bluuebunny/crossref_metadata_2025_split huggingface dataset:
ABA and Melatonin: Players on the Same Field?
Authors: Bychkov Ivan , Kudryakova Natalia , Pojidaeva Elena S. , Doroshenko Anastasia , Shitikova Victoria , Kusnetsov Victor 
Published: November 2024

In plants, abscisic acid (ABA) and melatonin (MT) are conventionally treated as molecules mitigating stress responses. To understand the mechanisms of ABA–MT interplay, we examined the effects of ABA and MT treatment in ABA and MT loss-of-function mutants of Arabidopsis thaliana exposed to high light (HL) stress. ABA constantly suppressed ASMT encoding N-acetylserotonin methyltransferase in the context of differential responses of other MT biosynthesis genes in both the wild type (WT) and mutants. However, this response was absent in the mutant with the disrupted ABI4. Given that the ASMT promoter region contains several potential ABI4-binding elements, these data suggest that ASMT can be a potential target gene for ABI4. A role for ABI4 in the interactions between ABA and MT is supported by the finding that ABI4 is constitutively derepressed in the MT signaling mutants cand2 and gpa1, which exhibited elevated steady state levels of ABI4 transcripts and were not regulated by either stress or melatonin. In addition, the abi4 mutant showed increased modulations in the expression of the MT catabolic genes M2H and M3H in response to ABA treatment, inferring that this transcription factor is a negative regulator of ABA-dependent changes in MT content. Furthermore, all tested mutants with impaired ABA synthesis or signaling displayed elevated steady state MT levels compared to WT, while MT treatment contributed to the downregulation of key ABA synthesis and signaling genes. Collectively, our results suggest that ABA and melatonin act antagonistically, modulating the expression of ABA and MT signaling and metabolism genes. To understand the mechanisms of ABA–MT interactions, we studied the effects of ABA and MT treatment in ABA and MT loss-of-function mutants of Arabidopsis thaliana exposed to severe light stress (SLS).
DECISION MAKING IN EPILEPTIC AVMS
Authors: Balasa Adrian 
Published: November 2024

While there is no doubt about the need for surgical treatment of a ruptured arteriovenous malformation (AVM), the decision to surgically treat a patient presenting solely with seizures is more controversial.

Arteriovenous malformations (AVMs) arise from an abnormal connection between high-flow arterial vessels and low-flow venous vessels, resulting in a dysplastic vascular nidus within the brain tissue. The inherent flow irregularities within AVMs make them prone to rupture, which occurs in approximately half of patients. Additionally, seizures represent the second most common clinical manifestation of AVMs, presenting in 20%–45% of individuals with these lesions.

This paper investigates the angiographic and MRI features of arteriovenous malformations that present with epilepsy, and discusses the surgical considerations in managing these patients and integration of multimodal approach focusing on the standard microsurgical techniques utilized.

Patients presenting with seizures as the primary symptom of an arteriovenous malformation carry a higher surgical risk compared to those presenting with haemorrhage.

Several factors have been associated with an increased risk of seizures in patients with arteriovenous malformations (AVMs). These include male gender, younger patient age, AVMs located in the frontal or temporal lobes, AVMs situated in the brain cortex, superficial venous drainage, a superficial temporal lobe AVM nidus, fistulous AVMs, and AVMs with venous stenosis.

Surgical treatment is the recommended approach for patients with Spetzler-Martin grade I–III arteriovenous malformations. Resecting an unruptured brain arteriovenous malformation in a patient presenting only with epilepsy is a complex decision that requires a thorough understanding of the lesion’s anatomy, the patient’s history, and the neurosurgeon’s skills.
A SPINAL TRAUMA, A TUMOR AND EVERYTHING IN BETWEEN
Authors: Chis Rafael Florin , Maior Sergiu , Domahidi Julia , Florian Ioan Stefan 
Published: November 2024

Introduction
Burkitt lymphoma is a male predominant (3:1 male:female ratio) aggressive B-cell non-Hodgkin lymphoma that can present as a sporadic variant with meningeal involvement in about 20% of cases. Therefore, it can manifest with neurologic deficits due to compression of the spinal cord or spine nerve root.

Case Report
We report the case of a 6 years-old girl who presented in the emergency department following a traumatic vertebral injury (fall from around 1.5 meters) with no spinal cord involvement. She accused upper back pain, walking and orthostatism difficulties and manifested a light to moderate inferior paraparesis (MCR 3/5) The MRI revealed a space-occupying epidural mass between T1-T4, severely compressing the spinal cord initially thought to be an epidural hematoma. Emergency surgery was performed with duro-radicular decompression and mass excision through a T1-T4 laminotomy followed by a laminoplasty. The unveiled mass was white, minimally vascularized and adherent to the dura raising the suspicion of a tumor. Postoperatively the patient exhibited significant neurological improvement with resolution of the paraparesis and normal gait restoration.

Three weeks later, the patient returned with complaints of abnormal gait, lumbar pain radiating in the right lower leg and upon examination a light right lower limb monoparesis (MRC 4/5) following another traumatic event. Emergency MRI of the whole spine with contrast was requested just as the pathologist in charge of the case suggested a diagnosis of Burkitt lymphoma, prompting a whole-body MRI. A severe recurrence was noted at the site of the previous lesion along with a new lumbar lesion, and several intraabdominal, intrathoracic, ovarian tumor sites with diffuse infiltration of the bone marrow. The patient was urgently referred to the pediatric oncology department and started on steroidal anti-inflammatory treatment and chemotherapy.

Conclusions
Burkitt lymphoma involving the nervous system in children requires increased medical attention during the clinical, histopathological examination and treatment phase, due to the association with advanced disease and, although rare, should be considered as a differential diagnosis in pediatric patients with epidural lesions. The management of such lesions demands a solid collaboration between neurosurgeon, pediatrician, pathologist and oncologist for an early diagnosis and proper treatment.
DEALING WITH TWO SYNCHRONOUS LESIONS
Authors: Chis Rafael Florin , Padurean Vlad Adrian , Domahidi Julia , Kiss Atilla 
Published: November 2024

Introduction
Multiple synchronous intracranial lesions present a significant diagnostic and therapeutic challenge, in most cases appearing as metastatic tumors or same-cell type tumors.

Case Report
We report the case of a 73-year-old patient admitted in our department with light left hemiparesis (MRC MMT 4/5), light left hypoesthesia and transitory and remitted state of temporo-spatial confusion that debuted around six weeks prior to presentation. The neurological exam confirmed the sensorimotor deficit and displayed the existence of left neglect syndrome. The patient’s MRI revealed a giant temporo-parieto-occipital mass almost 7 cm in diameter that appeared to have an intraventricular starting point and showed a relatively homogeneous contrast enhancement with significant mass effect. A concomitant superficial parieto-temporal lesion was also noted. Both lesions were excised in a successive manner from superficial to deep, using a right parieto-temporal craniotomy. While the giant mass had a yellowish color and an extremely hard consistency, the superficial one was easily suctionable and had a grey-reddish color and was extremely well vascularized, raising the suspicion of concomitant brain lesions of different histology. Postoperatively the patient underwent a routine thoracic CT scan in the context of a position related soft tissue injury that revealed the existence of two pulmonary lesions, further deepening our suspicion of concomitant brain lesions of different histology.

Conclusions
Although extremely rare, the appearance of two histologically distinct brain lesions in patients with no evidence of a genetic condition should be taken into consideration especially in the context of intraoperative differences in order to successfully guide the patients’ follow-up treatment.
BRIDGING TECHNOLOGY AND NEUROSURGERY
Authors: Saceleanu Vicentiu , Cindea Cosmin , Breazu Alexandru , Lucaciu Sonia 
Published: November 2024

Objectives
The BrainIT project aimed to revolutionize neurosurgical practices by integrating advanced technologies to enhance the precision and outcomes of neuro-oncology and neurovascular surgeries. The project sought to address the growing need for technological innovation in neurosurgery to improve patient outcomes and surgical efficiency.

Study Stages
The project encompassed several key stages. Initially, comprehensive e-learning modules were developed to provide continuous education and training for neurosurgeons, ensuring they stayed updated with the latest technological advancements. Concurrently, extensive research was conducted to explore the applications and benefits of cutting-edge technologies in neurosurgery. This research was pivotal in identifying new methods and tools that could be integrated into surgical practices.

To facilitate knowledge exchange and collaboration, the project organized international conferences and workshops. These events brought together neurosurgical professionals from around the world, fostering a collaborative environment where ideas and innovations could be shared. Additionally, strategic partnerships were established with leading institutions and organizations. These partnerships were crucial in promoting interdisciplinary collaborations, which were essential for the successful implementation and impact of the project.

Supported by the European Commission, the BrainIT project emphasized the importance of disseminating innovative practices and findings within the medical community. This dissemination ensured that the knowledge and advancements generated by the project were widely adopted and implemented, ultimately benefiting the broader medical field.

Conclusions
The integration of advanced technologies within the BrainIT project has demonstrated significant improvements in surgical precision and patient outcomes. These findings highlight the crucial role of interdisciplinary collaboration and continuous innovation in the advancement of neurosurgical practices. The project serves as a model for integrating technology and medicine, underscoring its potential to shape future neurosurgical methodologies. The successful implementation of the BrainIT project showcases the potential for technological advancements to revolutionize medical practices and improve patient care on a global scale.
MACHINE LEARNING-BASED PREDICTION OF CLINICAL OUTCOMES IN MICROSURGICAL CLIPPING TREATMENTS OF CEREBRAL ANEURYSMS
Authors: Serban Matei , Toader Corneliu , Buica Vlad , Dumitrascu David , Ciurea Alexandru Vlad 
Published: November 2024

Background
This study investigates the application of Machine Learning (ML) techniques to predict clinical outcomes in microsurgical clipping treatments of cerebral aneurysms. The goal is to enhance healthcare processes through informed clinical decision-making by utilizing a dataset of 344 patients' preoperative characteristics.Methods
Various ML classifiers were trained to predict outcomes measured by the Glasgow Outcome Scale (GOS). The dataset included 344 patients who underwent microsurgical clipping for intracranial aneurysms. Key features in the dataset included age, aneurysm diameter and neck, arterial hypertension, atherosclerosis, obesity, intubation, vasospasm, and hemorrhage. The study evaluated the models using ROC-AUC scores for outcome prediction and identified key predictors using SHAP analysis.

Results
- Model Performance: The models achieved ROC-AUC scores of 0.72 ± 0.03 for specific GOS outcome prediction and 0.78 ± 0.02 for binary classification of outcomes.
- Key Predictors: SHAP analysis identified intubation as the most impactful factor influencing treatment outcome predictions. Other significant predictors included vasospasm and the Hunt and Hess Scale.
- Patient Demographics: The study included 344 patients with a mean age of 55.05 ± 11.45 years. Gender discrepancy was noted, with 219 females (63.7%).
- Aneurysm Characteristics: The mean aneurysm neck was 3.93 ± 1.64 mm. Most aneurysms were of the saccular or berry type, with 308 cases (89.5%) being ruptured and 311 cases (90.4%) presenting with hemorrhage.
Conclusions
The study demonstrates the potential of ML in predicting surgical outcomes of cerebral aneurysm treatments. The findings emphasize the need for high-quality datasets and external validation to enhance model accuracy and generalizability. The integration of ML into clinical practice can potentially improve patient management and treatment outcomes in neurosurgery. The study contributes to the ongoing efforts in the medical AI community, supporting the use of ML techniques to enhance clinical decision-making and patient care.
GAMMA-KNIFE RADIOSURGERY IN ACOUSTIC NEUROMA
Authors: Stoica Fery , Perin Radu , Neamtu Daniela 
Published: November 2024

Lesions of the cerebellopontine angle (CPA) are frequent and represent 6%–10% of all intracranial tumors. Acoustic neuromas, which are also called vestibular schwannomas, along with meningiomas are the two most frequent lesions and account for approximately 85%–90% of all CPA tumors.

These benign lesions involving the middle ear comprise a diverse spectrum of local manifestations within the temporal bone. Despite their usually benign histopathological characteristics, these lesions may be locally destructive. Prompt diagnosis and treatment are therefore necessary to prevent progression of audiologic, vestibular, and facial nerve dysfunction, which may also be present.

Because of the surgically formidable anatomical location of these tumors, curative resection often proves challenging. Treatment options include surgical resection, stereotactic radiosurgery (SRS), hypofractionated stereotactic radiotherapy (SRT), alone or in combination.

Stereotactic radiosurgery is a minimally invasive option for management of skull base tumors. Brain stereotactic radiosurgery involves the use of precisely directed closed skull single fraction (one surgical session) radiation to create a desired radiobiologic response within the target with minimal effects to surrounding structures or tissues.
Stereotactic radiosurgery is associated with a high rate of local tumor control and a low risk of neurologic complications for patients with skull base tumors. Stereotactic radiosurgery can be used as an up-front treatment or as an adjuvant therapy for patients with recurrent or residual tumor after surgical resection.

The superior safety efficacy of stereotactic radiosurgery over microsurgery in small- to middle-sized vestibular schwannomas is demonstrated in worldwide comparative studies. Normal motor facial nerve function and serviceable hearing are more likely to be preserved with radiosurgery as compared with microsurgery. In very large schwannomas, a combined approach with a deliberate subtotal removal with functional monitoring of the facial nerve followed by radiosurgery of the remnant dramatically reduces the risk of facial palsy as compared with radical removal.

Hypofractionation of radiosurgery (stereotactic radiotherapy or multisession radiosurgery) has failed until now to demonstrate any advantage over single-dose, high-precision radiosurgery.

Literature has documented the cost savings benefit of stereotactic radiosurgery versus invasive surgical procedures and the lower risk potential of bleeding, anaesthesia problems, infections, and side effects which may result in transient or permanent disabilities from open surgery.

At the same time, literature has demonstrated that the risk of radiation-associated intracranial malignancy after stereotactic radiosurgery was found to be similar to the risk of developing a malignant CNS tumour in the general population of the USA and some European countries as estimated by the CBTRUS and IARC data, respectively.
DUAL MANIFESTATION OF INTRACRANIAL AND SPINAL CORD CAVERNOMAS
Authors: Zaharia M.C. , Andrasi C.M. , Popescu G. , Neacsu A. , Gorgan Radu Mircea 
Published: November 2024

Introduction
Cerebral and spinal cord cavernomas are vascular anomalies of the nervous system characterized by dilated vessels lined with a single layer of endothelium. They exhibit minimal blood flow and can occur in both the brain and spinal cord. They affect approximately 0.5% of the population and constitute 15% of cerebral vascular malformations. While spinal cavernomas are less common, they can cause significant morbidity due to the risk of hemorrhage and resulting neurological deficits. Surgical removal to completely eliminate the vascular abnormality is the preferred treatment.

Material and Methods
We present the case of a 66-year-old female patient who presented to our clinic with headache, dizziness, and left-sided hemiparesis, predominantly affecting the lower limb. Cerebral MRI revealed an intracranial mass in the left parietal lobe with signs of acute bleeding. Due to clinical symptom discrepancies and imaging findings, cervical MRI was performed, revealing an intramedullary tumor formation adjacent to the C4-C5 vertebral bodies. The patient underwent two surgeries, achieving total ablation of the lesions.

Results
Post-operative CT confirmed complete ablation of the cavernomas. No neurological deficits were reported after removal of the parietal cavernoma. One month after the first surgical intervention, the patient underwent a second surgery to excise the cervical tumor. Postoperatively, the patient experienced numbness in the left hand, which improved in the first week postoperatively.

Conclusions
The prevalence of associated intracranial cavernous malformations (CMs) in patients with spinal cord CMs was found to be 5 to 12% and typically observed in patients with the familial form of the condition. The coexistence of intracranial and spinal cord CMs is more likely to lead to aggressive disease progression. Therefore, it is imperative that both lesions are surgically removed within 30 days of each other. Managing cavernomas remains a complex clinical decision, often balancing intervention risks against potential neurological morbidity.
Metabolismo do cálcio em crianças com microcefalia: um estudo em uma coorte
Authors: Maciel Renata Franco , Rodrigues Letycia Santos , Bittencourt Anna Lillian Canuto , Miranda Phelipe Brito de , Silva Carla Thayná de Santana , Leite Rebecca Schuster Dorea , Guerra Julia Franco Maciel , Bispo Ana Jovina Barreto 
Published: November 2024

A microcefalia, definida pela Organização Mundial da Saúde como perímetro cefálico inferior a -2 desvios padrão da mediana, está associada a um risco elevado de disfunções motoras e endócrinas, levando a disfagias, desnutrição energético-proteica e deficiências de macro e micronutrientes. O presente estudo objetivou avaliar a evolução antropométrica e o metabolismo do cálcio em crianças com microcefalia acompanhadas em um ambulatório de referência no Estado de Sergipe. Para tanto, foi realizado um estudo observacional e descritivo em uma coorte de pacientes com diagnóstico de microcefalia, analisando-se parâmetros antropométricos (peso, estatura, IMC) e níveis séricos de cálcio, fósforo, fosfatase alcalina e vitamina D, do segundo ao sexto ano de vida. Observou-se que as frequências de crianças com crescimento inadequado variaram entre 12,8% e 32% para peso, zero a 12% para estatura e 19% a 40,9% para IMC, enquanto os parâmetros séricos de cálcio, fosfatase alcalina e vitamina D apresentaram alterações entre 17,6% e 50% ao longo dos anos. Apesar do risco, não foi verificado comprometimento importante dos valores de cálcio, fosfatase alcalina e vitamina D, assim como do peso. Acreditamos que acompanhamento regular da amostra permitiu identificar e corrigir essas alterações, reforçando a importância de um seguimento multidisciplinar sistemático para prevenir déficits prolongados e suas consequências no crescimento das crianças com microcefalia.
The Significance of Responsible Leadership for Innovative Work Behaviour: A Conceptual Framework
Authors: Soukupová Nikola , Kotková Stříteská Michaela 
Published: November 2024

Responsible leadership is a key foundation in today's dynamic business world, where the call for ethical behaviour and innovation is louder than ever. Unlike traditional leadership paradigms, responsible leadership represents a multifaceted relationship and views leadership as a dynamic interplay between leaders and stakeholders, rather than a one-sided leader-follower dynamic. Based on this understanding, our study developed a conceptual framework for the relationship between accountable leadership and innovative work behaviors. It also identified mediating-moderating roles to better understand the linkages and gaps in the research. The conceptual framework was developed based on a literature search of 82 studies. The individual constructs of the model were analysed with the findings of other studies and the theoretical and practical contribution was identified through synthesis. In order to create a sustainable future, it is imperative that the pursuit of continuous innovation and the principles of responsible behaviour form the cornerstones of any society. Responsible leadership stimulates innovative work behaviour not only for the benefit of the organisation but also for the well-being of all stakeholders. This is essential to building the relationships and corporate culture that mediate this relationship. The moderator of this relationship is the moral intelligence of the responsible leader, which strengthens the relationship between responsible leadership and innovative work behaviour. The study contributes by providing a comprehensive review of the existing knowledge on responsible leadership and innovative work behavior. Furthermore, it enriches scholarly knowledge and offers practical insights into the characteristics desirable in CEOs to promote responsible and innovative business behavior.