Two-stage reimplantation in periprosthetic knee infection

OBJECTIVE

The increasing number of total knee arthroplasties performed yearly worldwide has resulted in a concomitant rise in bacterial infections. Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The purpose of this study was to describe all the phases of the two-stage reimplantation and to review the literature regarding the topic.

MATERIALS AND METHODS

Most significant and recent papers about the management of periprosthetic knee infection through a two-stage reimplantation protocol were carefully analysed and reviewed. Our personal experience, previously published, with two-stage-reimplantation protocol was also briefly reported.

RESULTS

Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The strategy of using an antibiotic-loaded cement spacer and intravenous antibiotics with delayed exchange arthroplasty is actually considered the state-of-the-art, with a reported success rate of 88-96%. The two-stage protocol has been reported as a viable option also for patients with a periprosthetic knee infection by multidrug-resistant organisms. On the other hand, open debridement with polyethylene exchange and single-stage reimplantation have been reported effective only in selective case series involving acute infections by low-virulence organisms.

CONCLUSIONS

The strategy that involves the use of cement spacer, intravenous antibiotic therapy, and successive revision total knee implantation is nowadays considered the gold standard for the management of the periprosthetic knee infection. This treatment is actually considered the first choice not only for chronic but also for acute infections, especially in the presence of resistant bacteria.

Functional reorganization of the auditory pathways following late callosotomy

Injuries at various levels of the auditory system have been shown to lead to functional reorganization of the auditory pathways. In particular, it has recently been shown that such reorganization can occur in callosal agenesis. The pattern of cortical activity following callosotomy is however still unknown, but behavioral results suggest that it could be significantly different from that observed in callosal agenesis. We aimed to confirm this hypothesis by investigating fMRI responses to complex sounds presented binaurally and monaurally in a callosotomized patient. In the binaural condition, the callosotomized subject showed patterns of auditory cortical activation that were similar to those of neurologically intact individuals. However, in both monaural conditions, the callosotomized individual showed a significant increase of the asymmetries favoring the contralateral pathways. Such patterns of cortical responses are only partially consistent with the results obtained from callosal agenesis subjects using the exact same procedure. Indeed, the latter show differences compared with normals in both binaural and monaural conditions. These findings provide neurological evidence that callosotomy could lead to distinctive functional reorganization of the human auditory pathways.

The effect of displacement on sensitivity to first- and second-order global motion in 5-year-olds and adults

We compared the development of sensitivity to first- versus second-order global motion in 5-year-olds (n=24) and adults (n=24) tested at three displacements (0.1, 0.5 and 1.0 degrees). Sensitivity was measured with Random-Gabor Kinematograms (RGKs) formed with luminance-modulated (first-order) or contrast-modulated (second-order) concentric Gabor patterns. Five-year-olds were less sensitive than adults to the direction of both first- and second-order global motion at every displacement tested. In addition, the immaturity was smallest at the smallest displacement, which required the least spatial integration, and smaller for first-order than for second-order global motion at the middle displacement. The findings suggest that the development of sensitivity to global motion is limited by the development of spatial integration and by different rates of development of sensitivity to first- versus second-order signals.

Women process multisensory emotion expressions more efficiently than men

Despite claims in the popular press, experiments investigating whether female are more efficient than male observers at processing expression of emotions produced inconsistent findings. In the present study, participants were asked to categorize fear and disgust expressions displayed auditorily, visually, or audio-visually. Results revealed an advantage of women in all the conditions of stimulus presentation. We also observed more nonlinear probabilistic summation in the bimodal conditions in female than male observers, indicating greater neural integration of different sensory-emotional informations. These findings indicate robust differences between genders in the multisensory perception of emotion expression.

A mixed-signal multichip neural recording interface with bandwidth reduction

We present a multichip structure assembled with a medical-grade stainless-steel microelectrode array intended for neural recordings from multiple channels. The design features a mixed-signal integrated circuit (IC) that handles conditioning, digitization, and time-division multiplexing of neural signals, and a digital IC that provides control, bandwidth reduction, and data communications for telemetry toward a remote host. Bandwidth reduction is achieved through action potential detection and complete capture of waveforms by means of onchip data buffering. The adopted architecture uses high parallelism and low-power building blocks for safety and long-term implantability. Both ICs are fabricated in a CMOS 0.18-mum process and are subsequently mounted on the base of the microelectrode array. The chips are stacked according to a vertical integration approach for better compactness. The presented device integrates 16 channels, and is scalable to hundreds of recording channels. Its performance was validated on a testbench with synthetic neural signals. The proposed interface presents a power consumption of 138 muW per channel, a size of 2.30 mm(2), and achieves a bandwidth reduction factor of up to 48 with typical recordings.

Receptive field properties and sensitivity to edges defined by motion in the postero-lateral lateral suprasylvian (PLLS) area of the cat

The present study investigated the spatial properties of cells in the postero-lateral lateral suprasylvian (PLLS) area of the cat and assessed their sensitivity to edges defined by motion. A total of one hundred and seventeen (117) single units were isolated. First, drifting sinusoidal gratings were used to assess the spatial properties of the cells' receptive fields and to determine their spatial frequency tuning functions. Second, random-dot kinematograms were used to create illusory edges by drifting textured stimuli (i.e. a horizontal bar) against a similarly textured but static background. Almost all the cells recorded in PLLS (96.0%) were binocular, and a substantial majority of receptive fields (79.2%) were end-stopped. Most units (81.0%) had band-pass spatial frequency tuning functions and responded optimally to low spatial frequencies (mean spatial frequency: 0.08 c./degree). The remaining units (19.0%) were low-pass. All the recorded cells responded vigorously to edges defined by motion. The vast majority (96.0%) of cells responded optimally to large texture elements; approximately half the cells (57.3%) also responded to finer texture elements. Moreover, 38.5% of the cells were selective to the width of the bar (i.e., the distance between the leading and the trailing edges). Finally, some (9.0%) cells responded in a transient fashion to leading and to trailing edges. In conclusion, cells in the PLLS area are low spatial frequency analyzers that are sensitive to texture and to the distance between edges defined by motion.

Responses of inferior collicular cells to species-specific vocalizations in normal and enucleated rats

The inferior colliculus (IC) is an obligatory relay for the ascending and descending auditory pathways. Cells in this brainstem structure not only analyze auditory stimuli but they also play a major role in multi-modal integration of auditory and visual information. The aim of the present study was to determine whether cells in the central nucleus of the inferior colliculus (CNIC) of normal rats respond selectively to complex auditory signals, such as species-specific vocalizations, and compare their responses to those obtained in neonatal bilateral enucleated (P2-P3) adult rats. Extra-cellular recordings were carried out in anesthetized normal and enucleated rats using auditory stimuli (pure tones, broadband noise and vocalizations) presented in free field in a semi-anechoic chamber. The results indicate that most cells in the CNIC of both groups respond selectively to species-specific vocalizations better than to the same but inverted sounds. No significant differences were found between the normal and enucleated rat groups in their responses to broadband noise and pure tones.

Auditory processing in a patient with a unilateral lesion of the inferior colliculus

The role of the inferior colliculus (IC) in human auditory processing is still poorly understood. We report here the results obtained with a 12-year-old boy (FX) who suffered a very circumscribed lesion of the right IC without additional neurological damage. The child underwent an extensive battery of psychophysical hearing tests. Results revealed normal peripheral auditory functioning, bilaterally. Furthermore, masking-level differences and frequency-pattern recognition were normal for each ear. When the right ear was stimulated, behavioural tests assessing central auditory processing yielded normal results. However, when the left ear was stimulated, speech recognition in the presence of a competing ipsilateral signal and duration-pattern recognition were impaired. Similarly, performance on two dichotic speech recognition tests was poor when the target stimulus was presented in the left and the competing signal in the right ear. Finally, sound-source localization in space was deficient for speakers located on the side contralateral to the lesion. The pattern of results suggests that auditory functions such as recognition of low-redundancy speech presented monaurally, recognition of tone duration patterns, binaural separation and integration, as well as sound-source localization in space, depend on the integrity of the bilateral auditory pathways at the IC level.

Auditory responses in the visual cortex of neonatally enucleated rats

A number of studies on humans and animals have demonstrated better auditory abilities in blind with respect to sighted subjects and have tried to define the mechanisms through which this compensation occurs. The aim of the present study, therefore, was to examine the participation of primary visual cortex (V1) to auditory processing in early enucleated rats. Here we show, using gaussian noise bursts, that about a third of the cells in V1 responded to auditory stimulation in blind rats and most of these (78%) had ON-type responses and low spontaneous activity. Moreover, they were distributed throughout visual cortex without any apparent tonotopic organization. Optimal frequencies determined using pure tones were rather high but comparable to those found in auditory cortex of blind and sighted rats. On the other hand, sensory thresholds determined at these frequencies were higher and bandwidths were wider in V1 of the blind animals. Blind and sighted rats were also stimulated for 60 min with gaussian noise, their brains removed and processed for c-Fos immunohistochemistry. Results revealed that c-Fos positive cells were not only present in auditory cortex of both groups of rats but there was a 10-fold increase in labeled cells in V1 and a fivefold increase in secondary visual cortex (V2) of early enucleated rats in comparisons to sighted ones. Also, the pattern of distribution of these labeled cells across layers suggests that the recruitment of V1 could originate at least in part through inputs arising from the thalamus. The ensemble of results appears to indicate that cross-modal compensation leading to improved performance in the blind depends on cell recruitment in V1 but probably also plastic changes in lower- and higher-order visual structures and possibly in the auditory system.

Cross-modal reorganization and speech perception in cochlear implant users

Recent work suggests that once the auditory cortex of deaf persons has been reorganized by cross-modal plasticity, it can no longer respond to signals from a cochlear implant (CI) installed subsequently. To further examine this issue, we compared the evoked potentials involved in the processing of visual stimuli between CI users and hearing controls. The stimuli were concentric circles replaced by a different overlapping shape, inducing a shape transformation, known to activate the ventral visual pathway in human adults. All CI users had their device implanted for >1 year, but obtained different levels of auditory performance following training to establish language comprehension. Seven of the 13 patients showed good capacities for speech recognition with the CI (good performers) while the six others demonstrated poor speech recognition abilities (poor performers). The evoked potentials of all patients showed larger amplitudes, with different distributions of scalp activations between the two groups. The poor performers exhibited broader, anteriorly distributed, high P2 amplitudes over the cortex whereas the good performers showed significantly higher P2 amplitudes over visual occipital areas. These results suggest the existence of a profound cross-modal reorganization in the poor performers and an intramodal reorganization in the good performers. We interpret these data on the basis of enhanced audiovisual coupling as the key to a long-term functional improvement in speech discrimination in CI users.

Greater losses in sensitivity to second-order local motion than to first-order local motion after early visual deprivation in humans

We compared sensitivity to first-order versus second-order local motion in patients treated for dense central congenital cataracts in one or both eyes. Amplitude modulation thresholds were measured for discriminating the direction of motion of luminance-modulated (first-order) and contrast modulated (second-order) horizontal sine-wave gratings. Early visual deprivation, whether monocular or binocular, caused losses in sensitivity to both first- and second-order motion, with greater losses for second-order motion than for first-order motion. These findings are consistent with the hypothesis that the two types of motion are processed by different mechanisms and suggest that those mechanisms are differentially sensitive to early visual input.

Effects of excitation and inactivation in area 17 on paired cells in area 18

This investigation examines how neighboring neurons of area 18 react when area 17 inputs are excited or depressed. In anesthetized cats, area 18 responses to a sine-wave grating in the receptive field were analyzed, while a second grating was positioned in its periphery and responses were recorded in area 17. This latter site was also inactivated with GABA. A waveform template process sorted out at least two individual, neighboring cells with similar orientation preferences in area 18. These cells frequently displayed opposite reactions to stimulation and inactivation in area 17. Experiments suggest that nearby neurons belonging to the same functional domain in the visual cortex may simultaneously carry disparate information.

Putting order into the development of sensitivity to global motion

We studied differences in the development of sensitivity to first-versus second-order global motion by comparing the motion coherence thresholds of 5-year-olds and adults tested at three speeds (1.5, 6, and 9 degrees s(-1)). We used Random Gabor Kinematograms (RGKs) formed with luminance-modulated (first-order) or contrast-modulated (second-order) concentric Gabor patterns with a sinusoidal spatial frequency of 3c deg(-1). To achieve equal visibility, modulation depth was set at 30% for first-order Gabors and at 100%, for second-order Gabors. Subjects were 24 adults and 24 5-year-olds. For both first- and second-order global motion, the motion coherence threshold of 5-year-olds was less mature for the slowest speed (1.5 degrees s(-1)) than for the two faster speeds (6 and 9 degrees s(-1)). In addition, at the slowest speed, the immaturity was greater for second-order than for first-order global motion. The findings suggest that the extrastriate mechanisms underlying the perception of global motion are different, at least in part, for first- versus second-order signals and for slower versus faster speeds. They also suggest that those separate mechanisms mature at different rates during middle childhood.

Blind subjects process auditory spectral cues more efficiently than sighted individuals

The goal of the present study was to investigate how monaural sound localization on the horizontal plane in blind humans is affected by manipulating spectral cues. As reported in a previous study (Lessard et al. 1998), blind subjects are able to calibrate their auditory space despite their congenital lack of vision. Moreover, the performance level of half of the blind subjects was superior to that of sighted subjects under monaural listening conditions. Here, we first tested ten blind subjects and five controls in free-field (1) binaural and (2) monaural sound localization tasks. Results showed that, contrary to controls and half the blind subjects, five of the blind listeners were able to localize the sounds with one ear blocked. The blind subjects who showed good monaural localization performances were then re-tested in three additional monaural tasks, but we manipulated their ability to use spectral cues to carry out their discrimination. These subjects thus localized these same sounds: (3) with acoustical paste on the pinna, (4) with high-pass sounds and unobstructed pinna and (5) with low-pass sounds and unobstructed pinna. A significant increase in localization errors was observed when their ability to use spectral cues was altered. We conclude that one of the reasons why some blind subjects show supra-normal performances might be that they more effectively utilize auditory spectral cues.

Binocular fusion/suppression to spatial frequency differences at the border of areas 17/18 of the cat

As shown by various human psychophysical studies, interocular spatial frequency disparities can yield a variety of percepts. In order to examine how binocular fusion is affected by spatial frequency differences, we have recorded cells in the border region of areas 17/18 of anesthetized cats. The optic axes of the eyes were deviated onto cathode-ray screens, and the optimal spatial frequency of each eye was assessed by monocular stimulations using drifting sinusoidal gratings. The optimal relative phase using identical spatial frequencies in both eyes was first determined. Spatial frequency differences were then introduced by keeping the optimal spatial frequency constant in one eye and varying the spatial frequency in the other. Results indicate that cells (39%) responded with an increased firing rate (facilitation) to similar spatial frequencies in each eye and with a gradual attenuation (occlusion or suppression) when spatial frequency differences were increased. However, binocular facilitation did not always occur to the presentation of identical stimuli. For 16% of the cells, maximal responses were observed when lower spatial frequencies than the optimal one were presented in one eye while higher spatial frequencies produced suppression. The opposite pattern was observed only for two cells. These findings are discussed in terms of binocular fusion and suppression.

Longer VEP latencies and slower reaction times to the onset of second-order motion than to the onset of first-order motion

We compared visual evoked potentials and psychophysical reaction times to the onset of first- and second-order motion. The stimuli consisted of luminance-modulated (first-order) and contrast-modulated (second-order) 1 cpd vertical sine-wave gratings drifting rightward for 140 ms at a velocity of 6 degrees /s. For each condition, we analysed the latencies and peak-to-baseline amplitudes of the P1 and N2 peaks recorded at Oz. For first-order motion, both P1 and N2 peaks were present at low (3%) contrast (i.e., depth modulations) whereas for second-order motion they appeared only at higher (25%) contrasts. When the two types of motion were equated for visibility, responses were slower for second-order motion than for first-order motion: about 44 ms slower for P1 latencies, 53 ms slower for N2 latencies, and 76 ms slower for reaction times. The longer VEP latencies for second-order motion support models that postulate additional processing steps for the extraction of second-order motion. The slower reaction time to the onset of second-order motion suggests that the longer neurophysiological analysis translates into slower detection.

Contrast dependency of VEPs as a function of spatial frequency: the parvocellular and magnocellular contributions to human VEPs

The present study investigated the contrast dependency of visual evoked potentials (VEPs) elicited by phase reversing sine wave gratings of varying spatial frequency. Sixty-five trials were recorded for each of 54 conditions: 6 spatial frequencies (0.8, 1.7, 2.8, 4.0, 8.0 and 16.0 c deg(-1)) each presented at 9 contrast levels (2, 4, 8, 11, 16, 23, 32, 64 and 90%). At the lowest spatial frequency, the waveform contained mainly one peak (P1). For spatial frequencies up to 8 c deg(-1), P1 had a characteristic magnocellular contrast response: it appeared at low contrasts, increased rapidly in amplitude with increasing contrast, and saturated at medium contrasts. With increasing spatial frequency, an additional peak (N1) gradually became the more dominant component of the waveform. N1 had a characteristic parvocellular contrast response: it appeared at medium to high contrasts, increased linearly in amplitude with increasing contrast, and did not appear to saturate. The data suggest the contribution of both magnocellular and parvocellular responses at intermediate spatial frequencies. Only at the lowest and highest spatial frequencies tested did magnocellular and parvocellular responses, respectively, appear to dominate.

Binocular Interactions in the Lateral Suprasylvian Visual Area of Strabismic Cats Following Section of the Corpus Callosum

Visually responsive neurons have been recorded in the lateral suprasylvian area (LSA) of cats raised with either a convergent or a divergent strabismus. In contrast to areas 17 and 18, where many studies have documented a profound loss of binocularly activated neurons following early strabismus, in the LSA the majority of cells could still be binocularly driven. Acute or chronic section of the splenium of the corpus callosum reduced but did not abolish binocularity in the LSA. We propose that the widespread callosal connections, the large size of the receptive fields and the peculiar internal circuitry of the LSA all concur in permitting the maintenance of binocular coding in spite of early misalignment of the eyes.

Phase- and position-disparity coding in the posteromedial lateral suprasylvian area of the cat

The posteromedial lateral suprasylvian area of the cat is known to be involved in the analysis of motion and motion in depth. However, it remains unclear whether binocular cells in the posteromedial lateral suprasylvian area rely upon phase or positional offsets between their receptive fields in order to code binocular disparity. The present study aims at clarifying more precisely the neural mechanisms underlying stereoperception with two objectives in mind. First, to determine whether cells in the posteromedial lateral suprasylvian area code phase disparities. Secondly, to examine whether the cells sensitive to phase disparity are the same as those which code for position disparities or whether each group represent a different sub-population of disparity-sensitive neurons. We investigated this by testing both types of disparities on single neurons in this area. The results show that the vast majority of cells (74%), in the posteromedial lateral suprasylvian area, are sensitive to relative interocular phase disparities. These cells showed mostly facilitation (95%) and a few (5%) summation interactions. Moreover, most cells (81%) were sensitive to both position and phase disparities. The results of this study show that most binocular cells in the posteromedial lateral suprasylvian area are sensitive to both positional and phase offsets which demonstrate the importance of this area in stereopsis.

Spatial disparity sensitivity in area PMLS of the Siamese cat

Previous studies of the visual system of Siamese cats have shown that binocular cells are scarce in areas 17, 18 and 19, yet significantly more abundant in suprasylvian areas such as the postero-medial lateral suprasylvian area (PMLS). The present study aims at evaluating the sensitivity to spatial disparity of PMLS binocular cells in paralyzed and anesthetized Siamese cats. Centrally located receptive fields were mapped, separated using prisms and then stimulated simultaneously using two luminous bars optimally adjusted to the size of the excitatory receptive fields. Delays were introduced in the arrival of the luminous bars in the receptive fields so as to create the desired spatial disparities. Results indicate that approximately a third of PMLS units are binocular and that these binocular cells can detect spatial disparity cues. Indeed, although the sample was relatively small, cells of the tuned excitatory (14/34), tuned inhibitory (2/34), near (6/34) and far (1/34) types were identified. The spatial selectivity, as measured by the width at half height of the tuning curves of the excitatory and inhibitory cells and the slopes of the near and far cells, was similar to that obtained in PMLS of normal cats but not as precise as that found for primary visual areas in these animals. This suggests that these cells might serve as a substrate for coarse stereopsis.

Response characteristics of the normal retino-cortical pathways as determined with simultaneous recordings of pattern visual evoked potentials and simple motor reaction times

PURPOSE

In an attempt to explain the existing discrepancies regarding the relationship between electrophysiological and psychophysical measurements of visual transmission time we compared, in humans, the response characteristics of the normal retino-cortical pathways with simultaneously obtained pattern visual evoked potentials (PVEP) and simple motor reaction times (RT).

METHODS

PVEPs and manual RTs were recorded simultaneously using a reversing checkerboard with different spatial frequency and contrast combinations chosen to elicit responses favoring the magnocellular or parvocellular pathways. The amplitude and peak time of the P1 wave of the PVEP were compared to the mean RT. Other parameters of the RT, such as mode and standard deviation were also considered.

RESULTS

The RT is not modified in the same fashion as the peak time of the P1 wave of the PVEP, the peak time of the PVEP demonstrating a spatial frequency selectivity, while the RT does not. Further comparative analysis of the PVEP and RT shows that the RT is faster for stimuli of lower contrast and spatial frequency, while the PVEP amplitude is larger and its peak time shorter for higher contrast and spatial frequency stimuli.

CONCLUSIONS

Our findings suggest that PVEP and RT measures recruit distinct physiological characteristics and appear to be differently modulated while travelling along the retino-cortical pathway. Our results also show the importance of obtaining electrophysiological and psychophysical measures concomitantly to insure elimination of combined inter-stimulus and inter-session variability.

Concussions in athletes produce brain dysfunction as revealed by event-related potentials

We have used event-related potentials (ERP) to assess cerebral activity following mild traumatic brain injuries in 20 college athletes practising contact sports. Concussion victims showed a striking decrease in P300 amplitude, an effect presumed to reflect alterations in attentional-cognitive processes. Moreover, the degree of impairment was strongly related to the severity of post-concussion symptoms. Our data suggest that concussions cause objectively measurable changes in the electrophysiological markers of brain activity and hence in the functions of the structures from which they originate. ERPs may thus constitute a reliable method to accurately monitor the clinical course and recovery of head injuries in athletes.

Neurons in the posteromedial lateral suprasylvian area of the cat are sensitive to binocular positional depth cues

Single units in the posteromedial lateral suprasylvian area of the cat are known to be very sensitive to movement. A proportion of these cells can encode movement in depth, but it is unclear whether posteromedial lateral suprasylvian cells only rely upon motion cues to evaluate stimulus depth or whether they can also code for spatial cues. The present study aims at assessing the sensitivity to spatial disparity of binocular cells, in the postero-medial lateral suprasylvian area, in order to determine whether these units are tuned to positional depth cues. A total of 126 single cells located in the posteromedial lateral suprasylvian area of anesthetized, paralyzed cats were examined. As recordings were performed in the central visual field representation, receptive fields were small. A third of the receptive fields were surrounded by an inhibitory region and almost three-quarters of the cells were direction-selective. Most cells (110/114) were binocular, and a large proportion of single neurons responded to stimuli appearing on the fixation plane by increasing (tuned excitatory cells, 43%) or decreasing (tuned inhibitory cells, 14%) their response rate. A smaller proportion of cells increased their firing rate in response to crossed (near cells, 10%) or uncrossed (far cells, 6%) spatial disparities, hence demonstrating respective preference for stimuli presumably appearing in front of or behind the fixation plane. As compared to primary visual cortex, the proportion of disparity-sensitive cells in posteromedial lateral suprasylvian area is similar, but selectivity is significantly coarser. As the posteromedial lateral suprasylvian area can code for both spatial and temporal aspects of stimuli, this area might be involved in the spatiotemporal integration of depth cues, a process that may also participate in the control of accommodation and vergence.