(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.

Glioblastoma is the most common and lethal central nervous system malignancy with a median survival after progression of only 6–9 months. Major biochemical mechanisms implicated in glioblastoma recurrence include aberrant molecular pathways, a recurrence-inducing tumor microenvironment, and epigenetic modifications. Contemporary standard-of-care (surgery, radiation, chemotherapy, and tumor treating fields) helps to control the primary tumor but rarely prevents relapse. Cytoreductive treatment such as surgery has shown benefits in recurrent glioblastoma; however, its use remains controversial. Several innovative treatments are emerging for recurrent glioblastoma, including checkpoint inhibitors, chimeric antigen receptor T cell therapy, oncolytic virotherapy, nanoparticle delivery, laser interstitial thermal therapy, and photodynamic therapy. This review seeks to provide readers with an overview of (1) recent discoveries in the molecular basis of recurrence; (2) the role of surgery in treating recurrence; and (3) novel treatment paradigms emerging for recurrent glioblastoma.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Venous thromboembolism (VTE) is a common post-operative complication. The peri-operative incidence of VTE in neurosurgery patients on VTE chemoprophylaxis is consistently between 1.7 and 3.5%, excluding trauma patients. While the majority of VTE’s are asymptomatic and clinically insignificant, symptomatic VTE’s may result in serious adverse events or death. There are limited neurosurgery society guidelines making VTE prophylaxis recommendations for cranial or spine neurosurgery patients. While multiple other societies have published guidelines on VTE prophylaxis in neurosurgical patients, they are largely inconsistent in their recommendations on the timing and choice of agent for chemoprophylaxis. This has resulted in a wide variation of clinical practice according to neurosurgeon preference. Objective: The objective of this project is to assess whether implementing a single protocol of VTE guidelines at a large hospital system department of neurosurgery would decrease the rate of VTE incidence by 50% within a 12-month period. Methods: This project utilizes a department-wide protocol of chemical prophylaxis for admitted patients after neurological surgery. The primary outcome is the VTE incidence over 12 months following protocol implementation. Secondary outcomes include incidence of pulmonary embolism (PE), length of hospital stay, and unexpected treatment of patients, such as therapeutic anticoagulation, thrombolysis, or emergency surgical or catheter-directed embolectomy. Balancing measures and process measures are also considered. Interim analyses with department reports will be performed every 3 months, but every VTE event will trigger an analysis of the variables described in this protocol. Analyses will consider barriers to change and adequacy of the protocol to guide protocol modifications and continuous implementation of improvements. Results: The data collection of this project will be completed in 2024, with final data analysis and results expected to be published by March 2025. Conclusions: It is anticipated that this QI project implementing a department-wide protocol for chemical prophylaxis in neurosurgical patients will improve the rates of VTE of patients on our service. In addition to a discussion of our results, we provide a comprehensive review of the literature and establish a gap in consistent published guidelines for VTE prophylaxis in neurosurgery patients. Results from this quality improvement project will provide evidence for the effectiveness of a unified protocol of VTE prophylaxis in this patient group. Furthermore, outcomes from this study may be utilized as the basis for guideline recommendations and will benefit not only our department but may be utilized for quality improvement (QI) of patient care at other hospitals. Clinical Trial: Not applicable.

BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication. The perioperative incidence of VTE in patients undergoing neurosurgery on VTE chemoprophylaxis is consistently between 1.7% and 3.5%, excluding patients with trauma. While the majority of VTEs are asymptomatic, symptomatic VTEs may result in serious adverse events or death. There are limited neurosurgery society guidelines making VTE prophylaxis recommendations for patients undergoing cranial or spine neurosurgery. Several societies have published VTE prophylaxis guidelines for neurosurgery, but inconsistent recommendations have led to varied practices based on neurosurgeon preference. OBJECTIVE This study aims to assess whether implementing a single protocol of VTE guidelines at a large hospital system department of neurosurgery would decrease the rate of VTE incidence by 50% within a 12-month period. METHODS This project uses a department-wide protocol of chemical prophylaxis for admitted patients after neurological surgery. This quality improvement (QI) project has been designed and reported in accordance with the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. SQUIRE is the most appropriate framework for reporting system-level interventions aimed at improving health care quality, safety, and outcomes. This manuscript addresses all relevant SQUIRE elements. The primary outcome is the VTE incidence over 12 months following protocol implementation. Secondary outcomes include the incidence of pulmonary embolism, length of hospital stay, and unexpected treatment of patients, such as therapeutic anticoagulation, thrombolysis, or emergency surgical or catheter-directed embolectomy. Balancing measures and process measures are also considered. Interim analyses with department reports will be performed every 3 months, but every VTE event will trigger an analysis of the variables described in this protocol. Analyses will consider barriers to change and adequacy of the protocol to guide protocol modifications and continuous implementation of improvements. RESULTS This QI project was approved on February 16, 2023 (protocol ID NEU20230216-01). Adaptation and training began on August 1, 2023. As of May 2024, data collection is ongoing and scheduled to conclude by December 2024. Final data analysis is anticipated in March 2025, with results submitted for publication by the end of 2025. CONCLUSIONS It is anticipated that this QI project implementing a department-wide protocol for chemical prophylaxis in patients undergoing neurosurgery will improve the rates of VTE in patients on our service. In addition to a discussion of our results, we provide a comprehensive review of the literature and establish a gap in consistent published guidelines for VTE prophylaxis in patients undergoing neurosurgery. Results from this QI project will provide evidence for the effectiveness of a unified protocol of VTE prophylaxis in this patient group. Furthermore, outcomes from this study may be used as the basis for guideline recommendations and will benefit not only our department but may be used for QI of patient care at other hospitals. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/57278