Objective:To discuss the treatment and prognosis of poor healing of scalp incision after craniotomy.Methods:A retrospective analysis was conducted on the clinical data of 22 patients with poor healing of scalp incision after elective surgery in the Sixth Ward of Neuro-Oncology, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2014 to November 2020. Those patients accounted for 0.6%(22/3 667) of patients undergoing elective surgery in the same period. According to the scope of poor healing of the incision and the presence or absence of skin defects, the patients were divided into groups: poor healing of scalp incision without scalp defection (Group A1); poor healing of chronic wounds with cerebrospinal fluid leakage rather than defection of scalp (Group A2); poor scalp healing with skin defects (Group B); complex healing defect with osteomyelitis (Group C); complex healing defect, osteomyelitis and epidural abscess or brain abscess (Group D). Group A1 and A2 were given suture after exploring the scalp wound; Group B was given an incision dressing, and then underwent a second stage of suture; Group C and Group D were given debridement, bone flap removal and incision suture. Regular telephone or outpatient follow-up was performed to evaluate the patients′ incision healing.Results:Among the 22 patients, 7 were in group A1, 7 were in group A2, 4 were in group B, 1 was in group C, and 3 were in group D. Among 22 patients, 1 patient with recurrent craniopharyngioma in group D died of secondary subcutaneous empyema and brain abscess, and the remaining 21 patients completed the clinical follow-up of 3 to 60 months. One patient in group A2 after suboccipital far-lateral craniotomy had cerebrospinal fluid leakage lasting for 2 months and underwent ventriculoperitoneal shunt at another hospital due to hydrocephalus. By the last follow-up, the incisions of 21 patients were all healed, and the median healing time was 14 days (range: 7-42 d).Conclusion:Patients with poor incision healing after craniotomy have a generally good prognosis after individualized treatment according to the scope of the incision and the presence or absence of skin defects.

胶质母细胞瘤(GBM)是成人颅内最常见、最具侵袭力的原发性恶性肿瘤，病死率极高。接受标准治疗后新诊断的GBM患者，5年生存率<10%。改善GBM患者的生存预后是人类迄今尚未攻克的难题。鉴于免疫治疗在其他肿瘤的治疗中已取得良好的效果，国内外学者开始对GBM患者进行免疫治疗方面的研究，以期改善患者的生存预后。本文对国内外近期报道的GBM患者免疫治疗相关研究进展进行综述。

目的 探讨体素内不相干运动模型(intravoxel incoherent motion,IVIM)参数在预测胶质瘤术前分级中的价值,及其与Ki-67标记指数表达的相关性.材料与方法 回顾性分析63例经组织病理学证实为胶质瘤患者,男43例,女20例,年龄16～74(47±13)岁,分为低级别组(WHOⅡ级30例)和高级别(WHOⅢ级、Ⅳ级33例),经免疫组化获得胶质瘤的Ki-67标记指数.患者术前均行颅脑MRI常规扫描、IVIM-DWI检查,分别测量肿瘤最大层面实性区域和对侧正常白质区域的IVIM参数,获得ADC、假扩散系数(pseudo-diffusion coefficient,D*)、纯水扩散系数(pure water diffusion coefficient,D)、灌注分数(perfusion fraction,f)值,将肿瘤实质区测量值除以对侧正常脑实质测量数值,获得校正后参数,包括相对表观扩散系数(relative ADC,rADC)、相对假扩散系数(relative D*,rD*)、相对纯水扩散系数(relative D,rD)以及相对灌注分数(relative f,rf).利用秩和检验(Mann-Whitney U检验)比较高、低级别组间4个定量参数、Ki-67标记指数的差异.利用Spearman法分析4组定量参数与Ki-67标记指数之间的相关性.应用ROC曲线评估4组定量参数在脑胶质瘤分级中的诊断效能.结果 低级别胶质瘤组rADC值、rD值及rf值均高于高级别胶质瘤组(P值均<0.05),两组间rD*值无统计学差异(P=0.139),高级别胶质瘤组平均Ki-67标记指数明显高于低级别胶质瘤组,两组间差异有统计学意义(P<0.01).rADC、rD、rf值的ROC曲线下面积分别为0.912、0.911、0.714;阈值分别为1.280、1.295、1.171;敏感度分别为93.3％、90.0％、86.7％;特异度分别为75.8％、78.8％、48.5％.rADC、rD与Ki-67标记指数存在较强的负相关性,rD*与Ki-67标记指数存在低度相关性,rf与Ki-67标记指数不具有明显相关性.结论 IVIM可以无创地评估胶质瘤级别,其中rADC的诊断效能最高.Ki-67标记指数在高、低级别胶质瘤间存在显著差异,且与rADC、rD存在较强负相关,可以为临床诊断、治疗及预后判断提供帮助.

异柠檬酸脱氢酶(IDH)基因分型对于胶质瘤的精准诊疗具有重要意义.该文将组织涂片用于病理组织代谢物质谱分析的样品前处理,并采用2-羟基戊二酸与花生四烯酸质谱响应强度的比值作为胶质瘤IDH基因状态的判别指标,建立了基于空气动力辅助离子化(AFADESI)质谱技术的胶质瘤IDH基因状态快速判别分析方法.对组织涂片用于代谢物敞开式质谱分析的可行性进行考察和定量方法学验证,结果表明其具有样品分散性好、操作简单快速、代谢物覆盖度高、定量准确度好的优点.受试者工作曲线(ROC)评估显示,其用于胶质瘤IDH基因状态判别的诊断能力良好.组织涂片结合空气动力辅助离子化质谱分析用于胶质瘤IDH基因状态的快速判别有望为胶质瘤精准诊疗提供新的分析手段和技术支持.

目的 探讨脑胶质瘤术后张力性积液的临床特征.方法 回顾性分析8例脑胶质瘤术后发生张力性积液病人的临床资料,行瘤腔穿刺引流5例,穿刺后行开颅去骨瓣减压术1例,穿刺抽液1例,脱水治疗1例.结果 经治疗后病人症状均好转.GOS预后评分:恢复良好3例,轻度残疾3例,重度残疾2例,无植物生存及死亡病例.结论 体积较大的胶质瘤术后要注意瘤腔张力性积液的发生,积极调整机体内环境;如果发生张力性积液,及时瘤腔穿刺可取得较好预后.

Background The extent of resection of non-contrast enhancing tumors (EOR-NCEs) has been shown to be associated with prognosis in patients with newly diagnosed glioblastoma (nGBM). This study aimed to develop and independently validate a nomogram integrated with EOR-NCE to assess individual prognosis. Methods Data for this nomogram were based on 301 patients hospitalized for nGBM from October 2011 to April 2019 at the Beijing Tiantan Hospital, Capital Medical University. These patients were randomly divided into derivation (n=181) and validation (n=120) cohorts at a ratio of 6:4. To evaluate predictive accuracy, discriminative ability, and clinical net benefit, concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were calculated for the extent of resection of contrast enhancing tumor (EOR-CE) and EOR-NCE nomograms. Comparison between these two models was performed as well. Results The Cox proportional hazards model was used to establish nomograms for this study. Older age at diagnosis, Karnofsky performance status (KPS)<70, unmethylated O6-methylguanine-DNA methyltransferase (MGMT) status, wild-type isocitrate dehydrogenase enzyme (IDH), and lower EOR-CE and EOR-NCE were independent factors associated with shorter survival. The EOR-NCE nomogram had a higher C-index than the EOR-CE nomogram. Its calibration curve for the probability of survival exhibited good agreement between the identical and actual probabilities. The EOR-NCE nomogram showed superior net benefits and improved performance over the EOR-CE nomogram with respect to DCA and ROC for survival probability. These results were also confirmed in the validation cohort. Conclusions An EOR-NCE nomogram assessing individualized survival probabilities (12-, 18-, and 24-month) for patients with nGBM could be useful to provide patients and their relatives with health care consultations on optimizing therapeutic approaches and prognosis.

基于Bootstrap、Java、MySQL等开发技术,构建人类胶质瘤蛋白质组数据库系统,实现数据管理、检索、可视化及分析功能,包括聚类热图分析、基因本体分析和通路分析,指出系统具有良好的扩展性与数据兼容性,有助于蛋白质组学数据的综合管理与高效分析.

Purpose Body fluid is considered a rich source of disease biomarkers. Proteins in many body fluids have potential clinical applications for disease diagnostic and prognostic predictions. Experimental design To determine differences in the protein components and functional features of body fluids, a proteomic comparison of five body fluids (plasma, urine, cerebrospinal fluid, saliva, and amniotic fluid) was conducted by high‐resolution mass spectrometry. Results A total of 4717 nonredundant proteins were identified, and the concentrations of 3433 proteins were estimated by an intensity‐based algorithm quantitation method. Among them, 564 proteins were shared among the five body fluids, with common functions in the coagulation/prothrombin system and inflammatory response. A total of 36.7% of the proteins were detected in only one body fluid and were closely related to their adjacent tissues by function. The functional analysis of the remaining 2986 proteins showed that similar functions might be shared among different body fluids, which highlighted intimate connection in the body. Conclusions and clinical relevance The quantitative comparative functional analysis indicated that body fluids might reflect the diverse functions of the whole body rather than the characteristics of their adjacent tissues. The above data might indicate the potential application of body fluids for biomarker discovery.

We surveyed common genetic mutations (IDH1, H3F3A, PPM1D, and TP53) and immune features (PD-L1 expression and CD8+ T cell tumor infiltration) in a series of 62 malignant brainstem gliomas that were resected via microsurgery. IDH1 mutations were mutually exclusive with H3F3A mutations. IDH1 mutations appeared only in adults and occurred more frequently in tumors larger than 10cm3 (8/29 vs 1/32, Fisher's exact test, p=0.010). H3F3A mutations occurred more frequently in children and adolescent patients (19/24 vs 18/38, chi-square test, p=0.013), low preoperative Karnofsky Performance Scale (KPS) patients (10/11 vs 20/43, chi-square test, p=0.021), and higher grade brainstem gliomas (8/21 in grade II vs 16/24 in grade III vs 13/17 in grade IV; chi-square test, p=0.038). PPM1D mutations clustered in H3F3A-mutated tumors (12/37), whereas were rare in H3F3A wildtype tumors (1/25). MGMT promoter methylations clustered in IDH1-mutated tumors (4/9), but were rare in H3F3A-mutated tumors (1/37). PD-L1 staining was detected in 59.7% of brainstem glioma specimens (37/62). High intra-tumoral CD8+ T cell density was less frequent in the H3F3A-mutated than H3F3A-wild-type tumors (4/37 vs. 11/25, p=0.005). Patients with H3F3A-mutated tumors (13.8 months overall survival) had much worse prognoses than those with IDH1-mutated (54.9 months, p=0.001) or H3F3A-IDH1 co-wildtype tumors (38.4 months, p=0.001). H3F3A mutations independently increased the relative risk of death as much as 4.19-fold according to a multivariate Cox regression model. Taken together, resectable malignant brainstem gliomas can be classified into three subtypes: H3F3A-mutated, IDH1 mutated and H3F3A-IDH1 co-wildtype tumors, which have distinct clinical characteristics, prognoses, genetic and immune features.

OBJECTIVE:To evaluate the diagnostic accuracy of routine blood examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical Bacterial Meningitis (PBM) at a large sample-size of post-neurosurgical patients.METHODS:The diagnostic accuracies of routine blood examinations and CSF lactate level to distinguish between PAM and PBM were evaluated with the values of the Area Under the Curve of the Receiver Operating Characteristic (AUC-ROC) by retrospectively analyzing the datasets of post-neurosurgical patients in the clinical information databases.RESULTS:The diagnostic accuracy of routine blood examinations was relatively low (AUC-ROC<0.7). The CSF lactate level achieved rather high diagnostic accuracy (AUC-ROC=0.891; CI 95%, 0.852-0.922). The variables of patient age, operation duration, surgical diagnosis and postoperative days (the interval days between the neurosurgery and examinations) were shown to affect the diagnostic accuracy of these examinations. The variables were integrated with routine blood examinations and CSF lactate level by Fisher discriminant analysis to improve their diagnostic accuracy. As a result, the diagnostic accuracy of blood examinations and CSF lactate level was significantly improved with an AUC-ROC value=0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948) respectively.CONCLUSIONS:The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level.

Objective To evaluate the effect of varying duration of prophylactic antibiotics on the incidence of postoperative intracranial infection in neurosurgeries with Class Ⅰ wound.Methods A total of 1 130 patients were enrolled into this prospective study who underwent neurosurgeries with Class Ⅰ wound at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from August 2015 to March 2016.Based on the risk-stratified scales for postoperative intracranial infection,all patients were classified into two groups:low-risk group (LRG,n =807) and high-risk group (HRG,n =323).The two groups were further randomized into subgroups with various duration of postoperative prophylactic antibiotics.Specifically,LRG was subdivided into 0 h and 24 h subgroups (n =414 and 393,respectively).HRG was subdivided into 24 h,48 h and 72 h subgroups (n =116,113 and 94,respectively).The incidence of postoperative intracranial infections were compared between subgroups using Chi-square test.Results The incidences of intracranial infections were 2.9％ (12/414) and 2.0％ (8/393) in 0 h and 24 h subgroups within LRG,respectively;and they were 8.6％ (10/116),13.3％ (15/113) and 11.7％ (11/ 94) in 24 h,48 h and 72 h subgroups within HRG,respectively.The incidence of intracranial infection was significantly higher in HRG than LRG among the patients who received prophylactic antibiotics for 24 h post operation (x2 =11.385,P =0.001).There was no significant difference in the incidence of postoperative intracranial infection between the subgroups within the same group (all P ＞ 0.05).Conclusions Patients undergoing neurosurgeries with Class Ⅰ wound could be divided into low-risk and high-risk groups.Extended or shortened postoperative prophylactic antibiotics may not be able to significantly affect the incidence of postoperative intracranial infection.

Diabetic foot (DF) is one of the chronic complications commonly seen in patients with diabetes. It poses a serious burden that harms the patient’s extremity health. Lower limb artery disease is a major pathogenic factor that causes DF. Currently, digital subtraction angiography (DSA), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and color dopplerultrosonography (CDU) are dominant interventional imaging strategies applied in clinics, which are safe, effective and minimal invasive, and prevalent in the treatment of diabetic lower limb artery disease. This review will sum up the current research and development in the ifeld of imaging diagnostics and interventional therapy in the treatment of diabetic lower limb artery disease.

Bacterial meningitis is not rare in post-neurosurgical patients. If patients are not treated promptly, the mortality rate can reach 20 to 50 %. The concentration of cerebrospinal fluid (CSF) lactate has been reported to be helpful in the diagnosis of bacterial meningitis; however, no systematic evaluations have investigated CSF from a postoperative perspective. In this study, we performed a systematic evaluation and meta-analysis of the efficacy of using CSF lactate concentrations in the diagnosis of post-neurosurgical bacterial meningitis.

Polymeric micelles are effective drug-loading sites and often used to formulate poorly water-soluble agents. In the present study, the amphiphilic copolymer methoxy-capped poly(ethyleneglycol)-block-poly(Ɛ-caprolactone) (mPEG-b-PCL) was successfully developed for the delivery of 20(R)-dammarane-3β,12β,20,25-tetrol (25-OH-PPD), a natural anticancer product from Panax notoginseng. The 25-OH-PPD-loaded micelles were characterized by morphological observation and thermodynamic stability testing. The concentrations of 25-OH-PPD was determined by HPLC–MS/MS. The optimum MRM transition of 25-OH-PPD was selected at m/z 479.4.0→461.4. The chromatographic separation was achieved on a SB-C18 column (1.8μm, 2.1×50mm) with an optimized gradient mobile phase system. The extraction recoveries of plasma and various tissue homogenates were within the range of 81.1%–110.4% and the matrix effects ranged from 81.9% to 106.7%. The intra- and inter- day precision values (RSD%) were less than 12.0%, with accuracies ranging from 85.2% to 114.2%. In addition, 25-OH-PPD was found to be stable in different biological matrix after three freeze-thaw cycles, at room temperature and at −70°C for 4 weeks. The pharmacokinetics of 25-OH-PPD-loaded micelles was evaluated in rats. The micelles appeared as transparent liquid, stable and uniform spheres with an average particle size of 35.4±4.2nm. The maximum concentration of 25-OH-PPD in micelles was much lower than in free drug preparation. However, the drug in the micelles was released steadily, with a t1/2 of 9.1±4.0h, significantly longer than in free drug (3.3±1.4h). However, the drug concentrations in tissues after the micelle administration were lower than the levels after administration of the free drugs. In summary, the micelles were characterized by long circulation and sustained release, with an ability to avoid uptake by the reticuloendothelial system, providing a promising approach to deliver intravenous 25-OH-PPD for therapy.

Knowledge about the normal human cerebrospinal fluid (CSF) proteome serves as a baseline reference for CSF biomarker discovery and provides insight into CSF physiology. In this study, high-pH reverse-phase liquid chromatography (hp-RPLC) was first integrated with a TripleTOF 5600 mass spectrometer to comprehensively profile the normal CSF proteome. A total of 49,836 unique peptides and 3256 non-redundant proteins were identified. To obtain high-confidence results, 2513 proteins with at least 2 unique peptides were further selected as bona fide CSF proteins. Nearly 30% of the identified CSF proteins have not been previously reported in the normal CSF proteome. More than 25% of the CSF proteins were components of CNS cell microenvironments, and network analyses indicated their roles in the pathogenesis of neurological diseases. The top canonical pathway in which the CSF proteins participated was axon guidance signaling. More than one-third of the CSF proteins (788 proteins) were related to neurological diseases, and these proteins constitute potential CSF biomarker candidates. The mapping results can be freely downloaded at http://122.70.220.102:8088/csf/, which can be used to navigate the CSF proteome. For more information about the data, please refer to the related original article [1], which has been recently accepted by Journal of Proteomics.

Objective To investigate the role of the cerebrospinal fluid procalcitonin (PCT) in the identification of intracranial bacterial infection and aseptic meningitis in adults.Methods A total of 178 patients with the suspected symptom of intracranial bacterial infection at 48 to 72 h after neurosurgical brain tumor surgery at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from October 2013 to March 2014 were analyzed retrospectively.The cerebrospinal fluid routine,biochemical and procalcitonin tests were performed.According to the diagnostic criteria of intracranial infection,they were divided into either a bacterial infection group (n =50) or an aseptic meningitis group (n =128).The cerebrospinal fluid PCT and its changes of the traditional cerebrospinal fluid detection index were compared.The receiver operating characteristic curve (ROC) was used to analyze the values of cerebrospinal fluid PCT for identifying the infection and aseptic meningitis.Results Compared with the aseptic meningitis group,the white blood cell count,polynuclear cell ratio,protein content,and PCT content were all increased in the cerebrospinal fluid of bacterial infection,and the blood glucose was reduced.There were significant differences (all P ＜ 0.01).There was no significant difference in chloride.The median (range) of cerebrospinal fluid PCT in the bacterial infection group was 0.15 ng/ml (0-3.09 ng/ml),and in the aseptic meningitis group was 0 ng/ml (0-0.46 ng/ml).The ROC results showed that the area under curve of the differential diagnosis of intracranial bacterial infection was 0.746.The diagnostic threshold was 0.075 ng/ml,the sensitivity was 68.0％,specificity was 72.7％,positive predictive value was 49.3％,and negative predictive value was 85.3％.The PCT in cerebrospinal fluid was positively correlated with theleukocyte,proportion of multinucleated cells,and protein (r =0.446,0.453,and 0.482,respectively,all P＜0.01).It was negatively correlated with glucose (r=-0.201,P=0.007).Conclusion The detection of PCT in cerebrospinal fluid has an important clinical application value for the diagnosis of intracranial bacterial infection after neurosurgical operation.

Backgrounds: Pseudoprogression disease (PsPD) is commonly observed during glioblastoma (GBM) follow-up after adjuvant therapy. Because it is difficult to differentiate PsPD from true early progression of GBM, we have used a quantitative proteomics strategy to identify molecular signatures and develop predictive markers of PsPD.Results: An initial screening of three PsPD and three GBM patients was performed, and from which 530 proteins with significant fold changes were identified. By conducting biological functional analysis of these proteins, we found evidence that the protein synthesis network and the cellular growth and proliferation network were most significantly affected. Moreover, six of the proteins (HNRNPK, ELAVL1, CDH2, FBLN1, CALU and FGB) involved in the two networks were validated (n = 18) in the same six samples and in twelve additional samples using immunohistochemistry methods and the western blot analysis. The receiver operating characteristic (ROC) curve analysis in distinguishing PsPD patients from GBM patients yielded an area under curve (AUC) value of 0.90 (95% confidence interval (CI), 0.662-0.9880) for CDH2 and. 0.92 (95% CI, 0.696-0.995) for CDH2 combined with ELAVL1.Conclusions: The results of the present study both revealed the biological signatures of PsPD from a proteomics perspective and indicated that CDH2 alone or combined with ELAVL1 could be potential biomarkers with high accuracy in the diagnosis of PsPD.

BackgroundAs urine is less complex than plasma and accumulates substantial physiological and pathophysiological changes from both plasma and the urinary system, it is regarded as an ideal source of sample for biomarker studies.MethodsTo gain a better understanding of the biological functions of urinary proteins and their association with human diseases, we did an in-depth urinary proteome analysis, using urine samples from 24 healthy individuals, that was based on multiple separation strategies, including direct one-dimensional liquid chromatography–tandem mass spectrometry (1DLC/MS/MS), two-dimensional LC/MS/MS, and gel-eluted liquid fraction entrapment electrophoresis (GELFrEE) and liquid-phase isoelectric focusing (LP-IEF) followed by 2DLC/MS/MS.FindingsWe identified 6412 proteins, of which 2213 had not been reported in previous studies and 2571 were relatively and absolutely quantitated (spanning a magnitude of 106) with an intensity-based absolute quantification algorithm. Tissue-based analysis revealed that 514 tissue-enriched proteins from 27 tissues and 917 tissue-enhanced proteins from 32 tissues could be detected in urine, suggesting that the urinary proteome might have an important role in studying the physiological and pathological changes of the related organs, such as the brain and kidney. We selected potential urinary biomarkers that were previously identified for glioma and IgA nephropathy by filtering biomarkers from the publicly accessible Human Urine Proteome Database and verified them by Western blotting. We also observed that deeper separation allowed identification of more tissue-related and disease-specific proteins. All the detailed information—such as protein name, accession number, peptide sequence, sequence coverage, and biomarker application—could be obtained from the Human Urine Proteome Database, which provides information for prediction of urinary candidate biomarkers and modification of targeted proteomics workflow.InterpretationUrine might indicate the physiological and pathological changes of several organs and could therefore be used as a promising source of sample for biomarker discovery, especially for brain and kidney diseases.FundingThis work was supported by the National Basic Research Program of China (2013CB530805 and 2014CBA02005), the Key Basic Research Program of the Ministry of Science and Technology of China (2013FY114100), the National Natural Science Foundation of China (31200614 and 31400669), and the Beijing Natural Science Foundation (5132028).

Objectives To analyze the incidence,risk factors of intracranial infection after neurosurgical operation and to propose a prediction score scale based on these risk factors.Methods New prophylactic strategy of antibiotics (timing:0.5-2 h ahead of neurosurgical procedures;duration:24 hours for type Ⅰ incision and 48 hours for type Ⅱ incision) was used in 2012,and 2 058 patients from August to October were chosen for analysis.Based on the independent risk factors identified by logistic regression,a score scale was proposed to stratify patients into high-risk or low-risk group for postoperative intracranial infection.Results The incidence of intracranial infection for type Ⅰ and type Ⅱ incision was 10.1％ (115/1 137) and 11.0％ (101/921),respectively.Logistic regression revealed that younger patients,longer operative duration,and lesion in the posterior fossa or the ventricles were independent risk factors for postoperative intracranial infection.Compared with the patients aged 17-40,the ORs (95％ CI) of intracranial infection in patients aged 40-60 and ≥60 were 0.546 (0.401-0.745)and 0.277 (0.153-0.499),respectively.Compared with the lesions in the sellar region,the ORs (95％ CI) of intracranial infection for lesion in the supratentorial region,spinal canal,brainstem/cerebellopontine angle/cerebellum,and the ventricle were 3.014 (1.329-6.838),1.977 (0.855-4.571),4.585 (1.971-10.666),and 8.410 (2.924-24.195),respectively.Compared with operative duration ＜ 4 h,the ORs (95 ％ CI) of intracranial infection for 4-7 h and ≥7 h were 4.555 (2.280-9.100) and 8.939 (4.292-18.615),respectively.On ROC curve,the cutoff score to predict intracranial infection for type Ⅰ and type Ⅱ incision was-2.2 and-1.9,respectively.For type Ⅰ incision,the frequencies of intracranial infection in low-risk (＜-2.2) and high-risk (≥-2.2) groups were 4.4％ (30/685) and 18.8％ (85/452),respctively.For type Ⅱ incision,the frequencies of intracranial infection in low-risk (＜-1.9) and high-risk (≥-1.9)groups were 3.1％ (18/588) and 24.9％ (83/333),respectively.Conclusions Younger age,longer operative duration and lesions in the posterior fossa or the ventricle were independent risk factors for postoperative intracranial infection.The prediction score scale could be effectively used to stratify patients into high-risk or low-risk group for postoperative intracranial infection,which provided the basis for individualized prophylactic strategies of antibiotics.

Although a bone tumor, significant differences in the extent of bone invasion exist in skull base chordoma, which directly affect the extent of surgical resection, and have an impact on its prognosis. However, the underlying mechanism of the phenomenon is not clearly understood. Therefore, we used an iTRAQ-based quantitative proteomics strategy to identify potential molecular signatures, and to find predictive markers of discrepancy in bone invasion of clivus chordoma. According to bone invasive classification criteria, 35 specimens of clivus chordoma were calssified to be either endophytic type (Type I) or exophytic type (Type II). An initial screening of six specimens of endophytic type and six of exophytic was performed, and 250 differentially expressed proteins were identified. Through the GO and IPA analysis, we found evidence that the expression of inflammatory activity-associated proteins up-regulated in endophytic type, whereas the expression of cell motility-associated proteins up-regulated in exophytic ones. Moreover, TGFβ1 and mTOR signal pathway seemed to be related with bone invasion. Thus, TGFβ1, PI3K, Akt, mTOR, and PTEN were validated in the following 23 samples by immune histochemistry and Western blot. The expression levels of TGFβ1 and PTEN were significantly lower in the endophytic type than in the exophytic ones. It was found that TGFβ1 may play an important role in its bone invasion. The mechanisms may be related with conducting an increased inflammatory cell response and a decline in cytoskeletal protein expression. PTEN is confirmed to be associated with the degree of bone invasion. The PI3K/AKT/mTOR signaling pathway might be associated with the bone invasion, but still needs a larger sample size to be verified These results, for the first time, not only demonstrate the biological changes that occur in different growth patterns from the perspective of proteomics, but also provide novel markers that may help to reveal the mechanisms behind clivus chordomas.