Sex steroid and cognitive function among community-dwelling older men with or without vascular risk factors: a cross-sectional study.

BACKGROUND: The relationship of testosterone and estradiol concentrations with cognitive function among community-dwelling older men was inconclusive. To examine the association of serum testosterone and estradiol concentrations with cognitive function in older men with or without vascular risk factors (VRFs). METHODS: This cross-sectional study consisted of 224 community-dwelling men aged 65-90 years in the Songjiang District of Shanghai, China. Serum testosterone and estradiol were measured by electrochemiluminescence immunoassay. The following five factors were defined as VRFs in this study: obesity, history of hypertension, diabetes, stroke, and coronary heart disease. Multivariable linear regression was used to examine the association of testosterone and estradiol with the Mini-Mental State Examination (MMSE) in participants with or without VRF. Restricted cubic spline (RCS) regression was performed to account for the nonlinearity of these associations. RESULTS: An inverted "U" shaped non-linear relationship was found between testosterone concentration and MMSE score in men with one VRF (P overall =.003, non-linear P =.002). Estradiol showed an inverted "U" shaped non-linear relationship with MMSE score independent of VRFs (men without VRF, P overall =.049, non-linear P =.015; men with one VRF, overall P =.007, non-linear P =.003; men with two or more VRFs, overall P =.009, non-linear P =.005). CONCLUSION: In older men, an optimal level of sex steroid concentration may be beneficial to cognitive function and the VRFs should be considered when interpreting the relationship between sex steroid and cognitive function.

The impact of "Aging with Medical and Caregiving" on family caregiving-Evidence from China's pilot cities for integrating medical and caregiving.

Easing the pressure on family caregiving and addressing the shortage of manpower for family caregiving are significant challenges that China faces in responding to its aging population. This study utilizes data from the 2015 and 2020 China Health and Retirement Longitudinal Study (CHARLS) and employs a Difference-in-Difference method to investigate the impact of pilot policies that integration of medical and caregiving for aging individuals. The findings reveal that these pilot programs are successful in reducing the amount of time spent on family caregiving and the financial burden placed on families, effectively relieving the pressure associated with family caregiving. However, the effects of these programs differ depending on the level of disability, household registration, and the geographical location of the participants. Further analysis suggests that these pilot programs achieve these positive outcomes by increasing government investment in health and wellness funds and providing in-family medical and caregiving services.

Multi-omics approaches establishing histone modification based prognostic model in glioma patients and further verification of the carcinogenesis mechanism.

Glioblastoma (GBM) emerges as the most common malignant brain tumor. Histone modifications, as an epigenetic regulatory mechanism of gene expression, are closely associated with malignant tumors. Gene set related to histone modification was extracted from the MSigDB database, and scored by the function of AddModuleScore. Pearson correlation analysis was utilized using the "rcorr" function of "Hmisc" R package. Genes were screened out using the LASSO Cox analysis. TCGA-GBM and CGGA_array_301 cohorts were employed for constructing model and validation. We calculated immune infiltration scores using microenvironment cell populations counter (MCPcounter), single-sample gene set enrichment analysis (ssGSEA), and xCell algorithms. U87-MG and CHG-5 cell lines were utilized to evaluate expression level of TMEM176A by western blot (WB). Transwell, EDU, colony formation analysis (CFA), and CKK-8 assays were conducted to investigate cell proliferation and migration rate. The malignant cells in GBM patients exhibited notable activation in the TGF-ß and hypoxia pathway. Histone modifications were associated with adhesion and neuron development in GBM. We identified a model with five significant genes, namely NBEAL1, AEBP1, TMEM176A, FASTK, and CD81, with prognostic efficacy. Additionally, we observed increased infiltration of T cells and CD8+ T cells in the high-risk (HR) group. 5-Fluorouracil_1073 and Taselisib_1561 were predicted as potential treatment options for GBM patients, while ABT737_1910 and Wnt_C59-1622 exhibited superior response in GBM patients of the HR group. A spike in the TP53 mutation rate was observed in the HR group. TMEM176A played a role in regulating cell proliferation and migration in vitro. We presented a novel prognostic model for patients with GBM, based on histone modification-related genes. In addition, we identified the crucial role of the TMEM176A in the regulation of GBM carcinogenic phenotypes for the first time.

Deep Chemical and Physico-Chemical Characterization of Antifungal Industrial Chitosans-Biocontrol Applications.

Five different chitosan samples (CHI-1 to CHI-5) from crustacean shells with high deacetylation degrees (>93%) have been deeply characterized from a chemical and physicochemical point of view in order to better understand the impact of some parameters on the bioactivity against two pathogens frequently encountered in vineyards, Plasmopara viticola and Botrytis cinerea. All the samples were analyzed by SEC-MALS, 1H-NMR, elemental analysis, XPS, FTIR, mass spectrometry, pyrolysis, and TGA and their antioxidant activities were measured (DPPH method). Molecular weights were in the order: CHI-4 and CHI-5 (MW >50 kDa) > CHI-3 > CHI-2 and CHI-1 (MW < 20 kDa). CHI-1, CHI-2 and CHI-3 are under their hydrochloride form, CHI-4 and CHI-5 are under their NH2 form, and CHI-3 contains a high amount of a chitosan calcium complex. CHI-2 and CHI-3 showed higher scavenging activity than others. The bioactivity against B. cinerea was molecular weight dependent with an IC50 for CHI-1 = CHI-2 (13 mg/L) ≤ CHI-3 (17 mg/L) < CHI-4 (75 mg/L) < CHI-5 (152 mg/L). The bioactivity on P. viticola zoospores was important, even at a very low concentration for all chitosans (no moving spores between 1 and 0.01 g/L). These results show that even at low concentrations and under hydrochloride form, chitosan could be a good alternative to pesticides.

Exploration of Core Genes in ACTH-Independent Macronodular Adrenal Hyperplasia.

This study explores the core genes involved in the pathogenesis of ACTH-independent macronodular adrenal hyperplasia (AIMAH), so as to provide robust biomarkers for the clinical diagnosis and treatment of this disease. Gene Expression Omnibus (GEO) database was used to obtain GSE25031 microarray dataset. R package "limma" was applied to identify differentially expressed genes (DEGs) between AIMAH and normal samples. The Database for Annotation, Visualization and Integrated Discovery (DAVID) was employed to perform Gene Ontology (GO) annotation for the DEGs, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was conducted. A protein-protein interaction network (PPI) was constructed using the STRING online website and visualized using the Cytoscape software. The key modules and hub genes were then identified. Finally, Gene Set Enrichment Analysis (GESA) enrichment analysis was carried out to find the signaling pathways of significant clinical value in AIMAH. A total of 295 DEGs between AIMAH and healthy samples were screened out, including 164 upregulated genes and 131 downregulated genes. Combining enrichment analysis and PPI network construction, there were 5 signifiant pathways and 10 hub genes, among which 3 genes (FOS, FOSB, and DUSP1) were identified as potential core genes of clinical significance in AIMAH. In conclusion, the 3 core genes, FOS, FOSB, and DUSP1, identified here might be potential biomarkers for AIMAH, and the current study is of guiding significance for clinical diagnosis and treatment of this disease.

Involvement of regulation of the excitation:inhibition functional balance in the mPFC in the antidepressant-anxiolytic effect of YL-IPA08, a novel TSPO ligand.

TSPO, an 18 kDa translocator protein, has received increased attention due to its antidepressant-anxiolytic effects. The balance between glutamatergic and GABAergic (E: I) in the medial prefrontal cortex (mPFC) is crucial for antidepressant-anxiolytic effects. However, no evidence is available to clarify the relationship between TSPO and E:I balance. In the present study, we used the TSPO global-knockout (KO) and TSPO wild-type (WT) mice to assess the effects of TSPO on antidepressant-anxiolytic effects of YL-IPA08 (a novel TSPO ligand) and the underlying neurobiological mechanism. Additionally, a multichannel electrophysiological technique was used to explore the effects of YL-IPA08 on pyramidal neurons and interneurons in mPFC. Open field test (OFT) and elevated plus maze (EPM) test revealed that a single dose of YL-IPA08 (0.3 mg/kg, i.p.) exhibited significant anxiolytic actions in WT mice except in KO mice. In only WT mice, significant antidepressant effects were observed in tail suspension test (TST) and forced swim test (FST). The multichannel electrophysiological technique demonstrated that YL-IPA08 significantly increased the firing rates of pyramidal neurons and decreased those of interneurons. Further studies illustrated that the firing rates of glutamatergic might be antagonized by PK11195 (a classic TSPO antagonist). Our results suggest that YL-IPA08 might regulate the E:I balance in mPFC, mediated by TSPO. In summary, TSPO regulates E:I functional balance in mPFC, play a critical role in antidepressant-anxiolytic effects of YL-IPA08, and provide a potential target site for the development of antidepressant and anxiolytic drugs.

Long noncoding RNA FLVCR1-AS1 aggravates biological behaviors of glioma cells via targeting miR-4731-5p/E2F2 axis.

Long noncoding RNAs (lncRNAs) display essential roles in cancer progression. FLVCR1-AS1 is a rarely investigated lncRNAs involved in various human cancers, such as hepatocellular carcinoma and lung cancer. However, its function in glioma has not been clarified. In our study, we found that FLVCR1-AS1 was highly expressed in glioma tissues and cell lines. And upregulation of FLVCR1-AS1 predicted poor prognosis in patients with glioma. Moreover, FLVCR1-AS1 knockdown inhibited proliferation, migration and invasion of glioma cells. Through bioinformatics analysis, we identified that FLVCR1-AS1 was a sponge for miR-4731-5p to upregulate E2F2 expression. Moreover, rescue assays indicated that FLVCR1-AS1 modulated E2F2 expression to participate in glioma progression. Altogether, our research demonstrates that the FLVCR1-AS1/miR-4731-5p/E2F2 axis is a novel signaling in glioma and may be a potential target for tumor therapy.

Polymeric heptazine imide by O doping and constructing van der Waals heterostructures for photocatalytic water splitting: a theoretical perspective from transition dipole moment analyses.

Semiconductor-based photocatalysts have received extensive attention for their promising capacity in confronting global energy and environmental issues. In photocatalysis, a large band gap with suitable edge-position is necessary to warrant enough driving force for reaction, whereas a much smaller band gap is needed for visible-light response and high solar energy conversion efficiency. This paradox hinders the development of photocatalysts. Via state-of-the-art first-principles calculations, we find that the transition dipole moments (TDMs) are changed significantly in O-doped partly polymerized g-C3N4, i.e., OH-terminated polymeric heptazine imide (PHI-OH), and concomitantly, an enhancement of visible-light absorption is achieved; meanwhile a large enough band gap can provide a powerful driving force in the photocatalytic watersplitting reaction. Furthermore, by using TDM analysis of the PHI-OH/BC3N heterostructure, direct light excited transition between two building layers can be confirmed, suggesting it as a candidate catalyst for hydrogen evolution. From TDM analysis of the PHI-OH/BCN heterostructure, we also verify a Z-scheme process, which involves simultaneous photoexcitations with strong reducibility and oxidizability. Thus, TDM could be a good referential descriptor for revealing photocatalytic mechanisms in semiconductor photocatalysts and interlayer photoexcitation behavior in layered heterostructures. Hopefully, more strategies via modification of TDMs would be proposed to enhance the visible-light response of a semiconductor without sacrificing its photocatalytic driving force.

Brain Abnormalities in Different Phases of Working Memory in Schizophrenia: An Integrative Multi-Modal MRI Study.

The current study aimed to examine both gray matter and functional activity changes in schizophrenia by combing both structural and task-related functional magnetic resonance imaging (fMRI). Nineteen patients with schizophrenia and 17 controls were recruited. The fMRI scan was performed while performing a working memory (WM) task. In terms of task performance, accuracy did not differ between groups, but there were significant differences in reaction time. Compared with controls, patients exhibited decreased functional activation in prefrontal areas, insula, lingual gyrus, and superior temporal gyrus during different phases of WM. The subcallosal cortex showed increased activation. Intriguingly, a structural-functional correlation was found in the left dorsolateral prefrontal cortex, anterior cingulate cortex, and subcallosal cortex in patients when performing high-load WM task. This study demonstrated both impaired gray matter volume and functional activation during WM in schizophrenia, suggesting structural and functional impairments. The structural-functional correlation in schizophrenia suggested that structural damage in schizophrenia might induce a decreased ability to modulate functional response in accordance with increasing task difficulty.

Tracing major metabolites of quinoxaline-1,4-dioxides in abalone with high-performance liquid chromatography tandem positive-mode electrospray ionization mass spectrometry.

BACKGROUND: Owing to the comprehensive application of quinoxaline-1,4-dioxides (QdNOs) in aquaculture, QdNOs and metabolites are often detected in marine food, including abalone. QdNOs are reported to exhibit cytotoxicity, photoallergy, mutagenicity, and carcinogenicity activities. To monitor for contamination of QdNOS in abalone and assess dietary exposure, a simple and reliable analytical method for the detection of QdNOs and their major metabolites was developed. RESULTS: This work is the first to present a simple and fast pretreatment procedure coupled with high-performance liquid chromatography tandem positive-mode electrospray ionization mass spectrometry (LC-MS/MS) for tracing of major metabolites of QdNOs in abalone. Extraction steps were simplified by the use of methanol and ethyl acetate containing 0.1% formic acid instead of more complicated acidolysis and enzymolysis pretreatment procedures. High-sensitive characters were obtained with limits of detection ranged from 0.16 to 2.1 µg kg-1 for QdNOs and their major metabolites. CONCLUSION: These results indicate that the LC-MS/MS method developed could be applied for QdNOs and major metabolites detection in actual samples. Considering the large production and consumption of abalone in Shandong Province, China, this work will also contribute to the further understanding of the often-ignored exposure pathway of QdNOs. © 2019 Society of Chemical Industry.

Allergy in patients with anti-N-methyl-d-aspartate receptor encephalitis.

BACKGROUND AND OBJECTIVE: Allergy is a potential outcome of dysregulated immune system. Previous studies have shown the association of allergy and autoimmune diseases, however, there is few study to investigate the relationship between allergy and anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Thus, we investigate the rate of allergy in patients with anti-NMDAR encephalitis and analyze the risk factors. METHOD: The rate of allergy was investigated in patients with anti-NMDAR encephalitis and was compared with patients with virus encephalitis. The clinical cutaneous characters were described in details. All patients with anti-NMDAR encephalitis were divided into allergic and nonallergic group. Clinical factors were compared in the two groups, and logistic regression model was also used to analyze possible risk factors of allergy. RESULTS: Patients with anti-NMDAR encephalitis had a higher rate of allergy than those with viral encephalitis (22.1% vs 9.2%, odds ratio (OR)=3.23, confidence interval (CI)=1.40-7.42, P=0.006). In patients with anti-NMDAR encephalitis, allergic patients exhibited longer days in hospital (30days vs 22days, P=0.005) and higher occurrence of decreased consciousness (81.5% vs 58.9%, P=0.031), higher rate of complications (77.8% vs 57.9%, P=0.046) and abnormal electroencephalography (EEG) (100% vs 78.6%, P=0.021) than patients without allergy. Cerebrospinal fluid (CSF) antibody titers of allergic patients during the disease course were also higher than nonallergic patients (P=0.004). However, further logistic regression analysis did not reveal independent predictors of allergy. CONCLUSIONS: Patients with anti-NMDAR encephalitis show higher allergic rate than those with virus encephalitis. Patients with allergy show higher CSF antibody titers and greater illness severity. However, the final outcome of anti-NMDAR encephalitis was not influenced.

Late-onset anti-N-methyl-d-aspartate receptor encephalitis in China.

PURPOSE: This study aimed to summarize the clinical characteristics and outcome of late-onset anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis in China. METHOD: All cases of people with a definitive diagnosis of anti-NMDAR encephalitis in West China Hospital between June 2012 and April 2017 were retrospectively reviewed. The demographics, clinical characteristics, and outcome of those patients (age≥45years old) were summarized. Comparisons were conducted between older (≥45years old) and younger (18-44years old) adults. RESULT: Eighteen (12%) of 151 people were ≥45years old, 9 of whom (50%) were female. Psychiatric symptoms were the most common clinical manifestations of older adults and presented in all individuals. At the last follow-up, 14 (78%) of them had a good outcome (modified Rankin Scale: 0-2) and one (6%) died. Compared with 121 younger adults, older adults had a higher proportion of presenting memory deficit as the initial symptom (17% vs. 2%, p=0.023), longer interval from onset to admission (30 vs. 13days, p=0.013), and longer interval from onset to diagnosis (42.5 vs. 24days, p=0.045). No older adults' condition was accompanied with teratoma compared with 75% of younger adults with tumor (p=0.032). And older adults had a tendency to have a lower rate of positive NMDAR antibody (Ab) in serum (28% vs. 52%, p=0.053). CONCLUSION: Delayed admission and diagnosis are more common in older adults than in younger adults. A comprehensive consideration of all symptoms and early screening of NMDAR Ab, especially in cerebrospinal fluid, is necessary and beneficial to differential diagnosis.

The Efficacy of Antimuscarinics Alone or in Combination with Alpha-Blockers for the Treatment of Ureteral Stent-Related Symptoms: A Systematic Review and Meta-Analysis.

INTRODUCTION AND AIM: The purpose of this meta-analysis was to evaluate the efficacy of antimuscarinics alone or in combination with alpha-blockers for the treatment of ureteral stent-related symptoms. METHODS: The databases MEDLINE, EMBASE, PubMed, the Cochrane Controlled Trial Register of Controlled Trials from 2000 to February 2016 were searched to identify randomized controlled trials that referred to the use of a combination of antimuscarinics and alpha-blockers for the treatment of ureteral stent-related symptoms. A systematic review and meta-analysis was conducted. RESULTS: Seven publications involving 710 patients were included in the meta-analysis. In the analysis, we found significantly improved total International Prostate Symptom Score, quality of life, body pain and work performance score of the Ureteral Stent Symptom Questionnaire (USSQ) in the combination group compared with antimuscarinics alone (p = 0.00001, p = 0.00001, p = 0.00001 and p = 0.004, respectively). Antimuscarinics alone versus the control group showed significant improvement in urinary symptom, body pain and general health score of USSQ (p = 0.002, p = 0.00001 and p = 0.003, respectively). CONCLUSIONS: Our meta-analysis shows the beneficial effect of antimuscarinics alone in reducing stent-related symptoms. The combined use of antimuscarinics and alpha-blockers results in additive favorable effects in patients with ureteral stent-related symptoms compared with antimuscarinics monotherapy. The alpha-blockers may enhance the efficacy of the antimuscarinics, which is beneficial for the treatment of ureteral stent-related symptoms.

Effects of emergency cervical cerclage on pregnancy outcome: a retrospective study of 158 cases.

The aim of this study was to evaluate the effectiveness and safety of emergency cervical cerclage in women with advanced cervical dilatation and bulging of fetal membranes. The study included 158 women who underwent emergency cervical cerclage because of cervix dilatation and protruding membranes in mid-trimester at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Pregnancy outcomes and pregnancy outcome related to clinical features were analyzed retrospectively. Analysis revealed that the placement of emergency cerclage led to the delivery of live infants with a success rate of 82.28%. The mean interval between cerclage and delivery was 52.16.±26.62 days, with a mean gestation at delivery of 30.3±4.7 weeks and a mean birth weight of 1934.69±570.37 g. No severe maternal complications such as maternal death, hematosepsis, and hysterorrhexis occurred after the operation. Two women (1.25%) had laceration of the cervix, 1 woman (0.61%) suffered pulmonary edema, and 2 women (1.25%) developed deep vein thrombosis (DVT). There were significant correlations between the pregnancy outcome and risk factors, including any presenting symptoms, cervical dilatation, postoperative white blood cell count, and C-reactive protein (CRP) value. No significant difference was found in women with good vs. poor outcome in terms of maternal age and obstetric histories. Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in women with cervical incompetence. It should be considered a viable option for women with a dilated cervix in mid-trimester.

Generation of isolated sub-10-attosecond pulses in spatially inhomogenous two-color fields.

We present a theoretical investigation of high-order harmonic generation in spatially inhomogeneous two-color laser fields by solving three dimensional time dependent Schrödinger equation. The cutoff in the harmonic spectra can be significantly extended by means of our proposed method (i.e., from helium interacting with the plasmon-enhanced two-color laser fields), and an ultrabroad supercontinuum up to 1.5 keV is generated by selecting proper carrier-envelope phase of the controlling field. Moreover, classical trajectory extraction, time-dependent ionization and recombination rates, and time-frequency analyses are used to explain the generation of this ultrabroadband supercontinuum. As a result, an isolated 8.8 attosecond pulse can be generated directly by the superposition of the supercontinuum harmonics.

Effect of melilotus extract on lung injury by upregulating the expression of cannabinoid CB2 receptors in septic rats.

BACKGROUND: M. Suaveolens Ledeb has long been used in China to treat inflammatory infectious diseases. Melilotus is extracted from Melilotus Suaveolens Ledeb and its therapeutic potential is associated with its anti-inflammatory activity. However, the precise mechanisms underlying its effects are unknown. This study was conducted to evaluate the protective effects of melilotus extract in a rat cecal ligation and puncture (CLP)-induced animal model of acute lung injury (ALI). METHODS: A sepsis model was induced by CLP-like lung inflammation. Two hours prior to CLP administration, the treatment group was administered melilotus extract via oral injection. RT-PCR and Western blotting were used to test the expression of cannabinoid receptor (CB)2, NF-κß and IκB from single peripheral blood mononuclear cells and lung tissues respectively. Enzyme linked immune sorbent assay was used to detect serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and IL-12. The numbers of neutrophils, lymphocytes, macrophages and total cells in the bronchoalveolar lavage (BAL) fluid were counted. For histologic analysis, hematoxylin and eosin (H&E) stains were evaluated. RESULTS: After inducing ALI by CLP for 24 hours, melilotus extract up-regulated peripheral blood mononuclear cell CB2 expression, blocked the activity of NF-κß65, and the number of neutrophils, lymphocytes and total cells were significantly lower in the melilotus extract group than the control group. In addition, TNF-α and IL-6 levels were significantly decreased in the melilotus extract group. Histological results demonstrated the attenuation effect of melilotus extract on CLP-induced lung inflammation. CB2 was negatively correlated to NF-κß mRNA and proteins, respectively (r = -0.377, P < 0.05; r = -0.441, P < 0.05). CONCLUSION: The results of this study indicated melilotus extract significantly reduced CLP-induced lung inflammation by up-regulating CB2 expression. The remarkable protective effects of melilotus extract suggest its therapeutic potential in CLP induced-acute lung injury treatment.

Spatial heterogeneity of sedimentary organic matter sources in the Yangtze River estuary: Implications from fatty acid biomarkers.

This study investigated the sources of sedimentary organic matter (OM) in the Yangtze River estuary (YRE), using multiple biomarkers. The results of stable carbon isotope (δ13C) and total organic carbon to nitrogen ratio (TOC/TN) suggests the contribution of marine-derived OM significantly increased seawards, while fatty acid (FA) composition provides more specific information on OM sources. In total, 30 components of FAs were identified at the studied 17 sites, which mainly composed of phytoplankton FA, followed by ubiquitous FA and bacterial FA, while terrestrial FA contributed less to the total FAs. Under the strong impacts of the large physicochemical gradients in the YRE, TOC, TN and FA components showed higher concentrations in the estuary mixing zone (especially within the turbidity maximum zone), attributing to their strong binding with OM-enriched fine particles. The spatial heterogeneity of sedimentary OM sources was highly impacted by salinity and Chl-a, as well as bacteria-mediated OM degradation.

Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale.

Unilateral biportal endoscopic spinal surgery (UBE) is a rapidly growing surgical method and has attracted much interest recently. The most common complication of this technique is cerebrospinal fluid (CSF) leakage due to intraoperative dural tears. There have been no reports of bacterial meningitis due to dural tears in UBE surgery and its treatment and prevention. We reported a 47 year-old man with CSF due to an intraoperative dural tear. A drainage tube was routinely placed and removed on the fourth day after surgery, resulting in fever and headache on the fifith postoperative day. Blood and CSF cultures showed Klebsiella pneumoniae infection, and with lumbar drainage and appropriate antibiotics based on sensitivity tests, the patient's fever and headache were effectively relieved. This case report suggests the importance of prolonged drainage tube placement, adequate drainage, careful intraoperative separation to avoid dural tears, and effective sensitive antibiotic therapy.