Rathke's cleft cysts (RCCs) are benign cysts typically located in the sellar or suprasellar region; ectopic isolated lesions are extremely rare. The authors describe the case of a 25-year-old man with a giant symptomatic RCC arising primarily at the cerebellopontine angle (CPA), only the second case reported thus far. The patient presented with a 2-year history of right hearing impairment and tinnitus accompanied by vertigo and headache and a 2-week history of right facial numbness. Subsequently, he underwent total cyst removal via retrosigmoid craniotomy with a good recovery. He experienced no recurrence during a 64-month follow-up period. The possible pathogenesis, differential diagnosis, and surgical treatment of such cysts are discussed in this article. Isolated ectopic RCCs can arise from the ectopic migration of Rathke's pouch cells during the embryonic period. It is still difficult to distinguish ectopic RCCs from other cystic lesions of the CPA given the lack of specific imaging features. Aggressive resection of the cyst wall is not recommended, except when lesions do not closely adhere to adjacent structures.
Objective Primary embryonal carcinoma in pineal region is extremely rare.Here we report two such cases and combined literatures review to discuss its diagnosis,treatment and prognosis.Method Two primary embryonal carcinoma in pineal region verified histologically were presented.In one cases,the pre -operative serum alpha -fetoprotein (AFP) level reached significantly high level,6 810μg/L,but showed negative staining forβ-human chorionic gonadotropin (β- HCG).In the other one,accompanied by elevation of β-HCG level,5 260 mlU/ml,the serum AFP was negative.The tumors were microsurgically removed by transoccipito -tentorial approach.Endoscopic third ventriculostomy was used after tumor removal because of recurrent hydrocephalus.Both patients received adjunctive treatments included radiation therapy (whole central nervous system 30 Gy and tumor bed 50 Gy) and 4 course of chemotherapy.Results In both patients,the tumors were totally removed.Postoperative tumor immunohistochemistry indicators were present in case 1 with positive reaction for cytokeratin(CK) and AFP,in case 2 with positive CK and β-HCG.After adjunctive treatments,the serum AFP and β - HCG of two patiants were decreased to normal ranges.After post - operative follow - up of one year,two patients still survived and the serum markers were almost normal.Conclusions Measurement of serum β-HCG and AFP is extraordinarily significant for the diagnosis and post - treatment monitoring of pineal region embryonal carcinoma.Pathological differential diagnosis requires immunohistochemical indicators including cytokeratin (CK),AFP andβ - HCG.With radically surgical removal and combined adjunctive therapy including radiation and chemotherapy,good consequence could be obtained.
Key words:
Embryonal carcinoma ; Surgery ; Chemotherapy ; Radiotherapy ; Immunohistochemistry ;
Accumulating evidence has implied that microRNAs (miRNAs) are implicated in glioma progression, and genetically engineered mesenchymal stem cells can help to inhibit tumor growth of glioma. Herein we hypothesized that miR-199a could be delivered by mesenchymal stem cells to glioma cells through exosomes and thus prevent the glioma development by down-regulating ArfGAP with GTPase domain, ankyrin repeat and PH domain 2 (AGAP2). The expression pattern of miR-199a and AGAP2 was characterized in glioma tissues and cells using RNA polymerase chain reaction quantification, immunohistochemical staining and Western blot assays. Mesenchymal stem cells transfected with miR-199a mimic or their derived exosomes were co-cultured with U251 cells. The biological behaviors as well as chemosensitivity of U251 cells were assessed to explore the involvement of miR-199a/AGAP2 in glioma. MiR-199a was poorly expressed in glioma tissue and cells while AGAP2 was highly expressed. Mesenchymal stem cells delivered miR-199a to the glioma cells via the exosomes, which resulted in the suppression of the proliferation, invasion and migration of glioma cells. Besides, mesenchymal stem cells over-expressing miR-199a enhanced the chemosensitivity to temozolomide and inhibited the tumor growth in vivo. Taken together, mesenchymal stem cell-derived exosomal miR-199a can inhibit the progression of glioma by down-regulating AGAP2.
Objective To explore and evaluate the feasibility and clinical effects of early-stage nutritional target strategic treatment in severe craniocerebral injury cases.Methods The patients of severe craniocerebral injury were randomly divided into research group and control group.42 cases of research group accepted early-stage nutritional target strategic treatment,in which the enteral nutrition of integral protein fiber type was infused through naso-intestinal tube uniformly and optimally in the early stage.41cases of control group accepted enteral nutrition through naso-gastric tube in the early stage and the infusion rate was increased every day.Parenteral nutrition was added when the target nutritional level was not achieved after 24 hours of enteral nutrition.The factors of nitrogen balance status,necessary proportion of parenteral nutrition,time to achieve the target level of enteral nutrition,time of mechanical ventilation,time of ICU hospitalization and the complications were recorded and compared between the two groups.Results All the patients achieved the strategic target level of enteral nutrition.The proportion of parenteral nutrition in the research group was less than that in the control group.The time to achieve nitrogen balance and target level of enteral nutrition,time of mechanical ventilation and time of ICU hospitalization were significantly shorter in the research group.The incidence rates of gastrointestinal intolerance,pneumonia and blood glucose disturbance were significantly lower in the research group.Conclusions Optimized enteral nutrition in the early stage of severe craniocerebral injury may achieve the target level of nutrition and nitrogen balance in a short term.It could reduce the proportion of parenteral nutrition,decrease the time of mechanical ventilation and ICU hospitalization,and decrease the incidence of gastrointestinal intolerance and pneumonia.
Key words:
Target strategy; Enteral nutrition; Early stage; Craniocerebral injury
To explore the dynamic changes of serum interleukin-6 (IL-6) and IL-8 in acute traumatic brain injury (TBI) and their correlations to the severity of brain injury and the condition of the patients.Thirty-four patients with acute TBI were divided into two groups according to the Glasgow Coma Scale (GCS) score, clinical manifestations and the imaging data, namely patients with GCS score < or = 8 and those with GCS score between 9 and 12. Radioimmunoassay was employed to determine the serum levels of IL-6 and IL-8 at 6 different time points within 15 days after the injury in the two groups.The serum IL-6 reached the peak level on the second day after the injury in patients with GCS score < or = 8 and on the 7th day in patients with GCS score of 9-12, showing significant differences in IL-6 variations between the two groups (P=0.046). The peak serum level of IL-8 occurred on the 7th day in patients with GCS score < or = 8 and on the 3rd day in patients with GCS score of 9-12, also showing significant differences (P=0.045). The peak level of IL-6 on the second day after the injury was significantly higher than the peak level of IL-8 that occurred on the 7th day, demonstrating significant differences in the variations of IL-6 and IL-8 after the injury (P=0.000).The changes of serum IL-6 and IL-8 levels show positive correlations to the severity of the condition of the patients sustaining TBI. IL-6 variation is more obvious than that of IL-8 without intimate correlations between them. Clinically, serum IL-6 level can be more informative than serum IL-8 level in evaluating the changes of the condition of the TBI patients in early stage following the injury.
The cavitation flow of the cartridge pilot-operated relief valve's main valve port was numerically simulated and studied using Computational Fluid Dynamics (CFD) in our research, and the relief valve structure was modified to decrease cavitation noise. The findings indicate that cavitation in the relief valve occurs mostly downstream of the main valve port and is linked to the wall. Cavitation generation is influenced by the jet at the valve port. The closer the high-speed jet at the valve port is to the valve's inner wall, the more readily cavitation occurs. Conversely, there is less cavitation. This paper reports the effect of the forms and parameters of the main port structure on the jet angle and the morphology of cavitation. The structure of the spool's annular groove has a considerable influence on the cavitation attached to the spool wall and the valve sleeve wall, whereas the outlet position of the relief valve mostly impacts the intensity of cavitation near the valve sleeve wall. Based on this, the relief valve's optimized structure is designed, with which the maximum vapor volume fraction and total vapor volume of the cavitation flow are considerably decreased for various inlet pressures and spool openings. The results of the experiment show that following optimization, the noise of the relief valve drops dramatically, confirming that optimizing the structure has a beneficial impact on decreasing cavitation noise.
Purpose To explore the effects of recombinant human growth hormone (r-hGH) on inflammatory mediators, immune cells and prognosis in severe neurosurgical patients. Methods From August 2020 to June 2021, a total of 236 patients who admitted to the neurosurgical intensive care unit (NSICU) were retrospectively analyzed. The patients were divided into GH group (97 cases) and nGH group (139 cases) according to whether they received r-hGH treatment. Parameters including CD4 + T cell counts, inflammatory mediators and prognosis were recorded and assessed. Results The results showed that the cure time of pneumonia and intracranial infection in GH group patients was significantly shorter than in the nGH group (24.25 ± 4.89 days and 21.33 ± 1.53 days versus 29.13 ± 7.43 days and 25.17 ± 2.32 days, respectively). However, there was no significant difference in GOS scores between two groups (31.96% ≤ 3 and 68.04% > 3 vs 39.57% ≤ 3 and 60.43% > 3) ( P = 0.232). Furthermore, the number of CD4 + T cells and CD8 + T cells in the GH group showed a significant upward trend. Last but not least, significant differences were also observed in IL-6 and IL-10 levels between two groups at days 1, 3, and 7. Conclusion The application of r-hGH in severe neurosurgical patients was effective in increasing the number of CD4 + T cells, down-regulating inflammatory mediators, shortening the cure time of pneumonia, intracranial infections and urinary tract infections, and improving patients’ prognosis.
External ventricular drainage (EVD) is a common treatment method in neurosurgery. EVD-associated infections are severe complications of EVD catheterization. How to optimize catheterization and postoperative management to reduce EVD-associated infections remains a difficult clinical issue. In this article, the pathogenesis of EVD-associated infection, preoperative preparation and surgical process of EVD, fixation and maintenance of drainage tubes, nursing, preventive use of antibiotics, and disease status of patients are expounded, so as to provide reference for better reducing EVD-associated infections.
Key words:
Drainage; Infection; External ventricular drainage
Background: Glioma is responsible for a high mortality rate globally. Accumulating evidence reveals that microRNAs (miRs) are implicated in glioma progression, and mesenchymal stem cells (MSCs) play a significant part in glioma treatment. Herein we hypothesized that microRNA-199a (miR-199a) could be delivered by MSCs to glioma cells through exosomes and thus affect the glioma progression by regulating Arf GTPase-activating protein-2 (AGAP2).Methods: Bioinformatics analysis was conducted in an attempt to identify the differential genes in glioma. MSCs were infected with overexpressed miR-199a and the exosomes were extracted to co-culture with U251 cells. The expression of AGAP2 was quantified in glioma. The proliferation, invasion, migration and apoptosis of U251 cells were assessed to explore the involvement of miR-199a/AGAP2 in glioma. Furthermore, xenograft in nude mice was employed to evaluate the effect of MSCs-derived exosomal miR-199a on glioma in vivo.Results: MiR-199a was low expressed in glioma tissue and the cell lines while AGAP2 was highly expressed. MiR-199a could target AGAP2. miR-199a over-expression or AGAP2 silencing inhibited the glioma cell invasion, migration as well as proliferation. MSCs delivered miR-199a to the glioma cells via the exosomes, which resulted in the suppression of the proliferation, invasion and migration of glioma cells. Besides, the combination of miR-199a and MSCs enhanced the chemosensitivity to glioma and inhibited the tumor growth in vivo.Conclusion: Taken together, this study provides evidence that miR-199a can be delivered from MSC to the glioma cells through the exosomes and inhibits the progression of glioma by down-regulating AGAP2. This finding is potential to provide a novel target for glioma treatment. Funding: None.Declaration of Interest: The authors declare that they have no conflict of interest.Ethical Approval: This study was conducted with the approval of the Ethics Committee of Nanfang Hospital, Southern Medical University. All patients signed the informed consent. The animal experiment procedures were performed in strict accordance with the protocols approved by the Institutional Animal Care and Use Committee.
Abstract BackgroundLinezolid (LNZ) is a common antibiotic used to treat bacterial infections. But there is a lack of evaluation of pharmacokinetics (PK) of LNZ dose adjustment for creatinine clearance (CrCL) in highly heterogeneous critically ill patients. By using a population PK approach, we aimed to determine the optimal dosing strategy for LNZ in critically ill patients, especially those along with renal dysfunction. MethodsThis multicenter, prospective, open-label, observational study was conducted in intensive care units of 4 tertiary hospitals. Of the 152 eligible patients, 117 were included for establishing the PK model. Besides internal validation, external validation was conducted using another 35 patients as a validation group. The area under curve from 0 to 24h at steady-state divided by the minimum inhibitory concentration (AUC 24 /MIC) >80 and trough concentration of LNZ <10 mg/L was used as the target pharmacodynamic index. Dosing regimens for MIC of 0.5 to 4 mg/L were evaluated based on low, normal, and high creatinine clearance using Monte Carlo simulation.ResultsA one-compartment model was chosen as the base model. The PK parameter estimates were clearance of 5.60 L/h and the volume of the central compartment of 43.4 L. CrCL had a significant influence on clearance of LNZ, with an adjusting factor of 0.386. The standard dosing regimen [600 mg every 12 hour (q12h)] achieved adequate exposure in patients with severe renal impairment (CrCL, 40 mL/min). A daily dose of 1200 mg could provide sufficient exposure for MIC less than 2 mg/L in patients with normal renal functions (CrCL, 80 mL/min). For augmented renal clearance (ARC), a daily dose of 1200 mg could provide sufficient exposure for MIC less than 2 mg/L. Continuous infusion obtained a similar clinical response.ConclusionsFor critically ill patients, the standard dose of 600 mg LNZ q12h was adequate for MIC<1 mg/L. With ARC, a 1200 or 1800 mg/day 24h continuous infusion was recommended.
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