Murat Vural

Primary central nervous system lymphoma (PCNSL) is an aggressive malignancy for which early management decisions frequently occur within neurosurgical workflows prior to oncologic treatment. In this retrospective single-center study, we aimed to explore whether early neurosurgical workflow characteristics are associated with survival outcomes in patients with PCNSL. Consecutive adult patients diagnosed with PCNSL between 2012 and 2022 were included, and the variables of interest comprised pre-biopsy corticosteroid exposure, the interval between diagnostic magnetic resonance imaging (MRI) and stereotactic biopsy, and the time from biopsy to initiation of high-dose methotrexate–based induction therapy. All patients were treated under a standardized hematology protocol to limit systemic treatment heterogeneity. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of diagnostic biopsy, and survival analyses were performed using Kaplan–Meier methods and log-rank testing. Twenty-nine patients met the inclusion criteria. Median OS and PFS were not reached in steroid-naïve patients, whereas pre-biopsy corticosteroid exposure was associated with consistently shorter survival trajectories, with a clear separation of the survival curves, despite conventional statistical significance not being reached. Similarly, median OS and PFS were not reached in patients undergoing biopsy within 7 days of MRI, and an MRI-to-biopsy interval exceeding 7 days demonstrated an unfavorable survival trajectory compared with earlier biopsy; biopsy-to-induction timing did not show a measurable association with early survival outcomes. Established prognostic stratification using Memorial Sloan–Kettering Cancer Center classes showed expected survival discrimination within the cohort, supporting internal validity. Given the limited sample size and retrospective design, all findings should be interpreted as exploratory associations rather than evidence of causality. These results suggest that early neurosurgical workflow characteristics, particularly empiric pre-biopsy corticosteroids avoidance and diagnostic delay minimization, may be associated with early survival trajectories in PCNSL and warrant further evaluation in larger prospective studies.

Introduction Effective palliative care reduces unnecessary hospital admissions and intensive care length of stay. The present study aimed to investigate the parameters associated with mortality in patients receiving palliative care support. Material and methods This prospective observational...

To investigate the effects of genistein in a rat model of sciatic nerve crush injury and complete sciatic nerve transection. The effects of genistein were compared with those of gabapentin, which is widely used in clinical practice for peripheral nerve injury. Forty-eight rats were randomly divided into six groups (8 rats in each group): group 1 (sham); group 2, sciatic nerve crush injury (control); group 3, sciatic nerve crush injury+genistein 20 mg/kg; group 4, sciatic nerve crush injury+gabapentin 90 mg/kg; group 5, sciatic nerve transection+genistein 20 mg/kg; group 6, sciatic nerve transection+gabapentin 90 mg/kg. The effects of genistein and gabapentin were assessed with immunohistochemical staining for growth associated protein-43 (GAP-43) and myelin basic protein (MBP). Interleukin-1β and tumor necrosis factor α levels in the injured nerve specimens were assessed as a measure of inflammatory response; walking track analysis and sciatic function index for neurological recovery and the paw mechanical withdrawal threshold were examined for neuropathic pain. On histopathological examination, genistein use was associated with a greater immunoreactivity for GAP-43 and MBP compared with that associated with gabapentin. Genistein and gabapentin had similar effects on anti-inflammatory activity, functional recovery, and neuropathic pain. Genistein and gabapentin exhibit positive effects on histopathology, inflammation, and clinical findings of peripheral nerve injury. When the systemic side effects of gabapentin are considered, genistein (a basic soy isoflavone that has no side effects) can be used as an alternative to medical treatment in peripheral nerve injury.

< /B > Spinal cord injuries negatively affect the individuals and the life quality of their families due to neurological deficits caused by trauma. The prevalence of spinal cord injury is 15-45/1 million in the world. Caffeic acid phenethyl ester (CAPE) is the most active component of propolis and has neuroprotective, anti-oxidant and anti-apoptotic effects. Our aim was to determine the effects of CAPE on the prevention of secondary injury and to compare with methylprednisolone. Forty rats were divided into 4 groups. The control group did not undergo surgery (Group I), only trauma group (Group II), trauma+CAPE treatment group (Group III), and trauma+methylprednisolone treatment group (Group IV). Histopathological assessment was performed with two staining methods as hematoxylin-eosin (HE) and terminal deoxynucleotidyl Transferase Biotin - dUTP Nick End Labeling (TUNEL). The groups were statistically compared. The apoptotic cells decreased in treatment groups compared with the trauma. CAPE has more anti-apoptotic effect than methylprednisolone. The histological difference between the Group II, and Groups III and IV was statistically significant. CAPE has a positive effect on spinal cord injuries by preventing apoptosis.

This 45-year-old woman was admitted with neck and back pain and difficulty in ambulation that had been progressively worsening for 2 years. Admission MR imaging revealed a cervicomedullary junction tumor and 2 intradural-extramedullary spinal tumors located separately at the levels of T5–6 and T8–9. All masses were successfully resected in a 2-stage operation. Histopathological examination of the surgical specimens revealed that all the lesions were ependymomas. Genetic analysis was performed to determine if the tumors were related. Conventional cytogenetics, multiplex fluorescence in situ hybridization (M-FISH), interphase-FISH specific to 22q11, and epidermal growth factor receptor loci analyses of the tumor samples revealed that the lesions originated from the same primary tumor. Although 3 simultaneous tumors in different compartments of the neural axis were diagnosed as ependymoma by histopathological examination, it was not possible to be sure if their multiplicity was due to spread of tumor cells via CSF or if it was due to multicentric foci. Thus, genetic analysis of the tumor samples is essential to confirm the exact mechanism of development of multiple ependymomas.

2-amino-5-phosphonovaleric acid (APV) is an N-methyl-D-aspartate (NMDA) receptor blocker and has neuroprotective properties. This study is aimed at evaluating the effect of APV treatment on oxidative status after spinal cord injury (SCI). The experiment was carried out on the following five groups: Group 1: sham operated, non-traumatized; Group 2: with injured spinal cord, no treatment; Group 3: with SCI, injected with 100 microg kg(-1) APV; Group 4: with SCI, injected with 200 microg kg(-1) APV; and Group 5: with SCI, injected with 400 microg kg(-1) APV. SCI was inflicted by epidural compression with a cerebral vascular clip after T9-11 laminectomy. The experiments were completed after 12 h of trauma. Spinal cords were excised for evaluation of superoxide dismutase (SOD), catalase, reduced glutathione (GSH) and malonyldialdehyde (MDA) levels. After SCI, SOD and GSH levels decreased and the MDA level increased significantly. APV treatment decreased the MDA level and increased SOD, catalase and GSH levels. The maximum decrease in MDA was detected in the group treated with 100 microg kg(-1) APV compared with the other groups. The GSH level was significantly increased in the group treated with 200 microg kg(-1) APV. The SOD level was significantly increased in the group treated with 200 microg kg(-1) APV. The results of this study have shown that APV treatment creates a dose-dependent antioxidant effect in rats with SCI and may be used for the treatment of SCIs.