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NOABSTRACTDistal femur fractures have high risk of delayed union and poor functional results. The traditional lateral locking plate fixation can lead to non-union. Biological and mechanical augmentation is needed in some cases.The aim of our study is to present our experience with double plate fixation, to clarify when it is necessary, which is the optimal plates configuration and the ideal surgical approach.Twelve distal femoral fractures (AO types C2 and C3) stabilized with dual plates for a period of 6 years (2017-2023). Nine female patients, three male, average age 57 years. Eight high energy fractures (traffic accidents, falls from height), four low energy fractures. Two open fractures – Gustilio-Anderson type 2. One extensile anterolateral approach used in six cases. Six fractures treated through a combination of a lateral and a mini invasive medial approaches. Clinical and functional recovery assessed according to the criteria of the Knee Society Clinical Rating System (KSCRS).All fractures healed for a medium period of 4,5 months. Three of the functional results were graded as excellent, 6 as good, 2 as average and one as poor. The X-ray results were rated as excellent in nine fractures and good in three. There were 2 delayed healings. Distal medial screw loosening was reported in 5 cases. Flexion contracture was reported in four cases.The advantages of medial plate augmentation outweigh the risks and is indicated in certain complex distal femur fractures.

Recovery of mimic function after facial nerve transection is poor. The successful regrowth of regenerating motor nerve fibers to reinnervate their targets is compromised by (i) poor axonal navigation and excessive collateral branching, (ii) abnormal exchange of nerve impulses between adjacent regrowing axons, namely axonal crosstalk, and (iii) insufficient synaptic input to the axotomized facial motoneurons. As a result, axotomized motoneurons become hyperexcitable but unable to discharge. We review our findings, which have addressed the poor return of mimic function after facial nerve injuries, by testing the hypothesized detrimental component, and we propose that intensifying the trigeminal sensory input to axotomized and electrophysiologically silent facial motoneurons improves the specificity of the reinnervation of appropriate targets. We compared behavioral, functional, and morphological parameters after single reconstructive surgery of the facial nerve (or its buccal branch) with those obtained after identical facial nerve surgery, but combined with direct or indirect stimulation of the ipsilateral infraorbital nerve. We found that both methods of trigeminal sensory stimulation, i.e., stimulation of the vibrissal hairs and manual stimulation of the whisker pad, were beneficial for the outcome through improvement of the quality of target reinnervation and recovery of vibrissal motor performance.

Over the last decade, laser surface treatment of stones has gained increasing scientific interest. New technologies and processes based on different types of laser sources and processing modes are being studied. This report examines the process of laser ablation of a marble surface using a fiber laser. Three factors influencing the process of laser marking and engraving were studied: laser power, processing speed and step between raster lines. The functional dependencies between these factors and the contrast of the obtained graphic image are established. The optimal operating intervals for this group of technological parameters are analyzed. Thanks to the very-high-definition laser ablation, inscriptions, drawings and images can be re-created and processed with unique accuracy. In addition, the reduction of manufacturing time and resources used in the process makes this technology an environmentally-friendly and extremely cost-efficient solution.

Both olfactory ensheathing cells (OECs) and Schwann cells have been shown to promote axonal regrowth and remyelination in the central (CNS) and peripheral nervous systems under experimental conditions. During development, OECs and Schwann cells emerge from the olfactory placode and the neural crest, respectively, thus sharing a common \"peripheral\" origin. Both cell types are known to express a number of different molecular markers in common, to display a similar morphological phenotype in culture and to respond to the same growth-promoting molecules. Contrary to Schwann cells, OECs are found in association with neuronal processes in the CNS constituting the olfactory nerve layer of the olfactory bulb. OECs maintain their growth-promoting capacity in the CNS during adult life supporting the lifelong axonal growth of olfactory receptor neurons. Thus, OECs are considered an intermediate cell type combining a \"central\" location with \"peripheral\" permissiveness. Recently, the regenerative potential of OECs has been demonstrated in a variety of studies. However, OECs are still less clearly defined than Schwann cells. On designing future therapeutical strategies for nerve injury and disease, the important question arises as to whether OECs and Schwann cells are comparable cell types or whether they, indeed, mediate specific effects, making either the one or the other suitable for special applications. The present review summarizes recent data on the in vitro and in vivo properties of OECs and critically compares the analogies and differences in the biology of both cell types relevant in the above-mentioned context.

This work makes use of the finite element model, whose results are validated by experiments. The effect is discussed of the speed on the laser marking process. Numerical experiments are performed to determine the temperature fields produced by laser pulses on samples of aluminum, a material with wide industrial uses. The numerical calculations are performed for the cases of a fiber laser and a CuBr laser. Plots are drawn of the temperature dependence on the speed for two power densities for both lasers. Preliminary working speed intervals are determined for the power densities used.

Therapeutic vaccination with Copaxone (glatiramer acetate, Cop-1) protects motor neurons against acute and chronic degenerative conditions. In acute degeneration after facial nerve axotomy, the number of surviving motor neurons was almost two times higher in Cop-1-vaccinated mice than in nonvaccinated mice, or in mice injected with PBS emulsified in complete Freund's adjuvant (P < 0.05). In mice that express the mutant human gene Cu/Zn superoxide dismutase G93A (SOD1), and therefore simulate the chronic human motor neuron disease amyotrophic lateral sclerosis, Cop-1 vaccination prolonged life span compared to untreated matched controls, from 211 ± 7 days (n = 15) to 263 ± 8 days (n = 14; P < 0.0001). Our studies show that vaccination significantly improved motor activity. In line with the experimentally based concept of protective autoimmunity, these findings suggest that Cop-1 vaccination boosts the local immune response needed to combat destructive self-compounds associated with motor neuron death. Its differential action in CNS autoimmune diseases and neurodegenerative disorders, depending on the regimen used, allows its use as a therapy for either condition. Daily administration of Cop-1 is an approved treatment for multiple sclerosis. The protocol for non-autoimmune neurodegenerative diseases such as amyotrophic lateral sclerosis, remains to be established by future studies.

Objective:To provide insight into the clinical failure of the tumour necrosis factor α (TNFα) inhibitor, etanercept, in primary Sjögren syndrome (pSS), an extensive analysis of the systemic immune profile of patients with pSS was carried out and the effect of etanercept treatment on these immune parameters monitored.Methods:Peripheral blood mononuclear cells of patients with pSS and healthy controls were compared by flow cytometry to determine differences in distribution of specific cell populations (T cells, B cells, monocytes), and to determine their expression of activation markers (CD25, HLA-DR), TNF receptors and chemokine receptors (CXCR1, 2) before and after treatment. Systemic cytokine levels were measured by multiplex ELISA assay in plasma and in lipopolysaccharide-stimulated whole blood from healthy controls and from patients with pSS before and after etanercept treatment. Baseline cytokine levels were correlated with clinical markers of disease.Results:Before treatment, salivary gland inflammatory focus scores did not correlate with circulating TNF levels. Furthermore, consistent with the lack of evidence of significant clinical benefit, enhanced markers of immune activation, frequency of cell subpopulations and aberrant cytokine profiles were not restored to normal levels by etanercept treatment. Remarkably, the levels of circulating TNFα were significantly increased after treatment.Conclusion:Etanercept is an ineffective therapeutic agent in pSS consistent with the absence of suppression of TNFα and other indicators of immune activation in this patient population. These data suggest that TNFα may not be a pivotal cytokine in the pathogenesis of pSS, impelling continued molecular characterisation of disease parameters to define appropriate intervention targets.

Thoracic aortic aneurysms (TAAs) that progress to acute thoracic aortic dissections (TADs) are life-threatening vascular events that have been associated with altered transforming growth factor (TGF) β signaling. In addition to TAA, multiple genetic vascular disorders, including hereditary hemorrhagic telangiectasia (HHT), involve altered TGFβ signaling and vascular malformations. Due to the importance of TGFβ, genomic variant databases have been curated for activin receptor-like kinase 1 (ALK1) and endoglin (ENG). This case report details seven variants in SMAD4 that are associated with either heritable or early-onset aortic dissections and compares them to pathogenic exon variants in gnomAD v2.1.1. The TAA and TAD variants were identified through whole exome sequencing of 346 families with unrelated heritable thoracic aortic disease (HTAD) and 355 individuals with early-onset (age ≤ 56 years old) thoracic aortic dissection (ESTAD). An allele frequency filter of less than 0.05% was applied in the Genome Aggregation Database (gnomAD exome v2.1.1) with a combined annotation-dependent depletion score (CADD) greater than 20. These seven variants also have a higher REVEL score (>0.2), indicating pathogenic potential. Further in vivo and in vitro analysis is needed to evaluate how these variants affect SMAD4 mRNA stability and protein activity in association with thoracic aortic disease.

Recession of the mandibular central incisors is frequently associated with high frenum insertion. Often times, this recession is accompanied by a lack of sufficient amount of keratinized tissue and absence of attached gingiva. In this case report, an ASA I patient presented with Cairo Recession Type 2 (RT2) and a minimal amount of keratinized tissue on the mandibular central incisors and underwent frenuloplasty in the anterior mandible with the use of a conventional scalpel technique due to high frenum attachment. The results demonstrated creeping attachment of 1.0 mm as early as 10 days postoperatively resulting in complete root coverage and closure of the interproximal space between teeth #24 and 25. A second soft tissue surgery was avoided due to complete root coverage which remained stable at the 6-month follow-up appointment.