The Application of Intraoperative Ultrasound with Burr Hole Probe in Minimally Invasive Diagnosis and Treatment in Neurosurgery.

OBJECTIVE: To summarize the preliminary application experience of intraoperative ultrasound with burr hole probe in minimally invasive neurosurgery and to explore its application value. METHODS: Thirty-one patients who underwent intraoperative ultrasound guided puncture with burr hole probe in our center from August 2018 to May 2024 were collected, including 16 cases of ventriculoperitoneal shunt operation, 6 cases of assisted stereotactic needle biopsy, 3 cases of intracranial pressure probe implantation in lateral ventricle, 3 cases of brain abscess puncture for external drainage, and 3 cases of intracranial cyst puncture and peritoneal drainage. During the procedures, the burr hole probe was used to locate the intracranial targets and guide the puncture. The postoperative computed tomography (CT) scans or combined postoperative pathological results could verify the accuracy of puncture. In addition, the intervention effect and recovery status of patients were also recorded. RESULTS: The intraoperative ultrasound with burr hole probe could clearly display all the purposed targets and accurately guide the puncture procedures in all cases. All patients achieved satisfactory diagnostic and therapeutic results without new neurological dysfunction and serious complications. CONCLUSIONS: The intraoperative ultrasound with burr hole probe is an effective device for demonstrating intracranial structures. It not only enables minimally invasive and precise diagnosis or treatment of many neurosurgical diseases, but also is simple and safe to operate, which has important promotional value in the neurosurgery.

Value of Echocardiography and Cardiac Magnetic resonance in assessing left ventricular function in breast and gastric cancer patients after Anthracycline Chemotherapy.

BACKGROUND: Echocardiography (ECHO) and cardiac magnetic resonance imaging (MRI) are used to observe changes in the left ventricular structure in patients with breast and gastric cancer after 6 cycles of chemotherapy. Based on the observed values, we aimed to evaluate the cardiotoxicity of anthracyclines in cancer patients and to analyze the consistency of the two examination methods in assessing left ventricular function after chemotherapy. METHODS: From January 2020 to January 2022, the data of 80 patients with malignant tumors who received anthracycline chemotherapy (breast cancer, n = 40; gastric cancer, n = 40) and 40 healthy volunteers (Control group) were retrospectively collected. Serum high-sensitivity cardiac troponin T (hs-cTnT) levels were detected by an automatic immunoassay analyzer. Left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were measured by cardiac MRI and 2-dimensional ECHO using the biplane Simpson's method. RESULTS: Compared with baseline values, serum high-sensitivity cardiac troponin T (hs-cTnT) levels were significantly increased in patients with breast cancer and gastric cancer after 6 cycles of chemotherapy (P < 0.05). In addition, LVEDV, LVESV and LVEF measured with MRI were higher than those detected by ECHO in cancer patients after 6 cycles of chemotherapy (P < 0.05). And the Bland-Altman plot analysis showed that LVEDV, LVESV and LVEF measured by the two examination methods were in good agreement. CONCLUSION: Breast and gastric cancer patients exhibited elevated levels of hs-cTnT after 6 cycles of chemotherapy, indicating potential cardiotoxicity. Additionally, cardiac MRI and 2-dimensional ECHO showed good agreement in assessing left ventricular function, with ECHO tending to underestimate volume measurements compared to MRI.

Melatonin inhibits macrophage infiltration and promotes plaque stabilization by upregulating anti-inflammatory HGF/c-Met system in the atherosclerotic rabbit: USPIO-enhanced MRI assessment.

Macrophage plays critical roles in the pathogenesis of atherosclerosis (AS), and is an attractive target for detecting and treating vulnerable plaque. Our previous study showed that melatonin (MLT) ameliorated AS by suppressing the pro-inflammatory Toll-like receptor 4/nuclear factor kappa B system in high-fat-fed rabbit. However, it is unknown whether the anti-atherosclerotic properties of MLT are associated with the upregulation of anti-inflammatory hepatocyte growth factor (HGF)/mesenchymal-epithelial transition factor (c-Met) system. In present study, we examined whether MLT could inhibit macrophage infiltration and promote plaque stabilization by upregulating HGF/c-Met system with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) assessment in AS rabbit. Rabbits in this study were randomly divided into three groups and treated with a standard diet, high-fat diet, and high-fat diet plus 10 mg/kg/day MLT for 12 weeks, respectively. MLT treatment significantly reversed spotty signal void in 3D-TOF MRI, standard signal intensity reduction in T2WI MRI and aortic luminal area reduction in 2D-TOF MRI of the atherosclerotic abdominal aorta 72 h after USPIO injection. It also decreased serum interleukin-6 (IL-6), intima/media thickness ratio of the abdominal aorta, CD68 and iron-positive areas in the aortic intima, and increased serum IL-10, HGF and c-Met protein expression and the accumulation of vascular smooth muscle cell and collagen fiber in the aortic intima of AS rabbit. Our data demonstrated that MLT significantly decreased plaque macrophage infiltration and promoted plaque stability in AS rabbit assessed by USPIO-enhanced MRI. Remarkably, it was very first revealed that upregulation of anti-inflammatory HGF/c-Met system might contribute to the atheroprotective mechanisms of MLT.

Diagnostic Performance of MR Imaging-based Features and Texture Analysis in the Differential Diagnosis of Ovarian Thecomas/Fibrothecomas and Uterine Fibroids in the Adnexal Area.

RATIONALE AND OBJECTIVES: To investigate the value of MRI-based features and texture analysis (TA) in the differential diagnosis between ovarian thecomas/fibrothecomas (OTCA/f-TCAs) and uterine fibroids in the adnexal area (UF-iaas). MATERIALS AND METHODS: This retrospective study included 16 OTCA/f-TCA and 37 UF-iaa patients who underwent conventional MRI and DWI between August 2014 and September 2018. Three-dimensional TA was performed with T2-weighted MRI. The clinical, MRI-based and texture features were compared between OTCA/f-TCAs and UF-iaas. Multivariate logistic regression analysis was used for filtering the independent discriminative features and constructing the discriminating model. ROCs were generated to analyse MRI-based features, texture features and their combination for discriminating between the two diseases. RESULTS: Six imaging-based features (ipsilateral ovary detection, arterial period enhancement, lesion components, peripheral cysts, "whorl signs", mean ADCs) and six texture features (Histogram-energy, Histogram-entropy, Histogram-kurtosis, GLCM-energy, GLCM-entropy, and Haralick correlation) were significantly different between OTCA/f-TCAs and UF-iaas (p < 0.05). Multivariate analysis of the MRI-based features revealed that arterial period enhancement (OR = 0.104), peripheral cysts (OR = 16.513), and whorl signs (OR = 0.029) were independent features for discriminating between OTCA/f-TCAs and UF-iaas (p < 0.05). Multivariate analysis of the texture features showed that Histogram-energy and GLCM-energy were independent features for discriminating between OTCA/f-TCAs and UF-iaas (p < 0.05). The area under the curve of imaging-based diagnosis was 0.85, and the combination of imaging-based diagnosis and TA improved the area under the curve to 0.87, with higher accuracy, specificity and sensitivity of 86%, 92%, and 84%, respectively (p < 0.05). CONCLUSIONS: MRI-based features can be useful in differentiating OTCA/f-TCAs from UF-iaas. Furthermore, combining imaging-based diagnosis and TA can improve diagnostic performance.

Xanthatin induces glioma cell apoptosis and inhibits tumor growth via activating endoplasmic reticulum stress-dependent CHOP pathway.

Xanthatin is a natural sesquiterpene lactone purified from Xanthium strumarium L., which has shown prominent antitumor activity against a variety of cancer cells. In the current study, we investigated the effect of xanthatin on the growth of glioma cells in vitro and in vivo, and elucidated the underlying mechanisms. In both rat glioma C6 and human glioma U251 cell lines, xanthatin (1-15 µM) dose-dependently inhibited cell viability without apparent effect on the cell cycle. Furthermore, xanthatin treatment dose-dependently induced glioma cell apoptosis. In nude mice bearing C6 glioma tumor xenografts, administration of xanthatin (10, 20, 40 mg·kg-1·d-1, ip, for 2 weeks) dose-dependently inhibited the tumor growth, but did not affect the body weight. More importantly, xanthatin treatment markedly increased the expression levels of the endoplasmic reticulum (ER) stress-related markers in both the glioma cell lines as well as in C6 xenografts, including glucose-regulated protein 78, C/EBP-homologous protein (CHOP), activating factor 4, activating transcription factor 6, spliced X-box binding protein-1, phosphorylated protein kinase R-like endoplasmic reticulum kinase, and phosphorylated eukaryotic initiation factor 2a. Pretreatment of C6 glioma cells with the ER stress inhibitor 4-phenylbutyric acid (4-PBA, 7 mM) or knockdown of CHOP using small interfering RNA significantly attenuated xanthatin-induced cell apoptosis and increase of proapoptotic caspase-3. These results demonstrate that xanthatin induces glioma cell apoptosis and inhibits tumor growth via activating the ER stress-related unfolded protein response pathway involving CHOP induction. Xanthatin may serve as a promising agent in the treatment of human glioma.

The antitumour growth and antiangiogenesis effects of xanthatin in murine glioma dynamically evaluated by dynamic contrast-enhanced magnetic resonance imaging.

To investigate the suppressive effects of xanthatin on glioma growth in a nude mouse xenograft model and rat orthotopic implantation model using magnetic resonance imaging (MRI) to dynamically monitor the antitumour growth and antiangiogenesis effects of xanthatin. The nude mouse xenograft tumour model and rat orthotopic implantation model were established to observe the antitumour effects of xanthatin in vivo. In the rat orthotopic implanted tumour model, MRI scanning was used to dynamically monitor the antitumour growth effect and evaluate the antiangiogenesis effect of xanthatin. We found that xanthatin at a dose of 0.4 mg/10 g dramatically decreased the growth of xenograft tumours in nude mice. The antiangiogenesis effect of xanthatin C6 glioma was evaluated by dynamic contrast-enhanced (DCE) MRI via comparison of the volume transfer constant (Ktrans ) value, a parameter that reflects vessel permeability. We found that xanthatin at the doses of 8 and 16 mg/kg significantly decreased the Ktrans value, which suggests that xanthatin has antiangiogenesis effects. These data demonstrate the suppressive effects of xanthatin on C6 glioma occur via antiangiogenesis. Meanwhile, this study also provides evidence for the application of quantitative parameters of DCE-MRI for dynamically evaluating the growth and angiogenesis of intracranial tumours and for experimental and clinical research.

Mesencephalic Astrocyte-Derived Neurotrophic Factor Prevents Traumatic Brain Injury in Rats by Inhibiting Inflammatory Activation and Protecting the Blood-Brain Barrier.

BACKGROUND: Our previous studies have shown that mesencephalic astrocyte-derived neurotrophic factor (MANF) provides a neuroprotective effect against ischemia/reperfusion injury and is also involved in inflammatory disease models. This study investigates the potential role and mechanism of MANF in acute brain damage after traumatic brain injury (TBI). METHODS: The model of TBI was induced by Feeney free falling methods with male Sprague-Dawley rats. The expression of MANF, 24 hours after TBI, was detected by the immunohistochemistry, immunofluorescence, Western blot, and reverse transcription polymerase chain reaction techniques. After treatment with recombinant human MANF after TBI, assessment was conducted 24 hours later for brain water content, cerebral edema volume in magnetic resonance imaging, neurobehavioral testing, and Evans blue extravasation. Moreover, by the techniques of Western blot and reverse transcription polymerase chain reaction, the expression of inflammatory cytokines (interleukin 1ß and tumor necrosis factor α) and P65 was also analyzed to explore the underlying protective mechanism of MANF. RESULTS: At 24 hours after TBI, we found that endogenous MANF was widely expressed in the rat's brain tissues and different types of cells. Treatment with a high dose of recombinant human MANF (20 µg/20 µL) significantly increased the modified Garcia score, and reduced brain water content as well as cerebral edema volume on magnetic resonance imaging. Furthermore, MANF alleviated not only the permeability of the blood-brain barrier (BBB) but also the expressions of interleukin 1ß and tumor necrosis factor α messenger RNA and protein. Besides, the activation of P65 was also inhibited. CONCLUSIONS: These results suggest that MANF provides a neuroprotective effect against acute brain injury after TBI, via attenuating blood-brain barrier disruption and intracranial neuroinflammation; the inhibition of the NF-κB signaling pathway might be a potential mechanism.

Facile fabrication of water-dispersible nanocomposites based on hexa-peri-hexabenzocoronene and Fe3O4 for dual mode imaging (fluorescent/MR) and drug delivery.

The facile fabrication of multifunctional nanocomposites (Fe3O4/HBC@F127) consisting of superparamagnetic Fe3O4 nanoparticles and fluorescent organic hexa-peri-hexabenzocoronene (HBC) molecules incorporated in block copolymer diacylphospholipid-polyethyleneglycol F127 have been demonstrated for dual mode imaging (fluorescent/MR) and drug delivery. The obtained nanocomposites were water-dispersible, stable and biocompatible, as confirmed by dynamic light scattering (DLS) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Relativity measurements showed a T 2 relaxivity (r 2) of 214.61 mM-1 s-1, which may be used as T 2-weighted MR imaging agents. In vitro imaging studies indicated that the nanocomposites had good MR and fluorescence imaging effects with low cytotoxicity. Besides, the developed nanocomposites could also be applied as drug delivery vehicles. Doxorubicin (DOX) loaded Fe3O4/HBC@F127 nanocomposites significantly inhibited the growth of human hepatoma cells (HepG2). These findings suggested that the facile synthesized multifunctional nanocomposites may be used as a platform for dual mode imaging (both MR and fluorescence) and drug delivery.

Genetic Effects on Sensorineural Hearing Loss and Evidence-based Treatment for Sensorineural Hearing Loss.

In this article, the mechanism of inheritance behind inherited hearing loss and genetic susceptibility in noise-induced hearing loss are reviewed. Conventional treatments for sensorineural hearing loss (SNHL), i.e. hearing aid and cochlear implant, are effective for some cases, but not without limitations. For example, they provide little benefit for patients of profound SNHL or neural hearing loss, especially when the hearing loss is in poor dynamic range and with low frequency resolution. We emphasize the most recent evidence-based treatment in this field, which includes gene therapy and allotransplantation of stem cells. Their promising results have shown that they might be options of treatment for profound SNHL and neural hearing loss. Although some treatments are still at the experimental stage, it is helpful to be aware of the novel therapies and endeavour to explore the feasibility of their clinical application.

Correlation between CT attenuation value and iodine concentration in vitro: discrepancy between gemstone spectral imaging on single-source dual-energy CT and traditional polychromatic X-ray imaging.

INTRODUCTION: To assess the relation between CT attenuation value and iodine concentration in vitro, using gemstone spectral imaging (GSI) with single-source dual-energy CT and traditional polychromatic X-ray imaging (TPXI), respectively. METHODS: A polypropylene phantom with eight test tubes in which iodine concentrations of solution were 0.4, 0.7, 2, 5, 10, 20, 30 and 50 mg/mL underwent GSI and traditional polychromatic X-ray scans (80, 100, 120 and 140 kV(p)), using single-source dual-energy spectral CT (Discovery CT750HD; GE Healthcare Technologies, Milwaukee, WI, USA) at the same tube speed of 0.8 s/rotation. All spectral imaging data were analysed with GSI viewer to obtain monochromatic images (50-140 keV, interval of 10 keV). Computed tomography attenuation values of iodine solution were measured with the same size of regions of interest and at the exact same level for both monochromatic and polychromatic images. The relation between CT attenuation value and iodine concentration was examined. RESULTS: A linear correlation was found between CT attenuation value and iodine concentration for both monochromatic and polychromatic images. Moreover, the fitting coefficients for CT attenuation values and iodine concentrations were closer to one with GSI (r(2) = 0.99824-0.99996) than that with TPXI (r(2) = 0.99640-0.99736). CONCLUSIONS: Owing to the better correlation coefficients between CT attenuation value and iodine concentration, GSI may be a preferred method for quantitative measurement compared with TPXI.

[Three-dimensional fluid attenuated inversion recovery imaging at 3T MRI in sudden deafness: its findings and relationship with the prognosis].

OBJECTIVE: To investigate inner ear of patients with sudden deafness with three-dimensional fluid attenuated inversion recovery (3D FLAIR) MRI, and the relationship between the results of 3D FLAIR and the prognosis. METHODS: Twenty-three patients with sudden deafness received 3D FLAIR at 3T MRI, and the signals of inner ear were recorded. Hearing levels were evaluated at initial visit and after treatment. The relationship between 3D FLAIR findings and hearing prognosis was evaluated. RESULTS: Eight patients with sudden deafness showed high signals in the affected cochlea on 3D FLAIR, the others of affected cochlea and all of contralateral cochlea showed no signal on 3D FLAIR. The age, sex, affected side, period to initial visit and initial audiogram had no difference between cochlea no signal group and high signal group. The average auditory threshold (x±s) in cochlea high signal group (90±21) dB HL was significant higher than that in cochlea no signal group (60±28) dB HL, P<0.05 at patients' discharge. After treatment, in cochlea no signal group, two cases' hearing was complete recovered, remarkable improvement in five cases, slight improvement in two cases and no change in six cases. In cochlea high signal group, hearing was slight improvement in one case and no change in seven cases. The prognosis was significant difference between two groups. Five of seven patients with vertigo and sudden deafness showed high signal in affected side vestibule on 3D FLAIR, and the hearing of whom had no change after treatment. CONCLUSION: 3D FLAIR can show high signal in affected inner ear in sudden deafness patients, and which is related to a poor hearing prognosis.

CT volume measurement for prognostic evaluation of unresectable hepatocellular carcinoma after TACE.

AIM: To analyze the value of computed tomography (CT) volume measurements for evaluation of the survival rate of unresectable hepatocellular carcinoma (HCC) patients after transcatheter arterial chemoembolization (TACE). METHODS: One hundred and sixty-six unresectable HCC patients after TACE were involved in this retrospective study. Hepatic CT scan was performed for all patients before and 4 wk to 2 mo after TACE to define the morphologic features of HCC including its largest diameter, volume, product of the greatest axial dimension, tumor to liver volume ratio (TTLVR), and tumor shrinkage ratio. Clinical variables used in the study included gender, age, pattern of tumor growth, number of lesions, Child-Pugh classification of liver function, repeated TACE times, pre- or post-treatment alpha-fetoprotein (AFP) level, portal vein cancerous thrombus, tumor metastasis, degree of lipiodol retention within the tumor, and percutaneous ethanol injection. The correlation between survival time and clinical variables of patients or lesions was analyzed by combining morphologic features with the corresponding clinical and general data as input. A Cox proportional hazard model was used to analyze prognostic factors. The Kaplan-Meier method was used to calculate the cumulative survival time. Influence of the parameters on prognosis was analyzed by the log-rank test. RESULTS: The overall 6, 12, 24, 36 and 60 mo cumulative survival rates were 78.92%, 49.85%, 23.82%, 15.60% and 8.92%, respectively. The median survival time was 12 mo. Univariate and multivariate analysis showed that only 4 parameters were the independent prognostic factors including TTLVR (chi(2) = 14.328, P < 0.001), portal vein cancerous thrombus (chi(2) = 5.643, P = 0.018), repeated TACE times (chi(2) = 8.746, P = 0.003), and post-treatment serum AFP level (chi(2) = 5.416, P = 0.020). When the TTLVR value was less than 70%, the survival time was inversely correlated with the TTLVR value. CONCLUSION: CT volume measurement technique can predict the prognosis of unresectable HCC patients after TACE.

Induction profile of MANF/ARMET by cerebral ischemia and its implication for neuron protection.

Cerebral ischemia-induced accumulation of unfolded proteins in vulnerable neurons triggers endoplasmic reticulum (ER) stress. Arginine-rich, mutated in early stage tumors (ARMET) is an ER stress-inducible protein and upregulated in the early stage of cerebral ischemia. The purposes of this study were to investigate the characteristics and implications of ARMET expression induced by focal cerebral ischemia. Focal cerebral ischemia in rats was induced by right middle cerebral artery occlusion with a suture; ischemic lesions were assessed by magnetic resonance imaging and histology; neuronal apoptosis was determined by TUNEL staining; the expressions of proteins were measured by immunohistochemistry, immunofluorescent labeling, and Western blotting. ARMET was found to be extensively upregulated in ischemic regions in a time-dependent manner. The expression of ARMET was neuronal in all examined structures in response to the ischemic insult. We also found that ARMET expression is earlier and more sensitive to ischemic stimulation than C/EBP homologous protein (CHOP). ER stress agent tunicamycin induced ARMET and CHOP expressions in the primary cultured neurons. Treatment with recombinant human ARMET promoted neuron proliferation and prevented from neuron apoptosis induced by tunicamycin. These results suggest that cerebral ischemia-induced ARMET expression may be protective to the neurons.