Thalamo-hippocampal pathway regulates incidental memory capacity in mice.

Incidental memory can be challenged by increasing either the retention delay or the memory load. The dorsal hippocampus (dHP) appears to help with both consolidation from short-term (STM) to long-term memory (LTM), and higher memory loads, but the mechanism is not fully understood. Here we find that female mice, despite having the same STM capacity of 6 objects and higher resistance to distraction in our different object recognition task (DOT), when tested over 1 h or 24 h delays appear to transfer to LTM only 4 objects, whereas male mice have an STM capacity of 6 objects in this task. In male mice the dHP shows greater activation (as measured by c-Fos expression), whereas female mice show greater activation of the ventral midline thalamus (VMT). Optogenetic inhibition of the VMT-dHP pathway during off-line memory consolidation enables 6-object LTM retention in females, while chemogenetic VMT-activation impairs it in males. Thus, removing or enhancing sub-cortical inhibitory control over the hippocampus leads to differences in incidental memory.

Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Adverse Events and Outcome in a Series of Patients with Long-Term Follow-Up.

BACKGROUND: Vagal nerve stimulation (VNS) is a palliative treatment option for drug-resistant epilepsy. The aim of this study was to describe the clinical and demographic features of selected patients scheduled for VNS and to evaluate the long-term efficacy of VNS in seizure control. MATERIALS AND METHODS: Between 2006 and 2013, 32 consecutive epileptic patients (14 male and 18 female) were enrolled at our Institute for VNS implantation. In all cases resective surgery had previously been excluded by the use of a noninvasive presurgical study protocol. Mean age was 32 years (range 18-50), and mean epilepsy duration 23 years (range 11-39). All subjects were followed-up for at least 2 years (mean 6 years, range 2-9) after VNS implantation. Patients were considered responders when a reduction of seizures of more than 50 % was reported. RESULTS: All patients had complex partial seizures, in 81 % of the patients with secondary generalization and in 56 % with drop attacks. Neurological examination revealed focal deficits in 19 % of the patients. Brain magnetic resonance imaging (MRI) was positive in 47 % of the patients. No surgical complications were observed in this series. Three patients were lost to follow-up. Twelve patients were classified as responders. Among the others, 1 patient experienced side effects (snoring and groaning during sleep) and the device was removed. CONCLUSIONS: Our data confirm that VNS is a safe procedure and a valid palliative treatment option for drug-resistant epileptic patients not suitable for resective surgery.

Retrograde intramedullary osteosynthesis of femoral fracture: preliminary results of Maggiore Hospital.

The Distal Femoral Nail (DFN), Mathys Medical Ltd. Switzerland) was used in our division for the treatment of fractures of the distal metaepiphysis, and in some cases of the diaphysis, of the femur. A total of 16 cases treated over 30 months, between October 2000 and March 2003 (minimum 6, maximum 61 months), were analyzed retrospectively. A total of 11 metaepiphyseal fractures (65%) and 6 diaphyseal fractures (35%) were treated. Consolidation of the fracture was observed in 15 cases out of 16 (equal to 93.8%) with a mean time of 140 days (minimum 120 days, maximum 240 days) after surgery. Mean flexion of the knee equal to 90 degrees and 3 cases of stiffness with lower mobility at 45 degrees were observed: in 2 cases stiffness was of extra-articular origin caused by exuberant bone callus. There were no iatrogenic complications of the vascular type, nor were there infections, or cases of implant loosening. Shortening (1 cm) in a type B2 fracture (based on the AO classification) was observed. The results we obtained suggest that DFN represents a valid alternative to the open treatment of fractures of the distal metaphysis of the femur; in cases of patients with multiple trauma or in elderly patients where invasiveness is reduced, importance is awarded to less blood loss, a shorter amount of time required for surgery, and early mobilization and weight-bearing.

External fixation and sequential nailing in the treatment of open diaphyseal fractures of the tibia.

Between September 1996 and April 1998 a total of 26 open fractures of the tibia (Gustilo Anderson grade I in 4 cases, grade II in 3, grade IIIA in 8, grade IIIB in 11) were treated by debridement and monoaxial external fixation followed by locked intramedullary nailing after healing of the soft tissues had been observed. Nailing by reamed Grosse Kempf nail was carried out in all of the cases. The mean duration of external fixation was 50 days (with a minimum of 18 days and a maximum of 6 months). Upon removal of the external fixator intramedullary osteosynthesis was performed during the same surgical session in 25 cases. Nailing was carried out 45 days after removal of the external fixator in 1 case. Healing was obtained in all of the patients an average of 6 months after trauma, and 3 and 1/2 months after the second operation. There were two cases of infection, one deep (3.8%) and the other superficial (3.8%). No cases of chronic osteomyelitis were ever observed. Poor consolidation with valgus equal to 10 degrees and 15 degrees was observed in 2 patients. This method of treatment, based on our experience, allows for healing in some open fractures of the tibia in a relatively short amount of time and with an acceptable risk of complications.

Fracture of the posterior arch of the atlas.

The authors analyzed the results obtained in 10 fractures of the posterior arch of the atlas treated nonsurgically. There was consolidation in all of the cases at the end of treatment. According to the authors the element which most characterizes this fracture is constituted by its radiological diagnosis which principally makes use of lateral projection. In particular cases, when patients are characterized by multiple trauma, the fracture may go unrecognized.

[Osteotomy in the prosthetic substitution of severe axial deviation of the knee]. / Le resezioni ossee nella sostituzione protesica delle gravi deviazioni assiali del ginocchio.

Arthroplasty can be a successful treatment for arthritis even in cases of severe axial deviation of the knee. Since significant bone loss is often present in these cases, the technique and extent of the resection is very important. In this paper we review our series and compare it with solutions proposed by other authors, focusing our attention on the techniques of resection and replacement of lost bone employed in order to achieve optimal axial alignment and anchoring of the prosthetic components.