Cerebrospinal Fluid Parameters Predicting Contralateral Isolated Lateral Ventricle in Adult Tuberculous Meningitis with Hydrocephalus Post-Ventriculoperitoneal Shunt.

OBJECTIVE: Hydrocephalus, a major complication in tuberculous meningitis (TBM) patients, often necessitates treatment via ventriculoperitoneal shunt (VPS). However, post-VPS, some patients develop a complication called contralateral isolated lateral ventricle (CILV), leading to persistent hydrocephalus symptoms. This study aims to evaluate cerebrospinal fluid (CSF) parameters in predicting CILV occurrence post-VPS in adult TBM patients. METHODS: A retrospective analysis was conducted, focusing on the relationship between preoperative CSF parameters and the development of CILV in 40 adult TBM patients who underwent VPS. The study compared CSF parameters from lumbar puncture after admission with those from ventricular CSF post-external ventricular drainage tube insertion. RESULTS: CILV was observed in 6 of the 40 patients following VPS. Statistical analysis showed no significant difference between the CSF parameters obtained via lumbar and ventricular punctures. Notably, the mean CSF glucose level in patients with CILV was significantly lower (1.92 mmol/L) compared to the non-CILV group (3.03 mmol/L). Conversely, the median adenosine deaminase (ADA) level in the CILV group was higher (5.69 U/L) compared to the non-CILV group (3.18 U/L). The optimal cutoff values for CSF glucose and ADA levels were 1.90 mmol/L and 4.80 U/L, respectively, with a sensitivity of 66.67% and 83.33% and a specificity of 88.24% and 79.41%. CONCLUSIONS: The study identified elevated ADA levels and decreased glucose levels in CSF as potential risk factors for CILV development in adult TBM patients post-VPS. These findings suggest the necessity for more tailored surgical approaches, in patients with altered CSF parameters to mitigate the risk of CILV.

The safety of withholding hydrocortisone during preoperative periods in pituitary adenomas patients with an intact HPA axis: A meta-analysis of randomized controlled trials.

OBJECTIVES: For patients with pituitary adenomas with an intact hypothalamus-pituitary-adrenal axis before surgery, whether routine steroid therapy is needed is still controversial. We conducted a meta-analysis to assess the safety of withholding hydrocortisone compared with hydrocortisone in pituitary adenoma patients during preoperative periods. MATERIAL AND METHODS: We searched PubMed, Embase, Web of Science, and Cochrane Library databases up to November 2022 using inclusion and exclusion criteria. We employed either a fixed-effect or random-effect model for the analysis and assessed heterogeneity using the I2 statistic. RESULTS: Three studies involving 512 patients out of 400 studies were conducted. The pooled data revealed a higher incidence of postoperative transient diabetes insipidus in the no-hydrocortisone group than in the hydrocortisone group (RR, 1.88; 95% CI, 1.13 to 3.12; p = 0.02). The cortisol level in the no-hydrocortisone group was lower than in the hydrocortisone group after tumor removal (mean difference, -36.82; 95% CI, -44.27 to -29.38; p < 0.00001) but higher on the second day after surgery (mean difference, 4.04; 95% CI, 2.38 to 5.71; p < 0.00001). No significant differences were observed in early adrenal insufficiency (RR, 1.04; 95% CI, 0.37 to 2.96; p = 0.93), adrenal insufficiency in the third month after surgery (RR, 1.56; 95% CI, 0.70 to 3.48; p = 0.28), cortisol level on the first day after surgery (mean difference, 0.24; 95% CI, -11.25 to 11.73; p = 0.97), postoperative permanent diabetes insipidus (RR, 1.61; 95% CI, 0.43 to 6.07; p = 0.48), postoperative delayed hyponatremia (RR, 1.06; 95% CI, 0.41 to 2.74; p = 0.91), or postoperative blood glucose level (mean difference, -0.41; 95% CI, -1.19 to 0.37; p = 0.31) between the no-hydrocortisone and hydrocortisone groups. CONCLUSION: Withholding preoperative steroid therapy is safe for pituitary adenomas patients with an intact hypothalamus-pituitary-adrenal axis.

[miR-200b suppresses glioma cell invasion by targeting PROM1].

OBJECTIVE: To explore whether miR-200b suppresses tumor cell invasion by targeting PROM1, thus to reveal the molecular mechanism that miR-200b functions as a tumor suppressor in glioma. METHODS: PROM1 3'UTR-luciferase vector was constructed and dual-luciferase reporter gene assay was employed to examine the effect of miR-200b on luciferase activity. Human glioblastoma U87 cells were transfected with miR-200b mimics, and next qRT-PCR and Western blotting were performed to detect the expressions of PROM1 mRNA and protein. The effect of PROM1 down-regulation on invasion was observed after PROM1 siRNA were transfected into U87 cells. RESULTS: The miR-200b bound to the 3'-untranslated region (UTR) of PROM1 and inhibited the luciferase activity. Its luciferase activity was down-regulated by 57.0% (P < 0.01). PROM1 protein and mRNA expressions were significantly down-regulated when miR-200b was overexpressed in the U87 cells (P < 0.05). siRNA-mediated down-regulation of PROM1 suppressed the potential of cell invasion. The invasion ability of SKOV3 cells after transfection with siRNA-PROM1 was significantly lower than that in the negative control cells (P < 0.05). CONCLUSION: miR-200b may suppress cell invasion by targeting PROM1 in glioma.

MicroRNA218 inhibits glioma migration and invasion via inhibiting glioma-associated oncogene homolog 1 expression at N terminus.

Glioma is characterized by high invasion, migration and proliferation abilities. However, the molecular mechanism that triggers the development and recurrence of this tumor is also elusive. This study aims to investigate the biological function and molecular mechanism of microRNA218 in glioma. Human glioma samples were obtained and employed to investigate the correlation between microRNA218 and glioma pathological grading. Glioma cell viability was detected by the cell-counting kit-8 (CCK-8) cell counting assay. Transwell assay and wound-healing assay were employed to examine the migration and invasion of the glioma cells. The mRNA transcription and protein expression of glioma-associated oncogene homolog 1 (GLI1) were analyzed by quantitative RT-PCR and Western blot analysis, respectively. Southwestern blot assay was utilized to explore the possible interaction site of GLI1 and microRNA218. The results indicated that microRNA218 is significantly down-regulated in glioma samples and negatively correlated with the pathological grading. The cell viability was significantly decreased, and migration and invasion were significantly inhibited in microRNA218 treated cells, compared with un-treated cells. GLI1 was discovered acting as a functional downstream target of microRNA218, by which microRNA218 inhibited glioma cell migration and invasion. Southwestern blot result showed that microRNA218 targeted directly the N terminus of GLI1 molecular, and repressed the GLI1 expression in U87MG cells. In conclusion, microRNA218 could reduce the invasion and migration, and inhibit proliferation of glioma cells by suppressing the expression of GLI1 protein at the interacting with the N terminus.

[Microsurgical treatment of intramedullary tumor in the superior cervical spinal cord].

OBJECTIVE: To evaluate the curative effect of microsurgery for intramedullary tumor in the superior cervical spinal cord. METHODS: The clinical manifestations, microsurgical methods and results were reviewed retrospectively in 12 patients with intramedullary tumors in the superior cervical spinal cord. RESULTS: No death occurred in these cases after the operations. The intramedullary tumors were totally resected in 10 patients including 8 with ependymomas and 2 with astrocytomas, and subtotally in 2 patients with astrocytomas. The spinal functions of patients, graded by McCormick scale system 3 months after the operations, were improved in 8 cases and remained unchanged in 4 cases. Nine patients were followed up for 1-3 years after the operations, and no tumor recurrence was found in 8 cases with total tumor resection. CONCLUSION: Radical microneurosurgery is currently the best choice for the treatment of intradullary tumor in the superior cervical spinal cord.