Lumbar disc herniation (LDH) often results in significant pain and disability, and histopathologic evaluation of intervertebral discs offers critical insights into treatment outcomes. This prospective observational study explores histopathologic (HP) changes in intervertebral discs (IVD) and their association with clinical outcomes following surgical treatment for lumbar disc herniation (LDH). A cohort of 141 patients undergoing magnetic resonance imaging (MRI)-confirmed LDH surgery underwent HP evaluation using a semi-quantitative Histopathologic Degeneration Score (HDS). Preoperatively and at a six-month follow-up, comprehensive clinical assessment included the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), with a minimal clinically important difference (MCID) calculated from ODI and VAS. Results indicated significant associations between higher HDS and adverse clinical outcomes, including persistent pain and greater disability post-surgery. Specifically, HDS ≥ 7 was predictive (OR = 6.25, 95%CI: 2.56-15.23) of disability outcomes measured with MCID-ODI (AUC: 0.692, 95%CI: 0.609-0.767, P < 0.001), and HDS ≥ 8 was predictive (OR = 1.72, 95%CI: 1.04-2.77) of persistent pain measured with MCID-VAS (AUC: 0.628, 95%CI: 0.598-0.737, P = 0.008), highlighting the diagnostic potential of HDS in assessing postoperative recovery. This study underscores the potential of HP evaluation using HDS to provide valuable insights into disease progression and outcomes in LDH patients, complementing conventional radiologic methods. The findings support the application of personalized treatment strategies based on HP findings while acknowledging challenges in interpretation and clinical implementation.

Simple Summary This study explores hypoxia-inducible factors (HIFs) in glioblastoma development, progression, and treatment. Reviewing 104 relevant studies, it highlights diverse global contributions, with China leading at 23.1%. The most productive year was 2019, contributing 11.5% of the studies. Key factors studied included HIF1α, HIF2α, osteopontin, and cavolin-1, involving pathways such as GLUT1, GLUT3, VEGF, PI3K-Akt-mTOR, and ROS. HIF expression correlates with glioblastoma progression, survival, neovascularization, glucose metabolism, migration, and invasion. Overcoming treatment resistance and the lack of biomarkers is crucial for integrating HIF-related therapies into glioblastoma treatment to improve patient outcomes. Abstract Background: The study aims to investigate the role of hypoxia-inducible factors (HIFs) in the development, progression, and therapeutic potential of glioblastomas. Methodology: The study, following PRISMA guidelines, systematically examined hypoxia and HIFs in glioblastoma using MEDLINE (PubMed), Web of Science, and Scopus. A total of 104 relevant studies underwent data extraction. Results: Among the 104 studies, global contributions were diverse, with China leading at 23.1%. The most productive year was 2019, accounting for 11.5%. Hypoxia-inducible factor 1 alpha (HIF1α) was frequently studied, followed by hypoxia-inducible factor 2 alpha (HIF2α), osteopontin, and cavolin-1. Commonly associated factors and pathways include glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3) receptors, vascular endothelial growth factor (VEGF), phosphoinositide 3-kinase (PI3K)-Akt-mechanistic target of rapamycin (mTOR) pathway, and reactive oxygen species (ROS). HIF expression correlates with various glioblastoma hallmarks, including progression, survival, neovascularization, glucose metabolism, migration, and invasion. Conclusion: Overcoming challenges such as treatment resistance and the absence of biomarkers is critical for the effective integration of HIF-related therapies into the treatment of glioblastoma with the aim of optimizing patient outcomes.

Aim: To examine whether there is a correlation between blood pressure, heart rate, and pain with the level of preoperative and postoperative anxiety in surgery of impacted third molars under local anesthesia. Subjects and Methods: In the study, which included adult patients of both sexes with an indication for surgical extraction of impacted third molars, research parameters were measured as follows: 1st measurement (day of examination) - blood pressure, heart rate, preoperative anxiety with Spielberger’s State-Trait Anxiety Inventory (STAI); 2nd measurement (immediately before the intervention) - blood pressure, heart rate, preoperative anxiety with STAI; 3rd measurement (day after intervention) - blood pressure, heart rate, postoperative anxiety with STAI, postoperative pain with visual analog scale. Results: The values of preoperative and postoperative anxiety and the measured parameters of blood pressure, heart rate, and postoperative pain were statistically significantly positively correlated with each other during all measurements. Conclusion: In order to increase the satisfaction of both the patient and the ordinarius, and to prevent possible complications in this type of oral surgical intervention, it would be useful to consider adequate therapy in order to prevent the development of anxiety, considering the confirmed correlation with the measured parameters.

The topic of this research, chronic subdural hematoma (CSH), is one of the most common pathologies in neurosurgery, and it is more frequent in the elderly. Surgical evacuation has been widely considered the gold standard treatment. Despite the excellent outcomes, sometimes some cases require a different approach. The treatment choice depends on the general condition of the patients, as well as the clinical presentation and hematoma volume. Also, preexisting comorbidities in elderly patients, postoperative complications, and the ability to recover must be considered. Consequently, conservative treatment can be effective in carefully selected cases, and can be considered if the patient's neurological and physical conditions allow. Some drugs contribute to CSH resolution by changing the capsule membrane permeability and inhibiting the fibrinolytic and inflammatory systems. Our work is based on the efficacy of dexamethasone as a method of conservative therapy, and it was demonstrated in the case of a 91-year-old patient.

This study explores the anatomical relationship between iliac blood vessels and the lower lumbar spine during supine and prone patient positions. The average height of participants was 174.02 cm ± 9.01, while the average weight was 80.38 kg ± 13.48. Body mass index (BMI) analyses showed differences (p = 0.002), with 34.7% classified as normal weight, 53.1% as overweight, and 12.2% as moderately obese. The study examined the distances between iliac arteries and veins in relation to intervertebral anterior and posterior disc contours. Patient positioning significantly affected these measurements at both L4/L5 and L5/S1 levels. The findings highlight the critical influence of body position on anatomical relationships in the context of lower lumbar spine surgery. The study underscores the importance of preoperative awareness of vascular anatomy to prevent iatrogenic lesions during spine surgery, contributing valuable insights for optimizing surgical approaches and minimizing complications in spine surgery, particularly microdiscectomy.

Aim: The primary aim of the study was to determine the incidence of testicular neoplasms in the Zenica-Doboj Canton (ZDC) region for the period from 2019 to 2021. Also, the study aimed to examine the age structure of the affected population, the frequency of testicular neoplasms in all the ZDC cities and municipalities, and the pathohistological characteristics of neoplasms. Material and methods: The study was conducted at the Oncology and Radiotherapy Department of the Zenica Cantonal Hospital. The study period refers to the time interval from January 2019 to December 2021. The study included 37 patients with a verified diagnosis of testicular neoplasm. Results: Arithmetic mean of patients’ age was 33.49 years, while the standard deviation was 12.59. Most respondents, accounting for 40.5%, were aged 26-35 years. The incidence of testicular neoplasms in the ZDC region was 4.2/100,000 per - sons in 2019, 3.08/100,000 persons in 2020, and 3.10/100,000 persons in 2021. Most diagnosed neoplasms (48.6%) were the myxoid type germ cell originating tumors. Conclusion: The incidence of testicular neoplasms in the ZDC was 4.2/100,000 persons in 2019, 3.08/100,000 persons in 2020, and 3.10/100,000 persons in 2021.

Aim This study provides a comprehensive review of the current literature on the use of ChatGPT, a generative Artificial Intelligence (AI) tool, in neurosurgery. The study examines potential benefits and limitations of ChatGPT in neurosurgical practice and education. Methods The study involved a systematic review of the current literature on the use of AI in neurosurgery, with a focus on ChatGPT. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a comprehensive and transparent review process. Thirteen studies met the inclusion criteria and were included in the final analysis. The data extracted from the included studies were analysed and synthesized to provide an overview of the current state of research on the use of ChatGPT in neurosurgery. Results The ChatGPT showed a potential to complement and enhance neurosurgical practice. However, there are risks and limitations associated with its use, including question format limitations, validation challenges, and algorithmic bias. The study highlights the importance of validating machine-generated content for accuracy and addressing ethical concerns associated with AI technologies. The study also identifies potential benefits of ChatGPT, such as providing personalized treatment plans, supporting surgical planning and navigation, and enhancing large data processing efficiency and accuracy. Conclusion The integration of AI technologies into neurosurgery should be approached with caution and careful consideration of ethical and validation issues. Continued research and development of AI tools in neurosurgery can help us further understand their potential benefits and limitations.

Aim To investigate the correlations between tumour characteristics, symptoms, intraoperative findings, and outcomes in patient with meningioma. Methods A retrospective study was conducted on 86 surgically treated patients at Department of Neurosurgery of Cantonal Hospital Zenica from 2010 to 2020. Patients with intracranial meningiomas underwent neurological evaluation and MRI scans to analyse tumour characteristics, including volume (TV), peritumoral brain oedema (PTBE) and oedema index (EI). Surgical treatment was performed, followed by postoperative MRI and outcome assessment. Intraoperatively, the tumour's relationship with cortex, pial membrane, skull bones, and sinuses was evaluated, and the extent of tumour resection was graded. Meningioma samples underwent histopathological analysis to assess the grade and regularity of borders, and Ki-67 labelling index was determined using immunohistochemistry. Results Significant correlations were found between PTBE and Ki67 expression (p<0.001), PTBE and vomiting/nausea (p=0.002), cognitive impairment (p=0.047), venous compression (p=0.001), cortical, pial and dural invasion (p<0.05), and the postoperative presence of oedema (p=0.002). Venous compression, cortical, pial, dural and bone invasion positively correlated with Ki-67 expression (p<0.001). Grade and tumour border positively correlated with Ki-67 expression (p<0.001). Oedema persistence postoperatively showed a positive correlation with Ki-67 expression (p<0.001). Conclusion The study revealed significant correlations between Ki-67 expression and PTBE, with notable associations with clinical symptoms, tumour characteristics, and postoperative oedema presence.

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Aim To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration. Methods The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25. Results Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25 (controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001). Conclusion The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the importance of weight management in preventing disc degeneration.

This scoping review examines the use of CRISPR/Cas9 gene editing in glioblastoma (GBM), a predominant and aggressive brain tumor. Categorizing gene targets into distinct groups, this review explores their roles in cell cycle regulation, microenvironmental dynamics, interphase processes, and therapy resistance reduction. The complexity of CRISPR-Cas9 applications in GBM research is highlighted, providing unique insights into apoptosis, cell proliferation, and immune responses within the tumor microenvironment. The studies challenge conventional perspectives on specific genes, emphasizing the potential therapeutic implications of manipulating key molecular players in cell cycle dynamics. Exploring CRISPR/Cas9 gene therapy in GBMs yields significant insights into the regulation of cellular processes, spanning cell interphase, renewal, and migration. Researchers, by precisely targeting specific genes, uncover the molecular orchestration governing cell proliferation, growth, and differentiation during critical phases of the cell cycle. The findings underscore the potential of CRISPR/Cas9 technology in unraveling the complex dynamics of the GBM microenvironment, offering promising avenues for targeted therapies to curb GBM growth. This review also outlines studies addressing therapy resistance in GBM, employing CRISPR/Cas9 to target genes associated with chemotherapy resistance, showcasing its transformative potential in effective GBM treatments.

Introduction: Fear of intervention in the oral cavity is declared as dental fear and is defined as a specific form of anxiety. The reaction to oral-surgical intervention will also depend on the feeling the patient acquires about the operator, but the positive experience also plays an important role.Aim: The aim is to evaluate differences between the sexes and the influence of experience from a previous oral surgical intervention on a similar subsequent intervention.Material and methods: In the research, anxiety was assessed using Corah's Dental Anxiety Scale (DASR) and Spielberger's State-Trait Anxiety Inventory (X1 and X2). The study included adult patients of both sexes with an indication for surgical extraction of impacted third permanent molars. Preoperative and postoperative anxiety was assessed: 1st measurement (day of examination) - DASR, and STAI (X1 and X2); 2nd measurement (immediately before the intervention) – STAI (X1 and X2); 3rd measurement (day after the intervention) – STAI (X1 and X2).Results: Preoperatively determined high levels of general, immediate, and dental anxiety decreased before the surgical procedure itself and were significantly reduced in the postoperative period. The downward trend continued in line with the positive experience. Women had higher anxiety scores than men for all monitored parameters. The use of the STAI scales to assess anxiety by dental practitioners is on par with other well-known anxiety assessment instruments, such as the DASR. Conclusion: In order to increase patient satisfaction and to prevent possible complications in such oral-surgical procedures, it would be useful to consider adequate therapy for high anxiety.

This review paper explores the use of miswak, a teeth-cleaning twig made from the Salvadora persica plant, in maintaining oral hygiene and preventing oral diseases. Various aspects of miswak are analyzed, including its historical significance, chemical composition, pharmacological characteristics, and beneficial effects on oral health. The paper also investigates the Islamic perspective on oral hygiene and the use of miswak, as well as the socio-medical aspect of oral disease prevention. While there are studies that point out potential drawbacks of miswak usage, proper application and combination with conventional oral hygiene methods can result in good oral health. Considering its cost-effectiveness and the need for affordable oral hygiene methods, further research on the use of miswak is valuable and necessary. This paper provides an overview of modern and relevant scientific literature on miswak and its significance in maintaining oral health, highlighting its journey from tradition to paradigm. Keywords: miswak, oral health, social medicine.