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Background: A successful malaria elimination program calls for enough attention to parasite carriers, especially asymptomatic malaria, as well as the diagnosis and treatment of clinical cases. Asymptomatic malaria is an infection that patients do not show any symptom; thus, these patients play critical role in the concept of an elimination program. The current investigation was conducted to evaluate the presence of these cases in Bashagard District, formerly a high malaria transmission area in Hormozgan Province, Iran. Methods: Blood samples (n=500) were collected from symptomless individuals residing in Bashagard to evaluate Plasmodium infection by using microscopic, serological and nested-PCR techniques. Results: Regarding the microscopic and nested-PCR analysis, no asymptomatic infection was detected among studied individuals. Totally, 1% of the studied population (5 of 500) had anti PvMSP-119-specific IgG antibody; however, only 0.2% (1 of 500) of the individuals was seropositive to recombinant PfMSP-119, using ELISA. Conclusion: This study showed no asymptomatic malaria infection in the studied population; hence malaria elimination is feasible and can be successfully carried out in this region. [ABSTRACT FROM AUTHOR]

Inflammatory disorders historically have been difficult to monitor with conventional PET imaging due to limitations including radiation exposure, lack of validated imaging biomarkers, low spatial resolution, and long acquisition durations. However, the recent development of long-axial field-of-view (LAFOV) PET/CT scanners may allow utilization of novel noninvasive biomarkers to diagnose, predict outcomes, and monitor therapeutic response of inflammatory conditions. LAFOV PET scanners can image most of the human body (if not the entire body) simultaneously in one bed position, with improved signal collection efficiency compared to conventional PET scanners. This allows for imaging with shorter acquisition durations, decreased injected radiotracer dose, prolonged uptake times, or a combination of any of these. In addition, LAFOV PET scanners enable whole-body dynamic imaging. Altogether, these intrinsically superior capabilities in assessing both local and systemic diseases, have allowed these scanners to make increasingly significant contributions to the assessment of inflammatory conditions. This review aims to further explore the role and benefits of LAFOV scanners for imaging various inflammatory conditions while addressing future developments and challenges faced by this technology., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: UC Davis has a research agreement and a sales-based revenue sharing agreement with United Imaging Healthcare, the manufacturer of the total-body PET/CT scanner. No other potential conflicts of interest relevant to this article exist including employment, royalties, stock options, or patents. The authors would like to acknowledge funding from the National Institutes of Health via grants R01 AR076088, R01 AR085314 and R01 CA206187. Lorenzo Nardo is principal investigator of a service agreement with United Imaging Healthcare. Lorenzo Nardo has been the PI of more than 1 service agreements with United Imaging Healthcare. Lorenzo Nardo is mentioned in a recurrent gift from United Imaging Healthcare that support the American Board of Radiology Alternate Pathway at UC Davis. Lorenzo Nardo is site PI of clinical trials supported by Novartis Pharmaceuticals Corporation. Lorenzo Nardo is PI of a clinical trial supported by Telix Pharmaceuticals. Lorenzo Nardo is PI of clinical trial supported by Lantheus Medical Imaging. Lorenzo Nardo is PI of a clinical trials supported by Curium Pharma Healthcare. Lorenzo Nardo is Co-I of a clinical trial supported by Lilly. Lorenzo Nardo has a SPEAKING ENGAGEMENT AGREEMENT with Lilly. Lorenzo Nardo is associate editor for Current Problems in Cancer. Lorenzo Nardo served a panel reviewer for the European Health and Digital Executive Agency. Lorenzo Nardo served a panel reviewer for the National Cancer Center Network (NCCN) – multiple panels. Lorenzo Nardo served a panel reviewer for the National Institutes for Health (NIH). Lorenzo Nardo is PI and co-PI of multiple National Institutes for Health (NIH) grants. Lorenzo Nardo served a committee member for the American Board of Radiology - multiple committees. Ramsey Badawi is an investigator with Lilly. Ramsey Badawi is an investigator with United Imaging Healthcare. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Brain swelling after Traumatic Brain Injury (TBI) can elevate intracranial pressure, necessitating Decompressive Craniectomy (DC) as the preferred surgical intervention. This study aimed to analyze a large institutional database to identify clinical characteristics of patients requiring primary DC and their outcomes. We reviewed TBI patients admitted to our center from 2015 to 2021, utilizing a prospectively maintained registry. Data collected included demographics, injury mechanisms, admission findings, neuroimaging results, DC necessity, procedures during hospitalization, and functional outcomes at discharge and six-month follow-up. A total of 4,011 patients were analyzed, with 506 undergoing primary DC. Factors such as International Normalized Ratio, activated Partial Thromboplastin Time, subdural hematoma, midline shift, epidural hematoma, intracerebral hemorrhage, and the presence of compressed or absent basal cisterns were independently linked to the need for DC. Additionally, the requirement for DC correlated with an increased likelihood of tracheostomy. For patients requiring DC, older age, lower hemoglobin levels, higher Rotterdam scores, and the presence of compressed or absent basal cisterns were associated with unfavorable outcomes in mild to moderate TBI cases. In severe TBI patients, lower Glasgow Coma Scale scores and fixed pupils were linked to poor outcomes. This study represents one of the most comprehensive analyses of primary DC requirements and outcomes, revealing that the need for DC is associated with worse outcomes in TBI patients and identifying several independent predictors of outcomes across varying severity levels., Competing Interests: Declarations. Ethical approval: The study protocol was approved by the Institutional Board Review at our institution. Written informed consent was obtained from all participants on admission. Consent to participate: Written informed consent was obtained from all patients. Consent for publication: Written informed consent was obtained from all patients. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This case series presents five cases of adult atlantoaxial rotatory subluxation (AARS) following traumatic events, focusing on treatment strategies and long-term outcomes., Case Presentation: This paper includes four Iranian male patients and one Iranian female patient with ages ranging from 25 to 46 years old. Each case involved unique presentations and management approaches. Initial conservative treatments, including skull traction and orthoses, were attempted, but surgical intervention became necessary due to inadequate response. Surgical fixation significantly improved functional status and alleviated symptoms in all patients, leading to long-term relief. Radiological assessments demonstrated successful outcomes post-surgery., Conclusions: This study underscores the importance of considering both conservative and surgical options in managing adult atlantoaxial rotatory subluxation to achieve optimal outcomes., (© 2024. The Author(s).)

Tissue engineering is a multidisciplinary field that uses biomaterials to restore tissue function and assist with drug development. Over the last decade, the fabrication of three-dimensional (3D) multifunctional scaffolds has become commonplace in tissue engineering and regenerative medicine. Thanks to the development of 3D bioprinting technologies, these scaffolds more accurately recapitulate in vivo conditions and provide the support structure necessary for microenvironments conducive to cell growth and function. The purpose of this review is to provide a background on the leading 3D bioprinting methods and bioink selections for tissue engineering applications, with a specific focus on the growing field of developing multifunctional bioinks and possible future applications., Competing Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: Determining the long-term success of endoscopic third ventriculostomy (ETV) remains challenging. This study aimed to investigate the impact of clinical and radiological factors on ETV success in pediatric patients with hydrocephalus., Methods: The study included patients < 18 years old with hydrocephalus who underwent ETV between March 2014 and May 2021. Data including patient age, gender, history of previous shunt surgery, previous external ventricular drain placement, intraventricular hemorrhage history, and postoperative meningitis were extracted from medical records. Imaging features such as aqueductal stenosis, third ventricle floor bowing, displaced lamina terminalis, pulsatility index (PI), and maximum diameter of the cortical subarachnoid space (CSAS) were recorded for each patient using preoperative CT scans. Two independent neurosurgeons measured the CSAS maximum diameter and the PI. CSAS measurements were obtained on axial slices of the preoperative CT scans, whereas the PI was based on intraoperative third ventricle pulsatility. Patients were followed up for 1 year after surgery, with failure defined as the need for ventriculoperitoneal shunt (VPS) placement or death attributable to hydrocephalus., Results: Ninety-eight children with a mean age of 16.39 ± 19.07 months underwent ETV for hydrocephalus. No deaths were recorded, but over 6 months and 1 year of follow-up, 12.2% and 22.4% of patients, respectively, experienced documented ETV failure requiring VPS placement. At the 6-month follow-up, a smaller maximum diameter of the CSAS was significantly associated with ETV failure; multivariate analysis revealed that CSAS maximum diameter was a predictor of 6-month ETV failure. At the 1-year follow-up, a lower PI was significantly associated with ETV failure, and multivariate analysis confirmed the PI as a significant predictor of ETV failure within 1 year after surgery. CSAS and PI measurements were repeated to assess interrater reliability: the intraclass correlation coefficients were 0.897 and 0.669 for CSAS and PI, respectively., Conclusions: This study found that the CSAS maximum diameter and the PI are predictors of ETV failure at 6 months and 1 year, respectively. These findings highlight the importance of considering specific factors such as the CSAS and PI when assessing the likelihood of ETV success in pediatric patients with hydrocephalus. Further research and consideration of these factors may help optimize patient selection and improve outcomes for those undergoing ETV as a treatment for hydrocephalus.

Background: Traumatic brain injury (TBI) is a major cause of physical disabilities worldwide. Herein, we aimed to investigate the factors contributing to post-discharge recovery in patients who were discharged with an unfavorable outcome., Methods: We collected data on the characteristics of patients, with a focus on those who survived TBI but had an unfavorable outcome at discharge as measured by Glasgow Outcome Scale Extended (GOSE) categories 2, 3, and 4. Post-discharge recovery was defined as achieving a favorable functional status at 6 months (GOSE of 5 or more) with a minimum 2-point increase in GOSE., Results: Of 4011 TBI patients in our registry, 797 had an unfavorable discharge functional status. In severe TBI, 51% achieved recovery, while in mild to moderate TBI, 57% achieved recovery after 6 months. Older patients and those with shorter intensive care unit length of stay were more likely to experience post-discharge recovery in both mild to moderate and severe TBI groups. The presence of skull base fracture was also associated with post-discharge recovery in severe TBI patients. Lastly, we show that, after adjustment for potential confounders, GOSE at discharge is associated with post-discharge recovery in both mild to moderate and severe TBI patients., Conclusions: This study found that the majority of patients discharged with an unfavorable functional status were able to achieve a favorable outcome within 6 months. The novel post-discharge recovery in TBI patients might be a useful tool for illuminating the factors associated with a significant improvement after discharge., (Copyright © 2024. Published by Elsevier Inc.)

Background: Approximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery. Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared with patients with stenosis of the anterior circulation. Therefore, aggressive treatment is important for the patient's prognosis. Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment, but it is not without complications. We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting (PTAS) for intracranial vertebrobasilar artery stenosis (IVBS)., Methods: PubMed, Web-of-Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort, randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS. Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software., Results: 31 studies were found eligible which included 1928 cases. 1103 basilar artery stenosis cases were reported in 27 studies 0.65 (95% CI 0.53, 0.76), I 2 : 99.72%. 648 vertebral cases were reported in 18 studies 0.60 (95% CI 0.49, 0.70), I 2 : 97.49%. In four studies, the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10 (95% CI 0.05, 0. 15). Mean stenosis in 21 included studies was found to be 0.83 (95% CI 0.79, 0.88), I 2 : 0.00%, which shows variation of baseline stenosis between studies was minimal. 51 deaths were recorded in 24 studies. Meta-analysis of mortality showed the overall rate of mortality was 0.03 (95% CI 0.02, 0.05), I 2 : 44.90%. In 14 studies, symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01 (95% CI 0.00, 0.02), I 2 : 0.00%. Generally, a follow-up period of at least 3 months was reported in the included studies. Furthermore, procedural stroke/TIA was evaluated in seven studies, four of which reported no events (0.03 (95% CI 0.00, 0.08), I 2 : 20.38%). Mean time from initial symptoms to recanalisation was 23.98 (95% CI 18.56, 29.40), I 2 =98.8%, p=0.00 days., Conclusion: In certain individuals with medically unresolved, severe, symptomatic and non-acute IVBS, elective vertebrobasilar PTAS appears to be both safe and effective. Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions. Future randomised controlled trials are required to verify these results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Concussions are self-limited forms of mild traumatic brain injury (TBI). Gradual return to play (RTP) is crucial to minimizing the risk of second impact syndrome. Online patient educational materials (OPEM) are often used to guide decision-making. Previous literature has reported that grade-level readability of OPEM is higher than recommended by the American Medical Association and the National Institutes of Health. The authors evaluated the readability of OPEM on concussion and RTP., Methods: An online search engine was used to identify websites providing OPEM on concussion and RTP. Text specific to concussion and RTP was extracted from each website and readability was assessed using the following six standardized indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. One-way ANOVA and Tukey's post hoc test were used to compare readability across sources of information., Results: There were 59 concussion and RTP articles, and readability levels exceeded the recommended 6th grade level, irrespective of the source of information. Academic institutions published OPEM at simpler readability levels (higher FRE scores). Private organizations published OPEM at more complex (higher) grade-level readability levels in comparison with academic and nonprofit institutions (p < 0.05)., Conclusions: The readability of OPEM on RTP after concussions exceeds the literacy of the average American. There is a critical need to modify the concussion and RTP OPEM to improve comprehension by a broad audience.

Coagulopathy development in traumatic brain injury (TBI) is among the significant complications that can negatively affect the clinical course and outcome of TBI patients. Timely identification of this complication is of utmost importance in the acute clinical setting. We reviewed TBI patients admitted to our trauma center from 2015 to 2021. Demographic data, mechanism of injury, findings on admission, imaging studies, procedures during hospitalization, and functional outcomes were gathered. INR with a cutoff of 1.3, platelet count less than 100 × 10⁹/L, or partial thromboplastin time greater than 40s were utilized as the markers of coagulopathy. A total of 4002 patients were included. Coagulopathy occurred in 38.1% of the patients. Age of the patients (Odds Ratio (OR) = 0.993, 95% Confidence Interval (CI) = 0.986-0.999, p = 0.028), systolic blood pressure (OR = 0.993, 95% CI = 0.989-0.998, p = 0.005), fibrinogen level (OR = 0.998, 95% CI = 0.996-0.999, p < 0.001), and hemoglobin level (OR = 0.886, 95% CI = 0.839-0.936, p < 0.001) were independently associated with coagulopathy. Furthermore, coagulopathy was independently associated with higher mortality rates and longer ICU stays. Coagulopathy had the most substantial effect on mortality of TBI patients (OR = 2.6, 95% CI = 2.1-3.3, p < 0.001), compared to other admission clinical characteristics independently associated with mortality such as fixed pupillary light reflex (OR = 1.8, 95% CI = 1.5-2.4, p < 0.001), GCS (OR = 0.91, 95% CI = 0.88-0.94, p < 0.001), and hemoglobin level (OR = 0.93, 95% CI = 0.88-0.98, p = 0.004). Early coagulopathy in TBI patients can lead to higher mortality rates. Future studies are needed to prove that early detection and correction of coagulopathy and modifiable risk factors may help improve outcomes of TBI patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Intracranial hemorrhage (ICH) is a severe condition that requires rapid diagnosis and treatment. Automated methods for calculating ICH volumes can reduce human error and improve clinical decisioPlease provide professional degrees (e.g., PhD, MD) for the corresponding author.n-making. A novel automated method has been developed that is comparable to the ABC/2 method in terms of speed and accuracy while providing more accurate volumetric data., Methods: We developed a novel automated algorithm for calculating intracranial blood volume from computed tomography (CT) scans. The algorithm consists of a Python script that processes Digital Imaging and Communications in Medicine images and determines the blood volume and ratio. The algorithm was validated against manual calculations performed by neurosurgeons., Results: Our novel automated algorithm for calculating intracranial blood volume from CT scans demonstrated excellent agreement with the ABC/2 method, with a median overall difference of just 1.46 mL. The algorithm was also validated in patient groups with ICH, epidural hematoma (EDH), and SDH, with agreement coefficients of 0.992, 0.983, and 0.997, respectively., Conclusions: The study introduces a novel automated algorithm for calculating the volumes of various ICHs (EDH, and SDH) within CT scans. The algorithm showed excellent agreement with manual calculations and outperformed the commonly used ABC/2 method, which tends to overestimate ICH volume. The automated algorithm offers a more accurate, efficient, and time-saving approach to quantifying ICH, EDH, and SDH volumes, making it a valuable tool for clinical evaluation and decision-making., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Elevated skull fracture (ESF) is a rare but potentially life-threatening type of skull fracture. The literature on this topic is relatively sparse. Herein, we conducted a meta-analysis of all the patients reported in the literature with ESFs with respect to their clinical management to better inform practice. On 20th of January 2023, we conducted a systematic search of literature to find all published cases of ESF. We also conducted a retrospective review of ESF cases from our institution. The data collection and analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After screening, 28 studies met the inclusion criteria. A total of 104 individual patients were included in the meta-analysis, with a median age of 24 years and 85.7% of whom were males. 11 patients (11.2%) had an unfavorable outcome while 37 (35.2%) had one or more complications. We found that GCS on admission is an independent predictor of poor outcome in ESF (odds ratio (95% confidence interval) = 1.605 (1.110-2.315), p value = 0.012). Regarding complications, dural injury (odds ratio (95% confidence interval) = 66.667 (7.407-500.00), p value < 0.001) and multiple bone involvement (odds ratio (95% confidence interval) = 6.849 (2.127-22.222), p value = 0.001) were independent predictors of complication. ESFs represent a rare yet consequential form of cranial injury, carrying potentially life-threatening implications if not promptly addressed. In this study, we present the meta-analysis of outcomes and complications within this patient cohort, offering a comprehensive synthesis of existing literature on this pathology. However, further investigation is imperative to provide higher-quality evidence and address lingering uncertainties in the classification and management of ESFs., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Purpose: Spina bifida is the second major cause of congenital disorders and the most common central nervous system congenital malformation compatible with life primarily. Herein, we describe the short-term outcome of post-natal Myelomeningocele (MMC) surgical management and predictors of its postoperative complications and mortality., Methods: This retrospective chart review studies the children who underwent post-natal surgical management for MMC in Namazi hospital, a tertiary referral center, in southern Iran from May 2001 to September 2020., Results: 248 patients were included in this study. The mean age at the operation was 8.47 ± 8.69 days. The most common site of involvement of MMC was Lumbosacral (86%, n = 204). At the evaluation conducted prior to the operation, cerebrospinal fluid leak was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients expired in the 30-day follow-up after the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission were wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). Only the site of the lesion (p-value = 0.035) was associated with postoperative complication. After controlling for potential confounders, the site of the lesion (adjusted odds ratio = 0.146, 95% confidence interval = 0.035-0.610, p-value = 0.008) and age at surgery (adjusted odds ratio = 1.048, 95% confidence interval = 1.002-1.096, p-value = 0.041) were significantly associated with mortality CONCLUSIONS: The age of the patients at the surgery and the site of the lesion are the two factors that were associated with mortality. However, further investigations into preoperative interventions and risk factors to mitigate the risk of complications and mortality are highly encouraged., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The current convention for treatment of children with myelomeningocele (MMC) is timely surgical intervention combined with long-term follow-up by a multidisciplinary specialized team. This study aims to investigate the outcomes of MMC patients treated at Namazi Hospital., Methods: All children presenting to Namazi Hospital with myelomeningocele between May 2001 and August 2020 were eligible for this study. For those with a documented telephone number, follow-up phone surveys with the patient's caregivers, on top of the review of the medical documents were carried out to assess mortality, morbidities, and the functional outcome of the care provided to them., Results: A total of 125 patients were studied (62 females). All of the patients were followed up for a mean duration of 6.28 years (range 1-23 years). The majority were located in the lumbosacral area. All of the patients underwent postnatal surgical intervention for MMC in Namazi Hospital. Mean age at surgery was 9.51 days. There were statistically significant differences between urinary and bowel incontinence and presence of scoliosis, MMT grading of the lower limbs, school attendance, number of readmissions, and requirement of laminectomy at the initial surgical intervention., Conclusions: This study is the first to characterize the long-term outcomes of MMC patients in Iran. This study illustrates that there is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term stages to improve morbidity and mortality., (© 2024. The Author(s).)

In patients affected by traumatic brain injury (TBI), hypofibrinogenemia within the initial hours of trauma can be expected due to vascular and inflammatory changes. In this study, we aimed to evaluate the effect of hypofibrinogenemia on the in-hospital mortality and 6-month functional outcomes of TBI patients, admitted to Rajaee Hospital, a referral trauma center in Shiraz, Iran. This study included all TBI patients admitted to our center who had no prior history of coagulopathy or any systemic disease, were alive on arrival, and had not received any blood product before admission. On admission, hospitalization, imaging, and 6-month follow-up information of included patients were extracted from the TBI registry database. The baseline characteristics of patients with fibrinogen levels of less than 150 mg/dL were compared with the cases with higher levels. To assess the effect of low fibrinogen levels on in-hospital mortality, a uni- and multivariate was conducted between those who died in hospital and survivors. Based on the 6-month GOSE score of patients, those with GOSE < 4 (unfavorable outcome) were compared with those with a favorable outcome. A total of 3049 patients (84.3% male, 15.7% female), with a mean age of 39.25 ± 18.87, met the eligibility criteria of this study. 494 patients had fibrinogen levels < 150 mg/dl, who were mostly younger and had lower average GCS scores in comparison to cases with higher fibrinogen levels. By comparison of the patients who died during hospitalization and survivors, it was shown that fibrinogen < 150 mg/dl is among the prognostic factors for in-hospital mortality (OR:1.75, CI: 1.32:2.34, P-value < 0.001), while the comparison between patients with the favorable and unfavorable functional outcome at 6-month follow-up, was not in favor of prognostic effect of low fibrinogen level (OR: 0.80, CI: 0.58: 1.11, P-value: 0.19). Hypofibrinogenemia is associated with in-hospital mortality of TBI patients, along with known factors such as higher age and lower initial GCS score. However, it is not among the prognostic factors of midterm functional outcome., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Consciousness assessment is crucial for patients with traumatic brain injury. In this study, we developed a novel scoring system combining the Glasgow coma scale (GCS) and the full outline of unresponsiveness (FOUR) and evaluated its association with the intensive care unit (ICU) length of stay, mortality, and functional outcome., Methods: We retrospectively analyzed the data from patients with traumatic brain injury admitted to the neurosurgical ICU of our institution during a 2-year period. The eye and motor components of the GCS and the brainstem reflex component of the FOUR were used to compute the GCS-FOUR. We performed statistical analysis to demonstrate the association between the GCS, FOUR, and GCS-FOUR and the ICU length of stay, mortality, the development of a persistent vegetative state, and desirable recovery., Results: A total of 140 patients were included. The mean age was 30.6 years, and 89.3% were male. All 3 scores were associated with the ICU length of stay, mortality, a persistent vegetative state, and good recovery. In terms of predicting mortality, the GCS score exhibited a slight superiority compared with the other indexes, and the GCS-FOUR score showed a slight superiority over the other indexes in predicting for good recovery., Conclusions: The GCS-FOUR is a novel scoring system comparable to the GCS and FOUR regarding its association with functional status after injury, ICU length of stay, and mortality. The GCS-FOUR score provides greater neurological detail than the GCS due to the inclusion of brainstem reflexes, in addition to using the experience of healthcare providers with the GCS score compared with the FOUR in most settings., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Major depressive disorder (MDD) is a common neuropsychiatric challenge that primarily targets young females. MDD as a global disorder has a multifactorial etiology related to the environment and genetic background. A balanced gut microbiota is one of the most important environmental factors involved in human physiological health. The interaction of gut microbiota components and metabolic products with the hypothalamic-pituitary-adrenal system and immune mediators can reverse depression phenotypes in vulnerable individuals. Therefore, abnormalities in the quantitative and qualitative structure of the gut microbiota may lead to the progression of MDD. In this review, we have presented an overview of the bidirectional relationship between gut microbiota and MDD, and the effect of pre-treatments and microbiomebased approaches, such as probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and a new generation of microbial alternatives, on the improvement of unstable clinical conditions caused by MDD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Celiac disease (CD) as a chronic gluten-sensitive intestinal condition, mainly affects genetically susceptible hosts. The primary determinants of CD have been identified as environmental and genetic variables. The development of CD is significantly influenced by environmental factors, including the gut microbiome. Therefore, gut microbiome re-programming-based therapies using probiotics, prebiotics, postbiotics, gluten-free diet, and fecal microbiota transplantation have shown promising results in the modification of the gut microbiome. Due to the importance and paucity of information regarding the CD pathophysiology, in this review, we have covered the association between CD development and gut microbiota, the effects of infectious agents, particularly the recent Covid-19 infection in CD patients, and the efficacy of potential therapeutic approaches in the CD have been discussed. Hence, scientific literature indicates that the diverse biological functions of the gut microbiota against immunomodulatory responses have made microbiome-based therapy an alternative therapeutic paradigm to ameliorate the symptoms of CD and quality of life. However, the exact potential of microbiota-based techniques that aims to quantitatively and qualitatively alter the gut microbiota to be used in the treatment and ameliorate the symptoms of CD will be determined with further research in the future.

To present the outcomes and adverse events associated with the endoscopic-assisted, minimally invasive suturectomy in patients with multisuture synostosis. This retrospective cohort study included children < 65 days of age who underwent endoscopic-assisted suturectomy (EAS) for multisuture craniosynostosis at a single tertiary referral center from 2013 to 2021. The primary outcome was calvarial expansion, and the secondary outcome was adverse events. The pre- and post-operative 3-dimensional brain computed tomography (CT) scan was used to calculate the intracranial volume and cephalic index. During a period of 2 years, 10 infants (10-64 days) diagnosed with multisuture synostosis underwent single-stage EAS of every affected suture in our center. The coronal suture was the most prevalent involved suture among our cases. The mean age and weight of the patients were 39 ± 17.5 days and 4.39 ± 0.8 kg, respectively. The surgical procedure took 42 ± 17.4 min of time and caused 46 ± 25.4 mL of bleeding on average. Ninety percent of the operations were considered successful (n = 9) regarding calvarial expansion. There were two complications, one requiring an open vault surgery and one repairing a leptomeningeal cyst. In the eight patients who did not necessitate further interventions, the mean pre-operative intracranial volume was 643.3 ± 189.4 cm 3 . The follow-up results within the average of 38.9 months after surgery showed that as age increases, the intracranial volume also increased significantly (R: 0.6, P < 0.0001), which suggests continued skull growth in patients who underwent EAS. With the low rate of intra- or post-operative complications and promising results on revising the restricted skull sutures, EAS seems both a safe and effective therapeutic modality in patients with multisuture synostosis, especially if completed in the first months after birth., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)