Explore the vast range of titles available.

Supplementary motor area (SMA) syndrome is characterised by transient disturbance in volitional movement and speech production which classically occurs after injury to the medial premotor area. We present two cases of SMA syndrome following isolated surgical injury to the frontal aslant tract (FAT) with the SMA intact. The first case occurred after resection of a left frontal operculum tumour. The second case occurred after a transcortical approach to a ventricular neurocytoma. The clinical picture and fMRI activation patterns during recovery were typical for SMA syndrome and support the theory that the FAT is a critical bundle in the SMA complex function.

The goal of this study was to evaluate the efficacy, morbidity and safety of local parastomal hernia repair using biological mesh. A retrospective analysis of a prospectively maintained database was performed for parastomal hernia repairs. All patients who underwent local parastomal hernia repair with biological mesh between July 2006 and July 2015 were included in the study. Non-local (laparoscopic or midline incision) procedures were excluded. The type of repair, incision used, mesh placement and morbidity were analyzed. Time to recurrence was measured as an independent variable. 58 procedures with a median follow up of 3.8 years were analyzed. The majority (91%) of repairs were performed on an elective basis. Underlay technique was used in 24 patients (39%), overlay in 4 (7%) and both overlay and underlay (sandwich technique) in 33 (54%) of the cases. Overall, 11 patients (18.1%) experienced recurrence. Recurrence occurred in 8 patients in the underlay group (33%), 1 in the overlay group (25%), with 2 recurrences identified in the sandwich technique group (6%; p = 0.02). There was one occurrence of 30-day morbidity in our study population (0.016%). No difference was observed for recurrence or morbidity according to the type of biologic mesh used (human, bovine, or porcine). Our results demonstrate that local parastomal hernia repairs are associated with moderate recurrence rates, very low morbidity and consistent with the current literature. The sandwich technique was found to have a significantly lower recurrence rate compared to underlay or overlay techniques. Keyhole incisions were associated with less recurrence than traditional circular incisions. Our findings further reveal biologic mesh type was not associated with any difference in outcomes. Local parastomal hernia repair with biologic mesh is a safe procedure with very low morbidity and acceptable recurrence rate, especially using the sandwich repair technique.

IntroductionIschemia of the tip of the alimentary limb involving the gastrojejunostomy (GJ) is an unusual complication during Roux-en-Y gastric bypass (RYGB). Revision of the GJ may be needed to manage this complication.ObjectivesWe present a case of inadvertent perforation of the jejunum by a gastric calibration tube, which was recognized on the table and appropriate measures are then taken. Repair of this enterotomy however then led to ischemia of the tip of alimentary limb extending to a portion of the GJ anastomosis. We present its subsequent management.MethodsOur patient is a morbidly obese female patient with a BMI value of 44.6 kg/msq undergoing RYGB. We performed an antecolic, antegastric linear-stapled gastrojejunostomy of 2.5 cm. After hand-sewn closure of the common enterotomy, we tried passing a 38-F Bougie through the anastomosis into the Roux limb. During this maneuver, the Bougie inadvertently perforated the Roux limb at the mesenteric border. Following the repair of this jejunal rent, the distal part of the Roux limb became dusky and involved a portion of the gastrojejunal anastomosis. The gastrojejunostomy was therefore completely revised. Intraoperatively, methylene blue dye test was done which showed no leak.ResultsPost-operative gastrografin study revealed no leak and liquids were started on POD1.ConclusionInadvertent injury by a Bougie is a rare but known complication in laparoscopic RYGB. Intraoperative recognition of the complication is essential to prompt the necessary repair. Revision of the gastrojejunostomy is necessary if the Roux limb or the anastomosis itself is ischemic and can be accomplished with good results.

Background Phosphorylated tau (p-tau) and amyloid beta (Aβ) in human plasma may provide an affordable and minimally invasive method to evaluate Alzheimer’s disease (AD) pathophysiology. The medial temporal lobe (MTL) is susceptible to changes in structural integrity that are indicative of the disease progression. Among healthy adults, higher dynamic network flexibility within the MTL was shown to mediate better generalization of prior learning, a measure which has been demonstrated to predict cognitive decline and neural changes in preclinical AD longitudinally. Recent developments in cognitive, neural, and blood-based biomarkers of AD risk that may correspond with MTL changes. However, there is no comprehensive study on how these generalization biomarkers, long-term memory, MTL dynamic network flexibility, and plasma biomarkers are interrelated. This study investigated (1) the relationship between long-term memory, generalization performance, and MTL dynamic network flexibility and (2) how plasma p-tau231, p-tau181, and Aβ42/Aβ40 influence generalization, long-term memory, and MTL dynamics in cognitively unimpaired older African Americans. Methods 148 participants ( Mean age : 70.88 , SD age : 6.05 ) were drawn from the ongoing longitudinal study, Pathways to Healthy Aging in African Americans conducted at Rutgers University–Newark. Cognition was evaluated with the Rutgers Acquired Equivalence Task (generalization task) and Rey Auditory Learning Test (RAVLT) delayed recall. MTL dynamic network connectivity was measured from functional Magnetic Resonance Imaging data. Plasma p-tau231, p-tau181, and Aβ42/Aβ40 were measured from blood samples. Results There was a significant positive correlation between generalization performance and MTL Dynamic Network Flexibility ( t  = 3.372, β  = 0.280, p  < 0.001). There were significant negative correlations between generalization performance and plasma p-tau231 ( t = -3.324, β = -0.265, p  = 0.001) and p-tau181 ( t = -2.408, β = -0.192, p  = 0.017). A significant negative correlation was found between plasma p-tau231 and MTL Dynamic Network Flexibility ( t = -2.825, β = -0.232, p  = 0.005). Conclusions Increased levels of p-tau231 are associated with impaired generalization abilities and reduced dynamic network flexibility within the MTL. Plasma p-tau231 may serve as a potential biomarker for assessing cognitive decline and neural changes in cognitively unimpaired older African Americans.

This project presents an implementation of wearable, portable, low power consumption, real-time remote bio-signals monitoring system based on the internet of thing technology. This implementation provides an improved step-in remote health monitoring field. Numbers of people, who require health care increase year by year and the conventional bio-signals monitoring systems require patients' attendance in person inside hospitals. This might cause an inefficient situation to take care of the patients, especially those who have critical and unstable health conditions. Therefore, internet technology along with modern electronic devices could offer promising solutions in this field. Based on that, this project utilizes a mobile application as an IoT platform to monitor remotely the live ECG signal, heart rate, SPO2, and the body temperature of patients. The signals are measured and processed by using a microcontroller-based device (Arduino). The main contribution of this paper is sending an electrocardiogram (ECG signal) to a specific smart mobile phone to be watched by a doctor. This assists in heart diseases diagnosing before the worst case can happen. Finally, the obtained results of this project are illustrated on both smartphone and personal computer (PC) as well.

Background: The first medical college in Iraq was established in 1927, adopting a subject-based curriculum. Aims: To provide a description of undergraduate medical education curricula in Iraq and how they developed since 1927. Methods: We identified Iraqi medical schools and curricula from local and global directories. Curricular data were compared to 3 educational benchmarks (Dale’s effectiveness of teaching methods, SPICES, Miller’s pyramid). We searched for studies describing curricula and modernization. Results: There are 34 medical colleges in Iraq (32 with identified curricula) with a wide scope of visions and aims adopting 3 types of curriculum: subject-based (SBC) 20 (63%), integrated (IC) 10 (31%) and problem-based learning (PBLC) 2 (6%). The majority of updates were SBC to IC, with only 1 moving from SBC to PBLC. The predominant type of curriculum at the start of instruction is SBC or IC. Although PBLC and IC provide opportunities for inquiry-driven competencies in the first 3 years only, none provide such opportunities in the clinical phase (last 3 years). Conclusions: Curricular reform needs to focus on modernizing the learning process/outcomes rather than reorganization of the teaching only. A new approach is needed to provide opportunities for competence and experience to prepare doctors to deal with challenges. One such approach would be the adoption of an outcomes-based curriculum model based on domains of competence with clearly defined outcomes/competencies achievable the time of graduation. All curricula should lead to the achievement of the same outcomes.

Abstract BACKGROUND There are many questions that remain unanswered regarding outcomes following cranioplasty including the timing of cranioplasty following craniectomy as well as the material used. OBJECTIVE To establish and evaluate 30-d outcomes for all cranial reconstruction procedures in the United Kingdom (UK) and Ireland through a prospective multicenter cohort study. METHODS Patients undergoing cranioplasty insertion or revision between June 1, 2019 and November 30, 2019 in 25 neurosurgical units were included. Data collected include demographics, craniectomy date and indication, cranioplasty material and date, and 30-d outcome. RESULTS In total, 313 operations were included, consisting of 255 new cranioplasty insertions and 58 revisions. Of the new insertions, the most common indications for craniectomy were traumatic brain injury (n = 110, 43%), cerebral infarct (n = 38, 15%), and aneurysmal subarachnoid hemorrhage (n = 30, 12%). The most common material was titanium (n = 163, 64%). Median time to cranioplasty was 244 d (interquartile range 144-385), with 37 new insertions (15%) within or equal to 90 d. In 30-d follow-up, there were no mortalities. There were 14 readmissions, with 10 patients sustaining a wound infection within 30 d (4%). Of the 58 revisions, the most common reason was due to infection (n = 33, 59%) and skin breakdown (n = 13, 23%). In 41 (71%) cases, the plate was removed during the revision surgery. CONCLUSION This study is the largest prospective study of cranioplasty representing the first results from the UK Cranial Reconstruction Registry, a first national registry focused on cranioplasty with the potential to address outstanding research questions for this procedure. Graphical Abstract Graphical Abstract

The effect of Sodium Glucose Co-Transporter 2 inhibitors on cardiovascular, renal, dyslipidemia, and inflammatory markers has not been analyzed simultaneously. The goal is to determine if SGLT2 inhibitors significantly reduce cardiovascular and renal mortality, and improve these health outcomes. PubMed, Cochrane Library and MEDLINE databases were used to conduct a comprehensive literature search from inception to September 2023. Randomized control trials with follow-up for at least 8 weeks, with a group taking SGLT2 inhibitors being compared with a group taking either placebo or other medication, in which cardiovascular outcomes, renal outcomes, lipid biomarkers, and inflammatory markers were reported as the primary outcomes were included. The statistical analyses were conducted using Review Manager with a random-effects model. Thirteen studies comprising 92 920 patients were analyzed for several outcomes. The analysis revealed a significant reduction in overall mortality, death due to heart failure, cardiovascular causes, and renal causes in the SGLT2 inhibitor group as compared to placebo. Pooled results also revealed a significant reduction in the frequency of renal replacement therapy and renal composite endpoint in patients on SGLT2 inhibitors. There was also a significant reduction in IL-6, TNF-a, systolic blood pressure in the same group. On the other hand, Flow Mediated Dilation (FMD), lipid profile, and the incidence of amputations and fractures showed no significant associated SGLT2 inhibitor therapy. Our analysis indicates that diabetics and non-diabetics suffering from cardiovascular and renal diseases experience a significant reduction in morbidity and mortality from SGLT2 inhibitor therapy, leading to a better prognosis of such conditions in the long-term.

Objective Laparoscopic cholecystectomy (LC), a gold standard procedure can be done without energized dissection (ED). We did a randomized study for the outcomes of LC done with ED or without ED, i.e., with cold dissection (CD). Methods and Procedures At a tertiary level institution, open-ended prospective-randomized control study was conducted between September 2008 and June 2013. Consecutive, unselected, consenting candidates for LC were enrolled following standard ethics, informed consent, anesthesia, and clinical pathway protocol. They were allocated to control group (LC with ED) or study group (LC with CD, as per our published technique with the option for rescue ED). The study points were based upon Clavien–Dindo grading of postoperative complications. They were either, peri-operative events potentially affecting, hospital stay (Grade I) or Grade II–V, e.g., peri-operative hemodynamic instability, needing intervention/blood transfusion, injury to biliary ducts/hollow viscous, postoperative biliary leak, postoperative re-intervention, re-hospitalization, mortality, and any adverse event during a 90-day follow-up period. The data were prospectively collected in an integrated “hospital information system” that could be retrieved only by independent external coordinators. Results Demographics, co-morbidities, and gallbladder inflammation profile of the control group ( n  = 361) and study group ( n  = 384) were comparable. There was no rescue ED usage in the study group. Hospital stay (Grade I adverse outcome dependent) was longer, i.e., 1.6 ± 1.03 in the control versus 1.35 ± 1.2 days in the study group ( p  < 0.001). Grade II–IV complications were significantly more ( p  < 0.009) in control group. There was one common bile duct (CBD) injury in each group. The index bilio-enteric anastomosis for CBD injury in control group failed and needed a revision with multiple interventions. There was one grade V adverse outcome, i.e., mortality in the control group. Conclusion Avoiding the use of ED in LC is associated with better outcomes.

Background African Americans are at increased risk for cardiovascular‐related health problems (e.g., hypertension, cardiovascular disease, stroke, obesity) and cognitive dysfunction, including Alzheimer’s disease (AD)1,2. However, few studies have looked at the longitudinal influence of cardiovascular health and cognitive function in older African Americans. This study investigated the relationship between cardiovascular health markers and cognition in older African Americans. Method 836 participants were drawn from Pathways to Healthy Aging in African Americans, a longitudinal cohort study at Rutgers University–Newark. Participants completed a battery of self‐reported health and demographic questionnaires, neuropsychological tests, and a short physical battery of both anthropometric and physical assessments. Linear mixed models were used to examine the relationship between baseline cardiovascular health markers and cognitive function up to 6 years of follow up. Result Higher diastolic blood pressure was significantly associated with worse Trail Making Test Part A (B = 0.035, p < .001), and Montreal Cognitive Assessment (B = 0.085, p = .0029) performance across time. Higher systolic blood pressure was significantly associated with poorer Trail Making Test Part A (B = 0.017, p < .001) and MoCA (B = 0.055, p < .001). Higher resting heart rate was significantly associated with worse Trail Making Test Part A (B = 0.018, p = .0031) and Part B (B = 0.085, p = .013), Controlled Oral Word Association Test (B = 0.036, p = .025), and Montreal Cognitive Assessment performance across time (B = 0.047, p = .046). Conclusion In cognitively unimpaired older African Americans, cardiovascular health markers are predictive biomarkers for early working memory decline in preclinical AD. Our findings may inform holistic clinical decision‐making in AD prevention and personalized AD monitoring in patients with cardiovascular disease.