Effectiveness of Syrebo's Glove Rehabilitation Program in a Patient With Middle Cerebral Artery Infarct: A Case Report.

In India, stroke is a significant health concern, with an estimated prevalence of around 1.54% in adults over 20 years old. The incidence of stroke in India varies regionally but is generally high due to factors like hypertension and lifestyle changes. Ischemic strokes comprise the majority, particularly in the middle cerebral artery (MCA) territory. MCA stroke presents with diverse symptoms such as weakness, speech difficulties, and vision problems, emphasizing the need for comprehensive rehabilitation. Physiotherapy plays a vital role in addressing these challenges, focusing on strength, coordination, mobility, and independence through tailored interventions. Additionally, soft robotic gloves, such as Syrebo's rehabilitation, offer promising advancements in neurorehabilitation by enhancing motor recovery and functional abilities, particularly in improving grip strength and hand functionality, thus improving outcomes for stroke patients. This case describes a 66-year-old female presenting with sudden left-sided weakness, slurred speech, and facial deviation indicative of bilateral MCA territory infarct. After admission requiring ventilation and medication, imaging confirmed the diagnosis. Following stabilization, she underwent neurophysiotherapy for rehabilitation. Neurological examination revealed deficits in muscle tone, reflexes, cranial nerve function, language, and swallowing. Outcome measures indicated progress in rehabilitation. The case underscores the significance of timely diagnosis and personalized rehabilitation in optimizing outcomes for MCA territory stroke patients.

Physiotherapy Rehabilitation for Restoring Function in Quadriparesis After Cervical Spine Trauma: A Case Report.

A major neurological disorder with major socioeconomic effects is spinal cord injury (SCI). This case report aims to document the comprehensive physiotherapy rehabilitation intervention employed in the successful restoration of function in a patient with quadriparesis following cervical spine trauma. An 84-year-old male presented with quadriparesis resulting from a traumatic cervical spine injury sustained in a motor vehicle accident. The patient underwent an individualized physiotherapy rehabilitation program consisting of assessment, goal-setting, and targeted interventions. The rehabilitation plan included a combination of a range of motion exercises, strengthening exercises, neuro-muscular re-education, and functional training. The patient's progress was regularly monitored, and adjustments were made to the rehabilitation program as needed. Over the course of the rehabilitation program, the patient demonstrated significant improvements in muscle strength, joint range of motion, and overall functional abilities. Objective measures, such as manual muscle testing and goniometry, were used to track progress. The patient regained independence in activities of daily living, such as self-care and mobility, and exhibited enhanced motor control and coordination. This case report highlights the efficacy of a tailored physiotherapy rehabilitation approach in restoring function in a patient with quadriparesis following cervical spine trauma. The successful outcomes suggest that a comprehensive and individualized rehabilitation program can significantly contribute to the recovery of individuals with similar conditions. Further research and documentation of such cases may provide valuable insights into optimal rehabilitation strategies for individuals with cervical spine injuries and associated neurological deficits.

Functional imaging studies of acute administration of classic psychedelics, ketamine, and MDMA: Methodological limitations and convergent results.

Functional magnetic resonance imaging (fMRI) is increasingly used to non-invasively study the acute impact of psychedelics on the human brain. While fMRI is a promising tool for measuring brain function in response to psychedelics, it also has known methodological challenges. We conducted a systematic review of fMRI studies examining acute responses to experimentally administered psychedelics in order to identify convergent findings and characterize heterogeneity in the literature. We reviewed 91 full-text papers; these studies were notable for substantial heterogeneity in design, task, dosage, drug timing, and statistical approach. Data recycling was common, with 51 unique samples across 91 studies. Fifty-seven studies (54%) did not meet contemporary standards for Type I error correction or control of motion artifact. Psilocybin and LSD were consistently reported to moderate the connectivity architecture of the sensorimotor-association cortical axis. Studies also consistently reported that ketamine administration increased activation in the dorsomedial prefrontal cortex. Moving forward, use of best practices such as pre-registration, standardized image processing and statistical testing, and data sharing will be important in this rapidly developing field.

Comprehensive Review on the Role of Plant Protein As a Possible Meat Analogue: Framing the Future of Meat.

Animal proteins from meat and goods derived from meat have recently been one of the primary concerns in the quest for sustainable food production. According to this perspective, there are exciting opportunities to reformulate more sustainably produced meat products that may also have health benefits by partially replacing meat with nonmeat substances high in protein. Considering these pre-existing conditions, this review critically summarizes recent findings on extenders from a variety of sources, including pulses, plant-based ingredients, plant byproducts, and unconventional sources. It views these findings as a valuable opportunity to improve the technological profile and functional quality of meat, with a focus on their ability to affect the sustainability of meat products. As a result, meat substitutes like plant-based meat analogues (PBMAs), meat made from fungi, and cultured meat are being offered to encourage sustainability.

Clinical Reasoning: Adult Patient Presenting With Spine Pain Following a Motor Vehicle Accident.

A 52-year-old woman with a complex medical history, including a history of consanguinity, developed refractory uncontrollable spine pain after a motor vehicle accident 2 years before presentation. There were no well-defined findings on clinical examination. She was found to have mildly elevated serum creatine phosphokinase levels, and spine imaging revealed fatty replacement and atrophy affecting predominantly lumbar paraspinal muscles. Initial EMG sampling of multiple limb muscles was normal. However, a follow-up concentric needle examination sampling paraspinal and trunk muscles showed abundant myotonic discharges, fibrillations and positive sharp waves, and myopathic motor unit action potential changes. This pattern of neurophysiologic abnormalities prompted the search for a myopathic disorder, which was ultimately confirmed with additional studies. This case highlights the critical role of neurophysiologic evaluation of paraspinal and other trunk muscles in the disambiguation of clinical and imaging data, helping to establish the diagnosis of a rare but treatable myopathy at early disease stages.

The New England Neurosurgical Society: growth and evolution over 70 years.

The New England Neurosurgical Society (NENS) was founded in 1951 under the leadership of its first President (Dr. William Beecher Scoville) and Secretary-Treasurer (Dr. Henry Thomas Ballantine). The purpose of creating the NENS was to unite local neurosurgeons in the New England area; it was one of the first regional neurosurgical societies in America. Although regional neurosurgical societies are important supplements to national organizations, they have often been overshadowed in the available literature. Now in its 70th year, the NENS continues to serve as a platform to represent the needs of New England neurosurgeons, foster connections and networks with colleagues, and provide research and educational opportunities for trainees. Additionally, regional societies enable discussion of issues uniquely relevant to the region, improve referral patterns, and allow for easier attendance with geographic proximity. In this paper, the authors describe the history of the NENS and provide a roadmap for its future. The first section portrays the founders who led the first meetings and establishment of the NENS. The second section describes the early years of the NENS and profiles key leaders. The third section discusses subsequent neurosurgeons who steered the NENS and partnerships with other societies. In the fourth section, the modern era of the NENS and its current activities are highlighted.

Structural imaging studies of patients with chronic pain: an anatomical likelihood estimate meta-analysis.

ABSTRACT: Neuroimaging is a powerful tool to investigate potential associations between chronic pain and brain structure. However, the proliferation of studies across diverse chronic pain syndromes and heterogeneous results challenges data integration and interpretation. We conducted a preregistered anatomical likelihood estimate meta-analysis on structural magnetic imaging studies comparing patients with chronic pain and healthy controls. Specifically, we investigated a broad range of measures of brain structure as well as specific alterations in gray matter and cortical thickness. A total of 7849 abstracts of experiments published between January 1, 1990, and April 26, 2021, were identified from 8 databases and evaluated by 2 independent reviewers. Overall, 103 experiments with a total of 5075 participants met the preregistered inclusion criteria. After correction for multiple comparisons using the gold-standard family-wise error correction ( P < 0.05), no significant differences associated with chronic pain were found. However, exploratory analyses using threshold-free cluster enhancement revealed several spatially distributed clusters showing structural alterations in chronic pain. Most of the clusters coincided with regions implicated in nociceptive processing including the amygdala, thalamus, hippocampus, insula, anterior cingulate cortex, and inferior frontal gyrus. Taken together, these results suggest that chronic pain is associated with subtle, spatially distributed alterations of brain structure.

Cavernous segment internal carotid artery stenosis specific to meningiomas compared to pituitary adenomas.

BACKGROUND AND PURPOSE: Pituitary macroadenomas and meningiomas are common neoplasms arising within the cavernous sinus. Imaging characteristics on MRI can often distinguish these tumors from one another; however, some cases may be more difficult to differentiate. This study compares patterns of cavernous segment internal carotid artery (CS-ICA) stenosis between the two tumor types to establish a novel radiographic method of differentiation. METHODS: A retrospective analysis of patients with pathology-confirmed meningioma and pituitary adenomas at Tufts Medical Center was performed. The diameter of the CS-ICA at the narrowest point within the cavernous sinus was measured and compared to the ipsilateral petrous segment ICA and contralateral CS-ICA. The mean and range of percent stenosis and frequency of cases of CS-ICA stenosis >15% were determined. Statistical analysis to compare the groups was conducted using the Chi-squared test, Fisher's exact test, and t-test. RESULTS: There were a total of 78 out of 231 patients who were included in the study. The mean % ICA stenosis for all meningiomas was 9.3%, with increasing stenosis with increasing World Health Organization grade. Of all meningioma cases, 13 (33%) had greater than 15% ICA stenosis. Mean ICA stenosis for pituitary adenomas was -1.48%. There were no cases of pituitary adenomas causing ICA stenosis >15%. CONCLUSIONS: Differentiating pituitary adenomas and intracavernous meningioma tumors can have important implications on surgical approach and outcome. Our study found that stenosis of the CS-ICA greater than 15% is highly specific to meningiomas and can serve as a radiologic sign to distinguish between these two tumors.

Effect of Prehabilitation in Lung Cancer Patients Undergoing Lobectomy: A Review.

Deaths from lung cancer are mostly caused by smoking. Cough, dyspnea, fatigue, weight loss, and Horner's syndrome are among the symptoms. Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are the two categories into which lung cancer may be divided. Because of its effectiveness and lower death rates, lobectomy is the primary line of therapy for benign and early-stage lung illnesses. Pulmonary rehabilitation is a routine treatment for thoracic surgery individuals who are at a high risk to improve functional ability, avoid postoperative deterioration, avoid postoperative deterioration, and reduce complications and even hospital stays. Pulmonary rehabilitation is a multifaceted continuum of services intended to help individuals with pulmonary disease and their families reach and sustain their highest possible degree of independence and community functioning, typically provided by an interdisciplinary team of specialists.  The objective of this research was to gather preliminary information and assess the effects of pre-rehabilitation on those suffering from lung cancer and having lobectomy. The pre-rehabilitation program's outcomes include increased lung functional capacity, enhanced quality of life, patient independence in daily living activities, and a shorter hospital stay. Gradually increasing walking distance over time can build endurance, requiring consistency, pacing, proper hydration, nutrition, and regular breaks. This review analyzed the effect of pre-rehabilitation in lung cancer patients undergoing lobectomy. Pre-rehabilitation program for individuals with lung cancer improves both preoperative and postoperative health through various exercises. Pulmonary rehabilitation is a multidisciplinary approach that encourages physical activity, learning about disease, treatment options, and coping mechanisms. Instead of curing the illness, its goal is to lessen its symptoms and limitations. Patients with pulmonary diseases or undergoing thoracic surgery prefer pre-rehabilitation programs due to their non-traumatic nature and fewer resources required. Elastic resistance band exercises are beneficial for lung cancer patients' pre-rehabilitation by strengthening and stretching muscle groups, improving exercise capacity, and supporting white blood cell counts. These exercises can be customized to individual needs, making them a safe and effective addition to a patient's exercise routine. They have to be carried out at least three days a week. Pulmonary exercise, including the use of a tri-ball pulmonary exerciser or three-ball spirometer, can improve lung function, respiratory muscle strength, and exercise capacity in lung cancer patients. It involves breathing techniques, cough exercises, and inflating a balloon. Pulmonary rehabilitation has a positive impact on patient health. Improved lung vital capacity, shorter hospital stays, and fewer problems following surgery are all achieved with pulmonary rehabilitation. The pre-rehabilitation plan allows the patient to resume their daily routines.

Angiotensin-Converting Enzyme (ACE) Insertion/Deletion (I/D) Polymorphism as a Conjoint Regulator of Coagulation, Fibrinolytic, and RAAS Pathway in Infertility and Associated Pregnancy Complications.

Despite the increase in assisted reproductive technologies, the high rates of infertility and pregnancy complications are a major concern to infertility specialists worldwide. Infertility may be attributed to pregnancy complications like thrombophilia, preeclampsia and fibrin-induced recurrent pregnancy loss (RPL). Renin-angiotensin-aldosterone system (RAAS) directly or indirectly causes preeclampsia and thrombophilia through the fibrinolytic pathway that ultimately leads to RPL or infertility. The underlying mechanisms of this interaction are still unclear. The present comprehensive review is intended to demonstrate the role and interaction of RAAS and fibrinolytic pathways in pregnancy complications. How this interaction can induce pregnancy complications, and ultimately infertility, is also discussed in the light of current evidence. This study also presents common markers that link RAAS and fibrinolytic processes in developing thrombophilia, preeclampsia and RPL. The common link in these pathways is ACE gene I/D polymorphism. Apart from ACE, PAI-1, VIIa, XIIa, AT1R, AT1AA, and TF are common molecules that can delineate the underlying causes of pregnancy complications and infertility.

Radiographic risk factors for intracranial hemorrhage in patients with left ventricular assist devices.

OBJECTIVE: Intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVAD) is a devastating complication. Demographic risk factors for ICH in LVAD patients are defined, however anatomic predispositions to ICH are unknown. We sought to interrogate intracranial radiographic risk factors for ICH in LVAD patients. METHODS: We reviewed 440 patients who received an LVAD from 2008-2021. We selected patients with CT scans of the head either before or after LVAD placement, but typically within 5 years. 288 patients (21 ICH, 267 Control) with imaging were included. A detailed chart review was performed on demographics, radiographic features, and management. RESULTS: The incidence of ICH in our total cohort was 8.6% (38/440). The presence of pump thrombosis (p=0.001), driveline infection (p=0.034), other hemorrhage (p=0.001), or previous placement of a cardio-defibrillator (p=.003) was associated with increased risk for ICH. An analysis of imaging revealed that the presence of a mass (p=0.006), vascular pathology (p=0.001), and microangiopathy (p=0.04) was significantly associated with ICH in LVAD patients. These radiographic features were validated with a multivariate logistic regression which confirmed presence of a mass (aOR 332.1, 95% CI: 14.7-7485.1, p<0.001), vascular pathology (aOR 69.7, 95% CI: 1.8-2658.8, p=0.022), and microangiopathy (aOR 6.5, 95% CI: 1.1-37.6, p=0.035) were independently associated with ICH. CONCLUSION: Radiographic evidence of microangiopathy, intracranial mass, and vascular pathology are independent risk factors for ICH which are readily identified by imaging. We advocate that CT imaging be used to further stratify patients at highest risk of ICH during treatment with an LVAD.

The Relationship Between Wild-Type Transthyretin Amyloid Load and Ligamentum Flavum Thickness in Lumbar Stenosis Patients.

BACKGROUND: One key contributor to lumbar stenosis is thickening of the ligamentum flavum (LF), a process still poorly understood. Wild-type transthyretin amyloid (ATTRwt) has been found in the LF of patients undergoing decompression surgery, suggesting that amyloid may play a role. However, it is unclear whether within patients harboring ATTRwt, the amount of amyloid is associated with LF thickness. METHODS: From an initial cohort of 324 consecutive lumbar stenosis patients whose LF specimens from decompression surgery were sent for analysis (2018-2019), 33 patients met the following criteria: 1) Congo red-positive amyloid in the LF, 2) ATTRwt by mass spectrometry-based proteomics, and 3) an available preoperative magnetic resonance imaging. Histological specimens were digitized, and amyloid load was quantified through Trainable Weka Segmentation machine learning. LF thicknesses were manually measured on axial T2-weighted preoperative magnetic resonance imaging scans at each lumbar level, L1-S1. The sum of thicknesses at every lumbar LF level (L1-S1) equals "lumbar LF burden". RESULTS: Patients had a mean age of 72.7 years (range = 59-87), were mostly male (61%) and white (82%), and predominantly had surgery at L4-L5 levels (73%). Amyloid load was positively correlated with LF thickness (R = 0.345, P = 0.0492) at the levels of surgical decompression. Furthermore, amyloid load was positively correlated with lumbar LF burden (R = 0.383, P = 0.0279). CONCLUSIONS: Amyloid load is positively correlated with LF thickness and lumbar LF burden across all lumbar levels, in a dose-dependent manner. Further studies are needed to validate these findings, uncover the underlying pathophysiology, and pave the way toward using therapies that slow LF thickening.

Machine Learning Quantification of Amyloid Deposits in Histological Images of Ligamentum Flavum.

Wild-type transthyretin amyloidosis (ATTRwt) is an underdiagnosed and potentially fatal disease. Interestingly, ATTRwt deposits have been found to deposit in the ligamentum flavum (LF) of patients with lumbar spinal stenosis before the development of systemic and cardiac amyloidosis. In order to study this phenomenon and its possible relationship with LF thickening and systemic amyloidosis, a precise method of quantifying amyloid deposits in histological slides of LF is critical. However, such a method is currently unavailable. Here, we present a machine learning quantification method with Trainable Weka Segmentation (TWS) to assess amyloid deposition in histological slides of LF. Images of ligamentum flavum specimens stained with Congo red are obtained from spinal stenosis patients undergoing laminectomies and confirmed to be positive for ATTRwt. Amyloid deposits in these specimens are classified and quantified by TWS through training the algorithm via user-directed annotations on images of LF. TWS can also be automated through exposure to a set of training images with user-directed annotations, and then applied] to a set of new images without additional annotations. Additional methods of color thresholding and manual segmentation are also used on these images for comparison to TWS. We develop the use of TWS in images of LF and demonstrate its potential for automated quantification. TWS is strongly correlated with manual segmentation in the training set of images with user-directed annotations (R = 0.98; p = 0.0033) as well as in the application set of images where TWS was automated (R = 0.94; p = 0.016). Color thresholding was weakly correlated with manual segmentation in the training set of images (R = 0.78; p = 0.12) and in the application set of images (R = 0.65; p = 0.23). TWS machine learning closely correlates with the gold-standard comparator of manual segmentation and outperforms the color thresholding method. This novel machine learning method to quantify amyloid deposition in histological slides of ligamentum flavum is a precise, objective, accessible, high throughput, and powerful tool that will hopefully pave the way towards future research and clinical applications.

The life and legacy of William Beecher Scoville.

Dr. William Beecher Scoville (1906-1984) is a giant figure in the history of neurosurgery, well known by the public for his operation on Patient H.M. He developed dozens of neurosurgical instruments and techniques, with many tools named after him that are still widely used today. He founded numerous neurosurgical societies around the world. He led the movement in psychosurgery, developing the technique of selective orbital undercutting and performing hundreds of lobotomies throughout his career. However, his many contributions to the advancement of neurosurgery have not been well described in the medical literature. To bridge the knowledge gap, this article seeks to detail the life and career of William Beecher Scoville and bring to attention the enduring impact of his work.

Characteristics of Global Neurosurgery Sessions: A Retrospective Analysis of Major International Neurosurgical Conferences.

BACKGROUND: The global burden of neurosurgical disease is substantial, particularly in low- and middle-income countries (LMICs). Medical conferences are important in connecting those from LMICs to those from high-income countries for support and serve as an educational and networking tool. In this study, we sought to quantitatively assess the incorporation of global neurosurgery topics in international conferences related to the neurosurgical specialty. METHODS: A database of major international neurosurgical conferences, from the conference of a group of 9 major neurosurgical societies, that had global neurosurgery featured from 2015 to 2020 was created. We then did a retrospective analysis to study the characteristics of these conferences ranging from geographic location to number to different components of the conferences. RESULTS: There was an increase in the number of conferences with global neurosurgery since 2015. This, in addition to the occurrence of 3 wholly global neurosurgery-related conferences in recent years, is promising and suggests growth in the field. However, 52.6% of conferences took place in North American or European countries, the majority of which were high-income countries. Furthermore, a majority of the presence of global neurosurgery was in the form of individual talks (54.5%) as opposed to plenaries or sessions. CONCLUSIONS: The preponderance of conferences in North America and Europe can pose barriers for those from LMICs including travel time, expenses, and visa problems. As global neurosurgery becomes an increasing part of the global health movement, we hope that these barriers are addressed. Conferences may become an even stronger tool to promote equity in neurosurgical education and practice.

Brain Responses to Noxious Stimuli in Patients With Chronic Pain: A Systematic Review and Meta-analysis.

Importance: Functional neuroimaging is a valuable tool for understanding how patients with chronic pain respond to painful stimuli. However, past studies have reported heterogenous results, highlighting opportunities for a quantitative meta-analysis to integrate existing data and delineate consistent associations across studies. Objective: To identify differential brain responses to noxious stimuli in patients with chronic pain using functional magnetic resonance imaging (fMRI) while adhering to current best practices for neuroimaging meta-analyses. Data Sources: All fMRI experiments published from January 1, 1990, to May 28, 2019, were identified in a literature search of PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, PsycINFO, and SCOPUS. Study Selection: Experiments comparing brain responses to noxious stimuli in fMRI between patients and controls were selected if they reported whole-brain results, included at least 10 patients and 10 healthy control participants, and used adequate statistical thresholding (voxel-height P < .001 or cluster-corrected P < .05). Two independent reviewers evaluated titles and abstracts returned by the search. In total, 3682 abstracts were screened, and 1129 full-text articles were evaluated. Data Extraction and Synthesis: Thirty-seven experiments from 29 articles met inclusion criteria for meta-analysis. Coordinates reporting significant activation differences between patients with chronic pain and healthy controls were extracted. These data were meta-analyzed using activation likelihood estimation. Data were analyzed from December 2019 to February 2020. Main Outcomes and Measures: A whole-brain meta-analysis evaluated whether reported differences in brain activation in response to noxious stimuli between patients and healthy controls were spatially convergent. Follow-up analyses examined the directionality of any differences. Finally, an exploratory (nonpreregistered) region-of-interest analysis examined differences within the pain network. Results: The 37 experiments from 29 unique articles included a total of 511 patients and 433 controls (944 participants). Whole-brain meta-analyses did not reveal significant differences between patients and controls in brain responses to noxious stimuli at the preregistered statistical threshold. However, exploratory analyses restricted to the pain network revealed aberrant activity in patients. Conclusions and Relevance: In this systematic review and meta-analysis, preregistered, whole-brain analyses did not reveal aberrant fMRI activity in patients with chronic pain. Exploratory analyses suggested that subtle, spatially diffuse differences may exist within the pain network. Future work on chronic pain biomarkers may benefit from focus on this core set of pain-responsive areas.

Characterizing Physician Practice in Nursing Homes Using Claims-Based Measures: Correlation With Nursing Home Administrators' Perceptions.

Heterogeneity in physician practice within nursing homes (NHs) may explain variations in quality. However, data on physician practice organization in NHs are hard to obtain. We characterized NH physician practice using two claims-based measures: (a) concentration of NH care among physicians (measured by Herfindahl-Hirschman index of visits); and (b) physician NH practice specialization (measured by the proportion of a physician's visits to NHs). We examined the relationship between the measures and NH administrator perceptions of physician practice reported in the Shaping Long-Term Care in America (SLTCA) Survey. All 2011 Part B claims from 13,718 physicians who treated Medicare fee-for-service patients in 2,095 NHs in the SLTCA survey were analyzed. The median Herfindahl-Hirschman index was 0.44 (interquartile range [IQR] 0.28-0.70), and the median specialization was 38.1% (IQR 19.9% to 60.9%). NHs with higher physician specialization reported more frequent physician participation in care coordination activities. Claims-based measures could inform the study of NH physician practice.