Harnessing the power of mollusc lectins as immuno-protective biomolecules.

The rapid advancement of molecular research on macromolecules has contributed to the discovery of 'Lectin', a carbohydrate-binding protein which specifically interacts with receptors on the surface of glycans and regulates various cellular activities thereby stimulating immunological functions. Considering the wide variety of sources and immunological significance, research has led to the discovery of lectins in invertebrate molluscs. Such lectins in molluscs mediate active immune response as they lack adaptive immunity. Phylum Mollusca is identified with different types of lectins such as C-lectin, Galectin, P-lectin, I-lectin, and H-lectin, along with other immunologically significant lectin molecules such as F- lectin, R-lectin, ficolins, chitinase like lectin etc., all of these with specific ligand binding and structural diversity. Molluscan C-type lectins are the most functional ones that increase the activity of phagocytic cells through specific carbohydrate binding of antigenic ligands and haemocyte adhesion thereby enhancing the immune response. Helix pomatia agglutinin and Helix aspersa agglutinin are the two H-lectins that were identified within molluscs that could even target cancer-progressing cells through specific binding. Also, these lectins identified in molluscs are proven to be efficient in antibacterial and immunomodulatory functions. These insights attract researchers to identify novel lectins in molluscs and their characterization that play a key role in protection against diseases. This review discusses the structural features of mollusc lectins, their specific binding, molecular interactions and their immunological applications.

Comment on, "Decoding pediatric spinal tumors: a single-center retrospective case series on etiology, presentation, therapeutic strategies, and outcomes".

The article "Decoding pediatric spinal tumors: a single-center retrospective case series on etiology, presentation, therapeutic strategies, and outcomes" by Lenga et al. (2024) provides essential insights into pediatric spinal tumors, a rare and challenging area of medical research. The authors present a thorough analysis of clinical presentations, treatment strategies, and patient outcomes, offering valuable data to refine therapeutic approaches and improve outcomes. However, the study's retrospective design, confined to a single center, introduces potential biases and limits the generalizability of findings. The lack of long-term follow-up data and a control group further restricts the study's scope. Future research should prioritize multi-center collaborations, incorporate control groups, and extend follow-up durations to better understand long-term outcomes. The establishment of standardized treatment protocols is also recommended to enhance consistency in managing pediatric spinal tumors across diverse clinical settings.

Comment on, "Hypoxia preconditioning protects neuronal cells against traumatic brain injury through stimulation of glucose transport mediated by HIF-1α/GLUTs signaling pathway in rat".

Wu et al. (2021) investigated the neuroprotective effects of hypoxia preconditioning (HPC) in a rat model of traumatic brain injury (TBI). The study demonstrated that HPC enhances brain resilience to TBI by upregulating glucose transporters GLUT1 and GLUT3 through the HIF-1α signaling pathway. Comprehensive molecular and histological analyses confirmed increased expression of these transporters, correlating with reduced neuronal apoptosis and cerebral edema. The robust methodology, including rigorous statistical validation and time-course assessments, underscores HPC's potential therapeutic role in mitigating neuronal loss and improving glucose transport post-injury. However, the study could be strengthened by incorporating additional preconditioning controls, comparative analyses with other neuroprotective strategies, and exploring downstream metabolic effects in greater detail. Furthermore, expanding the research to include diverse animal models and examining sex-dependent responses would enhance the generalizability and translational relevance of the findings. Future studies should also integrate metabolic flux analysis and advanced imaging techniques to further elucidate HPC's mechanisms of action.

Comment on, "Expression of decitabine-targeted oncogenes in meningiomas in vivo".

The study by Canisius et al. (2022) explores the expression of decitabine-targeted oncogenes (TRIM58, FAM84B, ELOVL2, DIO3) in meningiomas, aiming to evaluate decitabine's therapeutic potential for high-grade tumors. Using immunohistochemical staining and RT-PCR in over 100 patient samples, the authors found significant correlations between oncogene expression and tumor grade, with elevated ELOVL2 levels being linked to tumor recurrence. This work highlights the role of decitabine in modulating oncogene expression and suggests its potential in treating refractory meningiomas. Despite the robust methodology, limitations such as the small sample size and the lack of comprehensive molecular data were noted. Future research should incorporate larger sample sizes and advanced genomic techniques like RNA sequencing to better understand oncogenic mechanisms. The study emphasizes the need for further in situ analyses of decitabine's efficacy, setting the foundation for future neuro-oncological treatments.

Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

The article by Liu et al. (2024) investigates the progression of ossification of the posterior longitudinal ligament (OPLL) in 29 patients post-cervical laminoplasty. The study meticulously tracks transverse and longitudinal OPLL progression, providing crucial insights into surgical planning and patient outcomes. While the research design is commendable, reliance on X-ray imaging limits precision compared to CT or MRI scans. The sample size, though adequate for initial findings, may not fully capture OPLL variability, and the follow-up period could be extended to better assess long-term outcomes. Future studies should incorporate advanced imaging techniques, larger cohorts, and patient-reported outcomes to enhance the understanding of OPLL progression, thereby refining surgical strategies and improving personalized care for OPLL patients.

Comment on, "Survival prediction of glioblastoma patients-are we there yet? A systematic review of prognostic modeling for glioblastoma and its clinical potential".

The article "Survival Prediction of Glioblastoma Patients-Are We There Yet? A Systematic Review of Prognostic Modeling for Glioblastoma and Its Clinical Potential" by Tewarie et al. (2024) critically examines the current landscape of prognostic models for glioblastoma, highlighting both advancements and challenges in their clinical application. Through a systematic review adhering to PRISMA guidelines, the authors synthesize findings from diverse studies, shedding light on the variability in model performance and the obstacles to clinical implementation. Despite these contributions, the review faces limitations due to the heterogeneity of the studies included, which complicates definitive conclusions. The authors emphasize the need for external validation and standardization, though further exploration of the persistence of these challenges and the biases in machine learning models is warranted. Future research should focus on standardizing protocols and integrating ethical considerations to enhance the clinical utility of these models, moving the field closer to practical application.

Comment on, "Creactive protein levels, the prognostic nutritional index, and the lactate dehydrogenasetolymphocyte ratio are important prognostic factors in primary central nervous system lymphoma: a singlecenter study of 223 patients".

This study by Zuo et al. (2024) investigates the prognostic significance of C-reactive protein (CRP) levels, the prognostic nutritional index (PNI), and the lactate dehydrogenase-to-lymphocyte ratio (LLR) in primary central nervous system lymphoma (PCNSL) using data from 223 patients. The research demonstrates that these markers are critical in predicting patient outcomes, offering novel insights beyond traditional prognostic models like the MSKCC and IELSG scores. Despite its strengths, the study's retrospective design and lack of validation cohort limit its generalizability. Future research should focus on validating these findings in diverse, multicenter settings and integrating these markers with existing prognostic models to improve clinical decision-making. Longitudinal studies and advanced statistical methods are recommended to further explore the interactions between these factors and their impact on patient outcomes, potentially leading to the development of targeted therapies for PCNSL.

Comment on, "Longterm outcome and quality of life after CNS cavernoma resection: eloquent vs. noneloquent areas".

The study titled "Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas," by Shoubash et al. (2022) provides crucial insights into the long-term neurological outcomes and quality of life (QoL) in patients following CNS cavernoma resection. Differentiating between eloquent and non-eloquent areas, the study shows that patients generally experience non-inferior QoL, with some differences in physical role functioning. Utilizing the Short Form-12 (SF12) questionnaire at a mean follow-up of 6.5 years, the study's findings are significant for clinical decision-making and patient counseling. However, the study's small sample size and retrospective design limit its generalizability and introduce potential biases. The lack of preoperative QoL assessments further constrains its conclusions. Future research should focus on larger, prospective studies with comprehensive QoL metrics and longitudinal follow-up to better understand the impact of surgery on patient outcomes and improve clinical strategies.

Comment on, "Superb microvascular ultrasound is a promising non-invasive diagnostic tool to assess a ventriculoperitoneal shunt system function: a feasibility study".

This study by Brawanski et al. (2024) contributes significantly to neurosurgery by assessing ventriculoperitoneal shunt (VPS) function using superb microvascular ultrasound (SMI). The authors provide a thorough evaluation of SMI as a novel, non-invasive diagnostic tool, demonstrating its effectiveness in detecting cerebrospinal fluid (CSF) flow within VPS systems. By focusing on asymptomatic hydrocephalus patients, the study offers a less invasive alternative to traditional diagnostic methods, potentially reducing the need for exploratory surgeries. However, the study could have been strengthened by exploring the variability of SMI measurements under different physiological conditions and including symptomatic patients. Additionally, further analysis of the long-term reliability of SMI is needed. Future research should expand the study's scope to assess SMI's diagnostic capabilities across varied conditions and explore its integration with other non-invasive techniques, thereby enhancing its clinical utility in managing hydrocephalus and VPS functionality.

Comment on, "A randomized controlled trial of social media promotion in neurosurgical publishing".

The study titled "A randomized controlled trial of social media promotion in neurosurgical publishing" by Vieli et al. (2024) evaluates the impact of social media on citation counts, website visits, and PDF downloads in neurosurgical publishing. Through a rigorous randomized controlled trial, the authors provide valuable insights into the influence of social media in academia, an area with limited prior research. Despite the study's strong design, the modest social media intervention-limited to a single Twitter/X post per article-may have contributed to the lack of significant differences observed between the intervention and control groups. The study also did not account for engagement levels across different platforms or follower counts, limiting its generalizability. Future research should explore more intensive, multi-platform promotion strategies, and consider the influence of follower engagement. Expanding research to other medical fields would help to confirm the broader applicability of these findings.

Comment on, "Interleukin-6 as a prognostic biomarker of clinical outcomes after traumatic brain injury: a systematic review".

The study by Ooi et al. (2022) systematically reviews the potential of Interleukin-6 (IL-6) as a prognostic biomarker for traumatic brain injury (TBI). By analyzing IL-6 levels in serum, cerebrospinal fluid (CSF), and brain parenchyma, the authors provide valuable insights into its role in predicting clinical outcomes. The study emphasizes the neuroinflammatory response and the mechanistic role of IL-6 in neuronal recovery, offering a strong rationale for its consideration as a biomarker. However, variability in IL-6 detection methods and timing of sample collection across studies highlights the need for standardization. Future research should focus on refining detection methods, exploring IL-6's temporal dynamics post-TBI, and accounting for interactions with other cytokines. Additionally, advanced statistical controls are recommended to better isolate IL-6's prognostic value. This research lays a solid foundation for future studies aimed at improving clinical prognostication in TBI.

Comment on, "Increased expression of ephrin A1 in brain arteriovenous malformation: DNA microarray analysis".

This study by Sasahara et al. explores the role of ephrin A1 in brain arteriovenous malformations (AVM) using DNA microarray analysis, quantitative real-time RT-PCR, and immunohistochemistry. The research identifies significant upregulation of ephrin A1 in AVM, suggesting its potential involvement in the abnormal vascular architecture characteristic of this condition. The study's innovative methodology and thorough exploration of gene expression patterns contribute valuable insights into AVM pathogenesis, highlighting ephrin A1 as a potential therapeutic target. However, the study's limitations include clinical variability among patient samples and the use of draining veins as controls, which may affect the robustness of the findings. Future research should address these limitations by using more homogeneous samples and expanding the investigation to include other ephrin family members. This could provide a broader understanding of ephrin signaling in AVM and guide the development of targeted therapies.

Comment on - "Access to Meckel's cave for biopsies of indeterminate lesions: a systematic review".

Accessing Meckel's cave for biopsies of indeterminate lesions presents significant surgical challenges. This systematic review evaluates various approaches, with a focus on minimally invasive endoscopic techniques. A review of 75 studies reveals that the endoscopic endonasal transpterygoid approach offers improved visualization, reduced morbidity, and favorable outcomes, as demonstrated by an illustrative case of diffuse large B-cell lymphoma. While promising, further studies are needed to assess long-term efficacy and patient outcomes, and comparative research between endoscopic and traditional approaches is recommended for future investigation.

Leveraging tardigrade proteins Dsup and CAHS D for enhanced neural protection in neurosurgery and neuroscience.

Tardigrades are microscopic organisms known for their remarkable resilience to extreme environmental conditions, including radiation and desiccation. Two key proteins, Dsup (Damage suppressor protein) and CAHS D (Cytoplasmic Abundant Heat Soluble protein D), play crucial roles in this resilience. Dsup protects DNA from radiation-induced damage, while CAHS D stabilizes cellular structures during desiccation by interacting with, but not retaining, water. These unique mechanisms have significant potential applications in neurosurgery and neuroscience. Dsup could inspire the development of protective agents for neural tissues during radiation-based treatments, minimizing collateral damage and improving patient outcomes. Meanwhile, CAHS D's stabilization properties could lead to new neuroprotective strategies, safeguarding brain cells under stress. Together, these tardigrade proteins offer innovative solutions for enhancing neural protection, opening new avenues for treating neurological conditions and improving the safety and efficacy of neurosurgical procedures.

Comment on - "The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review".

This systematic review examines the impact of the COVID-19 pandemic on global neurosurgical education, with a focus on the disparities between low- and middle-income countries (LMICs) and high-income countries (HICs). The study analyzes 26 articles, highlighting significant disruptions in neurosurgical training, including reduced surgical exposure and a transition to online learning. LMICs faced greater challenges, including limited access to virtual education and increased financial insecurities for trainees. Despite these setbacks, advancements in virtual technology provided new educational opportunities. The review underscores the need for continued innovation, particularly in cost-effective, immersive technologies, to bridge the gap in surgical training and enhance resilience for future crises.

Comment on - "Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach-surgical strategies, complications, and their avoidance".

Pineal cysts without hydrocephalus present a clinical dilemma, as surgical indications remain controversial. This study evaluates 73 patients who underwent microsurgical resection of pineal cysts via an infratentorial-supracerebellar (SCIT) approach, focusing on surgical strategies, complications, and outcomes. With a follow-up period averaging 26.6 months, 89% of patients reported significant symptom improvement, particularly in headache, visual disturbances, and dizziness. Total cyst resection was achieved in 95% of cases, with minimal complications. The findings suggest that microsurgical resection can provide marked relief in carefully selected patients, even in the absence of ventriculomegaly. Future studies should focus on randomized comparisons between surgical and conservative approaches and explore long-term outcomes.

Comment on - "Simulation training approaches in intracranial aneurysm surgery-a systematic review".

With the increasing complexity of intracranial aneurysm surgery and the reduced opportunities for hands-on training, there is a need for effective simulation-based training methods. This systematic review examines 26 studies on various simulation training approaches for intracranial aneurysm clipping, including ex vivo methods, virtual reality platforms, and 3D-printed models. The review evaluates these methods based on their effectiveness, realism, usability, and validation, highlighting that current simulation models are heterogeneous and lack standardization. Most existing simulations fail to replicate the complete microsurgical workflow, and their validation methods vary widely, limiting generalizability. The review recommends developing a standardized, comprehensive, and cost-effective simulation model that incorporates advanced haptic feedback and detailed anatomical features. Future research should focus on creating a universal validation framework to reliably assess simulation efficacy and ensure that neurosurgical trainees receive consistent, high-quality training experiences.

Comment on - "Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description".

Transorbital endoscopic approaches (TEAs) are emerging as effective techniques for accessing the skull base while minimizing morbidity. This systematic review and anatomical study evaluate TEAs' feasibility and safety by analyzing 42 studies and performing cadaveric dissections. TEAs offer promising access to anterior and middle cranial fossae with reduced invasiveness compared to traditional methods. The study highlights key anatomical landmarks and corridors for successful TEA application. While TEAs demonstrate potential, further clinical studies are needed to assess long-term outcomes, optimize techniques, and compare them with other minimally invasive approaches.

Letter to Editor, "The effects of dabrafenib and/or trametinib treatment in Braf V600mutant glioma: a systematic review and metaanalysis".

This systematic review and meta-analysis evaluates the effects of dabrafenib and/or trametinib in treating BRAF V600-mutant gliomas. The study analyzed eight trials involving both high-grade and low-grade glioma patients, assessing outcomes such as progression-free survival (PFS), overall survival (OS), adverse events (AEs), and disease response. The pooled results showed a median PFS of 6.10 months and OS of 22.73 months, with notable improvement in disease response rates when using combination therapy. However, the high incidence of AEs (50%) and death events (43%) necessitates caution in interpreting these results. The study's limitations include a lack of randomized controlled trials and high heterogeneity in AE data. Future research should focus on larger, controlled studies, standardized AE assessments, and exploration of neurocognitive outcomes to better understand and optimize treatment strategies for BRAF V600-mutant gliomas.

Comment on, "T2-FLAIR mismatch sign, an imaging biomarker for CDKN2A-intact in non-enhancing astrocytoma, IDH-mutant".

The study by Onishi et al. (2024) investigates the correlation between the T2-FLAIR mismatch sign and CDKN2A status in non-enhancing astrocytoma, IDH-mutant. Through the use of radiological and molecular pathological analyses, the research explores the potential of T2-FLAIR mismatch as an imaging biomarker for predicting CDKN2A-intact astrocytomas. Immunohistochemical staining and next-generation sequencing were employed to confirm molecular diagnosis, enhancing the study's robustness. While the findings contribute significantly to preoperative diagnostics and treatment planning, limitations exist. The relatively small sample size (31 patients) and exclusion of gadolinium-enhancing astrocytomas may restrict the generalizability of the results. Additionally, variation in imaging protocols and the retrospective nature of the study limit the overall impact. Future research with a larger cohort, standardized imaging protocols, and a prospective design is recommended to validate the clinical utility of T2-FLAIR mismatch in differentiating CDKN2A status in astrocytomas.