Symptomatic nonstenotic carotid artery disease has been increasingly recognized as a thromboembolic source in patients who would otherwise be classified as having embolic stroke of undetermined ...source. Evidence suggests that certain plaque features seen on sonography, CT, and MR imaging in nonstenotic carotid artery disease may predispose to recurrent stroke in patients with embolic stroke of undetermined source. We performed a focused literature review to further study plaque features in the context of embolic stroke of undetermined source and to determine which plaque features may be associated with ipsilateral ischemic events in such patients. Plaque thickness as seen on both ultrasound and CT appears to have a consistent association with ipsilateral stroke in patients with embolic stroke of undetermined source across multiple studies. Intraplaque hemorrhage as seen on MR imaging is now understood to have a strong association with ipsilateral stroke in patients with embolic stroke of undetermined source. Continued study of various plaque features as seen on different modalities is warranted to uncover other potential associations.
Background:
Meniscal repair is commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective multicenter studies have ...evaluated the long-term success and patient-oriented outcomes after combined ACLR and meniscal repair.
Purpose:
To define the operative success and patient-oriented outcome scores 6 years after combined meniscal repair and ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
All ipsilateral primary ACLR and meniscal repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively and then 2 and 6 years after the index procedure. Subsequent ipsilateral knee reoperations were confirmed by operative reports to evaluate for the failure of meniscal repairs.
Results:
In total, 286 patients with 1440 primary ACLRs underwent concurrent meniscal repairs (298 meniscal repairs). Of these, 235 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral, and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral one third of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with a mean length of 16.5 ± 5.8 mm. Overall, the meniscal repair failure rate was 14% (medial: 21/154; lateral: 10/72; both: 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 vs 3.7 years, respectively; P = .01). Significant improvements in outcome scores were sustained at 6-year follow-up. No differences in the suture number or type were detected between repair failures and successes. The rate of meniscal reoperations was higher in patients who underwent repair compared with those who did not have an identified meniscal injury at the time of ACLR (P < .01.
Conclusion:
Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome scores were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscal repair.
•We model the importance placed on saving for retirement as a function of time preference.•Time preference is measured through a comparison of dollar values and a combination of intertemporal ...behaviors.•Time preference explains retirement saving intention among college students.•A factor score of intertemporal behaviors has more explanatory power than dollar comparisons.•Sensation seeking behaviors are less predictive than health-related behaviors.
This study models the importance respondents place on saving for retirement as a function of time preference using a sample of 6812 undergraduate and graduate students. Individual time preference is measured by comparing dollar values over time and through a combination of intertemporal behaviors that may be the most theoretically appropriate measurement of the discount rate for utility over time. Results show strong correlations among decision making domains that involve time discounting. Time preference measured by comparing dollar amounts across time proves a much weaker predictor than a combination of intertemporal behaviors measured either as a linear scale or as factors. In multivariate models, a factor of intertemporal preventive health behaviors is a stronger predictor of the importance of saving for retirement than all other explanatory variables including age, race, parental income, gender, GPA, and college major.
Lesions with the neurotoxin 6-hydroxydopamine (6-OHDA) have provided an important tool to study dopamine neurons in the brain. The most common version of such lesions is the unilateral one where the ...toxin is placed in the area of mesencephalic dopamine cell bodies or their ascending fibers. This approach leads to a lateralized destruction of mesencephalic dopamine neurons and to a lateralized loss of striatal dopamine innervation. Such lesions have contributed substantially to neuroscientific knowledge both, at the basic and clinical level. Physiologically, they have been used to clarify the neuroanatomy, neurochemistry, and electrophysiology of mesencephalic DA neurons and their relationships with the basal ganglia; the relevant findings have been summarized in a previous review (Schwarting, R.K.W. and Huston, J.P. (1996) Unilateral 6-hydroxydopamine lesions of meso-striatal dopamine neurons and their physiological sequelae,
Progress in Neurobiology
49, 215–266). Furthermore, 6-OHDA lesions have been used extensively to investigate the role of these dopamine neurons with respect to behavior, to examine the brain's capacity to recover from or compensate for specific neurochemical depletions, and to investigate the promotive effects of experimental and clinical approaches which are relevant for the treatment of Parkinson's disease. These findings are summarized here, including the spectrum of behavioral deficits (turning, sensory neglect, etc.), functional recovery and its possible mechanisms, the behavioral effects of widely used pharmacological challenges (amphetamines, apomorphine, selective receptor agonists,
l-DOPA), and the effects of treatments which can promote recovery (like neuropeptides, neurotrophins, and grafts).
To describe the protocol of a multi-vendor, multi-site quantitative MRI study for knee post-traumatic osteoarthritis (PTOA), and to present preliminary results of cartilage degeneration using MR T1ρ ...and T2 imaging 10 years after anterior cruciate ligament reconstruction (ACLR).
This study involves three sites and two MR platforms. The patients are from a nested cohort (termed as Onsite cohort) within the Multicenter Orthopaedic Outcomes Network (MOON) cohort 10 years after ACLR. Phantoms and controls were scanned for evaluating reproducibility. Cartilage was automatically segmented, and T1ρ and T2 were compared between operated, contralateral, and control knees.
Sixty-eight ACL-reconstructed patients and 20 healthy controls were included. In phantoms, the intra-site coefficients of variation (CVs) of repeated scans ranged 1.8–2.1% for T1ρ and 1.3–1.7% for T2. The inter-site CVs ranged 1.6–2.1% for T1ρ and 1.1–1.4% for T2. In human subjects, the intra-site scan/rescan CVs ranged 2.2–3.5% for T1ρ and 2.6–4.9% for T2 for the six major compartments. In patients, operated knees showed significantly higher T1ρ and T2 values mainly in medial femoral condyle, medial tibia and trochlear cartilage compared with contralateral knees, and showed significantly higer T1ρ and T2 values in all six compartments compared to healthy control knees. The patient contralateral knees showed higher T1ρ and T2 values mainly in the lateral femoral condyle, lateral tibia, trochlear, and patellar cartilage compared to healthy control knees.
A platform and workflow with rigorous quality control has been established for a multi-vendor multi-site quantitative MRI study in evaluating PTOA 10 years after ACLR. Our preliminary report suggests significant cartilage matrix changes in both operated and contralateral knees compared with healthy control knees.
Abstract The present study aims to evaluate the applicability of the grid-walking test in rats with moderate or severe dopamine-depletion incurred by unilateral nigro-striatal 6-hydroxydopamine ...(6-OHDA) lesions. Striatum samples were analyzed by high pressure liquid chromatography coupled to electrochemical detection (HPLC-EC) after behavioral testing. In Experiment 1, 2 weeks after the injection of 6-OHDA into the medial forebrain bundle, adult Wistar rats were divided into an l -3,4-dihydroxyphenylalanine ( l -dopa) and a vehicle treatment group and their behaviors on the grid were compared. The severely lesioned animals (mean dopamine depletion of 92%) did not exhibit behavioral asymmetry in the number of contralateral foot-slips. However, l -dopa administration selectively reduced the number of foot-slips of the contralateral forelimb when compared with the vehicle group. In Experiment 2, 6-OHDA was injected into the dorsal striatum and foot-slips on the grid were analyzed 4, 9 and 13 days following the lesion. The rats with moderate dopamine-depletion (mean depletion of 54%) exhibited more contralateral forelimb-slips on all testing days. Compared with naive rats, hemiparkinsonian rats also showed more forelimb-slips. These results suggest that the grid-walking test should be a powerful and sensitive behavioral assay for sensory-motor deficits in rat models of nigro-striatal dopamine lesions.
Highlights ► Extinction of cued food reward increases the distance from the source of reward. ► Chronic treatment with two antidepressants attenuates withdrawal during extinction. ► Extinction ...significantly influences biting behavior, goal- and sign-tracking. ► Withholding of cued reward is a paradigm to model extinction-induced depression.
Esophagectomy is associated with substantial morbidity. Robotic surgery allows complex resections to be performed with potential benefits over conventional techniques. We applied this technology to ...transthoracic esophagectomy to assess safety, feasibility, and reliability of this technology. A retrospective cohort study of all patients undergoing robotic-assisted Ivor-Lewis esophagectomy (RAIL) from 2009 to 2014 was conducted. Clinicopathologic factors and surgical outcomes were recorded and compared. All statistical tests were two-sided and a P-value of <0.05 was considered statistically significant. We identified 147 patients with an average age 66 ± 10 years. Neoadjuvant therapy was administered to 114 (77.6%) patients, and all patients underwent a R0 resection. The mean operating room (OR) time was 415 ± 84.6 minutes with a median estimated blood loss (EBL) of 150 (25-600) mL. Mean intensive care unit (ICU) stay was 2.00 ± 4.5 days, median length of hospitalization (LOH) was 9 (4-38) days, and readmissions within 90 days were low at 8 (5.5%). OR time decreased from 471 minutes to 389 minutes after 20 cases and a further decrease to mean of 346 minutes was observed after 120 cases. Complications occurred in 37 patients (25.2%). There were 4 anastomotic (2.7%) leaks. Thirty and 90-day mortality was 0.68% and 1.4%, respectively. This represents to our knowledge the largest series of robotic esophagectomies. RAIL is a safe surgical technique that provides an alternative to standard minimally invasive and open techniques. In our series, there was no increased risk of LOH, complications, or death and re-admission rates were low despite earlier discharge.
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