Analysis of risk factors for postoperative deep vein thrombosis after craniotomy and nomogram model construction.

BACKGROUND: Deep vein thrombosis (DVT) of the lower extremity is one of the most common postoperative complications, especially after craniocerebral surgery. DVT may lead to pulmonary embolism, which has a devastating impact on patient prognosis. This study aimed to investigate the incidence and risk factors of DVT in the lower limbs following craniocerebral surgery. AIM: To identify independent risk factors for the development of postoperative DVT and to develop an effective risk prediction model. METHODS: The demographic and clinical data of 283 patients who underwent craniocerebral surgery between December 2021 and December 2022 were retrospectively analyzed. The independent risk factors for lower extremity DVT were identified by univariate and multivariate analyses. A nomogram was created to predict the likelihood of lower extremity DVT in patients who had undergone craniocerebral surgery. The efficacy of the prediction model was determined by receiver operating characteristic curve using the probability of lower extremity DVT for each sample. RESULTS: Among all patients included in the analysis, 47.7% developed lower extremity DVT following craniocerebral surgery. The risk of postoperative DVT was higher in those with a longer operative time, and patients with intraoperative intermittent pneumatic compression were less likely to develop postoperative DVT. CONCLUSION: The incidence of lower extremity DVT following craniocerebral surgery is significant, highlighting the importance of identifying independent risk factors. Interventions such as the use of intermittent pneumatic compression during surgery may prevent the formation of postoperative DVT.

Optimized risk stratification strategy for glioma patients based on the feature genes of poor immune cell infiltration patterns.

BACKGROUND: Gliomas, originating from glial cells within the brain or spinal cord, are common central nervous system tumors with varying degrees of malignancy that influence the complexity and difficulty of treatment. The current strategies, including traditional surgery, radiotherapy, chemotherapy, and emerging immunotherapies, have yielded limited results. As such, our study aims to optimize risk stratification for a more precise treatment approach. We primarily identify feature genes associated with poor immune cell infiltration patterns through various omics algorithms and categorize glioma patients based on these genes to enhance the accuracy of patient prognosis assessment. This approach can underpin individualized treatment strategies and facilitate the discovery of new therapeutic targets. METHODS: We procured datasets of gliomas and normal brain tissues from TCGA, CGGA, and GTEx databases. Clustering was conducted using the input of 287 immune cell feature genes. Hub genes linked with the poor prognosis subtype (C1) were filtered through WGCNA. The TCGA dataset served as the discovery cohort and the CGGA dataset as the external validation cohort. We constructed a prognostic model related to feature genes from poor immune cell infiltration patterns utilizing LASSO-Cox regression. Comprehensive analyses of genomic heterogeneity, tumor stemness, pathway relevance, immune infiltration patterns, treatment response, and potential drugs were conducted for different risk groups. Gene expression validation was performed using immunohistochemistry (IHC) on 98 glioma samples and 11 normal brain tissue samples. RESULTS: Using the filtered immune cell-related genes, glioma patients were stratified into C1 and C2 subtypes through clustering. The C1 subtype exhibited a worse prognosis, with upregulated genes primarily enriched in immune response, extracellular matrix, etc., and downregulated genes predominantly enriched in neural signal transduction and neural pathway-related aspects. Seven advanced algorithms were used to elucidate immune cell infiltration patterns of different subtypes. In addition, WGCNA identified hub genes from poor immune infiltration patterns, and a prognostic model was constructed accordingly. High-risk patients demonstrated shorter survival times and higher risk scores as compared to low-risk patients. Multivariate Cox regression analysis revealed that, after adjusting for confounding clinical factors, risk score was a vital independent predictor of overall survival (OS) (P < 0.001). The established nomogram, which combined risk scores with WHO grade and age, accurately predicted glioma patient survival rates at 1, 3, and 5 years, with AUCs of 0.908, 0.890, and 0.812, respectively. This risk score enhanced the nomogram's reliability and informed clinical decision-making. We also comprehensively analyzed genomic heterogeneity, tumor stemness, pathway relevance, immune infiltration patterns, treatment response, and potential drugs for different risk groups. In addition, we conducted preliminary validation of the potential PLSCR1 gene using IHC with a large sample of gliomas and normal brain tissues. CONCLUSION: Our optimized risk stratification strategy for glioma patients has the potential to improve the accuracy of prognosis assessment. The findings from our omics research not only enhance the understanding of the functions of feature genes related to poor immune cell infiltration patterns but also offer valuable insights for the study of glioma prognostic biomarkers and the development of individualized treatment strategies.

Inflammatory myofibroblastic tumor of the central nervous system: A case report.

BACKGROUND: An inflammatory myofibroblastic tumor (IMT) occurring in the central nervous system is very rare, and thus its pathogenesis is unknown. This case report and literature review aimed to explore the pathogenesis, clinical features, imaging findings, pathological characteristics, immunohistochemical characteristics, diagnoses, treatments, and risks of postoperative recurrence of IMT in the central nervous system. CASE SUMMARY: A 67-year-old woman was admitted to the hospital with an exophthalmic protrusion and double vision in the left eye that had persisted for 3 mo. Magnetic resonance imaging (MRI) showed a 2.4 cm × 1.3 cm heterogeneous large mass in the bottom of the left anterior cranial fossa, which was closely related to the dura mater. Before surgery, we suspected the mass to be meningioma. The entire mass was successfully removed under neuronavigation and electrophysiological monitoring, and postoperative pathology indicated an IMT with extensive infiltration of chronic inflammatory cells and scattered multinucleated giant cells. Head MRI at the 3-mo follow-up showed that the tumor at the bottom of left anterior cranial fossa had been completely resected without recurrence. CONCLUSION: From the histological, immunohistochemical, and genetic analyses, the present case suggests that the pathogenesis of IMT-CNS is related to autoimmunity.

Abnormal expression of menin predicts the pathogenesis and poor prognosis of adult gliomas.

Several brain tumors is closely related to the disorder of chromatin histone modification, whereas the epigenetic mechanisms of the incidence of highly malignant adult glioma is not yet deeply studied. Deletion or mutation of the MEN1 gene, which encodes the epigenetic regulator menin, specifically induces poorly differentiated neuroendocrine tumors; however, the biological and clinical importance of MEN1 in the nervous system remains poorly understood. Menin expression was robustly activated in 44.4% of adult gliomas. Abnormally high expression of menin was closely related to a shorter median survival time of 20 months, a larger tumor volume and a higher percentage of Ki67 staining. Interestingly, menin expression was also activated in the cytoplasm of tumor cells (38.8%) and was also closely related to the poor prognosis of patients with glioma. Importantly, in a screening of 96 types of small-molecule targeted histone modification regulators, menin inhibitors were found to significantly block the proliferation of adult glioma cells. Our findings confirm that menin is a potential biomarker of poor prognosis in adult gliomas, independent of the WHO grade. Targeting menin may effectively inhibit certain gliomas, and this information provides novel insight into therapeutic strategies for glioma.

Comparing different venous thromboembolism risk assessment machine learning models in Chinese patients.

OBJECTIVE: Venous thromboembolism (VTE) is a fatal complication and the most common preventable cause of death in hospitals. The risk-to-benefit ratio of thromboprophylaxis depends on the performance of the risk assessment model. A linear model, the Padua model, is recommended for medical inpatients in the United States but is not suitable for Chinese inpatients due to differences in race and disease spectrum. Currently, machine learning (ML) methods show advantages in modeling complex data patterns and have been applied to clinical data analysis. This study aimed to build VTE risk assessment ML models among Chinese inpatients and compare the predictive validity of the ML models with that of the Padua model. METHODS: We used 376 patients, including 188 patients with VTE, to build a model and then evaluate the predictive validity of the model in a consecutive clinical dataset from Peking Union Medical College Hospital. Nine widely used ML methods were trained on the model derivation set and then compared with the Padua model. RESULTS: Among the nine ML methods, random forest (RF), boosting-based methods, and logistic regression achieved a higher specificity, Youden index, positive predictive value, and area under the receiver operating characteristic curve than the Padua model on both the test and clinical validation sets. However, their sensitivities were inferior to that of the Padua model. Combined with the receiver operating characteristic curve, RF, as the best performing model, maintained high specificity with relatively better sensitivity and captured VTE patients' patterns more precisely. CONCLUSIONS: Advances in ML technology provide powerful tools for medical data analysis, and choosing models conforming to the disease pattern would achieve good performance. Popular ML models do not surpass the Padua model on all indicators of validity, and the drawback of low sensitivity should be improved upon in the future.

HOXA10­AS: A novel oncogenic long non­coding RNA in glioma.

Glioma is the most common primary malignant tumor of the central nervous system. Emerging evidence has demonstrated that long non­coding RNAs (lncRNAs) serve a major role of regulation in various types of human cancer, including glioma. However, the biological roles of thousands of lncRNAs remain unknown and require further identification. The present study investigated the functional role of lncRNA­HOXA10­AS in glioma. The present study examined the expression patterns of HOXA10­AS in glioma and normal brain tissues, as well as glioma cell lines and normal human astrocytes (HA) via reverse transcription­quantitative polymerase chain reaction. HOXA10­AS knockdown cells were generated using lentiviral short hairpin RNA against HOXA10­AS in A172 and U251 glioma cells. Cell growth was assessed by MTT assay, and a flow cytometer was used to investigate cell proliferation, cell cycle distribution and cell apoptosis. Western blot analysis was performed to analyze the expression levels of apoptosis­related proteins. HOXA10­AS was significantly upregulated in glioma tissues and cell lines, and increased HOXA10­AS expression levels were associated with higher grades of glioma. Knockdown of HOXA10­AS inhibited glioma cell proliferation and increased cell apoptosis rates compared with the control cells. HOXA10­AS markedly regulated the expression of the homeobox A10 (HOXA10) gene. Similarly, HOXA10 expression was increased with higher grades of glioma, and silencing of HOXA10 by small interfering RNA suppressed glioma cell proliferation and induced cell apoptosis. The results of the present study demonstrated that HOXA10­AS promoted cell growth and survival through activation of HOXA10 gene expression in glioma, which may potentially act as a novel biomarker and therapeutic target for clinical assay development.

[Effects of purine nucleotide on the expressions of FSH and LH and the ultrastructure of endocrine cells in the pituitary gland of heroin-addicted male rats].

OBJECTIVE: To investigate the effects of purine nucleotide on the expressions of follicle-stimulating hormone (FSH) and luteotrophic hormone (LH) and the ultrastructures of the distal somatotrophic and gonadotrophic cells in the pituitary gland of heroin-addicted and -withdrawal rats. METHODS: Ninety-two male Wistar rats were randomly divided into a control group (ip saline for 14 d), a nucleotide group (ip AMP and GMP for 10 d), a heroin group (ip heroin for 10 d), a heroin + nucleotide group (ip AMP and GMP + heroin for 10 d), a 3 d withdrawal group (ip heroin for 10 d and killed at 14 d), a 9 d withdrawal group (ip heroin for 10 d and killed at 20 d), a 3 d nucleotide group (ip nucleotide for 3 d after 10 d heroin administration and killed at 14 d), and a 9 d nucleotide group (ip nucleotide for 9 d after 10 d heroin administration and killed at 20 d). Changes in the mRNA expressions of FSH and LH in the pituitary gland of the rats were analyzed by semi-quantitative RT-PCR, and alterations in the ultrastructures of the distal somatotrophic and gonadotrophic cells were observed under the microscope. RESULTS: The expression of FSH mRNA was significantly increased in the nucleotide, heroin + nucleotide, 3 d nucleotide and 9 d nucleotide groups (0.099 +/- 0.018, 0.177 +/- 0.046, 0.151 +/- 0.030 and 0.184 +/- 0.028) as compared with the control group (0.045 +/- 0.009) (P < 0.01); and so was that of LH mRNA in the heroin + nucleotide, 3 d nucleotide and 9 d nucleotide groups (0.950 +/- 0.169, 0.990 +/- 0.171 and 0.960 +/- 0.147) in comparison with the control group (0.700 +/- 0.099) (P < 0.01). In the heroin group, the nuclei of the distal somatotrophic and gonadotrophic cells exhibited morphological abnormality, unclear membrane, slightly pyknotic matrix, marginal and agglutinated heterochromatin, dilated rough endoplasmic reticula, swollen mitochondria, broken and vacuolated cristae in the cytoplasm, obviously decreased number of secretory granules, and myelin bodies in some cells. However, the heroin + nucleotide group showed no significant changes in the ultrastructures of somatotrophic and gonadotrophic cells compared with the control group. CONCLUSION: Short-term use of heroin does not obviously affect the expressions of FSH and LH mRNA in the pituitary gland of rats, while heroin + nucleotide, or nucleotide following heroin withdrawal can enhance their expressions significantly. Heroin damages the ultrastructures of the distal somatotrophic and gonadotrophic cells in the pituitary gland of male rats, and purine nucleotide can diminish or inhibit this damage.

Large cystic hypoglossal schwannoma with fluid-fluid level: a case report.

Hypoglossal schwannomas are rare skull base tumors. Furthermore, cystic hypoglossal schwannomas are extremely uncommon. We report the first case of a large cystic hypoglossal schwannoma with a fluid-fluid level. A 36-year-old woman presented with increased intracranial pressure and cerebellar signs without hypoglossal nerve palsy. Magnetic resonance imaging showed a predominantly cystic mass with a fluid-fluid level in the foramen magnum region extending into the hypoglossal canal. The intracranial tumor was largely removed via a midline suboccipital subtonsillar approach, leaving only a tiny residue in the hypoglossal canal. Histology confirmed a schwannoma with relative hypervascularity. Twenty months later, the tumor recurred and presented as a multicystic dumbbell-shaped lesion, extending intra- and extracranially through the enlarged hypoglossal canal. A complete resection of the intracranial and intracanalicular parts of the tumor was achieved with a small extracranial remnant treated by radiosurgery. Histology revealed a focal increased K(i)67 proliferative index. In this report, we discuss the possible reasons for the absence of hypoglossal nerve palsy and the potential mechanism of the formation of the fluid-fluid level, and we consider the treatment of this lesion.

Brain stem candidiasis mimicking cerebellopontine angle tumor.

BACKGROUND: Infectious process can mimic cerebral tumors. We present the first report of a fugal infection in brainstem mimicking cerebral tumors in the literature. CASE DESCRIPTION: A 17-month-old boy presented with abnormal movements of his left arm and difficulty walking for 2 weeks. The MRI of the patient showed an enhancing partially cystic and partially solid mass in the right CP angle cistern, interpreting as CP tumor. On MRS, there was a decreased N-acetylaspartate/Creatine ratio and an elevated choline/Cr ratio. The patient underwent right retrosigmoid craniotomy and excisional biopsy. On the specimen, there were numerous fungal organisms consistent with Candida species. Our patient recovered completely after and 377-day voriconazole treatment. He was still quite well without neurologic sequelae at follow-up for 2 years. CONCLUSIONS: Brainstem candidiasis in immunocompetent host can masquerade the CP angle tumor. The MRI and MRS are not always diagnostic. Neurosurgical intervention is mandatory to relieve the mass effect in brainstem with high risk and achieve the pathologic diagnosis. Followed by voriconazole treatment, the patient could be treated successfully.

Tempol, one of nitroxides, is a novel ultraviolet-A1 radiation protector for human dermal fibroblasts.

BACKGROUND: Nitroxide has been reported to have antioxidant and some photoprotective properties. Exposure of skin to ultraviolet-A1 (UVA1, 340-400 nm) can lead to formation of reactive oxygen species, reduction in collagen, and increased expression of matrix metalloproteinases (MMPs). OBJECTIVE: The goal of this research was to determine the effects of 4-hydroxy-Tempo (Tempol), one of nitroxides, in the presence of UVA1 on cytotoxicity, superoxide dismutase enzyme (SOD) activity, lipid peroxidation, and expression of collagen I, collagen III and MMP-1, MMP-3 in human dermal fibroblasts in vitro. METHODS: Fibroblasts were irradiated by a single exposure to UVA1 and at the same time incubated with, or without, Tempol and detected twenty-four hours later. SOD activity and lipid peroxidation, as shown by accumulation malonyldialdehyde (MDA), were detected by biochemical assay. Expressions of collagen I, collagen III (protein levels) and MMP-1, MMP-3 (mRNA level) were detected by ELISA and semi-quantitative reverse transcriptase-PCR separately. RESULTS: Cell survival curve after UVA1 irradiation showed dose dependent decrement pattern and Tempol, between 0.03 and 8 mM, increased cell viability in a dose-effect manner when the cells were exposed to 20 J/cm(2) UVA1. Fifteen Joule per centimetre square of UVA1 significantly inhibited SOD activity and collagen I, collagen III protein levels, while increased MDA level and stimulated MMP-1 and MMP-3 mRNA expression. Tempol reversed these effects caused by UVA1 in some degree or completely and in proper concentration, the results were statistically significant compared with irradiated group. CONCLUSIONS: Tempol had photoprotective properties against UVA1 irradiation in vitro. With antioxidant ability, Tempol inhibited extracellular matrix degradation and preserved collagen production in dermis and may be used as an anti-photoaging agent.

[Assessment of exposure to extremely low frequency magnetic field emitted from monitors].

OBJECTIVES: To investigate intensity of extremely low frequency magnetic field (ELFMF) emitted from cathode-ray tubes (CRT) of monitors in various directions and to find ways to avoid its influence. METHODS: Two hundred CRT monitors and 10 monitors with liquid-crystal display (LCD) were selected. Their ELFMF was detected for three times in front of the monitor at an interval of every 5 cm from 0 cm to 50 cm, as well as at various directions from the monitor. RESULTS: Intensity of ELFMF significantly attenuated at regular operating position (30 - 40 cm) from 0 cm to 50 cm in front of both 38 cm and 43 cm CRT monitors (P < 0.05). Intensity exceeded 0.4 microT both within 15 cm and 10 cm in front of 38 cm and 43 cm monitors. The highest intensity was found at the upright top position of both kinds of monitors, 9.54 microT for 38 cm monitor and 6.38 microT for 43 cm one, respectively. CONCLUSIONS: It is suggested to keep away from monitor screen as possible when operating a computer, to reduce unnecessary operation in front of a monitor screen, and to shorten operating time. To avoid more hazards from interactive interference between computers, it is necessary to increase distance between monitors.