High PYGL Expression Predicts Poor Prognosis in Human Gliomas.

Background: PYGL has been reported as a glycogen degradation-related gene, which is up-regulated in many tumors. This study was designed to investigate the predictive value of high PYGL expression in patients with gliomas through bioinformatics analysis of the gene transcriptome and the single-cell sequencing data. Methods: The gene transcriptome data of 595 glioma patients from the TCGA database and the single-cell RNA sequencing data of 7,930 GBM cells from the GEO database were included in the study. Differential analysis was used to find the distribution of expression of PYGL in different groups of glioma patients. OS analysis was used to assess the influence of the high expression of PYGL on the prognosis of patients. The reliability of its prediction was evaluated by the AUC of ROC and the C-index. The GSEA be used to reveal potential mechanisms. The single-cell analysis was used to observe the high expression of PYGL in different cell groups to further analyze the mechanism of its prediction. Results: Differential analysis identified the expression level of PYGL is positively associated with glioma malignancy. OS analysis and Cox regression analyses showed high expression of PYGL was an independent factor for poor prognosis of gliomas (p < 0.05). The AUC values were 0.838 (1-year ROC), 0.864 (3-year ROC) and 0.833 (5-year ROC). The C index was 0.81. The GSEA showed that gene sets related to MTORC1 signaling, glycolysis, hypoxia, PI3K/AKT/mTOR signaling, KRAS signaling up and angiogenesis were differentially enriched in the high PYGL expression phenotype. The single-cell sequencing data analysis showed TAMs and malignant cells in GBM tissues expressed a high level of PYGL. Conclusion: The high expression of PYGL is an independent predictor of poor prognosis in patients with glioma.

Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia.

Background Microvascular decompression (MVD) has been widely accepted as a definitive therapy for primary trigeminal neuralgia (TN). However, some patients may not experience relief of TN symptoms following surgery. In this study, the findings of redo MVD are discussed. Methods Between 2015 and 2017, 205 patients with primary TN underwent MVD surgery in Shanghai Tongren Hospital. Among these patients, 187 had immediate complete relief of symptoms, 8 improved apparently, and 10 reported no symptom relief. Of the 10 patients without relief, 6 underwent reoperation within 5 days, 2 underwent reoperation 3 months after the first procedure, and 2 refused to undergo reoperation. Results The symptoms of those patients who received reoperation disappeared immediately after the surgery. In the second operations, new conflict sites at the motor roots were found in five cases. The real offending vessels were the superior cerebellar artery (SCA) or branch of the SCA in seven cases and the petrosal vein in one case. The nerve was not decompressed completely in either of the two cases. At the 12-month follow-up, no recurrence was found. For the other two patients who did not have reoperation, their symptom persisted. Postoperative complications showed no significant differences between the first and second operations. Conclusion Compression of the motor roots might be one of the causes of TN. Thorough exploration of both sensory and motor roots of the trigeminal nerve is essential to performing a successful MVD operation. Early reoperation for resistant TN after MVD does not increase the incidence of complications.

Improvement of quality of life and mental health in patients with spasmodic torticollis after microvascular decompression.

OBJECTIVE: Although not life threatening, spasmodic torticollis (ST) impairs patients' daily activity, socialization and work. The aim of this study was to evaluate the quality of life (QOL) and mental health in patients with ST after microvascular decompression (MVD). PATIENTS AND METHODS: From June 2014 to June 2017, patients with ST who underwent MVD in our department were included in this study. Toronto Western Sparse Torticollis Rating Scale (TWSTRS) were used to evaluate the ST symptoms. Quality of life was assessed by the craniocervical dystonia questionnaire (CDQ-24). Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI) were used to evaluate the mental health. Intraoperative findings and follow-up results were analyzed. RESULTS: A total of 104 consecutive patients were enrolled in this study. At the 12 months follow-up, the total effective rate was 81.73%. After MVD surgery, 88(84.62%) ST patients experienced QOL improvement. The severity of ST symptoms was positively correlated with the CDQ-24 score(r = 0.31, P = 0.02). Forty-eight patients (46.16%) with ST have moderate to severe depression and nine (8.65%) have depression preoperatively. Pain and disability domains of TWSTRS were found have high relation with BDI-II score(r = 0.27, P = 0.02; r = 0.33, P = 0.03). There was a positive correlation of educational levels with the BDI-II scores(r = 0.45, P = 0.02). CONCLUSION: ST affects patients' QOL both physically and mentally. MVD for ST not only provides high spasm-relief rate but also leads to significantly higher QOL after surgery. Not only ST symptoms, but also psychiatric status of patients should be routinely followed. Psychological care and psychopharmaceuticals should also be considered for these patients.

New Rhizotomy Procedure for Primary Spasmodic Torticollis.

OBJECTIVE: Spasmodic torticollis (ST) is an idiopathic neurologic disorder affecting the muscles of the neck. Surgery is a preferred treatment, when conservative treatments or Botulinum neurotoxin injections fail to relieve the symptoms. Our objective here is to report the outcome of a new surgical method for treating ST patients in our department. METHODS: The new procedure consists of rhizotomy of the spinal accessory nerve (SAN) and C1-C2 nerve roots, coagulation of the distal end of SAN (Group A). The results of this procedure were compared with a group of patients who underwent only rhizotomy of the SAN and anterior C1-C2 nerve roots (Group B). Clinical data were retrospectively collected from 39 patients with laterocollis and rotatory torticollis subtypes of ST from Jun 1, 2014 to Jun 1, 2015. The effect of the surgery was evaluated by the reduction in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores preoperatively and postoperatively. The mean duration of the postoperative follow-up period was 2.57 years, ranging from 2 to 3 years. RESULTS: The mean preoperative TWSTRS score was 65.89 ±â€Š3.55 and 65.80 ±â€Š3.45 in Groups A and B, respectively. Six months after the surgery, the TWSTRS scores decreased to 40.00 ±â€Š12.14 and 26.04 ±â€Š11.77, respectively. There was a statistically significant improvement preoperatively and postoperatively in both groups (P < 0.05). The decrease in TWSTRS score of Group B was more significant than that of Group A (P < 0.05). The main complications included shoulder numbness, shoulder weakness, and hoarseness. CONCLUSIONS: The procedure in this study provides a new and effective surgical method for patients with ST. This procedure should be recommended if conservative therapy does not offer satisfactory relief of symptoms.

Comparison of 2 Operative Methods for Treating Laterocollis and Torticollis Subtypes of Spasmodic Torticollis: Follow-Up of 121 Cases.

OBJECTIVE: The aim of this study was to compare the effects and complications of microvascular decompression (MVD) and neurectomy of spinal accessory nerve in the treatment of laterocollis and torticollis subtypes spasmodic torticollis (ST). METHODS: Clinical data were retrospectively collected from 121 patients with laterocollis and torticollis subtypes of ST from January 1, 2012 to January 1, 2016. Among all the patients, 80 were treated by MVD and 41 were treated by neurectomy of spinal accessory nerve. The effect of the surgery was evaluated by the reduction in the Toronto Western spasmodic torticollis rating scale total scores before and after the operation. The mean duration of the postoperative follow-up period was 18.7 months (range, 12-27 months). RESULTS: At the final follow-up, the Toronto Western spasmodic torticollis rating scale total score in the MVD group and in the neurectomy group was lowered by 50.43% ± 20.3% and 30.23% ± 19.4%, respectively, compared with the preoperative status (P < 0.05). In the MVD group, 25 (31.25%) patients achieved excellent relief, 44 (55%) patients improved moderate spasm, and 11 (13.75%) showed no relief. In the neurectomy group, 6 (14.63%) patients improved with excellent outcome, 7 (17.07%) had moderate relief, and 28 (68.29%) had no relief. There was no mortality or severe complication postoperatively, with the exception of hoarseness, shoulder numbness, and weakness. CONCLUSIONS: MVD for ST of laterocollis and torticollis subtypes can provide satisfactory and lasting improvements without nerve impairment. MVD is to be preferred to neurectomy of accessory nerve in treating ST of laterocollis and torticollis subtypes.

Dextromethorphan provides neuroprotection via anti-inflammatory and anti-excitotoxicity effects in the cortex following traumatic brain injury.

Traumatic brain injury (TBI) is caused by primary and secondary injury mechanisms. TBI induces a certain amount of inflammatory responses and glutamate excitotoxicity that are believed to participate in the pathogenesis of secondary injury. The non­narcotic anti­tussive drug dextromethorphan (DM) has been reported to have a high safety profile in humans and its neuroprotective against a variety of disorders, including cerebral ischemia, epilepsy and acute brain injury. However, few studies have explored the underlying mechanisms of the neuroprotective effects of DM in animals in the setting of TBI. The aim of the present study was to investigate the neuroprotective effects of DM on TBI and to determine the underlying mechanisms. Rats were subjected to a controlled cortical impact (CCI) injury and randomly divided into three groups: Sham­operated, TBI and DM treatment groups. The DM treatment group was administered DM (30 mg/kg of body weight, intraperitoneally) immediately after injury. It was identified that DM treatment following TBI significantly reduced brain edema and neurological deficits, as well as increased neuronal survival. These effects correlated with a decrease of tumor necrosis factor α, interleukin­1ß (IL­1ß) and IL­6 protein expression and an increase of glutamate/aspartate transporter and glutamate transporter­1 in the cortex of the brain. These results provided in vivo evidence that DM exerts neuroprotective effects via reducing inflammation and excitotoxicity induced following TBI. The present study has shed light on the potential use of DM as a neuroprotective agent in the treatment of cerebral injuries.