Natural history and clinical manifestation of Pediatric Brain Arteriovenous Malformations.

Brain arteriovenous malformations (bAVMs) are aberrant arteriovenous shunts through a vascular nidus with no intervening capillary beds. They are one of the commonest causes of spontaneous intracranial haemorrhage in children and may be associated with significant morbidity and mortality in cases of rupture. Treatment strategies include microsurgical resection, endovascular embolisation, stereotactic radiosurgery, multimodality treatment with a combination thereof, and particularly in high-grade bAVMs, conservative management. Clinicians involved in treating bAVMs need to have familiarity with the natural history pertaining to bAVMs in terms of risk of rupture, risk factors elevating rupture risk as well as understanding the clinical manifestations of bAVMs. This invited review serves to provide a synthesis on natural history and clinical presentation of bAVMs with particular focus in children to inform decision-making pertaining to management.

Artifical intelligence in surgery: ethical considerations in the light of social trends in the perception of health and medicine.

The use of artificial intelligence (AI) in medicine and surgery is currently predicted to be very promising. However, AI has the potential to change the doctor's role and the doctor-patient relationship. It has the potential to support people's desires for health, along with the potential to nudge or push people to behave in a certain way. To understand these potentials, we must see AI in the light of social developments that have brought about changes in how medicine's role, in a given society, is understood. The trends of 'privatisation of medicine' and 'public-healthisation of the private' are proposed as a contextual backdrop to explain why AI raises ethical concerns different from those previously caused by new medical technologies, and which therefore need to be addressed specifically for AI.

Temporal declines in fecundity: A study of southern Gulf of St. Lawrence Atlantic herring (Clupea harengus) and implications for potential reproductive output.

Individuals must reproduce to survive and thrive from generation to generation. In fish, the fecundity of individuals and estimates of total reproductive output are critical for evaluating reproductive success and understanding population dynamics. Estimating fecundity is an onerous task; therefore, many populations lack contemporary estimates of fecundity and size-fecundity relationships. However, reproductive dynamics are not static in time; therefore, it is important to develop contemporary fecundity estimates to better inform conservation and management action. To highlight the importance of contemporary fecundity estimates, we examined the fecundity of southern Gulf of St. Lawrence (sGSL) spring and fall spawning Atlantic herring in 2022, developed size-fecundity models, and compared these to historical fecundity estimates and models. Our results suggest that the average fecundity of sGSL spring and fall herring has undergone a substantial temporal decline of approximately 47% and 58%, respectively, since the 1970s and 1980s. The size-fecundity relationships for fall spawning herring have shifted, with fish of a given size exhibiting lower fecundity in 2022 compared to the 1970s. Alternatively, the size-fecundity relationships for spring spawning herring have remained relatively static. Furthermore, simulations highlighted a substantial reduction in potential reproductive output in 2022 compared to 1970 of approximately 32% and 68% for spring and fall spawners, respectively, based on a fixed number of mature females, which may have negative implications for stock rebuilding. Overall, our study provides support for periodic estimates of fecundity in fish populations to better understand temporal changes in reproductive and population dynamics.

Navigating an unpredictable environment: the moderating role of perceived environmental unpredictability in the effectiveness of ecological resource scarcity information on pro-environmental behavior.

BACKGROUND: The global issue of ecological resource scarcity, worsened by climate change, necessitates effective methods to promote resource conservation. One commonly used approach is presenting ecological resource scarcity information. However, the effectiveness of this method remains uncertain, particularly in an unpredictable world. This research aims to examine the role of perceived environmental unpredictability in moderating the impact of ecological resource scarcity information on pro-environmental behavior (PEB). METHODS: We conducted three studies to test our hypothesis on moderation. Study 1 (N = 256) measured perceived general environmental unpredictability, perceived resource scarcity and daily PEB frequencies in a cross-sectional survey. Study 2 (N = 107) took it a step further by manipulating resource scarcity. Importantly, to increase ecological validity, Study 3 (N = 135) manipulated the information on both ecological resource scarcity and nature-related environmental unpredictability, and measured real water and paper consumption using a newly developed washing-hands paradigm. RESULTS: In Study 1, we discovered that perceived resource scarcity positively predicted PEB, but only when individuals perceive the environment as less unpredictable (interaction effect: 95% CI = [-0.09, -0.01], ΔR2 = 0.018). Furthermore, by manipulating scarcity information, Study 2 revealed that only for individuals with lower levels of environmental unpredictability presenting ecological resource scarcity information could decrease forest resource consumption intention (interaction effect: 95%CI = [-0.025, -0.031], ΔR2 = .04). Moreover, Study 3 found that the negative effect of water resource scarcity information on actual water and (interaction effect: 95%CI = [3.037, 22.097], ηp2 = .050) paper saving behaviors (interaction effect: 95%CI = [0.021, 0.275], ηp2 = .040), as well as hypothetical forest resource consumption (interaction effect: 95%CI = [-0.053, 0.849], ηp2 = .023) emerged only for people who receiving weaker environmental unpredictability information. CONCLUSION: Across three studies, we provide evidence to support the moderation hypothesis that environmental unpredictability weakens the positive effect of ecological resource scarcity information on PEB, offering important theoretical and practical implications on the optimal use of resource scarcity to enhance PEB.

The Evolving Classification of Meningiomas: Integration of Molecular Discoveries to Inform Patient Care.

Meningioma classification and treatment have evolved over the past eight decades. Since Bailey, Cushing, and Eisenhart's description of meningiomas in the 1920s and 1930s, there have been continual advances in clinical stratification by histopathology, radiography and, most recently, molecular profiling, to improve prognostication and predict response to therapy. Precise and accurate classification is essential to optimizing management for patients with meningioma, which involves surveillance imaging, surgery, primary or adjuvant radiotherapy, and consideration for clinical trials. Currently, the World Health Organization (WHO) grade, extent of resection (EOR), and patient characteristics are used to guide management. While these have demonstrated reliability, a substantial number of seemingly benign lesions recur, suggesting opportunities for improvement of risk stratification. Furthermore, the role of adjuvant radiotherapy for grade 1 and 2 meningioma remains controversial. Over the last decade, numerous studies investigating the molecular drivers of clinical aggressiveness have been reported, with the identification of molecular markers that carry clinical implications as well as biomarkers of radiotherapy response. Here, we review the historical context of current practices, highlight recent molecular discoveries, and discuss the challenges of translating these findings into clinical practice.

Precision in IOL Calculation for Cataract Patients with Prior History of Combined RK and LASIK Histories.

Purpose: This study aimed to evaluate the accuracy of 12 intraocular lens (IOL) power calculation formulae for eyes that have undergone both radial keratotomy (RK) and laser assisted in situ keratomileusis (LASIK) surgery to determine the efficacy of various IOL calculations for this unique patient group. Currently, research on this surgical topic is limited. Methods: In this retrospective study, 11 eyes from 7 individuals with a history of RK and LASIK who underwent cataract surgery at Hoopes Vision were analyzed. Preoperative biometric and corneal topographic measurements were performed. Subjective refraction was obtained postoperatively. Twelve different intraocular lens (IOL) power calculations were used: Barrett True K No History, Barrett True K (prior LASIK, Prior RK history), Barrett Universal 2, Camellin-Calossi-Camellin (3C), Double K-Modified Holladay, Haigis-L, Galilei, OCT, PEARL-DGS, Potvin-Hill, Panacea, and Shammas. Results: The rankings of mean arithmetic error (MAE), from least to greatest, were as follows: 3C (0.088), Haigis-L-L (-0.508), Shammas (-0.516), OCT Average (-0.538), Barrett True K (-0.557), OCT RK (-0.563), Galilei (-0.570), IOL Master (-0.571), OCT LASIK (-0.583), Barrett True K No History (-0.597), Pearl-DGS (-0.606), Potvin-Hill SF (-0.770), Potvin-Hill TNP (-0.778), Panacea (-0.876), and Barrett Universal 2 (-1.522). The 3C formula achieved the greatest percentage of eyes within ±0.25 D of target range (91%), while Haigis-L, Shammas, Galilei, Potvin Hill, Barrett True K, IOL Master, PEARL-DGS, and OCT formulae performed similarly, achieving 45% of eyes within ±0.75D of target refraction. Conclusion: This study demonstrates the accuracy of the lesser known 3C formula in IOL calculation, particularly for patients who have undergone both RK and LASIK. Well-known formulae, such as Haigis-L, Shammas, and Galilei, which are used by the American Society of Cataract and Refractive Surgery (ASCRS), are viable options, although 3C formulae should be considered in this patient population. Furthermore, larger studies can confirm the best IOL power formulas for post-RK and LASIK cataract patients.

A Systematic Review of Risk factors for Sleep Apnea.

Background: Sleep apnea, a prevalent global health issue, is characterized by repeated interruptions in breathing during sleep. This systematic review aggregates global data to outline a comprehensive analysis of its associated risk factors. Purpose: The systematic review underscores the global prevalence of sleep apnea and the universal importance of its early detection and management by delineating key risk factors contributing to its development. Material and Methods: We conducted a thorough systematic review of international medical databases up to July 31, 2023, including PubMed, Medline, and Cochrane Library, to ensure a wide-ranging collection of data reflective of various populations. Results: The systematic review identifies several risk factors such as obesity, age, gender, neck circumference, family history, smoking, alcohol use, underlying medical conditions, and nasal congestion, highlighting their prevalence across diverse demographics globally. Conclusion: Emphasizing lifestyle modifications and proactive interventions, our findings advocate for global health strategies to mitigate the risk of sleep apnea and enhance sleep health worldwide.

Analyzing factors affecting positivity in drive-through COVID-19 testing: a cross-sectional study.

BACKGROUND: Demand for COVID-19 testing prompted the implementation of drive-through testing systems. However, limited research has examined factors influencing testing positivity in this setting. METHODS: From October 2020 to March 2023, a total of 1,341 patients, along with their clinical information, were referred from local clinics to the Sasebo City COVID-19 drive-through PCR center for testing. Association between clinical information or factors related to the drive-through center and testing results was analyzed by Fisher's exact test and logistic regression models. RESULTS: Individuals testing positive exhibited higher frequencies of upper respiratory symptoms; cough (OR 1.5 (95% CI 1.2-1.8), p < 0.001, q = 0.005), sore throat (OR 2.4 (95% CI 1.9-3.0), p < 0.001, q < 0.001), runny nose (OR 1.4 (95% CI 1.1-1.8), p = 0.002, q = 0.009), and systemic symptoms; fever (OR 1.5 (95% CI 1.1-2.0), p = 0.006, q = 0.02), headache (OR 1.9 (95% CI 1.4-2.5), p < 0.001, q < 0.001), and joint pain (OR 2.7 (95% CI 1.8-4.1), p < 0.001, q < 0.001). Conversely, gastrointestinal symptoms; diarrhea (OR 0.2 (95% CI 0.1-0.4), p < 0.001, q < 0.001) and nausea (OR 0.3 (95% CI 0.1-0.6), p < 0.001, q < 0.001) were less prevalent among positives. During omicron strain predominant period, higher testing positivity rate (OR 20 (95% CI 13-31), p < 0.001) and shorter period from symptom onset to testing (3.2 vs. 6.0 days, p < 0.001) were observed compared to pre-omicron period. Besides symptoms, contact history with infected persons at home (OR 4.5 (95% CI 3.1-6.5), p < 0.001, q < 0.001) and in office or school (OR 2.9 (95% CI 2.1-4.1), p < 0.001, q < 0.001), as well as the number of sample collection experiences by collectors (B 7.2 (95% CI 2.8-12), p = 0.002) were also associated with testing results. CONCLUSIONS: These findings underscore the importance of factors related to drive-through centers, especially contact history interviews and sample collection skills, for achieving higher rates of COVID-19 testing positivity. They also contribute to enhanced preparedness for next infectious disease pandemics.

"Spanish flu," encephalitis lethargica, and COVID-19: Progress made, lessons learned, and directions for future research.

One hundred years ago, an influenza pandemic swept across the globe that coincided with the development of a neurological condition, named "encephalitis lethargica" for the occurrence of its main symptom, the sudden onset of sleepiness that either developed into coma or gradually receded. Between 1917 and 1920, mortality of the flu was >20 million and of encephalitis lethargica approximately 1 million. For lessons to be learned from this pandemic, it makes sense to compare it with the COVID-19 pandemic, which occurred 100 years later. Biomedical progress had enabled testing, vaccinations, and drug therapies accompanied by public health measures such as social distancing, contact tracing, wearing face masks, and frequent hand washing. From todays' perspective, these public health measures are time honored but not sufficiently proven effective, especially when applied in the context of a vaccination strategy. Also, the protective effects of lockdowns of schools, universities, and other institutions and the restrictions on travel and personal visits to hospitals or old-age homes are not precisely known. Preparedness is still a demand for a future pandemic. Clinical trials should determine the comparative effectiveness of such public health measures, especially for their use as a combination strategy with vaccination and individual testing of asymptomatic individuals. It is important for neurologists to realize that during a pandemic the treatment possibilities for acute stroke and other neurological emergencies are reduced, which has previously led to an increase of mortality and suffering. To increase preparedness for a future pandemic, neurologists play an important role, as the case load of acute and chronic neurological patients will be higher as well as the needs for rehabilitation. Finally, new chronic forms of postviral disease will likely be added, as was the case for postencephalitic parkinsonism a century ago and now has occurred as long COVID.

A case study on anthrax in an eight-month old infant at Kyrgyz Republic.

Anthrax remains a threat, especially in countries like Kyrgyzstan with developed livestock farming. Despite preventive efforts, sporadic outbreaks endure on an annual basis, transmitted from infected animals to humans. Here, we report a severe anthrax case in an 8-month-old child known to be caused when a sick calf was slaughtered in the neighborhood without proper protocols, resulting in intra-family infection. This underscores the importance of swift diagnosis, treatment, preventive measures, and awareness of zoonotic infections, animal vaccination and adherence to sanitary and veterinary protocols.

How three linked clinical observations led to an understanding of perioperative heat balance: A personal reflection on the scientific process.

Three linked clinical observations prompted our current understanding of perioperative heat balance. The first was the extraordinarily rapid decrease in core temperature after induction of general anesthesia which led to an understanding of redistribution hypothermia. The second was the linear reduction in core temperature during the subsequent 2-3 h which led to an understanding of anesthetic effects on metabolic heat production and factors that influence cutaneous heat loss. And the third was the observation that core temperature reaches a plateau at about 34.5 °C which led to the understanding that thermoregulatory vasoconstriction re-emerges when patients become sufficiently hypothermic, and that arteri-venous shunt constriction constrains metabolic heat to the core thermal compartment.

Aimée REDONDO, The First Female Neurosurgeon Professor in France.

It is crucial to promote the role of women in surgery, particularly in the field of neurosurgery, which is still predominantly male-dominated. Without recognition and support, these talented and pioneering women may continue to be overlooked, despite their significant contributions to the field. One such remarkable woman is Professor Aimée Redondo, the first female neurosurgeon professor in France. She was born in 1944 during the last years of World War II to immigrant parents from Spain. Thanks to grants and scholarships from the French government, Aimée Redondo was able to continue her education. She excelled in high school and even passed the entrance exam for medical school on her first attempt - a rare achievement at the time. In 1975, at the young age of 31, she became the first female professor of neurosurgery in France. After completing her residency, she worked as a senior neurosurgeon at the Salpêtrière Hospital in Paris and then joined the newly established department of neurosurgery at Beaujon Hospital. For over thirty years, she was a crucial member of this department and served as its head from 2004 until her retirement. Sadly, she passed away in 2022 at the age of 78.

Balto and Togo during the cold winter of Alaska (1925): the two canine heroes in the fight against diphtheria.

In recent years, diphtheria has re-emerged in areas with inadequate vaccination coverage, and Europe has not been spared with several cases among migrants. Diphtheria is a potentially fatal infection caused mainly by toxigenic strains of Corynebacterium diphtheriae. Due to the high mortality rate, especially among young children, the fight against diphtheria is considered one of the first conquests of immunization. In the history of medicine, there is a unique case of an unconventional response to a diphtheria outbreak in which sled dogs were used to overcome the supply difficulties of diphtheria antitoxin. The mass media followed the medical response to the outbreak and raised audience awareness of public health issues. The facts of Nome, Alaska, in 1925 can serve as a catalyst to rethink conventional responses to diphtheria outbreaks in low-income countries today and promote mass media awareness of public health importance.

The history of polio vaccination with "Sabin's OPV" 60 years after its introduction in Italy: an unforgivable "delay".

In the spring of 1964, polio vaccination with the oral vaccine developed by Albert Sabin began in Italy. Polio was feared in the world and in Italy. Thus, between 1957 and the beginning of 1958, Italian children began receiving the "Salk vaccine", though the results were not particularly convincing. In July 1960, the international scientific community was able to verify the data from the mass testing of the Sabin vaccine. It became clear that the OPV, could prevent the virus from multiplying, thereby providing greater protection and determining the eradication of the disease. In 1960 over 70 million people in the USSR alone had already received the oral vaccine and mass vaccination in the USA would start in March 1961. However, in Italy there was no similar initiative; only later the new vaccine was accepted but was not made compulsory at the beginning. As a result of the commission's report, registration of the "Polioral" vaccine, was authorized in September 1962 but the sale of the vaccine was not authorized until November 1963. At the beginning of 1964, the production of "Polioral" started and the product was marketed and on the 1 st of March 1964, anti-polio vaccination with the "Sabin anti-polio vaccine" also began in Italy. This manuscript focuses on a crucial issue about a historical delay for public health and it points out as the preparation and diffusion of the Sabin polio vaccine demonstrates that decisions regarding health treatments, and specifically vaccination campaigns, must be based exclusively on the results of clinical studies and on independent evaluation by the scientific community. This process ensures trust in vaccines, adequate protection of public health andcitizens' well-being.

A historical and palaeopathological perspective on cancer.

Cancer is often wrongly considered to be a modern disease in many popular medical venues. Cancers have been known to humanity since ancient times. In fact, its antiquity can be identified through the application of palaeopathological methodologies. The present perspective demonstrates by means of a historical and palaeopathological analysis how oncological manifestations were present long before the emergence of anatomically modern humans and addresses the epidemiological transition from ancient times to the contemporary world. The final section of the article examines breast cancer and its identification in ancient human remains.

Prevalence and Associated Risk Factors of Irritable Bowel Syndrome Among General Population: A Cross-Sectional Study in Qassim Region, Saudi Arabia.

Background Irritable bowel syndrome (IBS) affects 10-20% of the global population, primarily manifesting as functional issues leading to abdominal discomfort. Key contributors like genetics, psychological factors, weakened immunity, and environmental pollutants play significant roles. Regional variations exist, with prevalence rates ranging from 7-10% in certain areas like South Asia and the Middle East to as high as 20% in many Western countries. Objective The objective of this study is to assess the prevalence of irritable bowel syndrome (IBS) and its related risk factors among the general populace of the Qassim region, Saudi Arabia, aiming to offer valuable insights for healthcare planning and intervention strategies. Methods A cross-sectional descriptive study was conducted, utilizing a validated self-administered questionnaire among residents of the Qassim region aged over 18 years. The questionnaire included demographic information about the participants and the validated Rome IV questionnaire for IBS in adults. Ethical approval for the study was obtained from the Qassim Research Ethics Committee, and data analysis was conducted using R script language version 4.3.3. A significance level of p < 0.05 was employed to interpret the results. Results Overall, significant associations were observed between IBS diagnosis and food allergy (AOR = 2.34, 99% CI: 1.27-4.29), family history of IBS (Adjusted Odd Ratio (AOR) = 7.03, 99% CI: 3.51-15.74), and abdominal pain lasting more than six months (AOR = 2.54, 99% CI: 1.49-4.33). Conclusion This study highlights a high IBS prevalence (21.4%) in Saudi Arabia's Qassim region. While no overall soda-IBS link was found, males showed a protective effect. Significant associations were noted between food allergy, family history, and abdominal pain with IBS diagnosis, especially among females. Further research on gender disparities and familial and abdominal pain roles in IBS management is warranted.

An early case of successful peripheral nerve repair in 1880: Francis L. Parker, MD.

The modern technique of epineural suture repair, along with a detailed reporting of functional restoration, came from Carl Hueter in 1873. While there is extensive information on peripheral nerve surgery throughout recorded history leading up to the 1800s, little early American scientific literature is available. While Schwann, Nissl, and Waller were publishing their work on nerve anatomy and physiology, Francis LeJau Parker was born. The South Carolina native would go on to describe one of the first American cases of peripheral nerve repair with the restoration of function. Francis Parker was born in 1836 in Abbeville, South Carolina. He gained local notoriety as one of the first American surgeons to suture a severed nerve, resulting in restored function. The case dates back to 1880, when a patient presented to his clinic with severing of the posterior interosseous nerve. The details of this case come from the archives of the South Carolina Medical Association. The authors reviewed these records in detail and provide a case description of nerve repair not previously reported in the modern literature. The history, neurological examination, and details of the case provide insight into the adroit surgical skills of Dr. Parker.

[What are the considerations for medium prematurity?] / Quelles considérations pour la moyenne prématurité ?

Despite its high prevalence, moderate prematurity has been little studied in comparison with great or very great prematurity. In order to better understand the causes of this under-representation in the literature and in post-hospital care, this article proposes to analyze the historical and medical issues surrounding prematurity, and to investigate the different representations, by caregivers and parents, of the subject of intermediate prematurity. A necessary step in the evolution of practices.