Medical Students Understanding of The Scope of Plastic Surgery.

Background Plastic surgery has developed to benefit in a variety of challenging areas formerly handled by other disciplines. Medical students do not have a clear picture of plastic surgery as a career due to lacking scope, clinical practice, and understanding of plastic surgery as a clinical area of expertise, including general practitioners, nursing staff, medical trainees, and the general public, and misconceptions about the extent of reconstructive and plastic surgery. Methods A cross-sectional observational study was conducted on Kuwait University Medical students (2nd-7th Years) over a period of 1 month. A questionnaire and a consent form were provided to eligible students. The inclusion criteria were Kuwait University Medical students from 2nd to 7th Years with signed consent form. The response was collected via email sent in coordination with the Vice Dean of Student Affairs in the Faculty of Medicine. Using statistical package for the social sciences, responses were statistically analyzed. Pearson's chi-square test was used to calculate p -values, where p < 0.05 was considered statistically significant. Results A total of 244 eligible medical students, 121 males and 123 females, were included in the study, with a mean age of 21 (±2) years. Similarly, 126 (51.6%) were preclinical students (2nd-4th-year students), while 118 (48.4%) were clinical students (5th-7th-year students). About 79.8% of medical students believed that plastic surgery plays an essential role in trauma management, whereas 9.2% did not consider plastic surgery significant for trauma management. This study found that only 15.5% of medical students were interested in enrolling in plastic surgery residency after graduation, while 47.1% of students did not consider plastic surgery residency after graduation. However, 37.4% were uncertain. The two most driving factors in deciding on plastic surgery residency were expected income (61.8%) and lifestyle (14.3%). Conclusion Improving medical students' education quality can enhance their perception and awareness of plastic surgery. Students should be taught the broader scope of plastic surgery. The inclusion of formal training during undergraduation is the essence of time and should be added to or improved during plastic surgery rotations with more emphasis on reconstructive and hand/peripheral nerve surgery. Student-led interest groups can be a useful tool for educating students about their specialty.

CD68 Antigen and Cerebral Aneurysms: A Case-Control Study.

BACKGROUND: Intracranial aneurysms are more commonly associated with inflammation as a cause of their development, progression, and rupture. Macrophages and other cells can express the CD68 antigen. The aim of this study was to assess the CD68 antigen levels in cerebral aneurysm (CA) patients compared to a control group at a referral center in Iran. METHODS: A case-control investigation was undertaken on 88 individuals (44 of whom were cases and 44 were controls). Individuals with CA as the case group consisted of 28 ruptured and 16 unruptured subgroups. Clinical, radiographic, and CD68 levels were evaluated and registered. RESULTS: The average age of the participants was 49 years. Males comprised 43.2% of the patients, while 56.8% were females (p = 0.002). There was a statistically significant difference in the CD68 levels between the two groups. There was no significant difference (p = 0.42) between the ruptured and unruptured subgroups (23.66 and 20.47, respectively) in this comparison. No significant correlation was seen between the patients' CD68 and Glasgow Coma Scale (GCS) levels and their aneurysm diameter (p = 0.74 and 0.45, respectively). A link between CD68 levels and age was found, but it was not statistically significant (r = 0.44 and p = 0.002). CONCLUSIONS: A possible involvement of CD68 as an inflammatory agent in the development of CAs but not in aneurysm rupture has been suggested. Inflammation and CD68 were positively associated with age. The CD68 antigen should be studied further in population-based cohort studies.

Temperature-induced dispersive solid-phase extraction as a new approach for preconcentration of Sudan dyes in water and food samples prior to the determination by high-performance liquid chromatography.

This study introduced a new microextraction method named temperature-induced dispersive solid-phase extraction. The performance of the method was demonstrated with the determination of Sudan dyes in food and natural water samples. In this method, a low quantity of sorbent was added to the aqueous solution and the mixture was shaken manually for about one minute. Then, the solution was heated in an ultrasonic water bath, and the sorbent was dissolved. Subsequently, the solution was cooled down with ice water, and consequently, the solubility of the sorbent was reduced in the sample solution and became cloudy. The phase separation was accelerated by centrifugation. The upper liquid phase was picked up using a syringe, and the remainder was solved in methanol and introduced into the HPLC for analysis. Various parameters affecting the extraction yield were evaluated. Analytical parameters, including limits of detection (0.011-0.016 µg/L) and quantification (0.038-0.055 µg/L), relative standard deviations (2.3%-3.1%), and preconcentration factor (40) proved the high efficiency of the developed method for the analysis of Sudan dyes. The proposed method was used to measure Sudan dyes in water and food samples and showed good extraction recoveries (95.0%-103.5%).

Dorsal intradural spinal arteriovenous fistula associated with giant intradural spinal aneurysm, a case report.

Arteriovenous fistula and spinal aneurysms like other vascular malformations can mimic radiculopathy and low back pain. Precise imaging work combined with a hybrid endovascular-microsurgical approach is the key element for the best clinical outcome.

Surgical Outcome of Pediatric Posterior Fossa Tumors in Shiraz, Southern Iran: A Brief Report.

Posterior fossa tumors (PFTs) are prevalent in children, and about half of all childhood brain tumors arise from the structures of the posterior fossa. Studies on PFTs in Iranian children have mainly focused on epidemiological characteristics. This study aimed to evaluate surgical outcomes and predictive factors for survival in children with PFTs in Shiraz, Iran. A prospective cohort study was conducted from March 2014 to September 2019 in Namazi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 87 pediatric patients under the age of 16 who were diagnosed with PFT and had undergone surgery were recruited. The children were followed up for postoperative outcomes such as mortality and neurological complications. Data were analyzed using SPSS software (version 20.0) and R software (version 3.3.1). P<0.05 was considered statistically significant. The mean age of the patients was 6.49±4.14 years and 64.4% were male. Sixteen patients were lost to follow-up, 31 died after surgery, and 40 were in remission during phone calls. The median survival time of the patients was four years. The most common type of PFT was medulloblastoma (n=46, 53%). The result of the multivariate Cox proportional hazards model showed that age (P=0.034) was correlated with postoperative survival, hazard ratio 0.90 (95% confidence interval 0.82 to 0.99). Among various predictive factors, lower age was associated with poor outcomes in pediatric children with PFTs.

Z-scan optical method complements the Thioflavin T assay for investigation of anti-Alzheimer's impact of polyphenols.

Polyphenols are effective in eliminating amyloid-beta aggregations, the main hallmark of Alzheimer's disease. Various nano drugs and biomaterials based on polyphenolic compounds have been synthetized to treat or prevent Alzheimer's disease, and the main in-vitro approach to investigate the anti-Alzheimer's properties of materials, is the Thioflavin T assay. While useful it has drawbacks and in particular cannot always guarantee the accuracy of data, specifically in cases of polyphenolic compounds; thus, in this situation accurate results requires utilizing other assays along with Thioflavin T. In this experiment, we introduced the Z-scan technique as a complementary test for Thioflavin T assay. In this study, the anti-Alzheimer's properties of two polyphenols quercetin and fulvic acid were assessed in the presence and absences of silver nanoparticles at various concentrations, both via Z-scan technique and Thioflavin T assay, after which the two tests were aligned with each other. The polyphenols' non-linear refractive indices obtained by the Z-scan technique correlated well with their related fluorescence intensities from the Thioflavin T assay in such a way that, the smaller the magnitude of the non-linear refractive indices, the stronger the anti-amyloidogenic impact. Our work shows that Z-scan could be used along with Thioflavin T for enhanced investigation of polyphenols' anti-Alzheimer's properties.

Evaluation of Serum Interleukin-1ß (IL-1ß) Levels in Patients with Intracranial Aneurysms Compared to a Control Group.

AIM: To examine the screening value of the serum level of interleukin-1ß (IL-1ß) in aneurysmal subarachnoid hemorrhage (SAH), and to evaluate its association with the severity of initial bleeding. MATERIAL AND METHODS: This case-control study was performed in Namazi Hospital, affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The study population included patients referred to Namazi Hospital with a diagnosis of SAH, whose symptoms had emerged within less than 48 hours. The case group consisted of patients with cerebral aneurysms, who were divided into two groups of raptured and un-raptured brain aneurysms. This study examined the relationship between the serum IL-1ß levels and brain aneurysms. The number of samples was 43 per group and 86 in total. Forty-eight hours before the onset of symptoms and before surgery, a blood sample was collected to measure the IL-1Β antibody (anti-IL-1ß) level; in less than three hours, the serum was isolated and placed in a -80ºC freezer. RESULTS: In patients with unruptured aneurysms, the Fisher's grade was 0, while most ruptured aneurysms were grade 3. The middle cerebral artery (MCA) (n=10, 23%) was the most common site of aneurysm, followed by the anterior communicating artery (ACom) (n=9, 20%). There was a significant correlation between ruptured aneurysms and the Glasgow Comma Scale (GCS) score (p=0.01) and also Fisher's classification (p=0.04). Patients with ruptured and unruptured aneurysms showed no significant differences regarding the serum IL-1ß levels. A significant difference was found in the serum level of IL-1ß between the case and control groups (p=0.04). CONCLUSION: Generally, knowledge of the association between aneurysm development and inflammatory response can have significant clinical implications in the future. The present findings suggested a significant correlation between the IL-1ß levels and the outcomes of aneurysmal SAH, independent of initial hemorrhage.

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types ofmicroorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in nontraumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injurywith air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

Are Findings From a Pragmatic Dry Needling Trial Always Applicable in the Real World?

Letter to the Editor-in-Chief in response to JOSPT article "Dry needling adds no benefit to the treatment of neck pain: a sham-controlled randomized clinical trial with 1-year follow-up" by Gattie et al.J Orthop Sports Phys Ther 2021;51(9):470-471. doi:10.2519/jospt.2021.0202.

An Unusual Dermoid Cyst of the Pineal Region: Case Report in a Child

Introduction The pineal gland is a common location for intracranial germ cells, but dermoids are not commonly observed in this area. In the present paper, we discuss the clinical and radiological features as well as the treatment and outcome of this cyst in a 6-year- old child with a pineal dermoid cyst. Case Presentation The patient presented with chronic headache 6 months before admission in 2018. On the first admission, an enhanced lesion with a small cyst was detected in brain imaging. Magnetic resonance imaging (MRI) of the brain at follow-up (2 months after the first presentation) showed enlargement of the cyst size with compression on the adjacent structures. Radical excision of the tumor was performed after the endoscopic biopsy due to pressure exerted on the adjacent structures. Conclusion Dermoid cyst should be considered as a differential diagnosis for enhanced lesions of the pineal region.

Impact of Bariatric Surgery in Reducing Macrovascular Complications in Severely Obese T2DM Patients.

BACKGROUND: Evidence from real-world studies have suggested a reduced rate of macrovascular complications following bariatric surgery. We undertook this meta-analysis to investigate the impact of bariatric surgery on macrovascular disease outcomes in severely obese type 2 diabetes mellitus (T2DM) patients. METHODS: An extensive literature search was performed in PubMed from inception until March 2020. All cohort studies assessing the association between bariatric surgery and macrovascular complications in severely obese T2DM patients were included. Two independent reviewers screened the articles, extracted data, and assessed the quality using the Newcastle-Ottawa Scale. The primary outcome was to assess the impact of bariatric surgery and the risk of macrovascular complications. Statistical analysis was performed using Review Manager 5.3. RESULTS: This meta-analysis comprised of five studies including 49,211 participants (75% female), of which 14,434 underwent bariatric surgery and 34,777 underwent usual care. Participants who underwent bariatric surgery had a significantly lower risk of macrovascular complications as compared to those with non-surgical interventions (RR: 0.50 [95% CI: 0.35-0.73], p = 0.0003). In the subgroup analysis, based on the geographical regions, studies conducted in the USA showed a higher reduction (RR: 0.41 [95% CI: 0.32-0.53], p < 0.00001) in macrovascular complications as compared to other parts of the world. The risk of all-cause mortality was also significantly lower in patients with bariatric surgery (RR 0.39 [95% CI: 0.30-0.50], p < 0.00001). CONCLUSION: Bariatric surgery was associated with a 50% reduction in macrovascular complications along with 61% reduction in risk of all-cause mortality in morbidly obese T2DM patients.

A game-theoretic approach for decision analysis in end-of-life vehicle reverse supply chain regarding government subsidy.

The presence of end-of-life vehicles (ELV) in the cities creates irreparable damage in environmental and economic terms. Thus, governments have been searching for ways to collect ELVs. An effective way to address ELVs is subsidies' policy. In this study, a supply chain including an ELV take-back center, an inspection center, and a repair center are considered. The decision variables are the purchase price of the ELVs, the sale price of the repaired vehicle, and the level of vehicle repair. In this supply chain, the government pays a subsidy to take-back centers that deliver their used vehicles. A Stackelberg game structure is considered with the government as the leader, the inspection center as the primary follower, and the collection and repair centers as the second followers. Using the game theory approach, the effects of government subsidies on equilibrium values of the decision-making variables of the centers in the ELV supply chain have been investigated in three scenarios. The scenarios comprise profit sharing, revenue sharing, and a centralized (cooperative) scenario. The results indicate that the centralized scenario has the most significant advantage compared to the two contracts of profit sharing and cost sharing. For example, the repair level of the ELVs, the amount of repaired vehicles demand, consumer surplus, and the whole supply chain's profit are at their maximum. The most significant impact of subsidy payment is related to the take-back center's profit and the ELV supply. On the other hand, the subsidy does not affect the profit of the repair center.

Burden of diabetes mellitus and its impact on COVID-19 patients: A meta-analysis of real-world evidence.

BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) spreads rapidly and within no time, it has been declared a pandemic by the World Health Organization. Evidence suggests diabetes to be a risk factor for the progression and poor prognosis of COVID-19. Therefore, we aimed to understand the pooled prevalence of diabetes in patients infected with COVID-19. We also aimed to compute the risk of mortality and ICU admissions in COVID-19 patients with and without diabetes. METHODS: A comprehensive literature search was performed in PubMed to identify the articles reporting the diabetes prevalence and risk of mortality or ICU admission in COVID-19 patients. The primary outcome was to compute the pooled prevalence of diabetes in COVID-19 patients. Secondary outcomes included risk of mortality and ICU admissions in COVID-19 patients with diabetes compared to patients without diabetes. RESULTS: This meta-analysis was based on a total of 23007 patients from 43 studies. The pooled prevalence of diabetes in patients infected with COVID-19 was found to be 15% (95% CI: 12%-18%), p = <0.0001. Mortality risk was found to be significantly higher in COVID-19 patients with diabetes as compared to COVID-19 patients without diabetes with a pooled risk ratio of 1.61 (95% CI: 1.16-2.25%), p = 0.005. Likewise, risk of ICU admission rate was significantly higher in COVID-19 patients with diabetes as compared to COVID-19 patients without diabetes with a pooled risk ratio of 1.88 (1.20%-2.93%), p = 0.006. CONCLUSION: This meta-analysis found a high prevalence of diabetes and higher mortality and ICU admission risk in COVID-19 patients with diabetes.

Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants.

BACKGROUND: The relationship between body mass index (BMI) and risk of venous thromboembolism (VTE) and pulmonary embolism (PE) is a controversial issue. This dose-response meta-analysis was performed to investigate the association between BMI and risk of VTE and PE incidence based on cohort studies. METHOD: A comprehensive systematic search was conducted up to August 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane. DerSimonian and Laird random-effects models were run to estimate combined hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out based on BMI values. RESULTS: Eleven articles with 16 arms and 3,910,747 participants were eligible for inclusion in this systematic review and meta-analysis. Pooled results showed a positive association between BMI and risk of VTE in the obese participants compared to participants classified in the normal BMI category (HR: 1.62, 95% CI: 1.29-2.04, I2 = 95%). Furthermore, results showed a significant association between lower BMI (underweight versus normal BMI category) and reduced risk of PE (HR: 0.80, 95% CI: 0.70-0.92, I2 = 9%) and higher risk of PE in obese versus normal BMI participants (HR: 2.24, 95% CI: 1.93-2.60, I2 = 0%). There was a significant linear relationship between BMI and risk of VTE (p < 0.001) and PE (p < 0.001). CONCLUSIONS: This systematic review and dose-response meta-analysis with 3,910,747 participants highlights obesity as a significant risk factor related to the incidence of VTE and PE.

Measuring Force of Droplet Detachment from Hydrophobic Surfaces via Partial Cloaking with Ferrofluids.

This paper presents a new approach to measure the force required to detach a water (a polar liquid) droplet from a hydrophobic surface. This is done by partially cloaking the droplet with a high-surface-tension oil-based ferrofluid and using a magnet to apply a controllable body force to the resulting compound droplet. Placing the assembly on a sensitive scale, the magnet can then be brought closer to the droplet to detach it from the surface while recording the forces applied to the droplet. The work presented here is novel as it uses the concept of partial cloaking in which the solid-droplet contact area is not contaminated by the ferrofluid (and the measured forces do not need postprocessing). Our study is accompanied by numerical simulations aimed at improving our understanding of the interplay between the interfacial forces in a two-phase droplet under the influence of a strong (detaching) body force and at providing additional data for in-depth analyses of these forces. In particular, the minimum ferrofluid volume required for successful water droplet detachment from hydrophobic surfaces is computed for ferrofluids of different surface tensions, and they are compared to experimental data obtained from detaching water droplets from electrospun polystyrene coatings. It is also shown that the detachment force measured via partial cloaking is independent of the volume of the ferrofluid used for the experiment.

No association between proton pump inhibitor use and risk of dementia: Evidence from a meta-analysis.

BACKGROUND AND AIM: A growing body of literature suggests the association between dementia risk and proton pump inhibitor (PPI) use. Therefore, we aimed to investigate the association between PPI use and dementia risk. METHODS: An extensive literature search was performed in PubMed, Embase, and Cochrane till March 31, 2019. All the studies (cohort and case-control) assessing the association between PPI use and dementia risk were eligible for inclusion. Articles were selected based on the screening of title and abstract, data were extracted, and risk of bias was assessed using Newcastle-Ottawa scale. The primary outcome was pooled risk of dementia among PPI user as compared with non-PPI user. Secondary outcomes include dementia risk based on subgroups. Statistical analysis was performed using review manager software. RESULTS: Twelve studies (eight cohort and four case-control) were found to be eligible for inclusion. Majority of the studies were of high quality. Dementia was diagnosed based on International Classification of Diseases 9/10 codes in majority of the included studies. PPI use was not associated with the dementia risk, with a pooled relative risk (RR) of 1.05 (95% confidence interval [CI]: 0.96-1.15), P = 0.31. Subgroup analysis based on study design (cohort: P = 0.14; case-control: P = 0.14), sex (RR 1.25 [95% CI: 0.97-1.60], P = 0.08), histamine 2 receptor antagonist blockers (P = 0.93), and Alzheimer's disease (RR 1.00 [95% CI: 0.91-1.09], P = 0.93) revealed no significant association between PPI use and dementia risk. CONCLUSION: We found no significant association between PPI use and the risk of dementia or Alzheimer's disease.

A proposed mechanism for mind-brain interaction using extended Bohmian quantum mechanics in Avicenna's monotheistic perspective.

In quantum approaches to consciousness, the authors try to propose a model and mechanism for the mind-brain interaction using modern physics and some quantum concepts which do not exist in the classical physics. The independent effect of mind on the brain has been one of the challenging issues in the history of science and philosophy. In some recent mind-brain interaction models, the direct influence of mind on matter is either not accepted (as in Stapp's model) or not clear, and there have not been any clear mechanism for it (as in Penrose-Hameroff's model or in Eccles's model). In this manuscript we propose a model and mechanism for mind's effect on the matter using an extended Bohmian quantum mechanics and Avicenna's ideas. We show that mind and mental states can affect brain's activity without any violation of physical laws. This is a mathematical and descriptive model which shows the possibility of providing a causal model for mind's effect on matter. It is shown that this model guarantees the realistic philosophical constraints and respects the laws of nature. In addition, it is shown that it is in agreement with the Libet style experimental results and parapsychological data. To propose this model, we obtained a modified (non-unitary) Schrödinger equation via second quantization method which affects the particle through a modified quantum potential and a new term in the continuity equation. At the second quantized level, which is equivalent to quantum field theory level (QFT), we can use the path integral formalism of Feynman. We show that there are three methods to extend Bohmian QM via path integral formalism, which has different interpretations. By numerical simulation of trajectories in the two-slits experiment, we show their differences and choose one of these methods for our mind-brain model which can be the basis for explaining some phenomena which are not possible to explain in the standard Bohmian QM.

Outcome Evaluation of Patients with Burst Thoracolumbar Fractures: A Case Series

Objective The aim of the present study was to evaluate the outcome of short segment instrumentation in patients affected by burst thoracolumbar fractures. Methods A total of 19 patients with unstable burst fractures of the thoracolumbar spine were eligible for short segment instrumentation. Their functional outcome (by using the Oswestry and Denis scales) and back pain (using the visual analog scale) were evaluated after 12 months. Results Themean age of the patients was 30.7 years old, andmost of them weremale (n » 15). The mean hospital stay was 4.6 days. The mean standard deviation (SD) of the pain score according to the visual analog scale was 1.63 1.25 after 12 months of surgery, and there were no patients classified with grades 4 or 5 on the Denis work scale. The average Oswestry disability index (ODI) was 17% during the follow-ups. Conclusions The outcome of the studied patients, including the clinical pain and the functional outcome of postsurgical patients, suggested that the short-segment instrumentation could be an appropriate method for patients with unstable thoracolumbar junction fractures. However, a long-term follow-up is recommended.