ABSTRACT
BACKGROUND: Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population. METHODS: We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses. FINDINGS: We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16â¯% (95â¯% CI 15â¯%-17â¯%) from 70 studies. In-hospital mortality was 5â¯% (95â¯% CI, 3â¯%-7â¯%), 18â¯% (95â¯% CI, 12â¯%-24â¯%), 65â¯% (95â¯% CI, 59â¯%-70â¯%) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981-2022) and in severe (1986-2022) elderly patients with TBI. Older age 1.69 (95â¯% CI, 1.58-1.82, P < 0.001), male gender 1.34 (95â¯% CI, 1.25-1.42, P < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95â¯% CI, 1.02-1.45, P = 0.029), GCS moderate (GCS 9-12 compared to GCS 13-15) 4.33 (95â¯% CI, 3.13-5.99, P < 0.001), GCS severe (GCS 3-8 compared to GCS 13-15) 23.09 (95â¯% CI, 13.80-38.63, P < 0.001), abnormal pupillary light reflex 3.22 (95â¯% CI, 2.09-4.96, P < 0.001), hypotension after injury 2.88 (95â¯% CI, 1.06-7.81, P = 0.038), polytrauma 2.31 (95â¯% CI, 2.03-2.62, P < 0.001), surgical intervention 2.21 (95â¯% CI, 1.22-4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95â¯% CI, 1.24-1.86, P = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95â¯% CI, 1.23-1.84, P < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95â¯% CI, 1.04-2.76, P = 0.032), Warfarin 2.26 (95â¯% CI, 2.05-2.51, P < 0.001), DOACs 1.99 (95â¯% CI, 1.43-2.76, P < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95â¯% CI, 1.024-1.034, P < 0.001) for every 1-year increase in age on in-hospital mortality. CONCLUSIONS: In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population. REVIEW REGISTRATION: PROSPERO CRD42022323231.
Subject(s)
Brain Injuries, Traumatic , Hospital Mortality , Humans , Brain Injuries, Traumatic/mortality , Brain Injuries, Traumatic/epidemiology , Aged , Risk Factors , Aged, 80 and over , Male , Female , Middle Aged , Age FactorsABSTRACT
Both therapeutic hypothermia and neural stem cells (NSCs) transplantation have shown promise in neuroprotection and neural repair after brain injury. However, the effects of therapeutic hypothermia on neuronal differentiation of NSCs are not elucidated. In this study, we aimed to investigate whether mild hypothermia promoted neuronal differentiation in cultured and transplanted human NSCs (hNSCs). A significant increase in neuronal differentiation rate of hNSCs was found when exposed to 35°C, from 33% to 45% in vitro and from 7% to 15% in vivo. Additionally, single-cell RNA sequencing identified upregulation of RNA-binding motif protein 3 (RBM3) in neuroblast at 35°C, which stabilized the SRY-box transcription factor 11 (SOX11) mRNA and increased its protein expression, leading to an increase in neuronal differentiation of hNSCs. In conclusion, our study highlights that mild hypothermia at 35°C enhances hNSCs-induced neurogenesis through the novel RBM3-SOX11 signaling pathway, and provides a potential treatment strategy in brain disorders.
ABSTRACT
In managing severe traumatic brain injury (TBI), emergency surgery involving the removal of damaged brain tissue and intracerebral hemorrhage is a priority. Secondary brain injury caused by oxidative stress and energy metabolic disorders, triggered by both primary mechanical brain damage and surgical insult, is also a determining factor in the prognosis of TBI. Unfortunately, the effectiveness of traditional postoperative intravenous neuroprotective agents therapy is often limited by the lack of targeting, timeliness, and side effects when neuroprotective agents systemically delivered. Here, we have developed injectable, intelligent, self-assembling hydrogels (P-RT/2DG) that can achieve precise treatment through intraoperative application to the target area. P-RT/2DG hydrogels were prepared by integrating a reactive oxygen species (ROS)-responsive thioketal linker (RT) into polyethylene glycol. By scavenging ROS and releasing 2-deoxyglucose (2DG) during degradation, these hydrogels functioned both in antioxidation and energy metabolism to inhibit the vicious cycle of post-TBI ROS-lactate which provoked secondary injury. In vitro and in vivo tests confirmed the absence of systemic side effects and the neuroprotective function of P-RT/2DG hydrogels in reducing edema, nerve cell apoptosis, neuroinflammation, and maintaining the blood-brain barrier. Our study thus provides a potential treatment strategy with novel hydrogels in TBI.
Subject(s)
Brain Injuries , Neuroprotective Agents , Humans , Reactive Oxygen Species/metabolism , Neuroprotective Agents/pharmacology , Oxygen/metabolism , Hydrogels/pharmacology , Brain/metabolism , Brain Injuries/drug therapy , Energy MetabolismABSTRACT
TRPA1 is pivotal in cold hypersensitivity, but its regulatory mechanisms in inflammatory cold hyperalgesia remain poorly understood. We show here that the upregulation of SUMO1-conjugated protein levels in a complete Freund's adjuvant (CFA)-induced inflammatory pain model enhances TRPA1 mRNA stability, ultimately leading to increased expression levels. We further demonstrate that hnRNPA1 binds to TRPA1 mRNA, and its SUMOylation, upregulated in CFA-induced inflammatory pain, contributes to stabilizing TRPA1 mRNA by accumulating hnRNPA1 in the cytoplasm. Moreover, we find that wild-type hnRNPA1 viral infection in dorsal root ganglia neurons, and not infection with the SUMOylation-deficient hnRNPA1 mutant, can rescue the reduced ability of hnRNPA1-knockdown mice to develop inflammatory cold pain hypersensitivity. These results suggest that hnRNPA1 is a regulator of TRPA1 mRNA stability, the capability of which is enhanced upon SUMO1 conjugation at lysine 3 in response to peripheral inflammation, and the increased expression of TRPA1 in turn underlies the development of chronic inflammatory cold pain hypersensitivity.
Subject(s)
Chronic Pain , Sumoylation , Animals , Mice , Chronic Pain/metabolism , Freund's Adjuvant , Ganglia, Spinal/metabolism , Hyperalgesia/metabolism , Inflammation/metabolism , RNA, Messenger/genetics , RNA, Messenger/metabolism , TRPA1 Cation Channel/genetics , TRPA1 Cation Channel/metabolismABSTRACT
Small ubiquitin-like modifier (SUMO) typically conjugates to target proteins through isopeptide linkage to the ε-amino group of lysine residues. This posttranslational modification (PTM) plays pivotal roles in modulating protein function. Cofilins are key regulators of actin cytoskeleton dynamics and are well-known to undergo several different PTMs. Here, we show that cofilin-1 is conjugated by SUMO1 both in vitro and in vivo. Using mass spectrometry and biochemical and genetic approaches, we identify the N-terminal α-amino group as the SUMO-conjugation site of cofilin-1. Common to conventional SUMOylation is that the N-α-SUMOylation of cofilin-1 is also mediated by SUMO activating (E1), conjugating (E2), and ligating (E3) enzymes and reversed by the SUMO deconjugating enzyme, SENP1. Specific to the N-α-SUMOylation is the physical association of the E1 enzyme to the substrate, cofilin-1. Using F-actin co-sedimentation and actin depolymerization assays in vitro and fluorescence staining of actin filaments in cells, we show that the N-α-SUMOylation promotes cofilin-1 binding to F-actin and cofilin-induced actin depolymerization. This covalent conjugation by SUMO at the N-α amino group of cofilin-1, rather than at an internal lysine(s), serves as an essential PTM to tune cofilin-1 function during regulation of actin dynamics.
Subject(s)
Actins , Sumoylation , Lysine , Actin Depolymerizing Factors , UbiquitinABSTRACT
The molecular mechanism underlying the functional interaction between H1R and TRPV1 remains unclear. We show here that H1R directly binds to the carboxy-terminal region of TRPV1 at residues 715-725 and 736-749. Cell-penetrating peptides containing these sequences suppress histamine-induced scratching behavior in a cheek injection model. The H1R-TRPV1 binding is kept at a minimum at rest in mouse trigeminal neurons due to TRPV1 SUMOylation and it is enhanced upon histamine treatment through a transient TRPV1 deSUMOylation. The knockin of the SUMOylation-deficient TRPV1K823R mutant in mice leads to constitutive enhancement of H1R-TRPV1 binding, which exacerbates scratching behaviors induced by histamine. Conversely, SENP1 conditional knockout in sensory neurons enhances TRPV1 SUMOylation and suppresses the histamine-induced scratching response. In addition to interfering with binding, TRPV1 SUMOylation promotes H1R degradation through ubiquitination. Our work unveils the molecular mechanism of histaminergic itch by which H1R directly binds to deSUMOylated TRPV1 to facilitate the transduction of the pruritogen signal to the scratching response.
Subject(s)
Histamine , Pruritus , Receptors, Histamine H1 , Sumoylation , Animals , Histamine/metabolism , Mice , Pruritus/chemically induced , Pruritus/metabolism , Receptors, Histamine H1/metabolism , Sensory Receptor Cells/metabolism , TRPV Cation Channels/genetics , TRPV Cation Channels/metabolismABSTRACT
BACKGROUND: After a traumatic brain injury (TBI), the cell environment is dramatically changed, which has various influences on grafted neural stem cells (NSCs). At present, these influences on NSCs have not been fully elucidated, which hinders the finding of an optimal timepoint for NSC transplantation. METHODS: Brain extracts of TBI mice were used in vitro to simulate the different phase TBI influences on the differentiation of human NSCs. Protein profiles of brain extracts were analyzed. Neuronal differentiation and the activation of autophagy and the WNT/CTNNB pathway were detected after brain extract treatment. RESULTS: Under subacute TBI brain extract conditions, the neuronal differentiation of hNSCs was significantly higher than that under acute brain extract conditions. The autophagy flux and WNT/CTNNB pathway were activated more highly within the subacute brain extract than in the acute brain extract. Autophagy activation by rapamycin could rescue the neuronal differentiation of hNSCs within acute TBI brain extract. CONCLUSIONS: The subacute phase around 7 days after TBI in mice could be a candidate timepoint to encourage more neuronal differentiation after transplantation. The autophagy flux played a critical role in regulating neuronal differentiation of hNSCs and could serve as a potential target to improve the efficacy of transplantation in the early phase.
ABSTRACT
Direct current electric field (DCEF) steers the migration of various neural cells. Microglia, as macrophage of the central nervous system (CNS), however, have not been reported to engage in electrotaxis. Here, we applied electric fields to an in vitro environment and found directional migration of BV2 microglia toward the cathode, in a DCEF strength-dependent manner. Transcriptome analysis then revealed significant changes in the mitogen-activated protein kinase cascades. In terms of mechanism, DCEF coordinated microglia movement by regulating the ERK/GSK3ß/cofilin signaling pathway, and PMA (protein kinase C activator) reversed cell migration through intervention of the ERK/GSK3ß/cofilin axis. Meanwhile, LiCl (GSK3ß inhibitor) showed similar functions to PMA in the electrotaxis of microglia. Furthermore, pharmacological and genetic suppression of GSK3ß or cofilin also modulated microglia directional migration under DCEF. Collectively, we discovered the electrotaxis of BV2 microglia and the essential role of the ERK/GSK3ß/cofilin axis in regulating cell migration via modulation of F-actin redistribution. This research highlights new insight toward mediating BV2 directional migration and provides potential direction for novel therapeutic strategies of CNS diseases.
Subject(s)
Actin Depolymerizing Factors , Microglia , Cell Movement/physiology , Glycogen Synthase Kinase 3 beta , Signal TransductionABSTRACT
Posttranslational modifications of nuclear proteins, including transcription factors, nuclear receptors, and their coregulators, have attracted much attention in cancer research. Although phosphorylation of oligodendrocyte transcription factor 2 (Olig2) may contribute to the notorious resistance of gliomas to radiation and genotoxic drugs, the precise mechanisms remain elusive. We show here that in addition to phosphorylation, Olig2 is also conjugated by small ubiquitin-like modifier-1 (SUMO1) at three lysine residues K27, K76, and K112. SUMOylation is required for Olig2 to suppress p53-mediated cell cycle arrest and apoptosis induced by genotoxic damage, and to enhance resistance to temozolomide (TMZ) in glioma. Both SUMOylation and triple serine motif (TSM) phosphorylation of Olig2 are required for the antiapoptotic function. Olig2 SUMOylation enhances its genetic targeting ability, which in turn occludes p53 recruitment to Cdkn1a promoter for DNA-damage responses. Our work uncovers a SUMOylation-dependent regulatory mechanism of Olig2 in regulating cancer survival.
Subject(s)
DNA Damage , Glioma/metabolism , Oligodendrocyte Transcription Factor 2/metabolism , Sumoylation , Tumor Suppressor Protein p53/metabolism , Animals , Apoptosis , Cell Cycle Checkpoints , Cyclin-Dependent Kinase Inhibitor p21/genetics , Cyclin-Dependent Kinase Inhibitor p21/metabolism , Gene Targeting , Glioma/genetics , Glioma/pathology , HEK293 Cells , Humans , Mice , Mice, Inbred BALB C , Mice, Nude , Oligodendrocyte Transcription Factor 2/genetics , Phosphorylation , Promoter Regions, Genetic , Protein Processing, Post-Translational , Tumor Suppressor Protein p53/genetics , Xenograft Model Antitumor AssaysABSTRACT
Imbalanced mitochondrial fission/fusion, a major cause of apoptotic cell death, often results from dysregulation of Drp1 phosphorylation of two serines, S616 and S637. Whereas kinases for Drp1-S616 phosphorylation are well-described, phosphatase(s) for its dephosphorylation remains unclear. Here, we show that dual-specificity phosphatase 6 (DUSP6) dephosphorylates Drp1-S616 independently of its known substrates ERK1/2. DUSP6 keeps Drp1-S616 phosphorylation levels low under normal conditions. The stability and catalytic function of DUSP6 are maintained through conjugation of small ubiquitin-like modifier-1 (SUMO1) and SUMO2/3 at lysine-234 (K234), which is disrupted during oxidation through transcriptional up-regulation of SUMO-deconjugating enzyme, SENP1, causing DUSP6 degradation by ubiquitin-proteasome. deSUMOylation underlies DUSP6 degradation, Drp1-S616 hyperphosphorylation, mitochondrial fragmentation, and apoptosis induced by H2O2 in cultured cells or brain ischemia/reperfusion in mice. Overexpression of DUSP6, but not the SUMOylation-deficient DUSP6K234R mutant, protected cells from apoptosis. Thus, DUSP6 exerts a cytoprotective role by directly dephosphorylating Drp1-S616, which is disrupted by deSUMOylation under oxidation.
Subject(s)
Dual Specificity Phosphatase 6/metabolism , Dynamins/metabolism , Oxidative Stress , Animals , Apoptosis/genetics , Dual Specificity Phosphatase 6/genetics , Dynamins/genetics , Gene Expression , Humans , Hydrogen Peroxide/metabolism , Male , Mice , Mitochondria/metabolism , Oxidation-Reduction , Phosphorylation , Protein Stability , Proteolysis , SUMO-1 Protein/metabolism , Sumoylation , Ubiquitins/metabolismABSTRACT
In order to overcome the side effects of pancreatic transplantation and insulin injection treatment for type I diabetes, we established a drug delivery system employing nanoparticle embedded microcapsules (NEMs). The system co-encapsulated chitosan nanoparticles with γ-aminobutyric acid and ß-TC-6 cells for combined drug and cell therapy in diabetes mellitus (DM). The NEMs, which were formed via high-voltage electrostatic method, had an excellent sphericity with a smooth surface. The average size NEM was 245.52 ± 22.00 µm, which indicated a good size for cell encapsulation. Haemolysis rate of NEMs at concentrations of 100, 200 or 300 mg/mL were all below 5%. Relative viability rates of L929 cells with the same concentrations at 24, 48 or 72 h were all above 80%. We implanted bioactive NEMs into type 1 DM mice to evaluate the effect of the combined therapy. The level of blood glucose in the group receiving the combined therapy decreased during the first 2 weeks of treatment. During the next week, the level of blood glucose stayed in a safe range. Body weight continuously increased during the postoperative period after combined therapy group. Oral glucose tolerance test (OGTT) performed after 24 d showed that the level of blood glucose combined therapy reached the maximum peak of 13.04 mmol/L, lower than 16.56 mmol/L for the cell therapy group. This primary study indicated that microencapsulation technology and combined therapy are promising for the treatment of type I diabetes mellitus.
Subject(s)
Chitosan/chemistry , Diabetes Mellitus, Type 1/therapy , GABA Agents/administration & dosage , Insulin-Secreting Cells/transplantation , Nanoparticles/chemistry , gamma-Aminobutyric Acid/administration & dosage , Animals , Blood Glucose/analysis , Capsules , Cell Line , Cells, Immobilized/cytology , Cells, Immobilized/transplantation , Diabetes Mellitus, Type 1/blood , GABA Agents/therapeutic use , Insulin-Secreting Cells/cytology , Mice , gamma-Aminobutyric Acid/therapeutic useABSTRACT
Chronic subdural hematoma (CSDH) is not a benign disease in the elderly, and the mortality of CSDH is reported to be up to 32%. The study aimed to analyze hospital mortality and evaluate the risk factors in patients with CSDH. We retrospectively reviewed all patients with CSDH treated in the neurosurgery department of Renji hospital, School of Medicine, Shanghai Jiao Tong University from 10/2003 to 10/2018. Univariate and multivariate logistic regression analyses on the factors, including gender, age, Glasgow Coma Scale (GCS) on admission, main symptoms, history of head trauma, location of hematoma, density of subdural hematoma, laboratory tests on admission, et al, were performed. A total of 1117 patients with CSDH were included in the study, among which 20 patients died (mortality rate: 1.8%). Comparing the survival group and the death group, gender (pâ¯<â¯0.01), GCS on admission (pâ¯<â¯0.01), impaired consciousness as the presenting symptom (pâ¯=â¯0.041), history of head trauma (pâ¯=â¯0.02), location of hematoma (pâ¯=â¯0.03), platelet (pâ¯<â¯0.01), prealbumin (pâ¯=â¯0.046), albumin (pâ¯<â¯0.01), international normalized rate (INR) (pâ¯=â¯0.03), high sensitivity C-reactive protein (hsCRP) (pâ¯<â¯0.01), postoperative hyperthermia (pâ¯<â¯0.01) were shown to have significance. The logistic regression analysis revealed that GCS on admission (odds ratio [OR] 0.077, pâ¯<â¯0.01), bilateral CSDH (OR 0.100, pâ¯<â¯0.01 left CSDH as reference), prealbumin (OR 0.137, pâ¯=â¯0.02), INR (OR 12.959, pâ¯<â¯0.01) and hsCRP (OR 8.397, pâ¯<â¯0.01) were significantly associated with a higher mortality rate in CSDH. GCS on admission, bilateral CSDH, prealbumin, INR and hsCRP might be independent predictors of CSDH mortality.
Subject(s)
Hematoma, Subdural, Chronic/mortality , Hospital Mortality , Adult , Aged , Aged, 80 and over , Biomarkers/analysis , China , Female , Glasgow Coma Scale , Hematoma, Subdural, Chronic/pathology , Humans , Male , Middle Aged , Odds Ratio , Retrospective Studies , Risk FactorsABSTRACT
Direct current electric field (DC EF) plays a role in influencing the biological behaviors and functions of cells. We hypothesize that human astrocytes (HAs) could also be influenced in EF. Astrocytes, an important type of nerve cells with a high proportion quantitatively, are generally activated and largely decide the brain repair results after brain injury. So far, no electrotaxis study on HAs has been performed. We here obtained HAs derived from brain trauma patients. After purification and identification, HAs were seeded in the EF chamber and recorded in a time-lapse image system. LY294002 and U0126 were then used to probe the role of PI3K or ERK signaling pathway on cellular behaviors. The results showed that HAs could be guided to migrate to the anode in DC EFs, in a voltage-dependent manner. The HAs displayed elongated cell bodies and reoriented perpendicularly to the EF in morphology. When treated with LY294002 or U0126, alternation of parameters such as cellular verticality, track speed, displacement speed, long axis, vertical length and circularity were inhibited partly as expected, while the EF-induced directedness was not terminated even at a high drug dosage which was not consistent with previous electrotaxis studies. In conclusion, applied EFs steered the patient-derived HAs directional migration and changed morphology, in which PI3K and ERK pathways at least partially participate. The characteristics of HAs to EF stimulation may be involved in wound healing and neural regeneration, which could be utilized as a novel treatment strategy in brain injury.
Subject(s)
Astrocytes/physiology , Cell Movement/physiology , Cells, Cultured , Electric Stimulation/methods , Electricity , Humans , MAP Kinase Signaling System/physiology , Nerve Regeneration/physiology , Signal Transduction/physiology , Wound Healing/physiologyABSTRACT
A prospective observational study collected temperature data from 51 patients in 11 neurosurgical centers and follow-up outcome information at 6 months in 49 patients. Brain temperature (Tbr) was measured directly by an intraventricular temperature sensor. Axillary temperature (Tax) and rectal temperature (Tre) were measured by electric thermometers. Tbr was 0.4 to 1.5°C higher than body temperature. Tre correlated well with the Tbr (coefficient: 0.7378; p < 0.05). Among all patients, Glasgow Coma Scale (GCS) scores on admission were significantly lower in the patients with post-operatively extreme peak temperature (Tpeak, < 37°C or >39°C in first 24 h) and major temperature variation (Tvari > 1°C in first 12 h; p < 0.05, p < 0.01, respectively). Among the patients with no temperature intervention, the extreme Tpeak group showed a lower Glasgow Outcome Scale-Extended (GOS-E) score at 6 months (p < 0.05) with lower GCS scores on admission (p < 0.01), compared with the moderate Tpeak group. Remarkably, the major Tvari group showed significantly lower GOS-E scores (p < 0.05) with the same GCS scores as the minor Tvari group. Thus, Tre is the better candidate to estimate Tbr. Spontaneously extreme Tpeak in TBI represents both more serious injury on admission and worse prognosis, and Tvari might be used as a novel prognostic parameter in TBI. Brain temperature is therefore one of the critical indicators evaluating injury severity, prognostication, and monitoring in the management of TBI. This prospective observational study has been registered in ClinicalTrials.gov ( https://clinicaltrials.gov ), and the registration number is NCT03068143.
Subject(s)
Body Temperature/physiology , Brain Injuries, Traumatic/physiopathology , Brain Injuries, Traumatic/therapy , Brain/physiopathology , Adult , Aged , Female , Glasgow Coma Scale , Glasgow Outcome Scale , Humans , Hypothermia, Induced , Male , Middle Aged , Prognosis , Prospective StudiesABSTRACT
Objective: To investigate the appropriate depth of drainage catheter in the patients with chronic subdural haematoma (CSDH). Methods: We retrospectively analysed the data of 190 patients with CSDH undergoing single parietal burr-hole evacuation and drainage. Results: According to the depth of catheter (DC), 190 patients were divided into three groups: shallow group (DC <4.3 cm), middle group (DC 4.3 ~ 5.4 cm) and deep group (DC > 5.4 cm). During postdischarge 6 months, two, six and nine patients had recurrences in shallow, middle and deep groups, respectively. The recurrence rate in shallow or middle group was significantly lower than that in deep group. No significant difference in preoperative haematoma volume (PHV) was observed in three groups. While the residual subdural space (RSS) in shallow group was significantly smaller than those in the other two groups. The duration of drainage in shallow, middle and deep groups increased successively, and the differences were statistically significant. The total drainage volume (TDV) in shallow group showed no significant difference when compared with the other two groups. Conclusion: The depth of catheter may affect the outcome of CSDH. Inserting drainage catheter shallowly might be a preferred choice in patients with CSDH undergoing burr-hole evacuation and drainage.
Subject(s)
Drainage/instrumentation , Hematoma, Subdural, Chronic/surgery , Subdural Space/pathology , Adult , Aged , Craniotomy , Female , Hematoma, Subdural, Chronic/diagnostic imaging , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Subdural Space/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Neutrophil-lymphocyte ratio (NLR) is a simple, low-cost and easily measured inflammation marker, corresponding with pathological tumor grading and clinical prognosis in various cancers. OBJECTIVES: This study aimed to investigate the relationship between preoperative NLR and glioma grading and also the correlation between NLR and glioblastoma survival. METHODS: The preoperative NLR was analyzed retrospectively in 239 gliomas of different grades, and receiver operating characteristic (ROC) curve analysis was adopted to investigate the prediction of glioma grading. Univariate and multivariate analyses were performed to analyze the variables of overall survival (OS) of glioblastoma patients. RESULTS: There were significant differences in the preoperative NLR values among the four glioma groups, with the highest values observed in the glioblastoma group (p < 0.05). ROC curve analysis showed the NLR value of 2.36 was a cutoff point for predicting glioblastoma. The OS of patients with high NLR (≥ 4.0) was shorter compared with that with low NLR (< 4.0) (mean 11.23 vs. 18.56 months, p < 0.05). Univariate analysis and multivariate analysis indicated age≥ 60, NLR≥ 4.0, Karnofsky Performance Scores (KPS) ≤ 70, incomplete tumor resection, incomplete Stupp protocol accomplishment and the isocitrate dehydrogenase 1 (IDH1) wild-type as independent prognostic indicators for poor outcome (each p < 0.05). CONCLUSION: The preoperative NLR was correlated with glioma grading, and the elevated NLR was an independent predictive factor for poor outcome of glioblastoma patients. Abbreviation IDH1: Isocitrate dehydrogenase 1IL-8: Interleukin-8KPS: Karnofsky Performance ScoresNLR: Neutrophil-lymphocyte ratioOS: Overall survivalROC: Receiver operating characteristicSD: Standard deviationsWHO: World Health Organization.
Subject(s)
Central Nervous System Neoplasms/blood , Central Nervous System Neoplasms/pathology , Glioma/blood , Glioma/pathology , Central Nervous System Neoplasms/mortality , Central Nervous System Neoplasms/surgery , Female , Glioma/mortality , Glioma/surgery , Humans , Kaplan-Meier Estimate , Leukocyte Count , Male , Middle Aged , Neoplasm Grading , Preoperative Period , Prognosis , ROC Curve , Retrospective StudiesABSTRACT
The vegetative state is a complex condition with unclear mechanisms and limited diagnostic, prognostic, and therapeutic methods. In this study, we aimed to explore the proteomic profile of tears from patients in a traumatic vegetative state and identify potential diagnostic markers using tears-a body fluid that can be collected non-invasively. Using iTRAQ quantitative proteomic technology, in the discovery phase, tear samples collected from 16 patients in a traumatic vegetative state and 16 normal individuals were analyzed. Among 1080 identified tear proteins, 57 were upregulated and 15 were downregulated in the patients compared to the controls. Bioinformatics analysis revealed that the differentially-expressed proteins were mainly involved in the wound response and immune response signaling pathways. Furthermore, we verified the levels of 7 differentially-expressed proteins in tears from 50 traumatic vegetative state patients and 50 normal controls (including the samples used in the discovery phase) using ELISA. The results showed that this 7-protein panel had a high discrimination ability for traumatic vegetative state (area under the curve = 0.999). In summary, the altered tear proteomic profile identified in this study provides a basis for potential tear protein markers for diagnosis and prognosis of the traumatic vegetative state and also provides novel insights into the mechanisms of traumatic vegetative state.
Subject(s)
Eye Proteins/metabolism , Persistent Vegetative State/metabolism , Proteome , Tears/metabolism , Adult , Aged , Aged, 80 and over , Biomarkers/metabolism , Chromatography, Liquid , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Mass Spectrometry , Middle Aged , Proteomics , ROC Curve , Young AdultABSTRACT
Diabetes mellitus is the most common endocrine disease worldwide; hyperglycemia is a hallmark of this disease. To alleviate the pain caused by diabetes, developing and utilizing effective diabetic drugs to maintain or recover the function of the residual ß-cells is an attractive therapeutic approach. γ-aminobutyric acid (GABA) has been shown to have such effects, but it is easy to have reduced GABA activity under physiological conditions. In the present study, GABA-chitosan nanoparticles (GABA-CS NPs) were prepared, and glucose homeostasis, pancreatic ß-cell protection, and anti-inflammatory effects of GABA-CS NPs were investigated in vivo. The results showed that blood glucose levels and IL-1ß levels in the GABA-CS NP-administered group were both significantly lower, whereas the PDX1 expression was significantly higher than that of the impaired group (p < 0.01). This indicates that GABA-CS NPs can efficiently maintain glucose homeostasis, protect ß-cells, and inhibit inflammation. These nanoparticles have the potential to be applied for future diabetes theranostics.
Subject(s)
Anesthetics, Intravenous/adverse effects , Cerebellar Diseases/complications , Intracranial Hemorrhage, Hypertensive/complications , Mydriasis/chemically induced , Mydriasis/therapy , Propofol/adverse effects , Cerebellar Diseases/surgery , Decompressive Craniectomy/methods , Female , Humans , Intracranial Hemorrhage, Hypertensive/surgery , Middle Aged , Unconsciousness/etiologyABSTRACT
Normal astrocytes are more resistant to radiation than glioma cells. Radiation-resistant glioma cells and normal astrocytes usuallly share similar mechanisms of radioresistance. Investigation of the underlying mechanisms of differential radiation response between normal astrocytes and glioma cells is thus significant for improvement of glioma treatment. Here, we report on the differential radiation responses between normal astrocytes and glioma cells at the transcriptome level. Human astrocytes (HA) and U251 glioma cell lines were used as in vitro models. The transcriptome profiles of radiation-treated and nontreated HA and U251 cells were generated by next-generation sequencing. In total, 296 mRNAs and 224 lncRNAs in HA and 201 mRNAs and 107 lncRNAs in U251 were found to be differentially expressed after radiation treatment. Bioinformatics analyses indicated that radiation causes similar alterations in HA and U251 cells, while several key pathways involved in cancer development and radiation resistance, including P53, TGF-ß, VEGF, Hippo and serotonergic synapse pathways, were oppositely regulated by radiation treatment, suggesting their important role in this process. Furthermore, we showed the critical role of Hippo/YAP signaling in radiation resistance of glioma cells. In summary, our findings revealed novel insights about differential responses between normal astrocytes and glioma cells. Our work suggested that YAP inhibitor could not be used in combination with radiation for glioma treatment.