Singapore Health Services (SingHealth) is Singapore's largest group of healthcare institutions. The group was formed in 2000 and consists of four public hospitals, three community hospitals, five national specialty centres and a network of eight polyclinics. The Singapore General Hospital is the largest hospital in the group and serves as the flagship hospital for the cluster.
Dexterous hand movements are uniquely developed in primates and indispensable for their daily activities. Traditionally, they were thought to depend primarily on the evolutionarily "newer" direct corticomotoneuronal (CM) pathway. However, recent studies suggest that the "older" indirect corticospinal pathways, mediated by spinal premotor interneurons (PreM-INs), also contribute, highlighting the need to clarify their functional differences. Here, we recorded neuronal activity from PreM-INs and CM cells in macaques during a precision grip task to compare their roles in generating hand muscle activity. Our results show that PreM-INs exert stronger facilitation across a broader set of muscles, promoting synergistic coactivation, whereas CM cells provide more selective facilitation, enabling control of relatively individual muscles. Decomposition analysis further revealed that these systems correspond to different control modes-synergy-based and individual-based control-balancing stability and flexibility. These findings redefine our understanding of primate dexterous hand control as emerging from the cooperative integration of evolutionarily distinct premotoneuronal systems.
The optimal treatment strategy for elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. While endovascular coiling and surgical clipping are both established interventions, age-related physiological vulnerability and comorbidity burden may alter the risk–benefit profile. We performed a systematic review and meta-analysis to compare outcomes between these two modalities in elderly patients with aSAH. Searches of PubMed, Embase, Scopus, and Cochrane CENTRAL were conducted from inception to 20th July 2025. The definition of elderly patients aged ≥ 60 years was adopted as per the World Health Organization. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0–2) and mortality. Secondary outcomes were delayed cerebral ischemia (DCI), delayed hydrocephalus and rebleed. Twenty studies (2 randomized controlled trials, 18 observational) were included. A total of 44,526 patients were included with 24,724 aneurysms clipped and 19,802 coiled. The mean age was 72.1 years in the coiling cohort and 72.8 years in the clipping cohort. Aneurysm location was anterior in 94
The field of regenerative medicine for Parkinson’s disease (PD) has reached a pivotal moment. After decades of preclinical research, recent first-in-human clinical trials demonstrated that cell replacement therapy using stem cell-derived dopaminergic neurons is not only feasible and safe but also shows promising signs of efficacy. Here we analyze three landmark 2025 studies, including the phase I/II trial of allogeneic induced pluripotent stem cell-derived dopaminergic progenitors, that mark a significant leap forward for PD therapy. We discuss principles underpinning the therapy, the historical context of fetal tissue transplants, findings from recent trials, and critical challenges. The convergence of robust cell manufacturing, precise stereotactic surgery, and advanced neuroimaging provides compelling evidence that stem cell-based therapies are potentially a viable treatment paradigm for PD.
To present a pattern-based, multimodality imaging approach for differentiating true high-flow vascular lesions from their clinical, imaging, and hemodynamic mimics in the head and neck. This curated pictorial review draws on cases from two tertiary institutions in Singapore, encompassing true high-flow vascular lesions – including arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), and carotid-cavernous fistulas (CCFs) – as well as mimics, including carotid arterial wall pathologies (e.g. pseudoaneurysms, carotid blowout, dissections) and hypervascular tumors (e.g. paragangliomas). Imaging findings across ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) were analyzed, with emphasis on structural and hemodynamic features. True high-flow vascular lesions are defined by direct arteriovenous shunting, with key imaging features including early venous opacification, arterialized venous drainage, and the presence of a nidus (in AVMs). In contrast, mimics may demonstrate overlapping clinical presentations or apparent high-flow characteristics but lack true arteriovenous communication. Advanced imaging techniques – including 3D CT angiographic reconstructions and time-resolved contrast-enhanced MR angiography (e.g. TWIST) – improve delineation of vascular architecture and enable dynamic assessment of flow patterns. Digital subtraction angiography remains essential for definitive characterization and treatment planning. Differentiation of true high-flow vascular lesions from their mimics relies on recognition of key hemodynamic and structural imaging features, particularly the presence of arteriovenous shunting. A pattern-based multimodality imaging approach facilitates accurate diagnosis, guides appropriate management, and reduces misclassification of clinically significant mimics.
The combined use of the Subdural Evacuating Port System (SEPS) and middle meningeal artery embolization (MMAE) offers a less invasive alternative to conventional surgical drainage of chronic subdural hematomas (cSDH), while potentially maintaining low retreatment rates. We aimed to perform the first systematic review and meta-analysis to evaluate the outcomes of combined SEPS and MMAE in the treatment for cSDH. Searches of the following three electronic databases were undertaken: Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials. Searches were performed in each database from its inception until 19th August 2025. The primary outcome was recurrence requiring re-evacuation. Secondary outcomes included perioperative complications, mortality, length of stay (LOS), functional and radiological outcomes. Four studies comprising 341 cases of SEPS and MMAE were included. Pooled recurrence rate after SEPS and MMAE was 9.1
