Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson’s disease (PD). Whether similar benefits may be realized by patients with early PD, however, is currently unclear, especially given the potential risks of the procedure. This systematic review and meta-analysis aimed to investigate the relative efficacy and safety of DBS in comparison to best medical therapy (BMT) in the treatment of PD. It also aimed to compare the efficacy of DBS between patients with early and advanced PD.A systematic search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) comparing DBS to BMT in PD patients were included. Outcome measures were impairment/disability using the Unified Parkinson’s Disease Rating Scale (UPDRS), quality of life (QoL) using the Parkinson's Disease Questionnaire (PDQ-39), levodopa equivalent dose (LED) reduction, and rates of serious adverse events (SAE).Eight eligible RCTs (n = 1,189) were included in the meta-analysis, two of which recruited early PD patients. Regarding efficacy outcomes, there were significant improvements in UPDRS, PDQ-39, and LED scores in favour of DBS (P < 0.00001). There was a significantly greater reduction of LED in patients with early PD (P < 0.00001), but no other differences between early and advanced PD patients were found. The risk of a patient experiencing an SAE was significantly higher in the DBS group (P = 0.005), as was the total number of SAEs (P < 0.00188).Overall, DBS was superior to BMT at improving impairment/disability, QoL, and reducing medication doses, but these benefits need to be weighed against the higher risk of SAEs. There was insufficient evidence to determine the impact of the PD stage on the efficacy of DBS.

Th yrostimulin is a glycoprotein heterodimer of GPA2 and GPB5, fi rst described in 2002. It is involved in the physiological function of several tissues. Moreover, evidence points towards the ability of thyrostimulin's individual monomers to induce a biological eff ect, which could denote the circulatory/systemic eff ects of the molecule when found in higher concentrations. From the evolutionary point of view, thyrostimulin shares a binding epitope with the thyroid-stimulating hormone for the thyroid stimulating hormone receptor, whilst possessing affi nity for another unique binding site on the same receptor. Although thyrostimulin can be involved in the hypothalamicpituitary-thyroid axis, its presence in various tissues in an eclectic array of diff erent species renders it multifunctional. From weight loss via increasing metabolic rate to progression of cancer in human ovaries, it is certainly not a signaling molecule to overlook. Furthermore, thyrostimulin has been implicated in bone metabolism, acute illness, and reproductive function. In summary, to our knowledge, this is the fi rst review dealing with the physiological role of thyrostimulin and its potential applications in the clinical practice.

Background Medical school assessments, clinical placements and teaching have been disrupted by the COVID-19 pandemic. The ADAPT consortium was formed to document and analyse the effects of the pandemic on medical education in the United Kingdom (UK), with the aim of capturing current and future snapshots of disruption to inform trends in the future performance of cohorts graduating during COVID-19. Methods Members of the consortium were recruited from various national medical student groups to ensure representation from medical schools across the UK. The groups involved were: Faculty of Medical Leadership and Management Medical Students Group (FMLM MSG); Neurology and Neurosurgery Interest Group (NANSIG); Doctors Association UK (DAUK); Royal Society of Medicine (RSM) Student Members Group and Medical Student Investigators Collaborative (MSICo.org). In total, 29 medical schools are represented by the consortium. Our members reported teaching postponement, examination status, alternative teaching provision, elective status and UK Foundation Programme Office (UKFPO) educational performance measure (EPM) ranking criteria relevant to their medical school during a data collection window (1st April 14:00 to 2nd April 23:59). Results All 29 medical schools began postponement of teaching between the 11th and 17th of March 2020. Changes to assessments were highly variable. Final year examinations had largely been completed before the onset of COVID-19. Of 226 exam sittings between Year 1 and Year 4 across 29 schools: 93 (41%) were cancelled completely; 14 (6%) had elements cancelled; 57 (25%) moved their exam sitting online. 23 exam sittings (10%) were postponed to a future date. 36% of cohorts with cancelled exams and 74% of cohorts with online exams were granted automatic progression to the next academic year. There exist 19 cohorts at 9 medical schools where all examinations (written and practical) were initially cancelled and automatic progression was granted. Conclusions The approaches taken by medical schools have differed substantially, though there has been universal disruption to teaching and assessments. The data presented in this study represent initial responses, which are likely to evolve over time. In particular, the status of future elective cancellations and UK Foundation Programme Office (UKFPO) educational performance measure (EPM) decile calculations remains unclear. The long-term implications of the heterogeneous disruption to medical education remains an area of active research. Differences in specialty recruitment and performance on future postgraduate examinations may be affected and will be a focus of future phases of the ADAPT Study.

Nanomedicine is an emerging field, which constitutes a new direction in the treatment of cancer. Magnetic nanoparticles (MNPs) can circumvent vascular tissue to concentrate at the site of the tumor. Under the influence of an external, alternating magnetic field, MNPs generate high temperatures within the tumor and ablate malignant cells while inflicting minimal damage to healthy host tissue. Due to their theranostic properties, they constitute a promising candidate for the treatment of cancer. A critical review of the type, size and therapeutic effect of different MNPs is presented, following an appraisal of the literature in the last 5 years. This is a multibillion dollar industry, with a few studies moving to clinical trials within the next 5 years.

Introduction The aim of this study was to evaluate the effect of perioperative vitamin D levels in terms of functional results, patient-related outcome measures (PROMs) and infection risk after hip or knee replacement. Materials and Methods A systematic search in PubMed, Cochrane library, ScienceDirect and ClinicalTrials.gov was conducted according to the PRISMA guidelines from inception to January 2020. Results Eighteen studies with more than 8000 knee and 1500 hip joint arthroplasties were included. The mean follow-up ranged from 6 weeks to 1 year and mean patients’ age from 59.4 to 76 years. Hypovitaminosis was diagnosed in 26.7% of cases. Most studies did not find significant differences in pre- and postoperative functional results, PROMs and length of hospital stay between hypovitaminosis and euvitaminosis groups. Deficient patients may be at higher risk of postoperative joint stiffness. Patients suffering from hip and knee periprosthetic joint infection seem to have lower vitamin D levels compared to those with aseptic loosening of implants. Conclusion The necessity of pre-operative correction of vitamin D levels to achieve better functional results and minimize the risk of infection following hip and knee arthroplasty remains inconclusive. Extend of exposure to low vitamin D levels and comparison between outliers needs further evaluation.