Xiujue Zheng

Elevation of neuron-specific enolase and S-100β protein level in experimental acute spinal cord injury

We evaluated the protein levels of neuron-specific enolase (NSE) and S-100beta in serum and cerebrospinal fluid (CSF) in an animal model of acute spinal cord injury and ascertained their relevance. Spinal cord injury was induced at the T8 level in rats. Enzyme-linked immunosorbent assay was used to measure the protein levels of NSE and S-100beta in both serum and CSF at different time points (30 min, 2 h, 6 h, 12 h and 24 h after induction of spinal cord injury). There existed a significant correlation between neurological deficits and the severity of spinal cord injury (p<0.05). Compared with the control group, the protein levels of NSE and S-100beta in serum and CSF significantly increased from 2 h after injury (p<0.05) and reached a maximum at 6 h. Within a certain time window, the protein levels of NSE and S-100beta in serum and CSF were closely related to the severity of injury level (p<0.05). The protein levels of NSE and S-100beta in serum and CSF significantly increased after experimental spinal cord injury in a time-dependent manner and thus may be considered specific biomarkers for acute spinal cord injury.

Drilling skull plus injection of urokinase in the treatment of epidural haematoma: A preliminary study

Primary objective: This study was performed to evaluate the effectiveness of a minimally invasive approach to manage patients with epidural haematoma (EDH). The surgical indication and key points were investigated. Research design: Descriptive, retrospective study. Methods and procedures: Twenty-one patients with traumatic EDH were treated through the following method: After anaesthesia, twist drill trepanations were performed followed by a placement of drainage tubes. Twenty ku urokinase in 3 ml saline was injected into the haematoma cyst through the tube, which was closed for 3 hours before connection to a vacuum ball with negative pressure. The injection was repeated three times a day after operation. The fibrinolytic agents were not used in the ‘acute group’ because of the risk of rebleeding. CT scans were performed according to the changes of clinical manifestations. Main outcomes and results: The drainage tubes were left for 3–5 days before most clots were resolved. The patients discharged after 7 days’ hospitalization on average. No infections or recurrence of EDHs were observed in this series. Conclusion: Drilling skull plus injection of urokinase through drainage tube is a safe and effective method with less injury in the treatment of a selected part of patients with EDHs.

Efficacy of large decompressive craniectomy in severe traumatic brain injury.

OBJECTIVE To investigate the role of large decompressive craniectomy (LDC) in the management of severe and very severe traumatic brain injury (TBI) and compare it with routine decompressive craniectomy (RDC). METHODS The clinical data of 263 patients with severe TBI (GCS < or = 8) treated by either LDC or RDC in our department were studied retrospectively in this article. One hundred and thirty-five patients with severe TBI, including 54 patients with very severe TBI (GCS < or = 5), underwent LDC (LDC group). The other 128 patients with severe TBI, including 49 patients with very severe TBI, underwent RDC (RDC group). The treatment outcome and postoperative complications of the two treatment methods were compared and analyzed in a 6-month follow-up period. RESULTS Ninety-six patients (71.7 %) obtained satisfactory treatment outcome in the LDC group, while only 75 cases (58.6 %) obtained satisfactory outcome in the RDC group (P < 0.05). Moreover, the efficacy of LDC in treating very severe TBI was higher than that of RDC (63.0 % vs. 36.7 %, P < 0.01). The chance of reoperation due to refractory intracranial pressure (ICP) in the LDC group was significantly lower than that of the RDC group (P < 0.05), while the incidences of delayed intracranial hematoma and subdural effusion were significantly higher than those of the RDC group ( P < 0.05). CONCLUSIONS LDC is superior to RDC in improving the treatment outcome of severe TBI, especially the very severe ones. LDC can also efficiently reduce the chances of reoperation due to refractory ICP. However, it increases the incidences of delayed intracranial hematoma and contralateral subdural effusion.

Endoscope‐assisted supraorbital keyhole approach for the resection of benign tumors of the sellar region

The objective of the study was to evaluate the effectiveness of the supraorbital “keyhole” approach with endoscope assistance in surgical treatment of benign tumors around the sellar region. Thirty‐five patients, including 19 pituitary tumors, 11 craniopharyngiomas and five tuberculum sellae meningiomas, were enrolled in this study. The tumors were resected through an endoscope‐assisted supraorbital keyhole approach via a small skin incision within the eyebrow. Complete removal of the sellar region tumors was achieved in all 35 cases by endoscope‐assisted supraorbital keyhole approach. Mean length of hospital stay after surgery was 10.2 days (range 5 – 17). There was no patient with evidence of residual or recurrent tumor during the follow‐up period. There was no infection, bleeding, further vision impairment, oculomotor nerve injury or other cranial nerve injury symptom owing to surgery. Though some patients suffered from insipidus, hyperprolactinemia, subcutaneous edema or other postoperative complications, they eventually recovered with or without drug administration. The supraorbital “keyhole” approach with endoscopic assistance in the surgical treatment of benign tumors around the sellar region is an ideal pattern.

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

Purpose Many epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma. Materials and Methods We searched PubMed to identify relevant articles. Two researchers evaluated the eligibility and extracted the data independently. Results Eleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively. Conclusion Our meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.

HSPB1 Enhances SIRT2-Mediated G6PD Activation and Promotes Glioma Cell Proliferation

Heat shock proteins belong to a conserved protein family and are involved in multiple cellular processes. Heat shock protein 27 (Hsp27), also known as heat HSPB1, participates in cellular responses to not only heat shock, but also oxidative or chemical stresses. However, the contribution of HSPB1 to anti-oxidative response remains unclear. Here, we show that HSPB1 activates G6PD in response to oxidative stress or DNA damage. HSPB1 enhances the binding between G6PD and SIRT2, leading to deacetylation and activation of G6PD. Besides, HSPB1 activates G6PD to sustain cellular NADPH and pentose production in glioma cells. High expression of HSPB1 correlates with poor survivalrate of glioma patients. Together, our study uncovers the molecular mechanism by which HSPB1 activates G6PD to protect cells from oxidative and DNA damage stress.

Serial Attacks: Contralateral Hematoma Secondary to Decompressive Craniectomy for Traumatic Brain Injury Led to Posttraumatic Cerebral Infarction.

A 40-year-old man suffered severe brain injury and received left side subdural hematoma evacuation with decompressive craniectomy. Intraoperative brain swelling had occurred during the surgery. Postoperative computed tomography (CT) scan was done immediately and showed a contralateral epidural hematoma resulting in herniation. Secondary hematoma evacuation was performed and found a linear fracture near a bleeding meningeal artery. 2 days later CT scan showed cerebral infarction mainly in right posterior cerebral artery distribution. Early diagnosis by postoperative CT scan or other potential ways such as intraoperative sonography is important to prompt treatments and interrupt the pathophysiological chain of the serial attacks.

Long non-coding RNA MALAT1 contributes to inflammatory response of microglia following spinal cord injury via modulating miR-199b/IKKβ/NF-κB signaling pathway

Long noncoding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was widely recognized to be implicated in human cancer, vascular diseases, and neurological disorders. This study was to explore the role and underlying mechanism of MALAT1 in acute spinal cord injury (ASCI). ASCI models in adult rats were established and demonstrated by a numerical decrease in BBB scores. Expression profile of MALAT1 and miR-199b following ASCI in rats and in vitro was determined using quantitative real-time PCR. RNA pull-down assays combined with RIP assays were performed to explore the interaction between MALAT1 and miR-199b. In the present study, MALAT1 expression was significantly increased (2.4-fold that of control) in the spinal cord of the rat contusion epicenter accompanied by activation of IKKβ/NF-κB signaling pathway and an increase in the level of proinflammatory cytokines TNF-α and IL-1β. Upon treatment with LPS, MALAT1 expression dramatically increased in the microglia in vitro, but knockdown of MALAT1 attenuated LPS-induced activation of MGs and TNF-α and IL-1β production. Next, we confirmed that LPS-induced MALAT1 activated IKKβ/NF-κB signaling pathway and promoted the production of proinflammatory cytokines TNF-α and IL-1β through downregulating miR-199b. More importantly, MALAT1 knockdown gradually improved the hindlimb locomotor activity of ASCI rats as well as inhibited TNF-α, IL-1β levels, and Iba-1 protein, the marker of activated microglia in injured spinal cords. Our study demonstrated that MALAT1 was dysregulated in ASCI rats and in LPS-activated MGs, and MALAT1 knockdown was expected to attenuate ASCI through repressing inflammatory response of MGs.

Primary sellar melanocytic tumor mimicking hemorrhagic pituitary macroadenoma: Case report and literature review

Abstract Primary melanocytic tumors of the central nervous system (CNS) are rare lesions, but primary sellar tumors are rarer. Only 10 cases have been reported, and they are often misdiagnosed as pituitary macroadenoma. We report the case of a 54-year-old Chinese man who developed progressive bitemporal hemianopsia and visual loss. Magnetic resonance imaging (MRI) revealed an intrasellar and suprasellar clouded lesion adhering to the optic chiasm, hypothalamus, and hypophyseal stalk that was suspected of being a hemorrhagic pituitary macroadenoma. Because of the atypically giant, hemorrhagic, and upward-growing lesion, an initial trans-sphenoidal approach failed, and subsequent transfrontal craniotomy was adopted to achieve macroscopically complete resection. Histopathologic findings revealed a benign melanocytic tumor. Despite an extensive search, no other primary or secondary site was found. Considering the relatively benign lesion, effective surgery, and potential significant consequences of radiotherapy, the patient received no further treatment and is still alive at the 7-year follow-up. Primary sellar melanocytic tumors are exceptional lesions that are difficult to diagnose before operating and/or obtaining pathological findings. The pathological classification and extent of surgical resection may play a key role in the prognosis. Once this type of lesion is suspected, the transfrontal approach may achieve preferable exposure and resection. Complete surgical resection may be sufficient for relatively benign lesions; otherwise, stereotactic fractionated radiotherapy is indicated. More cases should be reported to improve the treatment strategy.

Gadobutrol-enhanced magnetic resonance imaging of meningeal carcinomatosis: case report with emphasis on early diagnosis

BackgroundTimely diagnosis of meningeal carcinomatosis is often difficult even with the assistant of magnetic resonance imaging examination, cerebrospinal fluid analysis, or both. To the best of our knowledge, gadobutrol-enhanced MRI has not been reported in the diagnosis of meningeal carcinomatosis. Here we present two cases where meningeal carcinomatosis was identified on gadobutrol-enhanced magnetic resonance imaging.Case presentationWe identified two cases of meningeal carcinomatosis who had been diagnosed with malignant tumors several years ago. Both patients presented with progressive headache and seizures. Gadopentetate dimeglumine-enhanced magnetic resonance imaging of the brain was performed and did not detect any abnormality of meninges. Lumbar puncture was performed repeatedly, but cerebrospinal fluid cytology showed no evidence of malignant cells. Finally the gadobutrol-enhanced magnetic resonance imaging detected the meningeal metastasis, and supported the diagnosis of meningeal carcinomatosis.ConclusionGadobutrol provides higher lesion conspicuity and enhances lesion detection in meningeal metastasis compared with gadopentetate dimeglumine. Our observation is a cue to analyze the accuracy in the diagnosis of meningeal carcinomatosis, and presents a choice that may facilitate early diagnosis.