Quantitative evaluation of rejuvenation treatment of nasolabial fold wrinkles by regression model and 3D photography.

OBJECTIVE: With the application of 3D photography, our study aimed to quantify parameters of static nasolabial fold wrinkles and establish mathematic regression model between parameters of wrinkles and age, further to quantitatively evaluate the effect of rejuvenation treatment in terms of age. METHODS: From October 2016 to May 2018, 433 Chinese female volunteers, aged 25-60 years old, were enrolled in this study. Antera 3D camera was used to collect four parameters of static nasolabial fold wrinkles on the left and right sides of the volunteers, including overall size, average depth (mm), average width (mm), and maximum depth (mm). For those presented a linear relationship with age, univariate linear regression fitting was performed, followed by residual analysis, goodness of fit test, and significance test. RESULTS: The results of univariate linear regression fitting showed there was a clear linear relationship between the maximum depth, average depth, overall size of nasolabial fold wrinkles and age, and the regression equations were established. The significance test of regression coefficients showed P values were less than .0001. CONCLUSIONS: With application of the regression model between parameters of nasolabial fold wrinkles and age, the effect of rejuvenation treatment can be quantitatively evaluated in terms of age, which has certain reference and promotion value.

Anatomical Features and Clinical Significance of Radiculomuscular Artery Variants Involving the Suboccipital Segment of Vertebral Artery : Angiographic and Cadaver Studies.

OBJECTIVE: To discuss the significance of the radiculomuscular artery in typical variations of the distal vertebral artery (VA) from the viewpoint of microsurgical anatomy. METHODS: Some variations involving the radiculomuscular artery revealed by digital subtraction angiography (DSA) were recruited and studied together with our findings from cadaver dissections. RESULTS: A total of 29 variants were found in 26 patients, including 10 C­2 vertebral origins of the posteroinferior cerebellar artery (PICA), 13 duplicated (12 patients) and 6 aberrant V3s. An aberrant V3 was observed in our cadaver specimen. Each of these variants involved only the distal part of the lateral spinal artery (LSA) that incorporates the radiculomuscular artery and the radiculomedullary branch. Using DSA two aberrant V3s were indicated and another one was verified by anatomical study as an extradural location. CONCLUSION: The radiculomuscular artery accounts for the C­2 vertebral origin of the PICA, duplicated and aberrant V3, and extradural course of an aberrant V3 does exist. A probable extradural course of a variant between C­2 and C­1 should be kept in mind whenever each of the variations involving the radiculomuscular artery is detected by DSA or computed tomography angiography (CTA).

Gelidocalamus xunwuensis (Poaceae, Bambusoideae), a new species from southeastern Jiangxi, China.

Gelidocalamus xunwuensis W.G.Zhang & G.Y.Yang, a new species collected from Xunwu County of Jiangxi Province in China, is described and illustrated. The new species is similar to G. stellatus in the habit, but differs by internodes sparsely hairy with granuliferous warts, culm sheath stiffly hairy, culm sheath blade broadly lanceolate to narrowly triangular, each node with a ring of appressed trichomes below, foliage leaves broadly lanceolate to narrowly oblong, and new shoots occurring in late October.

Preoperative albumin-to-globulin ratio and prognostic nutrition index predict prognosis for glioblastoma.

OBJECTIVE: Impaired immunonutritional status has disadvantageous effects on outcomes for cancer patients. Preoperative albumin-to-globulin ratio (AGR) and the prognostic nutrition index (PNI) have been used as prognostic factors in various cancers. We aimed to evaluate the clinical significance of the AGR and PNI in glioblastoma. MATERIALS AND METHODS: This retrospective analysis involved 166 patients. Demographic, clinical, and laboratory data were collected. AGR and the PNI were calculated as AGR = albumin/(total serum protein - albumin) and PNI = albumin (g/L) + 5 × total lymphocyte count (109/L). Overall survival (OS) was estimated by Kaplan-Meier analysis. Receiver-operating characteristic analysis was used to assess the predictive ability of AGR and the PNI. Cox proportional-hazard models estimating hazard ratios (HRs) and 95% confidence intervals (CIs) were used for univariable and multivariable survival analyses. RESULTS: The cutoff values of AGR and PNI were 1.75 and 48. OS was enhanced, with high AGR (>1.75) and the PNI (>48) (P<0.001 for both). Areas under the receiver-operating characteristic curve for AGR and the PNI were 0.68 and 0.631 for 1-year survival and 0.651 and 0.656 for 2-year survival (P<0.05 for all), respectively. On multivariable analyses, both AGR and the PNI were independent predictors of OS (AGR, HR 0.785, 95% CI 0.357-0.979 [P=0.04]; PNI, HR 0.757, 95% CI 0.378-0.985 [P=0.039]). On subgroup analysis, AGR and the PNI were significant prognostic factors for OS in patients with adjuvant therapy (AGR P<0.001; PNI P=0.001). CONCLUSION: Preoperative AGR and the PNI may be easy-to-perform and inexpensive indices for predicting OS with glioblastoma. AGR and the PNI could also help in developing good adjuvant-therapy schedules.

Nuclear factor-κB activation in perihematomal brain tissue correlates with outcome in patients with intracerebral hemorrhage.

BACKGROUND: Nuclear factor-κB (NF-κB) plays an important role in the inflammatory response after intracerebral hemorrhage (ICH). We therefore proposed that NF-κB activation in perihematomal brain tissue might correlate with clinical outcome in patients with ICH. To confirm this, we studied clinical data of 45 patients with ICH and NF-κB activation in perihematomal brain tissue and analyzed predictors of clinical outcome as well as the predictive value of NF-κB activation. METHODS: Forty-five patients with spontaneous basal ganglia hemorrhage were prospectively investigated. The clinical data were collected, which include demographics, alcohol and tobacco abuse, stroke risk factors, neuroimaging variables at presentation, Glasgow Coma Scale (GCS) at admission, number of days in hospital, mechanical ventilation, pneumonia, and outcome. Clinical outcome was assessed by the modified Rankin Scale at 6 months after ICH. Perihematomal brain tissue was collected, and NF-κB activation was detected using immunohistochemistry. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of the poor outcome. RESULTS: Immunohistochemical detection showed that NF-κB p65 was expressed in the nuclei of neurons and glial cells in all patients. The number of nuclear NF-κB p65-positive cells was 54 ± 21. Six months after ICH, 18 (40%) patients achieved a favorable functional outcome (mRS ≤ 3) while 27 (60%) had a poor functional outcome (mRS 4 to 6). In univariate analysis, predictors of poor functional outcome were lower GCS score on admission (P = 0.004), larger hematoma volume (P = 0.004), intraventricular extension (P = 0.047), midline shift (P = 0.005), NF-κB activation (P < 0.0001), mechanical ventilation (P = 0.018), and co-morbidity with pneumonia (P = 0.002). In multivariate logistic regression analysis, NF-κB activation was the only independent predictor of poor outcome at 6 months after ICH. CONCLUSIONS: NF-κB activation is closely related to clinical outcome 6 months after ICH in humans. Therefore, it could be useful to predict prognosis of ICH accurately and should be further evaluated as a target for therapeutic strategies of ICH in the future.

[Clinical analysis of 42 cases of chronic expanding intracerebral hematoma].

OBJECTIVE: To summarize our own experiences of managing chronic expanding intracerebral hematoma (CEICH) and discuss its diagnosis and treatment. METHODS: The courses of CEICH, clinical and imaging features, intraoperative findings, pathological examinations and follow-up outcomes were reviewed retrospectively. The relevant literatures were reviewed simultaneously. RESULTS: The course of CEICHs ranged from 22 days to 10 years. Twenty-three cases (54.8%) were misdiagnosed as cystic gliomas, cystic gliomas, brain cysticercoses, brain abscesses and tumor strokes, etc. The misdiagnostic rate had decreased to 19.0% since June 1997. Thirty-eight patients underwent surgical operations and 4 had puncture drainage of hematoma. There was no operative death. Thirty-three cases achieved an excellent recovery and 9 cases had varying degrees of nervous dysfunctions. The follow-up period was 1-21 years. One patient had recurrence after 10 years. Among the cases of multiple CEICH, two lesions underwent no surgical treatment. One increased obviously after 7 years and another disappeared. CONCLUSION: The following five points may be used as the diagnostic criteria of CEICH: (1) intracerebral cystic space-occupying lesions on brain images; (2) circular or circle-like enhancement around lesions; (3) a mixed signal of concentric circular lamellar structures on MRI T1WI; (4) abnormal vascular lesions on CTA, MRA or DSA; (5) clinical signs and symptoms of slow progress of intracranial pressure. CEICHs with clinical symptoms of local mass effect shall be obliterated surgically. The abnormal tissues in cyst wall of hematoma should be resected. Small hematomas (< 2 cm) may be followed up.

[Aberrant methylation of NF2, TIMP-3 and THBS1 genes and their diagnostic values in meningiomas].

OBJECTIVE: To explore the functions of NF2, TIMP-3 and THBS1 genes in the tumorigenesis or progression of meningiomas and analyze the values of these genes in early diagnosis, therapy and prognostic evaluation in meningiomas. METHODS: A total of 66 cases with histological sections of meningiomas, including solitary (SMs, n = 30) and multiple meningiomas (MMs, n = 36), were retrieved from our departmental archives. All cases were regrouped as benign, atypical and anaplastic (malignant) by hematoxylin & eosin staining according to the recently published WHO classification of nervous system tumors. Genomic DNA was extracted from tumor sections and methylation-specific polymerase chain reaction (MSP) performed to detect the CpG methylation status. Normal brain tissue was used as the control group. And then the differences of methylation rate between SMs and MMs tissues and among different subgroups were analyzed by statistical analyses. RESULTS: The results of methylation in different types of meningiomas demonstrated that the rates of NF2, TIMP-3 and THBS1 methylation were 26.7% (8/30), 16.7% (5/30) and 36.7% (11/30) in 30 SMs tissues and 30.6% (11/36), 22.2% (8/36) and 22.2% (8/36) in 36 MMs tissues respectively. But no aberrant methylation of NF2, TIMP-3 and THBS1 genes was found in normal brain tissue. No significant differences in three types of gene methylation rates existed between SMs and MMs in the I-III grade meningiomas. Nevertheless, there was great difference between grades I, II and III in SMs and MMs while no significant difference was found between grades II and III. CONCLUSION: The methylation of NF2, TIMP-3 and THBS1 is correlated with the tumorigenesis of meningiomas (grade II and III). As an important pathogenetic cause of meningiomas, it may be used as a clinical tool for an early diagnosis of meningiomas.

[Expression and significance of MMP-9, PR, Ki-67 and Survivin in multiple meningiomas].

OBJECTIVE: To detect the expressions of matrix metalloproteinase-9(MMP-9), progesterone receptor(PR), Ki-67 and Survivin in the multiple meningiomas (MMs) and explore its genesis, diagnosis and bionomics features. METHODS: A total of 66 cases with histological sections of meningiomas retrieved from the archives of Department of Pathology of our hospital, including 30 cases of solitary meningiomas (SMs) and 36 cases MMs, were regrouped as benign, atypical and malignant by hematoxylin and eosin staining according to the World Health Organization classification of nervous system tumors. Immunohistochemistry was performed to detect the expressions of MMP-9, PR, Ki-67 and Survivin in 36 cases of MMs and 30 cases of SMs. And normal brain tissue was selected as a control group. The staining intensity was analyzed quantitatively for the differential expressions of MMP-9, PR, Ki-67 and Survivin between SMs and MMs. RESULTS: No expression of MMP-9, PR, Ki-67 and Survivin was detected in 5 normal brain tissues, but the expression rates were 100%, 53%, 23% and 88% respectively for significant difference comparing with normal tissue. The result of statistical analysis showed that there was significant difference in the expression intensity of MMP-9 and PR between two groups. The expression intensity MMP-9 in multiple group was significantly higher in MMs than that in SMs (P < 0.01) while PR was lower in MMs than that in SMs (P < 0.05). But no significant difference was found for the expression of Ki-67 or Survivin between two groups. CONCLUSION: The detections of MMP-9, PR, Ki-67 and Survivin are helpful in the clinical diagnosis and early detection of meningioma.

Surgical management and evaluation of prognostic factors influencing postoperative visual outcome of suprasellar meningiomas.

OBJECTIVE: To study the microsurgical technique and the prognostic factors influencing postoperative visual outcome in patients with suprasellar meningiomas (SMs). METHOD: The clinical materials of 45 patients with SMs treated microsurgically between January 2002 and October 2008 were analyzed retrospectively. Patients received ophthalmologic and radiologic assessment before and after operation. Follow-up ranged from 12 to 93 months (median, 39 months). As far as monocular vision was concerned, univariate and multivariate statistical analysis was performed among factors that might influence postoperative visual outcome. RESULTS: In this group, the mean age of the patients was 51 years. Median tumor size was 3.5 cm. The duration of symptoms ranged from 10 days to 35 years (median, 18 months). Total tumor resection was achieved in 40 cases (88.9%) and subtotal in 5 cases (11.1%). With respect to visual outcome of the 90 eyes, 54 eyes (60%) improved, 24 (26.7%) remained unchanged, and 12 (13.3%) had worsened. It has been illustrated that the postoperative visual improvement was determined by various factors, including age, recurrence, duration and severity of visual disturbance, preoperative condition of optic disc, tumor size, location, peritumoral edema, involvement with optic canal, arachnoid membrane interface, and extent of tumor removal. However, the multivariate analysis showed that recurrence, preoperative condition of optic disc, duration of impaired vision, and peritumoral edema are the most influential factors. CONCLUSIONS: Skillful microsurgical techniques are key to resect SMs while getting the desired visual outcome. The recurrence, preoperative condition of optic disc, duration of impaired vision, and peritumoral edema might be the most important factors influencing postoperative visual outcome.

Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression.

BACKGROUND: Microvascular decompression (MVD) is a well accepted surgical treatment strategy for trigeminal neuralgia (TN) with satisfying long-term outcome. However, considerable recurrent patients need more effective management. The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy (RTR) on patients with recurrent TN after MVD. METHODS: Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated. Based on surgical procedures undertaken, these 62 cases were classified into two subgroups: group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system. The patients in group A were followed up for 14 to 70 months (mean, 40 ± 4), and those in group B were followed up for 13 to 65 months (mean, 46 ± 7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups. RESULTS: All patients in both groups A and B attained immediate pain relief after RTR. Both groups attained good pain relief rate within the first two years of follow-up: 92.3%, 84.6% and 82.6%, 69.6% respectively (P > 0.05). After 2 years, the virtual reality or neuronavigation assisted RTR group (group B) demonstrated higher pain relief rates of 82.5%, 76.2% and 68.8% at 3, 4 and 5 years after operation respectively, while those in group A was 57.2%, 49.6%, and 36.4% (P < 0.05). Low levels of minor complications were recorded, while neither mortalities nor significant morbidity was documented. CONCLUSIONS: RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management. With the help of virtual reality imaging technique or neuronavigation system, the patients could attain better long-term pain relief.

[Selective radiofrequency thermocoagulation for trigeminal neuralgia].

OBJECTIVE: To study the technique and experience of selective radiofrequency thermocoagulation (SRFTC) for trigeminal neuralgia (TN) and the application of neuronavigation in SRFTC for TN. METHODS: SRFTC was performed in 3269 TN patients and neuronavigation-assisted SRFTC in 36 of them. Follow-up was carried out for over 2 years in 1722 cases. RESULTS: An excellent efficacy was achieved in 2590 cases, a fair outcome in 548 cases and no response in 131 cases. The recurrence rates at one and two years were 10.5% and 25.0% respectively. The efficacy was excellent in all cases treated by neuronavigation-assisted SRFTC. The effective rate was 96%. Neither serious complication nor death occurred in this series. CONCLUSION: SRFTC for TN is both safe and effective. And the neuronavigation technique can not only increase the surgical efficacy of SRFTCP for TN but also decrease the surgical risks.

[Recognition and management of hidden related vessel during the operation of microvascular decompression for hemifacial spasm].

OBJECTIVE: To investigate the recognition and approach of the hidden related vascular in hemifacial spasm patients during the operation of microvascular decompression. METHODS: The clinical records of 85 patients of hemifacial spasm were analyzed at our hospital. The hidden related vessel was found in 7 patients. REZ (root entry zone) was surrounded by Teflon cotton slice to separate the vessel from REZ. RESULTS: There were 7 patients of hidden related vessel in 85 patients. And the related vessels were anteroinferior cerebellar artery and its branches. The symptoms became totally relieved after operation and there was no recurrence. CONCLUSION: The microvascular decompression is an effectively treatment for hemifacial spasm patients. Searching for the related vessel (particularly hidden related vessel) is the most important part of the operation. An effective decompression of REZ is the key point of operation.

Virtual reality imaging technique in percutaneous radiofrequency rhizotomy for intractable trigeminal neuralgia.

Trigeminal neuralgia (TN) is the most common facial neuralgia, and is extremely painful. We evaluate the effectiveness of percutaneous controlled radiofrequency trigeminal rhizotomy (RFTR) assisted by a virtual reality (VR) imaging technique for idiopathic TN. A total of 2769 patients with TN underwent RFTR procedures between June 1986 and March 2007, with VR assisted guiding and electrode positioning in 26 patients from January 2006 to March 2007. A laminal basicranial CT scan (2 mm slice, 16 slices/s) was used during RFTR. The three-dimensional (3D) position of the electrode needle tip and the oval foramen can be seen clearly using this VR technique. The position and depth of the needle was adjusted according to the virtual 3D-CT scan. CT scanning was performed repeatedly until the needle tip was situated in the oval foramen. Usually, the tip of the electrode was adjusted once or twice. Acute pain relief was accomplished in the 26 patients who underwent a single RFTR procedure assisted with VR. No recurrence of pain was noted except in one patient after 16 months. There were no permanent complications or mortality. VR-assisted RFTR represents a minimally invasive, low-risk technique with a higher efficacy compared with traditional RFTR.

[Diagnosis and treatment of chronic expanding intracerebral hematoma].

OBJECTIVE: To explore the diagnosis, therapeutic strategy, and pathogenetic mechanism of chronic expanding intracerebral hematoma (CEICH). METHODS: The clinical presentation, radiological characteristics, d pathology, and treatment of 22 cases of CEICH, 15 males and 7 females, aged 29. 3, all treated with craniotomy and removal of the wall of the capsule and hematoma, were analyzed retrospectively. RESULTS: The clinical presentation and radiological characteristics of CEICH were atypical. After surgery, 18 patients recovered quite well, 3 patients suffered from hemiplegia, and 1 patient died from rebleeding. The diagnosis of CEICH of all the cases was confirmed by intraoperative finding and pathological results. CONCLUSION: CEICH can be found in any part of the brain that has 2 major characteristics: its clinical symptoms always develop slowly, and the typical radiological characteristic is intracerebral hematoma-form image. Surgery to evacuate the hematoma and remove the capsule is necessary and can be with good outcome.

Epidermoid cyst with infiltrative malignant melanoma in the cerebellopontine angle.

We report a patient with an intracranial epidermoid cyst associated with malignant melanoma in the cerebellopontine angle. The CT, MRI and histopathological findings showed an intracranial epidermoid cyst with an adjacent infiltrating melanoma. Immunohistochemical staining of the solid tumour was positive for the melanoma marker HMB45 and negative for GFAP and cytokeratin. Both CT and MRI were helpful in this patient but the diagnosis could only be made on histopathology.

Three-dimensional computed tomography-guided radiofrequency trigeminal rhizotomy for treatment of idiopathic trigeminal neuralgia.

OBJECTIVE: To evaluate the effectiveness of three-dimensional computed tomography (3D-CT) guided radiofrequency trigeminal rhizotomy (RF-TR) in treatment of idiopathic trigeminal neuralgia (ITN). METHODS: From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60 degrees C to 75 degrees C depending on the pain distribution and the age of patient. RESULTS: The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months (range 24-41 months). Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early (< 6 months) pain recurrence was observed in 2 patients (11.1%), whereas late (> 6 months) recurrence was reported in 3 patients (16.7%). Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. CONCLUSION: 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.

[Clinicopathologic characteristics and microsurgical treatment of glioma of limbic and paralimbic system].

OBJECTIVE: To explore the features of the clinical manifestations, imaging, pathology and microsurgery on the patients with gliomas of limbic and paralimbic system. METHODS: The clinical data of 28 patients with gliomas of limbic and paralimbic system were analyzed respectively. RESULTS: Seizure was the most common symptom, presented in 24 cases. CT scans showed hypodensity in 19 cases and isodensity in 9 cases. MRI scans were achieved in 23 cases, showing hypointense signal on T(1)WI and hyperintense signal on T(2)WI. Total resection was achieved in 19 cases, subtotal in 6 cases and partial in 3 cases. All patients had excellent postoperative recovery, except 5 patients who developed temporary frontal aphasia and 6 patients who developed contralateral hemiplegia. The patients had a postoperative follow-up ranging from 6 months to 5 years, and 23 cases still survived. CONCLUSION: High-resolution CT and MRI may reveal the size, location, confines and sharp demarcation of the tumors. Gliomas can be microsurgically removed with considerable results.

Development of stereotactic neurosurgery in China.

As a brief reflection on the development of stereotactic neurosurgery, this article reviews its founding and early history in China.

Traumatic subdural hydroma developing into chronic subdural hematoma.

OBJECTIVE: To probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma (CSDH). METHODS: We retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature. RESULTS: 16.7% of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage. CONCLUSIONS: TSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.