Notes

Expertise, Attitudes and Methods (KAP) about the Novel Coronavirus Ailment (COVID-19) Post-lockdown throughout Trinidad and Tobago.
T2DM patients with poor sleep quality show brain tissue changes in sites involved in sleep regulation. Findings indicate that improving sleep may help mitigate brain tissue damage, and thus, improve brain function in T2DM patients.
T2DM patients with poor sleep quality show brain tissue changes in sites involved in sleep regulation. Findings indicate that improving sleep may help mitigate brain tissue damage, and thus, improve brain function in T2DM patients.
Regular factor XIII (FXIII) prophylaxis is standard treatment for congenital FXIII A-subunit deficiency (FXIII-A CD). Recombinant factor XIII-A
(rFXIII-A
) was extensively evaluated in the mentor trials.

To assess real-world safety and treatment effectiveness of rFXIII-A
prophylaxis from the mentor 6 trial.

mentor 6 was a noninterventional, postauthorization safety study investigating rFXIII-A
prophylaxis in FXIII-A CD. rFXIII-A
treatment was observed for 2 to 6years per patient. The primary end point was documentation of adverse drug reactions (including anti-FXIII antibody development). Secondary end points were serious adverse events (SAEs), medical events of special interest (MESIs), and annualized bleeding rate (ABR).

Among 30 patients (mean age, 25.5years), there were 44 adverse events (AEs) (30mild, 13moderate, 1severe). Eleven AEs were possibly/probably related to rFXIII-A
. Of four MESIs, two were unlikely related to rFXIII-A
(accidental overdose, deep vein thrombosis), and two were possibly/probably related (nonneutralizing anti-FXIII antibody, decreased therapeutic response). All 10 SAEs were unlikely related to rFXIII-A
. Over a follow-up of 75.4 patient-years, there were six treatment-requiring bleeds (all trauma-related with no spontaneous bleeds), giving a treatment-requiring ABR of 0.066; five bleeds were treated successfully with rFXIII-A
. Eight of nine minor surgeries performed during rFXIII-A
prophylaxis reported successful hemostatic outcomes (one missing evaluation).

These data confirm that rFXIII-A
prophylaxis is well tolerated as long-term care. There were no spontaneous bleeds, ABR was low, and rFXIII-A
successfully treated bleeds in patients receiving rFXIII-A
prophylaxis.
These data confirm that rFXIII-A2 prophylaxis is well tolerated as long-term care. There were no spontaneous bleeds, ABR was low, and rFXIII-A2 successfully treated bleeds in patients receiving rFXIII-A2 prophylaxis.
The incidence and severity of chronic postoperative pain (POP) are major clinical challenges, and presurgical conditioned pain modulation (CPM) and pain catastrophizing scale (PCS) assessments have exhibited predictive values for POP. However, whether CPM and PCS assessments are also predictive of acute POP is unknown.

We aimed to investigate the relationship between preoperative CPM and PCS and acute POP severity after orthognathic surgery by assessing preoperative CPM and PCS in 43 patients.

The pressure pain threshold and tonic painful cold-heat pulse stimulation (applied with a pain intensity score of 70 on a visual analogue scale [VAS 0-100]) were used as the test and conditioning stimuli, respectively. The pain area under the postoperative VAS area under the curve (VASAUC) was estimated. The associations between CPM, PCS, and VASAUC were also analyzed.

No patient experienced chronic POP after 1 month. Negative and positive CPM effects (test stimulus threshold was 0% > and 0% ≤ during conditioning stimulation, respectively) were detected in 36 and 7 patients, respectively. For patients with negative CPM effects (CPM responders), multiple regression analysis revealed a prediction formula of log (VASAUC) = (-0.02 × CPM effect) + (0.13 × PCS-magnification) + 5.10 (adjusted

= 0.4578,
= 0.00002, CPM effect;
= 0.002, PCS-magnification;
= 0.0004), indicating that a weaker CPM and higher PCS scores were associated with more acute POP after surgery.

CPM and PCS can predict acute POP after orthognathic surgery.
CPM and PCS can predict acute POP after orthognathic surgery.Neurofibromatosis type 1 (NF-1) is associated with fatal vascular complications. A 40-year-old woman with NF-1 who had previously undergone left iliac artery ligation and femorofemoral bypass grafting for internal iliac artery (IIA) aneurysm rupture was transported to our hospital for the treatment of a newly developed IIA aneurysm. Although endovascular therapy was difficult owing to the previous surgery, we successfully performed embolization of the aneurysm and its feeding vessels via direct percutaneous puncture under ultrasound guidance. Aneurysm enhancement had completely disappeared at 2 months postoperatively. read more We have reported a novel approach of direct percutaneous puncture for IIA aneurysm embolization in a patient with NF-1.The duration that renal parenchyma will tolerate ischemia has continued to be debated. We have reported the cases of three patients who had undergone revascularization procedures with successful return of baseline renal function after prolonged renal artery occlusion of 14 days to 3 months. These cases highlight that aggressive revascularization can lead to successful renal salvage in selected patients. We examined the characteristics of these patients and those of others in the literature and reviewed the factors favoring recovery.
This study sought to investigate the utility of intraoperative neurophysiological monitoring (IONM) in the surgical treatment for spinal arteriovenous malformations (SAVMs).

We retrospectively reviewed the data of 39 patients who underwent surgical treatment for SAVMs. Twenty-eight patients who received multimodal IONM (transcranial electrical motor-evoked potentials [MEPs], somatosensory-evoked potentials, continuous electromyography, and bulbocavernosus reflex [BCR]) between 2011 and 2020 were compared to 11 historical controls between 2003 and 2011. The rates of postoperative neurological deficits (PNDs), neurophysiological warnings, and their characteristics were analyzed.

PNDs were developed in 10.7% and 54.5% of patients in the IONM and historical control (non-IONM) groups, respectively (
 = 0.008). Moreover, not applying IONM was the only significant risk factor for the development of PNDs in the logistic regression analysis (odds ratio 10.0,
 = 0.007). In the IONM group, a total of three electrophysiological warnings were observed, and two of these were true positives; one patient complained of leg motor weakness after surgery with loss of the abductor halluces MEPs. The other patient experienced disappearance of the BCR during surgery and newly developed urinary retention. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of IONM warnings for detecting PNDs were 66.7%, 96.0%, 66.7%, and 96.0%, respectively.

The neurological outcome of the IONM group was significantly better than that of the historical control group in the surgical treatments for SAVMs.

Multimodal IONM could be a useful tool to detect neurological damage with relatively high accuracy in this type of surgery.
Multimodal IONM could be a useful tool to detect neurological damage with relatively high accuracy in this type of surgery.
We investigated how clinical neurophysiological testing can help distinguish tremor and myoclonus and their subtypes.

We retrospectively analysed clinical and neurophysiological data from patients who had undergone polymyography (EMG + accelerometry) to diagnose suspected tremor or myoclonus. We show a systematic approach, which includes contraction pattern, rhythm regularity, burst duration and evidence of cortical drive.

We detected 773 patients in our database, of which 556 patients were ultimately diagnosed with tremor (enhanced physiological tremor n = 169, functional tremor n = 140, essential tremor n = 90, parkinsonism associated tremor n = 64, cerebellar tremor n = 19, Holmes tremor n = 12, dystonic tremor n = 8, tremor not further specified n = 9), 140 with myoclonus and 23 with a combination of tremor and myoclonus. Polymyography confirmed the presumptive diagnosis in the majority of the patients and led to a change of diagnosis in 287 patients (37%). Conversions between diagnoses of tremor and myoclonus occurred most frequently between enhanced physiological tremor, essential tremor, functional tremor and cortical myoclonus.

Neurophysiology is a valuable additional tool in clinical practice to differentiate between tremor and myoclonus, and can guide towards a specific subtype.

We show how the stepwise neurophysiological approach used at our medical center aids the diagnosis of tremor versus myoclonus.
We show how the stepwise neurophysiological approach used at our medical center aids the diagnosis of tremor versus myoclonus.
To determine the impact of an operator's experience on transcranial magnetic stimulation (TMS) measurement.

Operator B (beginner), operator E (expert), and 30 healthy participants joined the study consisting of two experiments. In each experiment, each operator performed a TMS protocol on each participant in a random order.

Compared with operator E, operator B exhibited higher resting motor threshold (RMT) in experiment I (60.1 ± 13.0 vs. 57.4 ± 10.9% maximal stimulation output, p = 0.017) and the difference disappeared in experiment II (p = 0.816). In 1-mV motor evoked potential (MEP) measurement, operator B exhibited higher standard deviation indicating lower consistency in experiment I compared with experiment II (1.05 ± 0.40 vs. 1.05 ± 0.16 mV with unequal variances, p = 0.001) and had poor intrarater reliability between the experiments (intraclass correlation coefficient = -0.130). There was no difference in the results of active motor threshold, silent period, paired-pulse stimulation, or continuous theta burst stimulation between the operators.

An operator's experience in TMS may affect the results of RMT measurement. With practice, a beginner may choose a more precise stimulation location and have higher consistency in 1-mV MEP measurement.

We recommend that a beginner needs to practice for precise stimulation locations before conducting a trial or clinical practice.
We recommend that a beginner needs to practice for precise stimulation locations before conducting a trial or clinical practice.
Program directors consider scholarly output to be integral in matching applicants with radiation oncology residencies. However, applicants' research productivity can be quantified in several ways, and the results can be misleading for both applicants and program directors. We conducted a bibliometric analysis to quantify the research productivity of applicants who had successfully matched to radiation oncology residencies and to test for associations between research productivity and residency program rankings.

We identified U.S. radiation oncology residency programs from the Accreditation Council for Graduate Medical Education website and sorted the findings into 4 tiers based on the programs' reputation and research output per Doximity's Residency Navigator. First-year (post-graduate year-2) radiation oncology residents starting in 2020 were identified on residency program websites. Residents' research productivity was estimated by identifying peer-reviewed research articles (published before the residency applications began) via PubMed, Scopus, and Google Scholar for each resident.
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