Introduction: The no-reflow phenomenon (persistent microvascular hypoperfusion despite macrovascular angiographic reperfusion) represents an explanation to poor outcome despite successful thrombectomy. There remains no universally-accepted definition to standardise future studies. We aim to compare the clinical features and outcomes of patients identified as having no-reflow using different perfusion MRI/CT definitions. Methods: We performed a pooled analysis of thrombectomy patients who underwent 24-hour follow-up perfusion MRI or CTs in the EXTEND-IA, EXTEND-IA TNK part 1 and 2 RCT. Presence of no-reflow was defined according to four definitions identified from a meta-analysis of 13 studies (Definition A = eTICI2c-3 and >15% asymmetry in CBV or CBF within the infarct on follow-up perfusion MRI/CT; definition B = mTICI2c-3 and >40% CBF asymmetry, definition C = mTICI2b-3 and presence of a Tmax>6s lesion; Definition D = mTICI2b-3 and >90% reduction of baseline Tmax>6s lesion). Receiver Operating Characteristics (ROC) analysis was performed with the outcome variable being poor functional outcome at 90 days (mRS≥3). Results: Of 325 patients analysed, the prevalence of no-reflow varied between definitions from 1.9 to 29.3% (p<0.001). There was poor agreement between definitions (kappa 0.062-0.745, 5 out 6 comparisons <0.196). Among patients identified as exhibiting no-reflow by any definition, there were significant differences in the intralesional interside differences in CBF (p=0.006), CBV (p<0.001) and MTT (p=0.005). Definition A yielded the highest Area Under the ROC Curve (AUC=0.679) for discrimination of 90-day functional outcome (Definitions C=0.649, D=0.597, B=0.515; p<0.0001). Sensitivity analyses testing across the eTICI≥2b, eTICI≥2c and eTICI3 strata showed consistent results. Conclusions: Existing imaging definitions of no-reflow varied significantly in prevalence and post-treatment perfusion imaging profile, suggesting that patients classified as having no-reflow by various definitions differ in their underlying pathophysiological processes. Definition A (eTICI2c-3 & >15% CBV/CBF asymmetry) discriminated prognostic performance best, supporting its use as the reference no-reflow imaging definition.

Background and Purpose: Cancer increases the risk for acute ischemic stroke (AIS) and deep venous thrombosis. The role of paradoxical embolization as a stroke etiology in patients with cancer is uncertain. Our study investigated the relationship between cancer-related stroke and the presence of a patent foramen ovale (PFO). Methods: We included AIS patients hospitalized at our comprehensive stroke center between January 2015 and December 2020 with available PFO status as detected on transesophageal echocardiography. Active cancer, including cancer known at the time of stroke as well as occult cancer newly diagnosed within one year after stroke, were retrospectively identified. The association between PFO status and active cancer was assessed with multivariable logistic regression and reported using adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Among 2236 AIS patients (median age 68.3 years, female sex 36.4%), 103 (4.6%) had active cancer, of whom 24 (23%) were diagnosed with PFO. This included 32 patients (1.4%) with occult cancer, of whom 19% were diagnosed with PFO. Conversely, among 2133 AIS patients without active cancer, 774 were diagnosed with PFO (36%). In multivariable analysis (Fig 1), the absence of PFO was associated with active cancer (aOR 2.62, 95% CI 1.28-5.38). This association appeared stronger when patients older than 80 years of age were excluded (aOR 3.06, 95% CI 1.42 - 6.58) and persisted among patients with occult cancer at the time of AIS (aOR 5.39, 95% CI 1.18-24.74). Conclusions: In patients with AIS, PFO was diagnosed more commonly among patients without cancer than those with cancer. This might be due to cancer-related stroke being related to arterial coagulopathy rather than paradoxical emboli resulting from venous thrombi. Further studies are needed to confirm these findings and to assess the diagnostic role of PFO in patients with cancer and AIS.

The paper describes the factorial design of the experiment with three input factors that change on two levels. For given values of the input parameters, it is shown how to obtain a variance analysis table and which factors and interactions between factors are significant. The example was done in the software intended for the design of the experiment and in the software R. It is shown how to use the software R to arrive at the final solution of the given example.

Remote driving plays an essential role in coordinating automated vehicles in some challenging situations. Due to the changed driving environment, the experiences and behaviors of remote drivers would undergo some changes compared to conventional drivers. To study this, a continuous real-life and remote driving experiment is conducted under different driving conditions. In addition, the effect of steering force feedback (SFF) on the driving experience is also investigated. In order to achieve this, three types of SFF modes are compared. According to the results, no SFF significantly worsens the driving experience in both remote and real-life driving. Additionally, less force and returnability on steering wheel are needed in remote driving, and the steering force amplitude appears to influence the steering velocity of remote drivers. Furthermore, there is an increase in lane following deviation during remote driving. Remote drivers are also prone to driving at lower speeds and have a higher steering reversal rate. They also give larger steering angle inputs when crossing the cones in a slalom manoeuvre and cause the car to experience larger lateral acceleration. These findings provide indications on how to design SFF and how driving behavior and experience change in remote driving.

Purpose- The purpose of this study is to investigate whether regional variations exist in the development of the digital economy and how they impact growth in the four global regions where Muslims predominate. Methodology- The study employs empirical examination of 48 countries with Muslim majority divided in four regions (Middle East and North Africa region, Europe and Eurasia region, South Asia, East Asia region and the Pacific and Africa region) between 2000 to 2021. The study employs Kao Residual Cointegration Test, and the Long-run Valuation of Fully Modified Ordinary Least Squares (FMOLS/DOLS-Dynamic). A certain number of specific variables in the econometric model will be employed to measure the level of digitization on economic growth, such as: Digital economy infrastructure proxied by Individuals using the internet, Digital economic openness proxied by ICT product exports and Digital technology competitiveness proxied by Research and Development as share of GDP. Findings- The analysis reveals that despite the fact that the digital economy made a positive contribution to economic growth in both Sub-Saharan Africa and Europe and Euroasia, the impact on these regions is less than that on the Middle East and North Africa, South Asia, East Asia, and the Pacific countries due to the underdeveloped infrastructure of the digital economy The least effect of digitalization on growth was found in Sub-Saharan African countries with low incomes.. Conclusion- Based upon the analysis, it may be concluded that digitalization can considerably boost economic growth, but its benefits may differ depending on how developed a nation is. There is a clear geographical imbalance in the development of the digital economy across 48 nations with a majority of Muslims .To increase overall GDP growth, those countries need to look into policies that will help increase ICT and the digital economy use. Keywords: Digital economy, economic growth, ICT, the Muslim Word, panel cointegration model. JEL Codes: O40, O47, E22.

Aim To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration. Methods The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25. Results Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25 (controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001). Conclusion The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the importance of weight management in preventing disc degeneration.

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Uterine leiomyosarcoma (uLMS) is a rare but aggressive cancer with a high metastatic potential and an unfavorable prognosis. A 54-year-old woman with a history of uterine fibroids clinically presented with a painless, palpable left breast mass measuring 20 mm. A core biopsy of the breast mass demonstrated a cellular spindle cell neoplasm (a potentially malignant smooth muscle neoplasm; B4). A wide local breast-mass excision was performed, revealing grade-2 leiomyosarcoma. A re-review of the uterine fibroids revealed that the largest one (200 × 130 mm), initially diagnosed as symplastic leiomyoma, was morphologically identical to the breast lesion. Additional diagnostic work-up revealed multiple liver and pulmonary metastases with a suspected metastatic sclerotic lesion in the L3 projection. The patient was subsequently treated with chemotherapy protocol for metastatic uLMS. The latest follow-up in September 2023 confirmed stable disease. This case highlights the importance of considering unusual metastatic patterns when evaluating breast masses, particularly in patients with a history of non-specific uterine conditions. Comprehensive diagnostic work-up, including imaging and histopathologic examinations, is crucial for an accurate diagnosis of uLMS and appropriate treatment selection. Further studies are needed to better understand the underlying mechanisms and optimal management strategies for metastatic uLMS.

Purpose There have been several studies into medical student career decision making in occidental countries (eg US, UK), but medical career selection in a Middle Eastern context has not been as well studied. This study aims to explore determinants underpinning medical students’ residency choice in Qatar. Patients and methods During the Fall semester of the 2022–2023 academic year, all (n=358) medical students from the College of Medicine at Qatar University were invited to participate in an online explorative questionnaire about students’ career choices and the factors determining their selection. Results Of the 358 students, 184 responded (51%). Respondents had a mean age of 20 years; the majority were female (73.9%), Qatari (54.3%), unmarried (97.3%), and enrolled in a pre-clerkship year (55.0%). The most important career determinant was specialty-specific factors. The relative importance of other determinants differed by gender and stage of training. Among our respondents, male students were more likely to rate role models and influencers as being important to their choice, while female students and Qatari students overall were more likely to cite societal obligation. Medical students in Qatar seemed to have career preferences in mind upon entry into medical education. Later-year students were more likely to identify the importance of work-life balance and place of practice, but were less likely to rank prestige and income as an important determinant. Conclusion The results of this baseline study suggest that socioeconomic and cultural context influence medical student career decisions.

Aim To analyse prevalence of metabolic syndrome (MS) in kidney transplant recipients at the University Clinical Centre Tuzla in Bosnia and Herzegovina (B&H), and determine effects of a modern drug therapy in achieving target metabolic control in kidney transplant patients. Methods A single-centre prospective study that included 142 kidney transplant patients over one year follow-up period was conducted. Patient data were collected during post-transplant periodical controls every 3 months including data from medical records, clinical examinations and laboratory analyses. Results Out of 142 kidney transplant patients, MS was verified in 85 (59.86%); after a pharmacologic treatment MS frequency was decreased to 75 (52.81%). After a one-year period during which patients were receiving therapy for MS, a decrease in the number of patients with hyperlipoproteinemia, decrease in average body mass index (BMI), glycemia and haemoglobin A1C (HbA1C) were observed. Hypertension did not improve during this period, which can be explained by transplant risk factors in the form of immunosuppressive drugs and chronic graft dysfunction. Conclusion A significant reduction in components of the metabolic syndrome after only one year of treatment was recorded, which should be the standard care of kidney transplant patients.