Ivermectin as a potential therapeutic strategy for glioma.

Ivermectin (IVM), a semi-synthetic macrolide parasiticide, has demonstrated considerable effectiveness in combating internal and external parasites, particularly nematodes and arthropods. Its remarkable ability to control parasites has earned it significant recognition, culminating in Satoshi Omura and William C. Campbell's receipt of the 2015 Nobel Prize in Physiology or Medicine for their contributions to the development of IVM. In recent years, investigations have revealed that IVM possesses antitumor properties. It can suppress the growth of various cancer cells, including glioma, through a multitude of mechanisms such as selective targeting of tumor-specific proteins, inducing programmed cell death, and modulation of tumor-related signaling pathways. Hence, IVM holds tremendous potential as a novel anticancer drug. This review seeks to provide an overview of the underlying mechanisms that enable IVM's capacity to suppress glioma. Furthermore, it aims to elucidate the challenges and prospects associated with utilizing IVM as a new anticancer agent.

Surgical Treatment of Pineal Region Tumors: An 18 year-Experience at a Single Institution.

BACKGROUND: The pineal tumor was once considered as a restricted area for surgery. Such cases are rare, with many different opinions on surgical treatment. This study aimed to review our experience of tumor treatment in the pineal region and explore the optimal treatment strategy. METHODS: The clinical data of 72 patients with pineal tumors from January 1997 to May 2015 (18 years) were retrospectively analyzed. Preoperative preparation, pathology type, tumor resection rate, surgical approach, and follow-up outcomes were used as the indicators to evaluate the treatment efficacy. RESULTS: The Krause approach was used in 46 cases, the Poppen approach in 10 cases, and the transcallosal-lateral ventricle-choroid fissure approach in 16 cases. The postoperative pathological results were as follows: 24 cases of germinoma, 11 of teratoma, 15 of glioma, 6 of meningioma, 11 of Pineocytoma, 2 of cholesteatoma, 2 of cavernous hemangioma, and 1 of choriocarcinoma. Further, the study included 64 cases of total surgical resections, 8 of subtotal resections, and 2 deaths. The follow-up period was from 7 months to 10 years. Further, 51 (70.8%) patients were followed up. The multivariate regression model showed that the surgical method and the pathological type contributed significantly to predicting outcomes. CONCLUSIONS: The type of pathology, extent of excision, and surgical approach had a significant impact on the prognosis of patients. The transcallosal-lateral ventricle-choroid fissure approach for large and medium-sized pineal tumors near the posterior part of the third ventricle had good efficacy.

Molecular characteristics and drug resistance of non-O1non-O139 Vibrio cholerae in Zhongshan City, Guangdong Province / 中国热带医学

@#Abstract: Objective　To investigate the molecular characteristics and drug resistance of non-O1/non-O139 Vibrio cholerae in Zhongshan City, and to provide laboratory basis for cholera prevention and control. Methods　The strains of non-O1/non-O139 Vibrio cholerae isolated from sporadic patients and aquatic products from 2015 to 2021 in Zhongshan city were collected. The identification and cluster analysis of the strains were analyzed by matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS), the ctxA virulence gene of strains were detected by real-time fluorescence quantitative PCR, the cluster analysis of the strains was analyzed by pulsed-field gel electrophoresis (PFGE), and the drug resistance of the strains were analyzed by microbroth dilution method. Results　From 2015 to 2021, 33 strains of non-O1/non-O139 Vibrio cholerae were isolated from Zhongshan City, including 28 strains from sporadic patients and 5 strains from aquatic products. Through MALDI-TOF-MS identification, 33 strains of non-O1/non-O139 Vibrio cholera can be identified to the level of species, and the identification results were all Vibrio cholerae. Among 33 non-O1/non-O139 Vibrio cholerae strains, 1 strain carried the ctxA virulence gene. The drug-resistant strains accounted for 69.7% (23/33), and the multidrug resistant strains accounted for 18.2% (6/33). A total of 7 kinds of drug resistance spectrum were produced, including 3 kinds of multidrug resistant spectrum, and showed drug resistance to 8 antibiotics, among which the resistance rates to streptomycin, cefazolin and compound sulfamethoxazole were above 30%. The 33 strains of non-O1/non-O139 Vibrio cholerae were divided into 32 PFGE fingerprints with a similarity ranging from 61.7% to 100%. MALDI-TOF-MS cluster analysis divided 33 non-O1/non-O139 Vibrio cholerae strains into two clusters. Conclusions The results of molecular typing of non-O1/non-O139 Vibrio cholerae in Zhongshan City presented diversity, and no significant correlation was found between PFGE and MALDI-TOF-MS cluster analysis. The strains demonstrated various degrees of resistance to certain antibiotics, and there were multidrug-resistant and toxigenic strains. Therefore, it is necessary to alert to the harmfulness of non-O1/non-O139 Vibrio cholerae and enhance monitoring.

Multimodal treatments combined with gamma knife surgery for primary atypical teratoid/rhabdoid tumor of the central nervous system: a single-institute experience of 18 patients.

OBJECTIVES: Atypical teratoid/rhabdoid tumor (AT/RT) is a rare, highly malignant tumor of the central nervous system with poor prognosis. Nowadays, multimodal management, including surgery, chemotherapy (CMT), and radiation therapy (RT), is advocated. However, AT/RT treatment with gamma knife surgery (GKS) was rarely reported. The aim of this study was to assess the efficacy and safety of GKS for the treatment of AT/RT. PATIENTS AND METHODS: Medical records of AT/RT patients who underwent surgery from 2007 to 2014 at the West China Hospital were retrospectively reviewed and statistically analyzed. RESULTS: Eighteen patients (12 males and 6 females) were presented with AT/RTs. Median age during presentation was 20.5 months (range, 4-179 months). Twelve patients were < 3 years and six patients were > 3 years. Tumor location was supratentorial in seven patients, infratentorial in ten patients, and center area of the brain in one patient. Treatments performed were as follows: surgery alone in two patients, surgery+RT in two patients, surgery+CMT in five patients, surgery+CMT+RT in two patients, and surgery+CMT+RT+GKS in seven patients. The 2-year overall survival (OS) rate and event-free survival (EFS) rate for all 18 consecutive patients were 33.3 and 27.8%, respectively. Cox regression analyses showed that multimodal management combined with GKS was an independent positive prognostic factor for OS. CONCLUSIONS: Although AT/RTs are lethal cancer types, the OS of the disease was improved by using multimodal therapeutic strategies, including surgery, CMT, and RT, combined with GKS.

Application of technical strategies for surgical management of adult intrinsic pontine gliomas: a retrospective series.

OBJECT: The authors retrospectively analyzed the surgical treatment of adult intrinsic pontine gliomas in their department, and to enhance the understanding of technical strategies to treat this disease. METHODS: 7 patients with intrinsic pontine gliomas were recruited for this study, between January 2011 and June 2013. All patients underwent preoperative MRI and Diffusion Tensor Imaging Fiber Tracking (DTI-FT). In addition, multimodal Intraoperative Neuromonitoring (IOM) and Intraoperative Neuronavigation were also applied during microsurgery. RESULTS: 7 patients with intrinsic pontine gliomas were treated at the West China Hospital of Sichuan University. Mean age, mean duration of symptoms prior to diagnosis, and mean duration of follow-up average time were 38.0 years, 2.0 months, and 23.4 months, respectively. The main presentations were progressive cranial nerve deficits and long tract signs. Total resection was achieved in 3 patients, subtotal resection in 2, and partial resection in 2. Postoperative pathological examination revealed: astrocytoma (WHO II) in 4 cases, anaplastic oligoastrocytoma (AO, WHO III) in one case, and anaplastic astrocytoma (AA, WHO III) in two cases. Postoperative radiotherapy were administered to all patients, and 4 patients with astrocytoma (WHO II) rejected chemotherapy. After 11-39 months of follow-up, patient symptoms were resolved or stable without aggravation except one patient died because of rapidly progressive glioma at 11 months after operation. MRI in other patients showed residual tumor size to be unchanged or without obviously recurrence. CONCLUSION: Combining preoperative MRI with preoperative DTI-FT, surgery can be better assessed and the operation for adult intrinsic pontine gliomas can be maximally and safely resected with the aid of Multimodal IOMs and Intraoperative Navigation during microsurgery.

Endolymphatic sac tumor with von Hippel-Lindau disease: report of a case with atypical pathology of endolymphatic sac tumor.

The authors described a case of a patient with co-existing endolymphatic sac tumor (ELST) and hemangioblastoma in the posterior cranial fossa, which belonged to a subtype of Von Hippel-Lindau (VHL) disease confirmed by the test of VHL-gene. The signs in this 42-year-old female included intermittent headache and dizziness. Imaging revealed a giant mass in the right cerebellopontine angle (CPA) region and another lesion in the left cerebellar hemisphere. The results of biopsy after two operations confirmed the diagnosis respectively. Both of the tumors were resected totally. Nevertheless, we had to confess the misdiagnosis as vascular tumor instead of ELST at the initial diagnosis because of the rarity of ELST associated with atypical histological characteristics. The purposes we reported this case were to describe the atypical pathological feature of ELST and the mutation of germline VHL not mentioned in previously literature, furthermore, to foster understanding of ELSTs with the avoidance of the similar misdiagnosis as far as possible in future.

Upper thoracic intradural-extramedullary cavernous malformation presenting as subarachnoid hemorrhage without spinal dysfunction: a case report and review of the literature.

A 45-year-old man had subarachnoid hemorrhage (SAH) which was confirmed by lumbar puncture, since it was negative on head computed tomography. The result of neurological examination was normal. Following pan-cerebral angiography and cranial magnetic resonance imaging (MRI) failed to find out the cause of bleeding. The whole spinal MRI revealed an intradural-extramedullary mass lesion at the upper thoracic level which was consistent with cavernous malformation after surgery. When patients presented with SAH of no spinal symptoms, the diagnosis of an intradural-extramedullary cavernous malformation is challenging. A whole spinal workup should be considered in a patient with spontaneous SAH when bleeding from intracranial origin is carefully excluded.

[Microsurgical management of adult brainstem gliomas under the DTI and intraoperative nuclei mapping: a retrospective analysis of 19 cases].

OBJECTIVE: To explore the role of DTI-Tractography and intraoperative nuclei mapping in microsurgery of adult brainstem gliomas. METHODS: Nineteen patients with adult brainstem gliomas were recruited for this study in our hospital from 2010 to 2012. The role of DTI-Tractography and intraoperative nuclei mapping in the microsurgery was retrospectively reviewed. RESULTS: Two patients underwent almost total resection, while 11 patents underwent subtotal resection and 6 patients underwent partial resection. Neurological functions improved or remained stable in 14 patients (73.7%) after surgery; whereas, 5 patients (26.3%) experienced deteriorated or transitory new symptoms. Follow-up visits found that 17 patients (89.5%)had improved or stable neurological functions. CONCLUSION: DTI-Tractography and intraoperative nuclei mapping provides great support to the choice of surgical approach and the determination of degree of resection. It helps achieve maximal safe resection of adult brainstem gliomas.

Atypical meningioma of sylvian fissure with a 20-year history: a rare case report.

Atypical meningiomas of sylvian fissure are extremely rare. We reported a case of sylvian fissure atypical meningioma with a 20-year history. The tumor was excised subtotally, thereafter a postoperative radiation therapy was done. The patient had a favorable outcome during the two-year follow-up. The possible pathogenesis of this case was hypothesized and analyzed in this article.

Intracranial extraaxial ependymoma in children: a rare case report and review of the literature.

Intracranial extraaxial ependymomas (IEAEs) are extremely rare. We present a pediatric patient with IEAE misdiagnosed as a meningioma preoperatively, successfully treated surgically with a favorite outcome. The literature about IEAEs was briefly reviewed. Thereafter we discuss the clinical characteristics of the disease.

CSF fistula through the left lumbar region in adult following a ventriculoperitoneal shunt surgery: a rare case report.

A cranial spinal fluid fistula through left lumbar region following a ventriculoperitoneal (VP) shunt is an extremely rare complication. We report a 25-year-old man who presented with the leakage of clear fluid from the left lumbar region, 3 years after a VP shunt surgery. Computerized tomography scan of abdomen revealed that the distal end of the catheter penetrated into the inner layer of the wall of left lumbar region. He was managed successfully with abdominal part of shunt catheter removal from primary cervical and abdominal incision, a new abdominal part of VP shunt catheter replacement and prophylactic antibiotic.

Microsurgery via modified far-lateral approach for giant dumbbell-shaped jugular foramen tumors.

BACKGROUND AND OBJECTIVE: During the resection of jugular foramen tumors via the basic far lateral approach, the jugular foramen tumor area as well as its adjacent structures, especially the intracranial part, can be better exposed, which avoids stripping of the petrous part of temporal bone and displacement of facial nerve, and protects the patient's hearing from damage. However, when applied in tumors developed from ventral to the brain stem and middle fossa, with extracranial tumors, this surgical approach seems to be inadequate and limited. This study was to explore the microsurgical technique and clinical value for treating giant dumbbell-shaped tumors at jugular foramen (JF) via a modified far lateral approach. METHODS: A retrospective analysis was performed in 16 patients with huge dumbbell-shaped tumors at JF which were removed through the modified far lateral approach (suboccipital transjugular-jugular tubercle-jugular process) between January 2001 and December 2008. The process of operation, and pre-and postoperative clinical data were included in the analysis. RESULTS: Gross total tumor removal was achieved in 14 cases, subtotal removal in 1 case, and partial removal in 1 case. Follow-up examinations in most patients demonstrated that the patient with an obvious preoperative deficit had a good recovery. During the follow-up from three months to seven years, 10 (76.9%) cases with lower cranial nerve involvement showed obvious improvement of symptom after operation, 8 (80.0%) cases with facial palsy obtained various degrees of alleviation, and 7 (77.8%) cases with hearing impairment at different levels restored hearing. Two patients developed new lower cranial nerve palsies after operation, and underwent functional rehabilitation in the three-month follow-up. CONCLUSIONS: Modified far lateral approach is helpful for removing the huge tumors at JF, especially for tumors extending to the petroclival region ventral part of pontomedullary junction. It has a higher rate of total resection, preoperative cranial nerve function impairment is expected to restore, and also has the advantage of protecting the facial nerve, labyrinth and vertebral artery structure from unnecessary damage.

An Echinococcosis multilocularis presenting as a giant anterior cranial basilar tumor.

Cerebral alveolar hydatid disease is a rare subtype of Echinococcus, and prevalent in northern China and Tibetan area. In this report, we presented a giant lesion of Echinococcus multilocularis which located in anterior cranial fossa, and discussed its clinicopathological and radiological features, and strategy of treatment.

Intracranial clear-cell meningioma.

Intracranial clear-cell meningioma (CCM) is rarely reported in the literature since it has to be distinguished from other subtypes of meningioma. Most of the CCMs are intraspinal, according to the related literature. We report a case of occipital parietal CCM in a 6-year-old child, review all the 35 intracranial CCMs that have been reported since 1995 to present and discuss their clinical, radiological and histopathologic characteristics.

Is radical surgery necessary to head and neck inflammatory myofibroblastic tumor (IMT) in children?

PURPOSE: We report a case of head and neck inflammatory myofibroblastic tumor (IMT) in an infant. Reviewing the literature, we discuss the etiology, diagnosis, treatment, and prognosis of the head and neck IMT in children. MATERIALS AND METHODS: A 52-day-old infant was admitted with an enlarging lesion in the right head and neck region. Following total excision, the lesion recurred and progressed to terminal stage. We performed a review of the literature on head and neck IMTs in children up to the age of 18 years and assessed the treatments and related prognosis of IMT in the head and neck region. RESULTS AND CONCLUSIONS: The children's prognosis of head and neck IMT is diverse with different treatments. Combined treatment of surgical and corticosteroid is recommended for younger children, especially infants.

[Impacts of tetramethylpyrazine on BDNF, bFGF expression and neuron-protection in severe brain injury tissue of rat].

OBJECTIVE: To observe the expression levels of BDNF and bFGF, the variation of superoxide dismutase (SOD) and malondialdehyde (MDA) in serum and injury neuron of rat, and to evaluate the effect of Tetramethylpyrazine (TMP) on neuro-protection finally. METHODS: 120 SD rats were randomly assigned into three groups: pseudo-operation group, severe brain injury model group and TMP treatment group. Every group contained 40 rats. The severe brain injury (SBI) of rat was established according to Feeney' s method. The treatment group was administrated with TMP transperitoneally. Rats were killed at 7 h, 24 h, 72 h, 168 h respectively after SBI. BDNF, bFGF, Nissl body and neurofunction were detected in every group at all the time scales. MDA and SOD of serum were also detected by radical immunoassay. RESULTS: After rat SBI treated with the administration of TMP, the expression of BDNF and bFGF increased significantly in the injured brain tissue (P<0.05), and the MDA level showed to be decreased but the SOD was increased in serum (P<0.05). The Nissl body and neuro-function were well protected. CONCLUSION: TMP may protect the rat cerebral neurons from SBI.

[Effects of tetramethylpyrazine on endothelin and nitric oxide contents in plasma and cerebrospinal fluid after subarachnoid hemorrhage].

OBJECTIVE: To observe the variation of endothelin (ET) and nitric oxide (NO) in plasma and cerebrospinal fluid (CSF) in rabbits, and evaluate the effects of tetramethylpyrazine (TMP) on the prevention and cure of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH). METHODS: 24 New Zealand rabbits were randomly assigned into three groups: contrast group, experiment group and blank group. Every group contained 8 rabbits. SAH was established according to inject blood into the cisterna magna. The experiment group was administrated with TMP (20 mg/kg x d) transperitoneally. ET and NO of plasma and CSF were detected by radical immunoassay at 72 h and 168 h after SAH. Neurofunction were detected in every group at all the time scales. RESULTS: (1) After SAH, the level of ET in CSF increased significantly in contrast group compared with that in experiment and blank groups (P<0.05). The value of ET at 168 h was higher than that at 72 h. The level of ET in plasma increased significantly in contrast group compared with blank and experiment groups (P<0.05), and no significant contrast could be found between blank and experiment group. (2) After SAH, the value of NO in CSF was lower in contrast group than in other groups (P<0.05), and the level of NO in CSF continued to decrease in all groups on some extent. As time went by, no significant contrast could be found in all groups. The value of NO in plasma was lower in contrast group than in other groups (P<0.05). There was no significant difference between experiment and blank groups. (3) The neuro-function score continued to be increased in contrast group, but decreased in experiment one. The neuro-function score was lower in experiment group than in contrast one at every time point (P<0.05). CONCLUSION: After administration of TMP, the variation of ET has the continued decrease in plasma and CSF; the variation of NO shows the continued increase in plasma and CSF; neurological function gets possibly protected. TMP may prevent from and cure CVS after SAH.

[Time-series analysis on road traffic injury in China].

OBJECTIVE: To establish the predictive models of road traffic injury(RTI) in China, to know the trend of RTI, and to provide the reference data for controlling RTI in China. METHODS: The China RTI data from 1951 to 2003 were collected, and in view of the problem of missing values, the method of intrapolation was adopted. The Box-Jenkins technique was used to analyze and predict the trend of RTI in China. Following the process for stationary time-series analysis, model identification, parameter estimation and model diagnosis, the predictive equation for RTI would be established. RESULTS: A series of predictive equations on RTI were finally established based on ARIMA models. The curve fitting is effective and the predictive data of RTI in 2003 are close to the true statistical data. CONCLUSION: The time-series model thus established proves to be of significant usefulness in RTI prediction.

[Presurgical evaluation and surgical treatment of medically refractory epilepsy: a report of 162 cases].

OBJECTIVES: To study presurgical evaluation and surgical treatment of medically refractory epilepsy. METHODS: One hundred and sixty-two cases of refractory epilepsy were analysed by their clinical manifestation, neuroradiology and neuroelectrophysiology. Different operative techniques were performed to all the 162 cases according to those analyses. RESULTS: Total effective rate of the surgical treatment was 87.7% and most patients have better life than preoperation. CONCLUSION: Surgical treatment with accurate preoperative location of the epileptogenic zone and suitable operative techniques is an effective method in the treatment of refractory epilepsy.