bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Surgical Outcome for Acute Traumatic Brain Injury in Older Adults
Authors: Hazare Pooja , Shukla Dhaval , Bhat Dhananjaya , Devi Bhagavatula Indira , Jayan Mini , Konar Subhas , Ratna Nikhil , Pateriya Vibhor , Patel Kautilya , Thombre Bhushan 
Published: August 2023

Background:
Increasing patient age is strongly associated with a rising incidence of traumatic brain injury (TBI) and a higher mortality and morbidity rates.

Objective:
This study aimed to identify the predictors of mortality after craniotomy for TBI in elderly patients.

Material and Methods:
Data of all patients aged ≥65 years who underwent craniotomy for acute TBI, over a period from January 2015 to October 2019, were retrospectively reviewed. The standard clinical and imaging variables for TBI were recorded. The medical comorbidities, indication for surgery, and intraoperative complications were also recorded. The outcome of interest was survival at 6 months after surgery.

Results and Conclusions:
A total of 206 patients were available for analysis. The age of patients ranged from 65 to 80 years. The most frequent surgical procedure performed was craniotomy and evacuation of supratentorial subdural hematoma with or without evacuation of the traumatic parenchymal lesion. The in-hospital mortality was 46 out of 206 (22.3%), and 6 months mortality was 116 out of 206 (56.3%). Among the survivors at 6 months, good recovery was seen in 70.5%, moderate disability in 19.8%, and severe disability in 8.6% patients. Only 1.2% patients survived in a vegetative state at 6 months. The odds of death are nearly three times more for patients with dilated and nonreactive pupillary reaction. The odds of death are less by 72% for a unit increase in motor score. In older adults, the main determinants of survival after surgery for TBI are pupillary reaction and motor score.
Multi-domain Cognitive Testing
Authors: Kumar Gurja John Preetham , Muthukrishnan Suriya Prakash , Tripathi Manjari , Mehta Nalin , Sharma Ratna 
Published: August 2023

Context:Cognition is impaired in Alzheimer's disease (AD) and patients with mild cognitive impairment (MCI) with varying levels of magnitude.Aim:The present study aimed to identify a biomarker for classifying MCI and AD using multi-domain cognitive testing.Settings and Design:This was a cross-sectional study.Methods and Materials:26 AD patients, 28 MCI patients and 25 controls were recruited. Cognitive assessment of different domains was done using standard questionnaires and cognitive function tests.Statistical Analysis Used:Cognitive task scores were compared between the groups using multivariate analysis of variance (MANOVA).Results:Patients with AD had significantly lower MMSE, CDR, cognitive task scores compared to controls and MCI. Cognitive scores of all tasks for MCI were significantly less than controls, except MMSE and digits forward score. ROC analysis showed that picture memory had 100% sensitivity, 91.6% specificity for AD and 88.4% sensitivity, 92.5% specificity for MCI. Word memory had 92.3% specificity, 100% specificity for AD and 80.7% specificity, 84.6% specificity for MCI.Conclusions:The global cognitive tools are less specific in bringing out the differences especially between MCI and control. Limitation of MMSE, heterogeneity of MCI and differential impairment of various domains of cognition, demands the inclusion of multi-domain cognitive evaluation especially picture and word memory tasks with high sensitivity and specificity into the existing diagnostic protocol. ROC results also suggested the continuum of cognitive impairment and MCI as a transitional stage leaving more scope on the quantum of research required for intervention to halt the structural and functional decline.
Delayed Vasospasm in Endoscopic Transsphenoidal Pituitary Surgery
Authors: S Birua Gyani J , Tyagi Gaurav , Beniwal Manish , L Rao Narasinga K V , Saini Jitender , Dwarakanath Srinivas 
Published: August 2023

Background:
Cerebral vasospasm (CVS) due to injuries to arteries of the circle of willies has been reported in transsphenoidal pituitary surgeries. However, the incidence of delayed vasospasm following endoscopic transsphenoidal surgery is rare.

Materials and Methods:
Total 569 pituitary adenomas were operated on by endoscopic transsphenoidal approach from January 2016 to February 2020. We retrospectively described two cases of vasospasm following pituitary surgery from our institution.

Objective:
To describe two cases of delayed cerebral vasospasm following endoscopic transsphenoidal surgery and review previous literature.

Results:
Out of two patients, the Glasgow outcome score (GOS) of one patient was favorable and the other was unfavorable.

Conclusion:
CVS is rare after transsphenoidal pituitary surgery, which makes its predictability difficult. The clinician should maintain a high index of suspicion in patients with suprasellar extension of the tumor and postoperative hematoma in the tumor bed. Similarly, care should be taken in patients with a subarachnoid hemorrhage in basal cistern, intraoperative arachnoid breach, and postoperative meningitis.
Surgical Outcome Analysis of Large and Giant Petroclival Meningiomas with Special Reference to Quality of Life Issues
Authors: Batish Aman , Gupta Sunil K , Mohanty Manju , Tripathi Manjul , Salunke Pravin , Aggarwal Ashish 
Published: August 2023

Background:
Management strategies for petroclival menigiomas remain controversial

Objectives:
We share our experience in management of large and giant true petroclival meniongiomas with special emphasis on patient reported quality of life parameters.

Methods:
This is a single center study of 47 patients between 2008 and 2018. All patients were checked for tumor specific parameters, clinical parameters, extent of surgical excision, and outcome, as assessed by Karnofsky performance score (KPS), Glasgow outcome score, clinical status, and by SF-36 questionnaire.

Results:
32/47 patients' data were assessed. Symptoms included headache (62.5%), involvement of 5th nerve (47%), facial nerve (40.6%), lower cranial nerves (37.5%), cerebellar signs (84%), and long tract signs in (50%) of patients. The mean preoperative KPS was 83.75+/−6.59. Surgical approaches included retromastoid suboccipital craniotomy (50%), Kawase's approach (31.25%), and others in 18.25% patients. 40.625% (n = 13) had a gross total excision, near total resection (NTR) was achieved in 53.125% (n = 17), and 6.25% (n = 2) had a subtotal excision (STE). In 13 patients who had gross total resection (GTR), there were 12 (70.5%) new neurological deficits, while among the 19 patients with NTR, only 5 (29.5%) new neurological deficits were seen. No new onset neurological deficit was seen in patients with STE of tumor. Patient assessed QoL parameters were worse in patients with GTR and best in patients with NTR/STE + GKRS.

Conclusion:
In patients of large/giant petroclival meningiomas, NTE/STE with adjuvant GKRS provided better preservation of quality of life.
Barriers to Thrombolysis at A Tertiary Care Public Hospital- A Prospective Observational Study from Southern Part of India
Authors: Kulkarni Girish Baburao , Mahajan Niranjan Prakash , Aravinda HR 
Published: August 2023

Background:
Intravenous thrombolysis (IVT) is an effective treatment for carefully selected acute ischemic stroke (AIS) patients. However, very few eligible candidates access it in time around the world, including India, due to multiple barriers.

Objective:
We explored the barriers to IVT in patients of AIS presenting within a 4.5-h window period in our hospital.

Materials and Methods:
This was a prospective study of AIS patients presenting in <4.5 h of symptom-onset, aged >18 years at the Neuro-casualty, Department of Neurology, from May 2016 to November 2017. Assessment of barriers to intravenous thrombolysis was done, and an attempt to delineate the reasons for the pre-hospital and the in-hospital delay was made.

Results:
A total of 103 (M:F: 67:36) patients aged between 18 and 80 years, were recruited, with 28 (27.2%) patients aged <45 years. Among them, 29 (28.2%) were thrombolysed. The major reasons for the pre-hospital delay were ignorance about the need for stroke center consultation- 94 (90.3%), consultation elsewhere before the presentation- 84 (81.5%), and non-availability of an ambulance at referring hospitals- 50 (59.52% out of 84). Sixty-four patients (62.1%) could not name any symptoms of stroke, 84 (83.5%) could not name any risk factor, and only 4 (3.9%) were aware of IVT. Key in-hospital barriers were crowded emergency- 80 (77.7%), financial constraints- 79 (76.7%), and delay in CT scan- 62 (61.4%). Delay in arriving at a consensus for IVT by the patient/relative and the treating neurologist, was noted in 24 (43.6%) of the 55 eligible.

Conclusion:
Many eligible patients remain deprived of thrombolysis due to lack of awareness, financial constraints, and organizational elements, which should be addressed to improve IVT rates.
Specifics of Relationship within a Complex of Neurological Deficit, Quality of Life and Depression in the Phenotypic Spectrum of Multiple Sclerosis
Authors: Sahakyan Anahit Y , Mavelyan Hovannes M 
Published: August 2023

Background:
The mechanisms, leading to depression development in multiple sclerosis (MS) include progressive demyelination and axonal degeneration along with neurological deficit and a certain similarity of mechanisms leading to the development of immunological disorders and neuroinflammation involved in the pathogenesis of MS and depression.

Objective:
The objective of the study was to examine the specifics of relationships within a complex of neurological deficit, depression, and quality of life in MS.

Materials and Methods:
For purposes of integral quantification of neurologic disability in various functional systems, the “Expanded Disability Status Scale” (EDSS) is used. The severity of depression was measured using the Beck Depression Inventory (BDI). The level of quality of life was measured through the MS Quality of Life (MSQOL)-54 Instrument and Physical Health Composite Score MSQOL-54. The study was conducted among patients with relapsing-remitting (RRMS (n = 52) and secondary-progressive (SPMS, n = 51) phenotypes of MS.

Results:
The study shows a positive correlation of depression with various indicators of the physical and mental components of the QOL of patients per course and progression of MS phenotypes. It was revealed that in SPMS patients' correlation is significant compared to patients with RRMS. It's proven that the risk of developing depression in patients with RRMS and SPMS depends on the level of neurological deficit.

Conclusions:
The infrastructure of the target parameters study evidenced that regardless of the type of MS course, depression was found to have a stable connection with neurological impairment (per EDSS scale), especially in the secondary-progressive course of MS (SPMS).
Trigeminal Neuralgia Secondary to Meckel's Cave Meningoencephaloceles
Authors: Martínez Jaime L , Domingo Ricardo A , Rowland Nathan C , Vandergrift William A 
Published: August 2023

Background:
The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN. Their management and surgical outcomes remain poorly understood.

Objectives:
To perform a systematic review of clinical presentation and surgical outcomes of middle fossa defects presenting with trigeminal nerve-related symptoms.

Materials and Methods:
A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management, and outcomes are discussed and illustrated with a case.

Results:
Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. “Empty sella” syndrome and radiologic signs of intracranial hypertension were present in 40%–62%. No patient presented with cerebrospinal fluid leak. The preferred treatment modality was surgical with subtemporal extradural repairs using combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases, and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.

Conclusions:
MEC containing prolapsed trigeminal nerve rootlets can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective, and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
A Comprehensive Stemness Gene Expression Analysis Signifies the Role of ABC Transporters and Molecular Chaperons in Determining the Fate of Human Neural Precursor Cells
Authors: Vishwakarma Sandeep Kumar , Bardia Avinash , B Fathima Syeda Sumaiya , Basha Paspala Syed Ameer , Khan Aleem Ahmed 
Published: August 2023

Background and Aim:
The major aim of this study was to identify the most common stemness genes across different stem cell types and further validate them in human fetal subventricular zone-derived primary and cultured neural precursor cells (NPCs). This study involved the use of a unique method of stemness meta-analysis (SMA) for investigating comprehensive upregulation and downregulation of differentially expressed genes (DEGs) among different stem cell populations.

Materials and Methods:
A total of 55 mouse and human data sets targeting crucial genes identified in seven different types of stem cells population were screened and subjected to independent DEGs analysis using SMA. Identified 30 meta-gene signatures were subjected to functional enrichment analysis based on their biological processes and molecular functions. Validation of enriched meta-gene signatures was performed using RT-qPCR. Cellular localization of ABCB1 and ABCG2 was identified using immunofluorescence staining, whereas functional assessment was performed using western-blot.

Results:
SMA analysis revealed that among 52 commonly expressed genes, 30 genes were either upregulated or downregulated in at least two stem cell populations. Further gene enrichment analysis showed nine genes (ABCB1, ABCG2, HSPA4, HSPA9, HSPA14, Nestin, Sox-2, Oct-4, and Notch-2) with the highest combined scores among 30 meta-gene signatures. RT-qPCR demonstrated that all the enriched gene signatures were significantly upregulated in primary NPCs and further downregulated during NPCs lineage differentiation in culture except HSPA4, HSPA9, and HSPA14 gene transcripts.

Conclusions:
The stemness meta-gene signatures were abundantly expressed in human NPCs population which categorically suggest the involvement of these genes/pathways in pluripotency maintenance and molecular switches for lineage differentiation while HSP-70 had a neuroprotective effect.
Quality of Communication Life (QoCL) In Persons with Expressive Aphasia With And Without Communication Intervention – A Comparative Study
Authors: Preetha Udayakumar Madhu , Perumal Radhakrishnan Chella 
Published: August 2023

Background:
Communication difficulties in aphasia can result in social isolation, challenges with interpersonal relationships, emotional changes, inability to return to work, and lack of independence. Therefore, intervention is essential particularly in the context of functional communication for persons with aphasia (PwAs). Studies have also indicated that quality of communication life (QoCL) is a valid measure of the impact of communication difficulty on quality of life.

Objective:
To estimate the relationship between communication intervention and QoCL in individuals with expressive aphasia.

Methods and Material:
Twenty PwAs were divided into two groups: group I individuals had undergone at least 3 months of speech and language intervention whereas group II individuals did not have any formal communication intervention. Tamil version of the QoCL scale was administered for all participants. Statistical analysis was carried out using Mann–Whitney U test and Spearman's rho correlation coefficient.

Results:
Individuals with speech and language intervention in group I had higher scores in overall QoCL domains as well as in overall QoL when compared to group II. The results of correlation analysis indicated that individuals with greater therapy duration had significantly high scores.

Conclusions:
The results prove that communication intervention is necessary for PwAs to improve QoCL and can be used to raise awareness of its importance. The findings can also guide treatment planning, counseling the PwA, and caregivers. It also indicates the importance of using patient-related outcome measures during the intervention process.
Risk Factors for and Outcomes of Postoperative Entrapped Temporal Horn in Trigone Meningiomas
Authors: Liu Shuang , Liu Xueyou , Wang Meng , Wang Zhengfeng 
Published: August 2023

Background:
Meningioma in the ventricle triangle area is a benign tumor that can be cured by surgery, but postoperative entrapped temporal horn may seriously affect the patient's quality of life and even require a second operation. Currently, there are few reports on this complication.

Objective:
The risk factors and prognosis of postoperative ETH in trigone meningiomas were investigated.

Material and Methods:
A retrospective analysis of the clinical data of 87 patients with trigone meningioma from 2010 to 2018 was performed, and univariate and multivariate analyses were used to assess the risk factors associated with postoperative ETH. The degree of ETH was evaluated using the modified ventriculocranial ratio.

Results:
The incidence of postoperative ETH in trigone meningioma was 29.9% (26/87). Preoperative ETH [odds ratio (OR): 4.826, 95% confidence interval (CI): 1.820–12.796, P = 0.002] and postoperative meningitis (OR: 12.811, 95%CI: 1.615–101.605, P = 0.016) are independent risk factors for postoperative ETH. Of the 18 patients with ETH syndrome, 12 improved after medical treatment, and finally, a total of 6 patients received ETH surgery. The mean duration from tumor resection to the appearance of ETH syndrome was 3.1 ± 1.9 months (range: 9 days–7 months). Patients with ETH grade II and III are more prone to clinical symptoms.

Conclusions
: The incidence of postoperative ETH for trigone meningiomas is high, and clinical symptoms generally appear delayed after surgery. Reducing postoperative infections can reduce the occurrence of postoperative ETH. Patients with symptoms of ETH who have failed medical treatment have clear indications for surgery.
Factors Associated with Outcomes in Patients with Chronic Subdural Hematoma who Underwent 'Burr Hole Craniotomy'
Authors: Allahdini Faramarz , Rahmani Khaled , Afkhamzadeh Abdorrahim 
Published: August 2023

Background and Objective:
Chronic subdural hematomas (CSDH) is frequently encountered in neurosurgical practice. The aim of this study was to investigate the factors associated with the outcome of Burr Hole Craniotomy.

Methods:
This study was conducted on 116 patients with CSDH in Be'sat Hospital, an educational hospital, in Kurdistan province, Iran. We used Glasgow outcome scale (GOS) at times of discharge and 1 month after stitch removal as favorable outcome. Student t-test or corresponding nonparametric test (Mann–Whitney U test) and logistic regression were used to assess the relationship between investigated variables and favorable outcome.

Results
: The results indicated that the chance of success after surgery in patients with CSDH was different based on several variables. The chance of cure after surgery among CSDH male patients (OR = 12.5), patients who have no atrophy (OR = 25.0), patients with no cardiovascular diseases (OR = 7.14), patients who had no medical complications after surgery (OR = 2.08), and patients with higher GCS score at the time of hospitalization (OR = 1.31) was higher.

Conclusions:
Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.

s:
Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.
Telomerase Reverse Transcriptase Promoter Mutations in A Cohort Of Adult Gliomas – Clinicopathological Correlates
Authors: Balakumar Shailaja , Pai Rekha , Chacko Ari G , Patel Bimal , Nancy Rachel , Balakrishnan Rajesh , Sarkar Sauradeep , Sampath Gowri , Chacko Geeta 
Published: August 2023

Background:
Introduction: Gliomas were previously classified histologically, although now the latest WHO classification incorporates several molecular markers to classify these. Detection of TERT promoter mutations is assuming increased importance due to its relevance to prognostication.

Objective
: The aim of this study was to determine the frequency of TERT promoter mutations, association of TERT promoter mutations with other molecular alterations and to assess the role of TERT promoter mutations in overall survival and progression-free survival in relation to histological and molecular glioma subtypes.

Materials and Methods:
This study analyzed a cohort of 107 adult patients with diffuse gliomas, WHO grades II and III and glioblastoma, by immunohistochemistry for IDH and ATRX mutations, FISH for 1p/19q co-deletions and PCR sequencing for TERT promoter mutation. Further, five glioma molecular sub-groups were derived using three molecular alteration and included the sub-groups with: i) IDH mutations only, ii) IDH and TERT mutations only, iii) IDH and 1p/19q co-deletion only, iv) Triple negative, and v) Triple positive.

Results:
IDH mutations and 1p/19q co-deletions were individually and significantly associated with an improved progression free (P = 0.001 and P = 0.002, respectively) and overall survival (P = 0.000 and P = 0.005, respectively) in the present cohort of gliomas. TERT promoter mutations occurred frequently in anaplastic oligodendrogliomas (94%), oligodendrogliomas (87.5%) and glioblastomas (54%). Sub-division into molecular sub-groups showed that the triple-positive tumors carried the best prognosis, followed by IDH only, triple negative and finally the TERT mutation only tumors (P < 0.000).

Conclusion
: This indicates that sub-classification using these molecular markers separates tumors into prognostically relevant categories.