Early antiseizure medication withdrawal and risk of seizure recurrence in children after epilepsy surgery: A retrospective study.

OBJECTIVE: The timing of antiseizure medication (ASM) withdrawal in children after epilepsy surgery remains controversial and lacks recognized standards. Given the various negative effects of ASM on development in children, this study aimed to evaluate the safety and feasibility of early ASM withdrawal after epileptic resection surgery. METHODS: We retrospectively assessed the seizure outcomes and ASM profiles of children who had undergone epileptic resection surgery between August 2015 and August 2020 and attempted ASM reduction in the early postoperative phase. Tapering the dose of ASM was attempted when children were seizure-free with no interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) for at least 6 months postoperatively. RESULTS: This study included 145 children with a median follow-up duration of 40 months. Early ASM tapering was attempted postoperatively in 99 (68.3 %) children. Postoperative ASM discontinuation was attempted in 87 (60.0 %) children. Nine (9.1 %) children experienced seizure recurrence during the ASM reduction stage, and 10 (11.5 %) experienced recurrence after ASM discontinuation. Incomplete resection (P = 0.003) and postoperative seizures before ASM tapering (P = 0.003) were independent predictors of seizure recurrence during and after early ASM withdrawal. SIGNIFICANCE: ASM withdrawal is viable and safe to be initiated in children who are seizure-free postoperatively and have no IEDs on the scalp EEG for at least 6 months. Children with incomplete resection and postoperative seizures before ASM withdrawal are at a higher risk of seizure recurrence and may need to continue ASM for a longer period.

Evaluating the performance of the language model ChatGPT in responding to common questions of people with epilepsy.

OBJECTIVE: People with epilepsy desire to acquire accurate information about epilepsy and actively engage in its management throughout the long journey of living with seizures. ChatGPT is a large language model and we aimed to assess the accuracy and consistency of ChatGPT in responding to the common concerns of people with epilepsy and to evaluate its ability to provide emotional support. METHODS: Questions were collected from the International League against Epilepsy and the China Association against Epilepsy. The responses were independently assessed by two board-certified epileptologists from the China Association against Epilepsy, and a third reviewer resolved disagreements. The reviewers assessed its ability to provide emotional support subjectively. RESULTS: A total of 378 questions related to epilepsy and 5 questions related to emotional support were included. ChatGPT provided "correct and comprehensive" answers to 68.4% of the questions. The model provided reproducible answers for 82.3% questions. The model performed poorly in answering prognostic questions, with only 46.8% of the answers rated as comprehensive. When faced with questions requiring emotional support, the model can generate natural and understandable responses. SIGNIFICANCE: ChatGPT provides accurate and reliable answers to patients with epilepsy and is a valuable source of information. It also provides partial emotional support, potentially assisting those experiencing emotional distress. However, ChatGPT may provide incorrect responses, leading users to inadvertently accept incorrect and potentially dangerous advice. Therefore, the direct use of ChatGPT for medical guidance is not recommended and its primary use at present is in patients education.

Direct Fabrication of PET-Based Thermotolerant Separators for Lithium-Ion Batteries with Ion Irradiation Technology.

Lithium-ion batteries (LIBs) play a pivotal role as essential components in various applications, including mobile devices, energy storage power supplies, and electric vehicles. The widespread utilization of LIBs underscores their significance in the field of energy storage. High-performance LIBs should exhibit two key characteristics that have been persistently sought: high energy density and safety. The separator, a critical part of LIBs, is of paramount importance in ensuring battery safety, thus requiring its high thermal stability and uniform nanochannels. Here, the novel ion-track etched polyethylene terephthalate (ITE PET) separator is controllably fabricated with ion irradiation technology. Unlike conventional polypropylene (PP) separators, the ITE PET separator demonstrated vertically aligned nanochannels with uniform channel size and distribution. The remarkable characteristics of the ITE PET separator include not only high electrolyte wettability but also exceptional thermal stability, capable of withstanding temperatures as high as 180 °C. Furthermore, the ITE PET separator exhibits a higher lithium-ion transfer number (0.59), which is advantageous in enhancing battery performance. The structural and inherent advantages of ITE PET separators contribute to enhance the C-rate capacity, electrochemical, and long-term cycling (300 cycles) stability observed in the corresponding batteries. The newly developed method for fabricating ITE PET separators, which possess high thermal stability and a uniform channel structure, fulfills the demand for high-temperature-resistant separators without requiring any modification procedures. Moreover, this method can be easily scaled up using simple processes, making it a competitive strategy for producing thermotolerant separators.

The complete mitochondrial genome of Priotyrannus closteroides Thomson, 1877 (Coleoptera: Cerambycidae).

Priotyrannus closteroides Thomson, 1877 (Coleoptera: Cerambycidae) is the trunk borer of orange trees. In this study, we sequenced and annotated the whole mitochondrial genome of P. closteroides. The results showed that the length of the complete mitochondrial genome is 15,854 bp with an overall GC content of 32.11%. The genome encodes 13 protein-coding genes (PCGs), 22 transfer RNA genes (tRNAs), and two ribosomal RNA genes (rRNAs). The relevant phylogenetic tree distinctly showed that P. closteroides is clustered with Dorysthenes paradoxus and Dorysthenes granulosus. This study provides a piece of valuable genomic information for the population genetics, evolution, and classification of P. closteroides.

MicroRNA-351 Promotes the Proliferation and Invasion of Glioma Cells through Downregulation of NAIF1.

Despite the well-characterized expression profile of miR-351 in the neural system, its molecular mechanisms in glioma still remain elusive. Here we intended to assess the regulatory function of miR-351 on nuclear apoptosis-inducing factor 1 (NAIF1) and, thereby, modulation of cancerous behaviors of human glioma cell lines. Two human glioma cell lines (U87 and U251) and normal human astroglia (NHA) cell line were cultured. The cell lines were prepared and transfected with mimic, inhibitor, and negative controls (NCs) of miR-351, then MTT and wound healing assays were performed. We extracted the total protein for western blotting assay and isolated the total RNA for real-time PCR. The miR-351 expression was significantly decreased in U87 and U251 cell lines compared with the NHA cell line (P < 0.05). NAIF1 expression was significantly higher in glioma cell lines compared with the NHA cell line (P < 0.05). Moreover, the NAIF1 expression showed a negative correlation with miR-351 (P = 0.005, r = -0.522). Apoptosis was significantly decreased in both cell lines transfected with miR-351 mimics compared with the NC group at 72 and 96 h after transfection (P < 0.05) and significantly increased in the transfected group with miR-351 inhibitors compared with the NC group at 72 and 96 h after transfection (P < 0.05). According to our results, after 24 and 48 h, migration was increased in the mimic group compared with the miR-351 NC group and decreased in the inhibitory group compared with the miR-351 NC group in the U251 cell line. Our findings provide theoretical evidence that miR-351, which targets NAIF1, could be considered an important marker in the pathogenesis of glioma. Furthermore, miR-351 has valuable potential to serve as a new prognostic and diagnostic biomarker and could be considered a potential target for the treatment of this cancer in the near future.

Correction to: MicroRNA-351 Promotes the Proliferation and Invasion of Glioma Cells through Downregulation of NAIF1.

The original version of this article unfortunately contained mistakes in the Affiliation section.

Arachnoid Cyst-Associated Chronic Subdural Hematoma: Report of 14 Cases and a Systematic Literature Review.

BACKGROUND: Arachnoid cyst (AC)-associated chronic subdural hematoma (CSDH) differs significantly from its counterparts without AC in epidemiologic, demographic, and clinical characteristics, as well as in management and prognosis. This study was conducted to further examine the epidemiologic, demographic, and clinical characteristics; diagnosis; treatment; and prognosis of AC-associated CSDH. METHODS: This was a retrospective study of the medical records at the neurosurgical departments of 2 institutions along with a systematic PubMed search for relevant studies published in English or Chinese. RESULTS: A total of 182 patients (148 males; 81.3%) were evaluated, including 14 cases in our present series. The patients ranged in age from 1 to 80 years (mean age, 24.41 ± 13.69 years). Among the 175 patients with adequate prehospital history information, 119 (68%) had a history of recent head trauma or sport-related injury. AC locations included the middle fossa and sylvian fissure in 162 cases (89.0%), cerebral convexity in 17 cases (9.3%), posterior fossa in 2 cases (1.1%), and interhemispheric fissure in 1 case (0.5%). Among the 161 patients with specific data on outcomes, 159 (98.8%) had favorable recovery, 1 patient had an evident neurologic deficit, and 1 patient died from cardiac arrest. CONCLUSIONS: CSDH is a rare complication in patients with intracranial AC. Male children, juveniles, and young adults with recent head trauma or sport-related injury are most commonly inflicted. Burr hole drainage is the first-choice surgical procedure in symptomatic patients and is still effective in some recurrent cases. Fenestration or resection of the AC membrane is not a requisite in patients with previous asymptomatic AC.

Post-treatment maturation of medulloblastoma in children: two cases and a literature review.

We herein report two cases of post-treatment maturation of medulloblastoma (MB). We also conducted a literature review to summarize the clinical and pathologic features of MB maturation. From January 1992 to February 2017, 52 patients with MB underwent surgical resection followed by radiotherapy and chemotherapy. Tumor cell maturation was identified in two patients who underwent a second surgery. We conducted a systematic search of PubMed and identified six such cases. In both of our patients, the pathologic type was MB with extensive nodularity (MBEN). Both patients underwent radiotherapy and chemotherapy. The tumor differentiated to gangliocytoma in both patients. In the overall analysis that also included the six cases identified in the literature, the pathologic types were classic MB (n=1), desmoplastic/nodular MB (n=2), MBEN (n=3), and unclassified MB (n=2). MB differentiated into the following types: gangliocytoma (n=2), ganglioglioma (n=1), melanocyte (n=1), neuronal differentiation (n=2), and classic MB (n=1). Desmoplastic/nodular MB and MBEN can differentiate into less malignant cells types after radiotherapy and chemotherapy. Maturation of MB may be affected radiotherapy and chemotherapy.

Dural-Based Cavernous Malformation at the Cerebral Convexity: Report of Two Pediatric Patients.

BACKGROUND: Intracranial cavernous malformations (CMs) are usually located at the cerebral parenchyma; dural-based CMs outside the middle fossa are rarely reported. To our knowledge, dural-based CMs located at the cerebral convexity are even rarer in that only 2 pediatric cases have ever been reported. In this report, we present 2 extremely rare cases of dural-based CMs at the cerebral convexity in pediatric patients. The clinical course, radiologic and pathologic features, treatment, and follow-up are described. CASE DESCRIPTION: The first case is a 6-year-old boy who presented with headache and vomiting and was found to have an acute subdural hematoma and space-occupying lesion. Intraoperative findings and histologic examination were consistent with a CM. He experienced an uneventful postoperative recovery. The second case is a 43-day-old female neonate who presented with a progressively enlarging neoplasm at the right occipital region since birth. Computed tomography of the head performed at admission showed a slight hyperdense occupying lesion communicating between the intra- and extracranial cavity through a skull defect. The lesion was resected en bloc and histologic examination was in accord with a CM. CONCLUSIONS: The clinical manifestations and radiologic characteristics of dural-based CMs are nonspecific. Unlike that of their cerebral parenchymal counterparts, the radiologic appearance of dural-based CMs is confusing and misleading. Surgical resection is the primary treatment selection for dural-based CMs. In cases with no close relationship to dural sinuses, complete surgical resection with minimal blood loss and few neurologic deficits could be easily achieved.

Astrocytes Regulate Angiogenesis Through the Jagged1-Mediated Notch1 Pathway After Status Epilepticus.

Vascular disruptions including blood-brain barrier breakdown and pathologic angiogenesis contribute to the development of epilepsy in normal brains. The Notch signaling pathway is activated in response to seizure activity, and its activation promotes seizures, although its exact role in angiogenesis is poorly understood. Here, we have examined the role of Notch signaling in angiogenesis in a kainic acid-induced mouse model of epilepsy. We show that following seizures, expression of the Notch ligand Jagged1 in the hippocampus is upregulated in astrocytes and levels of activated Notch1 are increased in endothelial cells. Using an in vitro model of angiogenesis, we provide evidence that brain endothelial tube formation is promoted in the presence of astrocytes. Isolated primary brain endothelial cells develop significantly longer vascular sprouts when cultured in the presence of astrocytes. Notch1 signaling is activated in brain endothelial cells cocultured with astrocytes, and astrocytic Jagged1 expression is required for angiogenic enhancement, as shown by the inhibitory effect of Jagged1 small interfering RNA (siRNA) expression in astrocytes on endothelial cell vascular sprouting in vitro. Therapies targeting the Jagged1/Notch1 signaling pathway may therefore be effective in limiting aberrant angiogenesis following status epilepticus.

[EFFECTIVENESS OF POSTERIOR MIDLINE APPROACH WITH COMPLETE LAMINECTOMY FOR GIANT INTRASPINAL TUMOR RESECTION AND VERTEBRAL CANAL RECONSTRUCTION].

OBJECTIVE: To investigate the effectiveness of the posterior midline approach with complete laminectomy for giant intraspinal tumor (more than 3 cm in diameter) resection and vertebral canal reconstruction. METHODS: Between March 2009 and February 2012, 21 cases of giant intraspinal tumor underwent the posterior midline approach with complete laminectomy and vertebral canal reconstruction. There were 12 males and 9 females with an average age of 40.5 years (range, 21-62 years). The Japanese Orthopaedic Association (JOA) scores were 0-5 in 4 cases, 6-11 in 9 cases, and 12-17 in 8 cases. The preoperative Cobb angle was less than 10° on the X-ray films. MRI showed that the tumor located at the cervical part in 3 cases, at the cervicothoracic part in 1 case, at the thoracic part in 8 cases, at the thoracolumbar part in 2 cases, and at the lumbar part in 7 cases; the long diameter of tumor on the sagittal view was 3.0-16.5 cm (mean, 8.3 cm). Total resection of tumor was performed in 17 cases, and subtotal resection in 4 cases. RESULTS: Postoperative pathological examinations showed 9 cases of neurilemmoma, 6 cases of neurofibroma, 3 cases of lipoma, 2 cases of meningioma, and 1 case of bronchogenic cyst. Primary healing of incision was achieved in all patients. The patients were followed up 1-3 years (mean, 2.3 years). Postoperative X-ray film showed that Cobb angle was more than 10° in 3 cases, and no displacement of internal fixator was observed. The JOA scores were 0-5 in 1 case, 6-11 in 10 cases, and 12-17 in 10 cases, showing significant difference when compared with preoperative scores (Z = -3.26, P = 0.02). CONCLUSION: The posterior midline approach with complete laminectomy for giant intraspinal tumor resection and vertebral canal reconstruction is a safe, simple, and feasible operation way, and it can resect tumor to a maximum extent, relieve the clinical symptoms, and maintain the spinal stability.