Medulloblastoma (MB) is one of the most frequent and malignant brain tumors in children. The prognosis depends on the advancement of the disease and the patient’s age. Current therapies, which include surgery, chemotherapy, and irradiation, despite being quite effective, cause significant side effects that influence the central nervous system’s function and cause neurocognitive deficits. Therefore, they substantially lower the quality of life, which is especially severe in a developing organism. Thus, there is a need for new therapies that are less toxic and even more effective. Recently, knowledge about the epigenetic mechanisms that are responsible for medulloblastoma development has increased. Epigenetics is a phenomenon that influences gene expression but can be easily modified by external factors. The best known epigenetic mechanisms are histone modifications, DNA methylation, or noncoding RNAs actions. Epigenetic mechanisms comprehensively explain the complex phenomena of carcinogenesis. At the same time, they seem to be a potential key to treating medulloblastoma with fewer complications than past therapies. This review presents the currently known epigenetic mechanisms that are involved in medulloblastoma pathogenesis and the potential therapies that use epigenetic traits to cure medulloblastoma while maintaining a good quality of life and ensuring a higher median overall survival rate.

To consolidate current evidence on predictors of neurological outcome following extracorporeal cardiopulmonary resuscitation (eCPR) in patients with cardiac arrest. We conducted a systematic review of the literature across databases including PubMed, MEDLINE, Embase, CINAHL, the Cochrane Library, and Web of Science. Studies assessing neurological outcomes post-eCPR were identified, with a total of 10 studies eligible for individual assessment of which 8 comprising 4353 patients allowed to perform collective statistical analysis. Favorable neurological outcomes were associated with age < 65 years (OR = 6.17), shockable rhythm at extracorporeal membrane oxygenation initiation (OR = 6.67) or hospital arrival (OR = 3.68), and initial pH ≥ 7.0 (OR = 2.01). Other factors involved the presence of any life sign (gasping, positive pupillary light reaction, or increased level of consciousness before or throughout cardiopulmonary resuscitation) (OR = 9.63; Se 0.89, Sp 0.46, PPV 0.22, NPV 0.96), transient return of spontaneous circulation, non-hypoxic mechanism of occurred hepatitis, public location, and hypothermic etiology of cardiac arrest; however, each of those findings was supported by only one study. Unfavorable outcomes were linked to hypoxic brain injury on computed tomography (OR = 12.40; Se 0.366, Sp 0.955, PPV 0.767, NPV 0.787) and elevated serum creatinine (OR = 2.22). The TiPS65 scale showed high predictive accuracy in two studies when the cut-off point was set at 4 points (88.4% and 88.6%; Se 0.172, Sp 0.971, PPV 0.423, and NPV 0.906, and Se 0.193, Sp 0.985, PPV 0.646, and NPV 0.896, respectively). Some predictors, like call-to-hospital time and bystander cardiopulmonary resuscitation, had mixed results across studies. Neurological prognostication in eCPR patients is a complex problem requiring the consideration of multiple variables regarding patient’s and cardiac arrest characteristics. Future research should focus on the determination of outcome-affecting factors and assessment of their applicability in clinical settings. New knowledge on this ground will help to create recommendations for eCPR initiation and termination, consequently contributing to treatment results improvement. PROSPERO CRD42024530305.

The role of myokines as a link between cardiac rehabilitation (CR) and cardiovascular benefits in patients recovering from acute coronary syndrome (ACS) is important but not well understood. We investigated the effect of CR on circulating levels of myostatin, follistatin, apelin, and follistatin-related protein 1 (FSTL1) in post-ACS patients. A total of 110 patients underwent a 2-week CR programme (group S) and were compared with 110 non-CR patients (group K). In group S, blood pressure, heart rate, anthropometrics, body composition, and serum myokine levels were measured at baseline and post-CR; in group K, these were assessed once. After CR, apelin, myostatin, and FSTL1 increased in group S. Apelin and myostatin were higher in group S post-CR compared with group K, while follistatin remained higher in group K at both time points. FSTL1 was initially higher in group K but increased post-CR in STEMI patients only; myostatin increased in NSTEMI patients. Apelin increased in STEMI patients. Apelin and myostatin levels were independent of cardiovascular risk factors. Post-CR, follistatin correlated inversely with diastolic pressure; FSTL1 was related to fat tissue, muscle mass and body mass index. CR modulates key myokines and differential myokine responses in STEMI vs. NSTEMI patients support the need for personalised rehabilitation strategies. ClinicalTrials.gov registration number: NCT03935438.

Neurosurgical training has evolved in recent years, influenced by technological innovations, an increasing complexity of neurosurgical procedures, and growing patients’ expectations. While highly effective, traditional methods of learning in neurosurgery require the support of modern technologies to address the intricacy of the field. By synthesizing recent findings and trends, this article aims to provide valuable perspectives on improving neurosurgical training programs to prepare the next generation of neurosurgeons for the demands of a rapidly advancing field. This review explores innovations in neurosurgical education, highlighting 3D printing, virtual reality, augmented reality, and artificial intelligence. New technologies support traditional neurosurgical education, providing reusability, limitless repetitions, relevant feedback, and increased procedure comprehension, but with partial realism. Hence, high-technology solutions remain a valuable complement to traditional training.

Background and Objectives: Blood product transfusion is an important emergency intervention for patients with acute bleeding, severe symptomatic anemia, and selected hematological conditions. Patterns of ED transfusion may differ according to the local case mix, referral pathways, and blood bank processes. We compared transfusion-related characteristics and outcomes among patients treated in one Lithuanian and two Polish academic emergency departments. Materials and Methods: We performed a retrospective comparative study of adults (aged ≥18 years) in whom a blood product transfusion was initiated in the ED between 1 January 2022 and 31 December 2024 at one Lithuanian and two Polish academic hospitals. We compared patient characteristics, indication categories, shock index values, time to transfusion, blood product use, adjunctive therapies, laboratory values, ED disposition, hospital length of stay, and in-hospital mortality. Findings are reported as center-cohort comparisons and are not intended to represent national practice. Results: A total of 670 patients were included: 367 at the Lithuanian center and 303 across the two Polish centers. GI bleeding was significantly more common in the Lithuanian center cohort (48.8% vs. 22.8%; OR 3.22 [95% CI 2.30–4.53]; p < 0.001), whereas anemia and malignancy-related anemia were more frequent in the Polish center cohort (anemia: 34.7% vs. 18.3%, OR 0.42 [95% CI 0.29–0.6]; p < 0.001; cancer: 26.4% vs. 7.6%, OR 0.23 [95% CI 0.15–0.37]; p < 0.001). The median shock index was significantly higher in the Lithuanian center cohort than in the Polish center cohort (0.9; [IQR 0.7–1.2] vs. 0.7; IQR 0.6–0.9; 0.2 [95% CI 0.1–0.3]; p < 0.001), and pre-transfusion hemoglobin was lower (64.5 g/L [IQR 50–86] vs. 119 g/L [IQR 83–139]; p < 0.001). Uncrossmatched RBC units were more frequently administered in the Lithuanian center cohort (133 (36.9%) vs. 47 (15.6%); OR 3.18 [95% CI 2.18–4.64]; p < 0.001), as was fresh frozen plasma (71 (19.5%) vs. 3 (1%); OR 24.23 [95% CI 7.55–77.8]; p < 0.001). Conversely, platelet transfusions were more common in the Polish center cohort (17 (4.6%) vs. 45 (14.9%), OR 0.28 [95% CI 0.16–0.5]; p < 0.001). The median time from ED arrival to transfusion was longer in the Lithuanian center cohort than in the Polish center cohort (150 [IQR 75–256] vs. 117 [IQR 103–154], 23 [95% CI 9–39]; p = 0.002). Hospital admission was significantly more frequent in the Lithuanian cohort than in the Polish cohort (350 (95.4%) vs. 112 (37.0%); p < 0.001). Among admitted patients, the median hospital length of stay was significantly longer in the Lithuanian cohort compared with the Polish cohort (6 days [IQR 3–11] vs. 1 day [IQR 1–5]; 95% CI for the difference 3–4; p < 0.001). In-hospital mortality was 33.5% (n = 123) in the Lithuanian cohort and 13.9% (n = 42) in the Polish cohort (OR 3.13 [95% CI 2.12–4.63]; p < 0.001). Conclusions: Among transfused patients in the three participating academic EDs, the case mix, blood product use, transfusion timing, and unadjusted outcomes differed substantially. These center-specific findings may inform future prospective studies of how referral pathways, clinical populations, and local transfusion processes influence ED blood product utilization. They do not establish differences in national practice, transfusion appropriateness, or causal effects on clinical outcomes.