bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the Brazilian Version of the Epworth Sleepiness Scale Using Item Response Theory: A Psychometric Study
Authors: Campelo Cleber Lopes , Batista Rosângela Fernandes Lucena , Silveira Victor Nogueira da Cruz , Figueiredo Kely Nayara dos Reis Silva , Machado Patrícia Maria Abreu , Borgatto Adriano Ferreti , Santos Alcione Miranda dos
Published: September 2023

There seems to be a consensus that adolescents worldwide are not getting enough sleep. This study aimed to evaluate the psychometric properties of the Epworth Sleepiness Scale (ESS) in adolescents using the item response theory. A psychometric study was conducted with 2206 adolescents aged 18 and 19 years in the city of São Luís, Maranhão, Brazil. The dimensionality of the ESS was assessed by principal component analysis. A Samejima’s graded response model (SGRM) was fitted to it. The findings of this study showed a good internal consistency and the unidimensionality of the ESS. Considering the latent trait continuum, we obtained three levels, with anchor items. For the item ‘Sitting still in a public place’, the adolescents presented a small possibility of dozing in level 1, and a medium and great possibility in level 2. The item ‘Sitting around talking to someone’ presented small, medium, and great possibilities of dozing in level 3. The ESS with five items showed satisfactory psychometric properties. In addition, the results from the SGRM showed that adolescents with high levels of sleepiness are likely to nod off or sleep sitting up while talking to someone. This study allows us to understand excessive daytime sleepiness in adolescents.
The Combined Therapy of Cabozantinib, Crizotinib, and Osimertinib in a Lung Cancer Patient with Acquired MET Amplification and Resistance Mutations
Authors: Jóri Balázs , Vössing Christine , Pirngruber Judith , Willing Eva Maria , Arndt Kathrin , Falk Markus , Tiemann Markus , Heukamp Lukas C. , Hoffknecht Petra
Published: September 2023

EGFR-mutant lung cancers develop a wide range of potential resistance alterations under therapy with the third-generation EGFR tyrosine kinase inhibitor osimertinib. MET amplification ranks among the most common acquired resistance alterations and is currently being investigated as a therapeutic target in several studies. Nevertheless, targeted therapy of MET might similarly result in acquired resistance by point mutations in MET, which further expands therapeutic and diagnostic challenges. Here, we report a 50-year-old male patient with EGFR-mutant lung adenocarcinoma and stepwise acquired resistance by a focal amplification of MET followed by D1246N (D1228N), D1246H (D1228H), and L1213V (L1195V) point mutations in MET, all detected by NGS. The patient successfully responded to the combined and sequential treatment of osimertinib, osimertinib/crizotinib, and third-line osimertinib/cabozantinib. This case highlights the importance of well-designed, sequential molecular diagnostic analyses and the personalized treatment of patients with acquired resistance.
Nonadditive Entropy Application to Detrended Force Sensor Data to Indicate Balance Disorder of Patients with Vestibular System Dysfunction
Authors: Köse Harun Yaşar , İkizoğlu Serhat
Published: September 2023

The healthy function of the vestibular system (VS) is of vital importance for individuals to carry out their daily activities independently and safely. This study carries out Tsallis entropy (TE)-based analysis on insole force sensor data in order to extract features to differentiate between healthy and VS-diseased individuals. Using a specifically developed algorithm, we detrend the acquired data to examine the fluctuation around the trend curve in order to consider the individual’s walking habit and thus increase the accuracy in diagnosis. It is observed that the TE value increases for diseased people as an indicator of the problem of maintaining balance. As one of the main contributions of this study, in contrast to studies in the literature that focus on gait dynamics requiring extensive walking time, we directly process the instantaneous pressure values, enabling a significant reduction in the data acquisition period. The extracted feature set is then inputted into fundamental classification algorithms, with support vector machine (SVM) demonstrating the highest performance, achieving an average accuracy of 95%. This study constitutes a significant step in a larger project aiming to identify the specific VS disease together with its stage. The performance achieved in this study provides a strong motivation to further explore this topic.
Energy-Aware Mode Selection for D2D Resource Allocation in 5G Networks
Authors: Tsai Hung-Chin , Kao Shang-Juh , Huang Ya-Ling , Chang Fu-Min
Published: September 2023

This paper proposes an energy-aware mode-selection mechanism for device-to-device (D2D) resource allocation in the coexisting 5G network environment of D2D users and traditional cellular users by taking into consideration the mechanisms of mode selection, transmit power, and spectrum resource allocation simultaneously. In the proposed approach, all spectrum resources are fully shared by traditional cellular users and D2D users. We first determine the communication mode of all users after considering the transmission opportunity of traditional cellular users and analyzing the interference degree of different D2D communication modes. Next, we divide all users into three tiers according to the distances between users and the base station to solve the interference problem generated by excessing transmit power in uplink transmission. Afterward, based on the different communication modes, corresponding spectrum resource allocation mechanisms using the Hungarian algorithm are developed. We simulate a single cell environment using Python language and perform several simulations for different pairs of traditional cellular users and D2D users. The simulation results reveal that the proposed approach outperforms the proposed approach by Hou et al. in system throughput. With power control, the energy efficiency of the proposed approach could be enhanced by 20%.
A Review of Powertrain Electrification for Greener Aircraft
Authors: Roboam Xavier
Published: September 2023

This review proposes an overview of hybrid electric and full electric powertrains dedicated to greener aircraft in the “sky decarbonization” context. After having situated the state of the art and context of energy hybridization in the aviation sector, we propose the visit of several architectures for powertrain electrification, situating the potential benefits but also the main challenges to be faced to takeoff these new solutions. Then, as a first example, we consider the EU project “HASTECS” (Hybrid Aircraft: reSearch on Thermal and Electric Components and Systems) in the framework of Clean Sky 2. It relates to a series hybrid chain integrated into a regional aircraft. This energy system integrates especially power electronics and electric machines with a high degree of integration, which raises the “thermal challenge” and the need to integrate cooling devices. Through the snowball effects typical of the aviation sector, this example emphasizes how important it is to “hunt for kilos”, an alternative solution consisting of eliminating the power electronics within the powertrain. This is why we propose a second example, which concerns an AC power channel without power electronics that only integrates synchronous magnet machines (generator and motor) directly coupled on an AC bus. This last architecture nevertheless raises questions in terms of stability, with one solution being to insert an auxiliary hybridization branch via battery storage. Theoretical analyses and experiments at a reduced power scale show the viability of this concept. Finally, some recommendations for future research with potential technological breakthroughs complete that review.
Maximizing Returns and Minimizing Risks in Hybrid Renewable Energy Systems: A Stochastic Discounted Cash Flow Analysis of Wind and Photovoltaic Systems in Brazil
Authors: Perrelli Antonio , Sodré Eduardo , Silva Vinícius , Santos Alex
Published: September 2023

The use of renewable energy sources has become strategic in the production of electricity worldwide due to global efforts to increase energy efficiency and achieve a net zero carbon footprint. Hybrid systems can maximize stability and reduce costs by combining multiple energy sources. A conventional metric, such as the levelized cost of energy (LCOE), that is appropriate for assessing the cost-effectiveness of an option may not be appropriate when evaluating the economic feasibility of hybrid systems. This study proposes a stochastic discounted cash flow model (DCF) to assess the economic viability of a hybrid renewable energy system (HRES) in Brazil. The objective is to determine the combinations that will provide the highest 50th percentile internal rate of return (IRR) and the lowest coefficient of variation (CV). Model variables include capital expenditures (CAPEX), operation and maintenance (O&M) costs, sectoral charges, taxes, and long-term energy production metrics. The results demonstrate that the synergies modeled contributed to the higher economic outcomes for the HRES obtained by combining both energy sources rather than opting for a stand-alone configuration. A wind-dominant combination of 60% wind was able to increase the 50th percentile of the IRR, while a solar-dominant combination of 65% solar minimized the CV.
Experimental and Numerical Study on Progressive Collapse of the Midcolumn in a Glulam Timber Frame Exposed to Fire
Authors: Huang Jingsong , Wang Lu
Published: September 2023

This paper presents experimental and numerical investigations on the progressive collapse behavior of a two-story glulam frame when the middle column is exposed to ISO834 standard fire. The stress characteristics, temperature distributions, and deformation relationship curves of the bottom middle column after a fire are obtained. The collapse resistance performance and the mechanism of the glulam structure under local fire are studied in combination with the failure mode of the frame. The experimental results show that the failure time of the middle column in fire is 16.8 min, and the time to determine the progressive collapse of the structure is 17.17 min when the rotation angle exceeds the limit. The structure can remain stable for some time after the failure of the fire column, but as the fire continues to spread, the structure will collapse further. In addition, a temperature-field analysis model with the grid element type of DC3D8 and a structural field analysis model with the grid element type of C3D8R was established by using ABAQUS software under the experimental conditions. The numerical simulation is carried out by means of thermal–mechanical sequential coupling. The numerical simulation results show that the temperature of the beam end rose to more than 300 °C in about 15 min although it was not directly exposed to fire. The temperature of the whole connector at the pillar foot in the bottom column reached more than 700 °C when the fire time reached 60 min. The numerical simulation results agree well with the experimental results. The analysis results show that, in the failure process of the fire column, the junction of beam ends begins to produce stretching force to form a catenary effect. As the fire time increases, the catenary effect eventually fails. The stretching force at the beam end rapidly decreases and withdraws from the work, causing the progressive collapse of the frame.
Multi-Peak and Propagation Behavior of M-Shape Solitons in (2 + 1)-Dimensional Integrable Schwarz-Korteweg-de Vries Problem
Authors: Ahmed Sarfaraz , Seadawy Aly R. , Rizvi Syed T. R. , Raza Umar
Published: September 2023

This paper examines the propagation of M-shape solitons and their interactions with kink waves to the (2 + 1)-dimensional integrable Schwarz-Korteweg-de Vries (ISKdV) problem by applying the symbolic computation with ansatz functions technique and logarithmic transformation. The governing model usually appears in the nonlinear shallow water waves and fluid mechanics. We discuss various nonlinear waves like multiwave solutions (MSs), homoclinic breather (HB), M-shape solitons, single exponential form (one-kink), and double exponential form (two-kink). These waves have lot of applications in fluid dynamics, nonlinear optics, chemical reaction networks, biological systems, climate science, and material science. We also study interaction among M-shape solitons with kink wave. At the end, we discuss the stability characteristics of all solutions.
Lentinula edodes Cultured Extract and Rouxiella badensis subsp. acadiensis (Canan SV-53) Intake Alleviates Immune Deregulation and Inflammation by Modulating Signaling Pathways and Epigenetic Mechanisms
Authors: Shahbazi Roghayeh , Yasavoli-Sharahi Hamed , Alsadi Nawal , Sharifzad Farzaneh , Fang Sandra , Cuenin Cyrille , Cahais Vincent , Chung Felicia Fei-Lei , Herceg Zdenko , Matar Chantal
Published: September 2023

Puberty is a critical developmental period of life characterized by marked physiological changes, including changes in the immune system and gut microbiota development. Exposure to inflammation induced by immune stressors during puberty has been found to stimulate central inflammation and lead to immune disturbance at distant sites from the gut; however, its enduring effects on gut immunity are not well explored. Therefore, in this study, we used a pubertal lipopolysaccharides (LPS)-induced inflammation mouse model to mimic pubertal exposure to inflammation and dysbiosis. We hypothesized that pubertal LPS-induced inflammation may cause long-term dysfunction in gut immunity by enduring dysregulation of inflammatory signaling and epigenetic changes, while prebiotic/probiotic intake may mitigate the gut immune system deregulation later in life. To this end, four-week-old female Balb/c mice were fed prebiotics/probiotics and exposed to LPS in the pubertal window. To better decipher the acute and enduring immunoprotective effects of biotic intake, we addressed the effect of treatment on interleukin (IL)-17 signaling related-cytokines and pathways. In addition, the effect of treatment on gut microbiota and epigenetic alterations, including changes in microRNA (miRNA) expression and DNA methylation, were studied. Our results revealed a significant dysregulation in selected cytokines, proteins, and miRNAs involved in key signaling pathways related to IL-17 production and function, including IL-17A and F, IL-6, IL-1β, transforming growth factor-β (TGF-β), signal transducer and activator of transcription-3 (STAT3), p-STAT3, forkhead box O1 (FOXO1), and miR-145 in the small intestine of adult mice challenged with LPS during puberty. In contrast, dietary interventions mitigated the lasting adverse effects of LPS on gut immune function, partly through epigenetic mechanisms. A DNA methylation analysis demonstrated that enduring changes in gut immunity in adult mice might be linked to differentially methylated genes, including Lpb, Rorc, Runx1, Il17ra, Rac1, Ccl5, and Il10, involved in Th17 cell differentiation and IL-17 production and signaling. In addition, prebiotic administration prevented LPS-induced changes in the gut microbiota in pubertal mice. Together, these results indicate that following a healthy diet rich in prebiotics and probiotics is an optimal strategy for programming immune system function in the critical developmental windows of life and controlling inflammation later in life.
A Comprehensive Computational NMR Analysis of Organic Polyarsenicals including the Marine Sponge-Derived Arsenicins A–D and Their Synthetic Analogs
Authors: Defant Andrea , Mancini Ines
Published: September 2023

The adamantane structure of arsenicin A and nor-adamantane structures of arsenicins B–D have gained attention as unique natural polyarsenicals, as well as hits showing promising anticancer activity. The purpose of this study is to apply the predictive power of NMR DFT calculations in order to identify a valid tool to be used in the structural elucidation of similar molecules. 1H- and 13C-NMR chemical shifts of twelve natural and synthetic polyarsenical analogs were calculated and validated by comparison with experimental data acquired in CDCl3 solutions, in regard to mean absolute error (MAE) values under various combinations of two methods (GIAO and CSGT), four functionals and five basis sets, also considering relativistic effects. The best computational approaches are highlighted for predicting the chemical shifts of 1H and 13C nuclei and J(1H,1H) coupling constants in the series of O- and S-polyarsenicals. This comprehensive analysis contributes to making NMR spectroscopy appealing for the structural elucidation of such molecules, contrary to the first structural elucidation of natural arsenicin A, in which the experimental NMR analysis was limited by the poor presence of proton and carbon atoms in its structure and by the shortage of reference data.
Quality of Life and Pain after Proximal Humeral Fractures in the Elderly: A Systematic Review
Authors: Iking Janette , Fischhuber Karen , Stolberg-Stolberg Josef , Raschke Michael J. , Katthagen Jan Christoph , Köppe Jeanette
Published: September 2023

Background and Objectives: The proximal humeral fracture (PHF) is one of the most common fractures in elderly patients. A PHF might influence the quality of life (QoL) on several different levels, especially in elderly patients, but it is unclear which treatment option results in a better QoL outcome. Therefore, we aimed to systematically review the current literature for studies that have analyzed the QoL and pain of elderly patients treated either surgically or non-operatively for PHF. Materials and Methods: A comprehensive search of the literature was performed in the PubMed database from January to April 2023. Studies describing the QoL or the level of pain of patients older than 60 years with the EuroQoL-5 Dimension (EQ-5D) score or the visual analogue scale (VAS) after the treatment of PHF, either non-operatively (non-OP), with open-reduction and internal fixation using a locking plate (LPF), or with reverse total shoulder arthroplasty (RTSA) were included. Twelve studies were analyzed descriptively and the individual risk of bias was assessed using the ROB2 and ROBINS-I tools. Results: A total of 12 studies with 712 patients at baseline were included (78% female sex, mean age 75.2 years). The reported VAS scores at 12-month follow-up (FU) ranged from 0.7 to 2.5. The calculated overall mean VAS score across all studies showed a decreasing tendency for all treatments, with an increasing FU time up to 12 months after PHF. None of the studies reported any significant differences of the EQ-5D across the groups. The overall calculated EQ-5D indices showed an increasing trend after 6–8 weeks FU, but did not differ significantly between the three treatments. Conclusions: In conclusion, the current literature suggests that there are no clinically important differences between the QoL or pain in elderly patients with PHF after non-operative treatment or surgical treatment with LPF or RTSA. However, the number of studies and level of evidence is rather low and further trials are urgently needed.
The importance of Veillonella in the oral microbiome and its impact on dental and periodontal pathology: a literature review
Authors: Saganova T. R. , Tsarev V. N. , Gianni A. B. , Signorini L. , Cavallé E.
Published: September 2023

Relevance. Veillonella is associated with diseases of the oral cavity. Representatives of this genus occupy a significant share in the composition of the plaque microbiota and are involved in the formation of food chains and regulating the pH of the oral microbiome.

The aim of this article is to provide an overview of scientific studies on the Veillonella taxonomic group's position in the oral microbiome and their possible impact on the development of infectious diseases of the oral cavity.

Materials and methods. A scientific search was conducted in the databases MEDLINE, EMBASE, NCBI, Web of Science, PubMed, Scopus, and eLibrary.RU for the last 40 years. 88 sources in English and 1 in Russian were analyzed and included in this review.

Results. Various species of Veillonella promote the adhesion of Streptococcus mutans and metabolize the lactate produced by streptococci. They also play an essential role in forming the periodontium microbial biofilm, entering into co-aggregation with primary, intermediate and late colonizers, including such periodontal pathogens as Fusobacterium nucleatum and Porphyromonas gingivalis. Veilonella is involved in the formation of lipopolysaccharides and hydrogen sulfide in pulpitis, periapical periodontitis and halitosis.

Conclusion. Veillonella spp. is a significant component of the oral microbiome and can be viewed as a stabilizing component and as an indicator of a violation of the ecosystem's metabolic situation.
Surface Engineering of GaN Photoelectrode by NH3 Treatment for Solar Water Oxidation
Authors: Kang Soon Hyung , Ha Jun-Seok
Published: September 2023

Photoelectrochemical (PEC) water splitting is a vital source of clean and sustainable hydrogen energy. Moreover, the largescale H2 production is currently necessary, while long-term stability and high PEC activity still remain important issues. In this study, a GaN-based photoelectrode was modified by an additional NH3 treatment (900°C for 10 min) and its PEC behavior was monitored. The bare GaN exhibited a highly crystalline wurtzite structure with the (002) plane and the optical bandgap was approximately 3.2 eV. In comparison, the NH3-treated GaN film exhibited slightly reduced crystallinity and a small improvement in light absorption, resulting from the lattice stress or cracks induced by the excessive N supply. The minor surface nanotexturing created more surface area, providing electroactive reacting sites. From the surface XPS analysis, the formation of an N-Ga-O phase on the surface region of the GaN film was confirmed, which suppressed the charge recombination process and the positive shift of EFB. Therefore, these effects boosted the PEC activity of the NH3-treated GaN film, with J values of approximately 0.35 and 0.78 mA·cm−2 at 0.0 and 1.23 VRHE, respectively, and an onset potential (Von) of −0.24 VRHE. In addition, there was an approximate 50% improvement in the J value within the highly applied potential region with a positive shift of Von. This result could be explained by the increased nanotexturing on the surface structure, the newly formed defect/trap states correlated to the positive Von shift, and the formation of a GaOxN1-x phase, which partially blocked the charge recombination reaction.
Single stent transverse-configuration in assisted coiling treatment of a double anterior communicating aneurysm
Authors: Chiriac A. , Dobrin N. , Ion Georgiana , Faiyad Z. , Turliuc Dana , Poeata I.
Published: September 2023

The stent-assisted coiling technique is more and more used for the anterior communicating aneurysms (AcomA) treatment due to the increasing incidence of complex and wide-necked aneurysms at this level. Different arrangements of a single stent for assisted coil embolization have been described. The transverse-configuration from A1-Acom-Contralateral A1 stent-assisted coiling procedure was previously reported as a feasible, effective, and relatively safe endovascular technique used to treat wide-necked complex AcomA aneurysms. In this article, we presented a technique involving transverse stenting through the AcomA via the dominant A1 and discuss some particular technical difficulties.
Clinical-pathological features and molecular background of oligodendrogliomas
Authors: Popescu G. , Paslaru Francesca , Paslaru A.C. , Apostol M. , Zaharia M.C. , Popescu M. , Gorgan R.M.
Published: September 2023

Background: Diffuse gliomas are the most frequent primary central nervous system (CNS) neoplasms, originating from the parenchyma itself, oligodendrogliomas accounting for approximately 10% of cerebral gliomas. For the past 20 years, the study of genetic/molecular mechanisms of gliomagenesis and progression has gradually come into focus. However, the biological and clinical significance of these mutations is still to be completely characterized. The purpose of this article is to describe our clinical experience with oligodendrogliomas and to review the current literature, in order to better describe the characteristics of the molecular/genetic oligodendroglioma subgroups.

Methods: We performed a single-institution retrospective study that included 66 patients with oligodendrogliomas operated in our department between January 2011 and December 2018.

Results: Our study included 26 female patients (39%) and 40 male patients (59%). The mean age at presentation was 39.9year-old (range 26-59year-old). The tumours were located predominantly in the right hemisphere (53%), the majority being situated in the frontal lobe (59%). 64% of the patients had signs of mass effect on the imaging studies, 13% presented with brain herniation syndromes, 16 % of the surgically treated patients had a relapse with regrowth and malignant transformation of the tumour. The most common complaint that the patients had at admission was headaches. Seizures were the second most common symptom that determined the patients to seek medical attention.

Conclusion: The expanding knowledge regarding the genetic alterations of oligodendroglial tumours could lead to significant changes in treatment strategies. However, the utility of each particular marker in planning the treatment has yet to be established. Emerging data will, most likely, improve outcome prediction and adjuvant therapy strategies through identifying the patients most likely to benefit from a particular treatment.
Spontaneous height restoration of cervical traumatic non-pathological vertebral compression fracture
Authors: Khelifa Adel , Aichaoui Fayçal , Berchiche Lakhdar , Morsli Abdelhalim
Published: September 2023

Spontaneous regaining of radiological normal shape with vertebral compression fracture is very uncommon in the cervical spine; conducting confusion regarding the presence of a potentially surgical lesion. We report the case of 48 years old man without past medical history who presented post traumatic compression fracture that resolved spontaneously after transcranial traction. The patient was operated on with a good outcome. This report aims to confirm the presence of such phenomena already reported in the dorso-lumbar spine.
Planning neurosurgical interventions in patients with anticoagulant therapy
Authors: G.A. Quiñones-Ossa , S.L. Angulo-Mariño , E. Garcia-Ballestas , L.R. Moscote-Salazar , Amit Agrawal , Ghosh Amrita , Pal Ranabir
Published: September 2023

Clinical practice guideline on anticoagulation is intended to manage patients undergoing neurosurgical procedures for the best possible short and long-term outcomes. In the clinical office practice, anticoagulation is offered to prevent thromboembolism with Warfarin, Heparin, Novel Oral Anticoagulants. The management approach starts with the mitigation plans from a reversal of pre-procedural anticoagulants for impending neurosurgical procedures by estimating procedural bleeding risk on the patients. The haemorrhage criteria and the timing of procedures are best assessed by the proceduralist during and after the intervention, standing on ground situations. Yet, intra- and post-procedure anticoagulant therapy should induct a multidisciplinary consultation paradigm for the best outcome in any emergent scenario. Further, each anticoagulation event should be monitored closely with competence in the optimum reversal process. Different neurosurgical procedures also should be weighed for their inherent hazards along with the probabilities of the bleeding and thromboembolism. The treating team should also concur to suggest a resumption of the pre-procedure anticoagulant therapy which may have been in place for altogether different morbidities. Regarding the anticoagulant agent, there are special conditions and recommendations to bear in mind in the daily medical practice for patient management. In the clinical practice guidelines for neurosurgical procedures, decisions about initiation and continuation of anticoagulants require experience and thorough internalization of the planned procedure, to avoid the risks of inherent risks of bleeding and thromboembolism.
Osmotherapy in patients with severe brain trauma
Authors: Reina-Rivero Randy , Gaitán-Herrera Gustavo , García-García Aixa Eliana , Molina-Trujillo Amalia , Jaramillo-Acosta Manuel Alejandro , Paniagua-Aguirre Juliana , Barón-Sánchez Alfonso , Castro-Castro Antonio Luis , Argüello-Manrique Mohamed , Ortega Sierra Michael Gregorio
Published: September 2023

Traumatic brain injury is still a major cause of mortality and morbidity in the world and is considered a public health problem that needs to be well attended to. Cerebral oedema due to brain injury compromises the delivery of essential nutrients and alters normal intracranial pressure, whose increase has been shown to be strongly associated with poor neurological outcomes and mortality for patients with head trauma. Intravenous fluids are a fundamental component of trauma care and fluid management influences patient outcomes. Thanks to advances in the research of osmotic agents, mortality has been reduced and there has been greater control in intracranial pressure. The osmotic agents most used for the control of intracranial pressure in patients who have suffered severe brain trauma are mannitol and hypertonic saline. However, in recent years have been studying the benefits that sodium lactate can generate in these cases. It has been found that sodium lactate has generated a greater decrease in intracranial pressure values and lower mortality rates with respect to mannitol and hypertonic saline. This still has been disputed as an application of mannitol, hypertonic saline or sodium lactate for treating patients who have suffered some head trauma. This review aims to show the advantages, disadvantages and recommendations of the different hyperosmolar solutions mentioned previously based on current evidence.
Brain abcess with "Nocardia Farcinica"
Authors: R.V. Tracicaru , A.I. Cucu , M. Loredana Curecheriu , Dana Mihaela Turliuc
Published: September 2023

Introduction: Brain abscesses caused by Nocardia farcinica pathogen are rare and usually present as large abscesses with a thick and irregular wall. We present a case of a patient with signs and symptoms of central nervous system infection and had a fulminant evolution with malign cerebral oedema and death.

Case report: The 35-year-old patient presented with mild symptoms that appeared 2 weeks prior and became more aggressive in the last 48 hours. After the initial examination and blood tests, the patient was suspected of a systemic infection because of the high white cell count and high level of inflammatory markers. Antibiotic therapy was started with Ciprofloxacin and Amoxicillin/ Clavulanic Acid. The brain MRI showed a multinodular lesion in the right hemisphere, with contrast enhancement and central high diffusion restriction on T1, T2 and FLAIR. During the antibiotic treatment, the patient suddenly became comatose. Urgent brain CT scan showed malign cerebral oedema with brain shift.

Discussion: There are 58 documented cases of Nocardia farcinica in the literature, as shown in a recent systematic review. Most of the cases are with immunocompromised patients, either through disease or secondary to treatment after organ transplant. In our case, we suspected immunodeficiencies based on the anamnestic data offered by the patient's family. Mortality rates are between 19% and 36,7% in all reported cases, but in our presented case the patient had a rapid aggressive evolution with malign brain oedema that resulted in death.

Conclusions. The management of these cases requires urgent diagnostics and treatment. For our team, the first reported case of Nocardia farcinica and the fast aggressive evolution resulted in a negative outcome, even with antibiotics treatment and surgical evacuation of the abscess.
Efficacy of neuronavigation guided biopsy in deep seated brain lesions
Authors: Chhabra Anuj , Kumar Singla Deepak , Singh Deepak Kumar , Gupta Surender Kumar , Kaif Mohd , Yadav Kuldeep , Ahmad Farhan
Published: September 2023

Localisation of brain lesions and prevention of damage to vital structures are important goals in the operation of brain pathologies, which can be aimed after the development of many techniques (e.g. angiography, MRI, sonography, frame base stereotaxy). In spite of current developments in radiological imaging techniques, accurate histological diagnosis is required to determine the appropriate treatment methods for intracranial lesions.

The study was conducted in the Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, over a period of 18 months. Descriptive statistics (frequencies and percentages) were used to interpret the collected data. After editing, data was entered into SPSS free versions for statistical studies. The results from various sites of the biopsy were compared based on sensitivity, specificity, positive and negative predictive values.

In this study, 4 patients were found to be below 20 years, 7 patients in the 20 – 40 years age group, 10 patients in the age group of 40 to 60 years and 4 patients were above sixty years. 22 (88%) patients were found to have positive yield when the biopsy was taken from the core area while 3 (12%) patients were not having any positive results from the biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of various sites of the biopsy were calculated Sensitivity of the periphery came out to be 68.2 % while specificity was 67.7%. The positive predictive value of the periphery was found to be 93.8 % while the negative predictive value was

22.2%. The sensitivity of the contrast-enhanced area came out to be 72.7 %, with specificity being 67.7%. The positive predictive value of periphery in such cases was found to be 94.1 % and the negative predictive value was 25%. The most common system-related complication was the inability to show choline peak properly, which was present in 7 patients.

Hence, it can be concluded safely that the use of neuronavigation is beginning to have a vital role in a variety of intracranial procedures with precise localisation of both intracranial as well as spinal lesions and prevention of damage to vital structures intraoperatively thereby significantly reducing procedure-related morbidity and mortality.
Comparison of levels of toxic trace elements in two most common spinal pathologies in three different tissues
Authors: A.K. Hakan , Yaycioglu Soner , Daltaban Iskender Samet , Gel Mehmet Selim , Canbek İhsan
Published: September 2023

Aim: The toxic trace element levels in serum, bone (lamina), and intervertebral disc tissues of patients with lumbar spinal stenosis and lumbar herniated nucleus pulposus (HNP) which are the two most common spinal pathologies were determined, and it was investigated whether they have a role in the pathophysiology of these pathologies.
Materials and methods: Cadmium (Cd), aluminium (Al), arsenic (As), mercury (Hg), and lead (Pb) levels in serum, intervertebral disc, and bone (lamina) tissue of patients with HNP (=20)  and 30 with lumbar spinal stenosis (LSS) (n=30) were determined by Inductively Coupled Plasma Mass Spectrometry technique.
Results: LDH group Cd serum level was found to be significantly higher than LSS group Cd serum level (p=0.024). The Al disc level in the HNP group was found to be significantly higher than the Al disc level in the LSS group (p=0.038). While As serum level increased in LDH group, it was determined that As bone level increased very significantly (r= 0.699, p=0.001). In the LSS group, it was determined that the Hg disc level increased significantly as the Hg serum level increased (r=0.608, p<0.01). On the other hand, as the Hg serum level increased in the LDH group, the Hg disc level also decreased significantly (r= -0.579, p<0.01).
Conclusion: The difference in toxic trace element levels seen in these pathologies has been discussed in terms of possible causes in light of current literature. The findings of our study support the hypothesis that toxic trace elements may be effective in lumbar disc degeneration.
Coil migration during pressure-cooker technique for cerebral AVM
Authors: Ismail Mustafa , H. Talib Sura , Albairmani Sama , Al-Khafaji Aktham O. , Al-Jehani Hosam , Hoz Samer S.
Published: September 2023

Introduction: In recent decades, the endovascular treatment of cerebral arteriovenous malformations (AVMs) has advanced. However, it still carries risks of unanticipated complications. Coil migration is a reported complication of aneurysmal coiling procedures. Herein, we report a case of early intraprocedural coil migration during pressure cooker technique embolization of right thalamic AVM, discussing the management and potential explanations. The literature showed no report of coil migration after the pressure cooker technique in the form of coil-augmented Onyx injection technique (CAIT).
Case description: An otherwise healthy 26-year-old female suddenly developed a severe headache with no loss of consciousness. Computed tomography (CT) scan of the head illustrated intraventricular haemorrhage. Magnetic resonance imaging (MRI) showed the bag of worms' sign in the right thalamic area. The size and location of the AVM prompted the decision for multistage endovascular embolization using onyx. In the anterior circulation, the right A5 arterial feeder has a high flow which indicates the pressure cooker technique embolization in the form of CAIT. In the procedure, early detachment and migration of the coil occurred in the medial prefrontal branch through the anterior cerebral artery. No intervention to retrieve the coil was carried out because the detachment piece is small and lodged distally. Onyx was injected directly without the coil because of the risk of radiation to the patient. Otherwise, the intraprocedural and postprocedural courses went uneventful.
Conclusion: This is the first report of coil migration during the pressure cooker technique with CAIT for the right thalamic AVM.
Therapeutic advances in treatment of patients with neurofibromatosis type 1 and type 2
Authors: Popescu G. , Paslaru Francesca , Zaharia M.C. , Popescu M. , Gorgan R.M.
Published: September 2023

Background: Neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) are rare tumoral suppressor syndromes, triggered by an abnormal mutation in a tumour suppressor gene (TSG) (1). Each of these syndromes represents an orphan disease (by itself), but the tumours encountered in these patients are the most frequent lesions of the nervous system. Between the two of these diseases, NF1 presents a greater risk of malignancy, hence the importance of an accurate diagnosis and distinction between the two pathological entities. The purpose of this paper is to describe our department's practice protocol with neurofibromatosis and review the current literature regarding clinical diagnosis and management of these complex diseases.

Methods: Our paper is a retrospective study that comprehends 25 patients with neurofibromatosis treated in our clinic between 2011 and 2018.

Results: Our study included 16 female patients (64%) and 9 male patients (36%). The mean age at presentation was 48,7 (range 14-72 years). There were 7 cases (28%) of NF1 and 18 cases (72%) of NF2. Seven cases (28%) had a positive family history and 18 patients did not (72%). The most common symptoms at presentation were hearing loss, vertigo, and headache.

Conclusions: Neurofibromatosis is a very complex disease in which the tumours may have an unforeseeable growth pattern. New tumours can grow over the years and the symptoms are unpredictable. Surgical treatment is best to be reserved for symptomatic tumours. Non-surgical procedures are also an important step of the treatment, but further studies are required to decide their effectiveness.
Intracranial aneurysms - a battle against time
Authors: Toader Corneliu , Marinescu Andrei Alexandru , Popa Andrei Adrian , Bratu Bogdan Gabriel , Ciurea Alexandru Vlad
Published: September 2023

Introduction: Intracranial aneurysms consist in abnormal dilatation of the cerebral arteries, most frequently asymptomatic, with symptoms appearing in the case of aneurysm rupture. From an imaging point of view, a cranial CT scan shows the subarachnoid haemorrhage caused by aneurysm rupture and the “gold standard” for aneurysm diagnosis is cerebral angiography.

Case presentation: A 49 years-old female, Ukrainian refugee, presented with a unique comitial crisis and chronic headache. Following an MRI performed in Kiev, it was decided to perform a bilateral carotid and vertebral angiography in our clinic. Clinical and imagistic results showed a giant left middle cerebral artery aneurysm. Postoperative, the patient had a favourable neurological recovery, with no neurological deficits. Additionally, control angiography and CT scan highlight complete occlusion of the aneurysm and no complications.

Conclusions: Cerebral aneurysms represent a high-risk vascular condition that needs a CT scan and angiography to be precisely diagnosed, surgical clipping should be performed as soon as possible.
Surgical management of spinal cord hemangioblastoma
Authors: Popescu George , Zaharia Marius C. , Giovani Andrei , Miron Ioana , Vîjlănescu Cezar , Gorgan Radu M.
Published: September 2023

Background. Hemangioblastomas are considered rare tumours that are located, in most cases, in the posterior cranial fossa. In most of cases, spinal hemangioblastomas are identified on the thoracic and cervical levels and can be associated in one-third of cases with von Hippel Lindau Syndrome.

Material and methods. In this paper, we are presenting our clinic`s experience with spinal hemangioblastomas and the follow-up of the patients in the last 10 years.

Results. In our study, we included six men and three women with a mean age of 45 years, ranging between 36 to 61 years. The mean hospitalization days was 17 days. Among nine patients, there were identified 12 tumors. Six patients presented cervical spine hemangioblastomas, two of them had thoracic spine lesions and in one case, the tumour was identified at the lumbar level. Furthermore, two patients presented multiple lesions. Two patients had been associated with von Hippel Lindau Syndrome. In all cases, surgery was the therapeutic approach.

Discussions. Despite the rapid advance of technology and the new alternatives for the treatment of these lesions, surgical resection of hemangioblastomas remains the gold standard treatment.

Conclusions. Hemangiolbastomas are benign tumours that can be associated with von Hippel Lindau. A whole-body scan is required to confirm or exclude this syndrome. Even though the surgical treatment for asymptomatic patients remains debatable, surgical intervention is the only treatment that can lead to the total removal of the tumour.
Bobble Head Doll Syndrome
Authors: Haro Yakouba , Zabsonre Sylvain D. , Sanou Abdoulaye , Zoungrana Inoussa , Biogo Joseph , Kabre Abel
Published: September 2023

Introduction. Bobble head doll syndrome is a neurological syndrome characterized by abnormal involuntary movements of the head combining repetitive or episodic movements of 2 to 3 Hz back and forth in the anterior-posterior direction that can be assimilated to approval movements (yes-yes) and occasionally lateral rotations that can be assimilated to disapproval signs (no-no). It is a rare entity first described by Benton[1]. We describe three cases managed at the Yalgado Ouédraogo University Hospital in Burkina Faso.

Observations. Three children, one girl and two boys, aged respectively 5, 9 and 14 years were seen for involuntary abnormal head movements associating lateral rotations assimilated to signs of disapproval (no-no) in two cases, and back and forth movements of the head in one case. In the 14-year-old adolescent, there was also a picture of intracranial hypertension. Clinical examination revealed ataxia and macrocrania in both cases and a syndrome in 1 case.    Imaging revealed triventricular hydrocephalus on aqueductal stenosis in all cases with an associated supra sellar cyst in 2 cases. The treatment consisted of endoscopic treatment in 2 cases and ventriculoperitoneal shunt in 1 case. Surgery allowed a considerable regression of involuntary movements of the head in the immediate postoperative period and a complete recovery in the long term.

Conclusion. The bobble head doll syndrome is a rare entity related to the consequences of chronic hydrocephalus responsible for abnormal movements whose management done well and early leads to favourable results.
Chiari 1 malformation with Platybasia
Authors: Mousa Abdurrahman , Nasution Deni , Irsyad M. Ari , Rasyid Fahmi
Published: September 2023

Background. The incidence of CM-I is estimated to be 1/1,000 births. In rare cases, CM-I is complicated by associations with other malformations of the craniocervical junction, including mainly Basilar invagination (BI). Chiari malformation (CM) is characterized by a congenital malformation of the posterior cranial fossa with cerebellar tonsils herniation through the foramen magnum, probably due to the underdevelopment of the posterior bony skeleton (exo-occipital and supraoccipital bones). CM may be complicated by a variety of other malformations, including platybasia, basilar invagination and occipitalization, although syringomyelia (SM) is the most commonly observed
Case Report. A girl, 14 years old came with a chief complaint of headache, which is exacerbated whenever the patient coughed or sneezed. The patient also complained about neck pain and a tingling sensation in her hand. A history of vomiting or seizure has not been found. A history of muscle weakness was not found. On physical examination, the patient has a GCS score of 15 on admission, with normal muscle tone and normal reflexes. The patient has a sensory deficit, on the level below C4. The patient underwent CT Scan and MRI whole spine, Chiari 1 malformation and platybasia were diagnosed. The patient underwent posterior fossa decompression, and postoperatively symptoms of Chiari and sensory deficit gradually improved.
Discussion. As an association with this syndrome, there is also basilar invagination as shown by flat basioccipt (platybasia) and upward odontoid projection. hydrocephalus [3].
Virchow coined the term ‘platybasia’ to describe an abnormal flattening of the skull base, a defect which he attributed to abnormal bone development. In addition to the flattening of the base of the skull, there was upward displacement (impression) of the basilar and condylar portions of the occipital bone, which caused infolding, or impression of the foramen magnum, reduction of the posterior fossa, and consequent protrusion of the upper cervical spine into the anterior brainstem, with neurological signs. The symptomatology presented by CM-1 patients is diverse, and its severity does not correlate with the degree of TH, with some asymptomatic cases presenting with prominent TH. The onset of symptoms generally develops gradually, however, trauma, coughing/sneezing or pregnancy can also precipitate the event. The most common treatment for these patients is surgical PCF decompression (alone or with duraplasty), although cerebellar tonsillectomy, cervical laminectomy, and suboccipital cranioplasty are also applied. The goal of these surgical procedures is to decompress the foramen magnum and increase the subarachnoid space in order to avoid the impaction of the cerebellar tonsils, reestablish the CSF flow and reverse the symptoms
Conclusion. This patient was diagnosed with Chiari 1 malformation and platybasia, as suggested in the literature, posterior fossa decompression was done and the patient improved clinically