Prechiasmatic Transection of the Unilateral Dodge Class â Optic Pathway Glioma without Neurofibromatosis Type 1: Technical Description and Clinical Prognosis.

OBJECTIVE: For unilateral Dodge Class Ⅰ optic pathway glioma (OPG-uDCⅠ) without neurofibromatosis type 1, unilateral isolated optic nerve gliomas before the optic chiasm have been confirmed to possibly cause visual deterioration and poor prognosis. For this type of highly selective localized tumor, we explored surgery as the only treatment method. This article retrospectively analyzed and summarized the clinical data of this case series, with the aim of exploring the main technical details and clinical prognosis. METHODS: Included were patients with OPG-uDCⅠ without neurofibromatosis type 1 and experiencing vision loss on the affected side. The fronto-orbital approach was used, which was mainly divided into 3 parts: intraorbital, optic canal, and intracranial. All patients underwent prechiasmatic resection without any adjuvant treatments. The follow-up period was 3 months after surgery, and magnetic resonance imaging and contralateral visual acuity were reviewed annually after surgery. RESULTS: All OPG-uDCⅠ cases were completely removed without any adjuvant treatments, and there was no recurrence during the follow-up period. Pathological results showed that, except for 1 adult patient with pilomyxoid astrocytoma (World Health Organization grade Ⅱ), the others all had pilocytic astrocytoma (World Health Organization grade Ⅰ). Five patients experienced transient ptosis, and all recovered 3 months after surgery. CONCLUSIONS: For OPG-uDCⅠ without neurofibromatosis type 1, radical prechiasmatic resection of the tumor is possible, without the need for postoperative radiotherapy and chemotherapy.

Clinical Characteristics and Prognostic Analysis of Osteolytic and Hyperostosis Sphenoid Orbital Meningiomas: A Single-Center Experience.

Reactive hyperostosis of spheno-orbital meningiomas (SOMs) often occurred in the sphenoid wing, while osteolytic SOMs (O-SOMs) were rarely discussed. This study preliminarily evaluated the clinical characteristics of O-SOMs and analyzed prognostic factors affecting the recurrence of SOMs. We retrospectively analyzed the medical records of consecutive patients who underwent surgery for a SOM between 2015 and 2020. According to the bone changes of sphenoid wing, SOMs were divided into O-SOMs and hyperostosis SOMs (H-SOMs). A total of 31 procedures were performed in 28 patients. All cases were treated by pterional-orbital approach. It was confirmed that 8 cases were O-SOMs and the other 20 cases were H-SOMs. Total tumor resection was performed in 21 cases. There were 19 cases with Ki 67 ≥3%. The patients were followed up for 3 to 87 months. Proptosis improved in all patients. All O-SOMs had no visual deterioration, while 4 H-SOMs cases had visual deterioration. There was no significant difference in clinical outcomes between the two types of SOM. The recurrence of SOM was related to the degree of resection, but not to the type of bone lesions, invasion of cavernous sinus and Ki 67.

Thrombospondin1 mimics rapidly relieve depression via Shank3 dependent uncoupling between dopamine D1 and D2 receptors.

Deficits in astrocyte function contribute to major depressive disorder (MDD) and suicide, but the therapeutic effect of directly reactivating astrocytes for depression remains unclear. Here, specific gains and losses of astrocytic cell functions in the medial prefrontal cortex (mPFC) bidirectionally regulate depression-like symptoms. Remarkably, recombinant human Thrombospondin-1 (rhTSP1), an astrocyte-secreted protein, exerted rapidly antidepressant-like actions through tyrosine hydroxylase (Th)/dopamine (DA)/dopamine D2 receptors (D2Rs) pathways, but not dopamine D1 receptors (D1Rs), which was dependent on SH3 and multiple ankyrin repeat domains 3 (Shank3) in the mPFC. TSP1 in the mPFC might have potential as a target for treating clinical depression.

A New Concept for Primary Reconstruction of Skull Defects with 3D-Molded PEEK Patch Assisted by Navigation Based on Animal Study.

AIM: To perform an accurate primary repair of temporal bone defects. MATERIAL AND METHODS: The temporal bone defect models were performed in beagles. Extended estimated patches of the defects were predesigned by 3D reconstruction software and molded from polyether ether ketone (PEEK) using a lathe. The precise trimming of the extended PEEK patches was established via coordinate transformation of the patches between the navigation system and the reconstruction software, and in real-time tracing via intraoperative navigation. Trimmed PEEK patches were embedded onto the defects. Blood tests and image examinations were conducted postoperatively. RESULTS: The extended PEEK patches were prepared precisely according to the predesign. Real-time tracing of the actual skull defect profile was performed quickly and accurately. Trimmed skull patches perfectly matched the shape of the defects. No signs of infection, absorption, or translocation of the patches occurred postoperatively, and little epidural effusion was found. CONCLUSION: With the assistance of navigation and 3D reconstruction technology, customized molded PEEK patches can be used for accurate primary repair of temporal bone defects.

Engineering highly efficient Li+ responsive nanochannels via host-guest interaction and photochemistry regulation.

Artificial nanochannels have seen great progress in energy storage, molecular filters, nanofluidic diodes, and biosensors. Precisely recognizing and transporting molecules or ions underpin the basis of artificial nanochannels. Here, we report highly efficient Li+ responsive nanochannels by design of functionalized porous anodic aluminum oxide (AAO) membranes. The 12-crown-4 unit was tethered to the synthesized spiropyran molecule, creating a smart Li+ responsive element, photochromic crowned spiropyran (CE-SP). The crown unit can specifically bind with Li+ while exempting the harassment of other metallic cations; and importantly, the spiropyran moiety possesses reversible photochemistry response, adding the flexibility to regulate ion transport behaviors. Upon the ultraviolet light stimulus, hydrophobic CE-SP molecules transform to positively charged crowned merocyanine (CE-MC), which can further convert to oxygen-negative ions in weak alkaline environment, thereby forming O--Li+ interaction. Such structural evolutions enable to deftly tune the surface charge and wettability of the nanochannels, and thus ingeniously manipulate Li+ recognition profiled by ionic current signal. Moreover, electrically-driven release of the captured Li+ can be realized in an amiable condition, showing controllable capture-to-release ability. Finite element simulation unveils the fundamental mechanisms of ion transport pertaining to Li+ recognition events in the nanoconfinement. This work thus paves a way to construct high-performance Li+-selective nanodevice, and holds promise for Li+-related electrochemistry energy research.

Multiple subtentorial metastasis in diffuse midline glioma receiving tumor treating fields: a case report and literature review.

Diffuse midline glioma (DMG) is one of fatal glioblastoma multiforme (GBM) with no proven medical therapies. Tumor treating fields (TTFields) is a new revolutionary therapy for GBM which prolongs the overall survival time obviously. However, we can observe more tumor growth phenomena (such as distant multiple metastases) than before. This report describes an adult patient who presented headache and dizziness, accompanied by left limb weakness, nausea, and vomiting following car accident trauma, following imaging examinations suggested thalamus GBM. He was treated with subtotal excision. Final pathology was diagnosed as DMG with H3F3A mutation, isocitrate dehydrogenase (IDH) wild type. Following concurrent chemoradiation therapy (CCRT) and adjuvant temozolomide (TMZ) chemotherapy + TTFields therapy were carried out. Supratentorial tumor has been exhibited a partial radiological response for nine months until TTFields was used irregularly or even discontinued in the later stage. Especially, subtentorial and spinal multiple metastasis occurred during this time. Both supratentorial and subtentorial tumors were treated with surgery, radiotherapy, chemotherapy, even targeted drugs, with the only difference being TTFields, but we could see different consequences for tumor growth. One conclusion might be drawn that TTFields can provide a longer survival time (14 vs. 8 months reported before) for DMG patients and improve survival benefits. However, we can observe that patients maybe die from subtentorial metastasis because TTFields could not cover the subtentorial tumors, which is the focal challenge at present. So further research on subtentorial tumors with TTFields is urgently needed.

Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions.

Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA ( p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group ( p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

Comparison of the Effectiveness of Ring-Stripping Retrograde Endarterectomy and Carotid Artery Crossover Bypass in the Treatment of Patients with Symptomatic Riles Type 1A Common Carotid Artery Occlusion.

OBJECTIVE: The surgical procedure most appropriate for treating symptomatic Riles type 1A common carotid artery occlusion (CCAO) is unclear. This study compares the effects of ring-stripping retrograde endarterectomy (RSRE) and carotid artery crossover bypass (CACB) on cerebral perfusion improvement in patients with symptomatic Riles type 1A CCAO. METHODS: We conducted a retrospective analysis of symptomatic Riles type 1A CCAO patients treated at our centre. Postoperative improvements in the ipsilateral internal carotid artery (ICA) flow rate, ipsilateral cerebral blood perfusion (CBP) and the stroke recurrence rate were compared between patients who underwent RSRE and those who underwent CACB. RESULTS: A total of 20 CCAO patients were surgically treated at our centre from 2011 to 2018. Nine of these patients underwent RSRE, and eleven underwent CACB. No significant differences were identified between the groups in the ipsilateral blood flow rate of the ICA immediately after surgery and the ipsilateral-to-contralateral mean transit time ratios 1 day after surgery. However, the flow rate in the ICA was significantly higher in the RSRE group than in the CACB group 1 year after surgery (135.44 ± 19.22 ml/min vs. 116.36 ± 17.70 ml/min, p = 0.033). For CBP, the ipsilateral-to-contralateral mean transit time ratios were significantly lower in RSRE patients than in CACB patients 1 year after surgery (1.005 ± 0.052 vs. 1.064 ± 0.066, p = 0.044). In addition, the postoperative modified Rankin scale (mRS) score at the latest follow-up point (p = 0.884) and the stroke recurrence rate during the follow-up (88.9% vs. 90.9%, p > 0.999) were not significantly different between the two groups. CONCLUSIONS: Although the postoperative mRS score and the stroke recurrence rate were not significantly different between RSRE and CACB patients, compared to CACB, RSRE was better for improving the ipsilateral ICA flow rate and cerebral perfusion in symptomatic Riles type 1A CCAO patients.

In-situ facile preparation of highly efficient copper/nickel bimetallic nanocatalyst on chemically grafted carbon nanotubes for nonenzymatic sensing of glucose.

Measuring glucose in a convenient and economical manner is crucial for diabetes diagnostics and surveillance. Ongoing efforts are devoted to nonenzymatic sensors using functional nanomaterials. Drawbacks due to costly and cumbersome process, however, hamper the practicality. Here, we report the facile preparation of Cu/Ni bimetallic nanocatalyst toward glucose electrooxidation. Carboxylated multi-walled carbon nanotubes were chemically grafted onto indium tin oxide glass via silanization reaction and amide coupling reaction, providing distinct nucleation sites for Cu/Ni bimetallic electrocatalyst prepared by in-situ succinct electrodeposition, which synthetically created a three-dimensional electron transfer network. The surface morphology and chemical constituents were characterized by scanning electron microscopy, transmission electron microscopy, X-ray energy dispersive spectroscopy, X-ray photoelectron spectroscopy, infrared spectroscopy and atomic force microscopy. The prepared electrocatalyst displayed ultrahigh electrochemical activity; the catalytic current density for glucose oxidation was found to be over 6.7 mA mM-1 cm-2. The linear response spanned three orders of magnitude of glucose concentration ranging from 1 µM to 1 mM. Analytical parameters such as accuracy, reproducibility, specificity and stability have also been validated. Importantly, we reveal that Ni plays a dominant role over Cu in electrocatalytic oxidation of glucose, thus bettering our understanding and strategy for nonenzymatic glucose sensor design. Advantages of the glucose sensor presented include easy bulk preparation, low cost, and ready-to-use.

Outcomes After Pterional and Supraorbital Eyebrow Approach for Cranio-Orbital Lesions Communicated via the Supraorbital Fissure-A Retrospective Comparison.

OBJECTIVE: The pterional approach (PA) has been used to remove cranio-orbital lesions that have communicated via the supraorbital fissure (SOF). The supraorbital eyebrow approach (SEA) has become increasingly popular as a minimally invasive approach. However, few reports have examined the SEA for cranio-orbital lesions. We assessed the relative advantages, disadvantages, and selection criteria for these 2 approaches. METHODS: The data from all consecutive patients who had undergone removal of a cranio-orbital lesion that communicated via the SOF using the PA or SEA were analyzed. RESULTS: Of the 25 patients, 13 had undergone surgical resection using the SEA and 12 had undergone resection using the PA. The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision (P < 0.05). Proptosis had improved significantly in all the patients. No significant differences were found in the total resection rates, visual outcomes, recovery of ptosis, or other new surgically related complications between the 2 groups (P > 0.05). All the patients were followed up for an average of 21.9 months. One patient in each group had developed recurrence or progression that required radiotherapy. The disease of the other patients with subtotal resection was stable or atrophic. CONCLUSION: The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision. The SEA might be a more minimally invasive option for lesions communicating via the SOF without obvious hyperostosis. The PA might be more reasonable for lesions with obvious hyperostosis and more extensive lesions in the cavernous sinus.

Superficial Temporal Artery Trunk-to-Middle Cerebral Artery Bypass with Short Radial Artery Interposition Graft for Symptomatic Internal Carotid Artery Occlusion.

OBJECTIVE: We investigated the use of high-flow superficial temporal artery trunk-to-radial artery-to-middle cerebral artery (STAt-RA-MCA) bypass to prevent ischemic stroke in patients with symptomatic internal carotid artery occlusion (SICAO). METHODS: We retrospectively analyzed the data from patients with SICAO who had undergone high-flow STAt-RA-MCA bypass in our center from October 2014 to November 2017. The incidence of ischemic stroke, changes in cerebral blood flow, characteristics of perioperative complications, and related factors determining the blood flow rate in the graft were analyzed. RESULTS: From October 2014 to November 2017, we treated 21 patients with SICAO using high-flow STAt-RA-MCA bypass. A total of 42 ischemic stroke events had been reported within 6 months before surgery. The ipsilateral/contralateral mean transit time (I/C MTT) ratio before surgery was 1.24 ± 0.10 (range, 1.14-1.51). During a median follow-up period of 692 days (range, 212-1114), 3 transient ischemic attacks occurred in 3 patients; 18 patients (85.7%) did not experience recurrent stroke. The patency rate of the bypass graft was 95.2% (20 of 21). The I/C MTT ratio was 1.06 ± 0.11 on postoperative day 1 in all patients and was significantly different from the preoperative I/C MTT ratio (P < 0.001). The surgical complication rate was 9.5% (2 of 21), and no reoperation was required. CONCLUSION: Our results suggest that high-flow STAt-RA-MCA bypass can effectively reduce the risk of stroke in patients with SICAO. Moreover, the surgical procedure is a highly safe procedure. Further randomized controlled studies are required to draw more precise conclusions.

The complete chloroplast genome of Plantago fengdouensis (Plantaginaceae): an endemic and Endangered species from China.

This study was the first report about the complete chloroplast genome of Plantago fengdouensis (Plantaginaceae). The circular whole cp genome of P. fengdouensis was in a total length 164,976 bp with the typical quadripartite structure of angiosperms, containing two inverted repeats (IRs) of 38,644 bp separated by a large single-copy (LSC) region and a small single-copy (SSC) region of 82,972 and 4716 bp, respectively. The plastid genome of P. fengdouensis contains 113 genes, including 79 protein-coding genes, 4 ribosomal RNA genes, and 30 transfer RNA genes. The overall GC content of P. fengdouensis plastid genome is 38.0% and the corresponding values in LSC, SSC, and IR regions are 36.6, 30.2, and39.9%, respectively.

A new application of ultrasound-magnetic resonance multimodal fusion virtual navigation in glioma surgery.

BACKGROUND: Long-term survival and high-quality life of patients with gliomas depends on the extent of resection (EOR) and the protection of functional white matter fibers. The navigation system provides precise positioning for surgery based on preoperative magnetic resonance imaging (MRI) but the precision decreases when intraoperative brain drift occurs. Ultrasound (US) can support real-time imaging and correct brain shift. The real-time US-MRI multimodal fusion virtual navigation system (UMNS) is a new technique for glioma surgery. In order to obtain a maximum EOR and functional protection, this study aimed to explore the feasibility, efficiency, and safety of real-time UMNS for glioma surgery, and to evaluate the benefit of the new application by UMNS presetting markers between the tumor and functional white matter fiber surgery. METHODS: A retrospective analysis included 45 patients who underwent glioma surgery, 19 patients with only intraoperative US, and 26 patients with UMNS. A preoperative plan was made by 3D-slicer software based on preoperative MRI. This was combined with a reconstruction of diffusion tensor imaging (DTI) that designed the important locations as "warning points" between functional white matter fibers and tumor. Following patient registration, markers were injected into preset "warning points" under image-guided UMNS in order to give us a warning during surgery in case of postoperative function deficits. The operating time, volumetric assessment in glioma resection, and postoperative complications were evaluated and used to compared those surgeries using intraoperative US (iUS) with those surgeries using intraoperate MRI (iMRI) navigation. RESULTS: A total of 45 patients underwent glioma surgery. Gross total removal (GTR) of iUS alone was achieved in 6 of 19 cases, while this was achieved in 22 of 26 cases with UMNS alone, demonstrating an improvement in rate of GTR from 31.58% to 84.62%, respectively. This may be attributable to the superior US image quality provided by UMNS. In 13 of 26 cases, there was improved image quality (from poor/moderate to moderate/good) with the aid of UMNS. In addition, the consistency of EOR of postoperative MRI evaluated by UMNS (92.31%) was higher than when using iUS alone (42.11%). The whole process of intraoperative scanning time and marker injection did not lead to a significant delay of the operating time compared to using iUS alone, and has been reported to be shorter than with iMRI as well. Furthermore, the percentage of postoperative morbidity in the UMNS group was lower than that in the iUS group (motor deficit: 11.54% vs. 42.11%; aphasia: P =3.85% vs. 31.58%, respectively). CONCLUSIONS: Real-time UMNS is an effective, timesaving technology that offers high quality intraoperative imaging. Injection markers between functional white matter fibers and tumor by UMNS can help to obtain a maximum EOR of glioma and functional protection postoperatively. The integration of iUS into the neuronavigation system offered quick and helpful intra-operative images.