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Background and Objectives: Despite growing interest in how patient frailty affects outcomes (eg, in neuro-oncology), its role after transsphenoidal surgery for Cushing disease (CD) remains unclear. We evaluated the effect of frailty on CD outcomes using the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) data set from a collaboration of US academic pituitary centers., Methods: Data on consecutive surgically treated patients with CD (2011-2023) were compiled using the 11-factor modified frailty index. Patients were classified as fit (score, 0-1), managing well (score, 2-3), and mildly frail (score, 4-5). Univariable and multivariable analyses were conducted to examine outcomes., Results: Data were analyzed for 318 patients (193 fit, 113 managing well, 12 mildly frail). Compared with fit and managing well patients, mildly frail patients were older (mean ± SD 39.7 ± 14.2 and 48.9 ± 12.2 vs 49.4 ± 8.9 years, P < .001) but did not different by sex, race, and other factors. They had significantly longer hospitalizations (3.7 ± 2.0 and 4.5 ± 3.5 vs 5.3 ± 3.5 days, P = .02), even after multivariable analysis (β = 1.01, P = .007) adjusted for known predictors of prolonged hospitalization (age, Knosp grade, surgeon experience, American Society of Anesthesiologists grade, complications, frailty). Patients with mild frailty were more commonly discharged to skilled nursing facilities (0.5% [1/192] and 4.5% [5/112] vs 25% [3/12], P < .001). Most patients underwent gross total resection (84.4% [163/193] and 79.6% [90/113] vs 83% [10/12]). No difference in overall complications was observed; however, venous thromboembolism was more common in mildly frail (8%, 1/12) than in fit (0.5%, 1/193) and managing well (2.7%, 3/113) patients ( P = .04). No difference was found in 90-day readmission rates., Conclusion: These results demonstrate that mild frailty predicts CD surgical outcomes and may inform preoperative risk stratification. Frailty-influenced outcomes other than age and tumor characteristics may be useful for prognostication. Future studies can help identify strategies to reduce disease burden for frail patients with hypercortisolemia., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Traumatic brain injury (TBI) is a major cause of health loss and disabilities globally, burdening health care systems. Mild TBI is a common cause of emergency department visits. Computed tomography (CT) scans are the mainstay for acute TBI imaging. S100 calcium-binding protein B (S100B) biomarker is promising for predicting intracranial lesions on CTs in mild TBI. A comprehensive search of the literature was conducted on PubMed, Google Scholar, and Cochrane electronic databases to find eligible studies reporting the diagnostic performance of S100B. A meta-analysis was conducted to evaluate the predictive ability of S100B for CT imaging abnormalities. Of 1545 articles, 32 were included in our meta-analysis. At the threshold of 0.1 μg/L, a bivariate model showed a sensitivity of 89% (95% confidence interval [CI] 83-92) with a specificity of 32% (95% CI 26-39). The aggregate analysis containing all cutoffs showed the optimal cutoff of 0.751 μg/L with a sensitivity of 64% (95% CI 32-87) and a specificity of 85% (95% CI 76-92). The optimal diagnostic performance of S100B in patients with Glasgow Coma Scale 14-15 was estimated to be 0.05 μg/L, with a sensitivity of 98% (95% CI 92-99) and a negative predictive value of 99%. These findings indicate that S100B analysis could minimize the need for unnecessary CT scans in individuals with mild TBI. The test's diagnostic accuracy improves when the S100B analysis is done within 3 h of the injury. However, further research is warranted to validate its superiority to other biomarkers before considering it the standard routine for managing mild TBI., Competing Interests: Conflicts of interest: The authors report no conflicts of interest. Ethical approval: Not applicable. Informed Consent: Not applicable., (© 2025. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Huntington's disease (HD) is an inherited neurodegenerative disease characterized by uncontrolled movements, emotional disturbances, and progressive cognitive impairment. It is estimated to affect 4.3 to 10.6 per 100,000 people worldwide, and the mean prevalence rate among all published studies, reviews, and genetic HD registries is 5.7 per 100,000. A key feature of HD is the loss of striatal neurons and cortical atrophy. Although there is no cure at present, the discovery of the gene causing HD has brought us into a new DNA era and therapeutic advances for several neurological disorders. PubMed was systematically searched using three search strings: '"Huntington disease" + "stem cell"', '"Huntington disease" + Mesenchymal stromal cell', and '"Huntington disease" + "induced pluripotent stem cell"'. For each string, the search results were categorized based on cell type, and papers that included a clinical analysis were categorized as well. The data were extracted up to 2024. We did not include other databases in our search to have a comparable and systematic review of the literature on the topic. The collected data were analyzed and used for critical interpretation in the present review. Data are presented chronologically as clinical studies were published. Therapeutic strategies based on stem cells have drawn a lot of interest as possible HD therapies. Recent research indicates that NSCs have been the most often utilized stem cell type for treating HD. NSCs have been generated and extracted from a variety of sources, including HD patients' somatic cells and the brain itself. There is strong evidence supporting the transplantation of stem cells or their derivatives in HD animal models, even if stem-cell-based preclinical and clinical trials are still in their early stages. Current treatment only aims at relieving the symptoms rather than treating the pathogenesis of the disease. Although preclinical trials in HD models have shown promise in improving cognitive and motor functions, stem cell therapy still faces many challenges and disadvantages including immunosuppression and immunorejection as well as ethical, technical, and safety concerns. Further research is required for a definitive conclusion.

Neurotrauma, stroke, and subarachnoid hemorrhage (SAH) are symptomatically diverse and etiologically complex central nervous system pathologies. Despite numerous therapeutic modalities that are available to minimize neurologic damage and secondary injury, the prognosis can still be dismal and unpredictable. Nanoparticle (NP) technology allows for deliberate, modular, and minimally invasive drug delivery. This literature review encompasses pertinent information on the impact and versatility of nanoparticle therapeutics when treating neurotrauma, stroke, and SAH. Currently, notable treatments such as Perfluorooctyl-Bromide (PFOB), PLGA nanoparticles, and ischemic relief-based NPs are promising new techniques for the management of these complex pathologies.

This review aims to explore the evolution, techniques, and outcomes of minimally invasive spine surgery (MISS) within the field of neurosurgery. We sought to address the increasing burden of spine degeneration in a rapidly aging population and the need for optimizing surgical management. This review explores various techniques in MISS, drawing upon evidence from retrospective studies, case series, systematic reviews, and technological advancements in neurosurgical spine treatment. Various approaches, including endonasal cervical, transoral cervical, transcervical, mini-open/percutaneous, tubular, and endoscopic techniques, provide alternatives for current approaches to a range of spinal pathologies. The main findings of this review highlight potential advantages of MISS over traditional open surgery, including reduced complications, shorter hospital stays, and improved patient outcomes. Our research underscores the importance of adopting MISS techniques to optimize patient care in neurosurgical spine treatment.

Glioblastoma (GBM) is one of the most common primary malignant brain tumors. Annually, there are about six instances recorded per 100,000 inhabitants. Treatment for GB has not advanced all that much. Novel medications have been investigated recently for the management of newly diagnosed and recurring instances of GBM. For GBM, surgery, radiation therapy, and alkylating chemotherapy are often used therapies. Immunotherapies, which use the patient's immune reaction against tumors, have long been seen as a potential cancer treatment. One such treatment is the dendritic cell (DC) vaccine. This cell-based vaccination works by stimulating the patient's own dendritic cells' antigenic repertoire, therefore inducing a polyclonal T-cell response. Systematic retrieval of information was performed on PubMed, Embase, and Google Scholar. Specified keywords were used to search, and the articles published in peer-reviewed scientific journals were associated with brain GBM, cancer, and Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination. Selected 90 articles were used in this manuscript, of which 30 articles were clinical trials. Compared to shared tumor antigen peptide vaccines, autologous cancer DCs have a greater ability to stimulate the immune system, which is why dendritic cell fusion vaccines have shown early promise in several clinical studies. Survival rates for vaccinated patients were notably better compared to matched or historical controls. For newly diagnosed patients, the median overall survival (mOS) ranged from 15 to 41.4 months, while the progression-free survival (PFS) ranged from 6 to 25.3 months. We discovered through this analysis that autologous multiomics analysis of DC vaccines showed enhanced antitumor immunity with a focus on using activated, antigen-loaded donor DCs to trigger T-cell responses against cancer, particularly in glioblastoma. It also showed improved patient survival, especially when combined with standard chemoradiotherapy. DC vaccines show promise in treating GBM by enhancing survival and reducing tumor recurrence. However, challenges in vaccine production, antigen selection, and tumor heterogeneity highlight the need for continued research and optimization to improve efficacy and patient outcomes., Competing Interests: Declarations. Ethics approval: Not applicable. Consent for publication: Not applicable. Competing interests: Not applicable. Informed consent: Not applicable., (© 2024. The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO).)

Background: With the increasing cases of TBI cases in the elderly population taking anticoagulants for comorbidities, there is a need to better understand the safety of new anticoagulants and how to manage anticoagulated TBI patients., Methods: A meta-analysis using a random-effect model was conducted to compare the effect of preinjury use of DOACs and VKAs on the outcomes following TBI., Results: From 1951 studies, 49 studies with a total sample size of 15,180 met our inclusion criteria. Our meta-analysis showed no difference between preinjury use of DOACs or VKAs on ICH progression, in-hospital delayed ICH, delayed ICH at follow-up, and in-hospital mortality, but using DOACs was associated with a lower risk of immediate ICH (OR = 0.58; 95% CI = [0.42; 0.79]; p  < 0.01) and neurosurgical interventions (OR = 0.59; 95% CI = [0.42; 0.82]; p  < 0.01) compared to VKAs. Moreover, patients on DOACs experienced shorter length of stay in the hospital than those on VKAs (OR = -0.42; 95% CI = [-0.78; -0.07]; p  = 0.02)., Conclusion: We found a lower risk of immediate ICH and surgical interventions as well as a shorter hospital stay in patients receiving DOACs compared to VKA users before the head injury.

Background: A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity., Methods: A cross-sectional study was conducted across public and private medical schools of Pakistan. A close-ended self-administered questionnaire was employed to assess subject-reported challenges and perceptions regarding neurosurgery. Statistical analysis was performed using SPSS, version 28, and P < 0.05 was considered significant. The influence of these perceptions on the choice of neurosurgery as a career was determined by binary logistic regression analysis., Results: Of the 387 responses received from over 45 institutions across the country, 55.6% were females and 44.4% were male respondents. Compared to men, women were more likely to opt out of neurosurgery due to fear of problems with parenting (P < 0.001), absence of daycare facilities (P < 0.001), lack of female role models (P = 0.001), fear of gender discrimination (P < 0.001), and the mental (P = 0.04) and physical distress (P = 0.008) associated with neurosurgery. Binary logistic regression revealed that these concerns were responsible for an increased likelihood of opting out of neurosurgery among female medical students and intern doctors., Conclusions: Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of daycare facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: We aimed to determine the association of neutrophil-to-lymphocyte ratio (NLR) with non-arteritic anterior ischemic optic neuropathy (NAION)., Methods: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus and Web of Science were searched from the establishment of the database to May 5, 2022 to find the relevant studies. The quality of the included literature was evaluated with the Newcastle-Ottawa scale (NOS). The results are reflected in the form of standard mean difference (SMD) and 95% confidence interval (CI)., Results: Finally, six articles were included in our study. Compared with healthy controls, patients' NLR levels were significantly higher (SMD = 0.47; CI 95% = 0.30-0.65, p<0.001). The included studies were not statistically heterogeneous (I 2 = 0.0%, p = 0.60); thus, the analysis used the fixed-effect model. The pooled sensitivity of NLR was 0.69 (95% CI 0.60-0.67), and the pooled specificity was 0.59 (95% CI 0.50-0.67). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NLR were 1.71(95%CI 1.48-1.98), 0.50 (95%CI 0.41-0.62), and 3.38 (95%CI 2.57-4.44), respectively., Conclusions: Our findings suggest NLR to be a potential marker of NAION, while also implicating a role for inflammation in underlying pathophysiology., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Glioblastoma multiforme (GBM), a WHO grade 4 glioma, is the most common and aggressive primary brain tumor, characterized by rapid progression and poor prognosis. The heterogeneity of GBM complicates diagnosis and treatment, driving research into molecular biomarkers that can offer insights into tumor behavior and guide personalized therapies. This review explores recent advances in molecular biomarkers, highlighting their potential to improve diagnosis and treatment outcomes in GBM patients. Key biomarkers such as MGMT promoter methylation, IDH1/2 mutations, EGFR amplification, and TERT promoter mutations, etc., are examined for their roles in prognosis, therapeutic response, and tumor classification. While molecular biomarkers offer valuable insights for tailoring GBM treatments, their clinical application is hindered by tumor heterogeneity, dynamic genetic evolution, and the lack of standardized testing methods. Future research should aim to confirm new biomarkers and incorporate them into regular clinical practice to improve prognosis and treatment choices. Advances in genomic and proteomic technologies, along with consistent biomarker detection, could transform GBM care and enhance patient outcomes.

Background: Traumatic brain injury (TBI) is a major cause of death and disability in the United States. There is a suggested association between TBI and stroke, emphasizing the need for increased medical monitoring post-trauma. We conducted a systematic review and meta-analysis to investigate the link between previous TBI and the future diagnosis of any type of stroke., Methods: A comprehensive search was conducted on PubMed, Google Scholar, and Cochrane Library to find eligible studies investigating the association between TBI and long-term risk of stroke., Results: Out of 2,378 studies, 11 articles met the inclusion criteria for our meta-analysis. The pooled analysis showed that the patients who had a history of TBI were at greater risk for stroke than patients in the control group (random-effect HR = 1.59, 95% CI 1.37-1.85, p < 0.001, I 2  = 97%). The risk of ischemic stroke in TBI patients was greater than in non-TBI patients (random-effect HR = 1.52, 95% CI 1.36-1.70, p < 0.001, I 2  = 93%). Additionally, there is a strong correlation between TBI and hemorrhagic stroke (random-effect HR = 4.68, 95% CI 2.93-7.49, p < 0.001, I 2  = 93%)., Conclusion: Our results indicate that there is a relationship between TBI and long-term risk of stroke, regardless of the stroke type. The risk is elevated in the first months post-injury and continues to be high in the years following the trauma. Individuals with moderate to severe TBI face a higher risk of developing a post-TBI stroke than those with mild TBI., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

Paper-based patient records have been associated with disorganization and redundancy and thus lack of efficiency and security. The electronic health record (EHR) is an electronic record for patient health information that has alleviated many of the traditional issues associated with paper-based records. However, in the current era of the internet and with the variability of EHR systems, privacy, security, and interoperability remain challenges of the current patient health information management systems. Blockchain technologies provide an opportunity to address many of the challenges associated with current EHR systems. In addition, new frameworks have explored the utility of blockchain-based applications in addressing concerns in different medical disciplines such as neurosurgery. This review discusses these applications, including blockchain-based solutions impacting all of medicine, relating to the EHR, and directly relating to neurosurgery. This review also discusses blockchain technology and the related intricacies for appreciating the relevant frameworks, while also highlighting the challenges associated with this technology., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Intensive care unit-acquired weakness (ICU-AW) is a prevalent issue in critical care, leading to significant muscle atrophy and functional impairment. Aiming to address this, Neuromuscular Electrical Stimulation (NMES) has been explored as a therapy. This systematic review assesses NMES's safety and effectiveness in enhancing functional capacity and mobility in pre- and post-cardiac surgery patients. NMES was generally safe and feasible, with intervention sessions varying in frequency and duration. Improvements in muscle strength and 6-minute walking test distances were observed, particularly in preoperative settings, but postoperative benefits were inconsistent. NMES showed promise in preventing muscle loss and improving strength, although its impact on overall functional capacity remained uncertain. Challenges such as short ICU stays and body composition affecting NMES efficacy were noted. NMES also holds potential for other conditions like cerebral palsy and stroke. Further research is needed to optimize NMES protocols and better understand its full benefits in preventing ICU-AW and improving patient outcomes., Competing Interests: Conflict-of-interest statement: All authors have no conflicts of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

This paper provides an overview of autoimmune disorders of the central nervous system, specifically those caused by demyelination. We explore new research regarding potential therapeutic interventions, particularly those aimed at inducing remyelination. Remyelination is a detailed process, involving many cell types-oligodendrocyte precursor cells (OPCs), astrocytes, and microglia-and both the innate and adaptive immune systems. Our discussion of this process includes the differentiation potential of neural stem cells, the function of adult OPCs, and the impact of molecular mediators on myelin repair. Emerging therapies are also explored, with mechanisms of action including the induction of OPC differentiation, the transplantation of mesenchymal stem cells, and the use of molecular mediators. Further, we discuss current medical advancements in relation to many myelin-related disorders, including multiple sclerosis, optic neuritis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, transverse myelitis, and acute disseminated encephalomyelitis. Beyond these emerging systemic therapies, we also introduce the dimethyl fumarate/silk fibroin nerve conduit and its potential role in the treatment of peripheral nerve injuries. Despite these aforementioned scientific advancements, this paper maintains the need for ongoing research to deepen our understanding of demyelinating diseases and advance therapeutic strategies that enhance affected patients' quality of life., Competing Interests: Conflict-of-interest statement: All authors report no conflicts-of-interests., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Quantum computing leverages the principles of quantum mechanics to provide unprecedented computational power by processing data in a fundamentally different way from classical binary computers. Quantum computers use "qubits" which superimpose 0 and 1. Because qubits can exist in multiple states at the same time, quantum computers can perform "quantum parallelism" wherein data are processed simultaneously rather than sequentially. The quantum parallelism is what enables the computer to have exponentially larger processing capabilities and consider all potential outcomes simultaneously to derive solutions. Our study aims to explore aspects of neurosurgery through which quantum computing could improve patient outcomes and enhance quality of care. Quantum computing has the potential for future applications in neuroprosthetics, neurostimulation, surgical precision, diagnosis, and patient privacy and security. It promises improved patient outcomes, enhanced surgical precision, and personalized healthcare delivery. With its inherent sensitivity and precision, quantum computing could advance the understanding of disease processes and development, providing neurosurgeons with deeper insight into patient pathologies. Challenges such as biocompatibility, cost, and ethical considerations remain significant barriers to integrating the technology into neurosurgical practice. Addressing these challenges will be crucial for realizing the transformative potential of quantum computing in advancing neurosurgical care and improving clinical outcomes., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head trauma. Historically, the diagnosis has been primarily clinical, which has hindered definitive early diagnosis and proactive intervention., Areas Covered: The authors analyze the recent advancements in early diagnosis of CTE by examining biomarkers, imaging, and clinical decision tools. They discuss the identification of neuropathologies - such as tau aggregates - through novel techniques ranging from blood sampling and to brain density scanning. The reader will walk away with a better understanding of current advancements in early detection and be better equipped to deal with encephalopathies secondary to trauma in clinical practice., Expert Opinion: Tremendous progress has been made in understanding the pathophysiology of CTE. Despite these advancements, CTE treatment is still primarily symptomatic rather than underlying disease. Future research should focus on integrating current understanding of CTE pathophysiology with treatment modalities.

Maladaptive inflammation underlies the formation and rupture of human intracranial aneurysms. There is a growing body of evidence that anti-inflammatory pharmaceuticals may beneficially modulate this process. Clopidogrel (Plavix) is a commonly used irreversible P2Y12 receptor antagonist with anti-inflammatory activity. In this paper, we investigate whether clopidogrel is associated with the likelihood of aneurysm rupture in a multi-institutional propensity-matched cohort analysis. Patients presenting for endovascular treatment of their unruptured intracranial aneurysms and those presenting with aneurysm rupture between 2015 and 2019 were prospectively identified at two quaternary referral centers. Patient demographics, comorbidities, and medication usage at the time of presentation were collected. Patients taking clopidogrel or not taking clopidogrel were matched in a 1:1 fashion with respect to location, age, smoking status, aneurysm size, aspirin usage, and hypertension. A total of 1048 patients with electively treated aneurysms or subarachnoid hemorrhages were prospectively identified. Nine hundred twenty-one patients were confirmed to harbor aneurysms during catheter-based diagnostic angiography. A total of 172/921 (19%) patients were actively taking clopidogrel at the time of presentation. Three hundred thirty-two patients were matched in a 1:1 fashion. A smaller proportion of patients taking clopidogrel at presentation had ruptured aneurysms than those who were not taking clopidogrel (6.6% vs 23.5%, p < .0001). Estimated treatment effect analysis demonstrated that clopidogrel usage decreased aneurysm rupture risk by 15%. We present, to the best of our knowledge, the first large-scale multi-institutional analysis suggesting clopidogrel use is protective against intracranial aneurysm rupture. It is our hope that these data will guide future investigation, revealing the pathophysiologic underpinning of this association., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Alzheimer's disease (AD) is the most prevalent kind of dementia and is a long-term degenerative disease. Pathologically, it is defined by the development of extracellular amyloid-β plaques and intracellular neurofibrillary tangles made up of hyperphosphorylated tau protein. This causes neuronal death, particularly in the hippocampus and cortex. Mesenchymal stem cell (MSC)-derived exosomes have been identified as possibly therapeutic and have promise for Alzheimer's disease due to their regenerative characteristics., Methods: A systematic retrieval of information was performed on PubMed. A total of 60 articles were found in a search on mesenchymal stem cells, exosomes, and Alzheimer's disease. A total of 16 ongoing clinical trials were searched and added from clinicaltrials.gov. We added 23 supporting articles to help provide information for certain sections. In total, we included 99 articles in this manuscript: 50 are review articles, 13 are preclinical studies, 16 are clinical studies, 16 are ongoing clinical trials, and 4 are observational studies. Appropriate studies were isolated, and important information from each of them was understood and entered into a database from which the information was used in this article. The clinical trials on mesenchymal stem cell exosomes for Alzheimer's disease were searched on clinicaltrials.gov., Results: Several experimental investigations have shown that MSC-Exo improves cognitive impairment in rats. In this review paper, we summarized existing understanding regarding the molecular and cellular pathways behind MSC-Exo-based cognitive function restoration, with a focus on MSC-Exo's therapeutic potential in the treatment of Alzheimer's disease., Conclusion: AD is a significant health issue in our culture and is linked to several important neuropathological characteristics. Exosomes generated from stem cells, such as mesenchymal stem cells (MSCs) or neural stem cells (NSCs), have been examined more and more in a variety of AD models, indicating that they may be viable therapeutic agents for the treatment of diverse disorders. Exosome yields may be increased, and their therapeutic efficacy can be improved using a range of tailored techniques and culture conditions. It is necessary to provide standardized guidelines for exosome manufacture to carry out excellent preclinical and clinical research.

Bai et al investigate the predictive value of T lymphocyte proportion in Alzheimer's disease (AD) prognosis. Through a retrospective study involving 62 AD patients, they found that a decrease in T lymphocyte proportion correlated with a poorer prognosis, as indicated by higher modified Rankin scale scores. While the study highlights the potential of T lymphocyte proportion as a prognostic marker, it suggests the need for larger, multicenter studies to enhance generalizability and validity. Additionally, future research could use cognitive exams when evaluating prognosis and delve into immune mechanisms underlying AD progression. Despite limitations inherent in retrospective designs, Bai et al 's work contributes to understanding the immune system's role in AD prognosis, paving the way for further exploration in this under-researched area., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Headache management after acute brain injury (ABI) is challenging. Although opioids are commonly used, selective cyclooxygenase 2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. A systematic review was conducted through MEDLINE and Embase for articles published through September 2023 (PROSPERO identifier: CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using DistillerSR. Descriptive statistics were used for data analysis, and meta-analysis was unfeasible because of study heterogeneity. Of 3190 articles identified, 6 studies met inclusion criteria: 4 randomized controlled trials and 2 retrospective cohort studies, all conducted in elective cranial neurosurgical patients (total N = 738) between 2006 and 2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, whereas one showed improvement only at 6 h postoperatively, and one did not find significant differences. Pain scores decreased between 4 and 15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, whereas one reported a reduction at 12 h postoperatively only. Opioid consumption decreased between 9 and 90%. Two studies found a decrease in hospital length of stay by ~ 1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically nonsignificant 3% reduction in the intervention group. COXIBs may serve as opioid-sparing adjunctive analgesics for headache control after elective cranial surgery. Limited or no literature exists for other forms of ABI, and additional safety data remain to be elucidated., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Objective: We conducted this study to summarize the results of studies reporting the role of NLR (neutrophil to lymphocyte ratio) in PSCC (penile squamous cell carcinoma)., Methods: This meta-analysis was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. A systematic search was conducted on PubMed, Scopus, and web of science up to March 10, 2023. Fourteen studies were included in the review. The NOS (Newcastle-Ottawa Scale) was used to determine the quality of the included studies. This meta-analysis was conducted on the studies reporting the relationship between NLR and survival using HR (hazard ratio) and 95% CI (confidence interval)., Results: There was a significant association between NLR levels and the prognosis, nodal stage, and anatomical tumor stage of PSCC patients. In the meta-analysis of the association of NLR with survival, NLR level was significantly associated with lower cancer-specific survival (HR = 3.51, 95% CI = 2.07-5.98, p < 0.001) and lower disease-free survival (HR = 2.88, 95% CI = 1.60-5.20, p < 0.001). However, NLR was found to have no association with the stage, grade, location, and size of the tumor., Conclusion: NLR has a significant diagnostic and prognostic value in PSCC., (© 2024. The Author(s).)

Objectives: Controlling elevated intracranial pressure following brain injury with hyperosmolar agents is one of the mainstay treatments in traumatic brain injury patients. In this study, we compared the effects of hypertonic saline (HS) and mannitol in reducing increased intracranial pressure., Methods: A total of 637 patients from 15 studies were included in our meta-analysis. The primary outcomes were mortality, the length of stay in the hospital and ICU, and the Glasgow Outcome Scale at follow-up., Results: The mortality in the mannitol group was not statistically different compared to the HS group (RR = 1.55; 95% CI = [0.98, 2.47], p  = 0.06). The length of stay in the ICU was significantly shorter in the HS group (MD = 1.18, 95% CI = [0.44, 1.92], p  < 0.01). In terms of favorable neurological outcomes, there was no significant difference between the two agents (RR = 0.92, 95% CI = [0.11, 7.96], p  = 0.94). The duration of the effect was shorter in the mannitol group than in the HS group (MD = -0.67, 95% CI = [-1.00, -0.33], p  < 0.01)., Discussion: The results showed that HS and mannitol had similar effects in reducing ICP. Although the HS was associated with a longer duration of effect and shorter ICU stay, other secondary outcomes including mortality rate and favorable neurological outcomes were similar between the two drugs. In conclusion, considering the condition of each patient individually, HS could be a reasonable option than mannitol to reduce ICP in TBI patients.