Cognitive impairment in asymptomatic carotid artery stenosis is associated with abnormal segments in the Circle of Willis.

OBJECTIVE: Our group has previously demonstrated that patients with asymptomatic carotid artery stenosis (ACAS) demonstrate cognitive impairment. One proposed mechanism for cognitive impairment in patients with ACAS is cerebral hypoperfusion due to flow-restriction. We tested whether the combination of a high-grade carotid stenosis and inadequate cross-collateralization in the Circle of Willis (CoW) resulted in worsened cognitive impairment. METHODS: Twenty-four patients with high-grade (≥70% diameter-reducing) ACAS underwent carotid duplex ultrasound, cognitive assessment, and 3D time-of-flight magnetic resonance angiography (MRA). The cognitive battery consisted of nine neuropsychological tests assessing four cognitive domains: learning and recall, attention and working memory, motor and processing speed, and executive function. Raw cognitive scores were converted into standardized T-scores. A structured interpretation of the MRA images was performed with each segment of the CoW categorized as being either normal or abnormal. Abnormal segments of the CoW were defined as segments characterized as narrowed or occluded due to congenital aplasia or hypoplasia, or acquired atherosclerotic stenosis or occlusion. Linear regression was used to estimate the association between the number of abnormal segments in the CoW, and individual cognitive domain scores. Significance was set to p<0.05. RESULTS: The mean age of the patients was 66.1 + 9.6 (mean + SD) years and 79.2% (n=19) were male. A significant negative association was found between the number of abnormal segments in the CoW and cognitive scores in the learning and recall (ß = -6.5, p = 0.01), and attention and working memory (ß = -7.0, p = 0.02) domains. There was a trend suggesting a negative association in the motor and processing speed (ß = -2.4, p = 0.35) and executive function (ß = -4.5, p = 0.06) domains that did not reach significance. CONCLUSION: In patients with high-grade ACAS, the concomitant presence of increasing occlusive disease in the CoW correlates with worse cognitive function. This association was significant in the learning and recall and attention and working memory domains. While motor and processing speed and executive function also declined numerically with increasing abnormal segments in the CoW, the relationship was not significant. Since flow restriction at a carotid stenosis compounded by inadequate collateral compensation across a diseased CoW worsens cerebral perfusion, our findings support the hypothesis that cerebral hypoperfusion underlies the observed cognitive impairment in patients with ACAS.

A randomized double-blind, placebo-controlled trial to evaluate the safety and efficacy of live Bifidobacterium longum CECT 7347 (ES1) and heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in participants with diarrhea-predominant irritable bowel syndrome.

To determine the efficacy of the probiotic Bifidobacterium longum CECT 7347 (ES1) and postbiotic heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in improving symptom severity in adults with diarrhea-predominant irritable bowel syndrome (IBS-D), a randomised, double-blind, placebo-controlled trial with 200 participants split into three groups was carried out. Two capsules of either ES1, HT-ES1 or placebo were administered orally, once daily, for 84 days (12 weeks). The primary outcome was change in total IBS-Symptom Severity Scale (IBS-SSS) score from baseline, compared to placebo. Secondary outcome measures were stool consistency, quality of life, abdominal pain severity and anxiety scores. Safety parameters and adverse events were also monitored. The change in IBS-SSS scores from baseline compared to placebo, reached significance in the ES1 and HT-ES1 group, on Days 28, 56 and 84. The decrease in mean IBS-SSS score from baseline to Day 84 was: ES1 (-173.70 [±75.60]) vs placebo (-60.44 [±65.5]) (p < .0001) and HT-ES1 (-177.60 [±79.32]) vs placebo (-60.44 [±65.5]) (p < .0001). Secondary outcomes included changes in IBS-QoL, APS-NRS, stool consistency and STAI-S and STAI-T scores, with changes from baseline to Day 84 being significant in ES1 and HT-ES1 groups, compared to the placebo group. Both ES1 and HT-ES1 were effective in reducing IBS-D symptom severity, as evaluated by measures such as IBS-SSS, IBS-QoL, APS-NRS, stool consistency, and STAI, in comparison to the placebo. These results are both statistically significant and clinically meaningful, representing, to the best of the authors' knowledge, the first positive results observed for either a probiotic or postbiotic from the same strain, in this particular population.

What is already known on this topicIBS is a chronic functional gastrointestinal disorder characterized by abdominal pain, bloating and abnormalities in stool frequency or form. The gut microbiota of people living with IBS differs markedly to the microbiota of healthy individuals. Gut microbiota may play a key role in IBS aetiology and IBS symptoms may be alleviated by modulating the gut microbiota. Several proposed ways to modulate gut health include normalizing the gut microbiota, preventing the overgrowth of pathogenic bacteria, modulating visceral afferent pathways, and enhancing intestinal barrier function. However, significant heterogeneity between studies, study quality and population, study design and concerns about sample size have limited national and supranational bodies from recommending probiotics for IBS. Further well-powered, randomized, repeatable and controlled trials are warranted.What this study addsThe results of this study substantially contribute to the IBS research field, firstly by providing clinically meaningful and statistically significant results from a rigorous, well designed randomized, placebo-controlled trial and secondly, by exploring the use of postbiotics in IBS, an area of research still in its infancy. Probiotic (ES1) and postbiotic (HT-ES1) supplementation significantly reduced IBS symptom severity scores compared to placebo. This study met primary and secondary outcomes and strongly suggest that ES1 and HT-ES1 could be beneficial in the management of IBS.How this study might affect research, practice, or policyThis study adds to the current evidence base, supporting the use of probiotic/postbiotics for IBS. This research could be used to inform health professionals about using probiotics in IBS and help improve the quality of life and wellbeing for people living with the condition.

Diagnostic and interventional neuroradiology training in the UK: a national trainee survey.

AIM: Training structure in neuroradiology can be variable, nationally and internationally. Globally, there is a trend towards standardised training pathways, curricula and targeted competencies. Currently, there is limited understanding of the structure of neuroradiology training in the UK. This survey aims to: [1] identify different contemporary models of neuroradiology training in the UK, [2] compare UK trainees' commitments against national and international standards, and [3] understand whether career expectations match the predicted future demands of neuroradiologists. MATERIALS AND METHODS: A survey was developed after consultation with BSNR and UKNG representatives. The eligibility criteria included current neuroradiology trainees in the UK with at least 3 months of experience or had recently completed neuroradiology training, but less than 18 months had elapsed since achieving a certificate of completion of training. RESULTS: A total of 50 trainees responded to the survey; 26 (52%) diagnostic neuroradiologists (DNRs) and 24 (48%) interventional neuroradiologists (INRs) with an overall mean age of 33 years. The mean duration of training at the time of survey was 18 months. The survey details trainee demographics, experience at work, research and teaching commitments and future goals. CONCLUSION: Most respondents are satisfied with their training and 90% want to remain in the UK after completion of training. There is room for improvement but the future of training and working in neuroradiology seems promising internationally, with ever-evolving techniques and developments. ADVANCES IN KNOWLEDGE: Advances in knowledge: This study evaluates neuroradiology training in the UK to enhance the training of future neuroradiologists, and safeguard the future of the speciality.

Survival of pre-formed zirconia crowns in primary teeth: a prospective practice-based cohort study.

BACKGROUND: This study aimed to investigate the (1) survival probabilities of prefabricated zirconia crowns (PZCs) placed on primary teeth and (2) identify demographic and tooth-related factors that might affect survival probability. METHODS: This study prospectively followed children treated under general anaesthesia by a single practitioner between 2012 and 2020. Demographic variables including the age at treatment, gender and tooth-related variables including FDI tooth number, crown size used and any procedural complications at postoperative reviews were collected. RESULTS: A total of 155 children involving 319 teeth with PZCs were followed up between 12 and 78 months postoperatively with a mean of 38 months. Of the 319 crowns followed, five failures were observed in three patients requiring extraction. Other procedural complications noted included fracture (n = 3), overhangs (n = 3), internal resorption (n = 5) and 24% of crowns showed signs of radiographic changes on postoperative radiographs when these were taken. Age at treatment, tooth type and need for pulp therapy were not statistically associated with clinical success (P > 0.1). CONCLUSIONS: PZCs provide an aesthetic and durable solution in the management of children with early childhood caries. This study shows very good clinical success and survival extending up to 78 months for PZCs placed on primary teeth under general anaesthesia.

Reporting of coronary artery calcification on chest CT studies in patients with interstitial lung disease.

AIM: To evaluate the prevalence of coronary artery calcification (CAC) on non-contrast computed tomography (CT) of the thorax in patients with interstitial lung disease (ILD), assess consistency of CAC reporting and assess incidence of subsequent cardiac events. MATERIALS AND METHODS: Patients with known interstitial lung disease who underwent a CT thorax over a 2-year period were retrospectively reviewed. Presence of CAC was assessed using a visual scale for CAC reporting and graded as mild, moderate, or severe by two cardiothoracic radiologists. CT reports were reviewed to determine if presence of CAC had been described. Electronic medical records were reviewed for any subsequent cardiothoracic events from the date of the CT thorax to present. RESULTS: 254 patients were included in the analysis (54.7% men; mean age 59.9 yo). 43.7% had CAC on their CT thorax; however, in 87.3% of those, reports did not comment on its presence. 8 patients had cardiac events; 7 of them had CAC on CT although only in 1 case this was reported. Global CAC and LAD CAC Patients with cardiac events had a significantly higher global CAC (p=0.016) and LAD CAC (p=0.048) when compared to patients without. CONCLUSION: We demonstrated a high prevalence of CAC in ILD patients and its significant association with adverse cardiac events. Unfortunately, CAC on CT thorax is still largely unreported. As per recent BSCI/BSCCT and BSTI guidelines, reporting of CAC should become part of routine practice, as may prompt prevention and impact on patients outcome.

AN IN-DEPTH ASSESSMENT OF THE TUMOR'S IMPACT ON SARCOPENIA.

Loss of muscle mass is a typical symptom of cancer and it is strongly correlated with poor prognosis. Cancer-related Sarcopenia is unresponsive to conventional dietary changes and exercise, in contrast to age-associated muscle atrophy. This particular type of weakness differs from different kinds of muscle loss in that it is triggered by a number of interrelated mechanisms, notably inflammatory processes, abnormal metabolic processes, proteolysis, and autophagy. This research is to examine evidence supporting the theory that tumors have a causal role in causing muscular atrophy. It seeks to investigate the precise regulators that the tumour generates and how they affect the processes that result in muscle waste. The evaluation looks for new directions for further studies and medical treatments. The analysis is based on a thorough examination of the scientific literature and research that shows how tumor and muscle atrophy are related. It concentrates on studies that clarify the numerous strategies by which malignancies cause the loss of muscle. This article highlights particular mechanisms by which these tumor-derived substances affect the development of muscle loss, including inflammatory processes, metabolic disturbance, proteolysis, and autophagy. The discovery of such targets offers hope for the creation of efficient treatment strategies that can enhance the long-term outlook and quality of life of cancer sufferers who are experiencing muscle loss.

UNDERSTANDING THE ADAPTATION AND SENSITIVITY OF THE MICROBIOME: MICROBIAL RESILIENT AND HUMAN WELL-BEING.

The term microbiome describes the assortment of microbes that dwell in and on a person's body, particularly in the gut, comprising fungi, bacteria, infectious agents and additional microbes. According to research, numerous elements of human well-being, such as digestion, immunological response and psychological well-being, have been linked to the microbiome. Preserving human wellness requires knowledge of the microbiome's stability and how it reacts to perturbations. According to preliminary research, adults' microbial ecosystems are considered stable with no signs of significant disturbances. This stability is not preserved by inertia and the system's interaction with restorative forces keeps the processes stable. Short antibiotic doses can result in quick and substantial microbiome alterations. However, there is confirmation that the taxonomic structure of the microbiome has at least recovered after such disruptions. The effect of antibiotics is individualized and can be altered by earlier exposure to a similar drug, which is a crucial aspect to remember. These results suggest that the individual's microbiome has adaptable qualities. Examining the microbiome's reactions to perturbations might be helpful in the prediction of potential instabilities and illness by revealing important features of function, microbial connections, and important species in the native microbiota. This information can benefit the management of the individual microbial community and the promotion of better health conditions.

EXPLORING CLINICAL VARIATIONS AND CO-MORBID TRENDS IN PD-MCI GROUPS.

Parkinson's Disease in Mild Cognitive Impairment (PD-MCI) is a complex condition characterized by a variety of cognitive problems that coexist with the physical symptoms of Parkinson's disease (PD). This study aims to examine the different medical indicators and associated tendencies among different PD-MCI groups. We investigated 132 people who had been given PD-MCI diagnoses. Utilizing SPSS, statistical evaluations are carried out. In overall PD-MCI variants, this investigation found that visuospatial ability and attentional/executive performance are the most impaired cognitive areas. It was also noticed that distinct PD-MCI groups had variances in their neurological characteristics, in multi domain amnesia (Non-Memory) PD-MCI patients exhibiting especially severe issues with unstable posture and walking. The intricacy of PD- Mild Cognitive Impairment (MCI) is highlighted by those results, which also imply that the interplay between mental and physical signs may be controlled by a number of interrelated factors, such as particular cognitive areas, brain surfaces, and the general level of cognitive impairment.

EXPLORING MEDICAL STUDENTS' COMPETENCY IN UNDERSTANDING PRIMARY IMMUNODEFICIENCY DISEASES IN INDIA.

Primary Immunodeficiency Disease (PID) represents a class of diverse illnesses marked by compromised immune system performance. For better patient outcomes, PIDs must be diagnosed and treated quickly. Medical graduates are essential to the detection and treatment of these illnesses. The purpose of this study was to evaluate medical students' knowledge about PIDs in different Indian medical colleges. To perform this analytical investigation, college students from Maharashtra-area universities were enlisted between March and April of 2023. The participants received a questionnaire from mediators from every institution. Of the 500 students in the study, 66% were between the ages of 22 and 24 and 52% were female. Their understanding ratings had an average of 16.3±6.2 and varied between 4 and 32. A set of students classified as below average (86%) and a mean/above average (14%), were separated among the students. The largest percentage of above-average knowledge was demonstrated by VI-year participants (p<0.05). This investigation emphasizes how critical it is to provide focused educational activities to improve medical students' comprehension of PIDs in India.

THE CORNEAL ENDOTHELIUM IN OCULAR SURFACE DISEASE AND GLAUCOMA: MECHANISMS OF DYSFUNCTION AND TREATMENT STRATEGIES.

To determine risk factors and the overall incidence of ocular surface disorders in a cohort of long-term glaucoma patients. Utilizing simple clinical tools, cross-sectional observational research were constructed to evaluate ocular surface problems and indicators. Using a four-grade scale, ten queries regarding symptoms and indications on the cornea's surface were used to create an OSD severity score. The patients were divided into three groups: A, B, and C, depending on the result. The variables that increase the incidence of surface sickness were identified using a multinomial logistic regression. Five hundred and twenty patients made up the total population. According to the multivariate analysis, the patient's age, the number of daily eyedrops, any previous changes in topical treatment for ocular intolerance, intraocular pressure, and degree of glaucoma were all connected with the severity of ocular surface illness. Ocular surface disorders are frequently developed by patients getting treatment for primary open-angle glaucoma or ocular hypotension. which are less prevalent and serious in geriatric patients because their use greater drugs and have greater advanced glaucoma.

NEUROPLASTICITY AND BRAIN STIMULATION: DEVELOPING INTERVENTIONS TO PROMOTE RECOVERY FROM STROKE AND TRAUMATIC BRAIN INJURY.

This article's purpose is to explore how "non-invasive brain stimulation" (NBS) can be used to treat "traumatic brain injury" (TBI) and promote neuroplasticity. Along with the pathophysiological processes that occur after a TBI, "transcranial direct current stimulation" (tDCS) and "transcranial magnetic stimulation" (TMS) are described. These processes are based on a study of the relevant literature. Individualized treatment plans are required because the pathophysiological processes that result from TBI change over time. Given their neurophysiological effects, TMS and tDCS may be used to (a) significant suppression of post-traumatic cerebral hyper excitability; (b) control synaptic plasticity over the long run to prevent unfavorable outcomes; and (c) in addition to other forms of treatment such as physical and behavioral, assist some neural networks to reorganize and consolidate their learning. These treatments have the potential to reduce the disabling symptoms of brain injury.Animal and human research show that NBS may help reduce the severity of injuries and increase plastic changes in lesioned brain tissue, both of which are necessary for the successful acquisition of new knowledge and the restoration of lost functions. However, at present, this evidence is mostly speculative. The relevance of NBS in TBI, further elucidating its therapeutic benefits, and defining appropriate stimulation levels all need investigations in TBI patients due to safety concerns.

THE GUT-BRAIN AXIS: IMPLICATIONS FOR NEUROLOGICAL DISORDERS, MENTAL HEALTH, AND IMMUNE FUNCTION.

A gut-brain axis (GBA) has a long history of conceptual development. Intestinal dysbiosis has now been recognized as a key player in the development of adult neurodevelopmental disorders, obesity, and inflammatory bowel disease. Recent developments in metagenomics suggest those nutrition and gut microbiotas (GM) are important regulators of the gut-brain communication pathways that cause neurodevelopmental and psychiatric problems in adulthood. Intestinal dysbiosis and neurodevelopmental disease outcomes in preterm newborns are being linked by recent research. Recent clinical investigations demonstrate that in critical care units, intestinal dysbiosis occurs before late-onset newborn sepsis and necrotizing enterocolitis. Strong epidemiologic data also shows a connection between necrotizing enterocolitis and extremely low birth weight babies' long-term psychomotor impairments and late-onset neonatal sepsis. The GBA theory suggests that intestinal bacteria may indirectly affect preterm newborns' developing brains. In this review, we emphasize the structure and function of the GBA and discuss how immune-microbial dysfunction in the gut affects the transmission of stress signals to the brain. Preterm babies who are exposed to these signals develop neurologic disorders. Understanding neuronal and humoral communication through the GBA may provide insight into therapeutic and nutritional strategies that may enhance the results of very low-birth-weight babies.

LIVER FIBROSIS: PATHOPHYSIOLOGY, DIAGNOSIS, AND EMERGING THERAPEUTIC TARGETS FOR A COMMON COMPLICATION OF CHRONIC LIVER DISEASES.

Fibrosis of the liver, which can be caused by either viral or chemical chronic liver illnesses, is a serious issue for the world's health. Collagen is crucial for the development of the illness and the possibility of developing hepatocellular carcinoma (HCC), which is linked to the progression of liver damage. Although there are various mechanisms for acute liver injury and diseases-specific cells response, almost all of fatty liver aetiologies share similar trends in the development of fibrous liver damage. The scientific community's knowledge of the fundamental causes of fibrosis of the liver has undergone a significant shift during the last ten years. It has been shown that the fundamental trigger, such as the control or management of an infectious disease, can be eradicated or eliminated in order to reverse liver fibrosis. Reversing frequently occurs prematurely or too rarely, particularly in severe fibrosis, to avoid possibly fatal effects. Therefore, there is an urgent need for anti-fibrotic medications to halt the progression of liver damage and the appearance of HCC. Even though various anti-fibrotic medication options have shown strong anti-fibrotic effects in lab animals, research studies have only seen a small amount or none of these advantages. There is not an approved remedy for the condition as a result. In this article, we give a general overview of the physiological and molecular origins of collagen in chronic liver disease and investigate how these causes can impact the quickly developing field of anti-fibrotic treatments.

THE MICROBIOME AND METABOLIC DISORDERS: THE LINK BETWEEN THE GUT MICROBIOTA AND METABOLIC SYNDROME.

The diverse population of microbes that live in our digestive system, known as the gut microbiota, remains essential for many physiological processes. It plays a role in obtaining energy from food and controls both regional and overall immunity. In addition, changes in the microbiota of the digestive tract are connected to the emergence of an extensive variety of illnesses, such as cancer, gastrointestinal problems, and metabolic disorders. From a metabolic perspective, the gut microbiota can affect processes like lipid accumulation, lipopolysaccharide satisfied, and short-chain fatty acid synthesis, all of which have an effect on food intake, inflammatory reactions, and insulin signaling. Prebiotics, probiotics, specialized anti-diabetic medications, and faecalmicrobiota implantation are a few of the ways that have been discovered to alter the gut microbiota; each has a different influence the human body's metabolism and the emergence of metabolic disorders. These therapies have been reported to be therapeutic strategies for enhancing general wellness and reestablishing a balanced gut flora.

PSORIASIS PATHOGENESIS: INSIGHTS FROM TRANSCRIPTOMICS AND PROTEOMICS STUDIES OF KERATINOCYTES.

Complex inflammatory skin disease with autoimmune roots is psoriasis. This disease affects various cell types, and the underlying signaling processes are complicated yet not fully understood. Extensive psoriatic lesions' proteome and transcriptome of several researches were combined to understand disease's underlying biological mechanisms. According to a network-based study, both transcriptomics and proteomics control were comparable. They discovered many pathways of signaling previously undiscovered and possibly involved in overexpression of psoriasis genes. They also found a collection of transcription factors in charge of this process. The functional overlap between the results of transcriptomics and proteomics was also examined. There created a network-based method for combining the analysis of many high-throughput data sources. Proteomic and transcriptome studies of psoriasis data sets demonstrated regulatory flexibility apparatus underpinning disease and complementary relationships within two cellular organizations.

CLINICAL AND OBJECTIVE TEST CHARACTERISTICS OF VESTIBULAR MIGRAINE: IMPLICATIONS FOR DIAGNOSIS AND MANAGEMENT.

The research we provided look at a number of factors, such as age, unilateral testing, and squinting both during the ictal and interictal periods to define vestibular migraine. One hundred and ten adults with recurrent spontaneous and positional vertigo participated in the study, which the investigators did. Vestibular migraines (VM) or probable vestibular migraine constituted the two diagnoses given to the patients (n = 29 and n = 76, respectively). The findings revealed those surveyed frequently complained of headache (85.3%), spinning vertigo (76.2%), and Mal de Débarquement (60.2%), with movement hypersensitivity (32.6%). After an episode, 75.2% of individuals having vestibular migraine showed spontaneous squinting, whereas 16.5% did so among assaults, although fixing was forbidden. 27.3% of people had clear spatial squinting after an assault, while 57.3% did so after assaults. In 51.2% of instances, the direction of ictal spontaneous Nystagmus was straight, while in 19.5% of cases, it was vertical. Positional and spontaneously ictal squinting was evaluated at speeds between 0.0 and 59.3 degrees per second and 0.0 and 99.9 levels per minute, respectively. In 92.6% and 25.1% of instances, respectively, the interact spontaneous and positional nystagmus velocities were typically less than 3 degrees/second. When contrasted with the time within assaults, squinting speeds were substantially greater after an assault. According to additional tests, 98.6% of those tested exhibited normal lateral video head impulse test gains, indicating that their vestibule-ocular responses were in place. The calorie test findings were symmetrical in 86.4% of the instances, showing normal vestibular function. In 90.4% and 95.2% of cases misogynic potentials displayed symmetrical magnitudes. In 69.8% and 98.1% of instances, misogynic possibilities were identical. In 89.3% of cases, the audiometer data is generally uniform and age-consistent. In outcome, low-velocity squinting that can be horizontal, vertical, or torsional motions occur throughout a sensory migraines event. The investigation also discovered that patients with vestibular migraine often had acceptable audio vestibular test findings.