Retrospective analysis of robot-assisted laparoscopic transabdominal anterior approach for the treatment of lumbar paravertebral schwannoma.

BACKGROUND: The main objective of this study was to investigate the impact of robot-assisted laparoscopic resection on paravertebral tumours using the anterior peritoneal approach. METHODS: A retrospective analysis to identify patients with paravertebral tumours. A total of 21 patients, who underwent robot-assisted laparoscopic transabdominal anterior approach surgery from March 2012 to August 2020. RESULTS: The median operation time was 66.2 ± 14.5 min, with a range of 0-100 min. Intraoperative blood loss was minimal, with a median of 11.4 ± 7.9 mL and a range of 5-30 mL. The median tumour length was 4.8 ± 2.3 cm, ranging from 2.1 to 11.3 cm. Postoperative hospitalisation lasted for a median of 3.2 ± 0.9 days. During the 48-month follow-up period, no tumour recurrence or residual was observed in any patient. CONCLUSIONS: Robot-assisted laparoscopic resection of lumbar paravertebral schwannoma proved to be a safe and viable surgical approach. It offers a relatively new treatment option for paraspinal schwannoma.

Differentiating Oxygen Exchange Reaction Mechanisms across Phase Boundaries.

Triggering phase transitions by controlling the anion stoichiometry is an effective method of tuning the electrocatalytic activity of the functional oxides. However, understanding the potential differences in the reaction mechanism(s) of different phases requires the accurate mapping of phase boundaries during the electrochemical reactions, which can be quite challenging. In this work, we have established a feasible electrochemical method based on the measurement of chemical capacitance to resolve the critical stoichiometry at phase boundaries under operando conditions. We select a simple binary oxide PrOx as a proof-of-principle model system, which shows excellent activity for high-temperature oxygen incorporation and evolution reactions (OIR/OER). We show that the phase transition can be sensitively probed by quantifying the chemical capacitance, which can be further used for differentiating the OIR/OER mechanisms across the phase boundary of PrOx. Therefore, our findings provide a new framework for exploring phase engineering as a tool for the design of electrocatalysts.

Hematoma evacuation based on active strategies versus conservative treatment in the management of moderate basal ganglia hemorrhage: A retrospective study.

Objective: The internal capsule of the basal ganglia is vulnerable to direct pressure from the hematoma and to secondary damage from toxic products of hemorrhage. Our study evaluated the risk and benefits of active strategies including ultra-early surgery and hematoma evacuation through a transsylvian-transinsular approach for moderate basal ganglia hemorrhage. Methods: We retrospectively collected patients with moderate basal ganglia hemorrhage in two hospitals. The conservative group contained 51 patients who had the best medical treatment, and the surgery group contained 36 patients who were treated with hematoma evacuation through a transsylvian-transinsular approach within 6 h from ictus. Motor function of upper and lower limbs recorded with the motor sub-score of NIHSS (m-NIHSS) at the baseline, 7 days, 30 days, and 90 days, the modified Rankin Scale (mRS), and Barthel Index (BI) scores at 30 and 90 days were compared between the two groups. Good recovery was defined as an m-NIHSS of 0-2 and poor recovery as 3-4. Favorable prognosis was defined as an mRS of 0-3 and unfavorable prognosis as 4-5. Results: The mean time from ictus to surgery was 250.3 ± 57.3 min. The good recovery proportions of upper and lower limbs in the surgery group were significantly higher than that in the conservative group (p < 0.05) at 7 days after hemorrhage. The good recovery proportion of upper limbs was significantly higher in the surgery group than in the conservative group (p < 0.05) at 3 months after hemorrhage. Living ability using BI scores was significantly higher in the surgery group than the conservative group (p < 0.05) at 3 months after hemorrhage. The favorable prognosis proportion had no statistically significant difference between the two groups at 3 months after hemorrhage. Conclusions: Ultra-early hematoma evacuation through a transsylvian-transinsular approach are active strategies for moderate basal ganglia hemorrhage and have potential advantages in improving motor function recovery and daily living. The postoperative rebleeding rate does not increase simultaneously.

"Cutoff Clipping" Technique as a Tentative Clipping Alternative for Large Aneurysms: A Preliminary Study.

BACKGROUND: Intraoperative rupture of an aneurysm is potentially devastating. The thin-walled regions (TIWRs) of an aneurysm are associated with rupture risk. This study aimed to describe the feasibility and concerns of the "cutoff clipping" technique for TIWRs disposition of certain complex aneurysms. METHODS: Three cases were reported to illustrate the "cutoff clipping" technique which was applied to clip a large aneurysm. This study emphasized the exposure and clipping of the aneurysm fundus. The fundus was dissected according to the TIWRs size threshold the author proposed and was clipped transversely by a temporary clip to achieve size reduction and blood flow disconnection. The authors called this the "cutoff clipping" technique. After the cutoff clip was placed, the neck of the aneurysm was further dissected and clipped. RESULTS: After successfully placing the cutoff clip, the surgeon achieved to reduce the size of the fundus, decrease the TIWRs proportion, and disconnect the blood flow from the neck to the distal thin-walled dome. Sequentially, three aneurysms were clip-ligated without complications. CONCLUSION: The "cutoff clipping" technique applied under suitable conditions is a potential choice to dissect and clip a complex aneurysm with an adhesive neck and thin-walled dome.

Quantifying Electrochemical Driving Force for Exsolution in Perovskite Oxides by Designing Graded Oxygen Chemical Potential.

Metal nanoparticles exsolved and anchored at the parent perovskite oxide surfaces can greatly enhance the activity and antisintering stability for high-temperature (electro-) chemical catalytic reactions. While exsolution of nanoparticles triggered by using conventional high-temperature thermal reduction suffers from slow kinetics, using an electrochemical driving force can promote the exsolution rate. However, a quantitative correlation between the applied electrochemical driving force and the spatial density of exsolved nanoparticles remains unknown. In this work, we use a specially designed electrochemical device to induce a spatially graded voltage in a La0.43Ca0.37Ti0.94Ni0.06O3-δ electrode, in order to systematically investigate the effect of electrochemical switching on exsolution. With increasing driving force, which leads to decreasing oxygen chemical potential, the density of nanoparticles was observed to increase dramatically, while the average particle size remained roughly constant. We further identified oxygen vacancy pairs or clusters as the preferential nucleation sites for exsolution. Our work provided a high-throughput platform for the systematic study of exsolution of perovskite oxides targeted for fuel electrode materials with improved electrocatalytic performance and stability.

Prognostic significance of serum annexin A7 in severe traumatic brain injury: A prospective longitudinal cohort study.

BACKGROUND: Annexin A7 (ANXA7) may have the potential to exacerbate brain injury. Our purpose was to investigate the role of serum ANXA7 as a biomarker of severity and prognosis after severe traumatic brain injury (sTBI). METHODS: In this prospective cohort study, we consecutively enrolled 102 sTBI patients and 102 controls and measured their serum ANXA7 concentrations. Post-trauma 180-day poor prognosis was considered as extended Glasgow outcome scale score 1-4. RESULTS: Significantly increased serum ANXA7 concentrations of sTBI patients, as compared to controls (median, 74.1 vs 8.0 ng/ml; P < 0.001), had independent correlation with Rotterdam computed tomography score (t = 3.251, P = 0.002) and Glasgow coma scale score (t = -2.253, P = 0.027), as well as serum ANXA7 concentrations > 74.1 ng/ml were independently predictive of 180-day overall survival (hazard ratio, 3.356; 95 % confidence interval (CI), 1.233-9.138; P = 0.018), and poor prognosis (OR: 3.558; 95 % CI, 1.264-10.015; P = 0.016). Serum ANXA7 concentrations were of significant efficiency for discriminating risks of mortality (area under receiver operating curve (AUC), 0.808; 95 % CI; 0.718-0.879) and poor prognosis (AUC, 0.772; 95 % CI; 0.678-0.849). Moreover, its AUC was in range of Glasgow coma scale score and Rotterdam computed tomography score (all P > 0.05) CONCLUSIONS: Increased serum ANXA7 concentrations, in close relation to severity, were independently associated with prognosis, indicating that serum ANXA7 may represent a clinically valuable biomarker of sTBI.

Clinical Observation of Patients Undergoing Glioma Surgery under Propofol and Sevoflurane Anesthesia: A Retrospective Study.

Objective: To observe the effects of propofol and sevoflurane anesthesia on patients undergoing glioma surgery. Methods: 192 patients with gliomas treated in our hospital from January 2016 to January 2021 were selected. All patients were randomly divided into observation group and control group. The observation group was given sevoflurane and the control group was given propofol. The clinical effects of the two groups were observed. Results: Comparison of clinical indexes related to intraoperative conditions between the two groups revealed that the time of anesthesia and extubation after operation in the observation group were shorter than those in the control group, and the difference was statistically significant (P < 0.05). The amount of intraoperative bleeding in the observation group was less than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in intracranial operation time, operation time, fluid volume, and urine volume between the two groups (P < 05). Comparing the recovery time of anesthesia between the two groups, the recovery time of orientation and the time of eye-opening in the observation group were significantly shorter than those in the control group (P < 0.05). Comparing the consciousness and cognitive function of the two groups, the OAAS score of the observation group after extubation, before leaving the operating room and 1 hour after extubation, was significantly higher than that of the control group (P < 0.05), and the MMSE score l h after extubation was significantly higher than that of the control group (P < 0.05). Comparing the incidence of postoperative complications between the two groups, the number of cases of restlessness, urinary infection, deep vein thrombosis, and hypertension in the observation group was lower than that in the control group, with statistical significance (P < 0.05). Conclusion: The anesthesia time and extubation time of the sevoflurane anesthesia group were shorter than that of the propofol anesthesia group, and the orientation recovery time and eye-opening time were shortened. The OAAS score of the sevoflurane anesthesia group was higher than that of the propofol anesthesia group after extubation, before extubation, and 1 hour after extubation. The probability of postoperative complications in the sevoflurane anesthesia group was lower than that in the propofol anesthesia group. Sevoflurane anesthesia may be more suitable for surgical induction of glioma patients than propofol anesthesia.

Phenotypic and Functional Characterizations of Mesenchymal Stem/Stromal Cells Isolated From Human Cranial Bone Marrow.

Mesenchymal stem/stromal cells (MSCs) are adult stem cells that were originally isolated from bone marrow. In contrast to long bone-derived MSCs that have been extensively characterized, our knowledge regarding to MSCs isolated from flat bones (e.g., cranial bones) remain less clear. In this study, MSCs were purified from human cranial bone marrow (CB-MSCs) and their transdifferentiation capacity and immunomodulatory functions were further characterized. Phenotypic analysis of CB-MSCs demonstrated high expression of CD73, CD90, and CD105 while negative for CD14, CD34, and HLA-DR. Further in vitro differentiation assay shown that CB-MSCs capable of differentiating into cell types of mesenchymal origin (i.e., adipocytes, osetoblasts, and chondrocytes) and collectively, these results indicated that cells isolated from cranial bone marrow in this study are bona fide MSCs according to the minimal criteria proposed by the International Society for Cellular Therapy. Following in vitro expansion, single colony-derived CB-MSCs (scCB-MSCs) were obtained and confocal microscopy analysis further revealed functional heterogeneity within primary CB-MSCs. Specifically, obtained scCB-MSCs exhibited GABA progenitor features, as determined by olig2 and nestin. As expect, scCB-MSCs were readily induced to differentiate into GABAergic neuron-like cells. Furthermore, immunomodulatory roles of scCB-MSCs were evaluated following co-culture with human peripheral blood lymphocytes and results shown that co-culturing with scCB-MSCs significantly suppressed lymphocyte proliferation and promoted differentiation of lymphocytes into regulatory T cells but not Th1/Th17 phenotype. Overall, our results indicated that CB-MSCs exhibited clonal heterogeneity with marked propensity to differentiate into neural-like cells and this might represent promising candidates for the treatment of neurodegenerative diseases.

Prognostic Factors and Treatments Efficacy in Spontaneous Spinal Epidural Hematoma: A Multicenter Retrospective Study.

BACKGROUND AND OBJECTIVES: Spontaneous spinal epidural hematoma (SSEH) is an uncommon but serious condition with a high morbidity rate. Although SSEH is related to numerous risk factors, its etiology remains unclear. There is a paucity of data on its prognostic factors. We aim to evaluate prognostic factors for SSEH in this study. METHOD: A retrospective study was performed on patients who were admitted for SSEH in 3 academic neurosurgical centers from January 2010 to June 2021. Clinical parameters, including clinical condition on admission, anticoagulants use, imaging modality, the timing and type of surgery performed, and outcomes, were collected. Prognostic factors were analyzed. The Frankel scale was used to assess the clinical condition. RESULTS: A total of 105 patients with SSEH were retrieved from medical records, with a mean age of 51.3 years. Eighty-three patients (79%) complained of acute onset of severe neck or back pain. Eighty-two patients (78%) suffered from moderate to severe neurologic deficits (Frankel scale A-C). Anticoagulation usage was found in 20% of cases. Lower thoracic spine (p = 0.046), use of anticoagulants (p = 0.019), sphincter function disfunction (p = 0.008), severe neurologic deficits at admission (p < 0.001), and rapid deterioration (<1 hour, p = 0.004) were found to be associated with poor outcomes. Surgical decompression was performed in 74 (70%) cases. The univariate and multivariate analysis revealed that preoperative severe neurologic deficits (p = 0.005) and extended paraplegia time (>12 hours, p = 0.004) were independent adverse prognostic factors. The univariate analysis revealed that lower thoracic spine location (p = 0.08) and rapid progression (<6 hours, p = 0.005) were correlated with poor prognosis, but the multivariate analysis failed to identify them as independent prognostic factors. DISCUSSION: Adverse prognostic factors for SSEH might include thoracic segment location, use of anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, and rapid progression. Preoperative neurologic deficit and extended paraplegia time were strongly correlated with the prognosis in the subset of patients who underwent surgical decompression. Timely surgical decompression is recommended for patients with moderate/severe neurologic deficits or progressive neurologic deterioration.

Ventriculoperitoneal Shunt Alone for Cerebrospinal Fluid Rhinorrhea With Neuroendocrine Alterations in Idiopathic Intracranial Hypertension: A Case Report and Literature Review.

Spontaneous skull base cerebrospinal fluid (CSF) leaks due to idiopathic intracranial hypertension (IIH) are a rare entity. Patients often present with CSF rhinorrhea, recurrent meningitis, chronic headache, and visual defects, while few patients have been reported to present with neuroendocrine alterations. Endonasal endoscopic repair is the first-line treatment for these leaks at present. However, the relatively high risk of recurrence remains the main cause of reoperation because of elevated intracranial pressure (ICP) after endoscopic surgery and absence of postoperative ICP management. A shunting procedure may stop CSF leakage or relieve symptoms in complex cases, and this is presently well-known as the last-line therapy for CSF liquorrhea. We describe a 29-year-old woman with spontaneous CSF rhinorrhea and neuroendocrine alterations due to IIH, and with no previous history of trauma, tumor, or nasal surgery. The bone defect in the skull base became implicated when the site of the leak was detected by cranial magnetic resonance imaging and computed tomography (CT). The patient was successfully managed via ventriculoperitoneal shunt (VPS) alone without endoscopic repair, and neuroendocrine alterations resolved after the shunting procedure.

An Optimized Method for Adipose Stromal Vascular Fraction Isolation and its Application in Fat Grafting.

BACKGROUND: The stromal vascular fraction (SVF) derived from adipose tissue contains heterogeneous cell populations and has enormous potential for clinical therapy. There are two main methods for SVF isolation: enzymatic isolation and mechanical isolation, both of which have shortcomings. In this study, optimized conditions for the isolation of high-quality SVF were established, and applications in fat grafting were evaluated. METHODS: Adipose tissue was chopped into small pieces and then ground into an erosive shape using a syringe. The pieces were digested with 0.15% type II collagenase for 35 min at 37 °C. After centrifugation, the pellets were resuspended in DMEM and passed through a 100-µm strainer. The filtered cells were analyzed by flow cytometry. The fat graft was enriched with isolated SVF and subcutaneously transplanted into nude mice. Three weeks after transplantation, grafts were isolated, and H&E staining, immunocytochemistry, and western blotting were conducted. RESULTS: The harvested SVF cells reached > 2 × 106/ml of adipose tissue within 90 min of operation. The number of CD34+ ADSCs in our SVF pellets was > 6 × 105/ml of adipose tissue, which has the potential for differentiating into osteoblasts, adipocytes, and chondrocytes. Freshly collected adipose tissue is better for SVF isolation, and isolated SVF should also be kept at 4 °C and used as soon as possible. SVF may promote revascularization after fat grafting. The adipose tissue of an SVF co-transplanted group had an integral structure, clear capillaries, and higher VEGF expression. SVF co-transplantation inhibited adipose cell apoptosis. CONCLUSION: Our study provides an efficient procedure for SVF isolation, its application in fat grafting, and possible underlying mechanisms. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Value of miR-296 and miR-517c in Evaluating the Prognosis of Patients with Glioma after Radiotherapy and Chemotherapy.

OBJECTIVE: To explore the value of miR-296 and miR-517c in evaluating the prognosis of patients with glioma after radiotherapy and chemotherapy. METHODS: 732 patients with glioma were selected from January 2012 to January 2018. According to the effect of postoperative chemotherapy, the patients were divided into two groups: the effective group and the ineffective group. The serum miR-296, miR-517c, and clinicopathological parameters of the two groups before chemotherapy were compared. The factors affecting the sensitivity of radiotherapy and chemotherapy and the predictive efficacy of miR-296 and miR-517c on the prognosis of patients were analyzed. RESULTS: The expression level of miR-296 in glioma tissue was significantly correlated with tumor pathological grade and depth of invasion (P < 0.05), and the expression level of miR-296 in glioma tissue was significantly correlated with tumor pathological grade (P < 0.05). Logistic regression analysis showed that tumor size, WHO grade, and serum miR-296 and miR-517c levels were all factors affecting chemosensitivity (P < 0.05). The sensitivity, specificity, accuracy, and AUC of serum miR-296 prediction were 76.95%, 89.64%, 85.35%, and 0.891, respectively. The sensitivity, specificity, accuracy, and AUC of serum miR-517c prediction were 72.81%, 86.50%, 82.19%, and 0.739, respectively. CONCLUSION: miR-296 and miR-517c are closely related to the chemosensitivity and prognosis of glioma patients. High levels of miR-296 and miR-517c can enhance chemosensitivity and serve as reliable indexes to predict the prognosis of patients with glioma.

Metformin Ameliorates Neuronal Necroptosis after Intracerebral Hemorrhage by Activating AMPK.

BACKGROUND: Intracerebral hemorrhage (ICH) is a major cause of death and disability globally. As a type of secondary injury after ICH, treatment for cell death can promote the recovery of neurological function. METHODS: Among all the cell death, neuronal necroptosis has recently been demonstrated of significance in the pathogenesis of ICH. However, the administration of drugs against necroptosis has many limitations. RESULTS: In the present study, we found that metformin, a first-line medication for the treatment of type 2 diabetes, can effectively inhibit neuronal necroptosis after ICH by activating the AMPK related pathway, thereby significantly improving neurological function scores and reducing brain edema. CONCLUSION: These results will provide a new perspective for future research in necroptosis.

Ultra-structural morphology analysis of human cranial bone marrow mesenchymal stromal cells during neural differentiation.

Neural differentiation of mesenchymal stromal cells has been widely studied. However, a comparative characterization of ultrastructural changes during neural differentiation has not been performed. In this study, we conducted scanning electron microscopy and transmission electron microscopy analysis to show the morphological changes in mesenchymal stromal cells upon induction of neural differentiation. In addition, transmission electron microscopy results demonstrated ultrastructural differences between human cranial bone marrow mesenchymal stromal cells and iliac crest bone marrow mesenchymal stromal cells. We propose that enriched microvesicles in cranial bone marrow mesenchymal stromal cells may be responsible for the increased efficiency of neural differentiation.

Comparison of phenotypic markers and neural differentiation potential of human bone marrow stromal cells from the cranial bone and iliac crest.

Cellular therapies represent a new frontier in the treatment of neurological diseases. Accumulating evidence from preclinical studies of animal models suggests that mesenchymal stromal cells (MSCs), also known as mesenchymal stem cells, are an effective therapy for neurological diseases. In this study, we established human MSC lines from both cranial bone marrow (cBMMSCs) and iliac crest bone marrow (iBMMSCs) from the same donors and found that cBMMSCs show higher expression of neural crest-associated genes than iBMMSCs. Moreover, as observed in both mRNA and protein assays, neurogenic-induced cells from cBMMSCs expressed significantly higher levels of neural markers, such as NESTIN, SLUG, SOX9, and TWIST, than those from iBMMSCs. Thus, cBMMSCs showed a greater tendency than iBMMSCs to differentiate into neuron-like cells.

Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult: A case report.

RATIONALE: Klebsiella pneumonia (K. pneumonia), primarily a hospital-acquired pathogen, can cause a variety of deep-seated infections with significant morbidities. However, in the current scenario of global rise in antibiotic abuse, unexpected infection could be caused by K. pneumoniae. PATIENT CONCERNS: A 56-year-old male who presented with intermittent headache and low fever was admitted, he had transsphenoidal surgery for pituitary adenoma 3 years ago. Routine laboratory tests revealed an elevated WBC count of 10.12 × 10/L and C-reactive protein (CRP) 12.9 mg/L. computed tomography (CT) revealed the sellar region with suspicious hemorrhage. DIAGNOSES: The patient was initially diagnosed with acute residual tumor hemorrhage. But the consequent diagnose of Klebsiella pneumoniae purulent meningitis was made based on the cerebrospinal fluid lab test and cerebrospinal fluid (CSF) and blood culture, and CT scan. INTERVENTIONS: Lumbar puncture examination was made and the antibiotics were adjusted to meropenem and vancomycin according to the antibiotic sensitivity test. But because of the patient's unstable vital signs, his family refuse further lateral ventricular drainage. OUTCOMES: The infection was out of control and the patient died of spontaneous breath and heartbeat arrest. LESSONS: Through this case, we could learn that any clue of suspicious intracranial infection should be carefully considered in the current scenario of global rise in antibiotic abuse. The manifestation of intermittent headache and mild fever could be potential signs of fatal infection, and prompt appropriate measures should be taken timely.

Correlation of tenascin-C concentrations in serum with outcome of traumatic brain injury in humans.

BACKGROUND: Tenascin-C, a matricellular protein, is involved in brain injury. However, change of tenascin-C concentrations in peripheral blood remains unknown after traumatic brain injury (TBI). METHODS: Serum tenascin-C concentrations were measured in 100 healthy controls, 108 severe TBI patients, 79 moderate TBI patients and 32 mild TBI patients. RESULTS: Serum tenascin-C concentrations of patients were significantly higher than those of controls. Tenascin-C concentrations negatively correlated with Glasgow Coma Scale (GCS) scores in all patients (r=-0.658, P<0.001). In severe TBI patients, tenascin-C in serum significantly discriminated patients at risk of 6-month mortality (area under curve, 0.821; 95% confidence interval, 0.735-0.888) and poor outcome (Glasgow Outcome Scale score of 1-3) (area under curve, 0.833; 95% confidence interval, 0.749-0.898) and emerged as an independent predictor for 6-month mortality (odds ratio, 1.114; 95% confidence interval, 1.008-1.233; P=0.005), overall survival (hazard ratio, 1.085; 95% confidence interval, 1.010-1.166; P=0.003) and unfavorable outcome (odds ratio, 1.049; 95% confidence interval, 1.014-1.076; P=0.001). By receiver-operating characteristic analysis, serum tenascin-C concentrations had similar prognostic value compared with GCS scores. CONCLUSIONS: Enhanced serum tenascin-C concentrations are closely related to trauma severity and clinical outcomes, substantializing tenascin-C as a potential prognostic biomarker after TBI.

Preoperative simulation of the running course of the abducens nerve in a large petroclival meningioma: a case report and literature review.

One of the most important and useful pieces of information in the preoperative evaluation of a large petroclival meningioma is the running course of the abducens nerve. The abducens nerve is small and has a long intracranial course, making it prone to compression by the tumor at various anatomical points. In relatively large tumors, it is difficult to confirm the entire course of the abducens nerve, even by heavy T2-thin slice imaging. We report a case of successful preoperative estimation of the course of the abducens nerve that aided in its complete preservation during the resection of a large petroclival tumor.