Evaluation of Outcome after Total Hip Arthroplasty for Femoral Neck Fracture: Which Factors Are Relevant for Better Results?

Background: Femoral neck fractures (FNFs) are frequent orthopedic injuries in elderly patients. Despite improvements in clinical monitoring and advances in surgical procedures, 1-year mortality remains between 15% and 30%. The aim of this study is to identify variables that lead to better outcomes in patients treated with total hip arthroplasty (THA) for FNFs. Methods: All patients who underwent cementless THA for FNF from January 2018 to December 2022 were identified. Patients aged more than 80 years old and with other post-traumatic lesions were excluded. Patient data and demographic characteristics were collected. The following data were also registered: time trauma/surgery, surgical approach, operative time, intraoperative complications, surgeon arthroplasty-trained or not, and anesthesia type. In order to search for any predictive factors of better short- and long-term outcomes, we performed different logistic regression analyses. Results: A total of 92 patients were included. From multivariable logistic regression models, we derived that a direct anterior surgical approach and an American Society of Anesthesiologists (ASA) classification < 3 can predict improved short-term outcomes. Moreover, THAs performed by surgeons with specific training in arthroplasty have a lower probability of revision at 1 year. Mortality at 1 year was ultimately influenced by the ASA classification. Conclusions: A direct anterior approach and specific arthroplasty training of the surgeon appear to be able to improve the short- and long-term follow-up of THA after FNF.

Neurons in the monkey frontopolar cortex encode learning stage and goal during a fast learning task.

The frontopolar cortex (FPC) is, to date, one of the least understood regions of the prefrontal cortex. The current understanding of its function suggests that it plays a role in the control of exploratory behaviors by coordinating the activities of other prefrontal cortex areas involved in decision-making and exploiting actions based on their outcomes. Based on this hypothesis, FPC would drive fast-learning processes through a valuation of the different alternatives. In our study, we used a modified version of a well-known paradigm, the object-in-place (OIP) task, to test this hypothesis in electrophysiology. This paradigm is designed to maximize learning, enabling monkeys to learn in one trial, which is an ability specifically impaired after a lesion of the FPC. We showed that FPC neurons presented an extremely specific pattern of activity by representing the learning stage, exploration versus exploitation, and the goal of the action. However, our results do not support the hypothesis that neurons in the frontal pole compute an evaluation of different alternatives. Indeed, the position of the chosen target was strongly encoded at its acquisition, but the position of the unchosen target was not. Once learned, this representation was also found at the problem presentation, suggesting a monitoring activity of the synthetic goal preceding its acquisition. Our results highlight important features of FPC neurons in fast-learning processes without confirming their role in the disengagement of cognitive control from the current goals.

Connecting the dots in the zona incerta: A study of neural assemblies and motifs of inter-area coordination in mice.

The zona incerta (ZI), a subthalamic area connected to numerous brain regions, has raised clinical interest because its stimulation alleviates the motor symptoms of Parkinson's disease. To explore its coordinative nature, we studied the assembly formation in a dataset of neural recordings in mice and quantified the degree of functional coordination of ZI with other 24 brain areas. We found that the ZI is a highly integrative area. The analysis in terms of "loop-like" motifs, directional assemblies composed of three neurons spanning two areas, has revealed reciprocal functional interactions with reentrant signals that, in most cases, start and end with the activation of ZI units. In support of its proposed integrative role, we found that almost one-third of the ZI's neurons formed assemblies with more than half of the other recorded areas and that loop-like assemblies may stand out as hyper-integrative motifs compared to other types of activation patterns.

Disentangling the identity of the zona incerta: a review of the known connections and latest implications.

The zona incerta (ZI) is a subthalamic region composed by loosely packed neurochemically mixed neurons, juxtaposed to the main ascending and descending bundles. The extreme neurochemical diversity that characterizes this area, together with the diffuseness of its connections with the entire neuraxis and its hard-to-reach positioning in the brain caused the ZI to keep its halo of mystery for over a century. However, in the last decades, a rich albeit fragmentary body of knowledge regarding both the incertal anatomical connections and functional implications has been built mostly based on rodent studies and its lack of cohesion makes difficult to depict an integrated, exhaustive picture regarding the ZI and its roles. This review aims to provide a unified resource that summarizes the current knowledge regarding the anatomical profile of interactions of the ZI in rodents and non-human primates and the functional significance of its connections, highlighting the aspects still unbeknown to research.

Static and dynamic coding in distinct cell types during associative learning in the prefrontal cortex.

The prefrontal cortex maintains information in memory through static or dynamic population codes depending on task demands, but whether the population coding schemes used are learning-dependent and differ between cell types is currently unknown. We investigate the population coding properties and temporal stability of neurons recorded from male macaques in two mapping tasks during and after stimulus-response associative learning, and then we use a Strategy task with the same stimuli and responses as control. We identify a heterogeneous population coding for stimuli, responses, and novel associations: static for putative pyramidal cells and dynamic for putative interneurons that show the strongest selectivity for all the variables. The population coding of learned associations shows overall the highest stability driven by cell types, with interneurons changing from dynamic to static coding after successful learning. The results support that prefrontal microcircuitry expresses mixed population coding governed by cell types and changes its stability during associative learning.

Experimental certification of contextuality, coherence, and dimension in a programmable universal photonic processor.

Quantum superposition of high-dimensional states enables both computational speed-up and security in cryptographic protocols. However, the exponential complexity of tomographic processes makes certification of these properties a challenging task. In this work, we experimentally certify coherence witnesses tailored for quantum systems of increasing dimension using pairwise overlap measurements enabled by a six-mode universal photonic processor fabricated with a femtosecond laser writing technology. In particular, we show the effectiveness of the proposed coherence and dimension witnesses for qudits of dimensions up to 5. We also demonstrate advantage in a quantum interrogation task and show it is fueled by quantum contextuality. Our experimental results testify to the efficiency of this approach for the certification of quantum properties in programmable integrated photonic platforms.

Timing measurements with silicon single photon avalanche diodes: principles and perspectives [Invited].

Picosecond timing of single photons has laid the foundation of a great variety of applications, from life sciences to quantum communication, thanks to the combination of ultimate sensitivity with a bandwidth that cannot be reached by analog recording techniques. Nowadays, more and more applications could still be enabled or advanced by progress in the available instrumentation, resulting in a steadily increasing research interest in this field. In this scenario, single-photon avalanche diodes (SPADs) have gained a key position, thanks to the remarkable precision they are able to provide, along with other key advantages like ruggedness, compactness, large signal amplitude, and room temperature operation, which neatly distinguish them from other solutions like superconducting nanowire single-photon detectors and silicon photomultipliers. With this work, we aim at filling a gap in the literature by providing a thorough discussion of the main design rules and tradeoffs for silicon SPADs and the electronics employed along them to achieve high timing precision. In the end, we conclude with our outlook on the future by summarizing new routes that could benefit from present and prospective timing features of silicon SPADs.

Structured-light-sheet imaging in an integrated optofluidic platform.

Heterogeneity investigation at the single-cell level reveals morphological and phenotypic characteristics in cell populations. In clinical research, heterogeneity has important implications in the correct detection and interpretation of prognostic markers and in the analysis of patient-derived material. Among single-cell analysis, imaging flow cytometry allows combining information retrieved by single cell images with the throughput of fluidic platforms. Nevertheless, these techniques might fail in a comprehensive heterogeneity evaluation because of limited image resolution and bidimensional analysis. Light sheet fluorescence microscopy opened new ways to study in 3D the complexity of cellular functionality in samples ranging from single-cells to micro-tissues, with remarkably fast acquisition and low photo-toxicity. In addition, structured illumination microscopy has been applied to single-cell studies enhancing the resolution of imaging beyond the conventional diffraction limit. The combination of these techniques in a microfluidic environment, which permits automatic sample delivery and translation, would allow exhaustive investigation of cellular heterogeneity with high throughput image acquisition at high resolution. Here we propose an integrated optofluidic platform capable of performing structured light sheet imaging flow cytometry (SLS-IFC). The system encompasses a multicolor directional coupler equipped with a thermo-optic phase shifter, cylindrical lenses and a microfluidic network to generate and shift a patterned light sheet within a microchannel. The absence of moving parts allows a stable alignment and an automated fluorescence signal acquisition during the sample flow. The platform enables 3D imaging of an entire cell in about 1 s with a resolution enhancement capable of revealing sub-cellular features and sub-diffraction limit details.

The transitive inference task to study the neuronal correlates of memory-driven decision making: A monkey neurophysiology perspective.

A vast amount of literature agrees that rank-ordered information as A>B>C>D>E>F is mentally represented in spatially organized schemas after learning. This organization significantly influences the process of decision-making, using the acquired premises, i.e. deciding if B is higher than D is equivalent to comparing their position in this space. The implementation of non-verbal versions of the transitive inference task has provided the basis for ascertaining that different animal species explore a mental space when deciding among hierarchically organized memories. In the present work, we reviewed several studies of transitive inference that highlighted this ability in animals and, consequently, the animal models developed to study the underlying cognitive processes and the main neural structures supporting this ability. Further, we present the literature investigating which are the underlying neuronal mechanisms. Then we discuss how non-human primates represent an excellent model for future studies, providing ideal resources for better understanding the neuronal correlates of decision-making through transitive inference tasks.

Proximal fibular stress fracture in adolecent soccer player. A case report.

Fibular fractures are the third most common stress fractures in children and adolescents. Proximal fibular location is a very rare finding, with few reports in the literature and, frequently, careful investigations before a definitive diagnosis could be necessary. The authors report a case of an adolescent 13 years old soccer player with a proximal fibular fracture that was initially underestimated and misdiagnosed and ultimately confirmed as a stress lesion by MRI.

Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review.

PURPOSE: Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. METHODS: A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. RESULTS: The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. CONCLUSION: Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. LEVEL OF EVIDENCE: III (systematic review of level III-IV-V studies).

Hallux rigidus: current concepts review and treatment algorithm with special focus on interposition arthroplasty.

BACKGROUND AND AIM OF THE WORK: Hallux rigidus represents a surgical challenge, with a multitude of possible surgical options, but with no ideal procedures.  The propose of this paper was to review the actual knowledge on the operative techniques, paying particular attention to the evolution of interposition arthroplasties, as an alternative to arthrodesis and prosthesis in the advanced stages of the disease. METHODS: A comprehensive literature PubMed search was performed, and the actual literature regarding hallux rigidus was overviewed. The operative and nonoperative options for HR were described. Studies on interposition arthroplasty were classified by publication year, summarizing the operative technique, results and complications. RESULTS: Among the various techniques for interposition arthroplasty, the Modified Oblique Keller Interposition Arthtoplasty (MOKCIA) showed the lower complication rate. It does not sacrifice the insertion of the flexor halluces brevis, maintaining the stability, length and strength of the big toe. CONCLUSIONS: Although long-term randomized controlled trials are lacking for interposition arthroplasties, the reported results are comparable to the other alternatives for the treatment of end-stage hallux rigidus, making this technique a valid alternative also in the young active patient, without precluding other end-stage procedures in case of failure. Based on the current knowledge, a treatment algorithm was developed, according to the Coughlin classification.

Integrated optical device for Structured Illumination Microscopy.

Structured Illumination Microscopy (SIM) is a key technology for high resolution and super-resolution imaging of biological cells and molecules. The spread of portable and easy-to-align SIM systems requires the development of novel methods to generate a light pattern and to shift it across the field of view of the microscope. Here we show a miniaturized chip that incorporates optical waveguides, splitters, and phase shifters, to generate a 2D structured illumination pattern suitable for SIM microscopy. The chip creates three point-sources, coherent and controlled in phase, without the need for further alignment. Placed in the pupil of a microscope's objective, the three sources generate a hexagonal illumination pattern on the sample, which is spatially translated thanks to thermal phase shifters. We validate and use the chip, upgrading a commercial inverted fluorescence microscope to a SIM setup and we image biological sample slides, extending the resolution of the microscope.

Social monitoring of actions in the macaque frontopolar cortex.

The frontopolar cortex (FPC) of primates appeared as a main innovation in the evolution of anthropoid primates and it has been placed at the top of the prefrontal hierarchy. The only study to date that investigated the activity of FPC neurons in monkeys performing a cognitive task suggested that these cells were involved in the monitoring of self-generated actions. We recorded the activity of neurons in the FPCs of two rhesus monkeys while they performed a social variant of a nonmatch-to-goal task that required monitoring the actions of a human or computer agent. We discovered that the role of FPC neurons extends beyond self-generated actions to include monitoring others' actions. Their monitoring activity was very specific. First, neurons in the FPC encoded the spatial position of the target but not its object features. Second, a dedicated representation of the human agent actions was tied to the time of target acquisition, while it was reduced or absent in the successive epochs of the trial. Finally, this other-specific neural substrate did not emerge during the interaction with a virtual agent such as the computer. These results provide a new perspective on the functions of a uniquely primate brain area, suggesting that FPC might play an important role in social behaviors.

Toward Higher Integration Density in Femtosecond-Laser-Written Programmable Photonic Circuits.

Programmability in femtosecond-laser-written integrated circuits is commonly achieved with the implementation of thermal phase shifters. Recent work has shown how such phase shifters display significantly reduced power dissipation and thermal crosstalk with the implementation of thermal isolation structures. However, the aforementioned phase shifter technology is based on a single gold film, which poses severe limitations on integration density and circuit complexity due to intrinsic geometrical constraints. To increase the compactness, we propose two improvements to this technology. Firstly, we fabricated thermal phase shifters with a photolithography process based on two different metal films, namely (1) chromium for microheaters and (2) copper for contact pads and interconnections. Secondly, we developed a novel curved isolation trench design that, along with a state-of-the-art curvature radius, allows for a significant reduction in the optical length of integrated circuits. As a result, curved Cr-Cu phase shifters provide a compact footprint with low parasitic series resistance and no significant increase in power dissipation (∼38 mW) and thermal crosstalk (∼20%). These results pave the way toward the fabrication of femtosecond-laser-written photonic circuits with a steep increase in terms of layout complexity.

Metacarpophalangeal joint hyperextension in rhizartrosis: is surgical correction necessary?

BACKGROUND AND AIM: Rhizarthrosis represents 10% of all arthritic manifestations and its prevalence increases with age and in women. The hyperextension of the metacarpophalangeal joint (MCPj) is consequent to a progressive dorsoradial subluxation of the trapeziometacarpal joint (TMj) in advanced osteoarthritis. The aim of this retrospective study is to evaluate the clinical and functional results of 32 patients affected by advanced rhizarthrosis who underwent to modified Burton-Pellegrini's trapeziectomy in absence of surgical correction of MCPj hyperextension in order to understand when this last step is really necessary. METHODS: Patients were assessed trough DASH and PRWHE questionnaires; the functionality of the hand was assessed by carrying out specific test (grip strength, key-pinch, kapandji test, reduction of wrist flexion strength) and the degree of MCP joint hyperextension was recorded. RESULTS: Clinical evaluation and individual satisfactory were positive in most cases (mean DASH 19 and mean PRWHE 21.8, with a reduction of 77% of VAS pain score). Kapandji test was excellent in 26 patients and grip strength and key pinch were stackable in operated and non-operated hands. Twenty-five out 32 patients presented a MCP joint hyperextension between 0° and 5°, 5 of 10° and other 2 of 15°. CONCLUSION: Modified Burton-Pellegrini's trapeziectomy is a valid option to treat patient with TMj osteoarthritis. The absence of surgical correction of the MCPj does not affect clinical and functional results in deformities <15°.

Dair approach in 7 infected total hip arthroplasties: our experience and current concepts of the literature.

INTRODUCTION: Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty. In early infection, within four to twelve weeks from surgery, debridement, antibiotics and implant retention (DAIR) can be the initial treatment. The aim of this study is to report our case series and review current concepts reported in the literature about this topic. MATERIALS AND METHODS: This was an observational cohort study that included 7 patients managed with DAIR for PJI following primary total hip replacement (THR) between 2014 and 2020. Inclusion criteria were a primary THR, direct anterior or lateral approach, DAIR procedure, and PJI. Exclusion criteria were a PJI following a revision total hip replacement or hemiarthroplasty, posterolateral approach, 1-stage revision, 2-stage revision, and Girdlestone procedure without prior DAIR. For each patient demographic characteristics, laboratory values, microorganisms involved, antibiotic therapy and outcome at one-year follow-up were registered. RESULTS: The mean duration between THR and DAIR was 19 days. In all cases only one DAIR procedure was performed. Most infections were caused by Staphylococcus aureus (4 cases) [one methicillin resistant (MRSA)]. The other infections were caused by Streptococcus agalactiae, Staphylococcus coagulase negative and Escherichia coli. At the final follow-up, the procedure was considered as successful in 6 out of 7 patients (85%). The one with unsuccessful outcome underwent to a two-stage revision. DISCUSSION: Our results were comparable with those of a recent systematic review of the literature. Factors that have been postulated to influence the outcome of DAIR in the management of PJIs include the timing and numbers of debridement, the exchange of components, the responsible microorganism and the duration of antibiotic treatment. In conclusion, the outcomes following DAIR are better as the indications are refined and risk factors identified. PJI prevention remains the key but the current literature still lacks well documented and effective PJI prevention protocols. (www.actabiomedica.it).

Deep learning to enable color vision in the dark.

Humans perceive light in the visible spectrum (400-700 nm). Some night vision systems use infrared light that is not perceptible to humans and the images rendered are transposed to a digital display presenting a monochromatic image in the visible spectrum. We sought to develop an imaging algorithm powered by optimized deep learning architectures whereby infrared spectral illumination of a scene could be used to predict a visible spectrum rendering of the scene as if it were perceived by a human with visible spectrum light. This would make it possible to digitally render a visible spectrum scene to humans when they are otherwise in complete "darkness" and only illuminated with infrared light. To achieve this goal, we used a monochromatic camera sensitive to visible and near infrared light to acquire an image dataset of printed images of faces under multispectral illumination spanning standard visible red (604 nm), green (529 nm) and blue (447 nm) as well as infrared wavelengths (718, 777, and 807 nm). We then optimized a convolutional neural network with a U-Net-like architecture to predict visible spectrum images from only near-infrared images. This study serves as a first step towards predicting human visible spectrum scenes from imperceptible near-infrared illumination. Further work can profoundly contribute to a variety of applications including night vision and studies of biological samples sensitive to visible light.

Neural representation of others during action observation in posterior medial prefrontal cortex.

Making decisions based on the actions of others is critical to daily interpersonal interactions. We investigated the representations of other's actions at single neural level in posterior medial prefrontal cortex (pmPFC) in two monkeys during the observation of actions of another agent, in a social interaction task. Each monkey separately interacted with a human partner. The monkey and the human alternated turns as actor and observer. The actor was required to reach one of two visual targets, avoiding the previously chosen target, while the observer monitored that action. pmPFC neurons decoupled in most cases self from others during both the execution and the observation of explicit actions. pmPFC neurons showed selective directional tuning specific for the agent who was executing the task. Moreover, we assessed the relationship of the response coding between the periods immediately before and after the action, by using a cross-modal decoding analysis. We found neural network stability from the action anticipation period to the observation of other's actions, suggesting a strong relationship between the anticipation and the execution of an action. When the monkey was the actor, the population coding appeared dynamic, possibly reflecting a goal-action transformation unique to the monkey's own action execution.

Strategies for improved temporal response of glass-based optical switches.

We present an optimization of the dynamics of integrated optical switches based on thermal phase shifters. These devices have been fabricated in the volume of glass substrates by femtosecond laser micromachining and are constituted by an integrated Mach-Zehnder interferometer and a superficial heater. Simulations, surface micromachining and innovative layouts allowed us to improve the temporal response of the optical switches down to a few milliseconds. In addition, taking advantage of an electrical pulse shaping approach where an optimized voltage signal is applied to the heater, we proved a switching time as low as 78 µs, about two orders of magnitude shorter with respect to the current state of the art of thermally-actuated optical switches in glass.