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Simple Summary The most frequent intracranial neoplasm is meningioma. About 30% of these are represented by skull base meningiomas (SBMs). Patients with SBMs can be treated with a multimodal approach based on surgery, medical treatment and radiation-based therapy; however, the gold standard treatment for the majority of symptomatic meningiomas is still surgery. Surgical intervention is performed with the goal of maximum safe resection. This, however, poses technical challenges because of the proximity of these tumors with deep critical neurovascular structures, tumoral texture and consistency. A multimodal treatment, in combination with stereotactic radiosurgery and radiation therapy, is thus of utmost importance to achieve a satisfactory functional outcome and tumor control. The aim of this review was based on the identification of optimal multidisciplinary management of patients with SBMs. The investigation includes the relevant biological and clinical characteristics, the novel therapeutic approaches, highlighting the importance of a specialized multidisciplinary team, which is mandatory for SBM management. Abstract The surgical management of Skull Base Meningiomas (SBMs) has radically changed over the last two decades. Extensive surgery for patients with SBMs represents the mainstream treatment; however, it is often challenging due to narrow surgical corridors and proximity to critical neurovascular structures. Novel surgical technologies, including three-dimensional (3D) preoperative imaging, neuromonitoring, and surgical instruments, have gradually facilitated the surgical resectability of SBMs, reducing postoperative morbidity. Total removal is not always feasible considering a risky tumor location and invasion of surrounding structures and brain parenchyma. In recent years, the use of primary or adjuvant stereotactic radiosurgery (SRS) has progressively increased due to its safety and efficacy in the control of grade I and II meningiomas, especially for small to moderate size lesions. Patients with WHO grade SBMs receiving subtotal surgery can be monitored over time with surveillance imaging. Postoperative management remains highly controversial for grade II meningiomas, and depends on the presence of residual disease, with optional upfront adjuvant radiation therapy or close surveillance imaging in cases with total resection. Adjuvant radiation is strongly recommended in patients with grade III tumors. Although the currently available chemotherapy or targeted therapies available have a low efficacy, the molecular profiling of SBMs has shown genetic alterations that could be potentially targeted with novel tailored treatments. This multidisciplinary review provides an update on the advances in surgical technology, postoperative management and molecular profile of SBMs.

In this work, we train the first monolingual Lithuanian transformer model on a relatively large corpus of Lithuanian news articles and compare various output decoding algorithms for abstractive news summarization. We achieve an average ROUGE-2 score 0.163, generated summaries are coherent and look impressive at first glance. However, some of them contain misleading information that is not so easy to spot. We describe all the technical details and share our trained model and accompanying code in an online open-source repository, as well as some characteristic samples of the generated summaries., Accepted in ICIST 2021

Gliomas are the most common primary neoplasm of the central nervous system. A promising frontier in the definition of glioma prognosis and treatment is represented by epigenetics. Furthermore, in this study, we developed a machine learning classification model based on epigenetic data (CpG probes) to separate patients according to their state of immunosuppression. We considered 573 cases of low-grade glioma (LGG) and glioblastoma (GBM) from The Cancer Genome Atlas (TCGA). First, from gene expression data, we derived a novel binary indicator to flag patients with a favorable immune state. Then, based on previous studies, we selected the genes related to the immune state of tumor microenvironment. After, we improved the selection with a data-driven procedure, based on Boruta. Finally, we tuned, trained, and evaluated both random forest and neural network classifiers on the resulting dataset. We found that a multi-layer perceptron network fed by the 338 probes selected by applying both expert choice and Boruta results in the best performance, achieving an out-of-sample accuracy of 82.8%, a Matthews correlation coefficient of 0.657, and an area under the ROC curve of 0.9. Based on the proposed model, we provided a method to stratify glioma patients according to their epigenomic state.

For patients undergoing brain surgery, once primary motor and sensory areas are identified by direct electrical stimulation, resection can be performed in the precentral and postsomatosensory areas while monitoring cognition. For this purpose, we developed a real-time neuropsychological testing (RTNT) protocol tapping sensorimotor cognition.We retrospectively reviewed a consecutive series of 57 adult patients with tumors in the precentral and postsomatosensory areas who performed the RTNT sequence. The testing protocol used continuously throughout resection for excisions comprised action verbs, mental rotation of body parts, action imagery, action semantics, ideomotor praxis, and short-term memory.The patients' median performance on RTNT tests was significantly lower for mental rotation and action imagery (χThe sensory-motor RTNT is performed to assist surgery in the precentral and postsomatosensory areas.

This paper proposes a novel version of the Hunger Games Search (HGS) Algorithm for solving the feature selection problems. The proposed method (mHGS) enhances the original Hunger Games Search performance by the local escaping operator (LEO). This operator encourages the original method to avoid the weaknesses of trapping in local search, premature conveyance, and equilibrium between the search strategies. To validate the performance of the proposed mHGS method, a set of comment benchmark feature selection problems are used, which are twenty datasets consists several variant sizes of high, medium, and small dimensional. Moreover, a real-world application of the Parkinson's disease phonation problem is also used to prove the proposed method's ability to solve the real application. The obtained results by the proposed mHGS method are analyzed in terms of Accuracy, Fitness Function, number of selected features, Precision, Recall, and F-score, and it compared with other well-established methods such as Hunger Games Search (HGS), Salp Swarm Algorithm (SSA), Whale Optimization Algorithm (WOA), Grey Wolf Optimizer (GWO), Grasshopper Optimization Algorithm (GOA), and Dragonfly Algorithm (DA). The results clearly showed that the proposed mHGS got promising output compared to other methods. It proved its ability to deal with real-world problems of Parkinson's disease phonation.

Transplantation medicine in Germany is clearly structured and strictly regulated. In recent years, various legal changes have been implemented to improve organ donation. Nevertheless, the restricted availability of donor organs remains the main limitation of the treatment, also in the field of heart and lung transplantation. Both procedures have now become established treatment options for selected patients with end-stage organ failure. The aim is to improve the quality of life as well as survival. The success of the treatment largely depends on the selection of suitable recipients as well as optimal perioperative and postoperative management including a lifelong specialized follow-up. The complexity of the treatment requires a high degree of specialized knowledge and skills. This article summarizes the current state of transplantation medicine of thoracic organs with a focus on the new additional subspecialty of transplantation medicine.

The Technical Guide explores some of the analytical possibilities provided by the National Surveys of Student Achievement (NSSA) data (open-access), collected in Lithuanian secondary schools during 2012-2016. The aim of the current Guide is to explore the possibilities of traditional scaling approachesand some alternativeswith the NSSA data in order to come up with a number of ready-made reliable indicators for the analyses of student achievement in the context of socio-economic disparities. The indicators described in this Guide include student achievement, student motivational, emotional, and social functioning at school, perceived teacher behaviors at school, as well as student family context, including socio-economic background and relationships in a family. The NSSA data can be openly accessed online:https://www.nsa.smm.lt/stebesenos-ir-vertinimo-departamentas/tyrimai/nacionaliniai-tyrimai/nacionaliniai-mokiniu-pasiekimu-tyrimai-nmpt/ &nbsp

Atypical teratoid rhabdoid tumor is a rare lesion that occurs mainly in children can be supratentorial or infratentorial and it accounts for 1-2% of pediatric brain tumors and over 10% of central nervous system (CNS) tumors in infants, with a male preponderance up to 3 years of age, more than 50% of these occur in the cerebellum. In this report we describe four new cases of sellar AT/RTs underwent endoscopic endonasal approach and different adjuvant therapies. Our aim is to report the clinical, radiological and pathological features of these rare lesions, focusing on the possibility to perform an early diagnosis and appropriate therapeutic strategy.

We investigated whether RV function recovers in children with pulmonary arterial hypertension (PAH) and RV failure undergoing lung transplantation (LuTx).Prospective observational study of 15 consecutive children, 1.9 to 17.6 years old, with PAH undergoing bilateral LuTx. We performed advanced echocardiography (Echo) and cardiac magnetic resonance imaging (MRI), followed by conventional and strain analysis, pre- and ∼6 weeks post-LuTx.After LuTx, RV/LV end-systolic diameter ratio (Echo), RV volumes and systolic RV function (RVEF 63 vs 30 %; p0.05) by MRI completely normalized, even in children with severe RV failure (RVEF40%). The echocardiographic end-systolic LV eccentricity index nearly normalized post-LuTx (1.0 vs 2.0, p0.0001) while RV hypertrophy regressed more slowly and was still evident. We found especially the end-systolic RV/LV ratios by Echo (diameter: 0.6 vs 2.6) or MRI (volumes: 0.8 vs 3.4) excellent diagnostic tools (p0.05): Together with RVEF by MRI, these ratios were superior to tricuspid annular plane systolic excursion (TAPSE; p = 0.4551) in assessing global systolic RV dysfunction. Moreover, children with severe PAH had reduced RV 2D longitudinal strain (Echo, MRI; p = 0.0450) and decreased RV 2D radial and circumferential strain (MRI; p = 0.0026 and p = 0.0036 respectively), all of which greatly improved following LuTx.We demonstrate full recovery of RV systolic function in children within two months after LuTx for severe PAH, independently of the patients' age, weight, and hemodynamic compromise preceding the LuTx. Even in end-stage pediatric PAH with poor RV function and low cardiac output, LuTx should be preferred over heart-lung transplantation.

Treatments involving stem cell (SC) usage represent novel and potentially interesting alternatives in facial nerve reanimation. Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth, spreading, myelinization, in addition to limiting fibrotic dege neration after surgery. However, the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.To investigate the histological, neurophysiological, and functional outcomes in facial reanimation using SC, compared to autograft.Our study is a systematic review of the literature, consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines. The review question was: In facial nerve reanimation on rats, has the use of stem cells revealed as effective when compared to autograft, in terms of histological, neurophysiological, and functional outcomes? Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.After screening 148 manuscript, five papers were included in our study. 43 subjects were included in the SC group, while 40 in the autograft group. The meta-analysis showed no significative differences between the two groups in terms of myelin thickness [CI: -0.10 (-0.20, 0.00);The role of stem cells in facial reanimation is still relatively poorly studied, in animal models, and available results should not discourage their use in future studies on human subjects.

BACKGROUND: Lung transplantation (LTx) can be considered for selected patients suffering from COVID-19 acute respiratory distress syndrome (ARDS). Secondary sclerosing cholangitis in critically ill (SSC-CIP) patients has been described as a late complication in COVID-19 ARDS survivors, however, rates of SSC-CIP after LTx and factors predicting this detrimental sequela are unknown. METHODS: This retrospective analysis included all LTx performed for post-COVID ARDS at 8 European LTx centers between May 2020 and January 2022. Clinical risk factors for SSC-CIP were analyzed over time. Prediction of SSC-CIP was assessed by ROC-analysis. RESULTS: A total of 40 patients were included in the analysis. Fifteen patients (37.5%) developed SSC-CIP. GGT at the time of listing was significantly higher in patients who developed SSC-CIP (median 661 (IQR 324-871) vs 186 (109-346); p = 0.001). Moreover, higher peak values for GGT (585 vs 128.4; p < 0.001) and ALP (325 vs 160.2; p = 0.015) were found in the 'SSC' group during the waiting period. Both, GGT at the time of listing and peak GGT during the waiting time, could predict SSC-CIP with an AUC of 0.797 (95% CI: 0.647-0.947) and 0.851 (95% CI: 0.707-0.995). Survival of 'SSC' patients was severely impaired compared to 'no SSC' patients (1-year: 46.7% vs 90.2%, log-rank p = 0.004). CONCLUSIONS: SSC-CIP is a severe late complication after LTx for COVID-19 ARDS leading to significant morbidity and mortality. GGT appears to be a sensitive parameter able to predict SSC-CIP even at the time of listing. ispartof: JOURNAL OF HEART AND LUNG TRANSPLANTATION vol:41 issue:10 pages:1501-1510 ispartof: location:United States status: published

Only two families have been reported with biallelic TMEM260 variants segregating with structural heart defects and renal anomalies syndrome (SHDRA). With a combination of genome, exome sequencing and RNA studies, we identified eight individuals from five families with biallelic TMEM260 variants. Variants included one multi-exon deletion, four nonsense/frameshifts, two splicing changes and one missense change. Together with the published cases, analysis of clinical data revealed ventricular septal defects (12/12), mostly secondary to truncus arteriosus (10/12), elevated creatinine levels (6/12), horse-shoe kidneys (1/12) and renal cysts (1/12) in patients. Three pregnancies were terminated on detection of severe congenital anomalies. Six patients died between the ages of 6 weeks and 5 years. Using a range of stringencies, carrier frequency for SHDRA was estimated at 0.0007–0.007 across ancestries. In conclusion, this study confirms the genetic basis of SHDRA, expands its known mutational spectrum and clarifies its clinical features. We demonstrate that SHDRA is a severe condition associated with substantial mortality in early childhood and characterised by congenital cardiac malformations with a variable renal phenotype.