Background and Objectives: The current research focuses on surgical safety and postoperative recurrence of chronic subdural hematoma (CSDH) treatment. This study proposes a micro-drill craniostomy drainage combined with perioperative treatment. The aim is to describe and validate this treatment approach and explore the risk factors influencing recurrence, to further improve the treatment outcomes for CSDH. Methods: A retrospective analysis was conducted on patients who underwent surgery for CSDH from 2018 to 2023. These patients were divided into two groups based on recurrence, and multiple logistic regression analyses were performed to identify the independent factors of postoperative recurrence. Additionally, detailed descriptions of the micro-drill craniostomy drainage surgical technique and perioperative treatment plan were provided. Results: A total of 106 patients with 140 CSDH were treated surgically. All patients experienced varying degrees of improvement in their clinical symptoms. No perioperative deaths or surgical complications occurred. Twelve recurrence cases were observed (8.6 %), 9 of which were managed through conservative treatment. The remaining three cases were treated with the same surgical procedure and urokinase injection, and no recurrence was observed during the last follow-up. After univariate analyses of all the clinical variables, the rate of recurrence was significantly lower in urokinase injection (P = 0.001) and long drainage duration (P = 0.042). Multiple logistic regression analysis identified the absence of postoperative urokinase injection was an independent risk factor for recurrence (odds ratio: 0.011, 95 % confidence interval: 0 - 0.485, P = 0.018), after adjustment for age, anticoagulant therapy, CT density, maximal thickness, pneumocrania, and other risk factors. Conclusion: The combination of micro-drill craniostomy drainage and perioperative atorvastatin treatment is safe and effective for CSDH. It is recommended that urokinase injection as a routine treatment CSDH and further prospective randomized controlled trial is needed to validate its usage details and efficacy.

OBJECTIVE:This study aims to assess the safety and efficiency of twist drill craniotomy (TDC) for surgical treatment of chronic subdural hematoma (CSDH) based on a single-center experience of 219 cases performed over nine years. METHODS:We performed a retrospective analysis of CSDH patients who underwent TDC treatment in our hospital between January 2013 and December 2021. Clinical and radiological characteristics, as well as surgical outcomes of the included patients, were reviewed and analyzed. Factors that may affect hematoma recurrence and outcomes were also investigated. RESULTS:A total of 219 patients (186 males and 33 females) were included. Eighteen (8.2%) patients experienced postoperative complications. The in-hospital mortality and recurrence rates in our series were 0.5% (1/219) and 4.1% (9/217), respectively. 91.7% (199/217) of patients achieved favorable outcomes six months after the operation. Duration of drainage catheter (odds ratio [OR] 0.135, 95% confidence interval [CI] 0.017-1.099; P = 0.030) was the only factor significantly related to the recurrence of CSDH. Moreover, brain infarction (OR 5.175, 95% CI 1.417-18.896; P = 0.013), Alzheimer's disease (OR 20.515, 95% CI 1.950-215.840; P = 0.012), and preoperative dysfunction of coagulation (OR 6.509, 95% CI 1.501-28.217; P = 0.012) were markedly associated with unfavorable functional outcomes. CONCLUSION:TDC with irrigation and closed-system drainage is a minimally invasive, simple, safe, and effective surgical technique that can serve as the first-choice for the treatment of CSDH with a low recurrence rate.

OBJECTIVE: Surgical intervention for chronic subdural hematoma (CSDH) in the extremely aged population mains a difficult challenge. This study aims to investigate the clinical characteristics and surgical outcomes twist drill craniotomy (TDC) of CSDH in super-elderly years) patients.METHODS: A retrospective analysis of super-elderly patients with CSDH who underwent TDC treatment hospital between January 2013 and December 2021 performed. Their clinical characteristics and surgical comes were compared with those of relatively younger patients (60-79 years). Factors that may affect functional outcomes were also investigated. RESULTS: Fifty-nine super-elderly patients and 133 tients aged 60-79 years were included. The preoperative hematoma volume of the super-elderly patients significantly larger than that of the 60-79 years whereas fewer super-elderly patients had headaches compared with the relatively younger counterparts. surgical treatment using the TDC procedure, the incidence of complication and the hematoma recurrence rate similar between the 2 groups. Moreover, according Markwalder score of the follow-up at 6 months operation, the prognosis of the super-elderly group was poorer than that of the patients of 60-79 years (P = Preoperative dysfunction of coagulation (odds ratio, 95% confidence interval, 1.185-681.677; P = 0.039) was independent risk factor significantly related to unfavorable outcomes of super-elderly patients with CSDH. CONCLUSIONS: Advanced age per se does not seem to be a contraindication for the operative intervention of CSDH. Surgical treatment using the TDC procedure can still provide considerable benefits for super-elderly patients with CSDH.

Objective:To investigate the surgical treatment strategies of brachial plexus schwannomas protruding from the foraminal area to the thoracic outlet through anterior cervical approach, and to evaluate the curative effect.Methods:The clinical data of 8 patients treated in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2016 to December 2020 who underwent supraclavicular cervical "barb" incision for protruding into the thoracic outlet through anterior cervical approach were retrospectively collected, including 5 males and 3 females, aged (50.75±11.14) years old, ranging from 31-66 years old. And the key points of the operation, postoperative complications and postoperative follow-up were analyzed. Measurement data with normal distribution were represented as mean±standard deviation( ± s), count data were described as numbers. Results:The tumors in all 8 cases were totally resected.The amount of bleeding during operation was (35.00±14.14) mL. No surgical complications such injury of pleura, aspneumothorax and hemothorax, except 2 cases which developed local sensory disturbance that improved that after neurotrophic treatment and hormonotherapy. All 8 patients were followed up by outpatient or telephone for 1-5 years, and cervical MRI review showed no tumor recurrence in situ.Conclusions:The anterior cervical approach with "barb type" incision above the neck clavicle is effective in excision of schwannomas protruding into the thoracic outlet, with less intraoperative injury, less blood loss, fast postoperative recovery.

OBJECTIVE: Head trauma is considered as the main cause of chronic subdural hematoma (CSDH). However, many patients develop CSDH with no identified cause. Herein, we conduct a comparative study to investigate the differences in clinical characteristics and surgical outcomes of CSDH patients with and without a history of head trauma. METHODS: We retrospectively reviewed CSDH patients who underwent surgical treatment in our hospital between January 2013 and December 2021. Patients were categorized into a with head trauma (WHT) group and a without head trauma (WOHT) group for comparative analysis. RESULTS: A total of 219 patients were included, 119 (54.3%) cases in the WHT group and 100 (45.7%) cases in the WOHT group. More cancer patients were found in the WOHT group than in the WHT group (P = 0.045). Both at discharge and 6-month follow-up, patients in the WOHT group achieved better clinical outcomes than the WHT group cases (P = 0.025 and 0.034, respectively). Furthermore, ordered multiclass logistic regression analyses indicated that a history of head trauma (odds ratio 2.151, 95% confidence interval 1.052e4.386; P = 0.036) was a risk factor significantly related to the unfavorable outcomes at 6-month follow-ups of CSDH. However, we did not find significant differences between the 2 groups in clinical manifestations, radiological characteristics, postoperative complications, mortality, and recurrence rates. CONCLUSIONS: CSDH patients with a history of head trauma may be more susceptible to unfavorable outcomes; thus, they should be carefully evaluated and given more attention during hospitalization and after discharge.

1 病例资料 65岁男性,因鞍区脊索瘤术后10年伴头痛及视物模糊1年余入院.10年前,因头痛伴左眼疼痛、视物模糊行头颅MRI示鞍区占位,行经鼻蝶入路鞍区占位切除术,术后头痛及眼部疼痛症状消失,术后病理示脊索瘤,术后行放疗(具体不详),但未定期复查头颅MRI.

Glioma is a common malignant tumor of the central nervous system with high incidence and mortality. The present study aimed to investigate the role of Microrchidia family CW-type zinc finger 2 (MORC2) in the development of glioma. Firstly, MORC2 expression was detected in several glioma cell lines (U251, SHG44, LN229 and T98G). Following MORC2 silencing, cell proliferation was evaluated using the Cell Counting Kit-8 assay and the expression of proliferation-related proteins was assessed via immunofluorescence staining or western blotting. Cell invasion and migration were assessed using transwell and wound healing assays, respectively. Western blotting and immunofluorescence staining were employed to determine the expression of epithelial-mesenchymal transition (EMT)-associated proteins. The protein expression of N-myc downstream regulated gene 1 (NDRG1) and PTEN/PI3K/AKT signaling was determined with western blot analysis. Then, the luciferase reporter assay and chromatin immunoprecipitation (ChIP) assay were employed to evaluate the binding between MORC2 and NDRG1 promoter. Subsequently, cellular functional experiments were performed to assess the effects of NDRG1 on the progression of glioma after NDRG1 and MORC2 overexpression. In addition, tumor-bearing experiments were conducted using a U251 tumor-bearing nude mice model to detect tumor growth. The expression of proliferation (proliferating cell nuclear antigen, cyclin-dependent kinase 2 and cyclin E1), migration [matrix metalloproteinase (MMP)2 and MMP9], EMT (E-cadherin, N-cadherin and Vimentin) and PTEN/PI3K/AKT signaling proteins in tumor tissues was examined with immunohistochemistry assay or western blotting. Results revealed that MORC2 was notably unregulated in glioma cells compared with the normal human astrocyte. Loss-function of MORC2 inhibited the proliferation, invasion, migration and EMT of glioma cells. Importantly, MORC2 silencing upregulated NDRG1 expression and inactivated PTEN/PI3K/AKT signaling. Additionally, the luciferase reporter- and ChIP assays confirmed that MORC2 could bind to the NDRG1 promoter. NDRG1 upregulation suppressed the progression of glioma and these effects were partially reversed by MORC2 overexpression. Results of tumor-bearing experiments suggested that gain-function of NDRG1 inhibited tumor growth and downregulated the expression of proliferation, migration and EMT-related proteins in tumorous tissue in U251 tumor-bearing mice, which was partially counteracted after MORC2 overexpression. In addition, MORC2 overexpression abrogated the inhibitory effect of NDRG1 on PTEN/PI3K/AKT signaling. In summary, MORC2 promoted the progression of glioma by inactivation of PTEN/PI3K/AKT signaling via binding to NDRG1 promoter, providing a novel and potent target for the treatment of glioma.

Nerve root metastases are extremely rare with only a handful of cases ever reported. Metastasis to sites other than the primary site is common in malignant tumors whereas spinal ganglion metastasis is extremely rare and has been only reported in individual cases. The lumbar spine tends to be more common areas of presentation whereas breast cancer metastasis has been rarely reported. We herein reported two cases of breast carcinoma metastasis to multiple spinal nerve roots. The metastasis sites were S1 nerve root in Case 1 and left L5 and bilateral cervical nerve roots in Case 2. On magnetic resonance imaging (MRI), the nerve roots in the intervertebral foramen zones appeared thickened and contrast-enhanced MRI exhibited intense enhancement. Pathological examination showed that these primary lesions were breast cancer in both cases, and there were intracranial multiple metastases in both cases, including preoperative metastasis to multiple nerve roots (lumbar and cervical) and postoperative recurrence. The clinical course was characterized by worsening radicular symptoms-especially intractable pain. The radiologic appearance might mimic a neurogenic tumor, which is performed intervertebral foraminal area lesion, and the corresponding ganglion/ nerve root became thickened and was enhanced significantly. Surgical intervention with tumor debulking followed by radiotherapy provides local tumor control and palliation from pain, but it is palliative. Therefore, for patients with radiological manifestations of radiculopathy, the possibility of metastatic tumors should be considered.

1病例资料 17岁女性,因背部肿物渐进性增大半年余入院.半年前发现背部正中隆起肿物,质韧,约"花生米"大小,肿物渐进性增大.入院体格检查:背部胸6～7椎体水平可触及肿物,大小约6 cm×4 cm,质韧,边界尚清楚,与后方胸椎黏连,活动度差,触之无压痛,无皮肤红肿;四肢肌力5级,肌张力正常.

Background Despite the capability of emergency surgery to reduce the mortality of severe spontaneous intracranial hemorrhage (SSICH) patients, the effect and safety of surgical treatment for severe spontaneous intracranial hemorrhage (SSICH) patients receiving long-term oral antiplatelet treatment (LOAPT) remains unclear. In consideration of this, the cohort study is aimed at figuring out the effect and safety of emergency surgery for SSICH patients on LOAPT. Methods As a multicenter and prospective cohort study, it will be conducted across 7 representative clinical centers. Starting in September 2019, the observation is scheduled to be completed by December 2022, with a total of 450 SSICH patients recruited. The information on clinical, radiological, and laboratory practices will be recorded objectively. All of the patients will be monitored until death or 6 months after the occurrence of primary hemorrhage. Results In this study, two comparative cohorts and an observational cohort will be set up. The primary outcome is the effect of emergency surgery, which is subject to assessment using the total mortality and comparison in the survival rate of SSICH patients on LOAPT between surgical treatment and conservative treatment. The second outcome is the safety of surgery, with the postoperative hemorrhagic complication which is compared between the operated SSICH patients on and not on LOAPT. Based on the observation of the characteristics and outcome of SSICH patients on LOAPT, the ischemic events after discontinuing LOAPT will be further addressed, and the coagulation function assessment system for operated SSICH patients on LOAPT will be established. Conclusions In this study, we will investigate the effect and safety of emergency surgery for SSICH patients on LOAPT, which will provide an evidence for management in the future. Ethics and dissemination The research protocol and informed consent in this study were approved by the Institutional Review Board of Beijing Tiantan Hospital (KY2019-096-02). The results of this study are expected to be disseminated in peer-reviewed journals in 2023. Trial registration Name: Effect and safety of surgical intervention for severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet treatment. ChiCTR1900024406 . Date of registration is July 10, 2019.

Background and Purpose Dioscin has multiple biological activities and is beneficial for cardiovascular and cerebral vascular diseases. Here, we investigated the protective effects of dioscin against subarachnoid haemorrhage and the molecular mechanisms involved. Experimental Approach Dioscin was administered after subarachnoid haemorrhage induced in rats. MCC950, a potent selective nod-like receptor pyrin domain-containing 3 (NLRP3) inhibitor, was used to suppress NLRP3 and EX527 (selisistat) was used to inhibit sirtuin 1 (SIRT1). Key Results In vivo, dioscin inhibited acute inflammatory response, oxidative damage, neurological impairment and neural cell degeneration after subarachnoid haemorrhage along with dramatically suppressing NLRP3 inflammasome activation. While pretreatment with MCC950 reduced the inflammatory response and improved neurological outcomes it did not lessen ROS production. However, giving dioscin after MCC950 reduced acute brain damage and ROS production. Dioscin increased SIRT1 expression after subarachnoid haemorrhage, whereas EX527 abolished the up-regulation of SIRT1 induced by dioscin and offset the inhibitory effects of dioscin on NLRP3 inflammasome activation. EX527 pretreatment also reversed the neuroprotective effects of dioscin against subarachnoid haemorrhage. Similarly, in vitro, dioscin dose-dependently suppressed inflammatory response, oxidative damage and neuronal degeneration and improved cell viability in neurons and microglia co-culture system. These effects were associated with inhibition of the NLRP3 inflammasome and stimulation of SIRT1 signalling, which could be inhibited by EX527 pretreatment. Conclusion and Implications Dioscin provides protection against subarachnoid haemorrhage via the suppression of NLRP3 inflammasome activation through SIRT1-dependent pathway. Dioscin may be a new candidate to ameliorate early brain injury after subarachnoid haemorrhage.

BACKGROUND AND PURPOSE:Oxidative stress and neuronal apoptosis play key roles in traumatic brain injury. We investigated the protective effects of astaxanthin against traumatic brain injury and its underlying mechanisms of action.EXPERIMENTAL APPROACH:A weight-drop model of traumatic brain injury in vivo and hydrogen peroxide exposure in vitro model were established. Brain oedema, behaviour tests, western blot, biochemical analysis, lesion volume, histopathological study and cell viability were performed.KEY RESULTS:Astaxanthin significantly reduced oxidative insults on Days 1, 3 and 7 after traumatic brain injury. Neuronal apoptosis was also ameliorated on Day 3. Additionally, astaxanthin improved neurological functions up to 3 weeks after traumatic brain injury. Astaxanthin treatment dramatically enhanced the expression of peroxiredoxin 2 (Prx2), nuclear factor-erythroid 2-related factor 2 (NRF2/Nrf2) and sirtuin 1 (SIRT1), while it down-regulated the phosphorylation of apoptosis signal-regulating kinase 1 (ASK1) and p38. Inhibition of Prx2 by siRNA injection reversed the beneficial effects of astaxanthin against traumatic brain injury. Additionally, Nrf2 knockout prevented the neuroprotective effects of astaxanthin in traumatic brain injury. In contrast, overexpression of Prx2 in Nrf2 knockout mice attenuated the secondary brain injury after traumatic brain injury. Moreover, inhibiting SIRT1 by EX527 dramatically inhibited the neuroprotective effects of astaxanthin and suppressed SIRT1/Nrf2/Prx2/ASK1/p38 pathway both in vivo and in vitro.CONCLUSION AND IMPLICATIONS:Astaxanthin improved the neurological functions and protected the brain from injury after traumatic brain injury, primarily by reducing oxidative stress and neuronal death via SIRT1/Nrf2/Prx2/ASK1/p38 signalling pathway and might be a new candidate to ameliorate traumatic brain injury.

三叉-心脏反射是一种脑干反射,由Schaller等于1 999年首次报道,典型的临床表现为:三叉神经的任一感觉支受刺激,出现心率变慢,血压下降,有时伴有呼吸暂停或胃肠蠕动增强等.本文报道1例蝶骨嵴内侧型脑膜瘤术中出现三叉-心脏反射. 1病例资料 46岁女性,因头痛头晕伴恶心呕吐、视物模糊半个月入院.既往无高血压、心脏病、脑血管病等病史.入院体格检查:心律84次/min,血压125/65 mmHg,未见明确神经系统阳性体征.心电图示:窦性心律,正常心电图.头颅增强MRI示:左侧蝶骨嵴内侧型脑膜瘤,与左侧海绵窦外侧壁关系紧密.全麻下行左侧翼点入路脑膜瘤切除术,用瑞芬太尼及丙泊酚进行麻醉诱导.麻醉状态下,病人心率60次/min,有创动脉压135/80 mmHg.术中牵拉海绵窦外侧壁肿瘤时,病人心率下降至40次/min,下降比例33％;血压下降至95/55mmHg,下降比例30％.暂停手术20 s后,心率及血压恢复至正常.同样力度再次牵拉外侧壁肿瘤后,病人再次出现心率及血压急剧下降,暂停手术刺激后,心率及血压恢复正常.

患者男,65岁,主因"突发左侧肢体无力2 d",于2018年2月22日收入首都医科大学附属北京友谊医院神经外科。入院体格检查:左侧肢体肌力Ⅴ - 级,肌张力偏高,神经系统其他检查未见异常。既往史:高血压病史10余年,平时血压控制在125/70 mmHg左右。既往多次发生短暂性肢体麻木。患者口服阿司匹林后有呕血症状。头部CT平扫示,右侧颞叶占位（图1）,肿瘤卒中可能。头部增强MRI示,右侧颞叶占位,血肿可能,右侧基底节区近期脑梗死（图2）。

Objective To explore the risk factors for formation of deep vein thrombosis (DVT)in lower extremity (LE)in order to avoid the occurrence of this complication. Methods A total of 42 patients with LE DVT in this hospital during March 2013 to May,2014 were entered in this study. Their lower limbs were preoperatively examined by color Doppler ultrasonography (CDU)on the 3rd,7th and 14th postoperative days,and every 7 days thereafter. If clinical signs and symptoms of LE DVT appeared,CDU will be performed immediately. The gender,age,di-agnosis,past medical history,alcohol drinking,intraoperative blood loss,pathological examination,postoperative consciousness,application of dehydrating agent,and occurrent time of LE DVTwere all recorded. Results Among 42 patients,there were 18 males (42. 9%)and 24 females (57. 1%),and the age of patients ranged from 15 to 80 years old (with mean of 58. 54 ± 13. 55 years),3 (7. 1%)patients with diabetes melli-tus and 9 (21. 4%)patients with alcohol drinking. The average amount of intraoperative blood loss was 232. 8 ml (5 ~ 1200 ml). There were 12 cases (28. 6%)with vascular diseases,21 (50. 0%)with tumors,and 9 (21. 4%)with other neurosurgical diseases. The levels of conscious-ness in postoperative patients ranged from clearness to coma [clearness in 29 cases (69%),sleepiness in 11 (26. 2%)and coma in 2 (4. 8%)] respectively. Mannitol had been administrated in 7 patients with an average dosage of 457. 1 g (200 ~ 800 g)and an average period of 5. 6 days (4 ~ 8 days)per person,glycerol fructose had been administrated in 9 patients with an average dosage of 161. 1 g (50 ~ 300 g)and an average period of 2. 9 days (1 ~ 7 days)per person. The DVT in LE was found between 1st to 16th postoperative days (with average of 6. 9 days). Con-clusion Diabetes mellitus,alcohol drinking,more intraoperative blood loss,tumor entity,consciousness disturbance and administration of de-hydrating agent can promote the occurrence of post operative LE DVT in neurosurgical patients. The DVT of LE occurred mostly in the 4th to 7th postoperative days in neurosurgical patients.

Objective To investigate the clinical effect of using anterior cervical approaches in the treatment of cervical neurogenic tumor of the peripheral nerve from different parts.Methods A retrospective review of 22 cases of cervical neurogenic tumor of peripheral nerves was performed,who were admitted to Department of Neurosurgery,Beijing Friendship Hospital,Capital Medical University from January 2009 to January 2015.All 22 patients underwent microsurgical operations with anterior approach of sternocleidomastoid muscle in 10 cases,posterior approach of sternocleidomastoid muscle in 4 cases,anterior cervical retropharyngeal approach in 3 cases,trans-oral approach in 2 cases,and supraclavicular approach in 3 cases.Results The tumors in all 22 cases were totally resected.No surgical complications such as cerebrospinal fluid leakage were observed except 2 cases which developed hoarseness postoperatively that improved that after neurotrophic treatment.All cases were followed up for 12-84 month with a mean 48.3 ± 18.7 month.Recurrence occurred in 1 case which underwent 2nd operation.Conclusion It seems safe and effective to select appropriate approaches corresponding to various tumor locations in the treatment of cervical neurogenic tumors of peripheral nerves.

目的 探讨显微手术夹闭治疗老年患者颅内动脉瘤的治疗效果.方法 回顾性分析49例60岁以上颅内动脉瘤患者的临床资料(包括破裂出血41例,未破裂出血8例).根据术前数字减影血管造影(DSA)和头颅CT血管造影(CTA)检查确认动脉瘤后,48例采用经翼点入路,1例采用经纵裂入路夹闭颅内动脉瘤,出院时根据格拉斯哥预后评分(GOS)评价预后.结果 根据GOS评分,41例破裂出血患者,Hunt-Hess分级Ⅰ~Ⅲ级28例,其中26例(93%)取得良好预后,重度残疾2例(7%);Hunt-Hess分级Ⅳ级13例,其中7例(54%)取得了良好的预后,重度残疾3例(23%),植物生存1例(8%),死亡2例(15%).未破裂动脉瘤8例,均取得良好预后(100%).结论 破裂动脉瘤的老年患者应尽可能早期手术,术前Hunt-Hess分级Ⅰ~Ⅲ级者预后良好,而Ⅳ级以上病死率和伤残率仍较高;未破裂动脉瘤老年患者应采取积极治疗.

BACKGROUND The purposes of this study were to explore the effects of high mobility group protein box 1 (HMGB1) gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. METHODS The expressions of HMGB1 in glioma cells (U251, U-87MG and LN-18) and one control cell line (SVG p12) were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected: the expression of HMGB1 in human glioma cell lines U251 and U-87MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. RESULTS As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells (U251, U-87MG, and LN-18) in comparison with the control cell line (SVG p12); the vitality, proliferation and invasive capabilities of U251 and U-87MG cells in the HMGB1 siRNA-transfected group were significantly lower than those in the blank control group and negative control (NC) siRNA group (P<0.05) but showed no significant difference between the blank control group and NC siRNA group. The percentage of apoptotic U251 and U-87MG cells was significantly higher in the HMGB1 siRNA-transfected group than in the blank control group and NC siRNA group (P<0.05) but was similar between the latter two groups. The HMGB1 siRNA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87MG cells and significantly higher expression of Bax protein than in the blank control group and NC siRNA group (P<0.05); the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siRNA group. CONCLUSIONS HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

Objective The aim of this study is to discuss the clinical characteristic and the selection of treatment of acute cerebral vein si-nus thrombosis. Methods Clinical data of 26 patients diagnosed with acute CVST were retrospectively analyzed. These patients were treated with simple anticoagulant therapy,intravenous thrombolytic therapy,and endovascular thrombolysis. Then all the patients took oral warfarin for 6~12 months. Results Among 16 patients who received systemic anticoagulant therapy,13 were cured,3 were improved. Among 6 patients who accept-ed intravenous thrombolytic therapy,4 were cured,2 were improved. Among 4 patients who accepted endovascular thrombolysis,3 were cured,1 was improved. The period of follow-up was between 6 months and 26 months( the median time was 18 months),and no recurrence happened or reported. Conclusion Personalized treatment of acute CVST should be selected in clinical practice. The influencing factors included the clinical manifestations,the degree of occlusion of cerebral vein sinus,and collateral circulation.

1 临床资料 患者女,24岁,主因"双下肢无力7年,加重3个月"于2013年8月25日入院.患者7年前出现双下肢无力,并进行性加重,半年后双下肢瘫痪伴感觉障碍,就诊多家当地医院,行胸椎核磁提示椎管内占位(T1-11),因手术困难,未行手术治疗,后服中药治疗(具体不详),症状逐渐缓解至正常.