bluuebunny/crossref_metadata_2025 huggingface dataset:
The Convergence of Antibiotic Contamination, Resistance, and Climate Dynamics in Freshwater Ecosystems
Authors: Gomes Marcelo Pedrosa
Published: September 2024

The convergence of antibiotic contamination, antimicrobial resistance (AMR), and climate dynamics poses a critical environmental and public health challenge. Freshwater ecosystems are increasingly threatened by the persistent presence of antibiotics, which, coupled with rising global temperatures, accelerate the development and spread of AMR. This review examines the sources, pathways, and mechanisms through which antibiotics enter freshwater systems and how climate change exacerbates these processes. This review discusses this convergence’s ecological and human health impacts, highlighting the implications for biodiversity and public health. It also explored the current monitoring and mitigation strategies, including advanced oxidation processes, natural-based solutions, and policy interventions. Finally, this review identifies critical research gaps and proposes future directions for managing the intertwined threats of antibiotic contamination, resistance, and climate change. It emphasizes the need for integrated, multidisciplinary approaches to protect freshwater resources in an increasingly volatile global environment.
Comprehensive Resilience Assessment Framework for Water Distribution Networks
Authors: Carneiro Joana , Loureiro Dália , Cabral Marta , Covas Dídia
Published: September 2024

A novel comprehensive resilience assessment framework for drinking water systems is proposed integrating different resilience perspectives (i.e., robustness, autonomy, flexibility, reliability, preparedness and recovery), oriented by objectives, criteria and metrics, applicable at the tactical level. The resilience assessment framework is applied to a Portuguese real water distribution network, enabling the evaluation of the system’s resilience. The infrastructure dimension is the main contributor to the low resilience results, particularly in terms of infrastructural robustness, as the infrastructure has exceeded the average service life and has low rehabilitation rates. In terms of autonomy, the system highly depends on external water and energy sources. Regarding the service dimension, most of the drinking water available is used for non-potable uses (e.g., irrigation), without alternative sources. The detailed diagnosis identified network area R6 as the priority area. Assets rehabilitation, increasing storage capacity, finding alternative water and energy sources, and minimizing non-potable uses are relevant improvement measures that promote the reinforcement of the system’s resilience. The resilience assessment framework is a very useful tool for the daily and tactical management of drinking water systems.
Spatiotemporal Dynamics and Drivers of Coastal Wetlands in Tianjin–Hebei over the Past 80 Years
Authors: Wang Feicui , Wang Fu , Zhu Ke , Yang Peng , Wang Tiejun , Hu Yunzhuang , Ye Lijuan
Published: September 2024

Coastal wetland ecosystems are critical due to their diverse ecological and economic benefits, yet they have been significantly affected by human activities over the past century. Understanding the spatiotemporal changes and underlying factors influencing these ecosystems is crucial for developing effective ecological protection and restoration strategies. This study examines the Tianjin–Hebei coastal wetlands using topographic maps from the 1940s and Landsat satellite imagery from 1975, 2000, and 2020, supplemented by historical literature and field surveys. The aim is to analyze the distribution and classification of coastal wetlands across various temporal intervals. The findings indicate an expansion of the Tianjin–Hebei coastal wetlands from 7301.34 km2 in the 1940s to 8041.73 km2 in 2020. However, natural wetlands have declined by approximately 44.36 km2/year, while constructed wetlands have increased by around 53.61 km2/year. The wetlands have also become increasingly fragmented, with higher numbers of patches and densities. The analysis of driving factors points to human activities—such as urban construction, cultivated land reclamation, sea aquaculture, and land reclamation—as the primary contributors to these changes. Furthermore, the study addresses the ecological and environmental issues stemming from wetland changes and proposes strategies for wetland conservation. This research aims to enhance the understanding among researchers and policymakers of the dynamics and drivers of coastal wetland changes, as well as the major challenges in their protection, and to serve as a foundation for developing evidence-based conservation and restoration strategies.
Technological Advancements and Prospects for Near-Zero-Discharge Treatment of Semi-Coking Wastewater
Authors: Quan Bingxu , Tang Yuanhui , Li Tingting , Yu Huifang , Cui Tingting , Zhang Chunhui , Zhang Lei , Su Peidong , Zhang Rui
Published: September 2024

This review examines the technological bottlenecks, potential solutions, and future development directions in the treatment and resource utilization of semi-coking wastewater (SCOW) in China. By comprehensively investigating the semi-coking industry and analyzing wastewater treatment research hotspots and existing projects, this study systematically explores the current status and challenges of each treatment unit, emphasizing the necessity for innovative wastewater treatment technologies that offer high efficiency, engineering feasibility, environmental friendliness, and effective resource recovery. This review highlights prospects and recommendations, including the development of novel extractants for phenol and ammonia recovery, a deeper understanding of biological enhancement mechanisms, exogenous bio-enhancement materials, and the creation of cost-effective advanced oxidation process (AOP)-based combined processes. Additionally, it underscores the potential for repurposing SCOW as a valuable resource through appropriate treatment, whether recycling for production or other applications.
Research on Glacier Changes and Their Influencing Factors in the Yigong Zangbo River Basin of the Tibetan Plateau, China, Based on ICESat-2 Data
Authors: Nie Wei , Du Qiqi , Zhang Xuepeng , Wang Kunxin , Liu Yang , Wang Yongjie , Gou Peng , Luo Qi , Zhou Tianyu
Published: September 2024

The intense changes in glaciers in the southeastern Tibetan Plateau (SETP) have essential impacts on regional water resource management. In order to study the seasonal fluctuations of glaciers in this region and their relationship with climate change, we focus on the Yigong Zangbo River Basin in the SETP, extract the annual and seasonal variations of glaciers in the basin during 2018–2023, and analyze their spatio-temporal characteristics through the seasonal-trend decomposition using the LOESS (STL) method. Finally, combining the Extreme Gradient Boosting (XGBoost) model and the Shapley additive explanations (SHAP) model, we assess the comprehensive impact of meteorological factors such as temperature and snowfall on glacier changes. The results indicate that glaciers in the Yigong Zangbo River Basin experienced remarkable mass loss during 2018–2023, with an average annual melting rate of −0.83 ± 0.12 m w.e.∙yr−1. The glacier mass exhibits marked seasonal fluctuations, with increases in January–March (JFM) and April–June (AMJ) and noticeable melting in July–September (JAS) and October–December (OND). The changes over these four periods are 2.12 ± 0.04 m w.e., 0.93 ± 0.15 m w.e., −1.58 ± 0.19 m w.e., and −1.32 ± 0.17 m w.e., respectively. Temperature has been identified as the primary meteorological driver of glacier changes in the study area, surpassing the impact of snowfall. This study uses advanced altimetry data and meteorological data to monitor and analyze glacier changes, which provides valuable data for cryosphere research and also validates a set of replicable research methods, which provides support for future research in related fields.
Economic Analysis of Sturgeon Farming and Caviar Production: A Case Study of an Italian Fish Farm
Authors: Onofri Laura , Pulcini Domitilla , Martini Arianna , Martinoli Marco , Napolitano Riccardo , Tonachella Nicolò , Capoccioni Fabrizio
Published: September 2024

Sturgeon farming poses an interesting decision: give priority to highly prized caviar or meat. Indeed, sturgeons are mainly reared in aquaculture to produce caviar. However, the economic profitability of a sturgeon farm also depends on the existence of a meat market. Meat is still an important product for sturgeon farmers once the stock of caviar-producing females has been established. This paper takes a case study approach and analyses how an Italian producer addresses the trade-off, adopting a methodology that measures the value of the economic productivity of production inputs, e.g., the measure of the profitability of the inputs, and compares them with the costs of the inputs and the prices of the outputs. This analysis is the first attempt, to our knowledge, to adopt an economic analysis to address this choice problem, based on a very representative case study. This helps monitor whether the farm’s production choices are economically efficient and effective and whether and how those can be improved. The results show that the farm maximizes profit but does not reach its optimal production level. This implies that both (1) producing more output and (2) a further switch to caviar production for less meat are economically efficient production strategies.
A Geophysical-Drilling-Hydrochemical Coupled Method for Accurate Detection of Concealed Water-Conducting Faults in Coal Mines
Authors: Lu Tuo , Liu Haodong , Jia Hailiang , Wang Bo
Published: September 2024

The detection of concealed water-conducting structures is essential for preventing water inrush disasters. Aiming to mitigate the limitations inherent in using any single technique, a comprehensive approach that combines integrated mining geophysical exploration, hydrogeological drilling, and hydrochemical exploration (GDH) is proposed for the exploration of concealed water-conducting structures. By conducting a thorough analysis of the background geological data obtained through surface exploration, potentially concealed water-conducting structures can be predicted. Then, a combination of the seismic reflection method (SRM) and mine transient electromagnetic method (MTEM) can be used to detect the location and water-bearing properties of the target structures. Afterwards, the target drilling areas are defined by the anomalies detected by the integrated mine geophysical technique, and the drilling method can directly acquire the hydrogeological information of water-conducting structures and verify the results of the geophysical methods. By means of hydrochemical analysis, inrush water sources and their runoff conditions can be identified, and the spatial relationship betweenof the source aquifers and mining space can be determined; hence, the properties, scale, and configuration of the water-conducting structures can finally be evaluated. Employing a water-conducting fault in a mine as a case study, we verified that the integrated method overcomes the limitations and possible biases of each method, providing a multiple-method solution that can accurately detect concealed water-conducting structures to help prevent water inrush disasters.
Seasonal Variability and Hydrological Patterns Influence the Long-Term Trends of Nutrient Loads in the River Po
Authors: Cavallini Edoardo , Viaroli Pierluigi , Naldi Mariachiara , Saccò Mattia , Scibona Alessandro , Barbieri Elena , Franceschini Silvia , Nizzoli Daniele
Published: September 2024

This study investigates the long-term trends (1992–2022) of nitrogen and phosphorus loadings exported by the River Po to the Adriatic Sea, to better analyse how changes in hydrology are affecting the timing and magnitude of river nutrient loads. We used 30 years of monitoring data in order to (a) identify the main temporal patterns and their interactions at a decadal, annual and seasonal scale, (b) estimate precipitation effects on load formation and evaluate whether and to which extent the hydrological regime affects nutrient export across the years and (c) analyse the nutrient export regime at a monthly scale and the main transport dynamic of N and P chemical species (hydrological vs. biogeochemical control). The long-term analysis shows a general decrease of both P and N loadings, but the trends are different between the elements and their chemical species, as well as undergoing different seasonal variations. We found a statistically significant relationships between precipitation and loads, which demonstrates that precipitation patterns drive the exported load at the intra- and interannual time scales considered in this study. Precipitation-induced load trends trigger seasonal changes in nutrient deliveries to the sea, peaking in spring and autumn. The nitrogen decrease is mainly concentrated in the summer dry period, while total phosphorus diminishes mainly in spring and autumn. This mismatch of N and P results in variable molar N:P ratios within the year. The effects of extreme drought and flood events, along with the progressive decrease in the snowmelt contribution to water fluxes, are expected to exacerbate the variability in the N and P loadings, which in turn is expected to perturbate the biodiversity, food webs and trophic state of the Northern Adriatic Sea.
Raindrop Size Distribution Characteristics of the Precipitation Process of 2216 Typhoon “Noru” in the Xisha Region
Authors: Wang Guozhang , Li Lei , Huang Chaoying , Zhang Lili
Published: September 2024

This study focuses on the comparative analysis and research of the raindrop size distribution (DSD) in the outer rainband and inner rainband of Typhoon “Noru” in 2022, using the OTT-Parsivel raindrop spectrometer deployed on Yongxing Island, Sansha City. The results indicate that precipitation intensity is lower when composed mainly of small and medium raindrops and increases with the presence of larger raindrops. Stronger precipitation is associated with a higher number of large raindrops. Due to the interaction of cold and warm air masses, the raindrop concentration is higher, and the raindrop diameters are larger compared to Typhoons “LEKIMA” and “RUMBIA”. The entire process predominantly consists of numerous small- to medium-sized raindrops, characteristic of a tropical typhoon. The precipitation in the inner and outer rainbands exhibits consistent types, characterized by a unimodal raindrop size distribution with a narrow spectral width, typical of stratiform-mixed cloud precipitation, where stratiform precipitation constitutes a significant portion. Strong echo reflectivity factors are often associated with higher raindrop number concentrations and larger particle sizes. The Z-R relationship of the precipitation shows a smaller coefficient but a consistent exponent compared to the standard. The calculated shape parameter slope relationship is Λ=0.02μ2+0.696μ+1.539, providing a reference for localizing the Z-R relationship in the South China Sea.
Backstepping-Based Quasi-Sliding Mode Control and Observation for Electric Vehicle Systems: A Solution to Unmatched Load and Road Perturbations
Authors: Hameed Akram Hashim , Al-Samarraie Shibly Ahmed , Humaidi Amjad Jaleel , Saeed Nagham
Published: September 2024

The direct current (DC) motor is the core part of an electrical vehicle (EV). The unmatched perturbation of load torque is a challenging problem in the control of an EV system driven by a DC motor and hence a deep control concern is required. In this study, the proposed solution is to present two control approaches based on a backstepping control algorithm for speed trajectory tracking of EVs. The first control design is to develop the backstepping controller based on a quasi-sliding mode disturbance observer (BS-QSMDO), and the other controller is to combine the backstepping control with quasi-integral sliding mode control (BS-QISMC). In the sense of Lyapunov-based stability analysis, the ultimate boundedness of the proposed controllers has been detailedly analyzed, assessed, and evaluated in the presence of unmatched perturbation. A modified stability analysis has been presented to determine the ultimate bounds of disturbance estimation error for both controllers. The determination of ultimate bound and region-of-attraction for tracking and estimation errors is the contribution achieved by the proposed control design. The performances of the proposed controllers have been verified via computer simulations and the level of ultimate bounds for the estimation and tracking errors are the key measures for their evaluation. Compared to BS-QISMC, the results showed that a lower level of ultimate boundedness with a higher convergent rate can be reached based on BS-QSMO. However, a higher control effort can be exerted by the BS-QSMO controller as compared to BS-QISMC; and this is the price to be paid by the BS-QSMO controller to achieve lower ultimate boundedness with a faster convergence rate.
Sustainable Business Models for Innovative Urban Mobility Services
Authors: Alessandrini Adriano , Cignini Fabio , Ortenzi Fernando
Published: September 2024

Any sharing mobility service aims to make urban mobility sustainable to help reduce environmental impacts and improve the quality of life for all in cities. Many transport services are not currently self-sustainable. The Life for Silver Coast (LifeSC) opened its mobility services on 22 May 2021 and offered electric mobility services during the summer for a few cities in Tuscany. E-bikes and e-scooters can be financially neutral, and even profitable, thanks to the low costs of the vehicles, but they only see a high utilization rate in winter. Shared electric cars, meanwhile, are not profitable. A new shared service that is viable must be profitable to become widely adopted and significantly contribute to sustainability. A few key characteristics have been identified, and one has been tested with a new business model that combines ride-sharing and car-sharing. The innovative Ride Sharing Algorithm (RSA) has been tested based on data from a potential city, Monterondo, where many commuters travel daily to Rome by train. The Italian census and local survey data allowed for the simulation of the scheduling of vehicle rides and an evaluation of the economic results, which could be positive if enough interest for such a system exists among the people, as at least 400 commuters from Monterotondo go to the train station daily in the morning and return in the afternoon. Such a transport demand would justify a new commercial sharing service by using the model tested with the RSA algorithm.
A rare case of Yhwag gene mutation causing developmental and epileptic encephalopathy
Authors: Gheorghita Karina Lidia , Ciurea A.V. , Rizea R.E.
Published: September 2024

Background: epileptic encephalopathy 56 or DEE is a rare disease characterized by early-onset treatment-refractory epilepsy accompanied by global developmental regression that has been shown to be caused by various mutations of the YWHAG gene.
Case presentation: We report a novel of a heterozygous mutation of YHWAG c.170G>A, p.(Arg57His), in a Caucasian male.
Conclusions: Our report further confirms that mutation of YWHAG results in developmental and epileptic encephalopathy.
Delayed diagnosis and management of a congenital intranasal meningoencephalocele in a 24-year-old male
Authors: Khizar Ahtesham , Niaz Adeel , Azeem Syed Muhammad , Ali Imran , Mahmood Khalid
Published: September 2024

Background: Intranasal meningoencephalocele is a rare congenital malformation. It is defined by protrusion of cerebral tissue and meninges through a defect in the skull base. Serious complications usually occur in early childhood, however, symptoms occasionally can wait until adulthood.
Case Presentation: We report a case of a 24-year-old male who had a congenital intranasal meningoencephalocele with recurrent episodes of bacterial meningitis. After a delayed diagnosis, he eventually underwent Endoscopic Endonasal Repair of Meningoencephalocele via 'Bath-plug' technique.
Conclusions: To prevent improper management, it is crucial that ENT colleagues, to whom these cases are primarily present, are well informed about this unusual condition. For the purpose of preventing further neurological problems, thorough neuroimaging evaluations and successful surgical repair are important. The 'Bath-plug' technique for anterior skull base cerebrospinal fluid leak repair is effective for a wide range of situations.
A prospective observational study on evaluating the efficacy of bedside optic nerve sheath diameter in assessing clinical progression of patients admitted in neurosurgical ICU with comparisons to CT scans and GCS score
Authors: Munakomi Sunil , Chaulagain Dipak , Bhattarai Binod , Shah Shashi Bhushan
Published: September 2024

Background: Ultrasound of the optic nerve sheath diameter (ONSD) is a non-invasive, repeatable tool that can be used to measure intracranial pressure in a dynamic way with high diagnostic accuracy. The goal of this study was to find out if a bedside ultrasonographic measurement of optic nerve sheath diameter (ONSD) can accurately predict the computed tomography (CT) findings of high intracranial pressure (ICP) and changes to the Glasgow Coma Scale (GCS) in adult head injury patients in the Neurosurgery ICU.
Methods: For 54 patients in the neurosurgical intensive care unit, we conducted a retrospective analysis of the results of cranial ultrasounds. Those under the age of 18 and those with apparent visual injuries were ineligible. Both horizontal and vertical optic nerve sheath diameters were measured 3 mm beneath the globe in each eye using a 7.5-10MHz ultrasonographic probe. A binocular change in optic nerve sheath diameter of more than 2.00 mm was deemed abnormal in two consecutive readings in the same patient. Patients in the neurosurgical ICU were given a GCS score, which was used to classify their level of brain damage as mild, moderate, or severe. The accuracy of the optic nerve sheath diameter was evaluated using cranial CT findings of shift, oedema, or effacement that suggested an increased intracranial pressure.
Results: The research has 54 participants. According to the results, 68.5% of those who took the study were men, while 31.5% of those who did so were women. Nearly 16.7 per cent of respondents were between the ages of 18 and 40, while 40.7% of respondents were between the ages of 40 and 60, and 42.6% of respondents were above 60. The significant change in ONSD- fall in GCS and CT-progression scan-findings correlation was very strong. When compared to CT scan progression, the ONSD bedside sonographic test had an 86.7% sensitivity and an 89.7% specificity for detecting elevated ICP. The Positive Predictive Value of the reduction in GCS with advancement in CT scan was 80% and the Negative Predictive Value was 89.7%, respectively.
Conclusions: The sensitivity, specificity, and positive predictive value of bedside ONSD ultrasonography in predicting high intracranial pressure are significant to those of progression in CT scan and drop in GCS. An ONSD bedside measurement may be used to determine elevated ICP since it is non-invasive and repeatable.
Diastasis coronal suture fracture with frontoparietal (vertex) epidural hematoma in adult
Authors: Diandra Aga Firza , Kausar T. Akmal , Aristo Reyhan , Farhan Luthfy , Mahyudanil Mahyudanil
Published: September 2024

Introduction: Vertex epidural hematoma (VEDH) is an uncommon presentation of extra-axial hematomas and comprises 1-8% of all extradural hematomas. It can represent a surgical dilemma regarding when and how to operate, particularly considering the potential implication of the superior sagittal sinus (SSS). It is estimated that up to 85%-95% of EDHs are associated with skull fractures. Nonetheless, diastasis of cranial sutures in adults has scarce scientific reports, let alone with associated epidural hematoma.
Cases: We reported a 42-year-old male patient who came with a main complaint of a lacerated wound on his head due to an accident when he repaired the truck tire. His GCS score was 15 without any neurological deficit. A Head CT scan revealed a hyperdense biconvex lesion on the frontoparietal (vertex), frontal sinus depressed fracture and diastasis fracture of the coronal suture. Craniotomy evacuated EDH and craniectomy elevated depressed fracture with cranialization of frontal sinus were performed. Postoperative there is no surgery complication.
Discussion: Vertex epidural hematoma (VEDH) frequently causes a diagnostic dilemma, both clinically and radiographically. Clinically, VEDH are often indicated by elevated intracranial pressure (a headache which is usually severe and unrelenting, nausea, visual impairment, and vomiting). Those resulted from compression of the venous outflow at the SSS and subsequently decreased absorption and outflow of cerebrospinal fluid (CSF), which may not contribute to the establishment of a specific diagnosis. Vertex fractures are present in most cases with a linear fracture line crosses (usually horizontally) the sagittal suture overlying the hematoma or diastasis of the coronal and/or sagittal suture, with or without significant external sub-galeal hematomas, indicating a vertex impact.
Conclusion: Vertex epidural hematoma is a rare case. In this case, the patient had GCS score 15 without any neurological deficit. The prompt decision to surgery is vital for good outcomes for the patient with VEDH.
Percutaneous pedicle screw fixation
Authors: Muhammad Jehanzeb  , Khizar Ahtesham , Naeem Ul Hassan  , Anwar Khawar , Arain Moin Islam , Bashir Asif
Published: September 2024

Percutaneous pedicle screw fixation (PSF) has emerged as a promising alternative to traditional open surgical approaches for spinal stabilization. Pedicle screws are inserted through percutaneous access sites without substantial soft tissue dissection. To ensure proper screw insertion, the procedure employs fluoroscopic or image-guided navigation devices. The popularity of percutaneous PSF has accelerated because of its prospective advantages and the mounting body of research demonstrating its effectiveness and safety. However, there are a few drawbacks to the procedure, such as a longer learning curve for surgeons, poor visibility when inserting screws, and a requirement for specialized tools and imaging guiding systems. This article provides a comprehensive review of the technique of percutaneous PSF, its clinical outcomes, and recent advancements in the field. It also aims to analyze the efficacy, safety, and limitations of percutaneous PSF, as well as explore the evolving technologies and techniques that have contributed to its improved application.
From low back pain to ochronosis
Authors: Turgay Turkan , Yayla Erdal , Baloglu Murat
Published: September 2024

Background: Alkaptonuria is a rare metabolic autosomal recessive disorder. Its aetiology involves homogentisate 1,2 dioxygenase (HGD) deficiency resulting in homogentisic acid accumulation in the connective tissues (ochronosis). The classic triad of the disease is: i) homogentisic aciduria, ii) bluish-black pigmentation in tissues such as the sclera, cornea, cartilage and skin, and iii) degenerative arthropathy usually in the fourth decade of life.
Case: In this case report, we present a 41-year-old man with diffuse musculoskeletal pain and additional clinical features in tissues such as the ear and urinary tract who was diagnosed late (>30 years). He was diagnosed with alkaptonuria based on clinical findings and elevated urinary homogentisic acid levels.
Conclusion: This case report underscores the need for early diagnosis of alkaptonuria, which can help in managing symptoms and improving the quality of life of patients. Further research is needed to develop more targeted therapies for alkaptonuria, which can help slow down the progression of joint degeneration and improve overall patient.
Impact of gross-total resection versus other extent of resections for the overall survival of anaplastic astrocytoma
Authors: Chaulagain Dipak , Smolanka Volodymyr , Smolanka Andriy , Munakomi Sunil
Published: September 2024

Aim: We aim to assess the overall survival (OS) in patients with Anaplastic Astrocytoma (AA) undergoing gross total resection (GTR) as compared to partial resection (PR) subtotal resection (STR), or biopsy.
Methods: This systematic review followed Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. An electronic search from PubMed/Medline was conducted from their inception to 26th April 2022. We included AA patients undergoing any surgical intervention resulting in GTR, PR, STR or biopsy. We did not include letters, case reports, abstracts, conference papers, reviews, and studies where full text was unavailable. We included only those articles which were published in English.
Results: Five cohorts were used in this study. Two studies assessed OS in GTR, PR/STR and biopsy, while one study compared GTR and STR/biopsy. Another study was used to compare OS between GTR and local excision/STR, and another was used to assess the complications/benefits of these surgeries. Three studies showed a significant increase in OS in patients who underwent GTR compared to the other interventions, while one study showed a non-significant effect on OS (p= 0.249).
Conclusion: Our study concluded a significant increase in OS when patients with AA had GTR instead of STR, PR or biopsy. Although these surgeries might carry some disadvantages, GTR allows a more positive effect on neurological status. Still, more studies need to be conducted to assess the efficiency of these surgeries.
Iatrogenic spinal cord herniation
Authors: Derou Louis , Landry Konan , Kounde Michum , Konan Serge , Teti Landry , Tokpa André , Haidara Aderehime
Published: September 2024

Introduction: Spinal cord herniation occurs idiopathically or is due to defective or weakened dura mater resulting from iatrogenic or traumatic lesions. Although there have been many reports of idiopathic cases, there are few reports of postoperative iatrogenic spinal cord herniation. The authors describe a rare case of postoperative spinal cord herniation in the cervical spine, with an extensive analysis of reported cases
Materials and methods: This article reports a documented case of postoperative spinal cord herniation. The case description is followed by an analysis of the literature.
Results: A 67-year-old woman who had cervical laminectomy 3 weeks before for cervical laminectomy, presented with neck pain and torticollis after coughing. The MRI findings showed a cervical medulla herniation with cerebrospinal fluid (CSF) leakage. The patient underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Over the previous 50 years (1973–2023), 16 post-operative spinal cord herniation cases were reported. The mean patient age was 43.3 years (range 15–67 years). There was a male predominance (80%). The mean onset period after surgery was 292 weeks (range, 1 week to 728 weeks). Clinical symptomatology was polymorphic with non-specific signs.
Conclusion: Iatrogenic spinal cord herniation is an extremely rare occurrence after spine surgery.  The diagnosis must be evoked in case of any neurological degradation after surgery of the cervical spine, thoracic spine or thoracolumbar junction.  The surgical management gives satisfactory clinical results.
Role of intrathecal and topical vancomycin in prevention of ventriculoperitoneal shunt infections
Authors: Ahmed Tanweer , Akbar Rabail , Ahmed Anas , Akbar Sana , Rehman Lal , Amjad Ali
Published: September 2024

The objective of this study is to assess the role of intrathecal and topical vancomycin in the prevention of ventriculoperitoneal shunt infection. Infections of the ventriculoperitoneal (VP) shunt are a frequent consequence of shunt surgery. Different strategies, and protocols in addition to prophylactic intravenous antibiotic administration have been described to limit the infection rate, but the burden still remains high. The use of intrathecal Vancomycin along with topical application can be implemented as an additional measure to limit shunt-related infections.
The study includes 105 patients who underwent ventriculoperitoneal shunt insertions for different reasons. Apart from the standard operative protocols used for shunt surgeries, intraoperatively intrathecal and topical vancomycin were administered to all the patients. Postoperatively, all the patients were followed for three months to assess shunt-related infections.
The study showed that the infection rate after administration of intrathecal and topical Vancomycin was found to be low, which is 4.7%, which shows a reduction of 5.8% from our baseline infection rate of 10.5%. We also found that patients having tuberculous meningitis were more at risk of developing shunt-related infections, the p-value being significant (0.001*).
Therefore we conclude that as part of a standardized shunt operation routine, Intrathecal and topical vancomycin treatment may be an appropriate option for preventing pediatric shunt infections.
Embolization of middle meningeal artery in chronic subdural haematoma
Authors: A-Kaabi Aisha , Al-Kharusi Nouf , Al-Breiki Almuntasar , Al-Saadi Tariq
Published: September 2024

Background:  Embolization of the middle meningeal artery (MMA) is a non-invasive procedure that is used as an alternative to surgical drainage in the treatment of subdural hematoma. The aim of our study is to represent the top-cited articles discussing the embolization of the MMA in treating chronic subdural hematoma (cSDH).
Methods: Scopus database was used in June 2022 to search for the top 50 cited articles related to the embolization of the MMA in cSDH. Articles were assessed using bibliometric parameters, H-indices, impact factor, number of citations per article, and article type. The data was statically analyzed by using SPSS 23 along with Microsoft Excel.
Results: Among the top 50 cited articles, the highest citation was 95 (article entitled “Middle meningeal artery embolization for chronic subdural hematoma”). The most productive year was 2020 with 13 articles, followed by 2021 with 11 articles. The United States of America (USA) contributed to 24 articles with 9 neurosurgical institutes.  Most articles were case reports and case series (48%).
Conclusion: This study collected the top 50 cited articles about embolization of the MMA in cSDH which can be used as a resource for clinicians in their practice and helps them to find the gap in the knowledge about this topic.
Fahr’s syndrome revealed by convulsive seizures
Authors: Dianka Mamadou Bata , Ennaki Fatima Zahra , Abdoulkader Guedi Farida , Osman Abdi Warsama
Published: September 2024

Fahr's syndrome is a fairly rare antomo-clinic entity, it is defined by the existence of bilateral and symmetrical cerebral calcifications, especially of the central grey nuclei and is often associated with dysparathyroidism. We report the case of a young 29-year-old patient who presented with seizures and headaches. A CT scan of the brain showed calcifications of the central grey nuclei, the periventricular and subcortical white matter as well as the dentate cerebellar nuclei. The biological assessment showed hypoparathyroidism and hypocalcaemia. Substitutive medical treatment based on calcium and vitamin D allowed a clear rapid clinical improvement.
Endoscopic third ventriculostomy in post traumatic hydrocephalus
Authors: Lobo Geover Joslen , Lobo Sarita
Published: September 2024

Background: Hydrocephalus is a known sequelae in traumatic brain injury patients. It may occur early or late and presents with dementia, urinary incontinence and difficulty in walking. There are two distinct types of normal pressure hydrocephalus one is idiopathic most commonly seen in the elderly age groups and the other is secondary due to a CerebroVascular Accident, trauma or surgery. The idiopathic type may not respond to the cerebrospinal fluid diversion procedure, but the secondary type responds to the cerebrospinal fluid diversion procedure. Our study aims at exploring the option of Endoscopic third ventriculostomy in these patients not making them shunt dependent.
Materials and methods: The patients with traumatic brain injury admitted to the department of neurosurgery between January 2012 and January 2018 were included in the study. Congenital hydrocephalus and secondary hydrocephalus due to spontaneous Sub arachnoid haemorrhage and tumours were excluded. 14 patients were identified and if there was some improvement in their condition after cerebrospinal fluid tap tests were planned for endoscopic third ventriculostomy.
Results: Out of the 14 patients 2 were females and the remaining 12 were males. 2 did not improve at all. 12 had some improvement out of which 3 had a failure and underwent a ventriculo peritoneal shunt. Hence there were 5 failures out of 14 which made 35.7%.
Conclusion: Endoscopic third ventriculostomy is an option which can be offered to patients with secondary hydrocephalus. The chances of failure though present the procedure is minimally invasive and improves cerebrospinal fluid dynamics.
Successful recovery of a young man with traumatic brainstem ischemia in a motor vehicle accident
Authors: Radanović Dražen , Peić Kristina , Elboursh Dušan , Bogosavljević Đurđina , Antonijević Jovana , Mirčić Uroš , Čukić Bojan , Pajić Srbislav
Published: September 2024

Introduction: The most common etiological factors of brainstem stroke and ischemia are atherosclerosis, thromboembolism, tumours, arterial dissection, and trauma. Infarction of the medulla oblongata in 73% of cases occurs as a result of stenosis of the vertebral arteries, 26% due to arterial dissection, while the topic of traumatic brainstem ischemia is still under-researched and under-represented.
Case report: We present a case of a 26-year-old male patient who was admitted to the Emergency Department due to multiple injuries of the head, chest, and upper, and lower extremities sustained as a motorcyclist in a traffic accident. A cranial CT scan revealed the presence of a minor subdural hematoma, traumatic brainstem ischemia, and a ruptured peduncular artery. From a neurosurgical perspective, surgical treatment was not indicated, thus a conservative therapeutic approach was adopted. After five days after admission, initial radiographic signs of ischemia regression were recorded, followed by complete absence.
Conclusion: Timely patient transportation from the accident site to the Emergency Center, followed by an appropriate multidisciplinary treatment approach and intensive neuroprotective and neuroregenerative therapy, along with organism reperfusion, played a pivotal role in the neurological, and subsequently, overall patient recovery in this case presentation.
Solitary intracerebral Langerhans cell histiocytosis
Authors: Vissa Shanthi , Prayaga Aruna Kumari , Bontha Swathi , Nandyala Rukmangadha , Ramesh Chandra  , Kattela VeeraSekhar
Published: September 2024

Background: Langerhans cell histiocytosis is an uncommon proliferative histiocytic disorder which can affect any organ. It is common in children and can rarely occur in adults. In the central nervous system, the hypothalamic-pituitary axis is most commonly involved. Brain parenchyma is rarely affected.
Case summary: We report a case of a 13-year-old male who presented with chief complaints of headache and swelling over the right frontal region. On imageology, a clinical diagnosis of meningioma was considered. The tumor was excised and on histopathological examination diagnosis of Langerhans cell histiocytosis was considered
Conclusion: Intracranial Langerhans cell histiocytosis is a rare condition which can mimic primary neoplasms of the central nervous system such as glioma, meningioma and metastatic deposits on imageology. Histopathology is the gold standard for diagnosis.
Neurosarcoidosis: overview of management and differentiation from fungal aetiologies
Authors: Khan Shawn , Saigal Khushi , Varela Juan , Flambert Gabriel , Patel Parth , Mahmood Arman , Lucke-Wold Brandon
Published: September 2024

Neurosarcoidosis, a rare inflammatory condition, poses a diagnostic challenge due to its various clinical presentations and potential mimics. This comprehensive review delves into the complexities of neurosarcoidosis, emphasizing the importance of a thorough diagnostic workup and the consideration of alternative conditions, such as fungal mimics. The study explores the intricacies of the diagnostic process, particularly the role of histopathology, imaging, and laboratory tests. The current state of neurosarcoidosis management is examined, such as the use of corticosteroids as well as novel therapies including Rituximab and JAK-STAT inhibitors. The clinical spectrum is described in detail for both the peripheral and central nervous systems, offering insights into the many presentations, which include ocular manifestations and syndromes like Heerfordt's syndrome. The complexities of neurosarcoidosis necessitate further research in its diagnosis, pharmacotherapy, and management. The inclusion of information on ongoing research and clinical trials underscores the need for tailored therapeutic approaches.
Neurofibroma of C2 root
Authors: Sincari Marcel , Nunes Andre , Pina Gabriel , Sincari Mark-Daniel
Published: September 2024

Background: Intra and extradural neurofibromas of C2 root is a challenging pathology, usually with indolent evolution, that is why the onset symptoms are neurologic deficit just like upper cervical myelopathy symptoms and explains the late diagnosis of giant tumours with severe spinal cord compression with involvement and distortion of great vessels anatomy. These facts make surgeries more difficult. The follow-up of this type of surgery must be very close because CSF fistula can often occur.
Case description: The present article reports a series of three cases of neurofibromas, two of them are giant dumbbell-shaped C2 neurofibromas and the third one is a case of neurofibromatosis type 1 of C2 roots bilaterally, C3 root unilateral with unusual postoperative course. Dural reconstruction was necessary in all cases.
Conclusions: The patients in this series were very symptomatic with good recovery. The surgical procedures were challenging, total tumour removal was possible, and the reconstruction of dural defects was needed in all cases. In the case of NF1, the postoperative period was practically just the follow-up of complications and addressing them. This fact stresses the importance of meticulous preoperative planning and close follow-up. Postoperative quality of life was better than preoperative in all the cases. The purpose of the surgical treatment is the decompression of the spinal cord, tumour removal and prophylaxis of CSF fistula by closing the dural defects. Overall, the surgical C2 root neurofibromas resection is a safe procedure and is associated with good clinical outcomes.
Comparative study of thoracolumbar fractures posterior fixations between long segment and short segment involving the fractured vertebra
Authors: Beltchika Antoine , Maoneo Israël , Ntsambi Glennie
Published: September 2024

Background.  Thoracolumbar fractures are among the most common and unstable traumatic injuries to the spine. They require a rigid fixation. However, there are controversies in the choice of fixation types. This study aimed to compare long-segment posterior fixation (LSPF) bridging the injured vertebra and short-segment fixation with screws in the fractured vertebra (SSFFV).
Methods. This was an analytical study of 22 patients admitted to the Kinshasa University Teaching Hospital from 2020 to 2023 with thoraco-lumbar fractures. Variables of interest included: sex, age, occupation, cause of fracture, ASIA score, injured vertebra, Magerl fracture types, Sagittal Cobb angle (SCA), and level of fixation. Data were analysed using SPSS 26 software.
Results. Ten patients (45.4%) had SSFFV and 12 (54.6%) had LSPF. Overall, the sex ratio was 4.5 and, the mean age was 35.27±9.88 years.  Road accidents accounted for 72.7% of causes, fracture of L1 (50%), ASIA A (41%) and Magerl B (54,5%). Pre-operative features did not show a difference between the two fixations. No difference was observed in function values before surgery (p=0.863) and at one year postoperatively (p=0.914).  The mean SCA was 15.57 ± 5.90° before surgery, and 12.60±5.94° one year after surgery showing a significant correction of local kyphosis of 3° (P <0.001). There was no significant difference in the degrees of correction of local kyphosis immediately postoperatively (p=0.591) and at one year postoperative (p=0.819) and also in the degrees of loss of local kyphosis (p=0.870) between SSFFV and LSPF.
Conclusion. This study did not show a significant difference in functional recovery, reduction and loss of correction of traumatic kyphosis between the two fixations. The SSFFV therefore appears to be an effective alternative to LSPF.
Evaluation of vertebral artery variations and arterial dominance in cervical CT angiographic images in Iranian population
Authors: Mehrpouyan Mohammad , Sametzadeh Mozhgan , Momen Garibvand Mohamad , Eftekhari Moghadam Ali Reza
Published: September 2024

Purpose: The aim of the present study was to determine the characteristics and variations in the origin of vertebral arteries (VA), its level of entry into the transverse foramen, VA diameter, Length of VA, and VA dominance.
Methods: A total of 250 adult patients (143 males and 107 females) were enrolled (Mean age: 60.92±13.44) and scanned with Computerized Tomography angiography (CTA).
Results: The VA entered the C6 transverse foramen in 97.8% of specimens. Abnormal entrance of VA was observed in 4.4% of specimens. The mean length of prevertebral (V1) right and left VA was 81.38±14.38 mm and 82.49±14.16 mm. The mean length of the intraforaminal segment (V2) of the right and left VA was 81.38±14.375mm and 82.49±14.162mm and showed sexual dimorphism. The mean diameter of the right and left VA was 3.297±0.85 and 3.676±0.88, respectively. We found 1(0.4%) left and 1(0.4%) right VA emerging from the aortic arch. The mean right and left VA diameters were 3.28 ± 0.83 mm and 3.6±0.88mm, respectively. A total of 90(0.36) patients were right dominant and 160(0.64) patients were left-dominant. The right VA of aortic arch origin entered the 4th cervical transverse foramina, whereas the left VA entered the 7th cervical transverse foramina. We found that 22(8.8%) of the right and 1 (0.4%) of the left vertebral arteries had distal origin. The results did not show any relationship between gender and origin of VA, diameter of VA, and level of entry. A significant relationship was observed between gender and VA length (P=0.0001).
Discussion: The present study confirms the presence of anomalous in the VA route. Knowledge of such anatomical variations is important in interpreting CTA and may reduce the risk of intraoperative VA injury.