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Objective:To evaluate the effect of microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach assisted by 3DSlicer software.Methods:From January 2020 to January 2021, 18 patients with parafalcine meningioma in The second hospital of Hebei Medical University were randomly selected as the observation group.The contralateral longitudinal fissure was treated by microsurgery assisted by 3DSlicer software.Before operation, improve the imaging examinations such as brain CT plain and enhancement, magnetic resonance angiography and magnetic resonance venography, establish the models of tumor, superior sagittal sinus and superior cerebral artery by using 3DSlicer software, analyze the positional relationship between tumor and superior sagittal sinus and superior cerebral vein, and remove the tumor by contralateral longitudinal fissure approach.Nineteen patients with parafalx meningioma treated by traditional ipsilateral longitudinal fissure approach from January to December 2019 were selected as the control group.The differences in operation time, intraoperative bleeding, limb muscle strength recovery rate, headache and dizziness relief rate were compared between the two groups.Results:In the observation group, the positional relationship between the reconstructed tumor and the superior cerebral vein above its base was completely consistent with the actual situation during the operation.All patients underwent Simpson grade I resection, and there was no injury to the superior cerebral vein and venous sinus during the operation.The recovery rate of limb muscle strength in the observation group (75%(9/12)) was higher than that in the control group (23%(3/13))( P=0.009). There was no significant difference in the operation time, intraoperative bleeding and the remission rate of headache and dizziness one week after operation in the observation group ( P>0.05). Conclusion:3DSlicer software was helpful for preoperative evaluation of the positional relationship between parafalcine meningioma and the anatomic structures such as superior cerebral vein and superior sagittal sinus.Under the guiding of 3DSlicer software, surgeon removed the tumor totally through the contralateral longitudinal fissure approach, which effectively reduced the operative side injury of the important structures such as superior cerebral vein and functional cerebral cortex, and contributed highly to the recovery of limb muscle strength of patients.
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Objective To investigate application value and significance of mixed reality technology in surgical treatment and doctor-patient communication for vestibular schwannoma. Methods We selected randomly 13 vestibular schwannoma patients treated with surgical treatment. After the three-dimensional models were constructed, preoperative surgical planning and doctor-patient communication were performed with mixed reality technology. Craniotomy through retrosigmoid sinus approach, tumor resection and facial nerve protection were achieved intraoperatively with the assistance of mixed reality technology. Questionnaires were collected and facial nerve function of 13 patients was recorded one week after operation. Results Holographic model images of 13 cases were showed successfully using mixed reality technology. The locations of preoperative facial nerves reconstructed were completely consistent with actual locations in 10 cases (84.6%). After preoperative anatomic analysis, it was decided to remove partly the posterior wall of the internal auditory canal in 11 cases. The result of doctor-patient communication questionnaire showed that 13 patients and their family all had a thorough understanding of the condition, operative plan and risks, and expressed satisfaction with the preoperative conversation. With the assistance of mixed reality technology, the tumors were resected totally without injury of vein sinus in 13 cases. The facial nerve function was gradeⅠin 3 cases, gradeⅡin 6 cases, grade Ⅲ in 3 case and grade Ⅳ in 1 case based on House-Brackmann grading one week after surgery. Conclusion Mixed reality technology is quite helpful in individual surgical planning and preoperative doctor-patient communication. It helps reduce the side injuries of surgery and protect the function of facial nerve as a surgical assistant tool intraoperatively.
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Objective To investigate the molecular mechanism of SNHG5 regulating the proliferation, invasion and apoptosis of glioblastoma multiforme (GBM) cells by targeting miR-421. Methods Real-time quantitative PCR test was performed to detect the expression levels of SNHG5 and miR-421 in 31 cases of GBM tissue samples and 32 cases of normal brain tissue samples. After increasing or decreasing SNHG5 expression in U87 cell lines by lentivirus or plasmid transfection, the changes of miR-421 expression were measured by real-time quantitative PCR, to explore the correlation between SNHG5 and miR-421 in GBM. The dual-luciferase reporter test was performed to explore the target interaction of SNHG5 and miR-421. The plasmids with low expression of SNHG5 and miR-421 were cotransfected into U87 cells for the rescue experiment. CCK-8 test, Transwell test, flow cytometry and tumor cell xenograft in nude mice were used to verify molecular mechanism of SNHG5 regulating the proliferation, invasion and apoptosis of GBM in vitro and vivo. Results The expression level of miR-421 was decreased in U87 cell line after SNHG5 upregulation. In addition, the expression level of miR-421 was increased in U87 cell line after SNHG5 downregulation (P < 0.05). The expression level of SNHG5 was correlated negatively with the expression of miR-421 in GBM and U87 cell line. The result of luciferase reporter tests indicated SNHG5 targetedly interacted with miR-421. Rescue experiment results showed that compared with si-SNHG5+miR-421-inhibitor group, the proliferation, invasion and anti-apoptosis ability of U87 cells were significantly inhibited in the si-SNHG5+control-inhibitor group, the expression levels of BAX and p21 were significantly higher, the expression levels of CyclinD1 and Bcl-2 were lower remarkably (P < 0.05). Conclusion SNHG5 promotes the proliferation, invasion and anti-apoptosis of GBM by targeting miR-421 and regulating the expression of CyclinD1, p21, BAX and Bcl-2. Downregulation of miR-421 is related to SNHG5 overexpression in GBM.
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Objective To investigate the reasons of HOXA5 overexpression in GBM and the molecular mechanism of miR-128-3p regulating the proliferation, invasion and apoptosis of glioblastoma multiforme. Methods After increasing and decreasing miR-128-3p expression in U87 cell lines by lentivirus transfection, the changes of HOXA5 expression were detected by Western blot, to explore the correlation between miR-128-3p and HOXA5 in GBM. The dual-luciferase reporter tests were performed to detect the target interaction of miR-128-3p with HOXA5. Through CCK-8 test, Transwell test, flow cytometric assay and tumor cell xenograft in nude mice, we verified molecular mechanism of miR-128-3p regulating the proliferation, invasion and apoptosis of GBM in vitro and in vivo. Results The expression level of HOXA5 was decreased in U87 cell line after miR-128-3p upregulation. In addition, the expression level of HOXA5 was increased in U87 cell line after miR-128-3p downregulation (P < 0.05). The expression level of HOXA5 was correlated negatively with the expression of miR-128-3p in U87 cell lines. MiR-128-3p targetedly interacted with 3'UTR of HOXA5 and inhibited the expression of HOXA5. The proliferation, invasion and anti-apoptosis of U87 cells were significantly decreased in the miR-128-3p+control group. Conclusion MiR-128-3p regulates negatively the proliferation, invasion and anti-apoptosis of GBM cells by targeting HOXA5. The overexpression of HOXA5 is induced by downregulation of miR-128-3p in GBM.
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Objective To investigate status quo of handover evaluation of nurses and analysis the related factors. Methods Study was administered to 505 nurses, using Handover Evaluation Scale, Perceived Organizational Support Scale, General Self-Efficacy Scale, Maslach Burnout Inventory and Nurse′s Work Pressure Sources Scale. Results The handover evaluation of nurses was in a high level (6.35±0.74)points,quality of information(6.39±0.89)points,interaction and support(6.23±0.88)points, efficiency (6.43 ± 0.69) points. Education background were influence factors of handover evaluation (F=31.97-53.65, P<0.01). Handover evaluation, organizational support and self-efficacy were positive correlation(r=0.263, 0.139, P<0.01). Handover evaluation, burnout and work pressure were negative correlation (r=-0.270,-0.257, P<0.01). Conclusions Nursing administrators should take effective measures to improve nurses′organizational support and self-efficacy level,decrease burnout and burnout for enhancing nurses′handover evaluation.
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PurposeVon Hippel-Lindau (VHL) syndrome is a rare autosomal dominant diseases involved multiple organs. This paper aims to explore the clinical and imaging features of VHL syndrome for the improvement of early diagnosis and treatment of this disease.Materials and Methods The clinical and imaging data, as well as their history of 5 patients with VHL syndrome were retrospectively studied. Follow-up was performed and the related literature was also reviewed.Results Among the 5 patients, 4 were found with angioreticulomas. One out of four patients simultaneously suffered from multiple angioreticulomas in brainstem, and another one had multiple cervical cord angioreticulomas. The typical MRI showed multiple cystic and solid mass with mixed intense signals, and the enhanced MRI displayed obvious enhancement in the solid part of the mass. Three patients were diagnosed with renal clear cell carcinomas. The typical CT scan showed equidensity or slightly low density signals, and the enhanced CT scan noted heterogeneous enhancement. Besides, bilateral epididymis cystadenoma occurred in one case. The ultrasonography presented heterogeneous echo and rich blood vessels. The follow-ups had been conducted till January 2015. According to the Glasgow outcome scale, three patients were in good conditions, while the other two died from renal clear cell carcinomas.Conclusion Patients with VHL syndrome usually have an unsatisfactory prognosis and most may die from renal carcinoma. Genetic test and investigation of family history should be performed as early as possible on patients with highly suspected or confirmed VHL Early treatment, life-long follow-up and periodic imaging examinations may be helpful in the prognosis.
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Objective To explore the relationship among psychological satety climate,proactive personality and self-efficacy.Methods Psychological safety climate scale,proactive personality scale,and self-efficacy scale were used to investigate a total of 228 registered nurses from two tertiary hospitals of Tianjin City from October to December,2013.Results The average points of nurses psychological safety climate was (3.05±0.53),average points of proactive personality was (2.70±0.48),average points of self-efficacy was (2.74±0.45),all were in the medium level.Both psychological safety climate and proactive personality could positively influence nursing self-efficacy directly(r=0349～0.472,P ＜ 0.01),and psychological safety climate could also indirectly influence nursing self-efficacy through the mediation of proactive personality (3 decreased from 0.472 to 0.352,P ＜ 0.01).Conclusions Hospi-tal should make concerted efforts to improve psychological safety climate and proactive personality so as to in-crease nurses' self-efficacy.
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Objective To investigate the operative techniques of microsurgery treatment of M1 segment of middle cerebral artery (MCA) aneurysms via pterional approach in 132 cases.Methods Retrospectively analyzed the clinical manifestation,angiograms,and surgical operation data of 132 patients with M1 segment of MCA aneurysms who underwent microsurgery through pterional approach.Results Preoperative digital subtraction angiography (DSA) was conducted in 121 cases to identify the size,shape,orientation and relationship with blood vessels around the MCA aneurysms.The other 11 cases underwent emergency operation.Among the 132 cases,72 patients were discharged in good condition according to Glasgow Outcome Scale; 41 patients were in poor condition; 19 cases were dead or in predying state.Postoperative CT showed that49 cases occurred new infarction and 7 cases developed hydrocephalus or enlargement of ventricles.Ventriculoperitoneal shunt was conducted in 2 cases.Intraoperation rupture and bleeding of aneurysms occurred in 17 cases.Conclusion The aneurysms in M1 segment of the middle cerebral artery are mostly located in the bifurcation of M1 segment.Most branches and perforating arteries stem from middle cerebral artery trunk.Patients with Hunt-hess grade Ⅰ-Ⅲ MCA aneurysms or with Hunt-hess grade Ⅳ,Ⅴ should be treated with microsurgery as soon as possible.Inside Sylvian fissure approach is the most frequently adopted in microsurgery via pterional approach.It is key for the success of the operation to preoperatively understand the anatomy surrounding the aneurysms,have good microsurgical skills and employ correct methods of preventing and managing of rupture of aneurysm.It can relieve the secondary cerebral vasospasm to clear up hematocele in the cisterns or to wash the cisterns or use adhesive wound dressing on blood vessels during operation using papaverine.