Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.

BACKGROUND: Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes. OBJECTIVE: In this large case series, we compare the outcomes of direct (DR) and indirect revascularisation (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya. METHODS: We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines of moyamoya affected hemispheres treated with DR and IR surgeries across 13 academic institutions predominantly in North America. All patients who underwent surgical revascularization of their moyamoya-affected hemispheres were included in the study. The primary outcome of the study was the rate of symptomatic strokes. RESULTS: The rates of symptomatic strokes across 515 disease-affected hemispheres were comparable between the two cohorts (11.6% in the DR cohort vs 9.6% in the IR cohort, OR 1.238 (95% CI 0.651 to 2.354), p=0.514). The rate of total perioperative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR 3.129 (95% CI 0.991 to 9.875), p=0.052). The rate of total follow-up strokes was slightly higher in the IR cohort (8.1% vs 6.6%, OR 0.799 (95% CI 0.374 to 1.709) p=0.563). CONCLUSION: Since both modalities showed comparable rates of overall total strokes, both modalities of revascularization can be performed depending on the patient's risk assessment.

Agricultural expansion and the ecological marginalization of forest-dependent people.

Agricultural expansion into subtropical and tropical forests causes major environmental damage, but its wider social impacts often remain hidden. Forest-dependent smallholders are particularly strongly impacted, as they crucially rely on forest resources, are typically poor, and often lack institutional support. Our goal was to assess forest-smallholder dynamics in relation to expanding commodity agriculture. Using high-resolution satellite images across the entire South American Gran Chaco, a global deforestation hotspot, we digitize individual forest-smallholder homesteads (n = 23,954) and track their dynamics between 1985 and 2015. Using a Bayesian model, we estimate 28,125 homesteads in 1985 and show that forest smallholders occupy much larger forest areas (>45% of all Chaco forests) than commonly appreciated and increasingly come into conflict with expanding commodity agriculture (18% of homesteads disappeared; n = 5,053). Importantly, we demonstrate an increasing ecological marginalization of forest smallholders, including a substantial forest resource base loss in all Chaco countries and an increasing confinement to drier regions (Argentina and Bolivia) and less accessible regions (Bolivia). Our transferable and scalable methodology puts forest smallholders on the map and can help to uncover the land-use conflicts at play in many deforestation frontiers across the globe. Such knowledge is essential to inform policies aimed at sustainable land use and supply chains.

The impact of hypertension on clinical outcomes in moyamoya disease: a multicenter, propensity score-matched analysis.

BACKGROUND: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive steno-occlusive changes in the internal carotid arteries, leading to an abnormal vascular network. Hypertension is prevalent among MMD patients, raising concerns about its impact on disease outcomes. This study aims to compare the clinical characteristics and outcomes of MMD patients with and without hypertension. METHODS: We conducted a multicenter, retrospective study involving 598 MMD patients who underwent surgical revascularization across 13 academic institutions in North America. Patients were categorized into hypertensive (n=292) and non-hypertensive (n=306) cohorts. Propensity score matching (PSM) was performed to adjust for baseline differences. RESULTS: The mean age was higher in the hypertension group (46 years vs. 36.8 years, p < 0.001). Hypertensive patients had higher rates of diabetes mellitus (45.2% vs. 10.7%, p < 0.001) and smoking (48.8% vs. 27.1%, p < 0.001). Symptomatic stroke rates were higher in the hypertension group (16% vs. 7.1%; OR: 2.48; 95% CI: 1.39-4.40, p = 0.002) before matching. After PSM, there were no significant differences in symptomatic stroke rates (11.1% vs. 7.7%; OR: 1.5; CI: 0.64-3.47, p = 0.34), perioperative strokes (6.2% vs. 2.1%; OR 3.13; 95% CI: 0.83-11.82, p = 0.09), or good functional outcomes at discharge (93% vs. 92.3%; OR 1.1; 95% CI: 0.45-2.69, p = 0.82). CONCLUSION: No significant differences in symptomatic stroke rates, perioperative strokes, or functional outcomes were observed between hypertensive and non-hypertensive Moyamoya patients. Appropriate management can lead to similar outcomes in both groups. Further prospective studies are required to validate these findings.

Identifying predictive factors for bowel control in patients with spina bifida and spinal cord injuries.

PURPOSE: This study aimed to assess our bowel management program (BMP) and identify predictive factors for bowel control in patients with Spina Bifida (SB) and Spinal Cord Injuries (SCI). Additionally, in patients with SB, we examined the impact of fetal repair (FRG) on bowel control. METHODS: We included all patients with SB and SCI seen in the Multidisciplinary Spinal Defects Clinic at Children's Hospital Colorado from 2020 to 2023. RESULTS: 336 patients included. Fecal incontinence was present in 70% and bowel control in 30%. All patients with urinary control also had bowel control. Fecal incontinence prevalence was higher in patients with ventriculoperitoneal (VP) shunt (84%), urinary incontinence (82%), and wheelchair users (79%) compared to those who did not need a VP shunt (56%), had urinary continence (0%) and non-wheelchair users (52%), respectively (p = < 0.001 in all three scenarios). After completing BMP, 90% remained clean for stool. There was no statistical significance when comparing bowel control in FRG with non-fetal repair group. CONCLUSIONS: Urinary continence predicts bowel control in patients with SB and SCI. Risk factors for fecal incontinence were the need for a VP shunt, urinary incontinence, and wheelchair usage. We did not find any positive impact of fetal repair on bowel and urinary control.

Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation.

PURPOSE: This study aimed to analyze our radiologically supervised bowel management program (RS-BMP) outcomes in patients with chronic idiopathic constipation (CIC). METHODS: A retrospective study was conducted. We included all patients with CIC who participated in our RS-BMP at Children´s Hospital Colorado from July 2016 to October 2022. RESULTS: Eighty patients were included. The average time with constipation was 5.6 years. Before our RS-BMP, 95% had received non-radiologically supervised treatments, and 71% had attempted two or more treatments. Overall, 90% had tried Polyethylene Glycol and 43% Senna. Nine patients had a history of Botox injections. Five underwent anterograde continence procedure, and one a sigmoidectomy. Behavioral disorders (BD) were found in 23%. At the end of the RS-BMP, 96% of patients had successful outcomes, 73% were on Senna, and 27% were on enemas. Megarectum was detected in 93% of patients with successful outcomes and 100% with unsuccessful outcomes (p = 0.210). Of the patients with BD, 89% had successful outcomes, and 11% had unsuccessful. CONCLUSION: Our RS-BMP has been proven to be effective in treating CIC. The radiologically supervised use of Senna and enemas was the appropriate treatment in 96% of the patients. BD and megarectum were associated with unsuccessful outcomes.

A Smart Agricultural System Based on PLC and a Cloud Computing Web Application Using LoRa and LoRaWan.

The increasing challenges of agricultural processes and the growing demand for food globally are driving the industrial agriculture sector to adopt the concept of 'smart farming'. Smart farming systems, with their real-time management and high level of automation, can greatly improve productivity, food safety, and efficiency in the agri-food supply chain. This paper presents a customized smart farming system that uses a low-cost, low-power, and wide-range wireless sensor network based on Internet of Things (IoT) and Long Range (LoRa) technologies. In this system, LoRa connectivity is integrated with existing Programmable Logic Controllers (PLCs), which are commonly used in industry and farming to control multiple processes, devices, and machinery through the Simatic IOT2040. The system also includes a newly developed web-based monitoring application hosted on a cloud server, which processes data collected from the farm environment and allows for remote visualization and control of all connected devices. A Telegram bot is included for automated communication with users through this mobile messaging app. The proposed network structure has been tested, and the path loss in the wireless LoRa is evaluated.

The relative importance of COVID-19 pandemic impacts on biodiversity conservation globally.

The COVID-19 pandemic has had an enormous impact on almost all aspects of human society and endeavor; the natural world and its conservation have not been spared. Through a process of expert consultation, we identified and categorized, into 19 themes and 70 subthemes, the ways in which biodiversity and its conservation have been or could be affected by the pandemic globally. Nearly 60% of the effects have been broadly negative. Subsequently, we created a compendium of all themes and subthemes, each with explanatory text, and in August 2020 a diverse group of experienced conservationists with expertise from across sectors and geographies assessed each subtheme for its likely impact on biodiversity conservation globally. The 9 subthemes ranked highest all have a negative impact. These were, in rank order, governments sidelining the environment during their economic recovery, reduced wildlife-based tourism income, increased habitat destruction, reduced government funding, increased plastic and other solid waste pollution, weakening of nature-friendly regulations and their enforcement, increased illegal harvest of wild animals, reduced philanthropy, and threats to survival of conservation organizations. In combination, these impacts present a worrying future of increased threats to biodiversity conservation but reduced capacity to counter them. The highest ranking positive impact, at 10, was the beneficial impact of wildlife-trade restrictions. More optimistically, among impacts ranked 11-20, 6 were positive and 4 were negative. We hope our assessment will draw attention to the impacts of the pandemic and, thus, improve the conservation community's ability to respond to such threats in the future.

La pandemia de COVID-19 ha tenido un impacto enorme sobre casi todos los aspectos de la sociedad humana y sus proyectos; el mundo natural y su conservación no han sido la excepción. Por medio de un proceso de consultas a expertos, identificamos y categorizamos en 19 temas y 70 subtemas las maneras en las que la biodiversidad y su conservación han sido o podrían ser afectadas mundialmente por la pandemia. Casi el 60% de los efectos han sido claramente negativos. Posteriormente, creamos un compendio de todos los temas y subtemas, cada uno con textos explicativos, para que en agosto de 2020 un grupo diverso de conservacionistas experimentados con conocimiento de todos los sectores y geografías evaluara cada subtema de acuerdo con su probabilidad de impactar sobre la conservación de la biodiversidad en todo el mundo. Los nueve subtemas con la clasificación más alta tienen un impacto negativo. Estos temas son, en orden de clasificación: los gobiernos dejando de lado al ambiente durante su recuperación económica, reducción de los ingresos basados en el turismo de fauna, incremento en la destrucción de hábitat, financiamiento reducido del gobierno, aumento de la contaminación por plásticos y otros desechos sólidos, debilitamiento de las regulaciones en pro de la naturaleza y su aplicación, incremento en la captura ilegal de animales, disminución de la filantropía y amenazas para la supervivencia de las organizaciones de conservación. La combinación de estos impactos representa un futuro preocupante lleno de amenazas para la conservación de la biodiversidad y una capacidad reducida para contrarrestarlas. El impacto positivo con la clasificación más alta, el 10, fue el impacto benéfico de las restricciones en el mercado de fauna. De manera más optimista, entre los impactos clasificados de los lugares del 11 al 20, seis fueron positivos y cuatro fueron negativos. Esperamos que nuestra evaluación enfoque la atención hacia los impactos de la pandemia y así mejore la habilidad de la comunidad conservacionista para responder a tales amenazas en el futuro. Importancia Relativa de los Impactos de la Pandemia de COVID-19 sobre la Conservación Mundial de la Biodiversidad.

The management of trigeminal neuralgia with triptans, a narrative review of the literature.

OBJECTIVE: The objective of this paper is to present a narrative review of the use of triptans in the treatment of trigeminal neuralgia (TN), as well as to outline possible therapeutic mechanisms of action. BACKGROUND: TN is a debilitating neuropathic disorder with a variety of surgical and pharmacological treatments currently available. Despite treatment being heavily individually tailored, some patients remain refractory to management. The use of triptans for the treatment of TN has been commented on in the literature, yet major trials showing their effectiveness are lacking. METHODS: A narrative review of current literature was conducted to identify published original research analyzing the usage of triptans in TN via PubMed and Google Scholar. RESULTS: Limited case reports and studies have been done to analyze the use of triptans for the treatment of TN. Despite the limited results, the studies that have been done show some promise for triptans as an alternative treatment, in particular to those with refractory TN. Given the incapacitating nature of TN, another alternative treatment may be of benefit to those patients and can help reduce its associated morbidity. CONCLUSION: Patients with refractory TN may find relief of symptoms from the use of triptans. Larger clinical trials are needed to help determine which patients would benefit from their use as well as specific dosing. Caution should be given regarding the long-term use of triptans, in particular for the typical patient population with TN.

Habitat destruction and overexploitation drive widespread declines in all facets of mammalian diversity in the Gran Chaco.

Global biodiversity is under high and rising anthropogenic pressure. Yet, how the taxonomic, phylogenetic, and functional facets of biodiversity are affected by different threats over time is unclear. This is particularly true for the two main drivers of the current biodiversity crisis: habitat destruction and overexploitation. We provide the first long-term assessment of multifaceted biodiversity changes caused by these threats for any tropical region. Focussing on larger mammals in South America's 1.1 million km2 Gran Chaco region, we assessed changes in multiple biodiversity facets between 1985 and 2015, determined which threats drive those changes, and identified remaining key areas for all biodiversity facets. Using habitat and threat maps, we found, first, that between 1985 and 2015 taxonomic (TD), phylogenetic (PD) and functional (FD) diversity all declined drastically across over half of the area assessed. FD declined about 50% faster than TD and PD, and these declines were mainly driven by species loss, rather than species turnover. Second, habitat destruction, hunting, and both threats together contributed ~57%, ~37%, and ~6% to overall facet declines, respectively. However, hunting pressure increased where TD and PD declined most strongly, whereas habitat destruction disproportionally contributed to FD declines. Third, just 23% of the Chaco would have to be protected to safeguard the top 17% of all three facets. Our findings uncover a widespread impoverishment of mammal species richness, evolutionary history, and ecological functions across broad areas of the Chaco due to increasing habitat destruction and hunting. Moreover, our results pinpoint key areas that should be preserved and managed to maintain all facets of mammalian diversity across the Chaco. More generally, our work highlights how long-term changes in biodiversity facets can be assessed and attributed to specific threats, to better understand human impacts on biodiversity and to guide conservation planning to mitigate them.

Functional outcome after cord detethering in fecally incontinent patients with anorectal malformations.

PURPOSE: Tethered cord (TC) occurs in 36% of patients with anorectal malformations (ARMs), for whom the benefit of detethering surgery remains unclear regarding bowel and/or bladder function. This study aimed to examine whether cord detethering could improve fecal and urinary incontinence in these patients. METHODS: This was a retrospective study of TC patients (>3 years old) with fecal incontinence and ARMs, who underwent detethering surgery between 2016 and 2020 and were followed up for at least 6 months. RESULTS: Of the 27 included patients, 55% had sacral ratios between 0.4 and 0.7, and in 37% it was < 0.4; the remaining 8% was over 0.7; 52% suffered from colonic hypermotility. After detethering surgery, partial fecal continence was achieved in five patients (18%); total fecal continence, in ten patients (37%); 12 (44%) remained fecally incontinent. Partial urinary continence was obtained in four cases (14%), and the number of patients with total urinary continence rose from 7 (25%) to 15 (55%). Lower extremity symptoms were also improved in 72% of the cases. Patients with colonic hypomotility were found to have a better functional outcome than those with colonic hypermotility (69% vs. 43%, respectively). CONCLUSION: Our study demonstrated that detethering surgery led to remarkably improved bowel and bladder control in ARM patients with fecal incontinence, which, surprisingly, was not associated with sacral ratio.

Optimization of the KNN Supervised Classification Algorithm as a Support Tool for the Implantation of Deep Brain Stimulators in Patients with Parkinson's Disease.

Deep Brain Stimulation (DBS) of the Subthalamic Nuclei (STN) is the most used surgical treatment to improve motor skills in patients with Parkinson's Disease (PD) who do not adequately respond to pharmacological treatment, or have related side effects. During surgery for the implantation of a DBS system, signals are obtained through microelectrodes recordings (MER) at different depths of the brain. These signals are analyzed by neurophysiologists to detect the entry and exit of the STN region, as well as the optimal depth for electrode implantation. In the present work, a classification model is developed and supervised by the K-nearest neighbour algorithm (KNN), which is automatically trained from the 18 temporal features of MER registers of 14 patients with PD in order to provide a clinical support tool during DBS surgery. We investigate the effect of different standardizations of the generated database, the optimal definition of KNN configuration parameters, and the selection of features that maximize KNN performance. The results indicated that KNN trained with data that was standardized per cerebral hemisphere and per patient presented the best performance, achieving an accuracy of 94.35% (p < 0.001). By using feature selection algorithms, it was possible to achieve 93.5% in accuracy in selecting a subset of six features, improving computation time while processing in real time.

Less Data Same Information for Event-Based Sensors: A Bioinspired Filtering and Data Reduction Algorithm.

Sensors provide data which need to be processed after acquisition to remove noise and extract relevant information. When the sensor is a network node and acquired data are to be transmitted to other nodes (e.g., through Ethernet), the amount of generated data from multiple nodes can overload the communication channel. The reduction of generated data implies the possibility of lower hardware requirements and less power consumption for the hardware devices. This work proposes a filtering algorithm (LDSI-Less Data Same Information) which reduces the generated data from event-based sensors without loss of relevant information. It is a bioinspired filter, i.e., event data are processed using a structure resembling biological neuronal information processing. The filter is fully configurable, from a "transparent mode" to a very restrictive mode. Based on an analysis of configuration parameters, three main configurations are given: weak, medium and restrictive. Using data from a DVS event camera, results for a similarity detection algorithm show that event data can be reduced up to 30% while maintaining the same similarity index when compared to unfiltered data. Data reduction can reach 85% with a penalty of 15% in similarity index compared to the original data. An object tracking algorithm was also used to compare results of the proposed filter with other existing filter. The LDSI filter provides less error ( 4 . 86 ± 1 . 87 ) when compared to the background activity filter ( 5 . 01 ± 1 . 93 ). The algorithm was tested under a PC using pre-recorded datasets, and its FPGA implementation was also carried out. A Xilinx Virtex6 FPGA received data from a 128 × 128 DVS camera, applied the LDSI algorithm, created a AER dataflow and sent the data to the PC for data analysis and visualization. The FPGA could run at 177 MHz clock speed with a low resource usage (671 LUT and 40 Block RAM for the whole system), showing real time operation capabilities and very low resource usage. The results show that, using an adequate filter parameter tuning, the relevant information from the scene is kept while fewer events are generated (i.e., fewer generated data).

Novel Resistance Measurement Method: Analysis of Accuracy and Thermal Dependence with Applications in Fiber Materials.

Material resistance is important since different physicochemical properties can be extracted from it. This work describes a novel resistance measurement method valid for a wide range of resistance values up to 100 GΩ at a low powered, small sized, digitally controlled and wireless communicated device. The analog and digital circuits of the design are described, analysing the main error sources affecting the accuracy. Accuracy and extended uncertainty are obtained for a pattern decade box, showing a maximum of 1 % accuracy for temperatures below 30 ∘ C in the range from 1 MΩ to 100 GΩ. Thermal analysis showed stability up to 50 ∘ C for values below 10 GΩ and systematic deviations for higher values. Power supply V i applied to the measurement probes is also analysed, showing no differences in case of the pattern decade box, except for resistance values above 10 GΩ and temperatures above 35 ∘ C. To evaluate the circuit behaviour under fiber materials, an 11-day drying process in timber from four species (Oregon pine-Pseudotsuga menziesii, cedar-Cedrus atlantica, ash-Fraxinus excelsior, chestnut-Castanea sativa) was monitored. Results show that the circuit, as expected, provides different resistance values (they need individual conversion curves) for different species and the same ambient conditions. Additionally, it was found that, contrary to the decade box analysis, V i affects the resistance value due to material properties. In summary, the proposed circuit is able to accurately measure material resistance that can be further related to material properties.

Comparative Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study.

BACKGROUND AND OBJECTIVES: Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD. METHODS: This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp). RESULTS: A total of 497 patients were included, including 90 who had bilateral revascularization and 407 who had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs 2.4%; odds ratio [OR] 4.41, 95% CI 1.73 to 11.19, P = .002) and higher rates of excellent functional outcomes (modified Rankin Scale 0-1) at discharge (92.2% vs 79.1%; OR 3.12, 95% CI 1.39 to 7, P = .006). After propensity score matching, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26). No significant differences were noted in modified Rankin scale 0 to 1 and 0 to 2 scores at discharge, National Institute of Health Stroke Scale at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, P = .15). CONCLUSION: This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.

Efficient Extraction of Deep Image Features Using a Convolutional Neural Network (CNN) for Detecting Ventricular Fibrillation and Tachycardia.

To safely select the proper therapy for ventricular fibrillation (VF), it is essential to distinguish it correctly from ventricular tachycardia (VT) and other rhythms. Provided that the required therapy is not the same, an erroneous detection might lead to serious injuries to the patient or even cause ventricular fibrillation (VF). The primary innovation of this study lies in employing a CNN to create new features. These features exhibit the capacity and precision to detect and classify cardiac arrhythmias, including VF and VT. The electrocardiographic (ECG) signals utilized for this assessment were sourced from the established MIT-BIH and AHA databases. The input data to be classified are time-frequency (tf) representation images, specifically, Pseudo Wigner-Ville (PWV). Previous to Pseudo Wigner-Ville (PWV) calculation, preprocessing for denoising, signal alignment, and segmentation is necessary. In order to check the validity of the method independently of the classifier, four different CNNs are used: InceptionV3, MobilNet, VGGNet and AlexNet. The classification results reveal the following values: for VF detection, there is a sensitivity (Sens) of 98.16%, a specificity (Spe) of 99.07%, and an accuracy (Acc) of 98.91%; for ventricular tachycardia (VT), the sensitivity is 90.45%, the specificity is 99.73%, and the accuracy is 99.09%; for normal sinus rhythms, sensitivity stands at 99.34%, specificity is 98.35%, and accuracy is 98.89%; finally, for other rhythms, the sensitivity is 96.98%, the specificity is 99.68%, and the accuracy is 99.11%. Furthermore, distinguishing between shockable (VF/VT) and non-shockable rhythms yielded a sensitivity of 99.23%, a specificity of 99.74%, and an accuracy of 99.61%. The results show that using tf representations as a form of image, combined in this case with a CNN classifier, raises the classification performance above the results in previous works. Considering that these results were achieved without the preselection of ECG episodes, it can be concluded that these features may be successfully introduced in Automated External Defibrillation (AED) and Implantable Cardioverter Defibrillation (ICD) therapies, also opening the door to their use in other ECG rhythm detection applications.

A Corneal Biomechanical Study Measured with a Scheimpflug Dynamic Analyser in Soft Contact Lens Wearers.

The aim of this study was to evaluate the biomechanical changes in the cornea after wearing soft contact lenses (CLs) in healthy myopic patients measured with a Corvis ST® (CST, Oculus Optikgeräte GmbH, Wetzlar, Germany) analyser. This prospective, cross-sectional, single-centre study was performed on twenty-two Caucasian patients aged between 19 and 24 years (20.64 ± 1.21 years) range. Five device-specific biomechanical parameters, the central corneal thickness (CCT), and biomechanically corrected intraocular pressure (bIOP) were measured prior to fitting and one month after CL wear. Differences between the means of the deflection amplitude ratio (DA Ratio) and the standard deviation of the DA Ratio (SD DA Ratio) pre- and post-CL wear were found to be significant (p value = 0.002 in both cases). Significant differences were found between pre- and post-CL wear values in CCT (p value = 0.013). For all other biomechanical measures, no significant differences were observed before and after treatment. A significant association was found between changes in bIOP and classification according to changes in Int. Radius (p value = 0.047) and SSI (p value = 0.026) standard deviations. The corneal biomechanical indices provided by CST demonstrate that the fitting of soft CLs is a safe optical compensation method for the stability of corneal stiffness. No significant differences were found pre- and post-CL wear in the assessment of bIOP.

A review of mechanical thrombectomy techniques for acute ischemic stroke.

Mechanical thrombectomy is established as standard of care in the management of acute ischemic stroke due to large vessel occlusion and evidence-based guidelines for mechanical thrombectomy have been defined. As research continues to further expand the eligibility criteria for thrombectomy and the number of thrombectomy procedures increase worldwide, there is also growing focus on innovation of thrombectomy devices, procedural techniques, and related outcomes. Thrombectomy primarily involves use of stent retrievers and distal aspiration techniques, but variations and different combinations of techniques have been reported. As this is a rapidly evolving area in stroke management, there is debate as to which, if any, of these techniques leads to improved clinical outcomes over another and there is a lack of data comparing them. In this review, currently published and distinct techniques of mechanical thrombectomy are described methodically along with illustrations to aid in understanding the subtle differences between the techniques. The perceived benefits of each variation are discussed.

The Effect of COVID-19 Vaccines on Stroke Outcomes: A Single-Center Study.

BACKGROUND: One of the defining narratives of the COVID-19 pandemic has been the acceptance and distribution of vaccine. To compare the outcomes of COVID-19 positive vaccinated and unvaccinated stroke patients. METHODS: This is a single-center retrospective study of COVID-19-vaccinated and unvaccinated stroke patients between April 2020 and March 2022. All patients presenting with stroke regardless of treatment modalities were included. National Institutes of Health Stroke Scale was used to assess stroke severity. The primary outcome was functional capacity of the patients at discharge. RESULTS: The study cohort comprised 203 COVID-19 positive stroke patients divided into 139 unvaccinated and 64 fully vaccinated patients. At discharge, the modified Rankin scale score was significantly lower in the vaccinated cohort (3[1-4] vs. 4[2-5], odds ratio = 0.508, P = 0.011). At 3 months of follow-up, the median modified Rankin scale score was comparable between both cohorts. CONCLUSIONS: Although vaccination did not show any significant difference in stroke patient outcomes on follow-up, vaccines were associated with lower rates of morbidity and mortality at discharge among stroke patients during the pandemic.

Key Factors in Early Diagnosis of Myopia Progression within Ocular Biometric Parameters by Scheimpflug Technology.

The aim of this study was to evaluate the relationship between myopia and ocular biometric variables using the Pentacam AXL® single rotation Scheimpflug camera. This prospective, cross-sectional, single-center study was performed in fifty Caucasian patients aged between 18 and 30 years (24.84 ± 3.04 years). The measured variables included maximum and minimum keratometry (K1 and K2, respectively), anterior chamber depth (ACD), corneal horizontal diameter or white to white (WTW), central corneal thickness (CCT), corneal asphericity (Q), and axial length (AXL). The tomographic and biometric measurements were considered optimal when the quality factor was greater than 95% according to the manufacturer's software instructions. The AXL presented a significant correlation with the spherical equivalent without cycloplegia (SE without CP), age at onset of myopia (r = -0.365, p = 0.012), mean keratometry (Km) (r = -0.339, p = 0.016), ACD (r = 0.304, p = 0.032), and WTW (r = 0.406, p = 0.005). The eyes with AXL higher than 25 mm had earlier onset; higher SE without CP, AXL, and Q; and a flatter Km. AXL is the biometric variable with the greatest influence on the final refractive state in the adult myopic eye. Ophthalmologists and optometric management must consider these biometric differences in order to identify the most appropriate correction techniques in each case. The use of the Pentacam AXL in ocular biometric measurement is effective, reproducible, and non-invasive.

Is colostomy closure without mechanical bowel preparation safe in pediatric patients? A randomized clinical trial.

BACKGROUND: Mechanical bowel preparation (MBP) is largely used worldwide prior to colostomy closure in children, although its benefits are questioned by scientific evidence, and its use can cause adverse reactions. We hypothesized that colostomy closure procedures in children are not associated with increased complications (surgical site infection [SSI] and anastomotic leakage) when performed without MBP. Thus, we conducted a noninferiority trial to compare the safety and efficacy of colostomy takedown with and without MBP. METHODS: A randomized noninferiority clinical trial was conducted at Hospital Infantil de Mexico in Mexico City from 2015 to 2019, in which the experimental group did not receive MBP prior to colostomy closure. A total of 79 patients were analyzed, and the primary outcomes were safety-related. Data were analyzed using the chi-squared test, Student's t-test, or Mann-Whitney U test as appropriate. RESULTS: The demographics in both groups were comparable. Statistical analysis revealed equivalence in safety outcomes (superficial SSI, 22.5% vs 15.3% p = 0.420; deep SSI, 7.5% vs 0% p = 0.081; reoperation, p = 0.320; intestinal occlusion, p = 0.986); no anastomotic leakage was observed in any group. Secondary outcomes such as fasting time and length of hospital stay after surgery were also similar between the groups. However, patients who received MBP were admitted 2 days before surgery. CONCLUSIONS: Our findings indicate that withholding MBP prior to colostomy takedowns in children is not associated with increased complications. Omitting MBP also leads to less discomfort and shortens hospital length of stay, suggesting that it has safer and more effective procedures. LEVEL OF EVIDENCE: Randomized controlled clinical trial with adequate statistical power.