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Objective:To explore the value of the model based on multi-sequence magnetic resonance imaging (MRI) radiomics and clinical features in predicting molecular subtypes of pediatric medulloblastoma (MB).Methods:MRI imaging data and clinical data of 100 children with primary MB admitted in the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2020 were analyzed retrospectively.Fifty children with primary MB were allocated to training cohort, and those of the other 50 were allocated to testing cohort by using simple random sampling method.In the training cohort, there were 5 cases of WNT-activated MB (Wingless, WNT), 5 cases of SHH-activated MB (Sonic hedgehog, SHH), 28 cases of non-WNT/non-SHH medulloblastoma Group3 (Group3), 12 cases of non-WNT/non-SHH medulloblastoma Group4 (Group4). The testing cohort included 11 cases of WNT, 3 cases of SHH, 24 cases of Group3 and 12 cases of Group4.The robust and non-redundant features were selected from 5 929 three-dimensional radiomic features extracted from the manually delineated tumor area, and Boruta algorithm was used to further select the optimal features.Based on the selected features, a random forest prediction model was constructed using the training cohort (50 cases), which was further used to evaluate the testing cohort (50 cases). Combined with radiomic features and clinical features, a joint random forest prediction, clinical-radiomic model was constructed.Results:A radiomic model containing 13 optimal radiomics features was used to predict molecular subtypes of MB.The area under curve(AUC) of receiver operating characteristic (ROC) curve for WNT, SHH, Group3 and Group4 MB cases in the testing cohort was 0.923 1, 0.673 7, 0.519 2 and 0.705 0, respectively.Incorporating clinical features into the radiomic model improved AUC for WNT and SHH at 0.944 1 and 0.819 1, respectively.Conclusions:The multi-sequence clinical radiomic model has a high predictive value for pediatric MB with the molecular subtypes of WNT and SHH, which provides decision-making supports for individualized diagnosis and treatment of pediatric MB.
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Objective:To investigate the effect of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet distribution width (PDW) on the clinical prognosis of childhood medulloblastomaMethods:Clinical data and survival data of 76 pediatric patients who were diagnosed as medulloblastoma by post-operative pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to December 2016 were collected. Kaplan- Meier method was used to calculate the overall survival(OS) and progression free survival(EFS) rates, Log- rank test was employed to compare the survival rates of different groups, and Cox proportional hazards regression model was used for multivariate analysis. Results:The log- rank test revealed that 5-year PFS rate and OS rate (22.2%, 22.2%) in the high NLR group (NLR>4.94) were significantly lower than those in the low NLR group (NLR≤4.94) (45.6%, 55.7%), and the differences were statistically significant(PFS: P=0.009, OS: P=0.001), and the 5-year PFS and OS (52.3%, 66.5%) of the high PDW group (PDW>15.90) were significantly higher than those in the low PDW group (PDW ≤ 15.90) (27.1%, 32.5%), and the differences were statistically significant(PFS: P=0.032, OS: P=0.039). Univa-riate analysis showed that the extent of resection (PFS: P=0.006, OS: P=0.009), and postoperative radiotherapy (PFS: P=0.011, OS: P=0.001) and postoperative radiotherapy(PFS: P=0.011, OS: P=0.001) were the factors influencing the prognosis of children with medulloblastoma.Multivariate Cox proportional hazards regression model analysis suggested that no postoperative radiotherapy (PFS: P=0.048, OS: P=0.008), NLR>4.94 (PFS: P=0.023, OS: P=0.003) and PDW≤15.90 (PFS: P=0.028, OS: P=0.006) were the independent risk factors for the prognosis of childhood medulloblastoma. Conclusions:Increased NLR and decreased PDW indicate unfavorable prognosis of the childhood medulloblastoma.Therefore, preoperative NLR and PDW may be the potential prognostic markers for childhood medulloblastoma.
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Objective Revascularization of the distal segment of the anterior cerebral artery (ACA) using extracranial donors requires long interposition grafts.A novel bypass procedure which uses the two main branches of the superficial temporal artery (STA) to reach the A3 segment of the anterior cerebral artery with a single skin incision was designed.Methods Ten cadaveric specimens were dissected through a single skin incision to harvest the frontal and parietal branches of the STA from June,2017 to September,2017.An anterior interhemispheric approach provided access to the middle internal frontal artery (MIFA).The parietal STA was used as an interposition graft between the frontal STA and MIFA.Lengths and calibers of the distal branches of STA and MIFA were measured at the anastomotic sites.All data was statistical analysis by t-test.Results The average caliber of MIFA was (1.4±0.2) mm,which matched the caliber of both frontal and parietal branches of STA.The mean distance for an end-to-side bypass from STA to MIFA was (144.5±7.4) mm and the average harvested donor-graft complex length was (203.1±27.9) mm.This bypass construct provided around 140％ donor graft length.Conclusion Using the parietal branch of the STA as an interposition graft enabled a successful tension-free STA-MIFA bypass.The advantages of this technique over existing approaches include sufficient graft length,caliber match and relative technical ease.
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Objective To explore the feasibility of occipital artery(OA) to anterior inferior cerebellar artery (AICA) through the extended retrosigmoid approach,also perform a systemic microanatomical study of OA and AICA with the exposure of extended retrosigmoid approach,find the easy way to perform the procedure.Methods From September,2016 to January,2017,5 adult cadaveric heads injected with colored latex (total 10 sides) were performed the extended retrosigmoid approach,and measured the caliber of distal occipital artery (OA),the final length of the OA harvest,the reliable landmark of the OA harvest,and the distance from the flocculonodular segment of anterior inferior cerebellar artery (AICA) to the OA,the diameter of AICA flocculonodular segment branch.Whole procedure of OA to IACA bypass also be performed.Statistical analysis was performed.Results By the extended retrosigmoid approach,AICA flocculonodular segment could be easily exposure,the average diameter was 1.2 mm,the OA branch could be harvested in average was (72.3±3.3)mm in length from the occipital sulcus,and the average distance between occipital sulcus and AICA flocculonodular segment was (47.6±l.9)mm.The bypass procedure also could be performed through the proper corridor.Conclusion The Extended retrosigmoid approach is a safe and efficient way to perform the OA-AICA bypass procedure,and the procedure is easier to be performed than other surgical approaches.
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Objective To explore the clinicopathological features,imaging manifestation and treatment of solitary fibrous tumor in the central nervous system(cSFT),in order to improve the diagnosis and treatment.Methods Fourteen cases of cSFT that had been received microsurgery treatment from June,2010 to July,2016 were analyzed retrospectively.The clinicopathological features,treatment and prognosis were concluded and analyzed.Results In 14 patients with cSFT treated with microsurgery,and 1 case in the foramen magnum region for the first time,and enriched the understanding of this disease.Of 14 patients with cSFT,12 received total resection and 2 subtotal or part.The cSFT were pathologically diagnosed as benign tumors in 11 patients and low grade cSFT in 3.The microscopical presence of spindle-shaped tumor cells arranged in fascicles that alternate hypocellular and hypercellular areas separated from each other by collagenous fibre.Immunohistochemistry was positive for Vimentin,and CD34,Bcl-2 of 14 patients,and positive for CD99 in 12 patients.Followed-up time was from 6 to 49 months.Twelve cases had good prognosis to total resection and 2 recurrence due to subtotal or part resection.Conclusion cSFT is extremely rare,and it has some characteristics on MRI,final diagnosis should be depended on pathological and immunohistochemical examination.There are good prognoses in the patients with cSFT after the total removal of cSFT,but when the lesion could not be totally resected,radiotherapy should be considered,the curative effect of chemotherapy on cSFT is not definitive.
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Objective To investigate the clinical effect of microsurgical resection combined with preoperative interventional embolization in the treatment of solid intracranial hemangioblastomas, and to analyze the effect of pre-operative embolization on tumor resection,and to discuss the surgical technique and perioperative management of mi-crosurgery. Methods From September, 2010 to September, 2015, the clinical signs, preoperative embolization, mi-crosurgery and prognosis of 18 patients with solid hemangioblastomas were retrospectively analyzed. The patients were examined by CTA and MRI,18 patients underwent DSA tumor arterial embolization and tumor microsurgery. Results The tumor diameter was 2.5-4.0 cm, the proportion of preoperative embolization tumor was 100% in 4 cases, 80% -95% in 9 cases,60%-70% in 3 cases and 60% in 2 cases.16 cases(88.9%)were subtotal tumors,2 cases(11.1%) were subtotal resection, 1 case died. No patients with intraoperative blood transfusion.followed up for 2 years without tumor recurrence. Conclusion The risk of postoperative hemangioblastomas is high, and the intervention of em-bolization for tumor artery will reduce the risk of operation.Microsurgery is the preferred treatment,and skilled micro-surgery is the key to treatment.
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Objective To discuss the safety of inhaled nitric oxide (iNO)for bronchopulmonary dysplasia (BPD).Methods We analysed 65newborns diagnosed as BPD from January 2012to December 2013in Maternal and Child Health Hospital of the Guangxi Zhuang Autonomous Region.They were divided into iNO group(n=35)and control group(n=30)according to whether administering iNO or not.The heart rate,blood pressure,oxygen supply time,assisted ventilation time,hospital stay,concentration of NO2 and methemoglobin,and the changes of coagulation function were observed dynamically before and after iNO treatment.Results There were significant differences in oxygen supply time[(37±9)d vs.(55±7)d], assisted ventilation time[(29±7)d vs.(35±9)d],hospital stay [(45±9)d vs.(54±7)d]between iNO group and control group(P﹤0.05).There were no obvious changes in heart rate,blood pressure and co-agulation function before and after iNO treatment(P﹥0.05).The incidences of the complications had no sig-nificant differences between the two groups (P﹥0.05).Conclusion Long-time iNO can shorten oxygen therapy time and assisted ventilation time,iNO therapy in BPD doesn′t found serious adverse effect to cardio-vascular function as well as coagulation function,and doesn′t increase the risk of intracranial hemorrhage and retinopathy of prematurity.
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<p><b>OBJECTIVE</b>To propose a clinically practical and simple fiber tracking method for language pathways, and to explore its feasibility in preoperative planning for brain tumors adjacent to the language cortex.</p><p><b>METHODS</b>Diffusion tensor imaging was examined in 18 healthy subjects and 13 patients with brain tumors adjacent to the language cortex between December 2013 and June 2014. The associated fibers of language pathways were reconstructed using a commercial software (Syngo workstation). Firstly, the feasibility of fiber tracking method for language pathways in healthy subjects were studied, and then its application was assessed in patients with brain tumors. The anatomic relationship between tumors and the associated fibers was analyzed.</p><p><b>RESULTS</b>By selecting appropriate regions of interest, the associated fibers in the dorsal pathways (superior longitudinal fasciculus/arcuate fasciculus, including both direct and indirect pathways) and ventral pathways (uncinate fasciculus, middle longitudinal fasciculus, inferior longitudinal fasciculus and inferiorfronto-occipital fasciculus) were reconstructed in all 18 healthy subjects. In patients with brain tumors, the relationship between the tumors and adjacent associated fibers were divided into two types: adjacent associated fibers could be displaced or separated, and involved the superior longitudinal fasciculus/arcuate fasciculus (n=6), middle longitudinal fasciculus (n=4), uncinate fasciculus (n=3), inferior longitudinal fasciculus (n=3) and inferiorfronto-occipital fasciculus (n=2); alternatively, the adjacent associated fibers were infiltrated or destroyed, and involved the inferiorfronto-occipital fasciculus (n=10), uncinate fasciculus (n=8), middle longitudinal fasciculus (n=5), inferior longitudinal fasciculus (n=4) and superior longitudinal fasciculus/arcuate fasciculus (n=3).</p><p><b>CONCLUSIONS</b>The associated fibers of language pathways could be visualized rapidly and in real-time by fiber tracking technology based on diffusion tensor imaging. This is feasible for preoperative planning regarding brain tumors adjacent to the language cortex.</p>
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Humans , Brain Neoplasms , General Surgery , Cerebral Cortex , General Surgery , Diffusion Tensor Imaging , Language , Neural Pathways , Postoperative ComplicationsABSTRACT
Objective To establish the rat model of experimental subarachnoid hemorrhage (SAH) and to detect the expression of ADAMTS-4 in early brain injury(EBI) after SAH in rats .Methods Totally 72 adult male SD rats were randomly divided into 2 groups ,the control group and SAH group .The expression of ADAMTS-4 and the content of brain Evans Blue(EB) were detected . The ADAMTS-4 inhibitor α2-macroglobulin was used to study the relationship between the expression of ADAMTS-4 and blood-brain barrier permeability .Results The expression of the mRNA and protein of ADAMTS-4 increased dramatically at 24 h and the contents of EB increased progressively at 12 h after SAH .The protein expression of ADAMTS-4 and the content of brain EB was positive correlated(r=0 .917 ,P<0 .05) .The expression of ADAMTS-4 was inhibited by α2-macroglobulin(P<0 .05) and the con-tents of EB decreased dramatically (P<0 .05) .Conclusion ADAMTS-4 may be involved in the pathological progression of early brain injury after SAH .
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ObjectiveTo identify and confirm a novel HLA allele in a Chinese individual.MethodsA new HLA allele was found during routine HLA genotyping by polymerase chain reaction-sequence specific oligonucleotide probes (PCR-SSOP) and sequencing-based typing (SBT).ResultsThe new sequence differs from HLA-B * 40:01:01 by two nucleotide substitutions in exon 2 at positions 103 (G＞T) and 106 (A＞G) ; These mutations result in two codon changes:at codon 35 (GCC＞TCC) where an alanine (A) is substituted by a serine(S) and at codon 36(ATG＞GTG) where a methionine(M) is substituted by a valine (V).ConclusionA novel HLA allele,HLA-B * 40:74,was identified,and was named officially by the WHO Nomenclature Committee (HWS10004518 - EF458488).
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<p><b>OBJECTIVE</b>To identify a novel human leukocyte antigen (HLA) A allele.</p><p><b>METHODS</b>A new HLA-A allele was found during routine HLA genotyping by polymerase chain reaction-sequence specific oligonucleotide probes (PCR-SSOP) and sequencing-based typing (SBT).</p><p><b>RESULTS</b>The novel HLA-A*30 allele was identical to A*300101 except that a nucleotide C at position 294 of exon 2 is substituted by A, resulting in codon 98 changed from GAC (D) to GAA (E).</p><p><b>CONCLUSION</b>A new HLA allele, HLA-A*3020, was identified, and was named officially by the WHO Nomenclature Committee.</p>
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Humans , Alleles , Base Sequence , HLA-A Antigens , Chemistry , Genetics , Molecular Sequence Data , Sequence Alignment , Sequence Analysis, DNAABSTRACT
<p><b>OBJECTIVE</b>A novel human leukocyte antigen-B (HLA-B) allele, B*9526, was identified and analyzed by sequencing-based method in a Chinese donor.</p><p><b>METHODS</b>HLA typing was performed by PCR-sequence-specific oligonucleotide (SSO). Molecular cloning and DNA sequencing were used to identify the sequence of the potential novel allele and the difference between this new allele and other known alleles were analyzed.</p><p><b>RESULTS</b>HLA genotyping of one sample gave different results. The sequencing result showed HLA-B alleles of the proband as B*5403 and a novel allele. The nucleotide sequence of the novel allele was different from all known B alleles and harbored one nucleotide change from the closest matching allele B*1507 at nucleotide 425 (A to G) in exon 3, resulting in an amino acid change from Y (TAC) to C (TGC) at codon 142.</p><p><b>CONCLUSION</b>A novel HLA allele was identified and officially designated as HLA-B*9526 by WHO Nomenclature Committee for Factors of the HLA System.</p>
Subject(s)
Humans , Male , Alleles , Amino Acid Sequence , Base Sequence , China , Cloning, Molecular , Genotype , HLA-B Antigens , Genetics , HLA-B15 Antigen , Molecular Sequence Data , Sequence Analysis, DNAABSTRACT
Objective To study the changes of cerebral blood flow and cerebral oxygenation during selective head cooling (SHC) in neonates with hypoxic-ischemic brain damage (HIBD). Methods Thirty-eight neonates with moderate and severe HIBD were enrolled in two groups: SHC group (n=18) and normal temperature group (n=20). The gestational age of all subjects were more than 38 weeks and Apgar score in 5 minutes after birth was less than 5 scores. Also, nerve system symptoms and electroencephalogram abnormal was found in 6 hours after birth. Neonates in SHC group had nasopharyngeal temperature maintained 34℃ and in normal trmerature guoup had rectum temperature maintained about 36℃. Seven healthy neonates were as control group. Three groups were observed 84 h. Cerebral blood flow velocity (CBFV) of middle cerebral artery (MCA) was measured with transcranial Doppler (TCD) at 6, 12, 24, 48, 72 and 84 hours after birth. Cerebral cytochrome aa3 (Cytaa3 ) was monitored continuously throughout the study using near infrared spectroscopy (NIRS). Results At 6th hours after birth, Vs [(25. 05?7. 69)cm/s]、Vd [(7. 22?3. 01) cm/s] and Vm [(15. 61?5. 97) cm/s] of MCA and △Cytaa3 in SHC group were lower, and RI (0. 81?0. 15) was higher than control group (P
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Objective:To study the mechanism of protein kinase C regulating CD44 gene expression in vascular endothelial cells.Methods:Human umbilical vein endothelial cells (HUVECs)were taken as study model.The extract of Raf-1 kinase by immunoprecipitation was used for the Western blot analysis,and its activity was determined by enhanced chemiluminescene assay.CD44 gene expression was detected with RT-PCR,and phosphorylation was measurated by autoradiography.Results:CD44 phosphorylation in HUVECs was enhanced by 10ng/ml PMA treatment as compared with untreated cells, which reached the highest level at 30 minutes. Raf-1 kinase activity increased significantly after exposure to 10ng /ml PMA, and 0.05 ?mol/L Calphostinc could inhibit the role of Protein kinase C(PKC). CD44 gene expression level increased obviously after exposure to 10 ng /ml PMA (PKC activator) for only 1 minute(P