013/p = 0.028). In patients with IPMN-Br, the presence of mural nodule was a predictive factor for malignancy/invasiveness (p = 0.005/p = 0.002). In patients with IPMN-Mixed, mural nodule (p = 0.038/p = 0.047) and see more wall thickening (> 2 mm, p = 0.015/p = 0.046) were risk factor for malignancy/invasiveness

and elevated CA19-9 (p = 0.046) for invasiveness.

The main pancreatic duct diameter (> 5 mm) is a significant predictor for malignancy and invasiveness. Therefore, IPMN patients with main pancreatic duct dilatation (> 5 mm) should be considered surgical resection. Mural nodule is the indicator of surgery in IPMN-Br and IPMN-Mixed. In case of IPMN-Mixed with wall thickening or elevated serum CA19-9, surgical resection is recommended.”
“Apraxic agraphia is a peripheral

writing disorder caused by neurological damage. It induces a lack or loss of access to the motor engrams that plan and programme the graphomotor movements necessary to produce written output. The neural network subserving handwriting includes the superior parietal region, the dorsolateral and medial premotor cortex and the thalamus of the dominant hemisphere. Recent studies indicate that the cerebellum may be involved as well. To the best of our knowledge, apraxic agraphia has not been described on a developmental basis. This paper reports the clinical, neurocognitive and (functional) neuroimaging findings of a 15-year-old left-handed patient with an isolated, non-progressive developmental handwriting disorder consistent with a diagnosis learn more of “”apraxic dysgraphia”". Gross motor coordination problems were objectified BMN 673 as well but no signs of cerebellar, sensorimotor or extrapyramidal dysfunction

of the writing limb were found to explain the apraxic phenomena. Brain MRI revealed no supra- and infratentorial damage but quantified Tc-99m-ECD SPECT disclosed decreased perfusion in the anatomoclinically suspected prefrontal and cerebellar brain regions crucially involved in the planning and execution of skilled motor actions. This pattern of functional depression seems to support the hypothesis that “”apraxic dysgraphia”" might reflect incomplete maturation of the cerebello-cerebral network involved in handwriting. In addition, it is hypothesized that “”apraxic dysgraphia”" may have to be considered to represent a distinct nosological category within the group of the developmental dyspraxias following dysfunction of the cerebello-cerebral network involved in planned actions.”
“Objective: To evaluate the quality of systematic reviews (SRs) affecting clinical practice in endocrinology.

Study Design and Setting: We identified all SRs cited in The Endocrine Society’s Clinical Practice Guidelines published between 2006 and January 2012. We evaluated the methodological and reporting quality of the SRs in duplicate using the Assessment of Multiple Systematic Reviews (AMSTAR) tool.