Single-Center Comparison of Chronic Subdural Hematoma Evacuation Outcomes Under Local Versus General Anesthesia.

BACKGROUND: Chronic subdural hematoma (CSDH) is a neurosurgical pathology of an aged populace. Pathogenetic risk factors include traumatic brain injury, prolonged use of antiplatelet drugs, hypertension, and some inflammatory processes. The incidence increases as patients age. Burr-hole evacuation is the most common approach in management of symptomatic cases. We compared evacuation of chronic subdural hematomas with general or local anesthesia (GA and LA, respectively) and evaluated the safety, economic benefits, effects of comorbidity, benefits, and shortcomings of both techniques. METHODS: We conducted a retrospective study of 67 consecutive patients who had 74 procedures for CSDH in a single neurosurgical center, the Regional Clinic, Centre of Neurosurgery and Neurology, over a 3-year period. They were grouped into the GA group (n = 44) and LA group (n = 23). Mean duration of procedure, length of hospital stay, complications, and preoperative and postoperative neurologic statuses were compared. The distribution of nominal variables between groups was compared using the Fisher exact test. The average duration of operation and length of hospital stay were compared using the Mann-Whitney U-test due to violation of the normality assumption. RESULTS: LA proved to be as effective as GA in CSDH evacuation. Seventy-four surgical procedures were performed on 67 patients due to recurrence in less than 30 days in 7 patients. Fifteen patients had tension pneumocephalus managed with fluid therapy to full recovery. LA was economical and required shorter hospital stays and surgical time. CONCLUSIONS: In our studies, LA proved to be noninferior to GA, time conserving, and less prone to some of the adverse effects of GA on elderly patients with comorbidity, although some patients who are hyperactive or contraindicated to LA will require GA.

Sphenoid wing meningiomas: peritumoral brain edema as a prognostic factor in surgical outcome.

Sphenoidal meningiomas constitute 18% of intracranial masses, and still present a difficult surgical challenge. PTBE has been associated with several complications and future recurrence. This study aims to evaluate the outcome of the operatively treated sphenoid wing meningiomas in relation to PTBE as a prognostic factor in a series of 65 patients. The clinical materials of 65 patients with SWM treated microsurgically between 2007 and 2020 were analyzed retrospectively. Follow-up ranged from 6 to 156 months (median, 86). Clinical outcomes include postoperative major neurological deficit, quality of life using KPS, recurrence, and mortality rates. The mean age of patients was 53.9 years (range 20-74), males 24.6% and females75.4%. An edema index (EI) of 1 (40%) was considered as absent edema, and EI > 1 (60%) indicated present edema. Total resection (Simpson I-II) was achieved in 64.6% and subtotal (Simpson IV) in 13.8%. Postoperative complications included vision impairment in 3 patients, motor weakness 6, third nerve palsy 6, intraoperative bleeding and edema 5, and MCA infarct 2, recurrence in 17% and 7.7% died. In univariate analysis, we found that the PTBE is one of the serious risk factors in the immediate surgical outcomes and complication, though more data is needed to support this claim, while having a negative effect on postoperative KPS at short-term follow up (χ2 = 6.44, p = 0.011). PTBE was associated with decline in KPS and quality of life in the early postoperative period (three months) while showing no significant effect at long-term outcomes.

Development of Predictive QSAR Models of 4-Thiazolidinones Antitrypanosomal Activity Using Modern Machine Learning Algorithms.

This paper presents novel QSAR models for the prediction of antitrypanosomal activity among thiazolidines and related heterocycles. The performance of four machine learning algorithms: Random Forest regression, Stochastic gradient boosting, Multivariate adaptive regression splines and Gaussian processes regression have been studied in order to reach better levels of predictivity. The results for Random Forest and Gaussian processes regression are comparable and outperform other studied methods. The preliminary descriptor selection with Boruta method improved the outcome of machine learning methods. The two novel QSAR-models developed with Random Forest and Gaussian processes regression algorithms have good predictive ability, which was proved by the external evaluation of the test set with corresponding Q2ext =0.812 and Q2ext =0.830. The obtained models can be used further for in silico screening of virtual libraries in the same chemical domain in order to find new antitrypanosomal agents. Thorough analysis of descriptors influence in the QSAR models and interpretation of their chemical meaning allows to highlight a number of structure-activity relationships. The presence of phenyl rings with electron-withdrawing atoms or groups in para-position, increased number of aromatic rings, high branching but short chains, high HOMO energy, and the introduction of 1-substituted 2-indolyl fragment into the molecular structure have been recognized as trypanocidal activity prerequisites.

QUALITY OF PHARMACEUTICAL CARE AT THE STAGE OF PATIENTS' NEEDS IDENTIFICATION UNDER CONDITIONS OF COMMUNITY PHARMACIES AS A TRANSBORDER PROBLEM.

The results of the study of the real pharmaceutical practice in relation to the patient's needs identification defined that the problem of not always high pharmaceutical care quality at this stage is equally up-to-date for the community pharmacies of Lviv (Ukraine) and Lublin (Poland). It was found that the quantity and amount of questions set by a pharmacist are not related to the conversation duration with a pharmacy visitor, and the communication duration does not have the statistically confirmed dependence on the queue availability, therefore in the context of pharmaceutical care quality, these criteria are of no high importance. Instead, drug-related problems (n = 209) verified by the authors of this article,tthat have been distributed into the groups according to the criterion of the information amount received by a pharmacist studying the needs of the patient (visitor of a pharmacy), were determined as a quantitative indicator of potential pharmaceutical care quality increase.

5-Year Trends in QSAR and its Machine Learning Methods.

BACKGROUND: Quantitative Structure-Activity Relationships (QSAR) is a well-established branch of computational chemistry. The presence of QSAR papers is decreasing for the last few years. OBJECTIVE: To highlight recent trends of QSAR in general and trends of machine learning methods in particular. METHOD: A bibliometric analysis of articles published in top ten molecular modeling and medicinal chemistry journals was carried out. The bibliometric statistics was collected for papers published in 2009 and 2015 and compared. RESULTS: During 5-year span studied, the fraction of QSAR studies underwent a twofold decrease. Top journals of both categories became less likely to publish Multiple Linear Regression models and increased the presence of Random forest and Naïve Bayes methods. 3D-QSAR remains the most popular method of studying structure-activity relationships with a slight decrease of its presence in molecular modeling journals but a relative increase in medicinal chemistry. CONCLUSION: The downward QSAR trend might have several reasons: more stringent criteria for QSAR studies acceptance by journals, transformation of QSAR studies into routine work due to wider availability of QSAR methods and the overall maturation of QSAR field, and possible disappointment in QSAR. We expect that the progress in machine learning methods being adopted by chem(o)informaticians finally will help QSAR to find its place in drug design and to move to the Plateau of Productivity.

3D-MoRSE descriptors explained.

3D-MoRSE is a very flexible 3D structure encoding framework for chemoinformatics and QSAR purposes due to the range of scattering parameter values and variety of weighting schemes used. While arising in many QSAR studies, up to this time they were considered as hardly interpreted and were treated like a "black box". This study is intended to lift the veil of mystery, providing a comprehensible way to the interpretation of 3D-MoRSE descriptors in QSAR/QSPR studies. The values of these descriptors are calculated with rather simple equation, but may vary when using differing starting geometries as optimization input. This variation increases with scattering parameter and also is higher for electronegativity weighted and unweighted descriptors. Though each 3D-MoRSE descriptor incorporates the information about the whole molecule structure, its final value is derived mostly from short-distance (up to 3Å) atomic pairs. And, if a QSAR study covers structurally similar set of compounds, then the role of 3D-MoRSE descriptor in a model can be interpreted using just several pairs of neighbor atoms. The guide to interpretation process is discussed and illustrated with a case study. Realizing the mathematical concept behind 3D-descriptors and knowing their properties it is easy not only to interpret, but also to predict the importance of 3D-MoRSE descriptors in a QSAR study. The process of prediction is described on the practical example and its accuracy is confirmed with further QSAR modeling.

Computational Search for Possible Mechanisms of 4-Thiazolidinones Anticancer Activity: The Power of Visualization.

Public databases of NCI-60 tumor cell line screen results and measurements of molecular targets in the NCI-60 panel give the opportunity to assign possible anticancer mechanism to compounds with positive outcome from antitumor assay. Here, the novel protocol of NCI databases mining where inferences are based on the visualization is presented and utilized with the aim to identify putative biological routes of 4-thiazolidinones anticancer effect. As a result, highly potent 4-thiazolidinone-pyrazoline-isatin conjugates show the similarity of activity patterns with puromycin and CBU-028 and their pattern is also highly correlated with fraction of methylated CpG sites in CD34, AF5q31 and SYK. Several compounds from this group show strong negative correlation with fraction of methylated CpG sites in HOXA5. Thiopyrano[2,3-d][1,3]thiazol-2-ones bearing naphtoquinone fragment were found to possess the same activity pattern as fusarubin does. But none of the studied 4-thiazolidinone derivatives has activity fingerprint similar to standard anticancer agents. The obtained results bring medicinal chemistry closer to the understanding of basic nature of 4-thiazolidinones effect on cancer cells.