Volume 40 · Issue 03 · 2024

In recent years, with the increasing pressure of international military competition, the research in the field of military medicine has become more and more active. Craniocerebral trauma is an important research direction in the field of military medicine. Domestic and foreign war trauma experts have applied the advanced achievements of computer science, biology, materials science and other disciplines to the field of war trauma treatment, constantly updated the concept of craniocerebral war trauma treatment, and developed many medical instruments and biological products suitable for the treatment of craniocerebral trauma in the battlefield, aiming at greatly shortening the injury-treatment time of the wounded and significantly improving the treatment effect of craniocerebral war trauma.

Moyamoya disease is a rare chronic occlusive cerebrovascular disease, the etiology of which is still unknown. The disease is characterized by progressive occlusion of the ends of bilateral internal carotid arteries (ICA) with the formation of an abnormal vascular network at the skull base, which is called "moyamoya disease" because this abnormal vascular network at the skull base resembles "smoke" on cerebral angiography. The incidence of moyamoya disease is high in East Asian countries, and there is certain family clustering, and genetic factors may be involved in the onset. In recent years, the incidence and prevalence of moyamoya disease in China have gradually increased, but there are still many controversies in the diagnosis and treatment. In 2017, experts from more than 20 clinical medical centers across the country jointly formulated the Chinese expert consensus on the diagnosis and treatment of moyamoya disease and moyamoya syndrome^[1]。 This expert consensus combines the new progress in the diagnosis and treatment of moyamoya disease in recent years, and adds and updates the content of the previous version of the consensus.

To explore the distribution characteristics of high-frequency oscillations (HFOs) in different wakefulness states and to clarify their relationship to the epileptogenic zone.

A prospective inclusion of drug-resistant epilepsy patients treated at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from January to June 2023. All patients underwent stereo-electroencephalogram (SEEG) monitoring. EEG recordings during wakefulness and non-rapid eye movement sleep (NREM) interictal periods were selected. HFO analysis was conducted using an automatic detection algorithm, classifying them into ripple (R) and fast ripple (FR). A comparative analysis of HFO discharge frequency and the number of high HFO discharge electrodes in the seizure onset zone (SOZ) and non-SOZ during wakefulness and sleep states was performed. Additionally, the spatial distribution of HFO and its relationship with the epileptogenic zone were observed.

A total of 17 patients were included, with an average of 11.6±0.5 electrodes implanted (range: 8-14), 100.1±4.2 effective contacts, and 18.0±2.2 SOZ contacts. Compared with that in the non-SOZ area, the frequency of R discharges in the SOZ during wakefulness (6.93±1.35 times/min vs. 1.63±0.41 times/min) and sleep (12.13±1.65 times/min vs. 3.52±0.75 times/min) was significantly higher, with statistically significant differences (both P<0.01). The frequency of FR discharges in the SOZ during wakefulness (5.29±1.92 times/min vs. 0.14±0.03 times/min) and sleep (6.05±1.71 times/min vs. 0.30±0.07 times/min) was also significantly higher than in the non-SOZ area (both P<0.05). The data above showed that the frequency of HFO discharges during sleep was generally higher than during wakefulness. In the SOZ, the frequency of R discharges during sleep was significantly higher than during wakefulness (P<0.001), while the increase in FR discharge frequency was not significant (P=0.613). In the non-SOZ area, the frequencies of R and FR discharges during wakefulness and sleep were both increased with significant differences (all P<0.05). Compared with wakefulness, the numbers of high discharge leads for R (13.06±2.27 vs. 4.59±0.21) and FR (9.88±1.70 vs. 4.59±0.21) during sleep were significantly increased (both P<0.01). SOZ leads with R distribution during wakefulness were 67.4±5.5% in the HFO distribution area and were 69.8±5.8% during sleep. For FR, it was 68.1±5.8% and 71.1±5.6% respectively. In wakefulness and sleep states, HFO in the SOZ leads was stably discharged.

SEEG monitoring shows that the frequency of HFO discharges in drug-resistant patients during sleep is significantly higher than during wakefulness. The distribution range of HFO during sleep is significantly increased. In wakefulness and sleep states, the SOZ area leads are mostly HFO frequently-bursting leads. the leads in the SOZ are mostly high-frequency HFO leads. The values of HFO during wakefulness and sleep in assisting the localization of the epileptogenic zone seem similar.

To investigate the effectiveness of integrating three-dimensional brain surface reconstruction with intraoperative neurophysiological monitoring in surgical interventions targeting the central zone for drug-refractory epilepsy.

A retrospective analysis was conducted on clinical data obtained from 21 patients with drug-refractory epilepsy who underwent surgical resection of the central epileptogenic focus at the Department of Neurosurgery, Beijing Fengtai Hospital between January 2019 and January 2022. Preoperative imaging encompassed three-dimensional brain surface imaging, vascular imaging, and pyramidal tract imaging reconstruction. Image superposition was employed to assess the positional relationship between the epileptogenic focus and the central area. Intraoperative neurophysiological monitoring was used to determine the position of the central sulcus, which was then compared with the results of three-dimensional brain surface reconstruction to identify the locations of the precentral and postcentral gyri. Patients underwent follow-up via telephone or outpatient clinic at 2 weeks, 3 months, 6 months, 12 months, and annually after surgery. The Engel classification was used to evaluate the outcome of epilepsy control, while the modified Rankin scale (mRS) was used to assess the improvement in neurological dysfunction.

Of the 21 patients, 18 cases (85.7%) were successfully located the central sulcus; neurophysiological monitoring and three-dimensional brain surface reconstruction were consistent in localizing the central sulcus. In 2 cases (9.5%), the two methods did not match in positioning the central sulcus. In 1 case (4.8%), the central sulcus was unsuccessfully identified. The surgery of 21 patients was successfully completed, of which 12 (57.1%) patients′ surgical resection scope was limited to the central area, and 9 (42.9%) patients underwent surgery involving the central area or edge. The removal site of epileptogenic zone was on the left hemisphere in 13 cases and right hemisphere in 8 cases. After surgery, 10 cases were pathologically confirmed to have focal cortical dysplasia (FCD), including 6 cases of FCD type Ⅱa and 4 cases of FCD type Ⅱb. Besides, there were 4 cases of were dysembryoplastic tumors, 1 case of ganglioglioma, 1 case of cavernous malformation, 1 case of glial scar, 1 case of tuberous sclerosis, 1 case of dual pathology of FCD type Ⅱb and ganglioglioma, 1 case of glioblastoma, and 1 case of unspecified type. Six cases (28.6%) developed new neurological dysfunction after surgery (mRS of 2 in 1 case, mRS of 4 in 5 cases), of which 4 cases still had neurological dysfunction 2 weeks after surgery (mRS of 2 in 2 cases, and mRS of 3 in 2 cases), but there were varying degrees of improvement compared with before. All 21 patients received clinical follow-up, which lasted for 3.1±0.7 years. The last follow-up showed that 18 cases were Engel grade Ⅰ, 2 cases were Engel grade Ⅱ, and 1 case was Engel grade Ⅲ; 20 cases (95.2%) had good neurological function (mRS of 1 in 4 cases, mRS of 0 in 16 cases), and 1 case (4.8%) had mild disorder (mRS of 2).

Three-dimensional reconstruction of the brain surface combined with neuroelectrophysiological monitoring can help to fully remove the epileptogenic area while protecting neurological function, improve the efficacy and safety of surgery, and achieve a good outcome.

To investigate the occurrence and amplitude of responses of different brain regions to electrical stimulation of the centromedian thalamic nucleus(CMT) in patients with drug-resistant epilepsy who underwent implantation of stereoelectroencephalography (SEEG) electrodes.

The clinical data of 10 patients with drug-resistant epilepsy who underwent SEEG electrode implantation in CMT and suspicious onset zone at the same time from January 2022 to May 2023 at the Clinic Neuroscience Center of Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. Through electrical stimulation and recording of effective electrophysiological signals, the occurrence rate of response contacts and response amplitude in different brain regions were compared.

A total of 1 062 effective contacts were determined in 10 patients, and the same-frequency responses were recorded in 491 contacts (46.2%). The occurrence of response contacts in the anterior and posterior central gyri was the highest [81.0%(51/63)], followed by the parietal and frontal lobes [56.5% (61/108) and 53.2% (253/475), respectively]. The two brain regions with the lowest rates were temporal lobe [18.6% (22/118)] and hippocampus and amygdala (4/19). The difference of response contact occurrence among various brain regions was statistically significant (H=14.13, P=0.049). The response amplitude of 10 patients was 40.3 (0-1 000.0) μV. In terms of the response degree of different brain regions, the highest amplitude was observed in the hippocampus and amygdala [398.0 (0-1 000.0) μV], followed by parietal lobe [81.5 (12.0-336.2) μV]. The lowest amplitude was found in temporal lobe [19.5 (8.1-27.8) μV]. After removing the outliers, there was no significant difference in the response degree of different brain regions (H=8.41, P=0.298).

When SEEG electrodes are used to electrically stimulate CMT, there are differences in the responses of different brain areas in patients with drug-resistant epilepsy. The response ratio of brain areas surrounding the central sulcus is higher than that of brain areas far away from the central sulcus. After removing the outliers, there is no obvious difference in the response levels of different brain areas.

To explore the methods and efficacy of surgical treatment of bilateral temporal lobe epilepsy (SEEG-BTLE) confirmed by stereoelectroencephalography (SEEG).

A total of 13 patients with SEEG-BTLE were treated at the Department of Neurosurgery, the Second Affiliated Hospital of Army Military Medical University from June 2019 to March 2023. Among them, 5 cases with obvious lateralization of the origin of epileptic seizures underwent unilateral anterior temporal lobe resection, 6 cases who had no obvious lateralization of the origin of epileptic seizures or refused resection underwent SEEG-guided radiofrequency thermocoagulation. There were 2 cases undergoing neuromodulation, including 1 case of deep brain stimulation (DBS) and 1 case of vagus nerve stimulation (VNS). In both cases, the origin of epileptic seizures could not be obviously lateralized. The clinical data and efficacy of patients were retrospectively analyzed. The efficacy of resection and radiofrequency thermocoagulation was evaluated using the Engle grading standard, with grades Ⅰ to Ⅱ representing good efficacy and grades Ⅲ to Ⅳ representing poor efficacy. Neuromodulation efficacy was evaluated according to the McHugh grading standard. Grades Ⅰ to Ⅱ indicated good efficacy and grades Ⅲ to Ⅴ indicated poor effect.

Five patients who underwent unilateral anterior temporal lobectomy were followed up for 14 to 45 months. There were 3 cases of Engle grade Ⅰ and 2 cases of Engle grade Ⅲ. Memory decline occurred in 2 cases. The follow-up time of 6 patients who underwent radiofrequency thermocoagulation ranged from 6 to 31 months. One case was Engle grade Ⅰ, 1 was Engle grade Ⅱ, 2 were grade Ⅲ, and 2 were grade Ⅳ. One patient had memory decline. The two patients who received DBS and VNS had follow-up times of 35 and 38 months respectively, and both were McHugh class ⅢA.

Preliminary research shows that individualized principles should be used to treat SEEG-BTLE. The efficacy of lesion resection in unilateral temporal lobe is relatively better, the efficacy of radiofrequency thermocoagulation is acceptable, and neuromodulation therapy may have certain efficacy.

To investigate the surgical strategies and outcome of periventricular nodular heterotopia (PNH) for children with epilepsy combined with or without other pathologic types.

The clinical data of 9 PNH patients who received surgical treatment from October 2017 to September 2023 in the Department of Functional Neurosurgery, Beijing Children′s Hospital, Capital Medical University were retrospectively analyzed. Neuroimaging data showed that 5 of the 9 patients also had focal cortical dysplasia (FCD) and 1 had megalencephaly and schizencephaly. All patients underwent non-invasive examination during pre-operation evaluation. After identifying the epileptogenic lesion, surgical treatment was directly performed. Stereo-electroencephalography (SEEG) was performed in those patients whose epileptogenic zone was unable to localize, at the same time, radiofrequency thermocoagulation(RFTC)was performed.And the following surgical treatment was determined according to the SEEG and RFTC results. Patients were followed up by outpatient visits or telephone interview. The Engel grading system was used to evaluate the results of seizure control.

All 9 patients underwent surgical treatment, 4 of whom underwent surgical resection, including 2 FCD patients underwent lesion resection directly. One patient with obvious genetic abnormalities and epileptic encephalopathy underwent vagus nerve stimulation. One child with megalencephaly and schizencephaly underwent hemispherotomy. The remaining 5 children underwent SEEG electrode implantation. Among them, 2 patients only underwent RFTC for PNH, and 3 children with FCD underwent RFTC of PNH followed by epileptogenic zonectomy. Five children with FCD were all confirmed to be FCD type Ⅱ by pathology after surgery. There were no surgery-related complications in any of the children. All 9 children received clinical follow-up, and the follow-up time M (Q₁, Q₃) was 20 (14, 29) months. The last follow-up showed that 7 children had a good outcome, all were Engel grade Ⅰ. There were 2 cases with poor outcome, including 1 case of Engel grade Ⅱ (the child underwent RFTC only for PNH) and 1 case of Engel grade Ⅲ (the child underwent hemispherotomy).

When PNH is combined with or without other pathological types of epilepsy, individualized treatment should be carried out according to the pathological type. Especially when combined with FCD, excision of FCD can obtain a good outcome.

To explore the efficacy of stereoelectroencephalography (SEEG) electrode-mediated radiofrequency thermocoagulation (RFTC) in the treatment of epilepsy caused by focal cortical dysplasia (FCD) type Ⅱ and the correlation between the degree of damage and the efficacy.

The clinical data of 31 patients with drug-refractory epilepsy caused by FCD type Ⅱ who were treated with SEEG electrode-mediated RFTC at the Neurosurgery Department of Guangdong Sanjiu Brain Hospital from October 2017 to November 2021 were retrospectively analyzed. The FCD lesions of 31 patients were located in the frontal lobe in 13 cases, the central area in 17 cases, and the parietal lobe in 1 case. The postoperative complications and modified Engel classification were documented. The efficacy of seizure control was evaluated by the degree of seizure frequency reduction. Based on the preoperative head MRI fluid-attenuated inversion recovery (FLAIR) sequence and postoperative head MRI 3D T1-weighted imaging, MATLAB software was used to measure the volume of the three-dimensional module of each lesion and damaged lesion. The volume of the spatial overlap between preoperative FCD lesions and post-RFTC damaged lesions was defined as the effective damaged volume of the lesions, and its ratio to the preoperative FCD lesions was the degree of lesion damage. Patients were divided into sufficiently damaged group and insufficiently damaged group according to whether the degree of lesion damage was ≥40%, and the proportion of Engel grade Ⅰ patients in the two groups was compared. The Spearman method was used to analyze the correlation between the degree of lesion damage and the efficacy of seizure control.

The RFTC surgeries of 31 patients were successfully completed, and the number of damaged targets [M (Q₁, Q₃)] was 20 (14, 26). Eight patients with lesions located in the central area experienced temporary mild decrease in muscle strength of the contralateral limb after RFTC treatment. The follow-up time [M (Q₁, Q₃)] of 31 patients was 38 (7, 50) months. As of the last follow-up, there were 17 cases (54.8%) of Engle classification grade Ⅰ, 3 cases (9.7%) of grade Ⅱ, 6 cases (19.4%) of grade Ⅲ, and 5 cases (16.1%) of grade Ⅳ. The degree of seizure frequency reduction [M (Q₁, Q₃)] was 100% (58%, 100%). Eight patients (25.8%) underwent further surgery for resection of lesions and epileptogenic zones due to poor efficacy, and no recurrence occurred after surgery. The volume of FCD lesions [M (Q₁, Q₃)] in 31 patients was 1 735 (1 176, 2 857) mm³. The volume of damaged lesions [M (Q₁, Q₃)] in 31 patients was 1 436 (1 255, 2 607) mm³. The effective damage volume was 591 (410, 932) mm³. The damage degree of the lesion was 37% (30%, 57%). Spearman correlation analysis results showed that the degree of lesion damage was positively correlated with the degree of seizure frequency reduction (Spearman correlation coefficient: 0.61, P<0.001). Compared with the insufficiently damaged group (18 cases), the sufficiently damaged group (13 cases) had a higher proportion of Engle grade Ⅰ patients (12/13 vs. 5/18), and the difference was statistically significant (P<0.001).

RFTC mediated by SEEG electrodes is safe and effective in the treatment of epilepsy caused by FCD type Ⅱ. Patients with higher degree of lesion damage have better seizure control efficacy.

To analyze the effect of adjusting the surgical strategy of pituitary neuroendocrine tumors (PitNET) on improving the treatment effect.

The clinical data of 3 504 PitNET patients who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from January 2008 to December 2022 were retrospectively analyzed. During this period, the surgical strategy was adjusted based on literature reports and independent exploration. Patients admitted from January 2008 to December 2016 (Group A) were treated with the pre-adjusted surgical strategy, and patients admitted from January 2017 to December 2022 (Group B) were treated with the adjusted surgical strategy. The surgical treatment effects and postoperative complications of the two groups of patients were compared and analyzed.

There were 1 394 patients in group A and 2 110 patients in group B. The total tumor resection rate of group B[91.0% (1 920/2 110) vs. 73.4% (1 023/1 394)], and the postoperative visual acuity improvement rate [89.6% (509/568) vs. 69.0% (260/377) ] were higher than those in group A (both P<0.001), while the incidence of postoperative cerebrospinal fluid leakage [0.5% (10/2 110) vs. 5.1% (71/1 394)], and the incidence of postoperative intracranial infection [2.4 % (50/2 110) vs. 4.2% (58/1 394)], and the postoperative lumbar catheterization rate [0.3% (6/2 110) vs. 3.6% (50/1 394)] were lower than those in group A (all P<0.05). Among them, the biological cure rate of patients with functional PitNET in group A after surgery was lower than that in group B [52.3% (203/388) vs. 83.6% (475/568), P<0.001].

Improvement of PitNET surgical strategy can significantly improve the effect of surgical treatment and reduce the occurrence of related complications.

To initially explore the safety and efficacy of the Woven EndoBridge (WEB) device in the treatment of intracranial aneurysms.

A retrospective analysis was performed on 40 patients with 40 intracranial aneurysms who were treated with the WEB device in multiple clinical centers including Zhengzhou University People′s Hospital(Henan Provincial People′s Hospital), Pingdingshan First People′s Hospital, Zhumadian Central Hospital and Yellow River Sanmenxia Hospital from May to November 2023. Among 40 aneurysms, 38 cases were unruptured aneurysms and 2 cases were ruptured aneurysms. The mRS of 40 patients before surgery were all 0 points. All patients underwent head CT or MRI within 48 hours after surgery to evaluate whether there was new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysm. The mRS was used to evaluate the patient′s neurological function. Telephone follow-up was conducted on the patients 30 days after surgery to document the occurrence of complications.

A total of 40 WEB devices were implanted in 40 cases of aneurysm, with a technical success rate of 100%. Among them, 35 cases (87.5%) of the patients had a one-time release of the WEB device during the operation; 5 cases (12.5%) of the WEB device were withdrawn and adjusted during the operation. The second release was successful. The aneurysms of 4 patients were treated with the WEB device combined with other adjuvant treatments, including 2 cases combined with stent-assisted embolization and 2 cases combined with coil-assisted embolization. No new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysm was found in the head CT or MRI examination within 48 hours after surgery, and the mRS was 0 at discharge. All patients completed the 30-day postoperative clinical follow-up. Except for 3 patients who developed cyanosis of the skin and mucous membranes while taking antiplatelet drugs, there were no other nervous system-related ischemic and hemorrhagic adverse events or puncture site bleeding complications.

Preliminary observations show that WEB device is safe and effective in the treatment of intracranial aneurysms without adverse complications occurring during short-term follow-up.

The clinical data of 32 patients who used double microcatheter injection of Onyx glue with different viscosity (DODT) as the first treatment for intracranial arteriovenous malformations in the Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from February 2018 to February 2023 were retrospectively analyzed. A total of 42 times of DODT embolization were performed in 32 patients (22 cases were embolized with 1 supply artery, 10 cases were embolized with 2 supply arteries), and 31 cases were satisfactory. Immediate postoperative digital subtraction angiography showed a lesion reduction rate of 100% in 21 patients (65.6%), 90%-99% in 7 (21.9%), 80%-89% in 3 (9.4%) and 70%-79% in 1 (3.1%). The proportion of immediate complete embolization was higher in patients with a maximum lesion diameter ≤4 cm than in patients with a maximum lesion diameter>4 cm (17/21 and 4/11, respectively,P＝0.020)。 Two patients (6.3%) experienced postoperative neurological dysfunction without complications related to surgical procedures and perioperative deaths. Preliminary results show that DODT is safe and effective in the treatment of intracranial arteriovenous malformations.

To investigate the effect of the expression of fatty acid synthase (FASN) in glioblastoma (GBM) cells on polarization of human monocyte macrophage U937.

Stable interference RNA control group (U87sh-con group and LN229sh-con group) and FASN knockout experimental group (U87sh-FASN group and LN229sh-FASN group) were obtained by lentivirus transfection of U87 and LN229 cell lines. The cell supernatant (GBM conditioned medium) of the above 4 groups was collected and co-cultured with the induced by PMA differentiated U937 macrophages (the cell supernatant after co-culture used as the macrophage conditioned medium), and then the macrophage conditioned medium of the 4 groups were co-cultured with U251 cells. Protein expressions of FASN in U87sh-con, U87sh-FASN, LN229sh-con, LN229sh-FASN groups and COX-2 and ARG1 after co-culture of GBM conditioned medium with U937 cells were detected by Western blot (WB) and (or) immunofluorescence (IF). The proliferation after FASN knockout in U87 and LN229 of cells was detected by CCK-8 assay. The expressions of mature macrophage marker CD68, M1 marker CD11c, COX-2 and M2 marker IL-10 and ARG1 in macrophages were detected by quantitative real-time fluorescent polymerase chain reaction (qRT-PCR) after co-culture of GBM conditioned medium with U937 cells in 4 groups. The effect of macrophage conditioned medium on the migration and invasion ability of U251 cells was detected by Transwell assay.

We successfully constructed U87 and LN229 cell lines with stable knockdown of FASN protein. WB and IF results showed that compared with sh-con group of corresponding cells, FASN protein expression in sh-FASN group of U87 and LN229 cells was decreased, and the differences were statistically significant (both P<0.05). The CCK-8 results showed that at 48 hours, the difference of cell viability between U87sh-con and U87sh-FASN groups was statistically significant (588.391±10.032% vs. 547.009±1.860%, P=0.002). At 24 hours and 48 hours, the differences of the cell viability between LN229sh-con and LN229sh-FASN groups were statistically significant (24 hours: 235.033±1.598% vs. 218.026±3.593%; 48 hours: 441.190±5.196% vs. 388.306±9.887%, both P<0.05). There was no significant difference in cell viability between sh-con group and sh-FASN group in U87 and LN229 cells at 8 or 12 hours (all P>0.05). The qRT-PCR results showed that compared with U937 cells, the relative expression of CD68 in U937 cells induced by differentiation and those co-cultured with four groups of GBM conditioned medium increased, with statistical significance (all P<0.05). Compared with the sh-con group of corresponding cells, the relative expression levels of CD11c and COX-2 in the sh-FASN group of U87 and LN229 cells were increased, and the differences were statistically significant (all P<0.05). However, there was no statistically significant difference in the relative expression levels of IL-10 or ARG1 (all P>0.05). The WB results showed that compared with the sh-con group of the corresponding cells, the expression of COX-2 protein in the sh-FASN group of U87 and LN229 cells was increased, and the differences were statistically significant (both P<0.05), while there was no statistically significant difference in the expression of ARG1 protein (both P>0.05). The results of transwell migration and invasion experiments showed that compared with the sh-con group of corresponding cells, the number of transmembrane penetrating cells in the U87, LN229 cell sh-FASN macrophage conditioned medium and U251 cell co-culture group decreased, and the differences were statistically significant (all P<0.05).

Down-regulation of FASN expression in GBM cells can promote M1 polarization of macrophages, thereby inhibiting the migration and invasion ability of GBM cells.

To investigage the expression of cancerous inhibitor of protein phosphatase 2A (CIP2A) in gliomas and its impact on the patient′s clinical prognosis, as well as its influence and mechanism on tumor cell migration and invasion.

CIP2A mRNA expression data in the brain gliomas and clinical data of these glioma patients were obtained from Chinese Glioma Genome Atlas (CGGA).Subsequently, 67 samples from patients with glioma admitted to Department of Neurosurgery, the Second People′s Hospital of Guiyang from January 2016 to October 2018 were selected in this study, and the expression levels of CIP2A in tumor tissues were detected using immunohistochemical staining methods. Based on data from the CGGA database, CIP2A mRNA expression in glioma patients with different gender, age, World Health Organization(WHO) grading, isocitrodehydrogenase (IDH) mutation statuses, 1p/19q co-deletion statuses, and primary-recurrent-secondary(PRS) type were compared. Kaplan-Meier survival analysis, univariate and multivariate Cox analysis and receptor operating characteristic (ROC) curve analysis were used to evaluate the prognostic value of CIP2A in glioma patients. The siRNA interference was used to knock down CIP2A expression in U87 and U251 cells. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression level of CIP2A mRNA in U87 and U251 glioma cells. Scratch test and transwell assay were used to analyze the effects of CIP2A on cell migration and invasion. Western blot was used to detect expression level of CIP2A, E-Cadherin, matrix metalloprotein(MMP)2 and MMP9 in U87 and U251 cells.

In CGGA database, the expression of CIP2A was significantly upregulated in glioma tissues and elevated with WHO grading increased successively(F=49.32, P<0.001).The overall survival of patients with low expression of CIP2A was significantly longer than that of patients with high expression of CIP2A (CGGA database: P<0.001; Clinical data: P<0.05).In CGGA database, high CIP2A expression was significantly related to PRS(tumor recurrent and secondary), IDH wild-type and 1p19q non-codeletion(all P<0.001). ROC curve analysis revealed that the area under the curve of CIP2A mRNA in predicting 1, 3, and 5 year survival rates of glioma patients were 0.72、0.74 and 0.73. Multivariate cox regression analysis indicated that high CIP2A expression, advanced age, PRS(tumor recurrent and secondary) and high-grade tumors were the independent risk prognostic factors in glioma patients (all P<0.001). The siRNA significantly reduced the mRNA and protein expression of CIP2A in U87 and U251 cells(both P<0.05). In U87 and U251 cells with low expression of CIP2A, there was a significant decrease in both wound healing ability and the capabilities for migration and invasion (all P<0.05). The expression of E-Cadherin in U87 and U251 cells with low expression of CIP2A was up-regulated, and the expression of MMP2 and MMP9 protein was down-regulated (all P<0.05).

CIP2A is significantly overexpressed in glioma, which predicts poor prognosis of glioma and thus may be a potential prognostic marker of glioma. Furthermore, the low expression of CIP2A may inhibit the migration and invasion of glioma cells through the suppression of epithelial-mesenchymal transition (EMT) pathway.

To explore the establishment method of a new Bama mini-piglet common carotid artery stenosis model and to evaluate the effect of its model establishment (referred to as modeling).

Nine Guangxi Bama mini-piglets were used as the research subjects. Eight experimental pigs were fed with high-fat and high-salt diets before surgery. After 8 weeks of feeding, intra-carotid artery biopsy was performed under general anesthesia via the femoral artery approach. The stenosis model was established by clamping the tunica intima with intravascular biopsy forceps. After the operation, the pigs were fed with high-fat and high-salt diets; the other pig was a blank control pig. The body weight, blood total cholesterol (TC) and blood triglyceride (TG) of the experimental pigs were measured at the time of enrollment, after 8 weeks of feeding, and at the 6th, 12th, 18th and 24th week after surgery, and changes were observed. At the end of 24 weeks after surgery, digital subtraction angiography (DSA) was used to evaluate the stenosis formation of the experimental pig common carotid artery and measure the maximum stenosis rate of the blood vessel. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were used to detect stenosis. The inside of the lumen was observed and the degree of obstruction of the vascular lumen and the area of intimal hyperplasia were measured. The tissue specimens of 9 mini-piglets were sacrificed for pathological examination to observe the intimal hyperplasia and pathological characteristics.

After enrollment into the study, the body weight of the experimental pigs gradually increased (F=977.97, P<0.001). TC and TG increased significantly at the end of the 8th week of feeding (both P<0.05), and then tended to be stable. At the end of 24 weeks after surgery, DSA confirmed that all 8 experimental pig common carotid artery stenosis models were successfully constructed, with a maximum stenosis rate of (55.63±10.89)%. Both IVUS and OCT confirmed significant proliferation of the vascular intima at the stenosis. There was no statistically significant difference in the intimal hyperplasia area measured (6.84±1.14 mm² and 7.13±1.27 mm² respectively) and the degree of vascular lumen obstruction [(58.38±10.72)% and (59.88±9.36)% respectively] (t values: -0.48 and -0.30 respectively; P values: 0.641 and 0.770 respectively). Histopathological examination of the modeled blood vessels showed that the lumen stenosis was caused by the obvious proliferation of the vascular intima, and part of the internal elastic plate was broken. The hyperplastic intima was mainly composed of smooth muscle cells, collagen fibers and proteoglycan deposition, of which collagen fibers were significantly more than proteoglycans.

The Bama mini-piglets common carotid artery stenosis model can be successfully established by feeding high-fat and high-salt diets combined with intravascular biopsy forceps to injure the intima of the common carotid artery. The operation is relatively simple and safe.

Limb dysfunction often occurs after stroke, and its treatment is difficult, which seriously affects the daily life of patients. Deep brain electrical stimulation targeting the cerebellar dentate nucleus (DN) combined with physical rehabilitation therapy can improve upper limb motor function in patients with limb dysfunction. A patient with upper limb dyskinesia after stroke caused by unilateral middle cerebral artery ischemia was admitted to the Department of Neurosurgery of Dong'e County People's Hospital in November 2023. His preoperative Fugl-Meyer scale upper limb portion (FMA-UE) score was 32 points and the modified Rankin scale score (mRS) was 3 points. After admission, the cerebellar DN was treated with deep brain electrical stimulation. The machine was turned on 3 weeks after surgery, the stimulation frequency was 30 Hz, the pulse width was 90 μ s, and the current intensity was 6 mA. The patient had no adverse reactions. One month after boot-up, the patient had an FMA-UE score of 45 and an mRS score of 2.

Idiopathic intracranial hypertension in children is rare, and severe cases may cause vision loss or even blindness. If early diagnosis and active treatment can be made, children can often get good curative effect and prognosis. In May 2022, a child with idiopathic intracranial hypertension was admitted to the Department of Neurosurgery, Children's Hospital affiliated to Nanjing Medical University. Except for lumbar puncture showing increased cerebrospinal fluid pressure, the imaging and laboratory tests of the child were negative. During the diagnosis and treatment, the child suddenly suffered from a sharp decrease in binocular vision accompanied by peripheral palsy of the eye. After ventriculo-peritoneal shunt treatment, the child's vision was restored and good therapeutic results were achieved.

Magnetic resonance-guided transcranial focused ultrasound (MRgtFUS) is a newly mature application paradigm of transcranial therapy ultrasound, which has the advantages of no craniotomy anesthesia and no ionizing radiation. Recently, it has been admitted to the clinical treatment of Parkinson's disease and essential tremor in China, and will be popularized and applied in clinical practice soon. Combined with the above situation, this article mainly focuses on the biological effects and characteristics of MRgtFUS, the research progress in the treatment of movement disorders, and the challenges and thinking of its future development, so as to provide reference for further clinical trials and research of transcranial ultrasound treatment of movement disorders.

As the most common primary malignant tumor of the central nervous system, glioma has the characteristics of rapid progression and poor prognosis. As an emerging method of cancer treatment, oncolytic virus has strong targeting and high safety, and has shown good application prospects in many clinical studies. The mechanism of oncolytic virus in the treatment of glioma, common viral vectors, clinical trials and related combination therapies are reviewed.

Atypical teratoid/rhabdoid tumor (World Health Organization grade IV) is a kind of embryonic tumor of the central nervous system that occurs in children. It is highly aggressive and has a very poor prognosis. Surgery is the cornerstone of the treatment of this disease. Although radiotherapy and chemotherapy can improve the prognosis of patients on the basis of surgery, the specific treatment plan is still controversial. In recent years, with the further elucidation of the molecular typing of the disease and the application of related targeting and immunological drugs, its prognosis is expected to be further improved. In order to improve clinicians' understanding of this disease, this article will review the research progress of its molecular typing and treatment.