Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy.

Background: Diffuse lower-grade glioma (DLGG) in the central lobe is a challenge for safe resection procedures. To improve the extent of resection and reduce the risk of postoperative neurological deficits, we performed an awake craniotomy with cortical-subcortical direct electrical stimulation (DES) mapping for patients with DLGG located primarily within the central lobe. We investigated the outcomes of cortical-subcortical brain mapping using DES in an awake craniotomy for central lobe DLGG resection. Methods: We performed a retrospective analysis of clinical data of a cohort of consecutively treated patients from February 2017 to August 2021 with diffuse lower-grade gliomas located primarily within the central lobe. All patients underwent awake craniotomy with DES for cortical and subcortical mapping of eloquent brain areas, neuronavigation, and/or ultrasound to identify tumor location. Tumors were removed according to functional boundaries. Maximum safe tumor resection was the surgical objective for all patients. Results: Thirteen patients underwent 15 awake craniotomies with intraoperative mapping of eloquent cortices and subcortical fibers using DES. Maximum safe tumor resection was achieved according to functional boundaries in all patients. The pre-operative tumor volumes ranged from 4.3 cm3 to 137.3 cm3 (median 19.2 cm3). The mean extent of tumor resection was 94.6%, with eight cases (53.3%) achieving total resection, four (26.7%) subtotal and three (20.0%) partial. The mean tumor residue was 1.2 cm3. All patients experienced early postoperative neurological deficits or worsening conditions. Three patients (20.0%) experienced late postoperative neurological deficits at the 3-month follow-up, including one moderate and two mild neurological deficits. None of the patients experienced late onset severe neurological impairments post-operatively. Ten patients with 12 tumor resections (80.0%) had resumed activities of daily living at the 3-month follow-up. Among 14 patients with pre-operative epilepsy, 12 (85.7%) were seizure-free after treatment with antiepileptic drugs 7 days after surgery up to the last follow-up. Conclusions: DLGG located primarily in the central lobe deemed inoperable can be safely resected using awake craniotomy with intraoperative DES without severe permanent neurological sequelae. Patients experienced an improved quality of life in terms of seizure control.

mTORC1-PGC1 axis regulates mitochondrial remodeling during reprogramming.

Metabolic reprogramming, hallmarked by enhanced glycolysis and reduced mitochondrial activity, is a key event in the early phase of somatic cell reprogramming. Although extensive work has been conducted to identify the mechanisms of mitochondrial remodeling in reprogramming, many questions remain. In this regard, different laboratories have proposed a role in this process for either canonical (ATG5-dependent) autophagy-mediated mitochondrial degradation (mitophagy), noncanonical (ULK1-dependent, ATG5-independent) mitophagy, mitochondrial fission or reduced biogenesis due to mTORC1 suppression. Clarifying these discrepancies is important for providing a comprehensive picture of metabolic changes in reprogramming. Yet, the comparison among these studies is difficult because they use different reprogramming conditions and mitophagy detection/quantification methods. Here, we have systematically explored mitochondrial remodeling in reprogramming using different culture media and reprogramming factor cocktails, together with appropriate quantification methods and thorough statistical analysis. Our experiments show lack of evidence for mitophagy in mitochondrial remodeling in reprogramming, and further confirm that the suppression of the mTORC1-PGC1 pathway drives this process. Our work helps to clarify the complex interplay between metabolic changes and nutrient sensing pathways in reprogramming, which may also shed light on other contexts such as development, aging and cancer.

Posttraumatic stress disorder after a first-ever intracerebral hemorrhage in the Chinese population: A pilot study.

The objective of this study was to reveal the prevalence, associated risk factors, and long-term outcomes of Posttraumatic stress disorder (PTSD) in patients after intracerebral hemorrhage (ICH). Consecutive patients admitted to our institute from January 2016 to September 2016 for a first-ever ICH were asked to participate in our study. PTSD was determined with Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5), and questionnaires on mental and physical status were used. Patients were followed at 3 and 12 months after ICH. Sixty-four patients were eventually included for analysis. Compared with patients without PTSD, patients with PTSD were more likely to be female (67% vs. 29%, p = 0.01), and had higher rates of receiving minimally invasive surgery (MIS; 47% vs. 18%, p = 0.04). Patients with PTSD achieved higher IES-R scores, had more intense anxiety and depression, were more habitually use maladaptive coping strategies, and had poorer quality of life and worse stroke-related disability than those without PTSD. At 12-months follow-up, 6 of the 14 (43%) patients initially diagnosed with PTSD had self-recovered. ICH leads to increased PTSD risk in the Chinese population, especially those who are female, more severely disabled, or received MIS.

Posttraumatic stress symptoms (PTSS) in patients with Cushing's disease before and after surgery: A prospective study.

The aim of this study was to investigate the occurrence, correlated factors and prognosis of posttraumatic stress symptoms (PTSS) in patients with Cushing's disease (CD). A total of 49 patients who were newly diagnosed with CD and underwent transsphenoidal surgery in our hospital from April 2015 to August 2017 were asked to participate in this study. Another group of 49 age and sex matched healthy control participants were also included for comparison. PTSS (measured with Impact of Event Scale-Revised, IES-R), depression/anxiety (measured with Hospital Anxiety and Depression scale, HADS) and quality of life (QoL; measured with 36-item short-form, SF-36) were evaluated at pre-surgery, 6 months post-surgery and 12 months post-surgery. The results showed that at preoperative stage, 15 (30.6%) CD patients developed PTSS, and they had higher 24 h UFC, and presented worse levels of depression, anxiety and QoL compared with patients without PTSS. Although most of them recovered postoperatively, there were still 5/15 (33.3%) patients persisted with PTSS for over a year. Additionally, one patient with recurred CD developed PTSS between 6 and 12 months postoperatively. Among the whole group of CD patients, the PTSS severity showed consistent improvement after surgery, which was in accordance with the progressing trends of depression, anxiety and psychological aspects of SF-36. However, compared with healthy individuals, CD patients in remission still performed worse in physical/mental health. In conclusion, patients with CD can develop PTSS, and they may persist for over a year even after successful surgery. Combined psychological intervention is advised for these patients.

Post-traumatic stress disorders in patients with low-grade glioma and its association with survival.

PURPOSE: The primary objective of this study was to investigate the incidence of PTSD at 3 months postoperatively in patients who were newly diagnosed with LGGs, and its association with 5-year survival. Moreover, QoL and other psychiatric disorders like depression and anxiety were also evaluated. METHODS: From February 2011 to April 2013, patients who underwent low-grade glioma surgery at our hospital and come back for reexamination at 3-month follow-up were considered for this study. Interviews, HADS-A, HADS-D, and SF-36 scales were used for evaluating PTSD, anxiety, depression, and quality of life. Participants were asked to complete these assessments at 3 months after surgery. Followed-ups on survival status were made for 5 years. RESULTS: A total of 219 subjects comprising 83 women and 136 men with a mean age of 41.5 years were included in this study. At 3 months after surgery, 35 (16%) patients were diagnosed with PTSD. Younger age (OR = 2.23, [95% CI 1.02-4.84], P = 0.04) and frontal lobe involvement of tumor (OR = 2.57, [95% CI 1.06-6.23], P = 0.04) predicted PTSD. Patients with PTSD had higher anxiety and depression level, and had worse QoL in all eight dimensions of SF-36. Kaplan-Meier analyses demonstrated that diagnosis of PTSD was associated with shorter overall survival in LGG patients (Log-rank = 7.45, P = 0.01). After adjusting for other variables, PTSD remained associated with elevated 5-year overall mortality risk of LGG patients (HR = 2.98 [95% CI 1.10-8.05], P = 0.03). CONCLUSIONS: The results showed that newly diagnosed LGG patients suffering from PTSD at 3 months after surgery had lower rates of 5-year survival. In clinical practice, psychological evaluation is suggested for LGG patients and proper psychotherapy should be considered for those with PTSD.

New Insights in Minimally Invasive Surgery for Intracerebral Hemorrhage.

The poor clinical outcome of acute intracerebral hemorrhage (ICH) relates closely to the bleeding amount per unit of time and the hematoma position in the brain. Removal of an intracerebral hematoma in time can effectively improve clinical prognosis. Minimally invasive surgery (MIS) for the treatment of ICH is the main clinical method that is currently used, despite the lack of large-scale, clinical, multi-center, randomized controlled trials. This article comprehensively reviews the history and development of MIS for ICH and analyzes various roles of MIS in ICH treatment. General CT image-guided surgery with the local use of thrombolysis techniques is a major MIS method used in current ICH treatment.