Volume of Enlarged White Matter of Thalamus among Individuals with Depression on Magnetic Resonance Image: A Study of BrainSuite Segmentation.

Background: The thalamus, located in the diencephalon, regulates emotions and memories. If there is a problem in this area of the brain, it can cause an amnestic syndrome characterized by difficulties in remembering and recognizing things. The objective of this study was to identify changes in the volume of the thalamus while contrasting them among individuals with depression. Materials and Methods: The study involved measuring the volumes of the white matter of the thalamus in 79 patients with depression (42 males and 37 females) between 20 and 40 years (24 ± 5.51). This was compared to a control group of 53 individuals (24 ± 4.91) consisting of 29 males and 24 females, who were comparable in terms of sex and age. The measurements were taken employing BrainSuite version 18a. 021 Win 64bit software on a Philips 1.5 Tesla Magnetom Avanto Vision System magnetic resonance imaging (MRI). The Magnetization Prepared Rapid Acquisition (MPRA) was utilized to acquire three-dimensional images with T1 weighting. Results: The volume of white matter in the respective right and left thalamus was 5.09 cm3 and 4.58 cm3 (±standard deviation (SD) = 6.43 and 4.74) among individuals with depression. In the control group, the volume of white matter in the right and left thalamus was 3.66 cm3 and 4.16 cm3 (±SD = 3.99 and 5.06), respectively. The P-value is more than 0.05. The average volume of white matter in the right and left thalamus of females with depression and controls was 6.47 cm3 and 6.77 cm3 (with SD of 4.17 and 4.3), and 3.25 cm3 and 3.13 cm3 (with SD of 6.55 and 6.77), respectively. Conclusions: Our data suggest that individuals with depression exhibit an augmentation in the white matter of the thalamus, particularly in female patients where there is an upsurge in white matter volume. Depression appears to be linked to a decrease in volume on the left side of the brain.

Development of a microcantilever-based biosensor for detecting Programmed Death Ligand 1.

The ongoing global concern of cancer worldwide necessitates the development of advanced diagnostic and therapeutic strategies. The majority of recent detection strategies involve the employment of biomarkers. A critical biomarker for cancer immunotherapy efficacy and patient prognosis is Programmed Death Ligand 1 (PD-L1), which is a key immune checkpoint protein. PD-L1 can be particularly linked to cancer progression and therapy response. Current detection methods, such as enzyme-linked immunosorbent assay (ELISA), face limitations like high cost, time consumption, and complexity. This study introduces a microcantilever-based biosensor designed for the detection of soluble PD-L1 (sPD-L1), which has a specific association with PD-L1. The biosensor utilizes anti-PD-L1 as the sensing layer, capitalizing on the specific binding affinity between anti-PD-L1 and sPD-L1. The presence of the sensing layer was confirmed through Atomic Force Microscopy (AFM) and contact angle measurements. Binding between sPD-L1 and anti-PD-L1 induces a shift in the microcantilever's resonance frequency, which is proportional to the PD-L1 concentration. Notably, the resonance frequency shift demonstrates a robust linear relationship with the increasing biomarker concentration, ranging from 0.05 ng/ml to 500 ng/ml. The detection limit of the biosensor was determined to be approximately 10 pg/ml. The biosensor demonstrates excellent performance in detecting PD-L1 with high specificity even in complex biological matrices. This innovative approach not only provides a promising tool for early cancer diagnosis but also holds potential for monitoring immunotherapy efficacy, paving the way for personalized and effective cancer treatments.

Zerumbone reduces TLR2 stimulation-induced M1 macrophage polarization pattern via upregulation of Nrf-2 expression in murine macrophages.

Hyperuricemia contributes significantly to gout arthritis pathogenesis, which promotes urate crystal deposition in the joints and activates joint-resident macrophages and circulating monocytes to initiate a state of inflammatory arthritis. In the joint, macrophages have an immune defense role where the presence of urate crystals results in the inflammatory mediators secretion, inflammatory cells recruitment to the joint, and shift macrophage population toward M1 pro-inflammatory phenotypes. Current treatment modalities of gout arthritis have side effects that limit their use in the elderly. A novel treatment that targets macrophage polarization to re-establish homeostasis may initiate a drug discovery program of novel disease-modifying agents for gout. Zerumbone (Zer) is a sesquiterpenoid bioactive compound found in the rhizome of Zingiberaceae family and possesses anti-inflammatory, antioxidant, and anti-proliferative activity. Our study hypothesized that soluble uric acid (sUA) and Pam3CSK4 (TLR2 agonist) reduce the anti-inflammatory function of murine M2 bone marrow-derived macrophages and change the expression of M2 genetic markers toward M1 phenotypes. We observed that priming of M2 macrophages with sUA and Pam3CSK4 significantly decreased M2 specific markers expression, e.g., Arg-1, Ym-1, and Fizz-1, enhanced mRNA expression of IL-1ß, TNF-α, CXCL2, and iNOS and increased oxidative stress in M2 macrophages, as exhibited by a reduction in Nrf2 expression. We also aimed to study the impact of Zer on reducing the pro-inflammatory effect of sUA in TLR2-stimulated M2 macrophages. We noticed that Zer treatment significantly reduced L-1ß and TNF-α production following Pam3CSK4 + sUA treatment on M2 macrophages. Furthermore, Zer reduced the caspase-1 activity without altering cytosolic NLRP3 content in challenged M2 BMDMs. We also observed that Zer significantly enhanced M2-associated marker's expression, e.g., Arg-1, Ym-1, and Fizz-1, and augmented Nrf-2 and other antioxidant proteins, including HMOX1 and srxn1expression following Pam3CSK4 + sUA treatment. We draw the conclusion that Zer is a potentially effective anti-inflammatory treatment for gout arthritis linked to hyperuricemia.

Assessing Family Medicine Residents' Knowledge, Attitudes, and Confidence in Managing In-Flight Medical Emergencies in Riyadh, Saudi Arabia.

The global increase in air travel has led to a rise in in-flight medical emergencies (IMEs), posing significant challenges to global public health. In a significant number of instances, physicians are often called upon to respond to IMEs during flights. These emergencies are unique due to the cabin environment's constraints, including confined space, ambient noise, and reduced atmospheric pressure. Various proactive measures have been introduced to mitigate IME occurrences, but many healthcare professionals, including family medicine (FM) residents, feel inadequately prepared to respond effectively. This cross-sectional study was conducted among all family medicine (FM) residents in Riyadh, Saudi Arabia, in January 2023. A self-reported questionnaire was used, including questions aimed at evaluating the sociodemographics, travel profiles, knowledge, confidence, and attitudes of FM residents toward IMEs and their ability to respond to such emergencies. A total of 189 FM residents participated in the study, revealing a young and diverse group of participants. Most were male (97 (51.3%)), averaging 27 years old. Nearly all held life support credentials (185 (97.9%)), particularly basic life support (BLS) and advanced cardiovascular life support (ACLS). Despite frequent travel, the majority lacked in-flight emergency training and experience. Allergic reactions (28%), cardiovascular (24%), and respiratory emergencies (24%) were the most common IMEs encountered. While 109 (57.7%) would assist during an IME, 87 (46%) were unsure of their competence, and 109 (57.7%) had medico-legal concerns. Most, i.e., 176 (93.2%) agreed with the need for more IME training, but 138 (73%) lacked clarity about in-flight medical supplies. In conclusion, this research underscores the importance of preparing FM residents and healthcare professionals for IMEs, advocating for specialized training programs that enhance their readiness to respond competently to an IME.

Role of neuroinflammation mediated potential alterations in adult neurogenesis as a factor for neuropsychiatric symptoms in Post-Acute COVID-19 syndrome-A narrative review.

Persistence of symptoms beyond the initial 3 to 4 weeks after infection is defined as post-acute COVID-19 syndrome (PACS). A wide range of neuropsychiatric symptoms like anxiety, depression, post-traumatic stress disorder, sleep disorders and cognitive disturbances have been observed in PACS. The review was conducted based on PRISMA-S guidelines for literature search strategy for systematic reviews. A cytokine storm in COVID-19 may cause a breach in the blood brain barrier leading to cytokine and SARS-CoV-2 entry into the brain. This triggers an immune response in the brain by activating microglia, astrocytes, and other immune cells leading to neuroinflammation. Various inflammatory biomarkers like inflammatory cytokines, chemokines, acute phase proteins and adhesion molecules have been implicated in psychiatric disorders and play a major role in the precipitation of neuropsychiatric symptoms. Impaired adult neurogenesis has been linked with a variety of disorders like depression, anxiety, cognitive decline, and dementia. Persistence of neuroinflammation was observed in COVID-19 survivors 3 months after recovery. Chronic neuroinflammation alters adult neurogenesis with pro-inflammatory cytokines supressing anti-inflammatory cytokines and chemokines favouring adult neurogenesis. Based on the prevalence of neuropsychiatric symptoms/disorders in PACS, there is more possibility for a potential impairment in adult neurogenesis in COVID-19 survivors. This narrative review aims to discuss the various neuroinflammatory processes during PACS and its effect on adult neurogenesis.

Hypothalamic Lipoma: Outcome of an Intracranial Developmental Lesion.

BACKGROUND: Hypothalamic lipomas are benign developmental lesions that tend to be discovered incidentally. This article describes the radiological features, outcome, and the postulated theories behind hypothalamic lipomas development. METHODS: The electronic archive of neurosurgery was retrospectively reviewed. All patients with a neuroradiological diagnosis of hypothalamic lipoma, between 2005 and 2020, were included. RESULTS: Out of 246 patients with intracranial lipomas, a total of six patients with hypothalamic lipomas have been identified. On computed tomography images, one of the hypothalamic lipomas demonstrated calcification. On magnetic resonance imaging, peripheral enhancement after contrast administration was noted in one of the lesions. Considering the benign nature of the lesions, neurosurgical intervention was not indicated. CONCLUSION: The majority of patients with hypothalamic lipomas are asymptomatic and undergo brain imaging for other indications. Although uncommon, such developmental lesions can be identified in the general population, especially with the advancement of neuroimaging techniques.

Traumatic superficial temporal artery pseudoaneurysm: Successful management using endovascular embolization.

Superficial temporal artery pseudoaneurysms are uncommon but can be potentially life-threatening. Considering their rarity, the present article outlines the clinical presentation, radiological findings, intervention, and outcome of traumatic pseudoaneurysm of the superficial temporal artery. An 83-year-old female sustained a traumatic injury to the temple, resulting in right-sided swelling of the forehead. Brain computed tomography and cerebral angiogram revealed a right-sided homogenously-enhancing pseudoaneurysm in the frontal region. Successful occlusion of the lesion was achieved utilizing endovascular embolization. Three months after discharge, the patient reported no complaints or recurrence. Subsequent management included reassurance and observation with periodic clinical assessments. The unusual presentation of superficial temporal artery pseudoaneurysms requires clinicians to have thorough knowledge on the clinical presentation, proper steps in diagnosis, and the approach of choice in management. Endovascular embolization of superficial temporal artery pseudoaneurysms remains a valid approach to achieve successful occlusion of the lesion.

Oculomotor nerve palsy following coronary artery bypass graft surgery: can pituitary apoplexy complicate the post-operative course of cardiac surgery?

Oculomotor nerve palsy, due to pituitary apoplexy, has been previously reported in the literature. However, the association with coronary artery bypass graft surgery (CABG) is rarely investigated. This article reports a case of pituitary apoplexy presenting with oculomotor nerve palsy following CABG. A 65-year-old male, known to have ischemic heart disease, diabetes mellitus and hypertension, presented with ptosis, diplopia and anisocoria that developed after 1 day of CABG. Radiological imaging demonstrated a pituitary adenoma with acute/subacute hemorrhage causing mild mass effect on the cavernous sinus. Considering the acute state of bypass surgery and pre-existing cardiac co-morbidities, expectant management was considered. The visual acuity and palsy gradually improved. Pituitary apoplexy, following CABG, is a rare phenomenon in the post-operative period. High index of suspicious is required to promptly identify high-risk patients to avoid further neurological sequelae.

Effect of cranioplasty timing on the functional neurological outcome and postoperative complications.

BACKGROUND: The optimal timing for performing cranioplasty and its effect on functional outcome remains debatable. Multiple confounding factors may come into role; including the material used, surgical technique, cognitive assessment tools, and the overall complications. The aim of this study is to assess the neurological outcome and postoperative complications in patients who underwent early versus late cranioplasty. METHODS: A retrospective cohort study was conducted to investigate the neurological outcome and postoperative complications in patients who underwent cranioplasty between 2005 and 2018 at a Level l trauma center. Early and late cranioplasties were defined as surgeries performed within and more than 90 days of decompressive craniectomy, respectively. The Glasgow Outcome Score (GOS) and modified Rankin scale (mRS), recorded within 1 week of cranioplasty, were used to assess the neurological outcome. RESULTS: A total of 101 cases of cranioplasty were included in the study. The mean age of the patients was 31.4 ± 13.9 years. Most patients (n = 86; 85.1%) were male. The mean GOS for all patients was 4.0 ± 1.0. The mean mRS was 2.2 ± 1.78. Hydrocephalus was noted in 18 patients (early, n = 6; late, n = 12; P = 0.48). Seizures developed in 28 patients (early, n = 12; late, n = 16; P = 0.77). CONCLUSION: The neurological outcome in patients who underwent early versus late cranioplasty is almost identical. The differences in the rates of overall postoperative complications between early versus late cranioplasty were statistically insignificant. The optimal timing for performing cranioplasty is mainly dependent on the resolution of cerebral swelling.

The Prevalence of Thyroid Papillary Microcarcinoma in Patients With Benign Thyroid Fine Needle Aspiration.

Introduction Thyroid nodules are a very common clinical finding in the general population. We use fine needle aspiration (FNA) as the gold standard workup test for a thyroid nodule, as it is capable of differentiating malignant nodules from benign in the majority of cases. Usually, FNA is done for nodules that are more than 1 cm; small malignant lesions that are less than 1 cm in size can be missed. That's why the risk of having undiagnosed microcarcinomas in an otherwise benign FNA needs to be explored. Aim To estimate the prevalence of thyroid papillary microcarcinoma in patients with benign FNA and evaluate and correlate the FNA cytological results with the final histopathological diagnoses. Methods This was a retrospective study of 1543 post-thyroidectomy patients who underwent FNA cytology, were classified according to the Bethesda scoring system, and were admitted to two tertiary care hospitals in Riyadh, Saudi Arabia, from 2010 to 2019. Results Six-hundred-seven (607) out of 1543 FNA cytology results were reported as benign, 215 as malignant, and 73 as suspicious of malignancy. On final histopathology diagnosis, 81/607 (13.34%) of benign cases and 35/215 (16.28%) of malignant cases did not meet the initial cytology and were confirmed as papillary microcarcinoma. In patients with microcarcinoma after initial benign FNA (89.2%) found to have benign multinodular changes, compared to only (31%) of initial malignant FNA patients. Conclusion  When non-surgical intervention is chosen in patients with benign FNA, the possibility of coexisting microcarcinoma with its variable prognosis should be taken into account and explained to the patient.

Bilateral petrous apex cephaloceles: Is surgical intervention indicated?

INTRODCUTION: Petrous apex cephaloceles are characterized by herniation of Meckel's cave into the petrous apex. An extensive review of the literature reveals 20 cases of bilateral petrous apex cephaloceles. This article reports an additional case of bilateral petrous apex cephaloceles and reviews the pertinent literature. PRESENTATION OF CASE: A 64-year-old female was referred from a primary care clinic due to longstanding headache. A non-enhanced CT scan of the brain revealed osteolytic bony lesions at the petrous apices and an empty sella. A brain MRI with contrast showed CSF-containing lesions in the petrous apices, communicating with Meckel's cave bilaterally. The patient was managed conservatively and is currently followed up in the neurosurgery clinic. DISCUSSION: While the exact etiology remains uncertain, petrous apex cephaloceles are postulated to originate from sustained, chronic elevation of intracranial pressure. On MRI, petrous apex cephaloceles display signal intensities resembling CSF throughout all sequences. They demonstrate well-defined margins continuous with Meckel's cave. CT scans allow further characterization, i.e. invasive erosions, of the osseous structures in patients with petrous apex cephaloceles. CONCLUSION: A thorough understanding of the petrous apex anatomy and its pathological lesions is paramount. A brain MRI remains the diagnostic imaging of choice to characterize petrous apex cephaloceles.

Comparison of the Outcomes Between Bilateral Thoracoscopic Maximal Thymectomy Versus Trans-Sternal Maximal Thymectomy for Non-Thyomomatous Myasthenia Gravis Patients: A Local University Hospital Experience.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disease characterized by excessive and intense weakness of both respiratory and skeletal muscles. Management of MG involves both medical and surgical treatment. The surgical management includes resection of the thymus gland by many approaches, either bilateral thoracoscopic maximal thymectomy (BTT) or trans-sternal maximal thymectomy (TS). We hypothesized that bilateral thoracoscopic maximal thymectomy is as effective as trans-sternal maximal thymectomy to treat and control the disease. OBJECTIVE: This study aimed to compare the two approaches (BTT and TS) and determine which is better in terms of outcomes. METHODOLOGY:  A retrospective cohort study was conducted among 50 myasthenia gravies patients; 30 patients underwent bilateral thoracoscopic maximal thymectomy (BTT) and 20 were operated by trans-sternal maximal thymectomy (TS). The study was conducted at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, between 2007 and 2017. RESULT: The mean age of the MG patients was 32.6 years, ranging from 14 to 75. Thirty-four (68%) patients were females, and 16 (32%) were males. The BTT showed less operation time (P<0.0001) and less intubation time (anesthesia time), which was statistically significant (P<0.0001). Hospital stay and ICU stay were both reported to be less in BTT (4.03 and 0.37, respectively) with p-values of 0.006 and 0.0001, respectively. There was no significant association between all categorical study variables and the MG patients' outcome (BTT/TS) in terms of mortality, morbidity, complete stable remission, pharmacological remission, and complications. CONCLUSION: Bilateral thoracoscopic maximal thymectomy is as effective as trans-sternal maximal thymectomy to control and treat the disease.

A fault-tolerant aware scheduling method for fog-cloud environments.

Fog computing is a promising technology that leverages the resources to provide services for requests of IoT (Internet of Things) devices at the cloud edge. The high dynamic and heterogeneous nature of devices at the cloud edge causes failures to be a popular event and therefore fault tolerance became indispensable. Most early scheduling and fault-tolerant methods did not highly consider time-sensitive requests. This increases the possibility of latencies for serving these requests which causes unfavorable impacts. This paper proposes a fault-tolerant scheduling method (FTSM) for allocating services' requests to the most sufficient devices in fog-cloud IoT-based environments. The main purpose of the proposed method is to reduce the latency and overheads of services and to increase the reliability and capacity of the cloud. The method depends on categorizing devices that can issue requests into three classes according to the type of service required. These classes are time-sensitive, time-tolerant and core. Each time-sensitive request is directly mapped to one or more edge devices using a pre-prepared executive list of devices. Each time-tolerant request may be assigned to one or more devices at the cloud edge or the cloud core. Core requests are assigned to resources at the cloud core. In order to achieve fault tolerance, the proposed method selects the most suitable fault-tolerant technique from replication, checkpointing and resubmission techniques for each request while most existing methods consider only one technique. The effectiveness of the proposed method is assessed using average service time, throughput, operation costs, success rate and capacity percentage as performance indicators.

Glioblastoma and prolactinoma: a rare simultaneous occurrence.

The simultaneous development of two or more primary central nervous system (CNS) tumors of different cell types represents 0.9% of all diagnosed CNS tumors. To the best of our knowledge, the simultaneous occurrence of glioblastoma and pituitary adenomas has been reported four times in the English literature, with only two cases harboring prolactinoma and glioblastoma. We report a case of a 42-year-old male who was diagnosed with a sporadic co-occurrence of glioblastoma and a prolactin-secreting pituitary adenoma (prolactinoma). This case report discusses the clinical presentation, radiological/histopathological features, and outcome as well as reviewing the pertinent medical literature. Glioblastoma and a prolactin-secreting adenoma may be detected within the same patient. Further studies are required to delineate the tumorigenesis of the development and co-occurrence of multiple intracranial tumors.

Memetic Search Optimization Along with Genetic Scale Recurrent Neural Network for Predictive Rate of Implant Treatment.

Implant treatment is one of the most important surgical processes in teeth which reduces the difficulties in teeth by providing the interface between bone and jaw. The established implant treatment used to support the denture, bridge and teeth crown. Even though it supports many dental related activities, the successive measure of implant treatment is fail to manage because it fully depends on the patient's personal activities and health condition of mouth tissues. So, the successive rate of implant treatment process is identified by applying the memetic search optimization along with Genetic scale recurrent neural network method. The introduced method analyzes the patient characteristics which helps to recognize the successive and failure rate of implant treatment process. The quality of the implant treatment of using simulation results in terms of sensitivity, specificity and accuracy metrics.