Significant Risk Research Articles

Current Landscape of Gene Therapy for the Treatment of Cardiovascular Disorders.

Cardiovascular disorders (CVD) are the primary cause of death worldwide. Multiple factors have been accepted to cause cardiovascular diseases; among them, smoking, physical inactivity, unhealthy eating habits, age, and family history are flag-bearers. Individuals at risk of developing CVD are suggested to make drastic habitual changes as the primary intervention to prevent CVD; however, over time, the disease is bound to worsen. This is when secondary interventions come into play, including antihypertensive, anti-lipidemic, anti-anginal, and inotropic drugs. These drugs usually undergo surgical intervention in patients with a much higher risk of heart failure. These therapeutic agents increase the survival rate, decrease the severity of symptoms and the discomfort that comes with them, and increase the overall quality of life. However, most individuals succumb to this disease. None of these treatments address the molecular mechanism of the disease and hence are unable to halt the pathological worsening of the disease. Gene therapy offers a more efficient, potent, and important novel approach to counter the disease, as it has the potential to permanently eradicate the disease from the patients and even in the upcoming generations. However, this therapy is associated with significant risks and ethical considerations that pose noteworthy resistance. In this review, we discuss various methods of gene therapy for cardiovascular disorders and address the ethical conundrum surrounding it.

Overlooked Valgus Bowing Deformity in Pediatric Tibial Shaft Fractures With/Without Fibular Involvement: Cause Residual Valgus Alignment in 2-year Follow-up.

Children with a tibial shaft fracture often present with valgus malalignment, even when anatomical reduction had been achieved at the fracture site. Pediatric bony structure has more elastic bones than that of adults, it can cause bowing deformity. Therefore, we evaluated pediatric tibial shaft fracture for the presence of bowing deformity, associated risk factors, and its clinical significance. There is an overlooked bowing deformity in pediatric tibial shaft fracture. 57 tibial shaft fracture patients aged 2 to 15 years with Risser stage 0 were retrospectively reviewed. Clinicoradiologic factors and radiographs taken within 3 post-traumatic months and at 2-years were assessed. To evaluate the tibial bowing deformity, the tibial interphyseal angle and tibial shaft angle were measured, and their differences were calculated as a tibial bowing angle. Multivariate analysis revealed the tibial shaft fracture with fibular involvement is significantly associated with a higher initial tibial bowing angle (valgus deformity). The tibial bowing angle did not change over 2-year follow-up. A high initial tibial bowing angle (≥5°) was a significant risk factor for the persistence of valgus malalignment. Pediatric tibial shaft fractures with/without fibular involvement carry the risk of valgus bowing deformity, which may not develop during post-traumatic growth but may be present at the time of injury. The risk is high if the tibial fracture is accompanied by a fibular fracture. This tibial deformity presents limited remodeling potential at 2-year follow-up. IV; Retrospective study.

Intima-Media Thickness in the Carotid Bifurcation is Related to Silent Brain Infarction: A Cross-Sectional Study.

Carotid intima-media thickness (IMT) measurement is used to assess subclinical atherosclerosis. We aimed to examine the association between the maximum IMT by location and the occurrence of silent brain infarction (SBI). Overall, 280 Japanese individuals (92 females, 52.6±5 years old) underwent a medical check-up at our hospital in Tokyo in 2015. Carotid IMT was measured at each site on ultrasound images (common carotid artery [CCA], internal carotid artery, or bifurcation). The risk factors for arterial dysfunction were evaluated. SBI was assessed using magnetic resonance imaging (MRI). The cross-sectional relationship between carotid maximum IMT and SBI was evaluated. Of the 280 individuals, 18 (6.4%) were diagnosed with SBI on MRI. The mean age of the SBI(-) and SBI(+) groups was 51.9±10.6 and 63.6±18.6 years, respectively. The correlation coefficients between the carotid maximum IMT at each location were very weak (correlation coefficient range: 0.180-0.253). The percentage of participants with SBI increased significantly with increasing maximum CCA and bIMT values. After adjusting for confounders, SBI was found to be significantly associated with the maximum bIMT (per 0.1-mm increase) (adjusted odds ratio [aOR], 1.10; 95% confidence interval [CI]: 1.03-1.17). When bIMT was categorized according to three groups (＜1.0 mm, 1.0-＜2.0 mm, and ≥ 2.0 mm), a significant SBI risk was also observed with an increase by each category of bIMT (aOR: 3.96, 95% CI: 1.63-9.52, P=0.002). The maximum bIMT was found to be the main determinant of SBI. A significant SBI risk was associated with an increase in each category of the maximum bIMT. Therefore, the maximum bIMT might be a useful predictor of future stroke in Japanese stroke-free medical check-up participants.

Does the Duty of Rescue support a moral obligation to vaccinate? Seasonal influenza and the Institutional Duty of Rescue

Seasonal influenza poses a significant public health risk in many countries worldwide. Lower immunity and less influenza virus circulating during the pandemic has resulted in a significant increase in cases...

Más que palabras: Understanding the mental health and behavioral consequences of sociodemographic risk and deportation fears in Latinx families.

Exponential increases in deportation and negative public discourse have resulted in heightened fears of profiling and deportation among Latinx immigrant families in the United States. Deportation fears could compound the inequalities Latinx families face, worsening mental and behavioral health. To better understand the mental health consequences of the climate of deportation concerns among low-income Latinx mothers in the United States, we conducted a linguistic analysis of interviews of Latinx mothers' parenting experiences, examining their use of words related to deportation fears (e.g., separado). We examined the interaction of sociodemographic risk with maternal deportation fears in predicting maternal and youth mental health. Recent immigrant Latinx mothers (N = 160) and youth (Mage = 12.88, SDage = 1.73) completed the Parent Development Interview-Revised (Slade et al., 2004), analyzed using a deportation fears custom dictionary (Linguistic Inquiry and Word Count; Pennebaker et al., 2003). Mothers completed the Brief Symptom Inventory (Derogatis, 2001); youth completed the Youth Self-Report (Achenbach, 1991). Cumulative sociodemographic risk was assessed using a composite score of six risk variables. Regressions revealed significant Sociodemographic Risk × Deportation Fear interactions for maternal depression (p = .01) and youth depression (p < .01) but not for maternal anxiety, youth anxiety, or aggression. As sociodemographic risk increased, associations between deportation fears and psychopathology decreased. The adverse impact of maternal deportation fears on mental health is visible only when demographic stress is lower. Deportation fears may increase mental health risk, potentially reducing treatment seeking among families previously at lower risk. Findings underscore the importance of policy and sociocultural shifts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk of Acute Kidney Injury Following IV Iodinated Contrast Media Exposure: 2023 Update, From the AJR Special Series on Contrast Media.

Iodinated contrast material (ICM) has revolutionized the field of diagnostic radiology through improvements in diagnostic performance and the expansion of clinical indications for radiographic and CT examinations. Historically, nephrotoxicity was a feared complication of ICM use, thought to be associated with a significant risk of morbidity and mortality. Such fears often precluded the use of ICM in imaging evaluations, commonly at the expense of diagnostic performance and timely diagnosis. Over the past 20 years, the nephrotoxic risk of ICM has become a topic of debate, as more recent evidence from higher-quality studies now suggests that many cases of what was considered contrast-induced acute kidney injury (CI-AKI) likely were cases of mistaken causal attribution; most of these cases represented either acute kidney injury (AKI) caused by any of myriad other known factors that can adversely affect renal function and were coincidentally present at the time of contrast media exposure (termed "contrast-associated AKI" [CA-AKI]) or a manifestation of the normal variation in renal function that increases with worsening renal function. This Special Series Review discusses the current state of knowledge regarding CI-AKI and CA-AKI, including the incidence, risk factors, outcomes, and prophylactic strategies in the identification and management of these clinical conditions.

Potential Antidiabetic Activity of β-sitosterol from Zingiber roseum Rosc. via Modulation of Peroxisome Proliferator-activated Receptor Gamma (PPARγ).

To evaluate the antidiabetic potential of β-sitosterol from Zingiber roseum. Diabetes mellitus is a cluster of metabolic disorders, and 90% of diabetic patients are affected with Type II diabetes (DM2). For the treatment of DM2, thiazolidinedione drugs (TZDs) were proposed, but recent studies have shown that TZDs have several detrimental effects, such as weight gain, kidney enlargement (hypertrophy), fluid retention, increased risk of bone fractures, and potential harm to the liver (hepatotoxicity). That is why a new molecule is needed to treat DM2. The current research aimed to assess the efficacy of β-Sitosterol from methanolic extract of Zingiber roseum in managing diabetes via PPARγ modulation. Zingiber roseum was extracted using methanol, and GC-MS was employed to analyze the extract. Through homology modeling, PPARγ structure was predicted. Molecular docking, MD simulation, free binding energies, QSAR, ADMET, and bioactivity and toxicity scores were all used during the in-depth computer-based research. Clinically, agonists of synthetic thiazolidinedione (TZDs) have been used therapeutically to treat DM2, but these TZDs are associated with significant risks. Hence, GC-MS identified phytochemicals to search for a new PPAR-γ agonist. Based on the in-silico investigation, β-sitosterol was found to have a higher binding affinity (-8.9 kcal/mol) than standard drugs. MD simulations and MMGBSA analysis also demonstrated that β-sitosterol bound to the PPAR-γ active site stably. It can be concluded that β-sitosterol from Z. roseum attenuates Type-II diabetes by modulating PPARγ activity.

Gene-environment transactions between peer cigarette use, parental supervision, and Chinese adolescent cigarette smoking initiation.

The initiation and continued use of tobacco products constitute an ongoing source of preventable disease that continues to pose a significant risk to global adolescent health. Scarce research has sought to explore the influences of two well-known environmental risk factors, parental supervision and peer cigarette use, on genetic and environmental contributions to adolescent cigarette use, especially in non-Western populations. Following 602 Chinese twin pairs (52% female, N = 1204) from early to middle adolescence at two-time points (Mage = 12 and 15) from 2006 to 2009 and using multivariate biometric modeling, this study examined gene-environment interplay (i.e., gene-environment correlation and interaction) between perceived parental supervision, peer cigarette use, and adolescent cigarette smoking initiation. From early to middle adolescence, genetic influences on cigarette smoking initiation became more pronounced, whereas shared environmental influences that promote similarity between family members diminished. Genetic factors primarily explained the links between parental supervision and cigarette smoking initiation in mid-adolescence. Peer cigarette use displayed stronger associations with and moderating potential in adolescent cigarette smoking initiation than parental supervision. High levels of peer cigarette use amplified genetic risk for cigarette smoking initiation in mid-adolescence. Chinese adolescent cigarette smoking initiation involves dynamic gene-environment transactions primarily with peer processes over development. Mid-adolescence constitutes a developmental period wherein underlying genetic risk for cigarette smoking initiation is particularly sensitive to peer influences. Targeted interventions aimed at reducing Chinese adolescent cigarette smoking initiation should focus on peer processes during this developmental period.

Sedation with Ketamine-Propofol in Patients Undergoing Transcatheter Aortic Valve Implantation: A Comparative Retrospective Study on General Anesthesia.

Transcatheter aortic valve implantation (TAVI) is used for patients with severe aortic stenosis who are at high risk for surgery. Since these patients are elderly and have comorbidities, their management is of great importance. This retrospective study compares two anesthesia techniques during TAVI: sedation (ketamine and propofol) and general anesthesia. Patients with severe aortic stenosis undergoing TAVI during 2021 in our hospital were retrospectively screened. Demographic data, comorbidities, anesthesia management, complications, and mortality of the patients were obtained from the records. There were 137 patients treated with TAVI; 74 (54%) patients had sedation and 63 (46%) had general anesthesia. When the anesthesia management was evaluated, no significant difference in mortality was observed between the patients who received general anesthesia and sedation. After univariate and multivariate logistic regression analyses were performed to investigate factors having an impact on mortality, anemia (only in univariate analysis) in the whole study population was a statistically significant risk factor for mortality in patients undergoing TAVI (p<0.014). There was no significant difference in mortality in terms of anesthesia management. Anemia was a risk factor for mortality (only in univariate analysis) in the whole study population. We concluded that conscious sedation with ketamine and propofol is effective and safe for TAVI procedures compared to general anesthesia.

A multi-omics approach to elucidate okadaic acid-induced changes in human HepaRG hepatocarcinoma cells

Okadaic acid (OA), a prevalent marine biotoxin found in shellfish, is known for causing acute gastrointestinal symptoms. Despite its potential to reach the bloodstream and the liver, the hepatic effects of OA are not well understood, highlighting a significant research gap. This study aims to comprehensively elucidate the impact of OA on the liver by examining the transcriptome, proteome, and phosphoproteome alterations in human HepaRG liver cells exposed to non-cytotoxic OA concentrations. We employed an integrative multi-omics approach, encompassing RNA sequencing, shotgun proteomics, phosphoproteomics, and targeted DigiWest analysis. This enabled a detailed exploration of gene and protein expression changes, alongside phosphorylation patterns under OA treatment. The study reveals concentration- and time-dependent deregulation in gene and protein expression, with a significant down-regulation of xenobiotic and lipid metabolism pathways. Up-regulated pathways include actin crosslink formation and a deregulation of apoptotic pathways. Notably, our results revealed that OA, as a potent phosphatase inhibitor, induces alterations in actin filament organization. Phosphoproteomics data highlighted the importance of phosphorylation in enzyme activity regulation, particularly affecting proteins involved in the regulation of the cytoskeleton. OA's inhibition of PP2A further leads to various downstream effects, including alterations in protein translation and energy metabolism. This research expands the understanding of OA's systemic impact, emphasizing its role in modulating the phosphorylation landscape, which influences crucial cellular processes. The results underscore OA's multifaceted effects on the liver, particularly through PP2A inhibition, impacting xenobiotic metabolism, cytoskeletal dynamics, and energy homeostasis. These insights enhance our comprehension of OA's biological significance and potential health risks.

Neonatal morbidity in the 2011 JAKIDS Jamaican birth cohort

ABSTRACT This study reports the spectrum of discharge diagnoses in a national cohort of newborns admitted during a 3-month period to hospitals across Jamaica. The data were analyzed using measures of central tendency and risk assessed using odds ratio. Data on 1607 admissions were used to describe the spectrum of morbidity in hospitalized infants. Eight hundred and seven (50%) male and 754 (48%) female neonates were admitted. There was a 15% (240) readmission rate during the neonatal period. Infants of diabetic mothers were almost three times as likely to be admitted as infants whose mothers were not diabetic OR 2.89 (CI 1.96 − 4.13). Infants of women who were hypertensive were 1.5 times more likely to be admitted than infants of non-hypertensive women OR 1.56 (CI 1.56–1.9). The odds ratio for admission of an infant born to a woman delivered by caesarean section was 2.1 (CI: 1.67–2.38). Premature infants constituted 50% of admissions. The most prevalent discharge diagnosis included presumed sepsis, respiratory distress and neonatal jaundice in both preterm and term neonates. In the extreme preterm infant respiratory distress syndrome was the most predominant discharge diagnosis. Multiple gestation was a significant risk for admission OR 2.7 (CI 1.8 to 3.9). Prematurity, multiple gestation, macrosomia, maternal diabetes, maternal hypertension and low 5 minute Apgar score < 7 were all found to be independent predictors of neonatal admission in a logistic regression model (p < 0.001). The recognition of the discharge morbidity is useful for future health planning for the most vulnerable in our population.

Barriers to the use of Methylphenidate in Pediatric Neuro-oncology Services.

Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent. To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK. We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data. Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate. We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.

Podocyte involvement in the pathogenesis of preterm-related long-term chronic kidney disease.

With the continuous advancement of neonatal intensive care technology, the survival rate of preterm infants is gradually increasing. However, this improvement in survival is accompanied by long-term prognostic implications in various systems. In the field of renal diseases, current epidemiological data indicate that preterm birth is a significant risk factor for the development of long-term chronic kidney disease (CKD). This not only imposes an economic burden on patients families but also severely impacts their quality of life. Understanding the underlying mechanisms involved in this process could offer potential strategies for early prevention and management of CKD. Although the nephron number hypothesis is currently widely accepted as a mechanism, there has been limited exploration regarding podocytes - one of the most important structures within nephrons - in relation to long-term CKD associated with preterm birth. Therefore, this review aims to summarize current knowledge on how prematurity influences CKD development overall, while specifically focusing on our current understanding of podocytes in relation to prematurity.

Obstructive sleep apnea in cardiology clinical practice. Epidemiology, diagnosis, and treatment. Observational, cross-sectional, retrospective study

To determine the clinical-epidemiological characteristics, diagnostic feasibility of home respiratory polygraphy and treatment of patients with suspected obstructive sleep apnea (OSA) at cardiovascular risk. An observational, cross-sectional, descriptive study was conducted in patients seen in a cardiology outpatient service with suspected OSA, from January 2015 to December 2019. The information was obtained from medical records, and a descriptive statistical analysis was applied to this information. 138 files were reviewed; only 8% of the home respiratory polygraphs were discarded, because they did not meet the required quality standards. It was demonstrated that 89% suffered from OSA, 60% moderate to severe; in men after 50 years of age. The main cardiovascular risk factors was hypertension (89%). The most prevalent heart disease was hypertension (52%). Cardiovascular pharmacological treatment was improved in 82% of the cases. Cardiac rehabilitation in 30%, noninvasive mechanical ventilation 41%, fixed modality 33%, and self-adjustable 9%, all with telemetry. The prevalence and severity of OSA is higher in the presence of risk or established cardiovascular disease. In the presence of clinical suspicion, it is feasible to confirm the diagnosis with home respiratory poligrafy due to the level of precision and the lower infrastructure required. Greater involvement of the cardiologist in the diagnosis and treatment of this disorder is necessary due to the significant risk of cardiovascular disease it represents.

Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration.

To investigate whether an earlier time to achieving and maintaining systolic blood pressure (SBP) at 120 to 140 mm Hg is associated with favorable outcomes in a cohort of patients with acute intracerebral hemorrhage. We pooled individual patient data from randomized controlled trials registered in the Blood Pressure in Acute Stroke Collaboration. Time was defined as time form symptom onset plus the time (hour) to first achieve and subsequently maintain SBP at 120 to 140 mm Hg over 24 hours. The primary outcome was functional status measured by the modified Rankin Scale at 90 to 180 days. A generalized linear mixed models was used, with adjustment for covariables and trial as a random effect. A total of 5761 patients (mean age, 64.0 [SD, 13.0], 2120 [36.8%] females) were included in analyses. Earlier SBP control was associated with better functional outcomes (modified Rankin Scale score, 3-6; odds ratio, 0.98 [95% CI, 0.97-0.99]) and a significant lower risk of hematoma expansion (0.98, 0.96-1.00). This association was stronger in patients with bigger baseline hematoma volume (>10 mL) compared with those with baseline hematoma volume ≤10 mL (0.006 for interaction). Earlier SBP control was not associated with cardiac or renal adverse events. Our study confirms a clear time relation between early versus later SBP control (120-140 mm Hg) and outcomes in the one-third of patients with intracerebral hemorrhage who attained sustained SBP levels within this range. These data provide further support for the value of early recognition, rapid transport, and prompt initiation of treatment of patients with intracerebral hemorrhage.

Novel odor sensing intelligence and surveillance capabilities in controller-responder robots

The rise in global travel has led to an increased need for heightened security measures at airports. Despite the best efforts of airport security officers, in the past year, hundreds of kilograms of illegal drugs and thousands of agricultural invasive species have found their way into the country, posing a severe threat to public safety and the environment. Moreover, human threats pose a significant risk to civil aviation, reinforcing the need for advanced security technology. In response to these challenges, NOSI (Novel Odor Sensing Intelligence) and ROSI (Reconnaissance Operations Security Intelligence), intelligence surveillance systems consisting of semi-autonomous controller-responder robots, were developed as a proof of concept to supplement the efforts of security and K-9 (police dogs) operators at airports. NOSI is equipped with multi-channel gas sensors for odor detection, enabling it to identify illegal drugs and invasive species in the baggage handling process, while ROSI is equipped with computer vision to identify individuals already in the government’s database of persons of interest. These coordinated robots also provide travelers with important information pertaining to their journey and allow them to trigger emergency alerts. The robots were tested in a custom-designed test bed that replicated both the behind-the-scenes baggage handling and front-office customer service operations of an airport, thus simulating a realistic airport-like setting. Based on design criteria, NOSI and ROSI demonstrated success rates of 73.4 percent and 69.8 percent, respectively. Improvements in areas of robot stability, sensor accuracy, and feature expansion were documented for further development. In conclusion, the NOSI and ROSI framework can enhance the efficiency and accuracy of airport infrastructure monitoring and supplement the capabilities of human and K9 operators. Overall, this approach can potentially revolutionize operations in various infrastructures and represents the future of human-robot collaboration.

1136 Risk Factors for Postoperative Urinary Retention After Deep Brain Stimulation Surgery: The Role of the Subthalamic Nucleus

INTRODUCTION: Deep brain stimulation (DBS) is a widely used neurosurgical procedure for treating Parkinson's disease (PD) and essential tremor (ET). Lower urinary tract dysfunction is a common complication in PD, and this study examines the risk factors for postoperative urinary retention (POUR) after DBS surgery in PD and ET patients to improve patient outcomes. METHODS: This retrospective study analyzed data from patients who underwent DBS surgery for PD and ET at the University of Florida between 2010 and 2021. Data on patient characteristics and surgical details were collected and analyzed using univariate and mixed-linear models. RESULTS: 350 patients underwent 1086 DBS or IPG surgeries, with 153 of them having PD and 197 having ET. The rate of POUR was 79/477 (16.6%), 19/295 (5.2%), and 1/246 (0.4%) for Part 1, Part 2, and IPG replacement. Optimal mixed linear modeling revealed history of urinary retention (OR = 10.2, p = .002), Part 1 surgery (OR = 3.6 compared to Part 2, p &lt; .0003), male sex (OR = 2.5, p = .011), having an electrode placed or connected for the first time (OR = 1.8, p = .046), surgical time (OR 1.5 for each 30 min increase, p &lt; .0001), CCI (OR = 1.4 per comorbidity, p= .006), and preoperative opioid use (OR 1.4 for each additional 10 MME, p = .022) to be significant risk factors for POUR. Having an electrode in STN was found to be protective of POUR (OR = 0.4, p = .030). CONCLUSIONS: While most identified risk factors for POUR in DBS are non-modifiable, they remain important for preoperative planning. Reducing opioid use and minimizing surgical time may help mitigate POUR risk. Targeting the STN during DBS may lead to decreased POUR rates, indicating the potential benefits of STN-targeted DBS for PD and ET patients.

Fine-tuning a pre-trained ResNet50 model to detect distributed denial of service attack

Distributed denial-of-service (DDoS) attacks pose a significant risk to the dependability and consistency of network services. The utilization of deep learning (DL) models has displayed encouraging outcomes in the identification of DDoS attacks. Nevertheless, crafting a precise DL model necessitates an extensive volume of labeled data and substantial computational capabilities. Within this piece, we introduce a technique to enhance a pre-trained DL model for the identification of DDoS attacks. Our strategy’s efficacy is showcased on an openly accessible dataset, revealing that the fine-tuned model we propose surpasses both the initial pre-trained model and other cutting-edge approaches in performance. The suggested fine-tuned model attained 95.1% accuracy, surpassing the initial pre-trained model as well as other leading-edge techniques. Please note that the specific evaluation metrics and their values may vary depending on the implementation, hyperparameter settings, number of datasets, or dataset characteristics. The proposed approach has several advantages, including reducing the amount of labeled data required and accelerating the training process. Initiating with a pre-existing ResNet50 model can also enhance the eventual model’s accuracy, given that the pre-trained model has already acquired the ability to extract significant features from unprocessed data.

Asleep triple-modality motor mapping for perirolandic gliomas: an update on outcomes.

Maximal safe resection of gliomas near motor pathways is facilitated by intraoperative mapping. Here, the authors review their results with triple-modality asleep motor mapping with motor evoked potentials and bipolar and monopolar stimulation for cortical and subcortical mapping during glioma surgery in an expanded cohort. This was a retrospective analysis of patients who underwent resection of a perirolandic glioma near motor pathways. Clinical and neuromonitoring data were extracted from the electronic medical records for review. All patients with new or worsened postoperative motor deficits were followed for at least 6 months. Regression analyses were performed to assess factors associated with a persistent motor deficit. Between January 2018 and December 2021, 160 operations were performed in 151 patients with perirolandic glioma. Sixty-four patients (40%) had preoperative motor deficits, and the median extent of resection was 98%. Overall, patients in 38 cases (23.8%) had new or worse immediate postoperative deficits by discharge, and persistent deficits by 6 months were seen in 6 cases (3.8%), all in patients with high-grade gliomas. There were no new persistent deficits in low-grade glioma patients (0%). The risk factors for a persistent deficit included an insular tumor component (OR 8.6, p = 0.01), preoperative motor weakness (OR 8.1, p = 0.03), intraoperative motor evoked potential (MEP) changes (OR 36.5, p < 0.0001), and peri-resection cavity ischemia (OR 7.5, p = 0.04). Most persistent deficits were attributable to ischemic injury despite structural preservation of the descending motor tracts. For patients with persistent motor deficits, there were 3 cases (50%) in which a change in MEP was noted but subsequent subcortical monopolar stimulation still elicited a response in the corresponding muscle groups, suggesting axonal activation distal to a point of injury. Asleep triple motor mapping results in a low rate of permanent deficits, especially for low-grade gliomas. Peri-resection cavity ischemia continues to be a significant risk factor for permanent deficit despite maintaining appropriate distance for subcortical tracts based on monopolar feedback.

A case study of posterior reversible encephalopathy syndrome: Not always reversible with detrimental consequences.

Posterior reversible encephalopathy syndrome, or PRES, is often an unrecognized sequela of uncontrolled hypertension that is associated with a significant risk of mortality. It is poorly understood and can lead to endothelial dysfunction with disturbance of the blood-brain barrier and subsequent brain edema. Headache, seizures, encephalopathy, and visual disturbances are among the most common symptoms associated with PRES. Testing and evaluation should be quickly initiated not only to solidify the diagnosis but also to rule out others such as infection or stroke. Prompt identification of the symptoms of PRES can potentially reverse long-term side effects such as life-long seizures or visual deficits.