Volume 34 · Issue 03 · 2018

stroke is the leading cause of death and disability in China. At present, the number of cerebrovascular disease patients in China is more than 10 million, and it is increasing at a rate of 8.7% year by year. Among them, acute ischemic stroke (AIS) accounts for about 70% ~80%^[1]。 For patients with AIS with large vessel occlusion (LVO), the severe disability and mortality rate are over 70%, and the standard intravenous thrombolytic therapy is not effective. Six studies published from 2015 to 2016 consistently confirmed the efficacy of AIS-LVO endovascular therapy^{[2,3,4,5,6,7]}, opening a new era of AIS-LVO treatment. The United States, South Korea, Canada, Europe and China have updated their respective AIS treatment guidelines^[8,9,10,11]Endovascular thrombectomy is recommended as the preferred treatment for patients with AIS-LVO. In the United States, a hierarchical stroke center system has been established. In 2016, there were more than 30,000 annual thrombectomies, accounting for about 38.5% of all AIS-LVO patients (the prevalence of AIS-LVO in the United States is about 24/100,000)^[12]。 In contrast, the situation in China is poor. In 2016, only less than 8 000 cases were carried out in China. Considering the large population base in China, the number of AIS-LVO patients may be higher than that in the United States, and its treatment proportion may be smaller. The reasons are, first of all, that stroke patients fail to reach hospitals with treatment ability in time; Secondly, at present, the construction of stroke centers in China is not ideal, and there is a lack of medical institutions that can quickly implement stroke treatment. Therefore, it is of great significance to solve the above problems as soon as possible, so that more and more AIS-LVO patients can get timely and reasonable treatment, which is of great significance to China, which has a heavy burden of stroke.

To comparatively analyze the safety and efficacy of bridging therapy versus direct endovascular treatment of acute large-vessel occlusion in anterior circulation stroke.

We retrospectively analyzed patients with acute large-vessel occlusion in anterior circulation stroke who underwent endovascular treatment at Department of Neurosurgery, Changhai Hospital, Naval Military Medical University from June 2014 to May 2017. A total of 231 patients, including 119 in the bridging therapy group and 112 in the direct endovascular treatment (dEVT) group, were enrolled. The degree of recanalization immediately after the procedure was estimated by the thrombolysis in cerebral infarction (TICI) scale. The National Institutes of Health stroke scale (NIHSS) and modified Rankin Scale (mRS) were used to estimate the prognosis.

There was no significant difference in statistics in gender, age, NIHSS score at admission, pathogeny of stroke, or medical history between two groups (all P>0.05). The onset-to-admission time was significantly longer in dEVT group than bridging therapy group (P<0.001). There was no significant difference in statistics in door-to-CT time, door-to-puncture time, door-to-recanalization time, puncture-to-recanalization time or number of passes between two groups (allP>0.05). The rate of good reperfusion (91.6%vs. 84.8%), incidence of symptomatic intracranial hemorrhage (12.6% vs. 14.3%), mortality rate (16.0% vs. 15.2%) or rate of good functional outcome (52.1% vs. 50.0%) was not significantly different between two groups (all P>0.05).

The clinical efficacy and safety might have no significant difference between bridging therapy and dEVT in treatment of acute large-vessel occlusion in anterior circulation stroke, which still needs further research with high-level evidences.

To analyze and compare the safety and therapeutic effect of stent retriever-based thrombectomy (SRT) in different subtypes of acute ischemia stroke with large vessel occlusion(AIS-LVO).

A cohort of 167 AIS-LVO patients were enrolled into this study who underwent SRT at Beijing Tiantan Hospital from March 2016 to September 2017. The patients were divided into cardioembolism (CE) and large artery artherosclerosis (LAA) groups according to TOAST (Trial of Org 10172 in acute stroke treatment) classification. The rate of successful recanalization, time from puncture to recanalization (PTR), symptomatic intracranial hemorrhage (sICH), mortality and good outcome (modified Rankin Scale score of 0-2) were compared between two groups.

Among the 167 patients, 130 (77.8%) were successfully recanalized including 30 (71.4%) cases in CE group and 100 (80.0%) cases in LAA group. The median PTR was 82 (45-132) min in CE group and 53 (40-90) min in LAA group. The median times of SRT was 3.0 (2.0-5.0) in CE group and 2.0 (2.0-4.0) in LAA group. There were 6 (3.6%) patients developing sICH including 2 (4.8%) in CE group and 4 (3.2%) in LAA group. Eleven (6.6%) patients died including 4 (9.5%) in CE group and 7 (5.6%) in LAA group. There were 69 (41.3%) patients reporting good outcome including 15 (35.7%) in CE group and 54 (43.2%) in LAA group. There was statistical difference in PTR between two groups(P=0.023), while no significant difference was found in the rates of successful recanalization, sICH, mortality or good outcome(all P>0.05).

SRT is suggested to be safe and effective in both CE and LAA subtypes of AIS-LVO.

To evaluate the safety and efficacy of mechanical thrombectomy for acute large vessel occlusion stroke (LVO) with mild symptoms.

A retrospective analysis was conducted on 16 patients with LVO and National Institutes of Health Stroke Scale (NIHSS) score <6, who were admitted to Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from April 2014 to November 2017. Among them, 5 cases had occlusion in middle cerebral artery (MCA) and included 2 cases in M1 and 3 cases in M2. In addition, there were 1 case with anterior cerebral artery (ACA) occlusion and 8 cases with vertebral-basilar artery occlusion. Besides thrombectomy, 6 cases with severe stenosis of large artery underwent acute angioplasty.

Successful reperfusion[thrombolysis in cerebral infarction (TICI) score of 2b-3] was achieved in all 16 patients. One case developed symptomatic hemorrhage after recanalization. There were no procedure-related complications. At 90 days, 13 patients obtained good outcome: the modified Rankin scale (mRS) of 0 was reported in 8 patients, 1 in 2, 2 in 3 and 6 (death) in 1 case.

Endovascular mechanical thrombectomy appears to be safe and effective in patients presenting with mild stroke symptoms and acute large vessel occlusion.

To evaluate the feasibility and efficacy of mechanical thrombectomy with retrievable stent for stroke patients with acute basilar artery occlusion (BAO).

A retrospective review was conducted of 30 cases with BAO admitted to Department of Neurosurgery, Changhai Hospital, the Second Military Medical University during the period from September 2013 to December 2016. 17 cases underwent mechanical thrombectomy by the Solumbra technology, while 13 cases underwent simple stent thrombectomy.The technical feasibility, rate of recanalization, good outcomes at 90 days and procedural complications were evaluated. The changes of National Institutes of Health Stroke Scale (NIHSS) score at 24 hours post procedure, influence of different techniques on recanalization rate and relationship between TOAST (Trial of Org 10172 in Acute Stroke Treatment) types and prognosis were further analyzed.

Among all 30 cases of BAO in this series, 50% were cardio-embolism of TOAST types. After mechanical thrombectomy with retrievable stent, successfully recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3] was achieved in 87% (26/30) of the patients and good outcome [modified Rankin Scale (mRS) ≤3 at 3 months] was reported in 67% (20/30) of the cases. Compared with preoperative conditions, the NIHSS score at 24 hours post procedure was markedly lower (3vs. 25, P=0.003). Univariate analysis showed that the Solumbra technology was better than simple stent thrombectomy in terms of successful recanalization rate (69% vs. 30%, P=0.033). The cases of cardio-embolism had greater chances of achieving good outcomes than atherosclerosis (87% vs. 45%, P=0.038). The common surgical complications or adverse events included ectopic embolization, arterial dissection, re-occlusion and hemorrhagic transformation. Our 90-day follow-up study reported the mortality rate of 10% (3/30).

Mechanical thrombectomy with retrievable stent for BAO is suggested to be safe and feasible, which might be good for improving the rate of one-pass recanalization. Cardiac embolism could be an important factor in predicting the prognosis of patients with BAO after mechanical thrombectomy.

To investigate the endovascular management strategy as well as its efficacy and safety for acute ischemic stroke caused by tandem occlusion of the extracranial internal carotid artery (ICA) and middle cerebral artery (MCA).

From January 2011 to January 2017, 25 patients with acute tandem occlusion of the ICA/MCA were admitted to Department of Neurosurgery, the First People＇s Hospital of Changzhou, the Third Affiliated Hospital of Soochow University and were treated by endovascular procedures. A retrograde approach (i.e., treating intracranial lesion first) was applied in 10 patients with pathological type of ICA dissection (ICAD) whereas an antegrade approach (i.e., treating extracranial lesion first) was used in 15 patients with pathological type of ICA atherosclerotic stenosis (ICAS). The degree of recanalization immediately after the procedure was estimated by the thrombolysis in cerebral infarction (TICI) scale. The National Institutes of Health stroke scale (NIHSS) and modified Rankin Scale (mRS) were used to estimate the prognosis.

Successful recanalization, defined as modified TICI score of 2b or 3, was achieved in 24 (96%) patients. The follow-up period was over 3 months. None of the patients had recurrent stroke. Good functional outcome, defined as mRS score of 0-2 at 90 days, was reported in 15 (60%) patients.

Endovascular management seems to be effective and safe for acute tandem occlusion of ICA/MCA. The retrograde and antegrade approaches might be suitable for tandem occlusion with ICAD and ICAS, respectively.

To analyze the clinical effect of emergent mechanical thrombectomy on acute ischemic stroke (AIS).

We retrospectively studied a total of 58 cases of AIS admitted to Department of Neurosurgery, the Tenth People＇s Hospital Affiliated to Tongji University from January to December of 2016. In all patients, the protocol of establishing stable vascular access was performed and stent retriever combined with manual aspiration was applied. The thrombolysis in cerebral infarction (TICI) score used to assess intraoperative revascularization and head CT scan was performed at 24 h after operation. In patients with stents implanted, CT angiography (CTA) was conducted at 3 days post operation to assess restenosis or occlusion of the stents. The National Institutes of Health Stroke Scale (NIHSS) before discharge and modified Rankin Scale (mRS) score at 90 days post operation were documented.

Among all 58 cases, successful intraoperative revascularization (TICI score of 2b-3) was achieved in 86.2% (50/58) of the patients. The mean admission-to-puncture time and puncture-to recanalization time were 98.2±21.6 and 45.4±21.3 min. The 24-h postoperative CT scan revealed large-area infarction in 4 patients and intracranial hemorrhage in 7 patients including 2 symptomatic cases. Five cases died before discharge. Long-term follow-up in the remaining 53 cases reported significant statistic difference (P<0.05) between the NIHSS score before discharge (5.9±4.7) and preoperative NIHHS score (13.7±5.3). The 90-d postoperative follow-up results indicated good outcome (mRS score of 0-2) in 68.9% (40/58) of the patients and the mean mRS score was 2.8±2.0.

With the establishment of stable vascular access and application of stent retriever combined with manual aspiration, emergent mechanical thrombectomy remains an effective treatment method of AIS.

To evaluate the effect of endovascular recanalization on acute ischemic stroke with large artery occlusion (LAO) in anterior circulation due to intracranial atherosclerotic disease (ICAD).

We conducted a retrospective analysis about 49 cases of ICAD-related LAO undergoing endovascular treatment at Department of Neurointervention, People＇s Hospital of Henan Province from June 2014 to June 2016. Recanalization result was assessed by catheter angiography according to Thrombolysis in Cerebral Ischemia (TICI) scale and the neurological function 1 week post procedure was evaluated by NIHSS (National Institutes of Health Stroke Scale). The 90-day outcome was assessed based on the modified Rankin Scale (mRS). In-stent restenosis was evaluated by DSA at 6-month follow-up.

Among the 49 cases ICAD-related LAO enrolled into this study, the mean time from puncture to recanalization was (78.4±29.0) minutes. The rate of successful intraoperative recanalization (TICI score of 2b-3)was 87.8% (43/49). Intraoperative embolization occurred in 5 patients. Among them, 1 patient underwent stent retrieval and 3 received intra-arterial tirofiban treatment resulting in recanalization in 2 cases. The CT scan at 24 h post surgery demonstrated intracerebral hemorrhage in 7 cases including 3 symptomatic cases. The mean NIHSS score (8.8±4.1) 1 week post procedure was significantly lower than that prior to operation (15.6±3.9). At 3-month follow-up, 6 deaths were reported. The mean mRS score was (2.9±1.7) and the rate of good outcome was 57.1% (28/49). DSA was conducted in 15 patients at 6 months post stent placement which reported 2 cases(13.3%) of intrastent restenosis.

Endovascular treatment seems beneficial for patients with ICAD-related LAO to achieve good recanalization and clinical outcome.

The prognosis of patients with acute ischemic stroke with large vessel occulsion (AIS-LVO) is extremely poor. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) can only benefit 10% ~20% of patients^[1]。 With the publication of the results of six randomized controlled trials and the expert consensus^[2]It was confirmed that endovascular therapy can significantly improve the clinical prognosis of patients with AIS-LVO with two determining factors: (1) the delay time from onset to reperfusion; (2) Guidance of multimodal imaging for suitable patient selection. Other literatures have further demonstrated and emphasized that the time from onset to reperfusion is closely related to the prognosis of patients^[3,4]。

To evaluate the efficacy and safety of genotype-guided postoperative anticoagulant therapy in patients with warfarin-associated intracranial hemorrhage (WICH).

Clinical and genetic data of 28 patients were investigated in this prospective study who developed WICH following cardiac valve surgery at Beijing Anzhen Hospital from May 2015 to January 2017. Warfarin treatment was restarted 14 days after surgical operation of intracranial hemorrhage. Based on whether genetic testing was conducted with consent, 28 patients were divided into genome and control groups. In the genome group, genotypes of CYP2C9 and VKORC1 were detected by pre-detection. The guideline dose was decided based on the genetic test results. Doses of warfarin were prescribed according to pharmacogenetic-based algorithms in genome group, while conventional standard doses (3 mg/d) of warfarin were administered in control group. In both groups, the doses were adjusted according to international normalized ratio (INR) and the values were monitored routinely and maintained in the range of 1.8-2.4. All patients were followed up for 3 months to compare the time to target INR, the time percentage of standard anticoagulation and major bleeding/thromboembolic events between 2 groups.

A total of 21 patients completed follow-up including 9 in genotype group and 21 cases in control group. The genotypes in genotype group were CYP2C9 CC/AA + VKORCl AA in 8 cases and CYP2C9 CC/AA + VKORCl GA in 1 case. The time required for INR to reach the target value was 7.0 ± 3.2 days in the genome group and 12.0 ± 5.9 days in control group. The genotype group had a shorter time to target INR (P=0.032). The time percentages of satisfied anticoagulation was 76±13% in genome group and 56±14% in control group, which were significantly different (P=0.006). In the control group, there were 2 cases of subdural hematoma and no ischemic events. There was no bleeding or ischemic events in the genotype group. There was no significant difference in the incidence of major hemorrhagic events between 2 groups (P=0.314).

Genotype-guided anticoagulant therapy seems safe, effective and advantageous to conventional one for postoperative re-initiation of warfarin administration in patients with WICH in terms of time to target INR and its duration.

To analyze different variables in relation to seizure outcome and to identify prognostic factors for selection of patients with focal cortical dysplasia (FCD) undergoing epilepsy surgery.

We retrospectively analyzed the data of 43 pharmacoresistant epilepsy patients with histologically proven FCD who were admitted to Epilepsy Center, Beijing Fengtai Hospital, Medical Alliance of Beijing Tiantan Hospital, Capital Medical University from June 2011 to April 2013. Clinical data included seizure semiology, video electroencephalography findings, PET-CT and MRI findings, location of lesion, extent of resection, and pathological classification. The patients were divided into favorable group (EngelⅠ) and unfavorable group (EngelⅡ-Ⅳ) according to postoperative seizure outcome. The univariate and multivariate logistic regression were used to identify predictors of post-operative seizure freedom.

Univariate analysis showed that patients with partial seizure onset, positive PET findings, temporal lobe FCD and completeness of resection would have a favorable seizure outcome (all P<0.05). The only significant predictor of surgical success was completeness of surgical resection by multivariate Logistic regression analysis (OR=6.857, 95%CI: 1.583-29.707, P=0.010).

The extent of lesion resection is significantly associated with post-operative seizure outcome in epilepsy patients with FCD. The seizure semiology, PET-CT and FCD location might be important factors for surgical outcomes as well.

To analyze and evaluate the effect of interventional treatment with stent assisted coiling of BBAs (blood blister-like aneurysms) arising from the dorsal wall of internal carotid artery (ICA).

We retrospectively analyzed the clinical data of 9 patients with BBAs protruding from the dorsal wall of ICA who underwent stent assisted coiling at Neurosurgery Department of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2011 to December 2014. CTA was performed immediately after completion of endovascular procedure and modified Rankin scale (mRS) was used for outcome assessment at discharge. DSA was performed for recurrence detection at 3-month, 6-month, 1-year and 2-year follow-up.

Among all 9 cases, 1 case underwent double overlapping stent-assisted coiling and single stent-assisted coiling was performed in 8 cases. CTA immediately after operation demonstrated complete occlusion in 7 cases and little residual aneurysm in the other 2 cases. Follow-up was conducted for all except 1 patient who developed rebleeding at 5 hours post operation and was subsequently in persistent vegetative state. The mRS score at discharge was 0 in 5 cases, 1 in 2 cases, 2 in 1 case and 5 in 1 case. Eight patients were followed up for a period of 3 to 38 months with an average of 13.6 months. Recurrence was found in 2 cases with little residual flow in the aneurysm neck including 1 undergoing second stent-assisted coiling and 1 receiving placement of weaved stent, and both recovered well. No recurrence was reported in the other 6 cases.

Endovascular treatment with stent assisted coiling is feasible and effective for BBAs arising from the dorsal wall of ICA.

To explore the risk factors of intraoperative and postoperative cerebrospinal fluid (CSF) leaks in endoscopic endonasal transsphenoidal pituitary surgery.

A retrospective analysis was conducted on clinical data of 112 cases of pituitary adenomas admitted to Neurosurgery Department at the Second Xiangya Hospital of Central South University from January 2011 to June 2017. All pituitary adenomas were treated through endoscopic endonasal transsphenoidal approach. The risk factors of intraoperative, early postoperative (within 7 days post surgery) and late postoperative (7 days post surgery) CSF leaks were explored by univariate and multivariate logistic regression analysis.

In this series, intraoperative CSF leaks occurred in 33.0% (37/112) of the patients, early postoperative CSF leaks in 9.8% (11/112), and late postoperative CSF leaks in 6.3% (7/112) of the cases. Univariate and multivariate logistic regression analysis showed that tumor size was the risk factor for intraoperative CSF leak (OR=1.090, 95%CI: 1.027-1.156, P=0.004); ASA (American Society of Anesthesiologists) score was the risk factor of postoperative early CSF leak (OR=4.920, 95%CI: 1.360-17.808, P=0.015); vascularized septal mucosal flap was the protective factors for early postoperative CSF leak (OR=0.100, 95%CI: 0.012-0.841, P=0.034); CRD (chronic respiratory disease) was the risk factor of late postoperative CSF leak (OR=68.667, 95%CI: 8.848-532.925, P<0.001).

For endoscopic endonasal transsphenoidal pituitary surgery, patients with large pituitary adenomas are more likely to develop intraoperative CSF leaks. Higher ASA score is associated to greater chance of early postoperative CSF leaks, while vascularized septal mucosal flaps could reduce its risk. CRD might be correlated with late postoperative CSF leaks.

To explore the optimal cortical puncture site in deep brain stimulation of subthalamic nucleus (STN-DBS).

Fifty patients of Parkinson’s disease (PD) were enrolled into this study who were consecutively admitted to Department of Neurosurgery, General Hospital of Shenyang Military Command from September 2016 to April 2017 and underwent bilateral STN-DBS (100 electrodes implanted) assisted by the ROSA (robotized stereotactic assistance) system. CT angiography and MRI fused images were used to avoid the blood vessels in plan of surgical trajectory. Data of microelectrode recording (MER) in 100 trajectories were documented, out of which 80 trajectories with MER≥5 mm were selected. Cartesian coordinate system was established in the 3D image of ROSA. The distances were measured which were from the cortical entry point to the median sagittal line and from the cortical entry point to projected line of coronal suture of the skull onto the cortex. Moreover, the reference range was calculated and the optimal cortical puncture site was decided.

There was no case of cerebral hemorrhage in this series. For those electrode implantation with MER ≥5 mm, distances from the entry point to the median sagittal line were decided to be 50.8 mm (maximal), 29.6 mm (minimal) and 37.9±5.0 mm (average). The distances between the cortical entry point to projection of coronal suture were 30.3 mm (maximal), -8.5 mm (minimal) and 9.0±6.5 mm (average).

In STN-DBS, choosing cortical puncture site within the area (32.9-42.8 mm lateral to the midline and 2.5-15.5 mm anterior to the coronal suture) might have greater chance of achieving satisfactory electrophysiological recordings, which could also be useful in operations assisted by the traditional stereotactic frame.

To analyze the influence of platelet inhibitor drugs in postoperative rebleeding of patients with hypertensive cerebral hemorrhage (HCH) who underwent hematoma evacuation.

A retrospective analysis was conducted on patients of HCH who underwent hematoma evacuation at Neurosurgery Department, General Hospital of Shenyang Military Command from January 2013 to June 2016. Among all cases, 25 had medical history of platelet inhibiting drug use and were assigned to Group A. Group B consisted of the remaining 128 cases without medication history of platelet inhibitors. The rebleeding rate was compared by case-control study between 2 groups.

No significant difference was found in the gender, age, blood pressure, location of hemorrhage or volume of hematoma between Group A and B (all P>0.05). In group A, postoperative CT demonstrated rebleeding in 2 (8.0%) patients including 1 case of symptomatic hemorrhage and 1 case of asymptomatic hemorrhage who remitted following second operation of hematoma evacuation and conservative therapy, respectively. In Group B, there were 8 (6.3%) patients of rebleeding including 2 asymptomatic cases and 6 symptomatic cases that underwent no further treatment. The postoperative rebleeding rate was not statistically significant between 2 groups (χ²=0.014, P>0.05).

The rebleeding rate might not be significantly increased in postoperative patients of HCH using platelet inhibiting drugs, which suggests that surgical operation could be indicated for proper selection of those patients.

Before the eighteenth century, wounds were treated primarily on the basis of personal experience; In the late 18th century, the theory of dry healing emerged, and doctors mainly used dry dressing changes to treat wounds^[1]。 Later, during surgical dressing change, it was found that the wound was easy to form crusts and adhere to the dressing during dry dressing change. When the dressing was removed, the patient felt pain, and the wound healed for a long time, which was easy to form infection under crusts^[1,2]。 Studies on wet healing theory began gradually in the 1960s^[3]Wet dressing change can cause wound hypoxia, stimulate capillary growth, increase blood supply, resist infection and promote wound healing^[3,4]。 Since then, wet dressing change has been gradually applied to clinical treatment of wounds.

To investigate the expression of TRIM33 and mechanism of TRIM33 overexpression in the regulation of biological function of U251 glioma cells under hypoxic condition.

U251 cells were cultured for varying periods under hypoxic and nonmonic conditions, and the endogenous expression of TRIM33 was detected by quantitative real-time PCR and Western blot. U251 cells were transduced with TRIM33 overexpression lentivirus and expression of TRIM33 was detected by Western blot. The proliferation assay and transwell assay were then conducted. The expression of proteins Vimentin, N-cadherin and E-cadherin was detected by Western blot.

(1) Compared with U251 cells cultured at normoxic condition, expression of TRIM33 under hypoxia was downregulated (P<0.001). (2) The TRIM33 expression level in TRIM33 group was significantly higher compared with that in control group (P<0.001). (3) Assessed by the CCK-8 assay, the cell viability had no significant difference between TRIM33 and control groups (P>0.05). (4) The migratory and invasive abilities were attenuated (bothP<0.05). (5) The results of Western blot revealed that the levels of Vimentin and N-cadherin in TRIM33 group were decreased (bothP<0.01) and E-cadherin expression was increased (P<0.001) as compared with the control group.

The expression of TRIM33 in human glioma U251 cells is down-regulated in hypoxic condition and overexpression of TRIM33 could significantly inhibit the ability of migration and invasion of U251 cells under hypoxia, which might be mediated by EMT. TRIM33 may serve as a potential target of gene therapy for antagonizing hypoxic microenvironment.

To investigate the effect of autophagy inducer AZD8055 on expression of Notch pathway-related proteins and neurosphere formation in U87 initiating cells.

CD133-positive glioma cells were isolated using magnetic activated cell sorting method. The expression of stem cell markers (CD133 and Nestin) and autophagy related proteins (LC3B and p62) were identified via immunofluorescence analysis in neurospheres of glioma-initiating cells (GICs). The effect of AZD8055 on the survival viability of U87 initiating cells was detected via CCK8 kit. The expression of Notch1, Notch intracellular domain, Hes1, p62, LC3B were observed using Western blot with different concentrations of AZD8055. The effect of AZD8055 on the ability of neurosphere formation was detected by single-cell neurosphere formation assay.

High expression of CD133 and Nestin was identified via immunofluorescence analysis in GICs’ neurospheres. CCK8 results showed that the increase of AZD8055 concentration was correlated with decrease of cell survival rate of U87 initiating cells. Compared with dissolvent group, the experimental groups had elevated level of autophagy and decreased expression of Notch1 pathway-related proteins assessed by Western blot. The difference in protein expression between each concentration group had a dose-dependent manner (all P<0.05). Immunofluorescence analysis indicated that autophagy related protein LC3B was highly expressed while p62 was down-regulated by AZD8055 treatment. In addition, with the increased drug concentrations, the number and capacity of neurospheres were decreased detected by single-cell neurosphere formation assay (allP<0.05) which suggested that the ability of neurosphere formation was inhibited.

AZD8055 could suppress the expression of Notch pathway-related proteins by inducing autophagy and inhibit the ability of neurosphere formation in U87 initiating cells.

medulloblastoma (MB) is the most common primary malignant embryonic tumor in the posterior cranial fossa of children, accounting for about 15% ~30% of intracranial tumors in children, and occurs in the cerebellar vermis and the fourth ventricle^[1]。 The peak age of onset is 5 to 7 years old, with more males than females, and less common in adults. According to the 2016 World Health Organization (WHO) pathological classification of central nervous system tumors, MB is divided into five categories: classical type, MB with extensive nodular type, anaplastic type, large cell type, and desmoplastic/nodular medulloblastoma (DMB), all of which are WHO grade IV. Clinically, the classical type of MB is the most common in children, while DMB is less common. From October 2014 to October 2015, two patients with DMB were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xiamen University, which are now reported as follows.

desmoplastic fibroma (DF) is also known as aggressive fibroma and desmoid fibroma. According to its onset site, it is divided into intra-abdominal type, abdominal wall type and external abdominal type, among which the external abdominal type is divided into limbs, trunk and head and neck. DF occurring in the skull is extremely rare, and only more than 20 cases have been reported^[1]。 It is reported abroad that it accounts for about 0.3% of benign bone tumors and 0.06% of all bone tumors^[2]There is still a lack of epidemiological data in China. At present, no reports of giant double skull DF have been retrieved. A patient with giant parieto-occipital double skull DF was admitted to the Department of Neurosurgery of Beijing Corps Hospital of the Chinese People's Armed Police Force, which is reported as follows.

arachnoid cysts (AC) are benign intracranial lesions, accounting for 1% of intracranial space-occupying lesions^[1]Generally, it is more common in lateral fissures, followed by the cerebellopontine angle area, tetraassic cistern, and cerebellar vermis. Fewer AC occurred in the sellar region, accounting for 3% of intracranial AC^[2]。 The Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, treated a patient with AC in the sellar area in January 2017, and the report is as follows.

Real-time fluorescence-guided surgery (FGS) refers to the use of specific wavelength excitation light irradiation to stimulate the tumor's own fluorescence, retained fluorescent molecules or exogenous fluorescent substances taken up by cells to emit fluorescence, and guide the surgeon to accurately resect the tumor. Intraoperative fluorescence guidance can be divided into two types: endogenous contrast enhancement and exogenous contrast enhancement. Endogenous contrast enhancement is the use of autofluorescence to distinguish tumor tissue from surrounding normal tissue, so the boundary between normal tissue and tumor cell is not clear and reliable enough. After the exogenous contrast agent is irradiated with excitation light of corresponding wavelength, it can form a region with fluorescence gradient according to the concentration difference of fluorescent molecules, which is conducive to effective identification of tumor boundary. Its technical difficulty is greater and its application value is higher. With the progress of imaging equipment and fluorescent molecule preparation technology, the effect of FGS is constantly improved. At present, it has shown the advantages of accurate, fast and intuitive imaging^[1]It enables surgeons to safely remove tumors in real time under direct vision to the maximum extent, and at the same time brings new opportunities for tumor diagnosis and targeted therapy.

Glioma is the most common primary tumor of the central nervous system. Even with the most aggressive treatment, the prognosis of patients with high-grade glioma is not significantly improved^[1]。 Implementing individualized diagnosis and treatment is a necessary means to improve the efficacy and prognosis of glioma, and the prerequisite for achieving this goal is accurate diagnosis and evaluation. However, the heterogeneity of cytological origin of glioma makes its molecular phenotype, histological composition and biological behavior varied. At present, the "gold standard" of glioma diagnosis is pathological diagnosis, and imaging is needed to accurately display the morphological structure of tumor and evaluate its biological behavior during the localization of pathological biopsy, the determination of treatment plan and the follow-up^[2]。 Routine MRI and enhanced MRI can provide information such as tumor size, peritumoral edema, tumor perfusion, etc. It plays an important role in the imaging diagnosis of glioma^[2]。 However, low-grade glioma is sometimes difficult to distinguish from non-neoplastic lesions because of small tumor body, insignificant enhancement and light space occupation effect. The boundaries of diffusely growing high-grade gliomas are often not clearly shown by enhancement; Non-specific enhancement caused by blood-brain barrier disruption brings illusions to the diagnosis and classification of glioma^[3,4]； Tumor recurrence or progression is often difficult to distinguish from post-treatment changes (including radionecrosis and pseudoprogression). In recent years, a variety of MRI imaging methods have been applied to the study of brain tumors, including diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI), perfusion weighted imaging (PWI), hydrogen proton magnetic resonance spectroscopic imaging,¹H-MRSI) and the like. PWI can show regional cerebral blood flow, but the perfusion itself is low in low-grade gliomas, while the destruction of the blood-brain barrier caused by inflammatory reactions, surgery, and post-radiotherapy injuries can lead to increased non-specific perfusion of lesions.¹H-MRSI provides partial metabolic information, but has limited value in the assessment of structures close to the scalp and ventricles, as well as calcified or bleeding lesions^[5]。

parkinsonism-hyperthermia syndrome (PHS) is a movement disorder emergency, which refers to a fatal central dopaminergic deficiency crisis that occurs within hours to days during the reduction, withdrawal or drug switching of dopaminergic drugs in patients with Parkinson's disease. It is mainly manifested as high fever, muscle rigidity (may not be accompanied by tremor), autonomic dysfunction (including tachycardia, blood pressure fluctuations, hyperhidrosis, etc.), and disturbance of consciousness.^[1]。 Complications include permanent neurological sequelae, acute kidney injury, aspiration pneumonia, deep vein thrombosis and pulmonary embolism, disseminated intravascular coagulation, etc. The mortality rate is about 4%^[2]。 Because its clinical manifestations are similar to antipsychotic drug withdrawal reactions, it is also called malignant withdrawal syndrome. This article reviews PHS related to deep brain stimulation (DBS), aiming to enable neurological, surgical and neurorehabilitation physicians to identify this potentially fatal syndrome in a timely manner.

diabetic peripheral neuropathic pain (DPNP) is one of the important factors affecting the quality of life of diabetic patients. About 30% to 50% of diabetic patients will develop diabetic peripheral neuropathy (DPN), and more than 20% of them can develop DPNP^[1]。 Peripheral nerves can change the biological activity of neurons and demyelinating lesions under long-term hyperglycemia, which leads to different types of sensory abnormalities in patients. It often manifests as hyperalgesia in the early stage, hypoesthesia in the late stage, and eventually refractory ulcers due to the lack of protective sensation, which may even require amputation treatment in severe cases. The prevention and treatment of DPNP is difficult, and pain often seriously affects the quality of life of patients. There are various ion channels and receptors on human cells, including dorsal root ganglian (DRG) and spinal cord neurons, which participate in normal biological activities of the body through the exchange of substances and information inside and outside the cell. At present, there are more and more research reports on ion channels and diabetes and pain, but there are few comprehensive research reports from three aspects: ion channels, diabetes and peripheral neuralgia. This article summarizes them as follows.