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Thalamo-cortical spiking style of incremental studying incorporating notion, context as well as NREM-sleep.
There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case-control studies are now available, while randomized controlled trials are awaited.

The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis.

Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pperior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible.

Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle.

The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases.

We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.
We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.Inadequate transition to practice increases stress for new health care providers and threatens employment longevity. This integrative review aimed to synthesize the evidence on transition process for newly graduated registered nurses and advanced practice nurses in hospital settings and to identify enablers/barriers and mitigating strategies. Two databases were systematically searched for articles that described the process, strategies, participant perceptions, and implications of role transition with a final yield of 23 articles. Synthesis of the evidence revealed three major themes (a) achieving competence for safe practice, (b) addressing stress during transition, and (c) reducing turnover. Emotional support for new graduates was instrumental to achieving clinical competence. Role transition adaptation was linked to anxiety, while emotional health was positively associated with retention. Developing best practices that address skill proficiency, attending to the emotional needs of new nurse graduates, and providing structured transition programs to improve clinical competence are the strategies of choice.
Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment.

To reveal the evolving ischemic stroke subtypes from 2004 to 2018.

We determined the stroke etiologies of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the two-year recurrence rate of major ischemic stroke subtypes.

Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p < 0.001), driven by the decrease in large artery disease (43.0-9.67 per 100,000 population (p < 0.001)), and small vessel disease (71.9-45.7 per 100,000 population (p < 0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p = 0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 20omparable preventive strategies might alleviate the enormous stroke burden in mainland China.
Chagas disease is a common cause of heart failure (HF) and death in developing countries. Although stroke is known to occur in these patients, an accurate estimate of stroke incidence is lacking. We aimed to determine the incidence of stroke and death in patients with HF, comparing Chagas and non-Chagas etiologies.

Cohort of stroke-free patients with HF (Framingham criteria) followed in a university-based outpatient clinic in Brazil. Baseline characteristics included sociodemographic, risk factor assessment, echocardiographic and electrocardiographic findings. Chagas disease was defined by appropriate serologic tests. Cause-specific Cox regression was used to search for predictors of stroke or death as separate outcomes.

We studied 565 patients with HF between January 2003 and December 2018, mean age 54.3 ± 12.9 years, 305 (54.0%) females, 271/535 (50.7%) with Chagas disease. Chagas patients were older (55.5 vs. Inflammation inhibitor 53.1 years), more frequently women (60.5% vs. 47.3%), less frequently harbored coronary arte to increased stroke risk and mortality in Chagas disease. Early prevention and treatment of Chagas disease is imperative to reduce a later risk of stroke in endemic areas.
Chagas disease is associated with increased risk of stroke and death when compared to other etiologies of HF, independently of HF severity or cardiac arrhythmias, suggesting other factors contribute to increased stroke risk and mortality in Chagas disease. Early prevention and treatment of Chagas disease is imperative to reduce a later risk of stroke in endemic areas.
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