacy (according to the Engel efficacy grading system, grades Ⅲ-Ⅳ indicating poor efficacy; 9.5±1.9 vs 7.9±2.1, 13.5±3.3 vs 14.8±3.0; t=2.789, 3.722; P=0.042, 0.029). There were no significant differences in SUVmax and AI values among different genders, pathological types and seizure types (all P>0.05). Conclusions:The imaging characteristics of patients with different types of FCD complicated with refractory epilepsy are different. PET/MRI fusion is better than MRI in the diagnosis of FCD complicated with refractory epilepsy, and is consistent with PET/CT in the location of epileptogenic foci.

Clinical analysis of 57 children with epilepsy caused by focal cortical dysplasia / 中华神经医学杂志

Objective:To summarize the clinical characteristics of patients with epilepsy caused by focal cortical dysplasia (FCD), and identify the influencing factors for postoperative seizure controls.Methods:Fifty-seven patients with epilepsy caused by FCD admitted to Department of Neurosurgery, Third Affiliated Hospital of Zhengzhou University from July 2019 to November 2023 were chosen; standard preoperative evaluation, surgery, postoperative management and follow-up were performed. A retrospective study of clinical data, imaging and video electroencephalogram (VEEG) data, surgical approaches, pathological findings, and follow-up data was performed; influencing factors for postoperative seizure controls were analyzed.Results:In these 57 patients with epilepsy caused by FCD, 29 were males (50.88%) and 28 were females (49.12%). Onset age was 30.00 (8.00, 74.50) months, and surgery age was 95.00 (50.00, 138.50) months. Focal to bilateral tonic-clonic seizures (42/57; 73.68%) and epileptic spasms (13/57; 22.81%) were common seizure types. Cranial MRI was positive in 34 patients (59.65%), mainly manifested as abnormal cortical gyri/sulci morphology (17/57; 29.82%). In 43 patients accepted PET-CT, hypometabolic sites were detected in 40 (93.02%), and complete agreement between PET/MRI fusion results and actual lesion sites was noted in 40 (93.02%). FCD type I was noted in 16 patients (28.07%), type II in 39 (68.42%), and type III in 2 (3.51%). By December 2023, 44 (77.19%) had Engel grading I, 4 (7.02%) had grading II, 4 (7.02%) had grading III, and 5 (8.77%) had grading IV. Children with good prognosis (Engel grading I+II) and those with poor prognosis (Engel grading III+IV) showed significant differences in terms of time from first seizure to surgery, positive/negative MRI, and regularity of postoperative ASMs ( P<0.05). Conclusions:Focal to bilateral tonic-clonic seizure is the most common seizure type in patients with epilepsy caused by FCD, and abnormal cortical gyri/sulci morphology is the most common MRI manifestation; PET/MRI fusion imaging is superior to PET-CT or MRI in identifying epileptogenic foci. Poor seizure control can be noted in patients with long onset time to surgery, with negative cranial MRI results, or with irregular postoperative ASMs.

A Novel Retrograde AAV Variant for Functional Manipulation of Cortical Projection Neurons in Mice and Monkeys / 神经科学通报·英文版

Retrograde adeno-associated viruses (AAVs) are capable of infecting the axons of projection neurons and serve as a powerful tool for the anatomical and functional characterization of neural networks. However, few retrograde AAV capsids have been shown to offer access to cortical projection neurons across different species and enable the manipulation of neural function in non-human primates (NHPs). Here, we report the development of a novel retrograde AAV capsid, AAV-DJ8R, which efficiently labeled cortical projection neurons after local administration into the striatum of mice and macaques. In addition, intrastriatally injected AAV-DJ8R mediated opsin expression in the mouse motor cortex and induced robust behavioral alterations. Moreover, AAV-DJ8R markedly increased motor cortical neuron firing upon optogenetic light stimulation after viral delivery into the macaque putamen. These data demonstrate the usefulness of AAV-DJ8R as an efficient retrograde tracer for cortical projection neurons in rodents and NHPs and indicate its suitability for use in conducting functional interrogations.

BMP7 expression in mammalian cortical radial glial cells increases the length of the neurogenic period

The seat of human intelligence is the human cerebral cortex, which is responsible for our exceptional cognitive abilities. Identifying principles that lead to the development of the large-sized human cerebral cortex will shed light on what makes the human brain and species so special. The remarkable increase in the number of human cortical pyramidal neurons and the size of the human cerebral cortex is mainly because human cortical radial glial cells, primary neural stem cells in the cortex, generate cortical pyramidal neurons for more than 130 days, whereas the same process takes only about 7 days in mice. The molecular mechanisms underlying this difference are largely unknown. Here, we found that bone morphogenic protein 7 (BMP7) is expressed by increasing the number of cortical radial glial cells during mammalian evolution (mouse, ferret, monkey, and human). BMP7 expression in cortical radial glial cells promotes neurogenesis, inhibits gliogenesis, and thereby increases the length of the neurogenic period, whereas Sonic Hedgehog (SHH) signaling promotes cortical gliogenesis. We demonstrate that BMP7 signaling and SHH signaling mutually inhibit each other through regulation of GLI3 repressor formation. We propose that BMP7 drives the evolutionary expansion of the mammalian cortex by increasing the length of the neurogenic period.

Characteristics of brain cortical morphology in children with attention deficit hyperactivity disorder co-occurred with oppositional defiant disorder / 中国心理卫生杂志

Objective:To investigate the characteristics of cortical morphology in children with attention defi-cit hyperactivity disorder(ADHD)and those with oppositional defiant disorder(ODD)from both categorical and dimensional analyses.Methods:A total of 72 children were enrolled,including 16 children with ADHD and ODD,20 children with ADHD without ODD,and 36 age-gender-matched normal children.The diagnoses were made ac-cording to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)criteria.The Chi-nese Wechsler Intelligence Scale for Children(C-WISC)was used to access intelligence quotient.All subjects par-ticipated in the magnetic resonance imaging(MRI)scan.The features of cortical morphology were determined using FreeSurfer software.Results:Children with ADHD and ODD[(6 528.1±857.5)mm3 vs.(7 591.2±657.3)]and children with ADHD only[(6 867.2±41.3)mm3 vs.(7 591.2±657.3)mm3]had smaller volume in the left later-al superior temporal gyrus(P＜0.05)than controls.No difference was found between ADHD with ODD group and ADHD without ODD group.There was no correlation between the cortical volume of left lateral superior temporal gyrus and ODD symptoms.Conclusion:The reduced cortical volume of left lateral superior temporal gyrus may be an important indication of the abnormal brain structure of ADHD in children.And comorbid status of ODD dose not change this structural variation.

Inhibitory effect of lead on GABA A receptor-mediated currents and GABAergic synaptic transmission in rat cortical neurons / 中国药理学与毒理学杂志

OBJECTIVE To investigate the inhibitory effect and mechanism of lead(Pb2+)on γ-amino-butyric acid(GABA)A receptor-mediated currents(IGABA)and GABAergic synaptic transmission in rat cortical neurons.METHODS ①The cortical neurons from 0 d Sprague Dawley(SD)rats were cultured for experiments.The cultured cells(7-14 d)were recorded using the patch-clamp technique to analyze the effects of Pb2+ at different concentrations(1,5,10,50 and 100 μmol·L-1)on IGABA induced by GABA 100 μmol·L-1.② The effects of Pb2+ 50 μmol·L-1 on IGABA induced by GABA at different concentrations(1,10,50,100,500 and 100 μmol·L-1)were detected.③Brain slices(350 μm)were prepared from SD rats(15-19 d).The spontaneous inhibitory post-synaptic currents(sIPSCs),miniature inhibitory post-synaptic currents(mIPSCs)and current injection-induced action potential(AP)were recorded to detect the effects of Pb2+ 10 μmol·L-1 on the amplitude and frequency of sIPSCs and mIPSCs,and the frequency of AP.RESULTS ①Pb2+ inhibited IGABA in a concentration-dependent manner,and IC50 was(68±20)μmol·L-1.②Pb2+ also suppressed the maximum current induced by GABA(P<0.01),with a significant increase of the GABA′s EC50 from(20±6)μmol·L-1 to(87±39)μmol·L-1,indicating that Pb2+ might inhibit IGABA in a non-competitive mechanism.③Pb2+ 10 μmol·L-1 inhibited the frequency(P<0.01)rather than the ampli-tude of sIPSCs reversibly,but had no effect on eigher the frequency or amplitude of mIPSCs.In addi-tion,Pb2+ decreased the frequency of evoked AP by current injection(P<0.01)and reduced the overall excitability of rat cortical neurons.CONCLUSION Pb2+ can significantly inhibit IGABA in primary cultured neurons.In the brain slice experiment,Pb2+ may affect sIPSCs frequency by inhibiting the AP of cortical neurons,suggesting that there are different intrinsic mechanisms through which Pb2+ inhibits both IGABA in primary cultured neurons and the frequency of sIPSCs in brain slice neurons,which points to the complexity of the mechanism of Pb2+ poisoning.