Fifteen Years' Experience of Thoracoscopic Sympathetic Chain Interruption for Palmar Hyperhidrosis in Children and Adolescents: Evaluation of Different Techniques.

Background: Thoracoscopic sympathetic chain interruption is a definitive and effective therapy for severe primary palmar hyperhidrosis (PPH). Well-known methods include sympathectomy, sympathotomy, and clipping, but the occurrence of compensatory sweating offsets these methods. This study aims to report our experience with thoracoscopic sympathetic chain interruption in a large group of patients of age <18 years with PPH, focusing on surgical outcomes, complication rates, and patient satisfaction. Patients and Methods: This retrospective study included patients who underwent thoracoscopic sympathectomy, sympathotomy, or clipping for severe PPH between April 2008 and March 2023 at the Pediatric Surgery Department, Al-Azhar University Hospitals. Demographic and clinical data, operative steps, postoperative outcomes, complications, and patient satisfaction were reviewed from the patients' medical records. Results: During the 15-year study period, 420 children with PPH underwent bilateral thoracoscopic sympathetic chain interruption by either sympathectomy, sympathotomy, or clipping, with a sex ratio of 60% being females. The mean ages were 12 ± 3.48, 13 ± 2.45, and 13 ± 2.45 years, respectively. Sympathectomy was performed in 190 patients (45.2%), sympathotomy in 170 patients (40.5%), and clipping in 60 patients (14.3%). All patients had completed follow-up, with mean periods of ∼43 ± 5 months, 45 ± 3 months, and 42 ± 6 months, respectively. Complete palmar dryness was achieved in 405 patients (overall 96.4%) (97.8% after sympathectomy, 97.05% after sympathotomy, and 90% after clipping), whereas 2.1%, 2.9%, and 10% of patients experienced symptom recurrence, respectively, denoting significant statistical differences. Overall, 94 patients (22.4%) experienced compensatory sweating. Eventually, 409 patients (97.4%) were satisfied with the outcome, whereas 11 patients (2.6%) reported dissatisfaction, yet no significant differences found. Conclusion: The presented three modalities of thoracoscopic sympathetic chain interruption for PPH in children and adolescents are safe and effective, with overall very high postoperative satisfaction, despite a relatively high rate of compensatory sweating in sympathectomy group. Other major complications in this age population were scanty.

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study.

INTRODUCTION: The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. MATERIALS AND METHODS: This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. RESULTS: Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. CONCLUSION: TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.

Laparoscopic assisted dismembered pyeloplasty versus open pyeloplasty in UPJO with poorly function kidney in pediatrics.

BACKGROUND: The management of UPJO with poor function kidney, less than 10%, has been the subject of debate for more than a decade. Some authors have recommended nephrectomy, while others favor renal salvage (pyeloplasty). We report our experience with laparoscopic assisted pyeloplasty in pediatric patients with poorly functioning kidneys in comparison with an open approach. MATERIALS AND METHODS: A retrospective study was conducted to review 65 patients who were diagnosed with hydronephrosis and had impaired renal function due to UPJO. The study was conducted in the pediatric surgery departments of Al-Azhar University Hospital and Fattouma Bourguiba University Hospital of Monastir over a period of 20 years. Limited to pediatric patients with UPJO with ≥ Grade III hydronephrosis, antero-posterior pelvic diameter ≥ 20 mm, as well as a renal function equal to or less than 10%, was corrected by laparoscopic assisted or open pyeloplasty. RESULTS: There were 40 cases in group A who underwent laparoscopic assisted pyeloplasty, and 25 cases in group B who underwent open pyeloplasty. There were no complications or difficulties during the operation. The mean operative time in group A was 90 ± 12 min, while in group B, it was 120 ± 11 min. The renal assessment parameters significantly improved in both groups. In group A, the mean split renal function was 7.9 ± 1.3% and increased to 22.2 ± 6.3%. In group B, the mean split renal function was 8.1 ± 1.1% and increased to 24.2 ± 5.1%. However, the differences between both groups in terms of pre-operative and post-operative renal functions were statistically insignificant. CONCLUSION: Laparoscopic assisted pyeloplasty is an effective treatment for patients with poorly functioning kidneys, especially those with less than 10% function. While this surgical procedure requires shorter operative times, it yields functional outcomes that are comparable to open approach.

Evaluation of inactivated avian influenza virus and Newcastle disease virus bivalent vaccination program against newly circulated H5N8 and NDV strains.

Avian influenza virus (AIV) and Newcastle disease virus (NDV) are respiratory illness syndromes that have recently been detected in vaccinated flocks and are causing major financial losses in the chicken farming industry. The objective was to evaluate the efficacy of Valley Vac H5Plus NDVg7 vaccine in protecting chickens against the H5N8 and NDV strains that have recently been circulating in comparison with the efficacy of the commercially available bivalent H5+ND7 vaccine. In contrast to the H5+ND7 vaccine, which was made of genetically distinct H5N8/2018 clade 2.3.4.4b genotype group (G5), H9N2/2016, H5N1/2017, and genetically comparable NDV genotype VII 1.1/2019 of the recently circulating challenge viruses, the Valley Vac H5Plus NDVg7 vaccine consisted of the recently isolated (RG HPAI H5N1 AIV/2015 Clade 2.2.1.2, RG HPAIV H5N8/2020 Clade 2.3.4.4b genotype group 6 (G6), and NDV genotype VII 1.1/2012) which were genetically similar to challenged strains. To determine the effectiveness of the Valley Vac H5Plus NDVg7 vaccine, a total of 70-day-old commercial chicks were divided into 7 groups of 10 birds each. Groups (G1 and G4) received Valley Vac H5Plus NDVg7 vaccine. Groups (G2 and G5) groups received commercial H5+ND7 vaccine. While groups (G3 and G6) were kept nonvaccinated, and group (G7) was kept as a nonchallenged and nonvaccinated. After 3-wk post vaccination (WPV), groups G1, G2, and G3 were challenged with A/Duck/ Egypt/SMG4/2019(H5N8) genotype G6. On the other hand, groups G4, G5, G6 were challenged with NDV/EGYPT/18629F/2018 genotype VII 1.1 with an intranasal injection of 0.1 mL. Antibody titer was calculated at the first 3 wk after vaccination, and the viral shedding titer was calculated at 3-, 5-, and 7-days post challenge. Mortality and morbidity rates were monitored daily during the experiment, and for the first 10 d after the challenge, to provide an estimate of the protection rate. The results showed that a single dosage of 0.5 mL per bird of Valley Vac H5Plus NDVg7 vaccine provides 80% protection against both H5N8 and NDV, compared to the bivalent H5+ND7 vaccine, which provided 20 and 80% protection against H5N8 and NDV, respectively. In addition, 0.5 mL per bird of Valley Vac H5Plus NDVg7 vaccine produced a greater immune response against both viruses than commercial vaccination at 1 to 3 WPV with a significant difference at 1 WPV for H5N8 and a comparatively higher immune response for NDV. Furthermore, it reduced virus shedding of H5N8 on the third, fifth, seventh, and tenth days lower than H5+ND7 vaccine with a significant difference on the third day for H5N8 and relatively lower than bivalent H5+ND7 vaccine for NDV with a significant difference on the fifth day. The Valley vaccinated group demonstrated more tissue intactness compared to the commercially vaccinated group against the H5N8 challenge, however the bivalent commercially vaccinated group showed the similar level of tissue integrity against NDV. In conclusion, Valley Vac H5Plus NDVg7  that contains the  genetically similar strain to recently circulating challenged virus (H5N8 genotype G6) provided better protection with greater immune response and decreased the amount of virus shed against H5N8 genotype G6 and showed less histopathological alteration than the commercial bivalent H5+ND7 vaccine that contain genetically distinct (H5N8 genotype G5). However the Valley Vac H5Plus NDVg7 provided the same protection with relatively high immune response and  relatively decreased the amount of virus shed and showed equal tissue integrity than the commercial bivalent H5+ND7 vaccine against NDV genotype VII 1.1 that contain the same genotype of NDV genotype VII 1.1.

Generative adversarial networks in EEG analysis: an overview.

Electroencephalogram (EEG) signals have been utilized in a variety of medical as well as engineering applications. However, one of the challenges associated with recording EEG data is the difficulty of recording large amounts of data. Consequently, data augmentation is a potential solution to overcome this challenge in which the objective is to increase the amount of data. Inspired by the success of Generative Adversarial Networks (GANs) in image processing applications, generating artificial EEG data from the limited recorded data using GANs has seen recent success. This article provides an overview of various techniques and approaches of GANs for augmenting EEG signals. We focus on the utility of GANs in different applications including Brain-Computer Interface (BCI) paradigms such as motor imagery and P300-based systems, in addition to emotion recognition, epileptic seizures detection and prediction, and various other applications. We address in this article how GANs have been used in each study, the impact of using GANs on the model performance, the limitations of each algorithm, and future possibilities for developing new algorithms. We emphasize the utility of GANs in augmenting the limited EEG data typically available in the studied applications.

New [1,2,4]triazolo[4,3-c]quinazoline derivatives as vascular endothelial growth factor receptor-2 inhibitors and apoptosis inducers: Design, synthesis, docking, and antiproliferative evaluation.

In continuation of our previous efforts in the field of design and synthesis of vascular endothelial growth factor receptor (VEGFR)-2 inhibitors, a new series of [1,2,4]triazolo[4,3-c]quinazoline derivatives were designed and synthesized as modified analogs of some reported VEGFR-2 inhibitors. The synthesized compounds were designed to have the essential pharmacophoric features of VEGFR-2 inhibitors. Antiproliferative activities of the synthesized compounds were investigated against two tumor cell lines (HepG2 and HCT-116) using sorafenib as a positive control. Compound 10k emerged as the most promising antiproliferative agent with IC50 values of 4.88 and 5.21 µM against HepG2 and HCT-116 cells, respectively. Also, it showed the highest inhibitory activity against VEGFR-2 with an IC50 value of 53.81 nM compared to sorafenib (IC50 = 44.34 nM). Cell cycle analysis revealed that compound 10k can arrest HepG2 cells at both the S and G2/M phases. In addition, this compound produced a tenfold increase in apoptotic cells compared to the control. Furthermore, the effect of compound 10k on the expression level of BAX, Bcl-2, and caspase-3 was assessed. This compound caused a 3.35-fold increase in BAX expression levels and a 1.25-fold reduction in Bcl-2 expression levels. The BAX/Bcl-2 ratio was calculated to be 4.57, indicating a promising apoptotic effect. It also showed a significant increase in the level of caspase-3 (4.12-fold) compared to the control cells. In silico docking, absorption, distribution, metabolism, excretion, and toxicity, and toxicity studies were performed for the synthesized compounds to investigate their binding patterns against the proposed biological target (VEGFR-2) and to assess the drug-likeness characters.

Risk factors of penile resurfacing in re-operative hypospadias repair: A retrospective analytical study.

INTRODUCTION: In re-operative hypospadias repair, scarred urethral plate, and deficient unhealthy penile skin are usually problematic. Difficulties are not only in urethroplasty but also in penile skin coverage. Penile skin coverage after urethroplasty with good viable skin decreases the complication rate and increases the satisfaction with repair. Studies reporting variables that increase the risks of the need for penile resurfacing in re-operative hypospadias are lacking. OBJECTIVES: To determine the risk factors of the need for penile resurfacing techniques (PRSTs) in re-operative hypospadias. STUDY DESIGN: A retrospective analysis of the redo hypospadias cases operated in-between January 2010 and December 2020 was done. Surgical data of the previous repairs, the indications for intervention, and the penile shaft coverage techniques at the time of the last repair were collected and analyzed. Patients' records were reviewed and categorized into two main groups. Group one include patients with simple skin closure, and group two include patients in whom penile resurfacing was done. Univariate analysis and Stepwise logistic regression measured the risk factors of the need for penile resurfacing techniques. RESULTS: Out of 223 re-operative hypospadias, simple skin closure was done in 105 (group 1). Penile skin resurfacing (Byars flaps, Heineke-Mikulicz technique, and Z-Plasty) was in 55 (group 2a). In 63 patients (group 2b), scrotal flaps and skin grafts (split and full thickness) were the PRSTs. Patients ages, proximal hypospadias, number of prior surgery, one-stage repair, penile skin use in repair especially flap techniques, more than one complication in the same case, and unsatisfactory skin appearance increased the risk for PRSTs. Each previous repair increases the odds ratio of penile and non-penile resurfacing 1.9 and 3.2 folds respectively. One-stage repair increases odds of PRSTs 4 folds. DISCUSSION: We analyzed the risk factors of the need for penile resurfacing techniques in the re-operative hypospadias cases. Step-wise logistic regression showed that the number of previous repairs and one-stage repair are the independent risk factors of penile resurfacing. Also, it showed that the number of prior surgeries is the only independent risk factor for non-penile skin resurfacing. CONCLUSION: Number of previous repair is the independent risk factors of penile resurfacing and non-penile skin use in resurfacing. Previous repair in one-stage is an independent risk factor of the need for penile resurfacing.

Effect of changes in optic nerve elasticity on central retinal artery blood flow in patients with idiopathic intracranial hypertension.

PURPOSE: To assess changes in central retinal artery (CRA) blood flow by orbital color-coded Doppler ultrasonography in patients with idiopathic intracranial hypertension (IIH) and their relation with optic nerve (ON) elasticity assessed by shear wave elastography (SWE). METHODS: This study was carried out on 68 eyes of patients diagnosed with IIH and 32 eyes of healthy controls. The severity of papilledema in IIH patients was sub-classified into mild and moderate/severe groups. Color-coded Doppler was used to measure peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (Vmean) and pulsatility index (PI) of the CRA. RESULTS: PSV, Vmean, and SWE were significantly higher in patients with IIH than in controls (p = 0.001). The optimal cut-off values of PSV and Vmean for differentiating IIH patients from controls were 11.25 and 6.75 cm/s with AUC 0.81 and 0.785 respectively. AUC was 0.92 and accuracy 91% for combined PSV, Vmean and SWE differentiation between IIH patients and controls. PSV, Vmean and SWE were significantly different between mild versus moderate/severe papilledema (p = 0.001). PSV and Vmean were correlated with papilledema (r = 0.790 and 0.722 respectively) and SWE (r = 0.818 and 0.761 respectively). CONCLUSION: IIH is associated with decreased ON elasticity and reduced CRA blood flow. Individual and combined color-coded Doppler of the CRA and SWE help in diagnosis of IIH. CRA hemodynamic changes are correlated with papilledema severity and with the extent of biomechanical changes in the ON represented by SWE.

Combined accuracy of optic nerve sheath diameter, strain ratio, and shear wave elastography of the optic nerve in patients with idiopathic intracranial hypertension.

PURPOSE: This study assessed the combined accuracy of optic nerve sheath diameter (ONSD), strain ratio (SR), and shear wave elastography (SWE) of the optic nerve (ON) in patients with idiopathic intracranial hypertension (IIH). METHODS: This prospective study was carried out on both ONs of 34 consecutive patients diagnosed with IIH and 16 age- and sex-matched healthy volunteers. All of the study participants were women. The ONSD, SR, and SWE of the ON were measured. The severity of papilledema of IIH patients was sub-classified into mild papilledema and moderate/severe papilledema. RESULTS: The mean ONSD (5.6±1.1 mm), SR (0.7±0.1), and SWE (30.1±16.7 kPa) of the IIH patients were significantly different (P=0.001) from the ONSD (4.1±0.5 mm), SR (0.9±0.1), and SWE (8.2±3.4 kPa) of controls. The cutoff values of ONSD, SR, and SWE of the ON for differentiating IIH patients from controls were 5.45 mm, 0.8, and 10.3 kPa with areas under the curve (AUCs) of 0.91, 0.86, and 0.96 and accuracy values of 91%, 81%, and 93%, respectively. Combined SWE and ONSD and combined SWE, ONSD, and SR for differentiating IIH patients from controls revealed AUCs of 0.98 and 0.99 and accuracy values of 96% and 96%, respectively. ONSD, SR, and SWE showed significant differences between mild and moderate/severe papilledema (P=0.001). Papilledema was correlated with SWE (r=0.8, P=0.001), ONSD (r=0.4, P=0.001), and SR (r=-0.4, P=0.001). CONCLUSION: The combination of ONSD, SR, and SWE may be helpful for diagnosing IIH, and a good indicator of the degree of papilledema.

Spirulina platensis extract addition to semen extender enhances cryotolerance and fertilizing potentials of buffalo bull spermatozoa.

The objective of this study was to investigate the effect of Spirulina platensis extract (SPE) addition to the freezing extender on freezability, lipid peroxidation, ultrastructure alterations and fertilizing potentials of frozen-thawed buffalo bull spermatozoa. Semen samples were collected with artificial vagina from five adult fertile bulls and diluted with Tris-base extender containing SPE (1, 5, 10 and 20 µg/mL) or without SPE (control). Diluted semen was cooled to 4 °C throughout one hour and frozen in 0.25 mL straws: prior to being stored in liquid nitrogen. Cryopresreved spermatozoa were assessed for post-thawing sperm motility, viability, acrosomal integrity, ultrastructure changes, antioxidant activities, lipid peroxidation and fertility rate. The current results clearly indicated that adding 10µg/mL SPE to the freezing extender significantly improved (P< 0.05) post-thawing motility and decrease the percentage of acrosomal damage (51.67±6.02% and 16.33±1.46%, respectively) compared with the control (28.33±4.41% and 26.33±1.77%, respectively). Moreover, addition of 10 µg/mL SPE to the semen extender significantly diminished (P< 0.05) MDA concentration (10.66±2.40 nmol/109) compared with the control (22.66±4.26 nmol/109). Therefore, the present results revealed that addition of 10µgl/mL SPE to the freezing extender might improve semen quality and reduce cryodamage of the buffalo bull spermatozoa.

Rice straw application with different water regimes stimulate enzymes activity and improve aggregates and their organic carbon contents in a paddy soil.

Soil organic carbon plays considerable roles in binding soil particles together forming aggregates. Carbon (C) incorporated within these aggregates is thought to be microbially processed; thus, investigating changes in microbial activities i.e. dehydrogenase, urease, catalase and phosphatase enzymes may explain, to some extent, the dynamics and probably mechanisms responsible of formation of these aggregates. Since, soil water content (SWC) may take part in stimulating/lessening activities of organic matter decomposers; thus, this study aimed at investigating the effects of rice straw as a source of organic C in combination with variable SWC on bioaccumulation of C within different soil aggregate size fractions (2000-250, 250-53 and < 53 µm) and hence formation of these aggregates. To achieve these objectives, a pot experiment was conducted for 90 days, including five water levels i.e. maintaining a water head 1 cm above the soil surface (W1), 100% of the saturation percentage, SP (W2), 80% of SP (W3), 65% of SP (W4) and 50% of SP (W5), beside of two rates of applied rice straw i.e. 0 and 15 g kg-1 (w/w). Results revealed that application of rice straw at a rate of 15 g kg-1 increased the activities of dehydrogenase, urease, neutral phosphatase and catalase enzymes within the first 60 days after application; thereafter, activities of the first three enzymes decreased considerably. Likewise, formation of soil macro- (2000-250 µm) and micro-aggregates (250-53 µm) increased by the end of the experimental period. The highest concentrations of soil carbon were incorporated within soil macro-aggregate, whereas the least C content was found within the "silt + clay" fraction. Increasing SWC resulted in significant reductions in activities of the aforementioned enzymes and consequent reductions occurred in soil aggregation. Carbon content within aggregates sized <250 µm were significantly correlated with the percentage of these aggregates in soil. Thus, soil aggregation is thought to be the byproduct of an aerobic biosynthetic microbial process in which more stable hydrophobic organic C existed mainly in macropores. This process probably occurred within the first 60 days after RS application.

Pathogenesis and Evaluation of the Effects of Idiopathic Intracranial Hypertension on the Optic Nerves.

Idiopathic intracranial hypertension (IIH) is a clinical syndrome of raised intracranial pressure of unknown aetiology. Although papilloedema and visual alterations are among the most important manifestations of the disease, their pathophysiological mechanisms are not fully understood. We aim to review the up-to-date evidence regarding how the optic nerves are affected, the possible pathophysiology and the methods of their assessment.

Congenital short bowel syndrome: a rare cause of neonatal intestinal obstruction.

Congenital short bowel syndrome (CSBS) is an uncommon gastrointestinal disorder in which an unclear aetiology causes considerable intrauterine reduction in small bowel length. As a result of reduced absorptive intestinal length, chronic diarrhoea, vomiting, and consequently, failure to thrive are likely. We report a case of CSBS in a 26-day-old girl who had malrotation and a short bowel with a length of bowel from the pylorus to the ileocecal junction of approximately 40 cm. The patient underwent Ladd's procedure, but she is still dependent on parenteral nutrition.

Is Percutaneous Nephrolithotomy the Modality of Choice Versus Extracorporeal Shockwave Lithotripsy for a 20 to 30 mm Single Renal Pelvic Stone with ≤1000 Hounsfield Unit in Adults? A Prospective Randomized Comparative Study.

Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pelvic stone with a density ≤1000 HU. Patients and Methods: Eighty patients were prospectively randomized to receive either PNL or SWL during May 2017 to April 2019. The relevant demographic and clinical characteristics were compared. Results: The mean age in the PNL and SWL groups was 43.25 ± 15.16 and 44.18 ± 12.08 years, respectively. The mean stone sizes were 25.2 ± 3.9 and 24.6 ± 2.3 mm, respectively. The stone-free rate (SFR) was significantly different after the primary procedures (92.5% vs 37.5%, respectively; p < 0.04), but it was comparable after 3 months (97.5% vs 90%, respectively; p = 0.723), with a higher rate of auxiliary procedures after SWL (p = 0.017). On multivariate analysis, stone density was the only significant variable for the SFR in the SWL group (p = 0.004). Complications occurred in 27.5% and 22.5% of cases, respectively (p = 0.796). The mean costs of SWL (650.23 ± 424.74 United States Dollars [US$]) were significantly lower than those of PNL (1137.65 ± 224.43 US$; p < 0.0001). Conclusions: The SFRs for PNL and SWL were not significantly different after 3 months in the treatment of a 20 to 30 mm single renal pelvic stone with ≤1000 HU, although PNL provided a significantly higher rate after its primary procedure. SWL was significantly less costly, but it mandated a significantly higher number of auxiliary procedures than PNL.

Role of susceptibility-weighted imaging in patients with idiopathic intracranial hypertension.

PURPOSE: To evaluate the role of susceptibility-weighted imaging (SWI) in patients with idiopathic intracranial hypertension (IIH). MATERIALS AND METHODS: A prospective study was done on 55 patients with IIH who underwent SWI of the brain. The images were evaluated by two independent readers for cerebral microbleeds (CMBs) and the interobserver agreement between both readers was calculated. The graphic rating scale (GRS) for headache was calculated. RESULTS: CMBs were found in 16 (29%) of patients with IIH for both readers with excellent interobserver agreement (K = 0.8, p = 0.001). There was excellent interobserver agreement for location (K = 0.8, p = 0.001) and side of CMBs (K = 0.8, p = 0.001). There was good interobserver agreement for size of CMBs (K = 0.75, p = 0.002) and number (K = 0.6, p = 0.006). The mean GRS for headache in patients with CMBs (5.61 ± 1.3) was significantly higher (p = 0.02) than that of patients without CMBs (4.9 ± 0.8). CONCLUSION: We concluded that SWI can detect CMBs in patients with IIH especially in  patients with higher GRS for headache.

Dynamic time warping-based transfer learning for improving common spatial patterns in brain-computer interface.

OBJECTIVE: Common spatial patterns (CSP) is a prominent feature extraction algorithm in motor imagery (MI)-based brain-computer interfaces (BCIs). However, CSP is computed using sample-based covariance-matrix estimation. Hence, its performance deteriorates if the number of training trials is small. To address this problem, this paper proposes a novel regularized covariance matrix estimation framework for CSP (i.e. DTW-RCSP) based on dynamic time warping (DTW) and transfer learning. APPROACH: The proposed framework combines the subject-specific covariance matrix ([Formula: see text]) estimated using the available trials from the new subject, with a novel DTW-based transferred covariance matrix ([Formula: see text]) estimated using previous subjects' trials. In the proposed [Formula: see text], the available labelled trials from the previous subjects are temporally aligned to the average of the available trials of the new subject from the same class using DTW. This alignment aims to reduce temporal variations and non-stationarities between previous subjects' trials and the available trials from the new subjects. Moreover, to tackle the problem of regularization parameter selection when only a few trials are available for training, an online method is proposed, where the best regularization parameter is selected based on the confidence scores of the trained classifier on the upcoming first few labelled testing trials. MAIN RESULTS: The proposed framework is evaluated on two datasets against two baseline algorithms. The obtained results reveal that DTW-RCSP significantly outperformed the baseline algorithms at various testing scenarios, particularly, when only a few trials are available for training. SIGNIFICANCE: Impressively, our results show that successful BCI interactions could be achieved with a calibration session as small as only one trial per class.

Sacral neuromodulation for female pelvic floor disorders.

Objective: To systematically review available studies on the effectiveness and safety of sacral neuromodulation (SNM) in women with various pelvic floor disorders not responding to more conservative treatment, as SNM is indicated in such women. Methods: Data source: We did a systematic review through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from 1998 to 2018 in English using the keywords 'Sacral Neuromodulation' and 'Sacral Nerve Stimulation'. Study selection: Randomised controlled trials and prospective studies were selected, with a minimum sample size of 20 patients and ≥6 months of follow-up. Results: We identified 19 articles. A ≥50% reduction in symptoms qualifies the patient for a permanent implant. Several advances have been introduced into SNM to decrease the invasiveness of the procedure, including a smaller implantable pulse generator battery (improved comfort) and better localisation of the lead wire (improved outcome). The literature reports success for overactive bladder (OAB) to range between 56% and 68% (up to 80%). We report a 5-year therapeutic success rate of 67%. In our previous studies, 38% of our patients with urge urinary incontinence achieved complete continence at 60-months follow-up, with a therapeutic response rate of 57%. Effectiveness in patients with urinary retention and faecal incontinence are about 70% and 85%, respectively. Effectiveness in interstitial cystitis/bladder pain syndrome appears to be lower compared with OAB. Conclusion: SNM is a safe and effective therapy for women with various pelvic floor disorders. Abbreviations: BONT: botulinum toxin; FDA: USA Food and Drug Administration; FS: Fowler's syndrome; FI: faecal incontinence; IC/BPS: interstitial cystitis/bladder pain syndrome; ICIQ-OABqol: International Consultation on Incontinence Modular Questionnaire-Overactive Bladder Symptoms Quality of Life; INS: implantable neurostimulator; OAB: overactive bladder; PET: positron emission tomography; PNE: peripheral nerve evaluation; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PTNM: posterior tibial nerve modulation; PVR: post-void residual urine; QoL: quality of life; RCT: randomised controlled trial; SNM: sacral neuromodulation; (U)UI: (urgency) urinary incontinence.

Update on vesicovaginal fistula: A systematic review.

Objective: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries; diagnosis; intraoperative prevention; and management. Methods: We conducted a systematic review of the literature on VVF through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted from 1985 to 2018 in English, using the keywords 'fistula' and 'vesicovaginal fistula'. Prospective studies were preferred; however, retrospective studies and case reports were used when no prospective studies were available. All authors' extracted relevant data related to the proposed review of VVF and carefully examined collected articles. Results: In all, 116 relevant articles were identified and 43 articles were included in this systematic review. The outcome of surgical reconstruction was >90%, but the outcome may be suboptimal in radiotherapy (RT)-induced VVFs. Absolute indications for an abdominal approach included: ureteric involvement, the need for concomitant bladder augmentation, severe vaginal stenosis, and an inability to tolerate the dorsal lithotomy position (e.g. due to muscular spasticity). Typically, it was recommended to wait at least 3 months to allow the inflammatory response to subside before definitive surgery. Early fistula repair can be performed in the absence of infection and in patients who have not received pelvic RT. Conclusion: VVF is rare in developed countries. Surgical treatment is the primary method of repair. The outcome of surgical reconstruction exceeds 90%, but the outcome may be suboptimal in RT-induced VVFs. Abbreviations: PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RT: radiotherapy; (S)UI: (stress) urinary incontinence; UVF: ureterovaginal fistula; VVF: vesicovaginal fistula.

Weighted Transfer Learning for Improving Motor Imagery-Based Brain-Computer Interface.

One of the major limitations of motor imagery (MI)-based brain-computer interface (BCI) is its long calibration time. Due to between sessions/subjects variations in the properties of brain signals, typically, a large amount of training data needs to be collected at the beginning of each session to calibrate the parameters of the BCI system for the target user. In this paper, we propose a novel transfer learning approach on the classification domain to reduce the calibration time without sacrificing the classification accuracy of MI-BCI. Thus, when only few subject-specific trials are available for training, the estimation of the classification parameters is improved by incorporating previously recorded data from other users. For this purpose, a regularization parameter is added to the objective function of the classifier to make the classification parameters as close as possible to the classification parameters of the previous users who have feature spaces similar to that of the target subject. In this paper, a new similarity measure based on the Kullback-Leibler divergence (KL) is used to measure the similarity between two feature spaces obtained using subject-specific common spatial patterns (CSP). The proposed transfer learning approach is applied on the logistic regression classifier and evaluated using three datasets. The results showed that compared with the subject-specific classifier, the proposed weighted transfer learning classifier improved the classification results, particularly when few subject-specific trials were available for training (p < 0.05). Importantly, this improvement was more pronounced for users with medium and poor accuracy. Moreover, the statistical results showed that the proposed weighted transfer learning classifier performed significantly better than the considered comparable baseline algorithms.

Long term effects of corticosteroids in multiple sclerosis in terms of the "no evidence of disease activity" (NEDA) domains.

BACKGROUND: Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the central nervous system (CNS) that usually is clinically characterized by multiple subacute relapses and remissions. The established therapeutic strategies include intravenous methylprednisolone (IV-MP) for treatment of relapses and immunomodulatory or immunosuppressive treatment to prevent new relapses and progression of disability. Despite not being one of the recommended immunomodulatory or immunosuppressive treatments, monthly IV-MP is frequently seen in clinical practice especially in the low income developing countries. OBJECTIVES: To review the evidences for the possible disease modifying potential of corticosteroids in the treatment of MS in terms of the NEDA 3 domains. MATERIALS & METHODS: Available literature from PubMed search and personal experiences on corticosteroid treatment in multiple sclerosis were reviewed. RESULTS: There is some evidence that pulsed treatment with methylprednisolone have beneficial long-term effects on relapse rate, MRI findings and disability progression. CONCLUSION: More data is needed to determine long-term disease modifying effects of corticosteroids. The findings of this study suggest that, perhaps, regular pulse glucocorticoid treatment may have important long-term consequences (beneficial) for patients with MS and it may achieve the NEDA target. Certainly, the magnitude of the reported effects deserves further investigation in both relapsing and progressive MS populations.