Volume 37 · Issue 12 · 2021

essential tremor (ET), also known as essential tremor, is the most common movement disorder. Its main clinical manifestation is 4-12 Hz action tremor of both upper limbs, with or without head, orofacial, voice or lower limb tremor^[1,2]。 The pathogenesis of ET is not fully understood, and the rhythmic oscillation of the cortical-pons-cerebellar-thalamic-cortical circuit is the main pathophysiological mechanism of ET^[3]。 At present, the treatment methods of ET mainly include drug therapy (oral drugs and botulinum toxin A injection), surgery, rehabilitation, etc. About 1/3 of ET patients have poor response to drug therapy^[1]。 The surgical treatment of ET includes: deep brain stimulation (DBS), stereotactic thalamic destruction, and MRI-guided focused ultrasound (MRgFUS) destruction. After 1987, DBS has been used in the surgical treatment of ET for more than 30 years, and has become the first choice for drug-refractory ET^[4]。 DBS, while improving tremor, significantly improves patients' quality of life and ability to live daily. At present, many centers in China have carried out DBS treatment for patients with drug-refractory ET, but there is a lack of targeted guidelines or consensus. In order to further standardize the indications and procedures of applying DBS to treat ET in China, strengthen the close cooperation between neurology and surgery, and improve the level of diagnosis and treatment, experts in related fields have formulated this consensus after full discussion.

traumatic brain injury (TBI), particularly severe TBI [Glasgow Coma Scale (GCS) ≤8], is the cause of children (<18) one of the most common causes of disability and death^[1]。 Because the anatomy, physiology and pathophysiology of children's nervous system are different from those of adults, the clinical characteristics and treatment strategies of TBI are also different from those of adults^[2]。 At present, most of the research subjects related to TBI in China are adults, and there is still no guideline and expert consensus on TBI in children. In order to better treat children with severe TBI, improve the overall treatment level of children with TBI in China, and standardize the treatment of children with TBI, experts from the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Traumatology Branch of Chinese Medical Association summarized clinical experience according to the existing clinical evidence, and jointly discussed and wrote the Chinese Expert Consensus on Diagnosis and Treatment of Craniocerebral Trauma in Children (hereinafter referred to as the Consensus), in order to improve the cure rate of children with TBI and reduce the mortality and disability rate.

To explore the value of machine learning model in predicting the prognosis of patients with hydrocephalus after craniocerebral injury treated by ventriculoperitoneal shunt(VPS).

A retrospective analysis was conducted on the clinical data of 94 patients who underwent VPS due to hydrocephalus after craniocerebral injury admitted to the Department of Neurosurgery of Huashan Hospital, Fudan University from January 2013 to July 2019. The last Glasgow coma score (GCS) at discharge after shunting was compared to preoperative GCS to determine the progressive group and the non-progressive group. Traditional statistical methods were used to compare the age, gender, length of hospital stay, intracranial infection, posterior fossa lesion, ventricular hemorrhage, skull defect, ventricular pressure and types of hydrocephalus (low pressure hydrocephalus and normal pressure hydrocephalus) between the two groups. Python 3.6 and scikit-learn 0.23 toolkit were used for machine learning analysis, logistic regression algorithm was used as the basic algorithm for machine learning analysis, and randomly split training and testing were performed. In this series, 70% of the data (65 cases) were the training set, and the remaining 30% of the data (29 cases) were the test set. We then analyzed the predictive effect of the above risk factors on the prognosis of patients after shunt.

Traditional statistical results showed that compared with the patients in non-progressive group, those in progressive group were older and had a lower GCS score before VPS, and the differences were statistically significant (both P <0.05); while there was no significant difference in the incidence of intracranial infection, posterior fossa lesion, intraventricular hemorrhage, skull defect, length of hospital stay, ventricular pressure, or presence of low-pressure hydrocephalus between the two groups (all P> 0.05). The prediction results of the machine learning model showed that the accuracy rate of predicting clinical progress after VPS in the training set was 67.4±20.0%, and the AUC was 0.69±0.18, and those in the test sets were 62.1% and 0.71 respectively. Compared with clinical diagnosis, the overall accuracy rate of predicting the poor prognosis of hydrocephalus after brain injury based on machine learning risk factors was 68.1% (64/94), the sensitivity was 71.4% (30/42), the specificity was 65.4% (34/52), and AUC was 0.89(χ² = 12.600, P<0.001). The weight analysis of the machine learning prediction model showed that low-pressure hydrocephalus accounted for 50.8%, pre-shunt GCS score accounted for 22.7%, intracranial infection accounted for 13.2%, and skull defect accounted for 9.7%.

Compared with traditional statistical methods, the prediction model based on machine learning can capture clinical indicators with smaller statistical effects, and has greater predictive value for the poor prognosis of hydrocephalus after brain injury.

To investigate the influencing factors of successful retropyloric placement of spiral nasointestinal tube in patients with traumatic brain injury (TBI).

A retrospective analysis was conducted on the clinical data of 267 patients with TBI at the Intensive Care Unit, Department of Neurosurgery, Xiangya Hospital, Central South University from December 2016 to October 2020. All patients underwent X-ray or CT examination after the tube was inserted, and successful placement was defined as tube tip passing through the pylorus based on imaging results. Information was collected regarding baseline characteristics, Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHE) Ⅱ score, acute gastrointestinal injury (AGI) grade, whether the patient underwent hypothermia therapy or not, laboratory parameters and medications, etc. Univariate and multiple logistic regression were performed to identify the contributing factors of successful placement. Receiver operating characteristic (ROC) curves were plotted and the significant indicators were applied to evaluate the efficacy of predicting successful placement. The optimal cut-off values were calculated accordingly.

The overall success rate of intubation was 89.5% (239/267). APACHE Ⅱ score(OR=0.792, 95%CI: 0.663-0.946, P=0.010), AGI grade(OR=0.119, 95%CI: 0.034-0.424, P=0.001), hypothermia therapy (OR=0.225, 95%CI: 0.051-0.985, P=0.048) and the level of serum albumin (OR=1.178, 95%CI: 1.045-1.328, P=0.007) were independent contributing factors of successful tube placement, with AUC of 0.800 (0.727-0.872), 0.791 (0.721-0.861), 0.650 (0.525-0.775), 0799 (0.733-0.865) respectively. The optimal cut-off values for APACHE Ⅱ and serum albumin were 10 (with the sensitivity of 85.7% and specificity of 61.9%) and 30.7 g/L (with the sensitivity of 89.3% and specificity of 61.9%) respectively.

APACHE Ⅱ score, AGI grade, hypothermia therapy and serum albumin are good predicting factors for successful retropyloric nasointestinal placement in patients with TBI.

To investigate the clinical outcomes and safety of polyetheretherketone (PEEK) and titanium mesh in cranioplasty.

The clinical data of 58 patients who were admitted to the Department of Neurosurgery of Peking University International Hospital and underwent cranioplasty from October 2015 to February 2021 were retrospectively analyzed. According to the repair materials used, the patients were divided into PEEK group (17 cases) and titanium mesh group (41 cases). The economic indicators (length of hospital stay, hospitalization cost), effectiveness (sculpting satisfaction) and safety (occurrence of postoperative complications) were compared between the two groups.

Patients in the PEEK group were younger than those in the titanium mesh group (32.1±3.8 years vs. 40.7±2.2 years, P=0.044). Length of hospital stay in the PEEK group was significantly longer than that in the titanium mesh group (25.1±2.9 days vs. 16.4±1.1 days, P=0.002). The hospitalization cost of PEEK group was higher compared with that of titanium mesh group (212 085±19 635 yuan vs. 76 514±5 937 yuan, P=0.001). The patient′s rate of satisfaction with cranioplasty in the PEEK group was significantly higher than that in the titanium mesh group (16/17 vs. 28/41, P=0.036). The incidences of postoperative complications were comparable between the two groups (2/17 vs. 5/41, P=0.964). There was no significant difference in postoperative white blood cell count or neutrophil percentage between the two groups on the first day post operation (both P>0.05).

The outcome of PEEK for cranioplasty is better than that of titanium mesh, while its economic indicators are not as good as the latter. PEEK can be used as one of the materials of choice in cranioplasty.

To examine trends in incidence and prevalence of traumatic brain injury (TBI) from 2000 to 2019 in China.

The latest TBI data estimated by the Global Burden of Disease study group was used to evaluate changes in the incidence and prevalence of TBI among the population of different genders, age groups and causes in China from 2000 to 2019, and the relative percentage changes in the incidence and prevalence of TBI between 2000 and 2019 were calculated. The chi square test was used to compare the differences in the incidence and prevalence of TBI among different genders and age groups.

(1) Excluding the impact of the 2008 Wenchuan earthquake, the age-standardized incidence rose from 152.5 per 100 000 in 2000 to 207.8 per 100 000 in 2019 (an increase of 36.3%), with age-standardized prevalence grew from 231.3 per 100 000 in 2000 to 342.3 per 100 000 in 2019 (a growth of 48.0%). During the same period, the number of TBI cases went up to 3.310 million from 2.032 million (an increment of 62.9%), while the number of patients escalated from 2.984 million to 6.546 million (a gain of 119.4%). (2) The incidence and prevalence of TBI revealed sex and age differences, as those rates were steadily higher in males than in females and higher in adults aged 50-69 and ≥70 years than any other age groups in the years between 2000 and 2019 (all P<0.05). (3) Road injury, the most prominent external cause of TBI among Chinese, accounted for 43.2%-55.1% and 56.9%-67.1% of the total incidence and prevalence of TBI respectively. (4) Riding motorcycles, bicycles and walking were the most important travel modes for road injury-induced TBI, consisting 80.4%-82.0% and 83.1%-85.3% of TBI cases and patients.

There is an overall trend of rapid growth in the incidence and prevalence of TBI in China from 2000 to 2019.

To investigate the predictive value of systemic inflammatory factors on short-term outcome of traumatic brain injury (TBI) patients.

A retrospective analysis was conducted on the clinical data of 74 patients with TBI treated by surgery who were admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to December 2019. Systemic inflammatory response factors, including white blood cell count, neutrophil count, lymphocyte count, monocyte count, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index, were evaluated within 24 hours after TBI. The Glasgow outcome scale (GOS) was used to evaluate the short-term efficacy of the patients at 1 month after the operation, and they were divided into two groups: good outcome (GOS Ⅳ, Ⅴ) and poor outcome (GOS Ⅰ-Ⅲ). Univariate and multivariate logistic regression analysis were used to screen independent risk factors for short-term efficacy in TBI patients. A receiver operating characteristic(ROC) curve was drawn and the area under the curve was calculated to evaluate the predictive value of systemic inflammatory factors for the prognosis of TBI patients.

Among 74 patients with TBI, 55 cases (74.3%) had good short-term outcomes, and 19 cases (25.7%) had poor outcomes. Univariate analysis showed that midline shift≥1 cm on brain CT, preoperative Glasgow coma score (GCS), blood glucose, hypocalcemia, white blood cells, neutrophils, monocytes, platelets, NLR, dNLR, PLR and MLR were all closely related to the short-term efficacy of TBI patients (all P<0.05). Multivariate logistic regression analysis showed that early hypocalcemia(OR=0.001, 95%CI: 0-0.376), white blood cell count ≥14.2×10⁹/L(OR=0.005, 95%CI: 0-0.604), monocyte count ≥0.9×10⁹/L(OR=0.012, 95%CI: 0-0.385) and NLR≥12.8(OR=0.001, 95%CI: 0-0.603) in TBI patients were independent risk factors for poor short-term efficacy (all P<0.05). White blood cells + monocytes had the strongest predictive values. The area under the curve was 0.801 (95%CI: 0.697-0.905), and the sensitivity and specificity were 84.2% and 72.7% respectively.

Among the systemic inflammatory factors, the combined analysis of white blood cell and monocyte counts has a relatively higher predictive value for the short-term outcome of TBI patients.

To explore the application value of heparin-binding protein (HBP) in patients with intracranial infection after trauma craniotomy.

A retrospective analysis was conducted on the clinical data of 75 cases of craniocerebral trauma patients with suspected intracranial infection after craniotomy at the Department of Neurosurgery, Nanning Second People′s Hospital from January 2020 to May 2021. Postoperatively, according to the " Consensus of Chinese Experts on the Diagnosis and Treatment of Central Nervous System Infections in Neurosurgery (2021 Edition)" , the patients were determined to have intracranial infection or not. Univariate and multivariate logistic regression analyses were used to determine whether HBP in cerebrospinal fluid was a risk factor for intracranial infection in patients with traumatic brain injury. The receiver operating characteristic (ROC) curve was further drawn and the area under the curve (AUC) was calculated to assess the predictive value of HBP.

All 75 patients underwent successful operation. After surgery, 40 cases were diagnosed as intracranial infection (intracranial infection group), and the other 35 patients were diagnosed as aseptic meningitis (non-intracranial infection group). The results of univariate analysis showed that the white blood cell count, multinucleated cell ratio, blood glucose ratio and HBP in the cerebrospinal fluid were the influencing factors of intracranial infection in patients with traumatic brain injury (all P<0.05). Multivariate logistic regression analysis showed that HBP in cerebrospinal fluid was a risk factor for intracranial infection in patients with traumatic brain injury (OR=1.118, 95%CI: 1.050-1.190, P<0.05). The results of ROC curve analysis showed that when the cut-off value of cerebrospinal fluid HBP was 35.55 ng/ml, the AUC=0.96 (95%CI: 0.967-1.000), the sensitivity was 95%, and the specificity was 95%.

HBP in cerebrospinal fluid is a risk factor for the diagnosis of intracranial infection in patients with traumatic brain injury. When the cut-off value is 35.55 ng/ml, the sensitivity and specificity of the diagnosis of intracranial infection are higher, and it has a certain predictive value.

To evaluate the long term outcome of gamma knife radiosurgery (GKS) for the treatment of arteriovenous malformations (AVMs) in children and to explore its relevant influencing factors.

We retrospectively studied 279 children with intracranial AVMs (age ≤ 16 years) treated at the Gamma Knife Center of Beijing Tiantan Hospital, Capital Medical University from January 1995 to December 2016. The marginal prescription dose for treatment was 12-25 Gy (median: 17.0 Gy), the central prescription dose was 19-50 Gy (median: 32.7 Gy); the volume of the malformations treated was 0.1-30.2 cm³ (median: 1.7 cm³); 54 children (19.4%) received multiple Gamma Knife treatments, of which 35 underwent repeated treatments due to residual lesion, and 19 underwent staged treatments as planned. The clinical and imaging effects of patients were followed up, and the relevant factors affecting the occlusion of AVMs were analyzed.

The follow-up time of 279 children after treatment was 6 to 276 months (median: 49 months), of which 197 cases (70.6%) had occlusion of AVMs. The occlusion rate at 3, 5, and 8 years after treatment was 33.5% (86/257), 69.4% (154/222), 81.1% (172/212) respectively. Twenty-four children (8.6%) had 30 cases of AVM-related bleeding after treatment, and 5 cases (1.8%) died. Five cases (1.8%) had radiotherapy-related complications, 4 cases had worsening neurological dysfunction, and 1 case had long-term radiation related cystic formation. Univariate analysis showed that compared with the non-occluded group, the children in the occluded group were older, the proportions of those with the lesion volume <3 cm³, Spetzler-Martin grade of 1 to 3, radiosurgery-based AVM score ≤1.5, and marginal prescription dose ≥17 Gy were higher, and the differences were statistically significant (all P<0.05). Multivariate Cox regression analysis showed that the marginal prescription dose ≥17 Gy was an influencing factor for occlusion of AVMs (HR=1.42, 95%CI: 1.07-1.89, P=0.015).

The long-term safety and efficacy of radiosurgery for intracranial AVMs in children seem good, particularly for children with small and medium-sized AVMs. The marginal prescription dose is the main factor that affects the long-term efficacy of GKS for AVMs.

To explore the characteristics of Langerhans cell histiocytosis (LCH) in sellar region.

The clinical data, 12 patients with LCH in sellar region admitted to the Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from June 2018 to August 2020 were retrospectively analyzed. Among them, 7 cases underwent stereotactic biopsy, 4 cases underwent craniotomy with resection of the sellar region lesions, and 1 case underwent resection of the right parietal bone lesions. The clinical, imaging and pathological characteristics of those cases were analyzed.

The age of the 12 patients was 29.0±16.3 years (3-54 years), the proportion of adults was 9/12, and the ratio of male to female patients was 5 ∶7. All patients started with polydipsia and polyuria. The course of the disease ranged from 1 month to 15 years. The proportion of patients with abnormal thyroid function was 10/10, and the proportion of patients with preoperative hypernatremia was 7/12. The ratio of misdiagnosis in preoperative imaging was 11/12. The head MRI results showed that all patients had a loss of physiological hyperintensity in the posterior pituitary gland and bilateral optic tract edema. Among the 12 patients, 4 showed diffuse and multiple small translucent areas in both lungs on CT results. The HE staining results of the pathological specimens of 12 patients showed the proliferation of histiocyte-like cells with large volume and rich cytoplasm; the immunohistochemical staining results showed that S-100, CD1a and Langerin proteins were all positively expressed.

Patients with LCH in sellar region often start with polydipsia and polyuria, and are often accompanied by abnormal thyroid function and hypernatremia. Adults and children can suffer from the disease and are easily misdiagnosed. In cranial MRI, the loss of physiological hyperintensity in the posterior pituitary gland and the edema of the bilateral optic fascicles are common, some of which are accompanied by characteristic changes in both lungs. The pathological features are proliferation of histiocyte-like cell and positive expression of S-100, CD1a and Langerin proteins.

To explore the survival, prognosis and influencing factors of high-grade spinal cord glioma.

A retrospective analysis was conducted on the clinical data of 48 patients with high-grade spinal cord glioma (WHO Grade Ⅲ, Ⅳ) who underwent tumor resection at the Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University from January 2015 to December 2020. Re-examination of spine MRI was performed after operation to determine the extent of tumor resection. All patients were followed up at outpatient clinics or by telephone and inquired about their survival status. The Kaplan-Meier method was used to draw the survival curve of patients with high-grade spinal cord glioma. Univariate and multivariate Cox regression methods were used to determine the clinical factors affecting patients with high-grade spinal cord glioma.

In 48 patients, the re-examination of spine MRI was performed after surgery. Total resection was achieved in 7 cases (14.6%), subtotal resection in 36 cases (75.0%), and partial resection in 5 cases (10.4%). Pathological examination results showed that there were 18 cases (37.5%) of anaplastic astrocytoma, 13 cases (27.1%) of diffuse midline glioma, 10 cases (20.8%) of glioblastoma, and 7 cases (14.6%) of anaplastic ependymoma. The average follow-up period of 48 patients was 12±6 months (1-79 months) and the median survival time was 12 months (1-79 months). At 1 year, 2 years and 3 years after the operation, the survival rates were 56.3% (27/48), 16.7% (8/48) and 4.2% (2/48) respectively. The results of multivariate Cox regression analysis showed that the course of the disease of more than 6 months (HR=0.393, 95%CI: 0.160-0.964), total resection (HR=0.180, 95%CI: 0.036-0.898) and subtotal resection (HR=0.246, 95%CI: 0.064-0.944) of tumor are protective factors for the survival prognosis of patients with high-grade spinal cord glioma (all P<0.05), and McCormick′s rating of Ⅲ, Ⅳ (HR=2.294, 95%CI: 1.056-4.986) was a risk factor affecting the patient′s survival prognosis (P<0.05).

The prognosis of patients with high-grade spinal cord glioma are proor. The patients with a course of ≤6 months, severe spinal cord function injury and partial surgical resection were worse.

To explore the efficacy and influencing factors of stereotactic aspiration in the treatment of primary brain stem hemorrhage (PBH).

The clinical data of 65 patients with PBH admitted to the Department of Neurosurgery of the First Hospital of Hebei Medical University from February 2019 to February 2020 were retrospectively analyzed. All patients were treated with stereotactic aspiration, and the patients with obstructive hydrocephalus were treated with occipital ventricle puncture and drainage at the same time. The survival status (mortality) of the patients was followed up 30 days after the operation, and the modified Rankin scale (mRS) was used to evaluate the 90-day neurological function recovery. Univariate and multivariate logistic regression analyses methods were used to explore the influencing factors of patients′ survival status and neurological function recovery.

Of the 65 patients, 15 patients (23.1%) died 30 days after the operation, and 21 patients (32.3%) reported good recovery of neurological function (mRS of 0 to 3 points). The results of multivariate logistic regression analysis showed that hematoma classification was an independent influencing factor of the survival of patients with PBH (OR=0.255, 95%CI: 0.074-0.880, P=0.031) and the recovery of neurological function (OR=0.029, 95%CI: 0.002-0.483, P=0.014).

The death probability of patients with giant hematoma who underwent stereotatic aspiration is higher than that of patients with other hematoma types. The neurological function recovery of patients with unilateral tegmental hematoma is better than that of patients with other types. Stereotactic aspiration surgery is an effective treatment for PBH and has clinical promotion value.

To discuss the risk factors of unplanned reoperation in adult patients with elective craniotomy for supratentorial tumors.

We retrospectively analyzed the clinical data of 961 adult patients with supratentorial tumors treated by craniotomy at the Department of Neurosurgery, the First People′s Hospital of Lianyungang from January 2010 to December 2019. All patients were divided into two groups: 921 cases in the non-reoperation group and 40 cases in the reoperation group (4.2%). We compared the gender, age, preoperative Karnofsky functional status score, history of hypertension and diabetes, tumor invades the skull base, recurrence of tumor, location of tumor, histopathology, maximum cross-sectional area of tumor, the volume, and extent of tumor resection between reoperation group and non-reoperation group. Differences in intraoperative blood loss and blood transfusion, operation time, and Glasgow Outcome Scale (GOS) at discharge were explored and multivariate regression analysis was used to analyze the indicators with statistically significant differences.

Among 40 patients undergoing unplanned reoperations, 28 suffered from hemorrhage in the surgical field, 10 underwent decompressive craniectomy due to cerebral edema, and 2 suffered from abscess due to infection at the surgical site. Compared with the non-reoperation group, the patients in the reoperation group were older, the proportion of patients who had malignant tumors and invasion of the skull base was higher, the tumor volume and maximum cross-sectional area of tumor were larger, the intraoperative blood loss was larger, the operation time was longer, and the proportion of patients with residual tumor was higher, the GOS score at discharge was lower in the reoperation group, and the differences were statistically significant (all P<0.05). The results of multivariate logistic regression analysis showed that older age(OR=1.039, 95% CI: 1.009-1.070), larger maximum tumor cross-sectional area (OR=1.034, 95% CI: 1.012-1.056), tumor residual (OR=4.363, 95% CI: 2.151-8.847), tumor invades the skull base(OR=3.342, 95% CI: 1.370-8.155) and malignant tumor(OR=3.348, 95% CI: 1.499-7.474) were risk factors for unplanned reoperation (all P<0.05).

The prognosis of adult supratentorial tumors with unplanned reoperation is relatively poor. The age, tumor invades the skull base, malignant tumor, maximum cross-sectional area of tumor and tumor residual are the main risk factors for unplanned reoperation.

To preliminarily explore the weight change of children with optic glioma (OPG) before and after surgery.

A retrospective analysis was conducted on the clinical data of 36 children with OPG admitted to the Department of Neurosurgery, Beijing Children′s Hospital, Capital Medical University from July 2015 to December 2020. All children underwent tumor resection. The degree of tumor resection was evaluated based on the results of intraoperative observation and postoperative re-examination of enhanced MRI of the head. The tumor resection volume of 60%-90% was defined as a major resection, and the tumor resection volume of >90% was defined as subtotal resection. The children were reviewed in outpatient clinics or online follow-up at 1, 2 weeks, 1, 3, 6 and 9 months after surgery. Follow-up content included subsequent treatment of the child, whether the tumor had recurred, spread and metastasis, and weight change. The weight-for-age Z-score (WAZ) was calculated based on the child′s gender, date of birth, weight and date of measurement, and the rate of increase in the child′s WAZ between two follow-ups was further calculated, which was (WAZ at the n+ 1 follow-up-WAZ at the n follow-up) × 1 000/interval between follow-ups (d). The single-sample t test was used to compare the WAZ before and after the operation with the international standard WAZ for children. Repeated measures analysis of variance was used to compare the WAZ and WAZ growth rate at different time points after the operation.

All 36 cases of children successfully underwent the operation, of which 28 cases of tumors were largely removed, and 8 cases of tumors were subtotally removed. Pathological results showed 11 cases of pilocytic astrocytoma and 25 cases of pilocytic myxoid astrocytoma. The median follow-up time (range) of 36 children was 25 months (9-40 months). At the last follow-up, there was no tumor recurrence or metastasis in 36 children, and the visual symptoms of 16 children improved. The preoperative WAZ of 36 children with OPG was -0.76±2.32 points, which was lower than the overall average WAZ of international normal children (0±1.00 points), the difference was statistically significant (P=0.024). The WAZ of 36 children with OPG at 9 months after operation was 0.82±2.14 points, which was higher than the overall average WAZ of international normal children (0±1.00 points), and the difference was statistically significant (P=0.006). The postoperative WAZ of the children increased compared with that before the operation, and the WAZ was the highest and the growth rate was the fastest at 1 month after the operation (all P<0.05).

Preliminary observations have suggested that the weight of OPG children after tumor resection increases compared with before, and the increase of WAZ growth rate is most obvious in the early postoperative period.

To explore the expression of phosphorylated signal transducers and activators of transcription 3(p-STAT3) in adamantinomatous craniopharyngiomas (ACP) and its significance.

ACP tissue specimens were obtained from 12 patients with craniopharyngiomas who underwent surgical resection at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University. The histological characteristics of the ACP specimens were determined by hematoxylin-eosin (HE) staining. The expression of p-STAT3, pan-CK, β-catenin and E-cadherin in tumor tissues was detected by immunofluorescence staining method.Primary ACP cells were cultured and the experimental group [treated by STAT3 inhibitor cryptotanshinone (5.0 mmol/L)], negative control group (DMSO treatment) and blank group (ACP primary cells, not treated) were set up. Wound healing test and transwell test were used to detect the migration and invasion ability of cells, respectively. The low-dose inhibitor group (2.5 mmol/L cryptotanshinone), high-dose inhibitor group (5.0 mmol/L cryptotanshinone) and negative control group (DMSO treatment) were set up, and the proliferation ability of each group was determined by CCK-8 test. Western blot was used to detect the changes of epithelial-mesenchymal transformation (EMT) related markers including transcription factors Slug, Twist, E-cadherin and N-cadherin before and after treatment.

HE results showed that finger -like structures were found between ACP and hypothalamus in all 12 cases of ACP specimens. Immunofluorescence staining results showed that the expression of p-STAT3 was positive, while the expression of pan-CK was negative. Nuclear β-catenin translocation was also identified in the whorl-like cells, and the expression E-cadherin was significantly down-regulated. Wound healing test revealed that the migration distance of cells in the experimental group (170±11 μm) was significantly decreased compared with that in the negative control group (290±61 μm) and blank group (282±44 μm) (P<0.05). Transwell experiment results showed that the number of transmembrane cells in the experimental group (57±14) was less than that in the negative control group (104±11) and blank group (95±14) (P<0.01). CCK-8 test showed that cryptotanshinone inhibited the proliferation of primary cells in both time and dose dependent manners (both P<0.05). Western blot results showed that after treating ACP primary cells with different concentrations of cryptotanshinone, the expression of Slug, Twist and N-cadherin decreased (all P<0.01), while the expression of E-cadherin protein increased (P<0.001).

p-STAT3 is expressed in the whorl-like cells of finger -like structures which were were found between ACP and hypothalamus in ACP specimens. The p-STAT3 mediated EMT may contribute to the hypothalamus involvement in ACP, and p-STAT3 may become a potential target for the treatment of ACP.

To investigate the mechanism of neuropilin-1 (NRP-1) and vascular endothelial growth factor (VEGF) in the recurrence and drug resistance of glioblastoma multiforme (GBM).

GBM1A and GBM22 cell lines were cultured in vitro, and VEGF or NRP-1 was silenced by infecting lentivirus shRNA. According to the type of lentivirus shRNA infected, the two cell lines were divided into shCont group (infected with nonsense sequence shRNA), shNRP-1 group (infected with NRP-1 lentivirus shRNA) and shVEGF group (infected with VEGF lentivirus shRNA). The gene and protein expression of stem cell markers [sex determining region Y-box 2 (Sox2), epidermal growth factor receptor (EGFR), N-cadherin, leukocyte mediated antigen (CD133)and cellular-mesenchymalepithelial transition factor(c-Met)] were detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blotting. Cell scratch test, Transwell chamber assay, neurosphere formation test and MTT method were used to detect the migration ability, invasion ability, neurosphere formation ability and metabolic activity of tumor cells. The sensitivity of tumor cells to temozolomide (TMZ), paclitaxel (PTX) and cabotinib (XL-184) was detected by cell growth inhibition assay. Ten μg of recombinant VEGF were added to the shCont group and shNRP-1 group in GBM1A and GBM22 cell lines, which were divided into shCont group, shCont+ VEGF group, shNRP-1 group, shNRP-1+ VEGF group, and the interaction between NRP-1 and VEGF was explored.

In GBM1A cell line, the mRNA contents of Sox2, EGFR, N-cadherin, CD133 and c-Met in shVEGF group and shNRP-1 group were lower than those in shCont group (all P<0.05). In GBM1A cell line, the relative protein expressions of EGFR, CD133 and N-cadherin in shNRP-1 group and shVEGF group were lower than those in shCont group (all P<0.05), the cell scratch healing rate at 24 and 48 hours was lower than that in shCont group (both P<0.05), and the proportion of cell migration was lower than that in shCont group (P<0.05), while there was no significant difference between shNRP-1 group and shVEGF group (all P>0.05). Similar results were obtained in GBM22 cell line. There was no significant difference in cell viability between GBM1A cell line and GBM22 cell line (both P>0.05). According to the dose growth curve, the IC₅₀ values of TMZ, PTX and XL-184 in shNRP-1 group and shVEGF group were lower than those in shCont group (all P<0.05). Similar results were obtained in GBM22 cell line (all P<0.05). In GBM1A cell line, the number of neurospheres formed in shCont + VEGF group was higher than that in shCont group (P<0.05), while there was no significant difference between shNRP-1 group and shNRP-1 + VEGF group (P>0.05). Similar results were obtained in GBM22 cell line.

Silencing VEGF or NRP-1 gene can effectively inhibit the stem cell viability, reduce its migration ability and invasion, and restore its drug sensitivity without affecting the activity of GBM itself. VEGF-mediated cell migration may depend on NRP-1 to play a role.