Safflor yellow injection combined with anti-vascular endothelial growth factor drugs in the treatment of non-ischemic central retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the efficacy and safety of safflor yellow injection combined with anti-vascular endothelial growth factor(VEGF)drug in the treatment of non-ischemic central retinal vein occlusion(CRVO).METHODS: A total of 91 patients(91 eyes)with non-ischemic CRVO complicated with macular edema who were treated in the Affiliated Eye Hospital of Nanchang University from April 2017 to December 2021 were selected. They were randomly divided into observation group, with 47 cases(47 eyes)treated with safflor yellow injection combined with intravitreal injections of ranibizumab, and control group with 44 cases(44 eyes)who were treated with intravitreal injections of ranibizumab. Followed-up for 11mo, the best corrected visual acuity(BCVA)and macular central retinal thickness(CRT)of the two groups were observed and the cases of complete absorption of retinal hemorrhage, the times of anti-VEGF drug injections, the cases of ischemic CRVO, and the occurrence of systemic or ocular complications were recorded.RESULTS: At 1, 2, 3, 5, 7, 9 and 11mo after treatment, the BCVA and CRT in both groups were significantly improved compared with those before treatment, and BCVA and CRT in the observation group were superior to the control group at 3, 5, 7, 9 and 11mo after treatment(all P<0.05). At 5, 7, 9 and 11mo after treatment, the complete absorption rate of retinal hemorrhage in the observation group was higher than that in the control group(P<0.05). During the follow-up period, the anti-VEGF drug injection in the observation group was significantly less than that in the control group(4.83±1.05 vs. 5.75±1.01, P<0.05), and the incidence of ischemic CRVO was significantly lower than that in the control group(21% vs. 86%, P<0.05), and there were no treatment-related systemic and ocular complications in both groups.CONCLUSION: Safflor yellow injection combined with anti-VEGF drugs is a safe and effective method for the treatment of non-ischemic CRVO, which can significantly improve vision and reduce CRT. It can increase the complete absorption rate of retinal hemorrhage, reduce the times of anti-VEGF drug injections and the incidence of ischemic CRVO compared with monotherapy of anti-VEGF drug.

Retinol dehydrogenase 10 promotes metastasis of glioma cells via the transforming growth factor-β/SMAD signaling pathway / 中华医学杂志(英文版)

BACKGROUND@#Glioma is the most common primary malignant tumor in the central nervous system. Because of the resistance of glioma to chemoradiotherapy and its aggressive growth, the survival rate of patients with glioma has not improved. This study aimed to disclose the effect of retinol dehydrogenase 10 (RDH10) on the migration and invasion of glioma cells, and to explore the potential mechanism.@*METHODS@#Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the expression levels of RDH10 in healthy glial cells and glioma cells. Human glioma cell strains, U87 and U251, were infected with negative control or RDH10-interfering lentiviruses. RT-PCR and Western blotting were performed to determine the knockdown efficiency. Scratch and transwell assays were used to assess cell migration and invasion after RDH10 knockdown. Finally, changes in transforming growth factor-β (TGF-β)/SMAD signaling pathway-related expression were examined by Western blotting. Differences between groups were analyzed by one-way analysis of variance.@*RESULTS@#RDH10 was highly expressed in glioma cells. Compared with the control group, RDH10 knockdown significantly reduced RDH10 messenger RNA and protein expression levels in U87 and U251 glioma cells (U87: 1.00 ± 0.08 vs. 0.22 ± 0.02, t = 16.55, P < 0.001; U251: 1.00 ± 0.17 vs. 0.39 ± 0.01, t = 6.30, P < 0.001). The scratch assay indicated that compared with the control group, RDH10 knockdown significantly inhibited the migration of glioma cells (U87: 1.00% ± 0.04% vs. 2.00% ± 0.25%, t = 6.08, P < 0.01; U251: 1.00% ± 0.11% vs. 2.48% ± 0.31%, t = 5.79, P < 0.01). Furthermore, RDH10 knockdown significantly inhibited the invasive capacity of glioma cells (U87: 97.30 ± 7.01 vs. 13.70 ± 0.58, t = 20.36, P < 0.001; U251: 96.20 ± 7.10 vs. 18.30 ± 2.08, t = 18.51, P < 0.001). Finally, Western blotting demonstrated that compared with the control group, downregulation of RDH10 significantly inhibited TGF-β expression, phosphorylated SMAD2, and phosphorylated SMAD3 (TGF-β: 1.00 ± 0.10 vs. 0.53 ± 0.06, t = 7.05, P < 0.01; phosphorylated SMAD2: 1.00 ± 0.20 vs. 0.42 ± 0.17, t = 4.01, P < 0.01; phosphorylated SMAD3: 1.00 ± 0.18 vs. 0.41 ± 0.12, t = 4.12, P < 0.01).@*CONCLUSION@#RDH10 knockdown might inhibit metastasis of glioma cells via the TGF-β/SMAD signaling pathway.

Retinol dehydrogenase 10 promotes metastasis of glioma cells via the transforming growth factor-β/SMAD signaling pathway / 中华医学杂志(英文版)

Background@#Glioma is the most common primary malignant tumor in the central nervous system. Because of the resistance of glioma to chemoradiotherapy and its aggressive growth, the survival rate of patients with glioma has not improved. This study aimed to disclose the effect of retinol dehydrogenase 10 (RDH10) on the migration and invasion of glioma cells, and to explore the potential mechanism.@*Methods@#Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the expression levels of RDH10 in healthy glial cells and glioma cells. Human glioma cell strains, U87 and U251, were infected with negative control or RDH10-interfering lentiviruses. RT-PCR and Western blotting were performed to determine the knockdown efficiency. Scratch and transwell assays were used to assess cell migration and invasion after RDH10 knockdown. Finally, changes in transforming growth factor-β (TGF-β)/SMAD signaling pathway-related expression were examined by Western blotting. Differences between groups were analyzed by one-way analysis of variance.@*Results@#RDH10 was highly expressed in glioma cells. Compared with the control group, RDH10 knockdown significantly reduced RDH10 messenger RNA and protein expression levels in U87 and U251 glioma cells (U87: 1.00 ± 0.08 vs. 0.22 ± 0.02, t= 16.55, P < 0.001; U251: 1.00 ± 0.17 vs. 0.39 ± 0.01, t= 6.30, P < 0.001). The scratch assay indicated that compared with the control group, RDH10 knockdown significantly inhibited the migration of glioma cells (U87: 1.00% ± 0.04% vs. 2.00% ± 0.25%, t= 6.08, P < 0.01; U251: 1.00% ± 0.11% vs. 2.48% ± 0.31%, t= 5.79, P < 0.01). Furthermore, RDH10 knockdown significantly inhibited the invasive capacity of glioma cells (U87: 97.30 ± 7.01 vs. 13.70 ± 0.58, t = 20.36, P < 0.001; U251: 96.20 ± 7.10 vs. 18.30 ± 2.08, t = 18.51, P < 0.001). Finally, Western blotting demonstrated that compared with the control group, downregulation of RDH10 significantly inhibited TGF-β expression, phosphorylated SMAD2, and phosphorylated SMAD3 (TGF-β: 1.00 ± 0.10 vs. 0.53 ± 0.06, t= 7.05, P < 0.01; phosphorylated SMAD2: 1.00 ± 0.20 vs. 0.42 ± 0.17, t= 4.01, P < 0.01; phosphorylated SMAD3: 1.00 ± 0.18 vs. 0.41 ± 0.12, t= 4.12, P < 0.01).@*Conclusion@#RDH10 knockdown might inhibit metastasis of glioma cells via the TGF-β/SMAD signaling pathway.

Frontolateral Approach Applied to Sellar Region Lesions: A Retrospective Study in 79 Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Various surgical approaches for the removal of sellar region lesions have previously been described. This study aimed to evaluate the reliability and safety of the frontolateral approach (FLA) to remove sellar region lesions.</p><p><b>METHODS</b>We presented a retrospective study of 79 patients with sellar region lesions who were admitted and operated by the FLA approach from August 2011 to August 2015 in Department of Neurosurgery of Beijing Tian Tan Hospital. We classified FLA into three types, compared the FLA types to the areas of lesion invasion, and analyzed operation bleeding volume, gross total resection (GTR) rate, visual outcome, and mortality.</p><p><b>RESULTS</b>Seventy-nine patients were followed up from 2.9 to 50.3 months with a mean follow-up of 20.5 months. There were 42 cases of meningiomas, 25 cases of craniopharyngiomas, and 12 cases of pituitary adenomas. The mean follow-up Karnofsky Performance Scale was 90.4. GTR was achieved in 75 patients (94.9%). Two patients (2.5%) had tumor recurrence. No patients died perioperatively or during short-term follow-up. Three patients (3.8%) with craniopharyngioma died 10, 12, and 23 months, respectively, after surgery. The operative bleeding volume of this study was no more than that of the other approaches in the sellar region (P = 0.783). In this study, 35 patients (44.3%) had visual improvement after surgery, 38 patients (48.1%) remained unchanged, and three patients' visual outcome (3.8%) worsened.</p><p><b>CONCLUSIONS</b>FLA was an effective approach in the treatment of sellar region lesions with good preservation of visual function. FLA classification enabled tailored craniotomies for each patient according to the anatomic site of tumor invasion. This study found that FLA had similar outcomes to other surgical approaches of sellar region lesions.</p>

Expression and significance of sonic hedgehog signaling pathway-related components in brainstem and supratentorial astrocytomas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Studies have shown that abnormal activation of the sonic hedgehog pathway is closely related to tumorigenesis in central nervous system. This study aimed to investigate the role of the sonic hedgehog signaling pathway in the occurrence of brainstem and supratentorial glioma.</p><p><b>METHODS</b>Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry were used to detect the expression of sonic hedgehog-related components in 5 specimens of normal brain tissue, 10 of grade II brainstem glioma, and 10 of grade II supratentorial glioma. The significance of differences between two groups was determined using the Mann-Whitney U test or the two-sample test according to the results of normality distribution tests.</p><p><b>RESULTS</b>The mRNA expression levels of sonic hedgehog-related genes were higher in brainstem astrocytomas than in supratentorial astrocytomas and normal brain tissue. The level of protein patched homolog 1 (PTCH1) was significantly higher in brainstem astrocytomas than in supratentorial astrocytomas and normal brain tissue (P < 0.01). Immunohistochemistry semi-quantitative analysis was consistent with the qRT-PCR result that PTCH1 expression was increased significantly in brainstem astrocytomas at the protein level (P < 0.05).</p><p><b>CONCLUSIONS</b>Enhanced PTCH1 expression and activation of the sonic hedgehog pathway are involved in brainstem glioma. This may be related to the difference in malignant biological behavior between brainstem and hemispheric glioma, and could be an ideal therapeutic target in brainstem glioma.</p>

Optimal microsurgical treatment of dorsum sellae meningioma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few reports of microsurgical treatment of dorsum sellae meningiomas-which, because of location, size, and differences in growth direction, clinical presentations, degree of surgical difficulty, have varied posttreatment sequelae. In pursuit of an optimal microsurgical treatment option for dorsum sellae meningioma patients, we performed a retrospective analysis of eight microsurgery-treated patients in our set up.</p><p><b>METHODS</b>Clinical data of eight microsurgery-treated dorsum sellae meningioma patients were analyzed. Dorsum sellae meningiomas were classified into 2 types based on tumor location, size, and direction of growth. Type I tumors (dorsum sellae-inferior third ventricle type, four cases) were resected by craniotomy via the frontotemporal or orbitozygomatic approach. Type II tumors (dorsum sellae-third ventricle type, 4 cases) were resected by frontal craniotomy via the transcallosal-interforniceal approach.</p><p><b>RESULTS</b>Complete tumor resection was achieved in all the eight patients. In Type I tumor patients, the only postoperative complication was oculomotor nerve palsy. In Type II tumor patients, the postoperative complications included hyperthermia, electrolyte imbalances, endocrinologic disturbances, and hydrocephalus. The mean follow-up was 2.1 years. Four patients returned to normal life and found a job, two were able to live independently, one required assistance, while one died.</p><p><b>CONCLUSIONS</b>Dorsum sellae meningioma surgery is challenging, and resection of Type II tumors is more difficult than Type I tumors. The selection of a suitable microsurgical approach based on tumor type, and the active treatment of postoperative complications are important means of increasing therapeutic efficacy.</p>

Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although various monitoring techniques have been used routinely in the treatment of the lesions in the skull base, iatrogenic facial paresis or paralysis remains a significant clinical problem. The aim of this study was to investigate the effect of intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation on preservation of facial nerve function.</p><p><b>METHOD</b>From January to November 2005, 19 patients with large acoustic neuroma were treated using intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation (TCEMEP) for preservation of facial nerve function. The relationship between the decrease of MEP amplitude after tumor removal and the postoperative function of the facial nerve was analyzed.</p><p><b>RESULTS</b>MEP amplitude decreased more than 75% in 11 patients, of which 6 presented significant facial paralysis (H-B grade 3), and 5 had mild facial paralysis (H-B grade 2). In the other 8 patients, whose MEP amplitude decreased less than 75%, 1 experienced significant facial paralysis, 5 had mild facial paralysis, and 2 were normal.</p><p><b>CONCLUSIONS</b>Intraoperative TCEMEP can be used to predict postoperative function of the facial nerve. The decreased MEP amplitude above 75 % is an alarm point for possible severe facial paralysis.</p>

Management of intracranial invasive olfactory neuroblastoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Olfactory neuroblastoma (ONB) is a rare tumor that often arise from the nasal cavity. The aim of this study was to investigate the clinical characteristics and treatments of intracranial invasive ONB.</p><p><b>METHODS</b>Between July 2001 and August 2005, 5 patients with intracranial invasive ONB were treated in our department. Their clinical features, radiological and pathological characteristics, and surgical treatments were analyzed. Among the 5 patients, 1 received transnasal biopsy, and 4 were operated through the transfrontal or extended bifrontal approaches to reconstruct the skull base. After the operation, all the patients received radiotherapy, and one received chemotherapy. They were followed up for 6 to 45 months.</p><p><b>RESULTS</b>The ONB was resected totally in the 4 patients. In all the patients, nasal obstruction was alleviated without cerebrospinal fluid leakage. The visual acuity was improved in 3 patients, who had a decreased visual acuity before the operation. Two patients had metastasis into the lumbosacral spinal canal 6 and 8 months after the operation, one of them received a second operation and the other died.</p><p><b>CONCLUSION</b>ONB has no specific symptoms. Intracranial ONB should be resected as far as possible, and treated by radiotherapy after the operation.</p>

A long term follow-up study of the skull base chordomas / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic features of the skull base chordomas treated with neurosurgical operations.</p><p><b>METHODS</b>One hundred and six patients of skull base chordomas were enrolled by means of telephone, letter and out-patient recheck who presented between May 1993 and June 2005. They were scored by Karnofsky Performance Scale (KPS) during admission respectively, before period of discharge and follow-up. SPSS Life-table method was used to calculate the recurrent rates and survival rates.</p><p><b>RESULTS</b>Seventy-nine patients were followed for 10-158 months. The average period was 63.9 months. Survival rates of 1, 3, 5 and 10 year were 87.2%, 79.4%, 67.6% and 59.5%, meanwhile recurrent rates of 1, 3, 5 and 10 years were 19.1%, 34.7%, 52.9% and 88.3% respectively. The mean KPS on admission, before discharge and follow-up were 71.0, 72.5 and 67.1 respectively, which demonstrated the significant differences between the before discharge item and the follow-up.</p><p><b>CONCLUSIONS</b>The prognosis of the skull base chordomas was poor. The recurrent rate was ascending year by year, meanwhile the survival rate was descending and 8 years later the tendency became gently. Neurosurgical treatments can improve majority long-term qualities, so they should be viewed as the first treatment choice.</p>

Surgical management of brain-stem gliomas: a retrospective analysis of 311 cases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To further study the clinical features, diagnosis, and surgery outcome of brain-stem gliomas.</p><p><b>METHODS</b>Totally 311 patients with brain-stem gliomas received surgery operations in our hospital from 1980 to the end of 2001. The clinical data, neuroimages, growth patterns, and operative feasibility were analyzed.</p><p><b>RESULTS</b>Different brain-stem gliomas showed different growth patterns. In this series, total excision rate of the tumor was 40.5%, subtotal 29.9%, partial 29.6%, and operative mortality 1.3%. Among 311 patients, 72.4% patients had been improved and stable in their symptoms after operation, and 27.6% deteriorated or having transitory new signs. Five years survival rate is 67% in ependymoma patients, 42% in astrocytoma patients. None of brain-stem glioblastoma patients survived up to 5 years.</p><p><b>CONCLUSIONS</b>The histology and growth pattern of brainstem gliomas varies. The patients with well-differentiated gliomas of brain-stem may be cured by microsurgical removal. For malignant ones, partial removal may prolong survival and facilitate the following combined therapy.</p>

Postauricular tran-supracondylar approach removed jugular foramen and hypoglossal canal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>Discuss the surgical treatment of jugular foramen and hypoglossal canal tumor, and choice of the best surgical approach.</p><p><b>METHODS</b>32 patients with jugular foramen and hypoglossal canal tumor were operated through the postauricular tran-supracondylar approach, 13 neurinoma, 7 glomus jugular tumors, 4 meningioma, 3 chordoma. 23 were total removed, with a subtotal of 9.</p><p><b>RESULTS</b>21 patients were followed up, mean 2.5 years. 18 patients work normally, 7 of them were hoarseness, 2 of other 3 patients lived by themselves, 1 of existed obstruct of limbs.</p><p><b>CONCLUSIONS</b>Postauricular tran-supracondylar approach exposes satisfactory for the dumbbell-shape tumors of intra-or extra cranial. It has high rate of total removal and low rate of complications. It is the best approach of treatment in jugular foramen and hypoglossal canal tumors. The outcome is good.</p>

Diagnosis and treatment of cavernous sinus neurinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and microneurosurgical treatment of cavernous sinus neurinoma.</p><p><b>METHODS</b>Twenty-two patients with cavernous sinus neurinoma which had been diagnosed by MRI were operated on by microsurgery. Fourteen patients received excision of tumor through frontotemporal approach with zygomatic osteotomy and, 8 patients via subtemporal and suboccipital transtentorial approaches.</p><p><b>RESULTS</b>Total resection was achieved in 21 patients (95.5%), and subtotal resection in 1. There was no operative death. The all operative samples were confirmed neurinoma pathologically. The symptoms postoperation such as headache and exophthalmos were reduced. Three months after operation, the function of the 6th nerve was improved in 12 of 19 patients with paresis of the 6th nerve. One patient with hemiplegia recovered well. The function of the 3th nerve recovered in 4 of 6 patients with recurrent paresis of the 3th nerve. Those patients with hydrocephalus were improved after operation. The patients were follow up 8 - 60 months (mean 20 months). No tumor recurrence was observed.</p><p><b>CONCLUSION</b>Cavernous sinus neurinoma can be removed successfully via subtemporal and suboccipital transtentorial approaches.</p>