The effect of Centella asiatica, cinnamon, and spirulina as neuroprotective based on histopathological findings in ratus Sprague Dawley with traumatic brain injury.

Background: Traumatic brain injury (TBI) is a global health problem with the potential to cause dangerous neurological problems. Based on histopathological findings in Sprague Dawley (SD) rats with TBI in the acute phase, the study seeks to discover the effect of Centella asiatica, cinnamon, and spirulina as neuroprotective. Methods: We conducted an experimental study with 30 SD rats randomly divided into three groups. The intervention was the administration of C. asiatica, cinnamon, and spirulina to the control and the experimental groups. Histological features were assessed using hematoxylin and eosin (H&E) staining and immunohistochemical examination. The data were analyzed using statistical analysis through correlation tests. Results: The test samples' average body weights had P > 0.05, indicating no significant difference in the test sample body weights. Therefore, the variations in the expression level of the dependent variable were expected to be caused by the induction of brain injury and the administration of C. asiatica, cinnamon, and spirulina. In addition, the variables were not normally distributed. Thus, the Spearman test was carried out and showed the correlation was very strong, with a value of r = 0.818 and P < 0.05. Conclusion: Based on histopathological findings from the brains of SD rats with TBI, pegagan, cinnamon, and spirulina will protect the brain (neuroprotective) in the acute phase.

The role of preoperative hematological inflammatory markers as a predictor of meningioma grade: A systematic review and meta-analysis.

Background: Inflammatory processes play an important role in the aggressiveness of a tumor. However, the relationship between inflammatory markers in meningioma grade is not well known. Knowledge of preoperative meningioma grade plays an important role in the prognosis and treatment of this tumor. This study aims to assess preoperative hematological inflammatory markers as a predictor of the pathological grade of meningioma. Methods: To ensure comprehensive retrieval of relevant studies, we searched the following key databases, PubMed, Science Direct, and Biomed Central, with evidence related to preoperative hematological inflammatory markers among meningioma up to September 2023. The studies involved were selected based on established eligibility criteria. The analysis in this study uses Review Manager 5.4. Results: Six studies were obtained from the search results. The total number of patients 2789 (469 high-grade meningioma and 2320 low-grade meningioma) analysis shows elevated neutrophil-to-lymphocyte ratio (NLR) (mean difference [MD]: 0.29; 95% confidence interval [CI] 0.13-0.45; P = 0.0004), monocyte-to-lymphocyte ratio (MLR) (MD: 0.02; 95% CI 0.00-0.04; P = 0.003), and low lymphocyte-to-monocyte ratio (LMR) (MD: -0.82; 95% CI -1.46--0.18; P = 0.005) significantly associated with high-grade meningioma compared to low-grade meningioma. No significant correlation between high-grade and low-grade meningioma based on platelet-lymphocyte ratio value is observed. Conclusion: The parameters of NLR, MLR, and LMR have been found to be cost-effective preoperative methods that demonstrate potential value in the prediction of meningioma grade. To enhance the reliability of the findings, it is imperative to do further prospective study.

Effects of Moleac 901 after severe spinal cord injury on chronic phase in Wistar rats.

Background: MLC901 is a phytopharmaceutical comprising significant compounds that can induce microenvironments conducive to the proliferation and specialization of neural cell progenitors. This study investigates the impact of administering MLC901, reducing the expression of NG2 and caspase-3 and increasing IL-10 levels, as well as histopathological and motor function, after severe spinal cord injury (SCI) in the chronic phase. Methods: The study employed a randomized post-test-only control group design conducted between February and April 2023 at the Integrated Biomedical Laboratory. The participants in this study were categorized into three distinct groups: normal control, negative control, and therapy. A cohort of 18 rats was utilized for the study, with each group assigned a random allocation of six rats as subjects. Results: The findings demonstrated a statistically significant disparity in the average NG2 expression (-52.00 ± 20.03; p ≤ 0.05), as well as Caspase-3 expression (-94.89 ± 8.57; p ≤ 0.05), which exhibited a lower magnitude. The levels of IL-10 (8.96 ± 3.98; p ≤ 0.05) were observed to be higher, along with an elevation in BBB score (7.67 ± 0.89; p ≤ 0.05), which was more pronounced in the treatment group compared to the negative control group. The cut-off point for cavitation diameter is determined to be 114.915 µm, exhibiting a sensitivity and specificity of 100%. The area under curve (AUC) value is 1.0. The administration of MLC901 demonstrated a strong positive correlation with the increase in IL-10 levels (B 8.968; p ≤ 0.05), as well as a substantial negative correlation with the decrease in Caspase-3 expression (B -52.000; p ≤ 0.05) and NG2 expression (B -94.892; p ≤ 0.05). The administration of MLC901 via the upregulation of NG2 and Caspase-3 significantly increased the Basso, Beattie, and Bresnahan (BBB) scores. Conclusions: MLC901 positively affects motor and histopathological outcomes in the chronic phase of severe SCI in the Wistar rat model. These benefits are believed to be achieved by suppressing gliosis, neuroapoptosis, and neuroinflammation processes.

The Impact of Machine Learning and Robot-Assisted Gait Training on Spinal Cord Injury: A Systematic Review and Meta-Analysis.

INTRODUCTION: Spinal cord injury (SCI) is a significant and transforming event, with an estimated annual incidence of 40 cases per million individuals in North America. Considering the significance of accurate diagnosis and effective therapy in managing SCI, Machine Learning (ML) and Robot-Assisted Gait Training (RAGT) technologies hold promise for enhancing optimal practices and elevating the quality of care. This study aims to determine the impact of the ML and RAGT techniques employed on the outcome results of SCI. METHODS: We reviewed four databases, including PubMed, Scopus, ScienceDirect, and the Cochrane Central Register of Controlled Trials (CENTRAL), until 20 August 2023. The keywords used in this study encompassed the following: a comprehensive search was executed on research exclusively published in the English language: machine learning, robotics, and spinal cord injury. RESULTS: A comprehensive search was conducted across four databases, identifying 2367 articles following rigorous data filtering. The results of the odd ratio (OR) and confidence interval (CI) of 95% for the ASIA Impairment Scale, or AIS grade A, were 0.093 (0.011-0.754, p = 0.026), for AIS grade B, 0.875 (0.395-1.939, p = 0.743), for AIS grade C, 3.626 (1.556-8.449, p = 0.003), and for AIS grade D, 8.496 (1.394-51.768, p = 0.020). The robotic group exhibited a notable reduction in AS (95% CI = -0.239 to -0.045, p = 0.004) and MAS (95% CI = -3.657 to -1.066, p ≤ 0.001) measures. This study also investigated spasticity and walking ability, which are significant. CONCLUSIONS: The ML approach exhibited enhanced precision in forecasting AIS result scores. Implementing RAGT has been shown to impact spasticity reduction and improve walking ability.

Particular Surgical Technique for Transorbital-Penetrating Craniocerebral Injury Inflicted by a Screwdriver: Technical Case Report.

Surgical techniques for non-missile penetrating brain injuries (PBI) are challenging because they require good preoperative planning. Generally, extraction is performed ipsilaterally at the entry site. In certain cases, the extraction can be performed contralaterally through the inner end of the foreign body; however, this requires special consideration. We present a case report of a patient who had a stab wound on the head via a screwdriver and underwent surgery, during which extraction was performed contralaterally through the inner end of the screwdriver without inducing any neurological deficit. Careful preoperative planning and surgical technique modification are required to minimize morbidity and mortality in patients with PBIs.

Purely extradural thoracal Schwanoma: Case report.

Introduction: and importance. Schwannomas are benign tumors that often occur in the medulla spinalis. It arises from the Schwann cells which form the sheath of peripheral nerves. Schwannomas comprise about 30% of primary intraspinal neoplasms and approximately 75% in intradural, 10% intra-extradural, and 15% extradural. Purely extradural schwannoma is rare. Case presentation: We present two adult males with extradural thoracal schwannoma. In this case, the main complaint is paraparesis and followed by suffered low back pain and spastic. The initial symptoms of this tumor depend on the level of the tumor location. Usually begins with localized pain, sharp and transient, followed by radicular pain and radiculopathy. We reported cases of schwannoma of the thoracal spine that have presented with neurological involvement. As a result of contrast, an MRI of the spine showed tumor extradural mass lesion extending from thoracal 1-2 vertebral and thoracal 4-6 vertebral level. Clinical discussion: The location of this tumor is rare because located in the extradural (15%), which are present between the bone structure and the dura. Surgery is the treatment of choice, in this case, usually results from excellent prognostic. This patient underwent hemilaminectomy and complete surgical resection. Conclusion: Early diagnostic and complete surgical resection before the occurrence of severe symptoms will show an excellent prognosis.

Effect of MLC901 on MIR30C-5P expression, TGF-Β expression, VEGF receptor expression, degree of axon demyelination and changes in neuropathic pain behaviour in experimental animals experiencing neuropathic pain with circumferential spinal stenosis method.

Neuropathic pain is a major problem whose pathogenesis is not known yet, which makes it difficult to treat. Effective treatment of neuropathic pain usually uses multimodal therapy that takes a long time but causes major health problems, which are commonly found in women over 50 years of age and are generally caused by lumbar radiculopathy due to lumbar spinal stenosis. The narrowing of the spinal canal resembles an ischemic condition that can increase the expression of VEGF in the dorsal root ganglion and then result in shortened walking distance (intermittent claudication). The effect of VEGF is thought to be through binding to VEGFR1 and VEGFR2, whose levels are increased in conditions of hyperalgesia and neuropathic pain. Immune mechanisms play a role in the pathogenesis of neuropathic pain, through the balanced process of pro-inflammatory cytokines and anti-inflammatory cytokines, TGF-ß, which are immunosuppressive. MLC901 is a simplified traditional medicine formula from MLC601, which affects the nervous system through three main mechanisms, namely neuroprotection, neuro-regeneration and neuro-restoration. Elevated levels of MLC901 promote angiogenesis. This review discusses the effect of MLC901 on miR30c-5p expression, TGF-ß expression, VEGF receptor expression, degree of axon demyelination and changes in neuropathic pain behaviour in experimental animals experiencing neuropathic pain using the circumferential spinal stenosis method. These findings may provide new targets for further scientific research on the molecular mechanisms of neuropathic pain and potential therapeutic interventions.

Treatment of bone defects with bovine hydroxyapatite xenograft and platelet rich fibrin (PRF) to accelerate bone healing.

INTRODUCTION: The autograft treatment has become a gold standard therapy for bone defects, although it has its drawbacks and a side effect of donor site morbidity. Furthermore, the bovine hydroxyapatite xenograft due to its excellent osteoconduction characteristic combined with platelet-rich fibrin (PRF), which is a source of growth factor, makes both utilized as therapeutic measures. Therefore, this study examines the potential use of bovine hydroxyapatite xenograft and platelet-rich fibrin in the treatment of bone defects. METHOD: The report on three cases of bone defects that were treated using a combination of bovine hydroxyapatite xenograft and platelet-rich fibrin (PRF) for internal fixation and grafting was used for this investigation. The study showed that delayed and non-union fractures of the femur, humerus, and tibia may cause bone deformities. RESULT: The outcome revealed a positive clinical and radiological finding about using the combination of bovine hydroxyapatite xenograft and platelet-rich fibrin (PRF) in the repair of bone defects and acceleration of healing processes. CONCLUSION: The use of a combination of bovine hydroxyapatite xenograft and platelet-rich fibrin (PRF) in the repair of bone defects shows more effective and accelerated healing. Future studies with a bigger sample size may be carried out and are expected to yield optimal results.

Bacterial infection and antibiotic resistance pattern in open fracture cases in Indonesia.

Background: The annual incidence of open fracture in Dr Soetomo Hospital, East Java were 400 cases with chronic infection complications exist in 14% (57 cases). A previous study in this hospital shows the resistance rate of Pseudomonas towards cefazolin and amikacin was 100% and 15%, respectively. The objective of this study was to identify bacterial infection type and antibiotic resistance pattern in infection caused by the open fracture. Methods: This was an analytic cross-sectional study. Samples were collected from three debridement surgery sites in Mataram Hospital, Mataram University Hospital, and Islamic Mataram Hospital from September 2019 until October 2020. Specimens from wound infection were cultured, and an antibiotic sensitivity test was performed. Results: Approximately 213 samples were analyzed in this study, comprising open fracture grade 3A (45%) and 3B (39%). The majority of fractures were lower extremity fractures (62%). Bacterial infection were found in 35% cases (80 isolates) in which 62,5% (50 isolates) were gram-positive bacteria and 37,5% (30 isolates) were gram-negative bacteria. Infection in open fracture was equivalent to grading. The predominant bacterial infection was caused by gram-positive bacteria, including Staphylococcus aureus and Staphylococcus negative coagulase. Gram-positive bacteria were sensitive towards Cepoferazone, Sulbactam and Ofloxacin, whereas gram-negative bacteria remains sensitive against Doxicyclin and Amicasin. Conclusion: Infection in open fracture was equivalent with the grade, and gram-positive were predominantly sensitive with cefoperazone sulbactam.

The role of MLC901 in reducing VEGF as a vascular permeability marker in rats with spinal cord injury.

Background: Damaged neural tissue caused by SCI could induce vascular endothelial growth factor (VEGF) that can worsen the condition in the late phase by increasing vascular permeability, thus inducing tissue oedema, which can worsen the infarction. MLC 901 has been widely used in Asia for stroke patients because its mechanism is known to down-regulate VEGF levels in ischemic tissue. Methods: Ten Sprague-Dawley rats were used in this experiment. To create a severe spinal cord injury in animal models. The animals were then randomly divided into two groups. MLC 901 was given to the first group, which was the intervention group, and placebo to the second group, which was the control group. Results: This study showed a decrease in the mean VEGF mRNA expression in the group given MLC 901 compared to the control group, which had a very high mean VEGF mRNA expression starting after 1 h of administration of MLC 901 until day 14 after spinal cord injury. In addition, there was a decrease in VEGF levels in the MLC 901 group compared to the control group from 3 h after spinal cord injury (1 h after MLC 901 administration) to 14 days after spinal cord injury. Conclusion: It can be concluded that administration of MLC 901 can reduce vascular permeability, one of the mechanisms that is thought to occur is to reduce VEGF levels. MLC 901 also maintains the neuroprotective effect provided by VEGF by maintaining this level above the basal level until day 14.

The effect of progesteron for expression delta (δ) opioid receptor spinal cord through peripheral nerve injury.

BACKGROUND: Neuropathic pain is a major problem to date because of its high prevalence and lack of effective treatment. Neuropathic pain processes can be influenced by many factors and at various levels of the nervous system, including progesterone and the opioid system. The various mechanisms of the effect of progesterone on pain are still controversial, while the effect of progesterone on the activation of the opioid system also needs to be proven. This study aimed to determine the effect of progesterone on pain through the modulation mechanism of the opioid system. METHODS: This research is a completely randomized experimental study using male wistar rats aged around three months at the Experimental Animal Laboratory, Department of Medical Biochemistry, Faculty of Medicine, Airlangga University. RESULTS: The result was analyzed by using statistical analysis of two independent samples (t-test). The t value was obtained at 6.880, p = 0.000 (p < 0.05). CONCLUSION: It was shown that there was a significant difference in the delta (δ) opioid receptor expression between the control group and the progesterone group, which indicated that progesterone causes an increase in the delta (δ) opioid receptor expression in the spinal cord.

Exercise adaptations and TGF-ß1 levels in recreational cyclists.

BACKGROUND: Cycling is a physical exercise that is widely performed to improve physical fitness. Regular physical exercise will lead to adaptations to exercise. This adaptation is useful in suppressing the production of reactive oxygen stress (ROS) generated in response to cellular metabolism that uses oxygen. Transforming growth factor beta-1 (TGF-ß1) plays a role in increasing the production of ROS, thus, when the concentration is low, it would lead to an improvement in physical fitness. This study aims to compare levels of TGF-ß1 between recreational cyclists and sedentary groups. In addition, this research also compares several other parameters, which are fasting blood sugar levels and lipid profiles (triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol) between cyclists and sedentaries. METHODS: This was an observational analytical study with a cross-sectional design. The research subjects consisted of 2 groups, each consisting of 21 participants, namely the recreational cyclist and the sedentary group. Anthropometric examinations were carried out, including body weight, height, body mass index, waist circumference, and body fat percentage. Fasting blood glucose concentration and lipid profile (Triglyceride - TG, Total Cholesterol - Total C, HDL Cholesterol - HDL-C, and LDL Cholesterol - LDL-C) were determined by the enzymatic colorimetric methods, and TGF-ß1 levels were determined using the fluorescence of specific antibodies for TGF-ß1 (pg/ml) using ELISA method. Statistical analysis was performed using IBM SPSS v. 25. RESULTS: The anthropometric variables, other than body height, did not differ significantly between the two groups, so did the fasting blood glucose concentration. Nevertheless, the lipid profile (TG, Total C, HDL-C and LDL-C) were found to be significantly better in the cyclist group (p < 0.05).The mean level of TGF-ß1 in recreational cyclists was 8, 908.48 pg/ml, lower than the control group, 10, 229.28 pg/ml. The results of the unpaired t-test showed significant mean differences between the two groups, (p = 0.001; p < 0.05). CONCLUSION: The levels of TGF-ß1 in the recreational cyclist group were lower than the sedentary group. Regular physical exercise will trigger exercise adaptations that can suppress latent TGF-ß1 activation.

An extremely rare case: Transorbital penetrating intracranial injury by wooden foreign body. Case report.

INTRODUCTION AND IMPORTANCE: Transorbital Penetrating Intracranial Injury (TOPI) is a rare case, but those caused by Wooden Foreign Body are even challenging that may pose unusual diagnostic and surgical challenges. CASE PRESENTATION: we presented a TOPI following a wood penetrated to the left temporal fossa region via orbital roof due to struck the tree branches while got a motor vehicle accident. The patient was fully conscious with decreased visual acuity in the left eye and left ophthalmoplegia. Non-contrast CT scan showed the linear-shaped foreign body, air mimicking that penetrated medial orbit plane to the left temporal fossa. CLINICAL DISCUSSION: The surgery was performed with a temporobasal approach and revealed good results with only mild ophthalmologic complications without long-term fatal complications (1-year followed-up). CONCLUSION: early removal of wooden foreign body that penetrates to the intracranial via transorbital is mandatory and should be involved multidisciplinary approach to get the optimal result and avoid the fatal complication both neurologically or ophthalmologically.

Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon.

Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

The extent of distal intramural spread of colorectal cancer cell study of it's relationship with histological grading, stage of disease and CEA level.

BACKGROUND: The free margin of distal resection is an attempt to prevent local recurrence of the tumor and prolong survival. The recommended length of distal resection margin are varied among the researchers. This study was done to know the correlation between extents of distal intramural spread (DIS) and histology grading, stage and CEA levels of colorectal cancer. METHODS: The design of the study was a cross sectional. Sample was patients diagnosed with colon or rectal adenocarcinoma in the period of September 2017-March 2018 and underwent resection at Dr.Kariadi Hospital. Resected fresh tissue tumors were directly measured for the distal resection margin and histopathologic examination done by anatomical pathologists. This study has been approved by the ethics committee of Dr.Kariadi Hospital/Faculty of Medicine Diponegoro University. The relationship between DIS length to histology grading, tumor stage and CEA level were analyzed using Spearman's correlation test. RESULTS: The subjects of this study were 26 patients with colorectal cancer consisted of 15 men and 11 women. The average age of the patients was 53,04 years. The locations of the tumor were 17 in the rectum and 9 in the colon. The length DIS were between 1,07 and 11,49 mm. The longer DIS were occurred when the grading histology worsens, the tumor stage increases and the higher CEA levels with correlation coefficient were r = 0,77 (p < 0,001); r = 0,66 (p < 0,001) and r = 0,44 (p = 0,024) respectively. For the rectal location, the DIS length range were 0,28-10,36 mm. The longer DIS when grading histology worsens r = 0,59 (p = 0,012) and an increased tumor stage r = 0,73 (p = 0,001). The DIS length of the rectum was not proven to correlate with elevated CEA levels r = 0,14 (p = 0,588). CONCLUSION: Histological grading, tumor stage and CEA levels can be predictors of distal intramural spread (DIS) colorectal cancer. The strongest correlation were between DIS and histologic grading. Thus, in mid and lower third of the rectal cancer, the histologic grade examination is strongly recommended. Based on this study, it is recommended that in rectal cancer undergoing sphincter preserving surgery distal resection sould be more than 2 cm from the tumor margin.

Algorithm of traumatic brain injury management at Indonesia in the COVID 19 pandemic ERA. Retrospective cohort study.

OBJECTIVES: COVID-19, a global pandemic, affects neurosurgical care in Indonesia. This study has objective to propose guideline and algorithm recommendation for the management of TBI patients during this pandemic, which can be used flexibly at neurosurgery centers, both in Indonesia and throughout the world. METHODS: We performed retrospective Cohort analysis from TBI database at tertiary public general hospitals. All neurotrauma cases from mid-February until mid-August 2020 was included in this study. The chronology of COVID-19 pandemics impact in Indonesia was defined by early period from mid-February until end of May 2020, and late period are latter. All subjects undergone the screening and perioperative measures that based on our proposes scoring system and algorithm as follows. RESULTS: There are many guidelines that explain screening methods in neurosurgery patients in general, as well as neurotrauma in particular. But here, we proposed our own scoring and screening algorithm that has been developed based on conditions in Indonesia. In total of 757 neurotrauma cases data were collected from the pandemic starts in Indonesia. DISCUSSION: Screening is a crucial initial step in this pandemic period, not only for COVID patients, but also all patients who enter the emergency room. The use of PPE is a necessity in several neurosurgery centers, especially with high COVID-19 case rates. CONCLUSION: The management of neurotrauma patients with suspected and confirmed COVID-19 requires special attention, starting from admission of the patient in ER. Rapid scoring and screening are important and the highest level of PPE is mandatory during patient care.

P2X3 receptor expression in dorsal horn of spinal cord and pain threshold after estrogen therapy for prevention therapy in neuropathic pain.

INTRODUCTION: Neuropathic pain may arise from conditions that affecting the central or peripheral nervous system. This study was held to determine the difference P2X3 receptor expression in the dorsal horn of the spinal cord and pain threshold after estrogen therapy in neuropathic pain. METHODS: This study design was an experimental research laboratory. The 24 mice samples divided into negative control group, positive control, and treatment groups. The treatment groups were given subcutaneous injections of estrogen 0.4 ml and also examined for the onset of thermal hyperalgesia in every rat. On day 15, an autopsy was performed on rats, and the spine was taken. The spinal cord was stained by hematoxylin-eosin, and the expression of P2X3 receptors was investigated. P2X3 receptor expression was examined in the dorsal horn on each sample. RESULTS: From 24 subjects of the study revealed an increase in the onset of thermal hyperalgesia on the estrogen group compared with the placebo group, a higher start. This study also obtained a decrease in the expression of P2X3 on the therapy group compared to the positive control group with significant differences. Statistical test results revealed the appearance of the P2X3 estrogen group had a substantial difference with the placebo group (p = 0.000) and the mean of the negative control group (p = 0.030). The placebo group had a significant difference from the negative control group (p = 0.035). CONCLUSION: Estrogen could decrease the expression of P2X3 receptors and prolonged the onset of thermal hyperalgesia. So, both of these explained that estrogen has a role in preventing the occurrence of neuropathic pain after peripheral nerve lesions.

Progesterone Receptor Expression and Score Differences in Determining Grade and Subtype of Meningioma.

Background Meningioma is the most common brain tumor in which therapy and monitoring depend on the histopathological grade (World Health Organization [WHO] Grade). Progesterone receptor (PR) expression was reported positive in meningothelial cells and meningiomas with various degrees of positivity. We evaluated PR expression to determine its correlation with WHO Grade and each subtype of meningioma. Materials and Methods This study used 70 samples of paraffin block that were diagnosed as meningioma and classified into WHO Grade I, II, and III. The paraffin blocks were sectioned in 5 µm thickness and immunohistochemically stained with the anti-PR antibody. Results PR expression was found positive in WHO Grade I and II groups, but negative in WHO Grade III group with the score of +2 found in clear cell and atypical subtype. These results were statistically significant with p -value < 0.05. Conclusion PR can be used as an additional marker to determine WHO Grade and subtype of meningioma.

Role of MLC901 in increasing neurogenesis in rats with traumatic brain injury.

BACKGROUND: Traumatic brain injury is a dangerous life threatening condition. This study examines the role of MLC901 in increasing neurogenesis. The aim of this study was to demonstrate the role of MLC901 in increasing neuron cell (neurogenesis) in rat with traumatic brain injury using the synaptophysin marker. METHODS: The synaptophysin levels were measured as a marker for neuron cell (neurogenesis) of brain nerve cells in Sprague-Dawley rats aged 10-12 weeks, weighing 200-300 g. All rats (n = 10) were performed as traumatic brain injury using The Modified Marmourou Model, then they were divided into 2 group, one group was given MLC901 (n = 5) and the other group was not given MLC901 (n = 5). The synaptophysin levels in both groups were assessed after 6 weeks and also carried out an examination of immnuhistochemical from the brain tissue of both groups. RESULTS: There was an increase in the number of neuron cells as evidenced by synaptophysin ihc staining in the rats given MLC 901 (Neuroaid II) compared to those without MLC 901. Synaptophysin levels were lower in the control group than in the MLC 901 group (81.6, SD: 13.52 vs 118.4, SD: 12.198, p = 0.062). CONCLUSION: These research suggest that MLC901 can increase neurogenesis in traumatic brain injury and also appeared as synaptophysin antibody that binding to cytoplasm of neuronal cells in the rat brain.

The state of neurosurgical training and education in East Asia: analysis and strategy development for this frontier of the world.

OBJECTIVE: The authors, who are from Indonesia, Japan, Malaysia, the Philippines, and Taiwan, sought to illustrate the processes of training neurosurgeons in their respective settings by presenting data and analyses of the current state of neurosurgical education across the East Asian region. METHODS: The authors obtained quantitative data as key indicators of the neurosurgical workforce from each country. Qualitative data analysis was also done to provide a description of the current state of neurosurgical training and education in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was also done to identify strategies for improvement. RESULTS: The number of neurosurgeons in each country is as follows: 370 in Indonesia, 10,014 in Japan, 152 in Malaysia, 134 in the Philippines, and 639 in Taiwan. With a large neurosurgical workforce, the high-income countries Japan and Taiwan have relatively high neurosurgeon to population ratios of 1 per 13,000 and 1 per 37,000, respectively. In contrast, the low- to middle-income countries Indonesia, Malaysia, and the Philippines have low neurosurgeon to population ratios of 1 per 731,000, 1 per 210,000, and 1 per 807,000, respectively. In terms of the number of training centers, Japan has 857, Taiwan 30, Indonesia 7, Malaysia 5, and the Philippines 10. In terms of the number of neurosurgical residents, Japan has 1000, Taiwan 170, Indonesia 199, Malaysia 53, and the Philippines 51. The average number of yearly additions to the neurosurgical workforce is as follows: Japan 180, Taiwan 27, Indonesia 10, Malaysia 4, and the Philippines 3. The different countries included in this report have many similarities and differences in their models and systems of neurosurgical education. Certain important strategies have been formulated in order for the system to be responsive to the needs of the catchment population: 1) establishment of a robust network of international collaboration for reciprocal certification, skills sharing, and subspecialty training; 2) incorporation of in-service residency and fellowship training within the framework of improving access to neurosurgical care; and 3) strengthening health systems, increasing funding, and developing related policies for infrastructure development. CONCLUSIONS: The varied situations of neurosurgical education in the East Asian region require strategies that take into account the different contexts in which programs are structured. Improving the education of current and future neurosurgeons becomes an important consideration in addressing the health inequalities in terms of access and quality of care afflicting the growing population in this region of the world.