Alzheimer’s disease (AD) is accompanied by smell dysfunction, as measured by psychophysical tests. Currently it is unknown whether AD-related alterations in central olfactory system neural activity, as measured by functional magnetic resonance imaging (fMRI), are detectable beyond those observed in healthy elderly. Moreover, it is not known whether such changes are correlated with indices of odor perception and dementia. To investigate these issues, twelve early stage AD patients and thirteen non-demented controls underwent fMRI while being exposed to each of three concentrations of lavender oil odorant. All participants were administered the University of Pennsylvania Smell Identification Test (UPSIT), the Mini-Mental State Examination (MMSE), the Mattis Dementia Rating Scale-2 (DRS-2), and the Clinical Dementia Rating Scale (CDR). The Blood oxygen level-dependent (BOLD) signal at primary olfactory cortex (POC) was weaker in AD than in HC subjects. At the lowest odorant concentration, the BOLD signals within POC, hippocampus, and insula were significantly correlated with UPSIT, MMSE, DRS-2, and CDR scores. The BOLD signal intensity and activation volume within the POC increased significantly as a function of odorant concentration in the AD group, but not in the control group. These findings demonstrate that olfactory fMRI is sensitive to the AD-related olfactory and functional cognitive decline.

Hyponatremia in orthopaedic patients is associated with longer, costlier hospitalizations. The factors that significantly increased the risk of developing postoperative hyponatremia were an older age, spine fusion, hip arthroplasty, and the amount of lactated Ringer solution used.

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Various surgical techniques of deltoid ligament and spring ligament reconstructions in advanced adult-acquired flatfoot deformity have been described. However, none has reported a simultaneous anatomic reconstruction of both the deltoid and spring ligaments. Advanced adult-acquired flatfoot deformity patients often present with combined deltoid and spring ligaments insufficiency, which should be addressed simultaneously to provide adequate correction and maintain static ligamentous stability. We describe a novel anatomic reconstruction of the tibiocalcaneonavicular ligament with peroneus longus allograft. This is the first surgical technique to reconstruct both the deltoid and spring ligament complex.Level of Evidence: Diagnostic Level 5, expert opinion. See Instructions for Authors for a complete description of levels of evidence.

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Overall, our results suggest increased wound dehiscence complications in the postoperative period for thyroxine-supplemented patients compared to control patients. This finding remained even after adjusting for the associated cardiovascular comorbidities seen in thyroxine-supplemented patients.

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