MedNexus
Volume 37 · Issue 07 · 2021
MedNexus
hemostatic disorders associated intracerebral hemorrhage (HDICH) refers to intraparenchymal hemorrhage that occurs during the use of anticoagulant or antiplatelet drugs, or on the basis of hemorrhagic disorders. With the aging of the population and the widespread development of endovascular therapy, the use of antiplatelet and anticoagulant drugs is increasing, and the incidence of HDICH is also increasing[
neurofibromatosis type 2 (NF2) is an autosomal dominant genetic disease caused by the mutation of NF2 gene on chromosome 22. It is manifested as a systemic multisystem lesion syndrome, mainly including neurological lesions, ophthalmic lesions and skin lesions[
Brainstem glioma is both a rare and refractory disease. In the past ten years, with the progress of medical technology, the development of basic research and clinical transformation, and the promotion of new treatment concepts, the biological characteristics and treatment modalities of brainstem glioma have been more deeply understood. However, compared with hemispheric glioma, there are gaps in basic and clinical research and prognosis of brainstem glioma, which is a huge challenge for neurosurgeons. This article discusses the surgical treatment of brainstem glioma, the progress of basic research and the hot topics and existing problems of disseminated endogenous brainstem glioma in children.
To explore the clinical diagnosis, treatment and long-term outcomes of brainstem gliomas (BSGs).
A retrospective analysis was conducted on the clinical and imaging data of BSG inpatients and outpatients at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2010 to December 2019. The patients′ clinical features, diagnosis, treatment, and overall outcomes were summarized.
A total of 1 257 patients with BSGs were enrolled, the male to female ratio was 1.2 ∶1.0, and the median age (Q25, Q75) was 15 (7, 34) years; 51.4% (645/1 256) of patients were> 14 years old, 48.6% (611/1 256) of patients were ≤14 years old. The results of imaging analysis showed that 14.6% (98/672) of the patients′ tumors were located in the midbrain, 35.0% (235/672) were located in the pons, 21.0% (141/672) were located in the medulla oblongata.68.1% (597/877) of patients were non-diffuse intrinsic pontine gliomas (DIPG), 31.9% (280/877) of patients were DIPG. The growth patterns of the 280 cases of DIPG were mainly central type (37.9%, 106 cases) and lateral type (32.9%, 92 cases). The results of pathology and molecular pathology showed that 52.0% (359/690) of the tumors were WHO grade Ⅰ-Ⅱ, 47.8% (330/690) were grade Ⅲ-Ⅳ; 57.5% (185/322) of the patients had H3 K27M mutations, 9.1% (22/243) had isocitrate dehydrogenase (IDH) mutations, and none of them had coexistence of H3 K27M and IDH mutations. A total of 672 patients were treated with surgery and included in the survival analysis; 67.4% (236/350) of low-grade gliomas were treated with surgery only and 32.6% (114/350) were treated with radiotherapy and/or chemotherapy at the same time; 46.3% (149/322) of high-grade gliomas were treated with surgery only and 53.7% (173/322) were treated with radiotherapy and/or chemotherapy at the same time. The median (Q25, Q75) follow-up time of 672 patients was 18.8 (9.3, 42.3) months. The results of survival analysis showed that the overall 1, 3, 5 and 10-year survival rates were 72.1%, 51.4%, 45.9% and 40.7%, respectively. The median survival time was 40.1 months. Patients(≤14 years) with non-DIPG (174 cases) had higher overall survival rate than Patients(≤14 years) with DIPG (157 cases), and the overall survival rate of non-DIPG patients (>14 years, 269 cases) was higher than that of DIPG patients (>14 years, 72 cases). The overall survival rate of patients with the main tumor in the midbrain was higher than that of patients with medulla oblongata and pontine involvement; the overall survival rate decreased with the increase of WHO classification; the overall survival rate of IDH wild-type patients without H3 K27M mutation was higher than that of IDH mutant or H3 K27M mutant patients (allP<0.001).
BSG patients are slightly more common in males, and >14 years of patients are slightly more than ≤14 years. The tumor is mostly located in the pons, non-DIPG is more common, and the H3 K27M mutation is more common. Low-grade gliomas are mainly treated with surgery, and high-grade gliomas are mainly treated with surgery combined with radiotherapy and/or chemotherapy. Among the treated patients, the prognosis of ≤14 years patients with non-DIPG, those with the main tumor in the midbrain, low-grade WHO classification, and IDH wild-type patients without H3 K27M mutation, is relatively favorable.
To summarize the clinical characteristics and prognosis of brainstem glioma (BSG) in children.
The clinical data of 19 children with BSG who underwent surgical treatment in Department of Neurosurgery, Beijing Children′s Hospital of Capital Medical University from May 2013 to December 2020 were retrospectively analyzed. Patients undergoing partial tumor excision received chemotherapy and/or radiotherapy after surgery. According to the WHO tumor classification, those children were divided into low-grade BSG group (WHO gradeⅠ-Ⅱ; 13 cases) and high-grade BSG group (WHO grade Ⅳ; 6 cases). The clinical characteristics and survival of BSG children were analyzed, and the differences between the two groups were analyzed. The patient′s physical status was assessed using the scoring standard of the Eastern Cooperative Oncology Group (ECOG).
The ratio of male to female in the 19 cases was 12/7. The median age at diagnosis was 4.5 years, and the median duration of disease was 1.0 month. Cranial nerve function damage occurred in 13 children before operation. The pathological results showed that the 6 cases in the high-grade group were all diffuse midline gliomas with H3K27M positive; among the 13 cases in the low-grade group, there were 6 cases of ganglioglioma and 7 cases of astrocytoma. Comparing the high-grade group with the low-grade group, the median age at diagnosis (4.5 years vs. 7.0 years), tumor diameter (3.2±0.8 mm vs. 2.2±0.9 mm), ratio of total surgical resection (0/6 vs. 10/13), as well as the median pre- and post-operative ECOG scores (2.0, 1.0 points vs. 4.5, 0 points) were statistically significant (all P<0.05). The 6 cases in the high-grade group were all endogenous; 12 in the low-grade group were exogenous and 1 was endogenous. The difference was statistically significant (P<0.05). The median follow-up time of 13 cases in the low-grade group was 8 months, and all the children survived. In the high-grade group, 5 patients died with a survival time of 0.5 to 8.0 months; 1 patient was still alive after 8 months of follow-up.
Cranial nerve damage is the most common clinical manifestation of children with BSG. Compared with children with low-grade BSG, children with high-grade BSG seem to have older diagnosis age, larger tumor volume, mainly endogenous type, shorter course of disease, and poorer prognosis.
To investigate the clinical features, diagnosis, treatment and prognosis of brain stem gliomas (BSG) in children.
The clinical data of 32 patients (<18 years old) with BSG who underwent surgery at Neurosurgery Center of Tsinghua University Yuquan Hospital from January 2015 to January 2020 were retrospectively analyzed. Among them, 9 cases originated from the midbrain, 19 from the pons and 4 from the medulla oblongata. According to the tumor location, growth characteristics and the relationship between nerve fiber tracts and tumors, the suboccipital posterior median approach was taken in 14 cases, retrosigmoid sinus approach in 6 cases, cerebellar horizontal fissure approach in 4 cases, suboccipital supratentorial approach in 2 cases, supratentorial combined approach in 1 case, transcallosal interforniceal approach in 3 cases and subtemporal approach in 2 cases. Intraoperative electrophysiological monitoring was performed during all operations. After surgery, whether to undergo radiotherapy and chemotherapy was determined according to the degree of tumor resection and pathological grade. Regular clinical and imaging follow-up was performed.
The male to female ratio of 32 patients with BSG was 2.2 ∶1.0, and the age of onset was 6.8±3.4 (1-17) years old. There were 19 cases of cranial nerve palsy, 13 cases of hydrocephalus, 8 cases of stiff neck or torticollis, and 3 cases of Parinaud syndrome. According to the characteristics of tumor growth, there were 14 cases of exophytic type, 5 cases of focal endophytic type, 11 cases of diffuse endophytic type and 2 cases of special type. Total resection was achieved in 17 cases, subtotal resection in 4 cases and partial resection in 11 cases. Postoperative pathological results revealed that there were 9 cases of grade Ⅰ, 5 cases of grade Ⅱ, 6 cases of grade Ⅲ and 12 cases of grade Ⅳ according to WHO classification. A total of 18 patients were treated with adjuvant chemoradiotherapy. The median follow-up time of 32 patients was 25 months (3-60 months). Among them, 18 patients died of primary brain disease during the follow-up period, with the median survival time of 7.5 months. All 6 patients with BSG of endophytic type died, with a median survival time of 7.5 months; 2 out of 14 patients with exophytic type died and 2 patients with special type survived. Among the 14 patients with tumors of WHO grade Ⅰ-Ⅱ, 2 died, and the rest survived without recurrence at the last follow-up. Among the 18 patients with tumors of grade Ⅲ-Ⅳ, 16 died, with a median survival of 11.5 months.
The clinical manifestations of children with BSG are mainly cranial nerve palsy and hydrocephalus, with various imaging and pathological features. The treatment options include surgery, radiotherapy and chemotherapy. The prognosis of exophytic type, special type or low-grade BSG seems relatively favorable, while the that of endophytic type or high-grade BSG is relatively poor.
To investigate the clinical efficacy of temporoparietooccipital disconnection in the treatment of posterior quadrantic intractable epilepsy.
The clinical data of 16 patients who underwent temporoparietooccipital disconnection at the Neurosurgery Department of Beijing Fengtai Hospital from January 2015 to June 2018 were included consecutively. The surgery-related complications were observed retrospectively, and the outcome of the patients was evaluated using the Engel scale (grade Ⅰ: no seizure; grade Ⅱ-Ⅳ, seizure recurrence).
All 16 patients successfully underwent temporoparietooccipital dissection. Three patints developed contralateral limb motor dysfunction, all patients developed contralateral hemianopia after operation, one patient developed transient Gerstmann syndrome, and none of the patients developed infection or hydrocephalus. The follow-up time of 16 patients was 26.3±2.4 months (20-60 months). Postoperative seizure control was good, there were 14 seizure-free patients and 2 patients with seizure recurrence at the first follow-up at 3 months post operation. At the last follow-up, there were 12 patients with seizure-free and 4 patients with seizure recurrence including 2 cases of Engel grade Ⅱ and 2 cases of grade Ⅲ. In 3 patients with contralateral limb motor dysfunction after operation, their motor function improved during the follow-up period. None of the patients recovered from contralateral hemianopia. The patients with transient Gerstmann syndrome basically recovered after 3 months.
Temporoparietooccipital disconnection seems to be a safe and effective method for the treatment of posterior quadrantic intractable epilepsy.
To preliminarily investigate the subdural pathological changes of syringomyelia (SM) and to discuss the therapeutic effect of foramen magnum and Magendie dredging (FMMD) on SM.
A retrospective analysis was conducted on the clinical data of 50 SM patients admitted to the Department of Neurosurgery, Xuanwu Hospital of Capital Medical University from July 2018 to January 2019. We summarized the subdural pathological changes seen during the operation and the factors that may cause cerebrospinal fluid (CSF) circulation obstruction, and used FMMD to relieve the obstruction. We documented postoperative complications and evaluated the safety of surgery. The outpatient follow-up was performed at 3, 6, and 12 months after the operation. The modified Japanese Orthopedic Association (mJOA) score for cervical myelopathy was followed up, the clinical efficacy was evaluated according to the Tator criteria, and the MRI of the craniocervical junction was reviewed to evaluate SM. The mJOA cervical for cervical myelopathy before and after surgery were compared.
Intraoperative observation revealed that in 50 patients, the cerebellar tonsils with inferior hernia occupied the foramen magnum and covered the foramen Magendie in 44 cases (88%); there were intertonsillar adhesions in 18 cases (36%), adhesions between the tonsils and the brainstem in 9 cases (18%), asymmetric tonsil development across the midline in 35 cases (70%), the posterior inferior cerebellar artery branching in the foramen Magendie in 11 cases (22%), the pseudomembrane or scar on the surface of the foramen Magendie in 8 cases (16%), cisterna magna cyst in 2 cases (4%) and adhesions between tonsils and dura mater in 4 cases (8%). Of the 50 patients, only 1(2%) had intracranial infection after surgery, and the other patients had no obvious postoperative complications. The follow-up time of 50 patients was 13.3±3.1 months (12-15 months). At the last follow-up, the MRI results of 50 patients showed that 44 cases of syringomyelia improved (88%), 6 cases (12%) were stable; the clinical efficacy was improved in 44 cases (88%), 4 cases (8%) were stable, and 2 cases (4%) deteriorated; the mJOA score for cervical myelopathy improved compared with preoperative conditions (14.7±3.2 points vs. 12.9±3.1 points, paired t=2.83, P=0.03).
There are many pathological changes in the subdural regions of SM patients. After FMMD treatment, the symptoms and imaging manifestations of the patients are significantly improved, and there are few complications.
To analyze the postoperative complications of vagus nerve stimulation (VNS) in children with refractory epilepsy, and to explore the corresponding treatment strategies.
A retrospective study was conducted on the clinical data of 294 children with refractory epilepsy who were treated with VNS at Department of Functional Neurosurgery, Beijing Children′s Hospital, Capital Medical University from September 2015 to December 2019 and followed up for more than 6 months. Postoperative complications were documented. Corresponding treatment and outcomes were summarized.
Among 294 patients, 23 cases (7.8%) had postoperative complications related to operation or hardware, including throat-related complications (4.4%, 13/294) which was mostly commonly observed, superficial incision infection(2.0%, 6/294), deep incision infection (1.4%, 4/294), subcutaneous hematoma around VNS device(0.7%, 2/294) and immune rejection (0.3%, 1/294). The local symptoms disappeared after anti-infection treatment in 6 children with superficial incision infection after operation. Among 4 children with deep incision infection, the infection was effectively controlled after removal of the VNS device and anti-infection treatment. In 2 children with subcutaneous hematoma around the stimulation device, the hematoma was resolved following pressure dressing and dressing change. In 1 child with immune rejection, the symptoms disappeared after all VNS devices were removed. In 13 children with throat complications, the symptoms disappeared after the programming of VNS and postoperative rehabilitation.
The incidence of postoperative complications of VNS in children with refractory epilepsy is low, and throat complications and infections are the most common. The outcomes of various complications are satisfactory after corresponding treatment. Many technical aspects in surgical operations are associated with postoperative complications, and the standardized operation is a key factor in the prevention of complications.
To investigate the clinical factors affecting the deep venous thrombosis (DVT) in neurosurgical patients during the perioperative period.
A retrospective analysis was conducted on the clinical data of 298 patients admitted to the Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from January to December 2019. We documented suspicious DVT risk factors including general clinical data, important laboratory test results, and surgical data. Based on whether there was DVT revealed by preoperative and postoperative intravenous ultrasound examination, the patients were divided into preoperative DVT group (n=24) and preoperative non-DVT group (n=274), postoperative DVT group (n=125) and postoperative non-DVT group (n=173). Univariate and multivariate logistic regression analysis were used to determine the risk factors that affected the formation of DVT before and after surgery.
No patient developed disability or died due to DVT during the perioperative period. Univariate logistic regression analysis showed that preoperative D-dimer and age were the clinical factors that affected the occurrence of preoperative DVT(all P<0.05); age, bed rest, postoperative dehydration ≥3 d and increase of postoperative D-dimer were the clinical factors that affected the occurrence of DVT post operation(allP<0.05). Multivariate logistic regression analysis showed that increase of preoperative D-dimer (OR=1.725, 95%CI: 1.149-2.590, P=0.009) and age (OR=1.055, 95%CI: 1.005-1.107, P=0.029) were independent risk factors for preoperative DVT; age (OR=1.065, 95%CI: 1.040-1.092, P<0.001) and increase of postoperative D-dimer (OR=1.091, 95%CI: 1.019-1.168, P=0.013) were independent risk factors for postoperative DVT.
The risk of perioperative DVT seems higher in neurosurgical patients with older age or elevated D-dimer.
From January 2019 to June 2020, 20 patients were treated in the Department of Neurosurgery of Beijing Ditan Hospital affiliated to Capital Medical University, including 6 cases of hydrocephalus after cerebral hemorrhage or subarachnoid hemorrhage, 7 cases of ventriculitis complicated with hydrocephalus, 2 cases of ventricular hemorrhage, 4 cases of AIDS complicated with cryptococcal meningitis, and 1 case of AIDS complicated with tuberculous meningitis. All patients underwent long-range ventricular-abdominal wall external drainage with a median drainage time of 46.2 d (range 28-180 d). None of the 20 patients developed drainage port infection, retrograde subcutaneous tunnel infection, scalp or abdominal wall incision infection. Eighteen patients underwent second-stage ventriculoperitoneal shunt, and none of them developed intracranial or abdominal infection after operation. The infection of 5 patients with intracranial infection was effectively controlled after operation, and the symptoms of hydrocephalus were relieved in 13 patients.
To explore the characteristics of lipid metabolism of malignantly transformed macrophages (tMΦ) in the microenvironment of glioma stem cells (GSCs) and the underlying regulatory mechanisms and to provide experimental basis for precision treatment against tMΦ.
In this study, we used macrophages (MΦ) and tMΦ cell lines (including tMΦ1 and tMΦ2), and analyzed the lipid metabolism characteristics of tMΦ by detecting the levels of triacylglycerol (TG) and total cholesterol (TC) in the cells. Western blot experiments were performed to detect the expression levels of key molecules regulating lipid metabolism including calmodulin (CaM), apolipoprotein E (ApoE), hormone-sensitive triacylglycerol lipase (HSL), and liver X receptor (LXR). We then constructed the differentially expressed long non-coding RNA (lncRNA) expression profile of tMΦ, chose HOXC-AS3 (homeobox C cluster antisense RNA3) as the research object, and established HOXC-AS3 over-expression and low-expression tMΦ cell lines. Real-time quantitative PCR (qRT-PCR) was used to detect the expression level of CaM in tMΦ after HOXC-AS3 was up-regulated and silenced. The colony forming ability of tMΦ after the silencing of HOXC-AS3 was observed through the colony formation experiment, the invasion ability was detected by the Transwell experiment, and the tumorigenic ability was observed by establishing an in vivo xenograft tumor mouse model. Proteomic analysis of the binding protein related to the lipid metabolism of HOXC-AS3 was performed, and RNA immunoprecipitation was used to verify whether the two could form a complex, and the regulation of HOXC-AS3 to its binding protein was analyzed by qRT-PCR and Western blot experiments.
The content of TC and TG and the expression levels of CaM, ApoE, HSL, and LXR proteins were higher in tMΦ than in normal MΦ (allP<0.01). LncRNA expression profile results suggested that compared with normal MΦ, HOXC-AS3 was highly expressed in tMΦ1 and tMΦ2. The results of colony formation assay showed that the number of clones of tMΦ1 and tMΦ2 after silencing HOXC-AS3(sh-HOXC-AS3 group) was significantly less than that of the blank control group (sh-NC group) (all P<0.01). Transwell experiment results showed that the number of transmembrane cells in the sh-HOXC-AS3 group tMΦ1 and tMΦ2 was less than that in the sh-NC group (both P<0.01). The tumorigenicity experiment results showed that the transplanted tumor volume of mice in the sh-HOXC-AS3 group was smaller than sh -NC group (bothP<0.01). The results of qRT-PCR indicated that overexpression of HOXC-AS3 could up-regulate the expression of CaM in tMΦ, while silencing HOXC-AS3 could down-regulate the expression of CaM in tMΦ (bothP<0.01). The proteomic analysis results indicated that the lipid metabolism-related protein with the highest correlation with HOXC-AS3 was hnRNPA1. The results of RNA immunoprecipitation confirmed that hnRNPA1 and HOXC-AS3 could form a complex. After hnRNPA1 was silenced, the expression of CaM in tMΦ was down-regulated (bothP< 0.01), and after silencing HOXC-AS3 in tMΦ, the changes of hnRNPA1 gene and protein levels were not statistically significant (allP>0.05).
The level of lipid metabolism and synthesis in tMΦ is higher than that in normal MΦ, and the mechanism may be that HOXC-AS3 binds to hnRNPA1 to affect the expression of lipid metabolism molecule CaM, thereby regulating the lipid metabolism remodeling of tMΦ. Targeting HOXC-AS3 can inhibit the proliferation and invasion of tMΦ in the microenvironment of GSCs. HOXC-AS3 may be a potential target for improving the immunotherapy effect of glioma.
To explore the expression characteristics and clinical significance of delta like canonical notch ligand 3 (DLL3) gene in gliomas, and to explore its biological functions in gliomas.
Two sets of mRNA sequencing datasets and their matched clinical data from the Chinese Glioma Genome Atlas (CGGA) database were retrospectively analyzed, among which dataset 1 contained 325 samples and dataset 2 contained 693 samples. The expression patterns of DLL3 in gliomas with different WHO grades and different molecular types were analyzed using the R software, and the expression levels of DLL3 protein in gliomas with different grades were verified by immunohistochemical assay. Kaplan-Meier survival curve was used to evaluate the survival differences among glioma patients with different DLL3 expression levels. Univariate and multivariate Cox regressions were used to analyze the factors associated with the overall survival of glioma patients. The genes associated with DLL3 expression were identified by Pearson correlation analysis. Functional enrichment analysis was used to analyze the biological functions of genes related to DLL3 expression.
In dataset 1, the expression of DLL3 gene was down-regulated with the increase of WHO grade, and the difference was statistically significant (P<0.001). The expression of DLL3 in IDH mutant patients was significantly higher than that in IDH wild-type patients (P<0.001). The expression of DLL3 in IDH wild-type patients was significantly lower than that in IDH mutant with chromosome 1p/19q co-deletion group or IDH mutant without chromosome 1p/19q co-deletion group (P<0.001). The expression of DLL3 in patients with O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation was significantly higher than that in non-methylated patients (P<0.001). The immunohistochemical staining confirmed that the expression of DLL3 gene was down-regulated with the increase of WHO grade (P<0.01). The above results of DLL3 were similar in dataset 2. Patients with high DLL3 expression had longer overall survival than those with low DLL3 expression (allP<0.01). Multivariate Cox regression analysis showed that pathological grade (WHO grade Ⅲ:HR=2.861, 95%CI: 1.910-4.287; grade Ⅳ: HR=4.655, 95%CI: 3.010-7.199), chromosome 1p/19q co-deletion (HR=0.439, 95%CI: 0.293-0.657), and high expression of DLL3 (HR=0.593, 95%CI: 0.427-0.823) were independent prognostic factors for glioma patients(all P<0.001). There are 661 genes that were associated with DLL3 expression (|r|≥0.4, P<0.05). Bioinformatics analysis suggested that DLL3 may be related to axonogenesis, synaptic organization, negative modulation of the nervous system development in glioma patients and so on.
As the pathological grade of glioma increases, the expression level of DLL3 is down-regulated. The expression level of DLL3 is closely related to the survival of patients with glioma, and can be used as a potential indicator and treatment target for judging the prognosis of patients with glioma.
To study the effect of different concentrations of nitrate on the biological activity of glioma C6 and U87 cells under starvation conditions and the changes of autophagy-related proteins.
The C6 and U87 cells were divided into control group and starvation group. Control group was cultured with normal medium, and starvation group was cultured with Hank′s balanced salt solution. The C6 cells and U87 cells were treated by nitrate (0 mmol/L, 0.05 mmol/L, 0.20 mmol/L, and 0.50 mmol/L) for 12 h and 24 h. The MTT method was used to assess the cell proliferation, and flow cytometry to measure the apoptosis level, and real time PCR (RT-PCR) to measure the mRNA level of p62, and Western blot to detect the expression levels of autophagy-related protein p62, microtubule-associated protein 1 light chain 3 (LC3) Ⅱ/Ⅰ and nitrate transporter (SLC17A5).
Compared with that in the control group, the ability of cell proliferation in starvation group was reduced in either C6 cell line or U7 cell line. The cell viability in starvation group of C6 was reduced by (63.60±2.40)% after 12-h treatment and by (77.10±2.70)% after 24-h treatment; the cell viability in starvation group of U87 was reduced by (65.60±2.70)% after 12-h treatment and by (86.80±3.20)% after 24-h treatment (all P<0.01). Compared with that of 0 mmol/L, nitrates of 0.20 mmol/L and 0.50 mmol/L reduced the cell proliferation in starvation groups of both C6 and U87 (P<0.05), while the nitrate concentration of 0.05 mmol/L had no significant effect on the cell proliferation activity of each group (P>0.05). Flow cytometry showed that after the C6 cell control group was given 0.20 mmol/L and 0.50 mmol/L nitrate, there was no significant difference in the number of Annexin V-positive cells and propidium iodide-positive cells in each group (bothP>0.05); after starvation for 12 h, the percentages of positive cells for Annexin V and propidium iodide were (13.50±0.71)% and (7.80±0.34)% respectively in the 0 mmol/L group, (17.30±0.82)% and (10.30±0.42)% respectively in the 0.20 mmol/L group, and (19.40±0.75)% and (12.60±0.75)% respectively 0.50 mmol/L group. The differences between the groups were statistically significant (allP<0.05). The apoptosis levels of U87 cells in each group also showed the same trend. Real-time fluorescence quantitative PCR experiments showed that different concentrations of nitrate in the control group did not affect the expression of p62 mRNA in C6 and U87 cells (allP>0.05). After the starvation group was given different concentrations of nitrate, the expression of p62 mRNA in C6 and U87 cells was significantly increased (allP<0.05). Western blot experiments showed that the ratio of LC3Ⅱ/I was significantly down-regulated after the starvation group was given different concentrations of nitrate, while the expression levels of p62 and SLC17A5 were significantly up-regulated (bothP<0.05).
Nitrate inhibits the proliferation of glioma cells and the level of autophagy in the glioma cells under starvation, thereby inducing cell apoptosis.
Penetrating skull base injury combined with cerebrospinal fluid leakage caused by large foreign bodies such as grinding wheels is clinically rare. Such patients are difficult to operate, and the risk of postoperative cerebrospinal fluid leakage and intracranial infection is higher. In April 2020, the Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, treated a patient with penetrating anterior skull base injury caused by grinding wheel combined with cerebrospinal fluid leakage. The anterior skull base was reconstructed by craniotomy with autologous pedicled periosteal flap microsuture. The patient recovered well after surgery, and there was no definite cerebrospinal fluid leak at 1 month follow-up.
Diffuse midline glioma is a widely aggressive malignant tumor, which occurs in children between 7 and 9 years old and occasionally in adults. Diffuse midline glioma in children grows in the midline structure of the nervous system. Its common sites include thalamus, brainstem and spinal cord. It grows diffusely, is prone to metastasis and recurrence, and has a poor prognosis. At present, the treatment methods are mainly surgical resection, radiotherapy and chemotherapy.
As a new type of endovascular embolization device, the clinical value of Pipeline embolization device in the treatment of intracranial aneurysms is constantly prominent, and its efficacy and safety in clinical application are gradually confirmed, which has become the first choice of treatment for many types of complex intracranial aneurysms. However, the effectiveness and safety of the Pipeline embolization device in the treatment of ruptured intracranial aneurysms are unclear. This article reviews the research progress of Pipeline embolization device in the treatment of ruptured intracranial aneurysms.
Pituitary cell tumor is a rare intrasellar or suprasellar parenchymal tumor with World Health Organization (WHO) tumor grade I. The clinical and imaging manifestations are very similar to those of pituitary adenoma. The diagnosis mainly depends on postoperative pathological diagnosis, and the treatment method is mainly surgery. This article reviews the status of diagnosis and treatment of pituitary cell tumors.
Stroke is one of the high-risk diseases. For many years, the research of microRNA (miRNA) has focused on the impact on stroke, and the results show that miRNA has important significance in the diagnosis, prognosis and treatment of stroke. This article reviews the related articles about miRNA and stroke, summarizes the value of miRNA in the diagnosis and prognosis of stroke, and its role in pathophysiological processes. Specifically, the roles of oxidative stress, apoptosis, inflammatory response and angiogenesis are described.
Studies have found that lithium salts have a therapeutic effect not only on mental diseases such as bipolar disorder, but also on organic diseases such as central nervous system injury. Lithium salt can maintain the integrity of blood-brain barrier after traumatic brain injury, alleviate neurodegeneration and cognitive impairment caused by it; Lithium salts can also reduce the inflammatory response and edema after cerebral hemorrhage and traumatic brain injury; In addition, lithium salt can promote the recovery of motor function in experimental animals with spinal cord injury. In this paper, the research progress of lithium salt in the treatment of traumatic brain injury, cerebral hemorrhage and spinal cord injury is briefly reviewed.
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