Prominent Perspective on Existing Biological Hallmarks of Alzheimer's Disease.

Biomarkers are the most significant diagnosis tools tending towards unique approaches and solutions for the prevention and cure of Alzheimer's Disease (AD). The current report provides a clear perception of the concept of various biomarkers and their prominent features through analysis to provide a possible solution for the inhibition of events in AD. Scientists around the world truly believe that crucial hallmarks can serve as critical tools in the early diagnosis, cure, and prevention, as well as the future of medicine. The awareness and understanding of such biomarkers would provide solutions to the puzzled mechanism of this neuronal disorder. Some of the argued biomarkers in the present article are still in an experimental phase as they need to undergo specific clinical trials before they can be considered for treatment.

Racemose neurocysticercosis: a case series.

Neurocysticercosis (NCC) is a common parasitic condition of the central nervous system in certain parts of the world. The racemose variety of NCC is distinct from the commonly seen parenchymal form. It frequently infiltrates the basal cisterns and Sylvian fissures. Imaging plays a vital role in the diagnosis; however, as their signal intensity is similar to cerebrospinal fluid and due to the absence of enhancement in most cases, imaging diagnosis is often difficult on the conventional MRI sequences. Here, we present five cases of racemose NCC to emphasize the importance of a heavily T2-weighted sequence (Fast Imaging Employing Steady-state Acquisition) sequence in the diagnosing this entity.

Endovascular embolisation of posterior condylar canal dural arteriovenous fistula.

We describe a rare case of dural arteriovenous fistula (dAVF) of the posterior condylar canal in a man in his 30s who presented with recent onset headache and neck pain and subsequently acute intracranial haemorrhage. Radiological workup showed a medulla bridging vein draining dAVF of the right posterior condylar canal supplied by a meningeal branch of the right occipital artery. A dilated venous sac was seen compressing over cerebellar tonsil on the right side. There was acute haemorrhage in the posterior fossa and fourth ventricle. He was successfully managed with transarterial endovascular embolisation via a supercompliant balloon microcatheter without any complication. The balloon microcatheter effectively prevented reflux of the liquid embolic agent into the parent artery and vasa nervosa of lower cranial nerves.

A holistic approach to performance prediction in collegiate athletics: player, team, and conference perspectives.

Predictive sports data analytics can be revolutionary for sports performance. Existing literature discusses players' or teams' performance, independently or in tandem. Using Machine Learning (ML), this paper aims to holistically evaluate player-, team-, and conference (season)-level performances in Division-1 Women's basketball. The players were monitored and tested through a full competitive year. The performance was quantified at the player level using the reactive strength index modified (RSImod), at the team level by the game score (GS) metric, and finally at the conference level through Player Efficiency Rating (PER). The data includes parameters from training, subjective stress, sleep, and recovery (WHOOP straps), in-game statistics (Polar monitors), and countermovement jumps. We used data balancing techniques and an Extreme Gradient Boosting (XGB) classifier to predict RSI and GS with greater than 90% accuracy and a 0.9 F1 score. The XGB regressor predicted PER with an MSE of 0.026 and an R2 of 0.680. Ensemble of Random Forest, XGB, and correlation finds feature importance at all levels. We used Partial Dependence Plots to understand the impact of each feature on the target variable. Quantifying and predicting performance at all levels will allow coaches to monitor athlete readiness and help improve training.

An Unusual Association of Idiopathic Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) With Interstitial Lung Disease (ILD).

Although the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is commonly associated with many lung conditions and drugs used for treating them, no literature describes a direct association between SIADH and interstitial lung disease. This case report discusses a 79-year-old male patient who presented to the emergency department (ED) with altered mental status following a fall. The patient had clinical symptoms and imaging findings concerning interstitial lung disease (ILD), and laboratory tests from the ER indicated severe hyponatremia and an increased white blood cell count, suggesting an unusual clinical picture. Detailed workup and medication reconciliation revealed no other medical conditions or intake of drugs associated with SIADH; however, the patient's low serum osmolality, high urine osmolality, high urine sodium, and improvement in serum sodium level with the initiation of 0.9% saline, salt tablets, and tolvaptan verify the presence of SIADH. While the association between SIADH and ILD is not well documented in medical literature, a few case reports from different regions have indicated a potential link, either through drug-induced ILD or SIADH resolution coinciding with ILD improvement. Hence, we describe a case of idiopathic SIADH, possibly associated with interstitial lung disease. This case demonstrates the importance of recognizing the coexistence of SIADH and ILD, as severe hyponatremia can lead to potential life-threatening neurological consequences.

Surgical Outcomes of Levator Resection in Moderate and Severe Ptosis With a Good Levator Function: A Retrospective Study.

INTRODUCTION: An abnormally drooping upper eyelid in comparison with the normal position in primary gaze refers to ptosis. Levator resection should be the procedure of choice in patients with moderate to severe ptosis and a good levator function. METHODS: In this retrospective study, we analysed the surgical outcomes after large and maximal levator resection in patients with moderate and severe ptosis with a good levator function and Bell's phenomenon. All patients had a good levator function; therefore, levator resection was the procedure of choice. We performed levator resection of 20 mm and above and the desired post-operative correction was achieved. RESULTS: One patient had microcornea, and hence, he was undercorrected and his post-operative marginal reflex distance 1 (MRD 1) was 3 mm. Two patients who had severe ptosis pre-operatively had a post-operative MRD 1 of 3 mm. Rest of the patients had a post-operative MRD 1 of 4 mm. CONCLUSION: Levator resection of 20 mm or more should be performed in patients with congenital simple ptosis with a good levator function and Bell's phenomenon to achieve a favourable post-operative outcome.

Understanding the roles and regulation of mitochondrial microRNAs (MitomiRs) in neurodegenerative diseases: Current status and advances.

MicroRNAs (miRNA) are a class of small non-coding RNA, roughly 21-22 nucleotides in length, which are master gene regulators. These miRNAs bind to the mRNA's 3' - untranslated region and regulate post-transcriptional gene regulation, thereby influencing various physiological and cellular processes. Another class of miRNAs known as mitochondrial miRNA (MitomiRs) has been found to either originate from the mitochondrial genome or be translocated directly into the mitochondria. Although the role of nuclear DNA encoded miRNA in the progression of various neurological diseases such as Parkinson's disease, Alzheimer's disease, Huntington's disease, etc. is well known, accumulating evidence suggests the possible role of deregulated mitomiRs in the progression of various neurodegenerative diseases with unknown mechanism. We have attempted to outline the current state of mitomiRs role in controlling mitochondrial gene expression and function through this review, paying particular attention to their contribution to neurological processes, their etiology, and their potential therapeutic use.

Direct Percutaneous Thrombolysis (DPT): A novel method of salvaging Thrombosed Native Arteriovenous Fistula.

INTRODUCTION: Thrombosed arteriovenous fistulas (AVFs) are either treated by thrombectomy or pharmaco-mechanical thrombolysis with or without percutaneous balloon angioplasty. In this study, we have described an effective and economical technique of salvaging these fistulae using a 20-22-gauge spinal needle and urokinase and have named it direct percutaneous thrombolysis (DPT). MATERIALS AND METHOD: This prospective study comprised of 148 patients out of which 120 patients presented with AVF thrombosis and were divided into two groups; those with no obvious stenosis on ultrasound (n = 38) and second with venous stenosis (n = 82). Remaining 28 patients developed thrombosis post angioplasty for venous stenosis. Percutaneous injection of urokinase into the thrombus was done under ultrasound guidance, followed by balloon angioplasty if there was associated stenosis. RESULTS: In 38 patients who didn't have any stenosis, 32 AVFs were successfully thrombolysed by DPT, with technical success of 84.2%. Remaining six patients required angioplasty because of chronic nature of clot. In 82 patients who had venous stenosis, 80 cases were treated successfully by DPT followed by angioplasty with technical success of 97.5%. In third group (n = 28), who developed thrombosis post angioplasty, 100% success rate was noted. The mean length of thrombus was 31.4 ± 4.6 mm and mean diameter of thrombosed vein was 10.5 ± 1.2 mm. There were no major complications encountered during the procedure. Minor complications were seen in 19 patients which included prolonged oozing from puncture site and local hematoma formation. CONCLUSION: Ultrasound guided DPT with urokinase is a safe and economical option for salvaging thrombosed AVF without vascular stenosis that does not need angioplasty.

Cyclin-Dependent Kinase 5 Regulates cPLA2 Activity and Neuroinflammation in Parkinson's Disease.

Hyperactivation of cyclin-dependent kinase 5 (Cdk5) by p25, contributes to neuroinflammation causing neurodegeneration in Parkinson's disease (PD) and Alzheimer's disease. However, the mechanism by which Cdk5 induces neuroinflammation in the PD brain is largely unexplored. Here, we show that Cdk5 phosphorylates cytosolic phospholipase A2 (cPLA2) at Thr-268 and Ser-505 sites lead to its activation and generation of eicosanoid products. Mutational studies using site-directed mutagenesis and molecular simulations show that the architecture of the protein changes on each single-point mutation. Interestingly, double mutations also led to a severe decline in the activity of cPLA2 and to the disruption of its translocation to the plasma membrane. Further, the brain lysates of transgenic PD mouse models show hyperactivation of Cdk5, resulting in enhanced phosphorylation of Thr-268 and Ser-505 of cPLA2 and its heightened activity, confirming the findings observed in the cell culture model of PD. These phosphorylation sites of cPLA2 and Cdk5 could be explored as the future therapeutic targets against neuroinflammation in PD. Further, conjoint transcriptomic analysis of the publicly available human PD datasets strengthens the hypothesis that genes of the arachidonic acid, prostaglandin synthesis, and inflammatory pathways are significantly upregulated in the case of PD patients compared with that of healthy control subjects.

Endovascular management of pulmonary arteriovenous malformations presenting as multiple brain abscesses.

Pulmonary arteriovenous malformations (PAVMs) are rare vascular lesions characterised by abnormal connections between the pulmonary artery and vein bypassing the pulmonary capillary bed and causing right-to-left shunt. Paradoxical embolism is known to occur in these cases, leading to inoculation of septic focus in the systemic circulation. We report a case of multiple PAVMs who presented clinically with seizures and altered sensorium. On radiological work-up, multiple brain abscesses and large PAVMs were evident. The patient was successfully treated by endovascular embolisation of the PAVMs using a vascular plug and multiple coils. The patient showed complete clinical recovery and resolution of brain abscesses on follow-up.

CT-Based Definition and Structured Reporting of Abdominal Lymph Node Stations.

Background Meticulous evaluation of abdominal lymph nodes on computed tomography (CT) is a fundamental task in radiological practice especially in oncological reporting. Although various reporting systems exist to define abdominal nodal stations for malignancies of individual abdominal organs, a complete and uniform framework for radiological reporting of abdominal lymph nodes does not exist in the literature. Purpose The goal of this review was to provide a step-wise reporting template and precise definitions of the radiological anatomy of abdominal lymph nodes and to generate a CT-based illustration of the lymph node stations of the abdomen. Conclusion This CT-based illustration and reporting template will help the radiologists to aptly describe the extent of the lymph nodal diseases and will help in comparison with posttherapy scans.

Late presentation of lane-hamilton syndrome in a 33 year old female: A case report.

Lane-Hamilton syndrome (LHS) is a rare syndromic association between idiopathic pulmonary hemosiderosis and celiac disease (CD). It is usually seen in children below 15 years of age. It can occasionally be seen in adults. We present the case of a 33-year-old female patient who presented with recurrent episodes of hemoptysis to the pulmonary outpatient department. She also gave a history of having frequent loose stools. She was admitted and investigated thoroughly and was found to be suffering from LHS which is a rare disease. High-resolution computed tomography (HRCT) of the chest and duodenal biopsy helped in concluding the diagnosis. She was started on gluten-free diet (GFD) and has responded well with no episodes of hemoptysis on 9-month follow-up and is in good general condition. This case highlights the importance of keeping a high index of suspicion of LHS in a young patient presenting with unexplained hemoptysis and diarrhea. In a known case of CD presenting with hemoptysis, a HRCT chest aids in the diagnosis of LHS. A GFD is the mainstay of long-term treatment, and adherence to this diet shows remarkable improvement in the symptoms of the patient and their overall general condition.

Late Presentation of Hirayama Disease With "Snake Eye Sign": A Case Report.

Hirayama disease, also called non-progressive juvenile muscular atrophy of distal upper limbs, is a type of cervical myelopathy associated with flexion movements of the neck. It is a type of benign motor neuron disease seen typically in young males in the age group of 15 to 25. The disease has an insidious onset with a stationary stage following a progressive phase. It is also called monomelic amyotrophy with patients usually presenting with insidious onset unilateral upper limb weakness and muscle wasting. A bilateral and asymmetrical presentation can be seen very rarely. A middle-aged male patient presented with bilateral asymmetrical upper limb weakness, muscle wasting involving forearm and hand muscles. Neurological examination showed bilateral upper limb weakness and muscle wasting involving forearm and hand muscles, with a classical pattern of muscle wasting in bilateral forearm muscles called oblique amyotrophy. A clinical diagnosis of Hirayama disease was made and the patient was sent to the radiology department for Magnetic Resonance Imaging of the cervical spine in flexion and neutral positions. The imaging findings were consistent with the clinical diagnosis of Hirayama disease with the presence of an abnormal "snake eye appearance". The electrophysiological assessment done including the electromyography and nerve conduction studies were also consistent with the clinical diagnosis. "Snake eye appearance" on MRI in patients with Hirayama disease is associated with unfavorable outcomes and represents cervical myelopathy involving the anterior horn cells.