Unveiling the axonal connectivity between the precuneus and temporal pole: Structural evidence from the cingulum pathways.

Neuroimaging studies have consistently demonstrated concurrent activation of the human precuneus and temporal pole (TP), both during resting-state conditions and various higher-order cognitive functions. However, the precise underlying structural connectivity between these brain regions remains uncertain despite significant advancements in neuroscience research. In this study, we investigated the connectivity of the precuneus and TP by employing parcellation-based fiber micro-dissections in human brains and fiber tractography techniques in a sample of 1065 human subjects and a sample of 41 rhesus macaques. Our results demonstrate the connectivity between the posterior precuneus area POS2 and the areas 35, 36, and TG of the TP via the fifth subcomponent of the cingulum (CB-V) also known as parahippocampal cingulum. This finding contributes to our understanding of the connections within the posteromedial cortices, facilitating a more comprehensive integration of anatomy and function in both normal and pathological brain processes. PRACTITIONER POINTS: Our investigation delves into the intricate architecture and connectivity patterns of subregions within the precuneus and temporal pole, filling a crucial gap in our knowledge. We revealed a direct axonal connection between the posterior precuneus (POS2) and specific areas (35, 35, and TG) of the temporal pole. The direct connections are part of the CB-V pathway and exhibit a significant association with the cingulum, SRF, forceps major, and ILF. Population-based human tractography and rhesus macaque fiber tractography showed consistent results that support micro-dissection outcomes.

Surgical site infection in a Greek general surgery department: who is at most risk?

OBJECTIVE: Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. METHOD: In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. RESULTS: Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. CONCLUSION: This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.

Machine Learning-Based Predictive Models for Patients with Venous Thromboembolism: A Systematic Review.

BACKGROUND: Venous thromboembolism (VTE) is a chronic disorder with a significant health and economic burden. Several VTE-specific clinical prediction models (CPMs) have been used to assist physicians in decision-making but have several limitations. This systematic review explores if machine learning (ML) can enhance CPMs by analyzing extensive patient data derived from electronic health records. We aimed to explore ML-CPMs' applications in VTE for risk stratification, outcome prediction, diagnosis, and treatment. METHODS: Three databases were searched: PubMed, Google Scholar, and IEEE electronic library. Inclusion criteria focused on studies using structured data, excluding non-English publications, studies on non-humans, and certain data types such as natural language processing and image processing. Studies involving pregnant women, cancer patients, and children were also excluded. After excluding irrelevant studies, a total of 77 studies were included. RESULTS: Most studies report that ML-CPMs outperformed traditional CPMs in terms of receiver operating area under the curve in the four clinical domains that were explored. However, the majority of the studies were retrospective, monocentric, and lacked detailed model architecture description and external validation, which are essential for quality audit. This review identified research gaps and highlighted challenges related to standardized reporting, reproducibility, and model comparison. CONCLUSION: ML-CPMs show promise in improving risk assessment and individualized treatment recommendations in VTE. Apparently, there is an urgent need for standardized reporting and methodology for ML models, external validation, prospective and real-world data studies, as well as interventional studies to evaluate the impact of artificial intelligence in VTE.

Robotic assisted and exoskeleton gait training effect in mental health and fatigue of multiple sclerosis patients. A systematic review and a meta-analysis.

PURPOSE: Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue. MATERIALS AND METHODS: We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models. RESULTS: The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36-MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS). CONCLUSIONS: Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9.Implications for rehabilitationMultiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective.Rehabilitation strategy must take into consideration the non-physical effects of a training intervention.Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression.

Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms.

Aims: The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals. Methods: The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest. Results: Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184). Conclusion: Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.

Spontaneous Visual Acuity Recovery After Cilioretinal Artery Occlusion Combined With Central Retinal Vein Occlusion in a Young Patient.

This work illustrates the case of cilioretinal artery occlusion (CilRAO) combined with central retinal vein occlusion (CRVO) in a young patient that resolved spontaneously. A 17-year-old male with an unremarkable medical history presented with acute painless loss of vision unilaterally. Upon ophthalmologic examination, retinal hemorrhages in all four quadrants and edema extending from the optic disc to the macula were reported. Using optical coherence technology (OCT) imaging and fundus fluorescein angiography (FFA), combined CilRAO/CRVO was diagnosed. The full medical evaluation was unremarkable. Within the next month, the patient had regained full visual acuity (VA) in the affected eye, and the retinal findings resolved without intervention. Combined CilRAO/CRVO is a common vascular pathology in young, otherwise healthy patients. It is commonly considered a hemodynamic block in the capillary bed, hence its hopeful prognosis. Nonetheless, several risk factors have been proposed that need to be eliminated. Despite the initial alarming symptoms, young patients with CilRAO/CRVO should be monitored closely, and intervention should be resorted to when necessary.

Prosthetic reconstruction following resection of lower extremity bone neoplasms: A systematic review and meta-analysis.

Prosthetic reconstructive procedures have become the mainstay in contemporary surgical treatment following resection of extremity bone neoplasms. Given that these patients are of young age most of the time, achievement of robust functional outcomes is of paramount importance. The aim of this study is to assess the impact of this procedure on the gait parameters of cancer patients compared to healthy individuals. The Medline, Scopus and Cochrane databases were systematically searched until January 2022 for eligible studies. Gait parameters measured by gait analysis after prosthetic reconstruction were the outcomes of interest. Eight cohort studies were included in our analysis. From these, seven studied prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one exclusively studied prostetic reconstructions of the proximal femur. Compared to healthy individuals a significant decrease was evident in gait velocity (-0.16 m/sec, 95 %CI: -0.23 to -0.09, p-value < 0.001), in stride length (-6.07 %height, 95 %CI: -9,36 to -2.78, p-value < 0.001), in cadence (-3.96 stride/min, 95 %CI: -5.41 to -2.51, p-value < 0.001) and significant increase in cycle time (0.10 s, 95 %CI: 0.03 to 0.17, p-value = 0.005). Prosthetic reconstruction following lower limb tumor resection significantly affects the gait of patients. This knowledge can be utilized for further refinement of surgical techniques, rehabilitation strategies and follow-up programming.

Gait and balance patterns related to Free-Walking and TUG tests in Parkinson's Disease based on plantar pressure data.

Continuous monitoring of patients with Parkinson's Disease (PD) is critical for their effective management, as early detection of improvement or degradation signs play an important role on pharmaceutical and/or interventional plans. Within this work, a group of seven PD patients and a group of ten controls performed a set of exercises related to the evaluation of PD gait. Plantar pressure signals were collected and used to derive a set of analytics. Statistical tests and feature selection approaches revealed that the spatial distribution of the Center of Pressure during a static balance exercise is the most discriminative analytic and may be used for every-day monitoring of the patients. Results have revealed that out of the 28 features extracted from the collected signals, 10 were statistically significant (p < 0.05) and can be used to machine learning algorithms and/or similar approaches.

Evaluating the Performance of Balance Physiotherapy Exercises Using a Sensory Platform: The Basis for a Persuasive Balance Rehabilitation Virtual Coaching System.

Rehabilitation programs play an important role in improving the quality of life of patients with balance disorders. Such programs are usually executed in a home environment, due to lack of resources. This procedure usually results in poorly performed exercises or even complete drop outs from the programs, as the patients lack guidance and motivation. This paper introduces a novel system for managing balance disorders in a home environment using a virtual coach for guidance, instruction, and inducement. The proposed system comprises sensing devices, augmented reality technology, and intelligent inference agents, which capture, recognize, and evaluate a patient's performance during the execution of exercises. More specifically, this work presents a home-based motion capture and assessment module, which utilizes a sensory platform to recognize an exercise performed by a patient and assess it. The sensory platform comprises IMU sensors (Mbientlab MMR© 9axis), pressure insoles (Moticon©), and a depth RGB camera (Intel D415©). This module is designed to deliver messages both during the performance of the exercise, delivering personalized notifications and alerts to the patient, and after the end of the exercise, scoring the overall performance of the patient. A set of proof of concept validation studies has been deployed, aiming to assess the accuracy of the different components for the sub-modules of the motion capture and assessment module. More specifically, Euler angle calculation algorithm in 2D (R 2 = 0.99) and in 3D (R 2 = 0.82 in yaw plane and R 2 = 0.91 for the pitch plane), as well as head turns speed (R 2 = 0.96), showed good correlation between the calculated and ground truth values provided by experts' annotations. The posture assessment algorithm resulted to accuracy = 0.83, while the gait metrics were validated against two well-established gait analysis systems (R 2 = 0.78 for double support, R 2 = 0.71 for single support, R 2 = 0.80 for step time, R 2 = 0.75 for stride time (WinTrack©), R 2 = 0.82 for cadence, and R 2 = 0.79 for stride time (RehaGait©). Validation results provided evidence that the proposed system can accurately capture and assess a physiotherapy exercise within the balance disorders context, thus providing a robust basis for the virtual coaching ecosystem and thereby improve a patient's commitment to rehabilitation programs while enhancing the quality of the performed exercises. In summary, virtual coaching can improve the quality of the home-based rehabilitation programs as long as it is combined with accurate motion capture and assessment modules, which provides to the virtual coach the capacity to tailor the interaction with the patient and deliver personalized experience.

Integrating MAES implementation into protected area management under climate change: A fine-scale application in Greece.

Increasing anthropogenic pressures often jeopardize ecosystem integrity and policy-relevant conservation management in protected areas. To harmonize nature conservation with human well-being, EU Biodiversity Strategy to 2020 suggests Mapping and Assessment of Ecosystems and their Services (MAES) as the key concept for environmental planning and management in EU Member States. Applying this procedure is challenging due to its data-demanding and multidisciplinary nature, resulting in the ecoystem services (ES) approach being scarcely used in protected areas management. Increased data availability under EU biodiversity-related inventories and monitoring projects, as well as theoretical and empirical research advances developed during the last decade, should be put into practice to guide Member States towards local management frameworks and scenario building under the ongoing changes in the EU socio-economic environment. This study aims at filling this gap by embodying into the MAES operational framework a scenario-based approach and demonstrates this in a challenging case study of a Natura 2000 site, Lake Stymfalia, in Greece. The present management strategy, an ecological-friendly management practice, a water-efficient management practice and a non-environmentally friendly option (e.g. ecosystem destruction) are examined for current and future water demand under current and future climatic scenarios. The proposed methodological framework for ES operationalization is based on the available data (derived by EU Directives and/or modelling), expert judgment and stakeholder involvement. Therefore, this work applies and tests the importance of the MAES approach as a management and coordination platform.