Recurrent patellar instability increases the risk of developing patellofemoral arthritis, among other complications. Chronic patellar instability frequently evolves into a debilitating issue that necessitates surgical intervention. Lateral patellar dislocation caused by a torn medial patellofemoral ligament (MPFL) is commonly addressed with an isolated MPFL reconstruction. Risk factors of MPFL graft failure and further patellar instability include patella alta and elevated tibial-tubercle trochlear-groove distance, which are addressed by a tibial tubercle osteotomy with distalization and/or medialization. Trochlear dysplasia is addressed through a sulcus-deepening trochleoplasty. An osteochondral autograft transfer is used to transfer healthy cartilage from a lesser-articulating surface to address areas of small cartilage defects. We describe a concomitant MPFL reconstruction, tibial tubercle osteotomy, trochleoplasty, and osteochondral autograft transfer to address chronic recurrent lateral patellar instability, patella alta, trochlear dysplasia, and a full-thickness patellar osteochondral defect.

Fetal alcohol spectrum disorders (FASD) continue to be the leading preventable cause of intellectual disability in the U.S., Europe, and in endemic areas, such as the Western Cape region of South Africa. Arithmetic is highly sensitive to prenatal alcohol exposure (PAE). The intraparietal sulcus (IPS) is known to play a critical role in number processing. In this study, we investigate whether smaller IPS volumes play a role in the number-processing deficits observed in children with PAE. Participants were 52 9- to 14-year-old children from a historically disadvantaged community in Cape Town, who are participating in our ongoing studies on the effects of PAE on the brain. The IPS was manually parcellated into its medial (MIPS) and lateral (LIPS) walls on magnetic resonance images. The study aimed to examine: (1) the effects of PAE on IPS regional volumes and asymmetry, (2) whether IPS regional volumes are related to number processing performance and, if so, whether these relations are moderated by PAE and (3) potential mediation by regional IPS volumes of the relation between PAE and number processing performance. Total intracranial volume (TIV) was associated with volumes in all regions except the right LIPS. Both left MIPS and left LIPS volumes were significantly smaller in children in the fetal alcohol syndrome (FAS)/partial FAS (PFAS) group compared to controls. The finding in the left LIPS remained significant after controlling for potential confounders and after adjustment for the smaller overall brain size of the children in the FAS/PFAS group. Smaller left LIPS volumes in the FAS/PFAS group may account for the absence of left-right asymmetry in the LIPS in children with FAS/PFAS compared to controls and nonsyndromal heavily exposed (HE) children. Bilaterally, larger MIPS volumes were associated with better WISC IQ Arithmetic scores. These effects, however, were not moderated by the degree of PAE, and regional IPS volumes did not mediate the effect of PAE on WISC Arithmetic scores. Although we found that certain regions of the IPS were smaller in children with FAS and PFAS, these PAE-induced changes in IPS volume did not mediate the alcohol-related deficits in arithmetic.

Evidence strongly suggests that being overweight or obese at midlife confers significantly higher risk for Alzheimer's disease and greater brain atrophy later in life. Few studies, however, examine associations between longitudinal changes in adiposity during early adulthood and later brain morphometry. Measures of body mass index (BMI) were collected in 373 men from the Vietnam Era Twin Study of Aging at average ages 20, 40, 56, and 62 years, yielding 2 BMI trajectories. We then examined associations between BMI phenotypes (trajectories, continuous BMI, obese/nonobese), cortical thickness, and white matter measures from structural magnetic resonance imaging at mean age 62 (time 4, range 56-66 years). Those on the obesity trajectory (N = 171) had a thinner cortex compared with the normal/lean trajectory (N = 202) in multiple frontal and temporal lobe bilateral regions of interest: superior, inferior, middle temporal gyri, temporal pole, fusiform gyrus, banks of the superior temporal sulcus, frontal pole, pars triangularis, caudal and rostral middle frontal gyri (all p < 0.05, false discovery rate corrected). Frontal lobe thinness tended to occur mainly in the right hemisphere. Results were similar for obese versus nonobese adults at age 62. There were no significant differences for white matter volume or abnormalities. Taken in the context of other research, these associations between brain structures and excess BMI at midlife suggest potential for increased risk for cognitive decline in later life.

Number processing deficits are frequently seen in children prenatally exposed to alcohol. Although the parietal lobe, which is known to mediate several key aspects of number processing, has been shown to be structurally impaired in fetal alcohol spectrum disorders (FASD), effects on functional activity in this region during number processing have not previously been investigated. This fMRI study of 49 children examined differences in activation associated with prenatal alcohol exposure in five key parietal regions involved in number processing, using tasks involving simple addition and magnitude comparison. Despite generally similar behavioral performance, in both tasks greater prenatal alcohol exposure was related to less activation in an anterior section of the right horizontal intraparietal sulcus known to mediate mental representation and manipulation of quantity. Children with fetal alcohol syndrome and partial fetal alcohol syndrome appeared to compensate for this deficit by increased activation of the angular gyrus during the magnitude comparison task.

Effective learning requires that attentional resources be focused on target information and withheld from irrelevant events in the learner's surroundings. This requires engagement of the brain substrates of selective attention and the concurrent disengagement of brain substrates of orienting toward changes in the environment. In the present study, we attempted to modulate activation of cortical substrates of attention during learning by physiological intervention, using transcranial direct current stimulation (tDCS). To effect adversarial modulation, we applied anodal stimulation directed toward left intraparietal sulcus/superior parietal cortex (IPS/SPL; a substrate of selective attention) and cathodal stimulation directed toward right inferior parietal cortex (IPL; a substrate of orienting). Such stimulation during study of verbal materials led to superior subsequent recognition memory relative to the opposite polarity of stimulation. To our knowledge, this is the first application of direct current stimulation to parietal regions implicated in different forms of attention in an oppositional manner in order to modulate learning in a verbal recognition memory task. Additionally, these results may have practical implications for the development of interventions to benefit persons with various types of attentional deficits.

By contrast to the adult literature, in which a consistent parietofrontal network for number processing has been identified, the data from studies of number processing in children have been less consistent, probably due to differences in study design and control conditions. Number processing was examined using functional magnetic resonance imaging in 18 right-handed children (8-12 years) from the Cape Coloured community in Cape Town, South Africa, using Proximity Judgment and Exact Addition (EA) tasks. The findings were consistent with the hypothesis that, as in adults, the anterior horizontal intraparietal sulcus (HIPS) plays a major role in the representation and manipulation of quantity in children. The posterior medial frontal cortex, believed to be involved in performance monitoring in more complex arithmetic manipulations in adults, was extensively activated even for relatively simple symbolic number processing in the children. Other areas activated to a greater degree in the children included the left precentral sulcus, which may mediate number knowledge and, for EA, the head of the caudate nucleus, which is part of a fronto-subcortical circuit involved in the behavioral execution of sequences. Two regions that have been linked to number processing in adults - the angular gyrus and posterior superior parietal lobule - were not activated in the children. The data are consistent with the inference that although the functional specialization of the anterior HIPS may increase as symbolic number processing becomes increasingly automatic, this region and other elements of the parietofrontal network identified in adults are already reliably and robustly activated by middle childhood.

This study was designed to assess the perceived optimal profiles of African Americans versus white Americans. A survey was conducted using profile silhouettes of 30 African American and 30 white patients, ranging in age from 7 to 17 years. Twenty white orthodontists, 18 African American orthodontists, 20 white laypersons, and 20 African American laypersons evaluated the profiles. The preference of each rater for each of the 60 profiles was scored on an attached visual analog scale. Eighteen cephalometric variables were measured for each profile, and statistical analyses were performed on the profiles that had a mean rating of 60 or greater from an analog scale of 0 to 100. The results show the following 6 cephalometric variables were significant: Z-angle, skeletal convexity at A-point, upper lip prominence, lower lip prominence, nasomental angle, and mentolabial sulcus. All raters preferred the African American sample to have a greater profile convexity than they preferred for the white sample. The raters preferred the African American sample with upper and lower lips that were more prominent compared with the white sample. However, only the choice of the African American orthodontists for the African American sample was significantly different for this parameter. The white orthodontists gave the highest mean scores for the profile chosen, whereas the African American laypersons gave the lowest scores.

The anatomy of the vomeronasal complex and, in connection with this, the structures of the rostral palate were studied in different species of mammals, namely members of the order Marsupialia, Scandentia, Insectivora, Primates, Rodentia, and Lagomorpha. The following results were obtained: The organs of Jacobson of all forms studied are well-developed. The organ of Jacobson is situated at the base of the nasal septum and opens rostrally, always closely connected to the nasopalatine duct. Even in rodents, lagomorphs and Solenodon, where the openings of the organs are positioned rostral to the ductus, both systems are nevertheless connected by means of special furrows. Accordingly the organs of Jacobson are functionally much more closely related to the oral cavity than to the nasal cavity, which they actually belong to. This can be emphasized by the peculiar structures of the rostral palate inclosing the papilla palatina and with it the oral openings of the nasopalatine ducts. In all species studied, the anterior part of the upper jaw presents a very interesting situation because the median furrow of the rhinarium communicates directly or indirectly with the sulcus papillae palatinae, thus forming a very distinct system of grooves which preserves a connection between the nasopalatine ducts and the preoral surroundings. In rodents, lagomorphs, and Solenodon, we find in this part of the palate a special situation because of their unusually arranged incisors, which are not separated by a diastema. However, also in these cases, there are distinct connecting passages between the papilla palatina and the extraoral surroundings. The conditions found in Ratufa bicolor and in early stages of the rat demonstrate that the extraordinary topography of the rostral palate in rodents is a secondary formation by means of ontogeny and phylogeny. Cebus apella, a platyrrhine simian, shows already a clear reduction of palatal structures compared to those found in prosimians. In Setifer setosus and Echinops telfairi, we find the papilla palatina and with it the oral openings of the nasopalatine ducts overgrown by a bipartite caudal branch of the rhinarium. The neonate Setifer allows us to reconstruct the mechanism of this overgrowing procedure. We find a similar situation in Erinaceus, where the papilla palatina remains uncovered, however. Because of contradictory bibliographical data, some elements of the vomeronasal complex in mammals needed to be carefully analysed in regard to structure and nomenclature: in many species the paraseptal cartilage bifurcates rostrally into a dorsal and a ventral branch.(ABSTRACT TRUNCATED AT 400 WORDS)

Although the functional significance of the midprincipalis region is well known, the afferent and efferent connections of this zone, in comparison to the anterior and posterior portions of the cortex lining the principal sulcus, are poorly understood. In 3 animals the retrograde tracer HRP and the anterograde tracers, tritiated proline, lysine and leucine, were injected into the sulcal cortex lining the principal sulcus. The cortex forming the banks of the principal sulcus was divided into anterior, middle and posterior sectors with one animal used for each zone. As expected from previous studies, the heaviest afferents to the cortex forming the principal sulcus were from the parvocellular portions of the medical dorsal nucleus. The medial pulvinar nucleus and the nucleus limitans projected to only the anterior and posterior portions of the cortex lining the principal sulcus. Projections were seen to all 3 sectors from the anterior, midline, intralaminar and lateral thalamic nuclei. Although cells were seen in the hypothalamus following injections in all 3 sectors of the cortex lining the principal sulcus, the heaviest hypothalamic projections were noted after injections into the mid-sector of the cortex. These HRP-positive cells were in the dorsal and lateral hypothalamic area, dorsal medial nucleus and in the lateral mammillary nucleus. These findings link the midprincipalis region with the prefrontolimbic circuit, and suggest that the midprincipalis region, n. medialis dorsalis, the mammillary bodies and perhaps the cingulate gyrus constitute part of an anatomical circuit concerned with memory processes.