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In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline as well as with their caregivers.

The emergency phase represented a significant occasion of discussion on the possibilities of telemedicine which will inevitably become increasingly important, but all the limits of its use in the elderly population have to be considered. In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline as well as with their caregivers.ALS2 gene encoding for alsin protein is responsible for neurological disorders due to retrograde degeneration of the upper motor neurons of the pyramidal tracts, inherited in an autosomal recessive manner, and displaying a clinical continuum including the infantile ascending hereditary spastic paraplegiaidentified in three Spanish children presented here.

Trans-sphincteric anal fistula (TAF) is a common type of anal fistula that can be divided into low and high subtypes. Sphincter-sparing surgery is usually used for treatment of high TAF to avoid any compromise of the anal continence.

A 38-year-old male patient with recurrent Grade III TAF was treated with the modified Parks' technique. This technique can be summarized as three main steps; each addresses a component of the anal fistula. (1) The extra-sphincteric component, which lies outside the external anal sphincter (EAS), is laid open with electrocautery. (2) The intersphincteric component is laid open, starting from the internal opening, dividing the internal anal sphincter, until the EAS fibers were reached. (3) The trans-sphincteric component that traverses the EAS was carefully curetted from the anal and the outer sides with a surgical curette. An important step of the procedure is to close the defect through which the fistula tract passed through the EAS with interrupted sutures.

The operation time was 35 min. Complete healing was achieved in 5 weeks with no persistence or recurrence of the anal fistula after a follow-up of 6 months. No affection of the continence state was recorded.

The modified Parks' technique is a simple and convenient operation for TAF. Further prospective studies are needed to substantiate the efficacy and safety of the procedure.

The modified Parks' technique is a simple and convenient operation for TAF. Further prospective studies are needed to substantiate the efficacy and safety of the procedure.Primary lateral sclerosis (PLS) is classically considered a 'pure' upper motor neuron disorder. Motor cortex atrophy and pyramidal tract degeneration are thought to be pathognomonic of PLS, but extra-motor cerebral changes are poorly characterized. In a prospective neuroimaging study, forty PLS patients were systematically evaluated with a standardised imaging, genetic and clinical protocol. Patients were screened for ALS and HSP associated mutations, as well as C9orf72 hexanucleotide repeats. Clinical assessment included composite reflex scores, spasticity scales, functional rating scales, and screening for cognitive and behavioural deficits. The neuroimaging protocol evaluated cortical atrophy patterns, subcortical grey matter changes and white matter alterations in whole-brain and region-of-interest analyses. PLS patients tested negative for known ALS- and HSP-associated mutations and C9orf72 repeat expansions. Voxel-wise analyses revealed anterior cingulate, dorsolateral prefrontal, insular, opercular, orbitofrontal and bilateral mesial temporal grey matter changes and white matter alterations in the fornix, brainstem, temporal lobes, and cerebellum. Significant thalamus, caudate, hippocampus, putamen and accumbens nucleus volume reductions were also identified. Extra-motor clinical manifestations were dominated by verbal fluency deficits, language deficits, apathy and pseudobulbar affect. Our clinical and radiological evaluation confirms considerable extra-motor changes in a population-based cohort of PLS patients. Our data suggest that PLS should no longer be considered a neurodegenerative disorder selectively affecting the pyramidal system. PLS is associated with widespread extra-motor changes and manifestations which should be carefully considered in the multidisciplinary management of this low-incidence condition.Traumatic brain injury (TBI) is common among military personnel and the civilian population and is often followed by a heterogeneous array of clinical, cognitive, behavioral, mood, and neuroimaging changes. Unlike many neurological disorders that have a characteristic abnormal central neurologic area(s) of abnormality pathognomonic to the disorder, a sufficient head impact may cause focal, multifocal, diffuse or combination of injury to the brain. This inconsistent presentation makes it difficult to establish or validate biological and imaging markers that could help improve diagnostic and prognostic accuracy in this patient population. The purpose of this manuscript is to describe both the challenges and opportunities when conducting military-relevant TBI research and introduce the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Military Brain Injury working group. ENIGMA is a worldwide consortium focused on improving replicability and analytical power through data sharing and collaboration. In this paper, we discuss challenges affecting efforts to aggregate data in this patient group. In addition, we highlight how "big data" approaches might be used to understand better the role that each of these variables might play in the imaging and functional phenotypes of TBI in Service member and Veteran populations, and how data may be used to examine important military specific issues such as return to duty, the late effects of combat-related injury, and alteration of the natural aging processes.

Endoscopic submucosal dissection (ESD) is gaining ground as a minimally invasive treatment for early gastric cancer (EGC) that has a negligible risk of lymph node metastasis. According to the 5th edition of Japanese gastric cancer treatment guidelines, annual or biannual follow-up with endoscopy is recommended, but follow-up with abdominal ultrasonography or computed tomography (CT) for surveillance of metastases is not recommended after the eCuraA resection. However, we experienced a case of lymph node recurrence following ESD resulting in eCuraA.

A 76-year-old female received ESD for EGC in a previous hospital 4years ago. Pathological findings were tub1, 30mm, T1a (M), UL0, Ly0, V0, pHM-, pVM- (eCuraA) according to the 15th edition of Japanese Classification of Gastric Carcinoma. Follow-up esophagogastroduodenoscopy revealed submucosal tumor, which was suspected as a swollen lymph node by CT and endoscopic ultrasound fine-needle aspiration revealed the recurrence of gastric cancer. We performed total gastrectomy with D2 lymph node dissection. Postoperative pathological examination revealed no local recurrent tumor at the ESD site in the stomach. Swollen lymph node was diagnosed as metastasis and lymph node metastasis was limited near the cardia.

This case provides valuable information about tumor with a minimum poorly differentiated adenocarcinoma component may develop lymph node metastasis even satisfying the guidelines criteria for curative resection.

This case provides valuable information about tumor with a minimum poorly differentiated adenocarcinoma component may develop lymph node metastasis even satisfying the guidelines criteria for curative resection.Magnetic resonance imaging (MRI) systems and their continuous, failure-free operation is crucial for high-quality diagnostics and seamless workflows. One important hardware component is coils as they detect the magnetic signal. Before every MRI scan, several image features are captured which represent the used coil's condition. These image features recorded over time are used to train machine learning models for classification of coils into normal and broken coils for faster and easier maintenance. The state-of-the-art techniques for classification of time series involve different kinds of neural networks. We leveraged sequential data and trained three models, long short-term memory (LSTM), fully convolutional network (FCN), and the combination of those called LSTMFCN as reported by Karim et al. (IEEE access 61662-1669, 2017). We found LSTMFCN to combine the benefits of LSTM and FCN. Thus, we achieved the highest F1-score of 87.45% and the highest accuracy of 99.35% using LSTMFCN. Furthermore, we tackled the high data imbalance of only 2.1% data collected from broken coils by training a Gaussian process (GP) regressor and adding predicted sequences as artificial samples to our broken labelled data. Adding 40 synthetic samples increased the classification results of LSTMFCN to an F1-score of 92.30% and accuracy of 99.83%. Thus, MRI head/neck coils can be classified normal or broken by training a LSTMFCN on image features, successfully. Augmenting the data using GP-generated samples can improve the performance even further.A new metal-organic framework compound (MOF@MOF, NUZ-8) comprised of NH2-UiO-66 and ZIF-8 under the polyvinylpyrrolidone (PVP) as the structure modifier was synthesized through an internal extended growth method (IEGM). The resulting NUZ-8 emerged the unreported unique polyhedron shape and showed considerable specific surface area (1466.1862 m2/g), excellent adsorption capacity, and fluorescence. NUZ-8 was used as a probe for the rapid optical detection of natural antioxidant quercetin (QCT). Its outstanding selectivity and sensitivity to QCT are derived from the fact that NH2-UiO-66 acted as an optical tentacle to perceive QCT in virtue of its luminescence advantages, and ZIF-8 realized the selective enrichment of the QCT through its electron-rich framework structure. The experiments were carried out at an excitation wavelength of 335 nm and an emission wavelength range of 370-530 nm. Under conditions of the investigation, this probe realized the rapid detection of QCT and considerable adsorption capacity with wide linearity (0.3-80 μM), a low detection limit (0.14 μM), and acceptable recoveries (84.0-97.0%) in red wine samples, properties which were superior to many other detection platforms. The synthesis and the use of the above polyhedral composite provide guidance for the application of the IEGM in enhancing chemical sensing and instant determination of drugs.Graphical abstract Flow chart of this paper.

This prospective study investigated whether the use of 3D-printed model facilitates novice learning of radiology anatomy on multiplanar computed tomography (CT) when compared to traditional 2D-based learning tools. Specifically, whether the use of a 3D printed model improved interpretation of multiplanar CT tracheobronchial anatomy.

Thirty-one medical students (10F, 21 M) from years one to three were recruited, matched for gender and level of training and randomized to 2D or 3D group. Students underwent 20-min self-study session using 2D-printed image or 3D-printed model of the tracheobronchial tree. Immediately after, students answered 10 multiple-choice questions (Test 1) to identify tracheobronchial tree branches on multiplanar CT images. Two weeks later, identical test (Test 2) was used to assess retention of information. Mean scores of 2D and 3D groups were calculated. Student's t test was used to compare mean differences in tests scores and analysis of variance (ANOVA) was used to assess the interaction of gender, CT imaging plane and time on test scores between the two groups.