bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ethical aspects of integrating sentiment and emotion analysis in chatbots for depression intervention
Authors: Denecke Kerstin , Gabarron Elia 
Published: November 2024

IntroductionDigital health interventions specifically those realized as chatbots are increasingly available for mental health. They include technologies based on artificial intelligence that assess user’s sentiment and emotions for the purpose of responding in an empathetic way, or for treatment purposes, e.g. for analyzing the expressed emotions and suggesting interventions.MethodsIn this paper, we study the ethical dimensions of integrating these technologies in chatbots for depression intervention using the digital ethics canvas and the DTx Risk Assessment Canvas.ResultsAs result, we identified some specific risks associated with the integration of sentiment and emotion analysis methods into these systems related to the difficulty to recognize correctly the expressed sentiment or emotion from statements of individuals with depressive symptoms and the appropriate system reaction including risk detection. Depending on the realization of the sentiment or emotion analysis, which might be dictionary-based or machine-learning based, additional risks occur from biased training data or misinterpretations.DiscussionWhile technology decisions during system development can be made carefully depending on the use case, other ethical risks cannot be prevented on a technical level, but by carefully integrating such chatbots into the care process allowing for supervision by health professionals. We conclude that a careful reflection is needed when integrating sentiment and emotion analysis into chatbots for depression intervention. Balancing risk factors is key to leveraging technology in mental health in a way that enhances, rather than diminishes, user autonomy and agency.
Motives and constraints to bike tourism in Greece: “the Go-bike” project
Authors: Ntovoli Apostolia , Karagiorgos Thomas , Myrovali Glykeria , Anoyrkati Eleni , Papadopoulou Sousana , Tamiakis Iason , Alexandris Kostas 
Published: November 2024

IntroductionBike tourism is one of the fast-developing alternative forms of tourism since it can satisfy the main pillars of sustainability (economic, social, and environmental). The current study is part of a larger funded project (GoBike) and aims to profile bike tourists in Greece, examine the motives and constraints to tourism participation, and show the value of using technology as a means of promoting bike tourism.MethodsThe data was collected through a quantitative study, with one hundred and five individuals who had experience with bike tourism activities, with the use of an online questionnaire. Items were used to measure socio-demographics, motives, constraints, involvement, and attitudes toward a smartphone application.ResultsThe results indicated that “Nature”, “Health”, “Bike eco-friendly place” and “Interesting places” were the most important motives. On the other hand, the lack of “Guides”, “Appropriate Routes” “Bike tourism Programs” and “Limited Information” were reported as the most important barriers. The bikers reported that technology can facilitate their decision to do bike tourism activities.DiscussionA smartphone application should include several attributes the most important of which are the “Elevation difference”, the “warnings of obstacles/risks”, “the level of difficulty”, “the bike distance” and the “condition of the routes”.
A comparison of subperiosteal vs subdural drainage in the treatment of chronic subdural haemorrhage
Authors: Gupta Sajag 
Published: November 2024

Introduction. Symptomatic chronic subdural haemorrhages (CSDH) continue to be one of the most common diagnoses in modern neurosurgery. The current standard procedure for symptomatic CSDH is a burr-hole craniostomy with irrigation and the installation of close-system drainage. The purpose of this study is to conduct a direct comparison of two surgical procedures for the treatment of symptomatic CSDH that are effective in prior studies. Our main goal was to compare the efficacy of placing a subperiosteal drain (SPD) and a subdural drain (SDD) after a single burr-hole craniostomy and irrigation and to show any significant differences in terms of overall surgical complications, functional outcome and mortality rate at three months, and complications at six months.
Materials and methods. From August 2022 to December 2023, the study was conducted in the Department of Neurosurgery at a tertiary care centre, with a total of 25 patients in both treatment groups.
Results. Overall, there was no statistically significant difference between the two groups in terms of patient general characteristics, pre-and post-operative symptoms, Markwalder grades, postoperative hematoma volume and recurrence, mortality, and functional outcome at discharge and at three months follow-up. Despite not reaching statistical significance, we found a decreased risk of surgical complications, particularly post-operative cerebral haemorrhage, with SPD system implementation.
Conclusions. According to our findings, both therapy modalities are extremely successful in the treatment of CSDH. therapy with a single burr-hole craniostomy, irrigation, and implantation of the SPD system, on the other hand, has a reduced overall surgical complication rate and can be regarded as a therapy of choice for the management of symptomatic CSDH.
TIPS AND TRICKS IN SURGICAL TREATMENT OF LARGE VESTIBULAR SCHWANNOMAS
Authors: Balasa Adrian 
Published: November 2024

Vestibular schwannomas (VS) frequently referred to as acoustic neuromas are the most common tumours of the cerebellopontine angle. They are benign, generally slow-growing tumors that arise from the vestibular portion of the eighth cranial nerve. For patients with large vestibular schwannomas or those exhibiting symptoms from the tumor’s mass effect, surgical intervention remains the preferred treatment approach.

This paper discusses the surgical management of patients with large vestibular schwannomas operated in our department and emphasizes the use of intraoperative monitoring for preserving facial nerve function. We review the key surgical steps and highlight the importance of preoperative planning, patient position, and the use of microsurgical techniques to optimize the surgical outcome.

Gross total resection of large vestibular schwannomas is associated with worse facial nerve outcomes. Our preferred treatment strategy, especially for older patients, is planned subtotal resection followed by periodic imaging evaluation and radiotherapy in cases of documented tumor growth. This approach may lead to superior facial nerve preservation and improved quality of life for individuals with large vestibular schwannomas.

Conclusion
The optimal treatment approach for vestibular schwannoma remains a subject of debate. Gross total resection has traditionally been the gold standard for large tumors, but this is often accompanied by a higher risk of postoperative facial nerve dysfunction. Planned subtotal resection with the goal of preserving facial nerve function, followed by closed observation is an alternative approach.
INTRACRANIAL ANEURYSMS IN CHILDREN - A NEW PERSPECTIVE
Authors: Ciurea Alexandru Vlad , Ples H. , Dobrin Nicolaie , Popa Andrei Adrian , Bratu Bogdan-Gabriel , Corlatescu Antonio-Daniel 
Published: November 2024

Introduction
Intracranial aneurysms in children are very rare pathologic entities. (1200 cases presented in literature from 1939-2011).

Material and Methods
The authors present 51 cases of children (aged: 0-16) operated between January 1999 and December 2023 - 24 years in three neurosurgical centers: “Bagdasar Arseni” Emergency University Hospital (Bucharest), Sanador Clinical Hospital (Bucharest) and Timis County Emergency Hospital (Timisoara). We collected data from many children’s intracranial aneurysms cases because “Bagdasar-Arseni” Emergency University Hospital has the most important pediatric neurosurgical unit in the country.

Regarding our series, pediatric aneurysms represent 6.14% (51 cases) of all operated intracranial aneurysms (765 cases). The mean age of the patients was 14.3 years. There were 29 boys (58.7%) and 22 girls (41.2%). The clinical features are dominated by headache (48 cases - 95.7%), neck stiffness (45 cases - 91.4%), vomiting (44 cases - 89.3%), focal neurological deficit (24 cases - 44.6%), an altered level of consciousness (17 cases - 36.1%), seizures (24 cases - 44.6%, fever (20 cases - 34%). The majority of patients were Hunt & Hess Il at admittance (27 cases, 53%). All neuroimagistic investigations were done in the first 48 hours (CT, DSA, MRI). Locations: anterior communicating artery aneurysms (20 cases, 36.1%), followed by middle cerebral artery aneurysms (15 cases, 25.5%) and internal carotid artery bifurcation aneurysms (9 cases, 19.1%) and so on. Many aneurysms were large and giant (18 cases - 31.9%). Microsurgery approach was performed in 48 cases (99.7%) and 3 case (4.4%) were endovascular approached. This represents a new vision because the actual endovascular way is extremely efficient and performant in occluding pediatric intracranial aneurysms.

The Glasgow Outcome Scale (GOS) at six months postop. showed GR in 40 cases (78.5%), MD in 9 cases (17.2%), SD in 1 patient (2.1%) and (preoperative) death in 1 patient (2.1%).

Conclusions
Intracranial aneurysms in children are a very rare pathologic entity. Early microsurgical or endovascular approach is mandatory and has excellent results (good recovery).
MULTUM IN PARVO-THE GLASGOW COMA SCALE
Authors: Ciurea Alexandru Vlad , Saceleanu Vicentiu , Gramescu Ovidiu , Bentia Dan , Serban Matei 
Published: November 2024

Introduction
Coma assessment scales have been developed to facilitate ease of communication between emergency team members and to facilitate ease of clinical assessment for patients with severe impairment of consciousness.

In 1974 Graham Teasdale and Bryan Jennett published in the Lancet a scale which theoretically helped physicians get a quick and accurate status of comatose patients. The scale they described assessed patient behaviour regarding three key aspects – motor reactivity, verbal communication and eye opening. As the two authors were working in Glasgow, the scale was dubbed the Glasgow Coma Scale (GCS) a name which all neurologists and neurosurgeons are well-accustomed with.

Material
The use of the GCS is based on the patient’s capacity to react using language and motion to external stimuli. Eye movement (1-4 points), Speech (1-5 points) and Motion (1-6 points) for a maximum total of 15 points or a minimum total of 3 points. A patient with a Glasgow Coma Score of 3 is completely non-reactive, while a patient with a Glasgow Coma Score of 15 is perfectly aware.

This scale introduced in neurotrauma has simplified enormously the communication in neurosurgery, accompanying neurotrauma to the whole spectrum of neurosurgical pathology.

Despite its wide use today, the GCS has been seriously criticised due to its incapacity to determine the functional status of brainstem structures. Therefore, various improvements and updates were performed for the Glasgow Coma Scale.

Conclusions
Over the years, the use of the GCS extended in the entire medical meme despite its criticism. The simplicity and ease of use which characterize the GCS made it a very useful instrument for neurological examination since the first moment a patient is seen by a medical professional.

The Glasgow Coma Scale which recently reached its 50th birthday became a universal language for physicians. Since it has been in use neurological status can be expressed with great ease and without loss of meaning.
RETROSPECTIVE ANALYSIS OF GLIOBLASTOMA OUTCOMES
Authors: Ciurea Alexandru Vlad , Onciul Razvan , Covache-Busuioc Razvan-Adrian , Glavan Luca-Andrei , Toader Corneliu 
Published: November 2024

Background
Glioblastoma (GBM) is one of the most aggressive brain cancers, with a median overall survival (OS) of about 15 months. This retrospective study focuses on 144 GBM cases treated over 12 years in our clinic in Romania, analyzing factors affecting progression-free survival (PFS) and OS, including genetic markers and treatment modalities.

Methods
This study involved patients treated between 2012 and 2024 at the National Institute of Neurology and Neurovascular Diseases in Bucharest. The cohort included 144 patients, with variables such as age, gender, tumor location, IDH mutation status, Karnofsky Performance Status (KPS), and genetic markers (MGMT methylation and EGFR amplification) analyzed. Survival outcomes were evaluated using Kaplan-Meier curves and log-rank tests.

Results
- Patient Demographics: The cohort included 64 males (44.4%) and 80 females (55.6%) with a mean age of 60.7 years.
- Tumor Characteristics: The most common tumor location was the frontal lobe (31.9%), followed by multilobular GBM (26.3%). Right-side tumors were more prevalent (51.3%).
- Genetic Markers: MGMT promoter was methylated in 46 patients (31.9%), and EGFR was amplified in 76 patients (52.7%).
- Treatment Modalities: 105 patients (72.9%) received chemotherapy with temozolomide (TMZ), and 116 patients (80.5%) underwent radiotherapy.
- Survival Outcomes: Median PFS was 5 months, and median OS was 8.5 months. Kaplan-Meier survival curves indicated significantly increased OS in patients with MGMT methylation undergoing chemotherapy (p<0.005) and radiotherapy (p<0.005). Similarly, OS was significantly higher in patients without EGFR amplification receiving chemotherapy (p<0.005) and radiotherapy (p<0.005).

Conclusion
The study emphasizes the importance of MGMT methylation and EGFR amplification in predicting survival outcomes in GBM patients. Immediate postoperative adjuvant therapy significantly improves PFS and OS. The findings underscore the need for coordinated care and timely access to adjuvant therapies to enhance survival rates in GBM patients. Second surgical interventions also showed a survival benefit, highlighting their potential role as salvage therapy in recurrent GBM cases.
INTRACRANIAL ARTERIAL LOOP WITH A COMPLEX PARTIALLY THROMBOSED LARGE ANEURYSM ON THE POSTERIOR CIRCULATION: WHAT TO DO NEXT?
Authors: Domahidi Julia-Melinda , Cosma George-Mihai , Chis Rafael-Florin , Florian Ioan Stefan 
Published: November 2024

Introduction
Managing intracranial aneurysms in the posterior circulation is particularly challenging due to anatomical complexities and the high risk of rupture. The presence of a large, partially thrombosed aneurysm adds another layer of difficulty. This report details the case of a 66-year-old female patient presenting with a symptomatic intracranial arterial loop and a large, partially thrombosed aneurysm in the posterior circulation, successfully treated through microsurgical clipping.

Material and Methods
A 66-year-old female with a history of intermittent headaches, vertigo, and diplopia underwent neuroimaging, including computed tomography angiography (CTA) and magnetic resonance imaging (MRI). Imaging revealed a large aneurysm in the posterior circulation, with partial thrombosis and an associated intracranial arterial loop. The patient was scheduled for a craniotomy to perform microsurgical clipping of the aneurysm. Two titanium aneurysm clips were applied to achieve complete occlusion.

Results
Intraoperative findings confirmed the large, partially thrombosed aneurysm arising from the basilar artery, with a complex arterial loop intricately intertwined with the aneurysm and adjacent neurovascular structures. The first clip was placed to secure the primary inflow, and the second clip provided additional reinforcement. Postoperative imaging demonstrated successful clipping with no residual aneurysm filling. The patient had an uneventful recovery with no immediate postoperative complications. Clinically, the patient reported significant improvement in symptoms, with a complete resolution of headaches and vertigo.

Conclusions
This case highlights the challenges and considerations in managing large, partially thrombosed aneurysms in the posterior circulation, particularly in the presence of an intracranial arterial loop. Successful management requires precise microsurgical technique and careful intraoperative decision-making. Further research is needed to optimize treatment strategies, potentially incorporating adjunctive endovascular techniques to enhance surgical outcomes.
CHALLENGES IN BRAIN METASTASES DIAGNOSIS AND TREATMENT
Authors: Florea Alina , Iftimie Dragoș , Moisescu Cristiana , Papacocea Toma 
Published: November 2024

Although brain metastases are the most frequent type of intracranial tumors, their diagnosis and treatment is still challenging. They have poor prognosis and life expectancy is short, as brain metastases appear in advanced stage cancers.

In U.S., the rate of recently discovered cancer that will evolve with brain metastases is considered to be 6-14%. Left untreated, brain metastases become lethal in less than 2 months. The most common primary cancers that develop brain metastases are lung, breast, melanoma and colorectal.

In our department, approximately 60 patients with brain tumors were diagnosed after surgery with brain metastases in the last 10 years. The most common cancer to metastasize by far was lung cancer, with a mean age at diagnosis 60 years old, affecting mostly smoking men. The majority of patients presented with multiple metastases, unaware of the primary disease and without conducting any oncological treatment prior to admission in our departement.

We observed that COVID-19 pandemic period highly affected patients with cancer. The number of patients with brain metastases operated on in our department has drastically decreased in that period. There were a lot of reasons why cancer patients among which being the imposibility to reach emergency rooms without having COVID-19 symptoms and difficulty of reaching radiology centers for early imaging.

Most of the patients presented in the Emergency Department with multiple brain metastases, comatose or with focal neurological deficits installed long before presentation, regardless of their primary cancer, thus making neurosurgery an impractical option for most of these cases.

Although there have been significant advances in systemic oncological treatment and radiotherapy, surgery remains an essential method of managing brain metastases, even in cases presenting with multiple lesions. Careful patient selection is essential in obtaining the best outcome.
ADVANCING PRECISION
Authors: Ivanov Marcel 
Published: November 2024

Augmented reality (AR) technology is revolutionizing spine surgery, offering unprecedented intraoperative image guidance and enhancing patient safety, particularly in complex procedures. This presentation explores the expanding applications of AR in spinal surgery, highlighting recent technological advances that have transformed surgical practices. In addition to improving surgical precision and accuracy, AR provides real-time visualization of critical anatomical structures, aiding in navigation and decision-making during intricate spinal procedures.

This presentation will delve into the benefits that AR brings compared to classical techniques, including enhanced visualization, improved spatial awareness, and reduced radiation exposure for both patients and surgical teams. By overlaying virtual information onto the surgeon’s view of the patient, AR facilitates a more intuitive understanding of complex spinal anatomy and pathology, leading to optimized surgical outcomes.

Furthermore, this session will cover the diverse applications of AR in a range of spinal conditions operated in Royal Hallamshire Hospital, Sheffield, UK - including spinal tumors, calcified disc herniation, spinal CSF-venous fistula etc.

By showcasing the benefits of AR technology across various pathologies, this presentation aims to underscore its transformative potential in advancing spinal surgical care.
UNVEILING THE VEIN
Authors: Ivanov Marcel , Romanowski Charles , Martin Andrew , Blackburn Daniel 
Published: November 2024

Cerebrospinal fluid (CSF)-venous fistula represents a formidable yet often overlooked neurosurgical dilemma. Despite its disabling consequences, it remains significantly underdiagnosed.

This abstract sheds light on the clinical intricacies, diagnostic challenges, and therapeutic interventions associated with CSF-venous fistula. Early diagnosis is paramount, yet hindered by its rarity and diverse and often unspecific clinical presentations. The importance of heightened awareness among clinicians and radiologists for timely detection and management cannot be overstated.

This presentation will draw upon a review of clinical cases operated in the Royal Hallamshire Hospital, supplemented by a concise surgical video which is focused on surgical technique and benefit of microscope mediated augmented reality.
NEW TECHNOLOGIES AVAILABLE FOR MICRONEUROSURGICAL REMOVAL OF ACOUSTIC NEUROMAS
Authors: Mastronardi Luciano 
Published: November 2024

Introduction
The aim of this study was to analyze the results of microsurgery removal of acoustic neuromas (AN) using new technologies: flexible hand-held laser fiber, Sonopet Ultrasound Aspirator, Facial Nerve “detector” monopolar stimulation (for localize position and course of facial nerve), BAER’s with level specific (LS) CE-Chirp stimulus for hearing preservation, endoscope for IAC final check, and injectable bone substitute for closure. We report a retrospective nonrandomized clinical study on 300 cases consecutively operated on.

Material and Methods
From July, 2010 to December, 2023, 350 consecutive patients suffering from AN have been operated on with microneurosurgical technique by key-hole retrosigmoid approach. In majority of cases tumor resection was performed with the aid of a handheld flexible laser fiber. In the same period, Sonopet Ultrasound aspirator was used for tumor debulking and/or opening of the internal auditory meatus and canal. From May 2015, hearing preservation by means LS CE-Chirp BAER was attempted in patients with preoperative socially useful hearing (AAO-HNS class A and B). In addition, we check the removal of tumor inside the internal auditory canal (IAC) by using the flexible and/or rigid endoscope, for completing tumor removal near the fundus.

Results
Overall time from incision to skin suture changed in relation to size of tumor (from 165 to 575 minutes) and was not affected by the use of hand-held laser. Facial nerve function was clinically assessed with the House-Brackmann (HB) scale preoperatively, in the early postoperative period (after 1 week), and at 6-month follow-up. In 3 cases a preoperative facial nerve palsy was observed (HB III and HB IV, respectively). In the remaining cases, 6 months after surgery facial nerve preservation rate (HB I) was 92%, Hearing preservation rate (AAO-HNS A and B, pre- and postoperatively) was 52% in eligible cases. Total and “nearly total” removal of tumor was possible in about 80% of cases. Dura closure was performed with underlaying autologous pericranium. Injectable bone substitute in the gaps after bone flap repositioning minimized postoperative CSF leakage and improved the aesthetic result.

Conclusions
The use of new technologies (handheld flexible laser fibers, Sonopet Ultrasound Aspirator, fluoreceine, Nimbus facial nerve continuous monitoring, LS CE-Chirp BAER, endoscope for IAC final check) in AN microsurgery seems to be safe and efficacious and facilitates tumor resection, especially in ‘‘difficult’’ conditions (e.g., large size, highly vascularized, or hard tumors). The good functional outcome following conventional microsurgery seems to be further improved and the extent of tumor removal could be increased with the proper use of the new technologies available in the neurosurgical armamentarium.