Volume 102 ·  Issue 19 ·  2022

Glioma is one of the most common central nervous system tumors in children.Increasing studies show that compared with adults, some gliomas in children have unique molecular genetic characteristics and completely different biological behaviors, although they are similar to adults in morphology and nomenclature. Therefore, pediatric glioma is by no means a "miniature version" of adults. In the 5th edition of WHO classification of central nervous system tumors published in the end of 2021, one of the most important revisions is the division of the classification into adult-type and pediatric-type diffuse gliomas, and the latter is further divided into pediatric-type diffuse low-grade gliomas and pediatric-type diffuse high-grade gliomas. In addition to histological morphology and clinical features, the basis of classification includes more molecular features. Therefore, in clinical practice, we need to pay more attention to the significance of molecular pathological diagnosis in the diagnosis and treatment of gliomas in children.

To explore the changes of cerebral blood perfusion in patients with unilateral sudden sensorineural hearing loss (SSNHL) by using the three-dimensional pseudo-continuous arterial spin labeling (3D pCASL) technique.

The clinical characteristics and ASL data of the 32 patients with unilateral SSNHL were retrospectively collected from November 2020 to June 2021 in Beijing Fuxing Hospital of Capital Medical University, among them, there were 7 males and 25 females, aged from 17 to 73 (44.9±14.4) years. According to the location of SSNHL, they were divided into the left SSNHL (L-SSNHL) group (18 cases) and the right SSNHL (R-SSNHL) group (14 cases). A total of 34 healthy volunteers, which including 14 males and 20 females, aged from 24 to 68 (46.2±14.4) years were enrolled from the local community. The parameter of cerebral blood flow (CBF) of each brain area was obtained using the CereFlow software. The Brainnetome Atlas software package based on MATLAB was used for visualization. The independent-samples t test was conducted to compare the difference of cerebral blood perfusion between the unilateral SSNHL group and healthy control (HC) group. Pearson correlation analysis was used to evaluate the correlation between changes in cerebral blood perfusion and clinical scale scores.

The CBF of left orbital gyrus part 5, left inferior temporal gyrus part 7, right orbital gyrus part 5, right inferior temporal gyrus part 1, right inferior temporal gyrus part 7, and right parahippocampal gyrus part 3 of the L-SSNHL group were higher than that in the HC group[(49.1±8.8) vs (31.6±10.9)ml·100g^-1·min^-1;(42.8±14.3) vs (27.1±13.6)ml·100g^-1·min^-1;(51.8±9.4) vs (27.2±11.2)ml·100g^-1·min^-1;(38.8±5.7) vs (28.0±9.2)ml·100g^-1·min^-1;(38.4±13.8) vs (23.6±10.3)ml·100g^-1·min^-1;(42.4±9.4) vs (30.1±12.6)ml·100g^-1·min^-1; all P<0.05]. The CBF of left superior frontal gyrus part 7 and left middle frontal gyrus part 3 of the L-SSNHL group were lower than that in the HC group[(48.2±7.9) vs (59.3±13.7)ml·100g^-1·min^-1;(46.4±10.3) vs (59.3±16.9)ml·100g^-1·min^-1;all P<0.05]. The CBF of left orbital gyrus part 5, right orbital gyrus part 5, right inferior temporal gyrus part 1, and right inferior temporal gyrus part 7 of the R-SSNHL group were higher than that in the HC group[(50.6±7.0) vs (31.6±10.9)ml·100g^-1·min^-1;(50.9±8.8) vs (27.2±11.2)ml·100 g^-1·min^-1;(38.0±7.2) vs (28.0±9.2)ml·100g^-1·min^-1;(35.7±8.5) vs (23.6±10.3)ml·100g^-1·min^-1;all P<0.05]; the CBF of right insular part 4 was lower than that in the HC group [(44.2±6.1) vs (54.4±11.3) ml·100 g^-1·min^-1, P=0.018]. In the L-SSNHL group, the CBF of left superior frontal gyrus part 7 and right orbital gyrus part 5 were negatively correlated with the VAS score(r=-0.83, -0.81, all P<0.05), and the CBF of right orbital gyrus part 5 was negatively correlated with the THI score(r=-0.75, P=0.013). There was no statistically significant correlation between the remaining differences in brain regions and clinical scale scores(all P>0.05).

Changes in cerebral blood perfusion in multiple brain regions were found in patients with unilateral SSNHL by using the 3D pCASL technique.

To evaluate the impact of number-indexes of lymph nodes for prognostic stratification in stage N1c colorectal cancer (CRC) patients.

The clinicopathologic data of CRC patients with stage pTxN1cM0 who initially underwent radical surgery in Cancer Hospital, Chinese Academy of Medical Sciences and the Surveillance, Epidemiology and End Results (SEER) database from January 2010 to December 2015 were retrospectively analyzed. A total of 1 165 patients with stage N1c were included in this study. Among them, 85 patients (including 54 males and 31 females) were from Cancer Hospital, Chinese Academy of Medical Sciences and their median age was 58 (range: 32-80) years; 1 080 patients (including 566 males and 514 females) were from the SEER database and their median age was 66 (range: 24-98) years. The prognostic significance of total number of lymph node (TLN), number of negative lymph node (NLN), and log odds of positive lymph nodes (LODDS) in stage N1c CRC patients were explored.

The optimal cut-off value of TLN or NLN was 13, and the optimal cut-off value of LODDS was -1.43. Among the 85 patients of Cancer Hospital, Chinese Academy of Medical Sciences, the 5-year overall survival (OS) rates of stage N1c1 (TLN or NLN≥13, 69 cases) and group LODDS1 patients (LODDS≤-1.43, 69 cases) were both 80.9%, which higher than that of stage N1c2 (TLN or NLN<13, 16 cases) and group LODDS2 (LODDS>-1.43, 16 cases) patients (both 53.3%, P=0.002); In the SEER cohort, the 5-year OS rates of stage N1c1 (837 cases) and group LODDS1 patients (LODDS≤-1.43, 837 cases) were both 64.7%, which higher than that of stage N1c2 (243 cases) and group LODDS2 (LODDS>-1.43, 243 cases) patients (both 52.2%, P<0.001). Both in the NCC cohort and SEER cohort, the results of Cox multivariate analysis all demonstrated that TLN or NLN<13 was the risk factor of OS of CRC patients with stage N1c (HR=3.794, 95%CI: 1.539-9.349, P=0.004; and HR=1.588, 95%CI:1.232-2.048, P<0.001; respectively); LODDS≤-1.43 was the independent protective factor of OS of stage N1c CRC patients (HR=0.264, 95%CI: 0.107-0.650; and HR=0.630, 95%CI: 0.488-0.812; respectively).

TLN or NLN and LODDS were all independent prognostic factors of CRC patients with stage N1c. The clinicians could use TLN or NLN and LODDS for prognostic stratification and make the different adjuvant therapeutic schemes for CRC patients with stage N1c.

To investigate the effect of spread through air spaces (STAS) on the postoperative prognosis of patients with stage pT1N0M0 lung adenocarcinoma according to different tumor sizes.

The clinicopathological and follow-up data of 511 patients with pT1N0M0 lung adenocarcinoma treated surgically in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2018 were retrospectively analyzed. There were 285 males and 226 females, aged 60 (53, 66) years. Those patients were divided into two groups according to STAS status, including STAS (-) group (342 cases) and STAS (+) group (169 cases). And the stratified analysis was performed according to the American Cancer Consortium (AJCC) 8th edition postoperative pathological tumor size T-stage (pT) of lung cancer, which was divided into pT1a (pT≤1 cm, 93 cases), pT1b (1 cm<pT≤2 cm, 280 cases), pT1c group (2 cm<pT≤3 cm, 138 cases) and pT1b/c (1 cm<pT≤3 cm, 418 cases). Univariate and multivariate Cox regression analyses and inverse probability weighted (IPTW) adjusted Kaplan-Meier (K-M) curves were used to analyze the effect of STAS on recurrence-free survival (RFS) in patients included in this study.

The recurrence rate was significantly higher in the STAS (+) group compared to the STAS (-) group (22.5% vs 3.2%, P<0.001). Multifactorial Cox regression analysis based on pT stratification showed that the risks of recurrence were 4.56-fold (95%CI:1.56-13.33; P=0.006) and 3.16-fold (95%CI:1.07-9.33; P=0.038) higher in pT1b and pT1c staged patients with STAS (+) than in STAS (-) patients, respectively. There was no significant difference in RFS between the STAS (-) group of pT1b/c, pT1b and pT1c and all pT1a patients [(84.97±0.72) vs (84.05±1.11) months, (85.60±0.74) vs (84.05±1.11) months, (81.49±1.63) vs (84.05±1.11) months; all P>0.05]. Before and after IPTW adjustment, statistically significant differences were found in RFS between STAS (+) group and STAS (-) group [(72.50±2.23) vs (85.12±0.72) months, (77.74±1.12) vs (84.59±0.64) months, all P<0.001]. In addition, the risks of both local and distant recurrence were higher in STAS (+) group compared to STAS (-) group (6.7% vs 1.2% and 8.2% vs 3.6%, respectively; both P<0.05).

For lung adenocarcinoma patients with pT1bN0M0 and pT1cN0M0, those patients with STAS (+) had a higher incidence of both local and distant recurrence and with poor RFS.

To analyze the gender differences of genetic etiology in the incidence of major depression disorder among Han freshmen.

A 1-year follow-up survey was carried out among 8 079 Han freshmen from Jining, Rizhao and Weifang without lifetime major depressive disorder (MDD) at baseline (April to October 2018) and 4 828 venous blood samples were also collected. After extracting DNA, Sequenom Mass Array time-of-flight mass spectrometry biochip technology was used to detect the genotypes of 17 single nucleotide polymorphisms (SNPs) MDD-related loci. Logistic regression was used for univariate analysis. Generalized multifactor dimension reduction was used to analyze gene-gene interactions. Composite International Diagnostic Interview (CIDI) 3.0 was used for MDD diagnosis.

The 1-year incidence of MDD among Han freshmen was 2.23% (95%CI: 1.91%-2.60%) and the gender difference of incidence between males (1.97%, 95%CI: 1.52%-2.56%) and females (2.39%, 95%CI: 1.98%-2.90%) was not statistically significant (P>0.05). AG genotype of rs768705 (nearby gene: TMEM161B) was a risk factor for MDD (OR=1.98, 95%CI: 1.24-2.83). The TC genotype of rs17727765 (nearby gene: CRYBA1) was only a risk factor for MDD in males (OR=9.61, 95%CI: 2.04-45.30). An 8-loci interaction model (PMFBP1, OLFM4, LHPP, ENOX1, TMEM161B, SPPL3, FBXL4 and L3MBTL2) could predict MDD in women with an accuracy rate of 60.05%. No effective prediction model was found for MDD in men.

There might be gender differences in the genetic etiology of MDD. Further researches on the genetic causes of MDD in men should be explored.

To analyze the clinical characteristics and related genetic variation of juvenile myasthenia gravis (MG) patients.

We collected the clinical data of adolescent MG patients who were treated in the Department of Neurology of the First Affiliated Hospital of Sun Yat-sen University from June 2019 to May 2020. After obtaining the patient′s informed consent, the blood samples were collected. The Whole Exome Sequencing (WES) was performed on peripheral blood samples. And use biological information software and SPSS 22.0 for data processing and result analysis.

According to the inclusion and exclusion criteria, 54 patients with juvenile MG were included, 28 males and 26 females. And the average age of onset was (3.79±0.89) years. Among the enrolled patients, there were 52 (96.3%) patients with ocular MG, the MG-ADL scores of 54 patients were (3.44±0.44) points, and the titer of AChR antibody was (5.88±2.45) nmol/L. Two patients had thymic hyperplasia, and 5 patients had a family history of MG.A total of 169 variant genes were found in 54 patients, of which TTN gene variants had the largest number, with a total of 17 variants (31.5%). In the TTN gene variant group, 7(41.2%) patients had eye fixation symptoms, and 4 (10.8%) patients in the non-mutation group had eye fixation symptoms. And The difference between the two groups was statistically significant (P=0.016). In addition, the synaptic nucleus envelope protein-1 (SYNE1) and the ryanodine receptor-1 (RYR1) gene variations were also found in 7 cases (13.2%), and no clear relationship between these gene variations and clinical manifestations of MG was found.

The incidence of juvenile MG was preschoolers with no gender difference, and ocular MG was more common. The proportion of TTN gene variation in adolescent MG was higher, suggesting that this gene may be a potential therapeutic target for juvenile MG patients.

To investigate the difference in clinical efficacy between zero-profile interbody fusion (ROI-C) and stand-alone interbody cage combined with cage-titanium plate construct for patient with two-segment skipped cervical spondylosis who received the anterior cervical discectomy and fusion (ACDF) surgical strategies.

The clinical data of 62 patients with two-segment skipped cervical spondylosis who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2020 were retrospectively analyzed, included 38 males and 24 females, aged (53.3±8.5) years. Thirty-three cases were treated with ROI-C (ROI-C group), and 29 cases with stand-alone interbody cage combined with cage-titanium plate construct (cage+titanium plate group). The following parameters, including operation time, intraoperative blood loss, dysphagia Bazaz grade, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) of pain, neck disability index (NDI), average intervertebral height of operated segments, C_2-7 Cobb angle, and related complications, were compared between the two groups.

The patients were followed up for (28±5) months (16-34 months). The operation time of ROI-C group was (127.6±34.2) min, which was shorter than that in cage+titanium plate group [(157.1±43.9) min, P=0.004]. The scores of JOA and VAS in both ROI-C group and cage+titanium plate group were significantly improved 3 months after operation when compared with those before operation, and there was no significant difference between the two groups (all P>0.05). The average intervertebral space height of fusion segment in ROI-C group was (6.02±1.03) mm before operation, it was improved to (8.38±1.47) mm at 3 months after operation, (8.16±1.40) mm at 12 months after operation, and it was (6.24±1.05) mm, (8.58±1.18) mm and (7.87±0.73) mm in cage+titanium plate group, respectively, and there was no significant difference between the two groups at each time point (all P>0.05). The Cobb angle of cervical vertebrae in ROI-C group was 10.5°±6.8° before operation, improved to 19.2°±9.0° at 3 months after operation, 18.2°±5.8° at 12 months after operation, and it was 10.9°±4.6°, 18.5°±7.8°, 17.1°±5.2° in cage+titanium plate group, respectively, and there was no significant difference between the two groups at each time point (all P>0.05). The incidence of postoperative dysphagia was 9.1%(3/33) in the ROI-C group and 37.9%(11/29) in the cage+titanium plate group, and the difference was statistically significant (P=0.007).

Both ROI-C and stand-alone interbody cage combined with cage-titanium plate construct can achieve good results for two-segment skipped cervical spondylosis. However, ROI-C is more advantageous in shortening the operation time and reducing early postoperative dysphagia.

To analyze the relationship between post-operative proximal junctional kyphosis (PJK) and C₂-femoral heads center (C₂-FH), pelvic fixation in adult spinal deformity (ASD) patients, so as to provide a reference for the preoperative decision-making and the postoperative intervention timely.

It was a retrospective study that analyzed 34 cases of ASD patients who underwent posterior pedicle screw fixation in Nanjing Drum Tower Hospital between January 2017 and May 2017. ASD patients were divided into two groups according to fixation options: the sacroiliac fixation group and the non-sacroiliac fixation group. The spine-pelvis parameters were evaluated on full-length X ray films of spine at preoperatively, 2 weeks postoperatively and the last follow-up, and the incidence of PJK was recorded.

A total of 34 ASD patients (3 males and 31 females) were included in this study, with an average age of (58±6) years. The mean follow-up period was (2.9±1.0) years (2.0-4.0 years). The age, follow-up time and various spine-pelvis parameters showed no significant differences between the two groups (all P>0.05). The immediate postoperative C₂-FH in the sacroiliac fixation group was significantly lower than that in the non-sacroiliac fixation group [(-69.46±30.85) mm vs (-31.62±15.31) mm, P<0.001]. The incidence of PJK was as high as 50.0% (8/16) in patients with sacroiliac fixation, but it was only 22% (4/18) in patients without sacroiliac fixation (P=0.016). At the last follow-up, the C₂-FH of both groups were both higher than -20 mm (both were approximately -15 mm, P=0.976), indicating that the C₂-FH was compensated in both groups. Due to the loss of the distal compensation ability, the incidence of PJK in the sacroiliac fixation group was higher than that in the non-sacroiliac fixation group. Due to the fixation of pelvis and most of lumbar spine, no significant differences were found in lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS) at the last follow-up in both groups when compared with those after the operation (all P>0.05); while the thoracic kyphosis (TK) and cervical lordosis (CL) increased significantly (both P<0.05) to compensate C₂-FH at the last follow-up.

It′s demonstrated that C₂-FH< -2 cm and pelvic fixation are high risk factors of PJK in ASD patients. It is suggested that both global sagittal balance and pelvic fixation should be considered in decision-making and corrective surgery, rather than only focusing on spine-pelvic parameters.

The current study aimed to investigate the efficacy and safety of carotid endarterectomy combined with endovascular therapy in hybrid operating room for patients with segmental atherosclerotic internal carotid artery occlusion, and share the experience of preoperative screening of patients suitable for vascular reconstruction. A total of 20 patients with internal carotid artery occlusion (ICAO) who were admitted to the Department of Neurosurgery, General Hospital of Tianjin Medical University from May 2018 to May 2020 were collected, and 15 patients met the inclusion criteria. All patients received hybrid surgery. The total success rate of recanalization was 14/15, and only 1 patient developed ICA re-occlusion at 1 year follow up.Therefore, carotid endarterectomy combined with endovascular treatment in hybrid operating room was an alternative treatment for patients with segmental atherosclerotic internal carotid artery occlusion.

Nine patients with large complex paraclinoid aneurysms were treated by hybrid surgery in the Second Affiliated Hospital of Zhejiang University between January 2016 and July 2021. Intraoperative angiography was conducted for real-time evaluation of the aneurysm and its clipping efficacy. A total of 8 aneurysms were clipped under temporary proximal control with balloon occlusion. Suction decompression was simultaneously applied in 2 of these cases. After surgery, 2 patients developed symptomatic cerebral infarction, 3 patients developed transient oculomotor nerve palsy, but no patients had vision deterioration. Postoperative follow-up showed that small neck residue occurred in 1 case, but with the rest of aneurysms were completely occluded without parent artery stenosis. Hybrid surgery was proved to be advantageous in real-time assessment of aneurysm morphology and clipping efficacy. Combination of temporary proximal balloon occlusion and suction decompression technique can help in reducing the difficulty of aneurysm exposure and remodeling, thereby improving the outcome and decreasing the complications.

This study aims to explore the clinical efficacy of arthroscopic-assisted reduction combined with robot-navigated nail placement in the treatment of talar neck fractures. The clinical data of 13 patients with talar neck fracture in Xuzhou Benevolent Hospital from January 2018 to January 2021 were analyzed in the retrospective study. Among them, there were 9 males and 4 females, aged (36±12) years; there were 8 cases suffered on the right and 5 cases on the left. All patients were reset under arthroscopy and cannulated screws were placed in combination with three-dimensional navigation and positioning of orthopedic robot. The wounds and complications were observed in the postoperative follow-up. The activities of bilateral ankle dorsiflexion and plantar flexion were measured in the last follow-up. The visual analogue scale score (VAS) of pain in the affected feet before operation were compared with that at the last follow-up. The ankle and hind foot work energy scale of American Foot and Ankle Association (AOFAS) was used to assess the ankle function. The results showed that the wounds of 13 patients healed in one stage. The operation time was (95±45) min and the blood lose was (45±10) ml. All the patients were followed-up for (15.0±3.5) months. Two cases developed subtalar arthritis without talus necrosis and fracture nonunion. At the last follow-up, there was no significant difference in the dorsal extension and plantar flexion of the ankle between the affected side and the healthy side (25.8°±1.9° vs 26.2°±2.3°, 44.2°±2.7° vs 44.7°±2.8°, both P>0.05). The VAS score of pain in the affected foot at the last follow-up was 0.53±0.18, it was significantly lower than that before operation (0.87±0.29) (P<0.001). The mean AOFAS ankle and hind foot energy scale of the ankle function was 93.5 at the last follow-up. It′s showed that treatment of talus neck fracture with arthroscopy assisted and robot guided nail placement is satisfactory and is worthy of clinical promotion.

This paper reports a case of primary clear cell sarcoma of uncinate bone of the wrist in a young woman. The patient has no induced wrist tenderness. The image suggests that the uncinate bone of the wrist occupies space. The pathological and immunohistochemical manifestations are consistent with clear cell sarcoma and malignant melanoma. Surgical resection was given and the prognosis was good. Clear cell sarcoma originating from bone is rare, and no occurrence of carpal bone has been reported. The diagnostic process of this patient suggests that the diagnosis of clear cell sarcoma and malignant melanoma should be considered for the intraosseous occupation of melanosomes, and the diagnosis depends on pathological and cytogenetic examinations. The treatment mode is mainly surgical resection.

Simultaneous electroencephalogram-functional magnetic resonance imaging (EEG-fMRI) technology combined with the high temporal resolution of electroencephalogram (EEG) and the advantages of functional magnetic resonance imaging (fMRI) plays an important role in the study of brain function, especially epilepsy: it can not only detect epileptic activity, be used to assist in the localization of epileptic foci and evaluate the efficacy of epileptic drugs, but also analyze the spread of epileptic activity and epileptic network. This article reviews the principles, techniques and current applications of EEG-fMRI in epilepsy.

Obesity is associated with many complications and has become a chronic disease that seriously affects the quality of life. However, the effect of obesity on cognitive function, especially in the elderly, is still unclear. It is generally believed that obesity can damage the cognitive function of the elderly, especially in the aspects of executive function, memory, processing speed, attention, etc. However, some studies have found that overweight or obesity are protective factors that can slow down the decline of cognitive function. This complex relationship is affected by a variety of factors. This paper summarizes the common risk factors that affect the cognitive ability of the obese elderly, and systematically expounds the effects of obesity on the cognitive function and its mechanism from the perspectives of age, gender, exercise, diet and disease.

Patients with early stage non-small cell lung cancer (NSCLC) require new adjuvant therapeutic strategies to optimize their prognosis after complete surgical resection. The aim of the study was to evaluate the effect between adjuvant atilizumab therapy and optimal supportive therapy in patients following platinum-based adjuvant chemotherapy. IMpower010 is a randomized, globally multicenter, open-label Phase III study completed at 227 sites in 22 countries and territories. Eligible patients were stage IB (tumor ≥4 cm) to IIIA NSCLC aged 18 years or older and completely resectable according to the staging system (7th edition) of the International Cancer Federation and the American Joint Committee on Cancer. A total of 1 280 patients were enrolled after complete tumor resection between October 7, 2015 and September 19, 2018. 1 269 patients received adjuvant chemotherapy, of which 1 005 patients were eligible to receive randomized atilizumab (n=507) or the best supportive treatment (n=498）； 495 patients in each group were treated. Patients were randomized (1:1) by permutation block method (4 blocks) to receive atilizumab adjuvant (1 200 mg every 21 days; 16 cycles or 1 year) or optimal supportive therapy (observation and periodic scanning for disease recurrence) after platinum-based chemotherapy adjuvant (1 to 4 cycles). The primary endpoint was the investigator's assessment of disease-free survival, and the grading test was performed first in the subgroup of stages II to IIIA population [≥1% tumor cells express PD-L1 (SP263))] in order, followed by all patients in stages II to IIIA, and finally the intent-to-treat (ITT) population (stages IB to IIIA). Safety was assessed in all patients randomized to receive atilizumab or optimal supportive therapy. After a median follow-up of 32.2 months (quartile interval: 27.4 to 38.3) in stage Ⅱ to ⅢA patients, atilizumab treatment increased PD-L1 expression by ≥1% of tumor cells compared with best supportive treatment in stage Ⅱ to ⅢA patients (HR=0.66； 95%CI：0.50~0.88；P=0.003 9), and all stage II to IIIA patients (0.79; 0.64 to 0.96;P=0.020) of disease-free survival. In the ITT population, disease-free survivalHR0.81 (0.67-0.99;P=0.040）。 In terms of adverse events, 53 (11%) of 495 patients experienced atilizumab-related grade 3 and 4 adverse events and 4 (1%) experienced atilizumab-related grade 5 adverse events.