Intracerebral hemorrhage (ICH) remains a major cause of morbidity and mortality, with no rapid blood-based biomarkers available to assess secondary brain injury. This study aimed to identify a circulating pan-cell death protein signature for diagnosing and prognosing ICH. We prospectively enrolled 60 ICH patients and 60 age/sex-matched healthy controls, collecting plasma at defined time points after ICH onset. Using Olink proteomics, we identified 13 apoptosis-related proteins with significant dysregulation. Four key proteins─TLR4, ALOX15, FTL, and BMF─were validated through ELISA and RT-qPCR, showing good diagnostic performance (AUCs 0.799-0.835). A multiprotein logistic model demonstrated excellent diagnostic accuracy (AUC = 0.955). These biomarkers correlated with clinical severity and prognosis, including hematoma volume and a 90-day modified Rankin Scale (mRS). Additionally, animal models confirmed time-dependent upregulation of TLR4 in astrocytes. This pan-cell death protein signature provides valuable insights into ICH pathology and offers a promising tool for early diagnosis, risk stratification, and therapeutic targeting.

Multidrug-resistant (MDR) Chryseobacterium indologenes is an emerging pathogen causing challenging central nervous system (CNS) infections, for which there are no standardized treatment guidelines. A systematic review of the literature indicates that such infections are extremely rare. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the most frequently reported first-line therapy, its clinical efficacy is not universal, posing a significant therapeutic challenge. We present the case of a 25-year-old postpartum woman who developed MDR C. indologenes meningitis and a brain abscess after undergoing a neurosurgical procedure. The infection did not respond to initial treatment with meropenem or a subsequent course of the first-line agent TMP-SMX. Based on antimicrobial susceptibility testing, therapy was switched to rifampin monotherapy, which led to rapid clinical and microbiological recovery. The patient completed a 24-day course of rifampin and remained recurrence-free during a 20-month follow-up. This is the first report of successful rifampin monotherapy for an MDR C. indologenes CNS infection in a patient unresponsive to TMP-SMX. When considered alongside existing literature, these findings highlight the essential role of susceptibility testing and establish rifampin as an important salvage therapy for this life-threatening infection, particularly when recommended first-line treatments fail.

Introduction: Pancreatic cancer metastasis to the cerebellopontine angle (CPA) is extremely rare and often misdiagnosed preoperatively. The clinical characteristics and prognosis of this uncommon condition remain largely unknown. Case presentation: We report the case of a 68-year-old male who presented with recurrent headaches, dizziness, and gait disturbances. The patient had undergone pancreaticoduodenectomy for pancreatic head adenocarcinoma two years prior. Preoperative imaging suggested a right CPA meningioma. The patient underwent resection of the CPA tumor under general anesthesia. Postoperative pathology revealed a metastatic pancreatic adenocarcinoma. Despite treatment with adjuvant chemotherapy, the patient developed widespread metastatic disease and succumbed 2 months after the CPA tumor resection. Discussion: The rarity of pancreatic cancer metastasizing to the CPA presents diagnostic challenges, as evidenced by the initial misdiagnosis of meningioma in this case. The clinical presentation can mimic benign conditions, leading to delays in appropriate management. This case underscores the importance of considering metastatic disease in patients with a history of cancer, even when presenting with symptoms typical of more common CPA lesions. Conclusion: Vigilant monitoring is crucial in pancreatic cancer patients, as neurological symptoms may herald metastatic spread to uncommon sites like the CPA. Despite surgical intervention, widespread metastasis can lead to poor outcomes. Early diagnosis and a high index of suspicion are essential for optimal management of these rare cases.

During acute ischemic stroke, a cascade of pathophysiological reactions leads to brain cell injury, primarily via disruptions in energy metabolism and increased oxidative stress. In this study, we scrutinized the neuroprotective effects of bryodulcosigenin (BRY) against acute cerebral ischemia/reperfusion (CIR) injury in rats. To induce middle cerebral artery occlusion (MCAO) in rats, a nylon monofilament suture with a silicon-coated tip was inserted into the internal carotid artery. The cerebral infarct volume, brain water content, neurological deficits, brain edema, Evan Blue extravasation and blood brain barrier (BBB) leakage were estimated. The antioxidant, cytokines, inflammatory and matrix metalloproteinases (MMP) parameters were evaluated. mRNA expression and histopathological study were performed. Bryodulcosigenin significantly suppressed the neurological deficits, cerebral infarct volume, brain edema, brain water content, BBB leakage and Evan Blue extravasation. It also suppressed brain injury markers like K+-Cl− cotransporter 1 (KCC1), S100 calcium-binding protein B (S-100β), neuron specific enolase (NSE), occludin and clusterin. Moreover, bryodulcosigenin altered antioxidant levels via enhancing the level of glutathione peroxidase (GPx), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), while reducing malonaldehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OhdG). It altered the pro-inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-1β, IL-4, IL-6, IL-10, as well as inflammatory mediators such as inducible nitric oxide (iNOS), cyclooxygenase-2 (COX-2), vascular endothelium growth factor (VEGF), prostaglandin (PGE2), nuclear factor kappa B (NF-κB) and MMP (MMP-2, MMP-3 and MMP-9) level in the serum and brain tissue. Additionally, bryodulcosigenin modulated the mRNA expression of Toll-Like Receptor 4 (TLR4), syndecan-1, cerebrospinal fluid (CSF), aquaporin-1 (AQP1), organic cation transporter 3 (OCT3), reduced expression 1 (REX1) and improved the histopathological condition. Bryodulcosigenin exerted anti-inflammatory and neuroprotective effects against CIR injury via alteration of TLR4/NF-κB signaling pathways.

Primary intracranial-extracranial communicating leiomyosarcomas, capable of invading both intracranial and extracranial regions and involving complex anatomical structures, are exceedingly rare neoplasms. We present the case of a 37-year-old male initially presented with a subcutaneous mass on the left frontal vertex. Post-surgical intervention, a recurrent lump emerged on the left frontotemporal vertex. Symptoms, computed tomography (CT), and magnetic resonance imaging (MRI) revealed a mass on the left frontal vertex accompanied by an irregular abnormal lesion. Leiomyosarcoma diagnosis was confirmed on both occasions. The patient underwent leiomyosarcoma excision under general anesthesia. Recurrence was noted 2 years and 4 months post-surgery, necessitating an expanded excision. After 2 years of follow-up, no significant complications were observed, and the patient’s condition remains stable. Primary extracranial communicating leiomyosarcoma is exceptionally rare, with surgery as the primary treatment modality. The decision to excise the lesion should consider the patient’s age, tumor location, pathological features, and presence of distant metastases.

Background Primary intracranial-extracranial communicating leiomyosarcomas, which invade both intracranial and extracranial regions and involve complex anatomical structures, are extremely rare tumors. Case presentation: A 37-year-old male initially exhibited a subcutaneous mass on the left frontal vertex. Post-surgical resection, a recurrent mass manifested at the left frontotemporal vertex. Computed tomography (CT), and magnetic resonance imaging (MRI) revealed a lump on the left frontal vertex accompanied by an irregular abnormal lesion, and the diagnosis of leiomyosarcoma was confirmed. The patient underwent leiomyosarcoma excision under general anesthesia. The tumor recurred after 2 years and 4 months, leading to a more extensive surgical excision. Following a 2-year follow-up, the patient showed no major complications and maintained a stable condition. Conclusion Primary intracranial-extracranial communicating leiomyosarcoma is a rare condition. Surgical removal is the main therapeutic approach. The decision for lesion excision should consider factors such as the patient’s age, tumor location, pathological characteristics, and any distant metastasis.

随着医学诊疗技术的迅速发展,造影剂被越来越广泛使用,其副反应如过敏反应、肾功能损害及造影剂脑病(contrast-induced encephalopathy,CIE)等也随之增多.造影剂对神经系统的副反应的患病率约为1％～2％[1].CIE是一种使用造影剂后出现短暂性、可逆性的神经功能障碍和CT扫描异常的罕见疾病,大部分预后良好,但仍有极少数患者出现严重神经功能障碍,甚至死亡.大部分致死性CIE病例均因为使用高渗性造影剂,对于非离子单体低渗造影剂诱发的致死性CIE报道极为少见.本文报道1例使用碘普罗胺造影剂的颅内动脉瘤栓塞术后发生致死性CIE的临床表现、病因、诊治经过,旨在提高对CIE的认识.

目的:观察脑疝所致动眼神经损伤术后恢复情况并探讨影响动眼神经术后恢复的影响因素.方法:回顾性分析昆明市第一人民医院收治的脑疝所致动眼神经损伤患者55例的临床资料,收集患者临床资料.根据术后6～12个月随访动眼神经恢复情况分为预后不良组与预后良好组,分析动眼神经损伤术后恢复的影响因素.结果:预后良好组和预后不良组的年龄、术前格拉斯哥昏迷量表(GCS)评分、术前双侧瞳孔大小、瞳孔对光反射、影像下CT中线偏移距离及颅内血肿计算量差异有统计学意义(P<0.05).进一步Logistic多因素回归分析显示瞳孔对光反射消失是脑疝性动眼神经损伤术后恢复的独立影响因素.结论:影响脑疝性动眼神经损伤术后恢复因素较多,瞳孔对光反射消失是其独立影响因素.

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤(DA-SICA)的可行性、有效性.方法 回顾性分析2015年1月至2020年7月运用LVIS支架辅助弹簧圈栓塞治疗的28例DA-SICA的临床资料.结果 双LVIS支架辅助栓塞13例,术后即刻造影显示Raymond分级Ⅰ级10例,Ⅱ级3例;单LVIS支架辅助栓塞15例,术后即刻造影显示均为Raymond分级Ⅰ级.术中动脉瘤破裂出血2例.围手术期死亡3例,其中2例死于恶性脑肿胀,1例死于再出血.存活25例术后随访3～49个月,平均(26.5±2.5)个月;2例术后复发,再次使用LVIS支架辅助弹簧圈栓塞治愈;其余23例术后3个月复查DSA无动脉瘤复发及载流动脉狭窄.结论 LVIS支架辅助弹簧圈栓塞治疗DA-SICA,是一种有效、可行的选择,使用支架的数目应根据术中具体情况决定,术后应制定个体化的抗血小板治疗方案.

backgroundTo analyze and summarize the clinical features and diagnosis and treatment experience on primary intracranial and extracranial communicating leiomyosarcoma to deepen clinicians’understanding of the rare disease.Cases presentationThe clinical data and recurrence of a patient who was diagnosed with primary intracranial and extracranial communicating leiomyosarcoma admitted to the Neurosurgery Department, The Affiliated Ganmei Hospital of Kunming Medical University in May 2015 were retrospectively analyzed. According to the patient data, two successful surgical operations were performed and the surgeries went well, with more than 2-year and 8-month follow-up so far. No obvious complications were found after hospital discharge, and follow-up was continued.ConclusionsSurgical removal is the most important and effective treatment means for primary intracranial and extracranial communicating leiomyosarcoma currently.

目的 探讨颞肌下与颞肌外钛网颅骨修补对创伤性颅脑损伤去骨瓣减压术后患者预后的影响.方法 选取2017年1月～2020年10月昆明市第一人民医院神经外科收治的60例外伤性颅内脑损伤去骨瓣减压术患者为研究对象,随机分成颞肌外组(n=28)和颞肌下组(n=32).颞肌外组采用颞肌外颅骨修补术,颞肌下组采用颞肌下颅骨修补术.比较两组患者格拉斯哥预后评分(GOS)、简明精神状态量表(MMSE)评分、术后并发症发生率、住院时间、术中失血量.结果 术后3个月两组GOS及MMSE评分均高于术前,差异有统计学意义(P<0.05),术后两组GOS及MMSE评分比较,差异无统计学意义(P>0.05);两组术中失血量、住院天数比较,差异无统计学意义(P>0.05);两组硬膜外血肿、积液及癫痫等并发症发生率比较,差异无统计学意义(P>0.05).结论 虽然颞肌下颅骨修补对患者术后并发症发生率及预后与颞肌外颅骨修补无区别,但颞肌下颅骨修补符合生理解剖复位,可避免咀嚼受限,卡压痛和外观异常,故颞肌下颅骨修补可能是一种可行的、更优的选择.

随着医学影像学技术快速发展,对比剂应用日渐广泛,相关不良反应随之增加.对比剂脑病(CIE)是应用对比剂后出现的短暂性、可逆性神经功能障碍性疾病,多预后良好,但少数患者可出现严重神经功能障碍甚至死亡.本文对CIE临床特点、发病机制、高危因素及治疗措施等研究进展进行综述.

Temozolomide (TMZ) is currently one of the first-line drugs used for the treatment of high-grade gliomas. However, TMZ resistance results in unsatisfactory therapeutic effects in gliomas. Cancer stem cells (CSCs) have recently been determined to serve a pivotal regulatory role in tumor metastasis, recurrence and chemoresistance. In addition, numerous reports have shown that long non-coding RNAs (lncRNAs) exert an essential role in the occurrence and development of tumors, and can be used as biomarkers for tumor diagnosis and treatment. Among them, studies have revealed that taurine upregulated gene 1 (TUG1) exhibits an important regulatory effect on the malignant biological behavior of glioma cells. Moreover, it has been reported that enhancer of Zeste homolog 2 polycomb repressive complex subunit 2 (EZH2) promotes tumorigenesis, including in glioma. However, the underlying mechanism of the interaction of TUG1 and EZH2 with CSCs of glioma remains elusive, and thus requires further clarification. The present study aimed to explore the role of TUG1 and EZH2 in TMZ resistance in glioma. Cell Counting Kit-8, colony formation,sphere formation and Annexin V-FITC/PI assays were used to detect the proliferation, clone formation efficiency, stemness and apoptosis of TMZ-resistant glioma cells. Xenograft tumor assay was used to detect the effect of TUG1 on the tumorigenesis of TMZ-resistant glioma cells. The present findings demonstrated that TUG1 exhibited a low expression in glioma cells, while EZH2 expression was the opposite. Moreover, it was observed that A172/TMZ cells possessed higher CSCs-like properties compared with parent cells, and that TUG1 and EZH2 were abnormally expressed in A172/TMZ cells. Knockdown of TUG1 or overexpression of EZH2 promoted A172/TMZ cell proliferation and CSCs-like properties, as well as inhibited their apoptosis, thereby enhancing the TMZ resistance of A172/TMZ cells. Furthermore, it was found that TUG1 alleviated the TMZ resistance of A172/TMZ cells by inhibiting EZH2 expression. Of note, overexpression of TUG1 inhibited the tumorigenicity of A172/TMZ cells by downregulating EZH2 expression in vivo. Collectively, the present study demonstrated that TUG1 served an essential regulatory role in TMZ resistance of gliomas.

目的 探讨不同时期行颅骨修补的安全性和可行性.方法 回顾性分析昆明市第一人民医院神经外科2014年1月～2020年8月收治的233例行颅骨修补的患者的临床资料,根据颅骨修补的时机将其分为早期组(术后≤3个月,78例)与晚期组(术后>3个月,155例);比较两组术后感染、脑出血、癫痫、脑积水发生率及术后住院天数、术中失血量及手术时间.结果 两组术后感染、脑出血、癫痫、脑积水发生率及并发症总发生率比较,差异均无统计学意义(P>0.05);两组术后住院天数、术中失血量及手术时间比较,差异均无统计学意义(P>0.05).结论 早期颅骨修补较晚期颅骨修补并未增加患者并发症的发生率,且也未增加住院时间、术中出血量及手术时间,故建议临床应用早期行颅骨修补术.

颅内鲍曼不动杆菌感染是一种少见的临床疾病,其发病率逐渐上升且病死率极高.随着细菌耐药性的不断增强,临床上出现越来越多多重耐药和广泛耐药鲍曼不动杆菌的颅内感染,其治疗已经成为神经外科医生面临的一大挑战和难题.其治疗难点包括抗菌药物的选用、使用方式、剂量以及是否需要脑脊液引流等,尚需规范化的治疗方案.该文将结合国内外文献,对多重耐药和广泛耐药鲍曼不动杆菌颅内感染的治疗进行梳理总结,旨在为临床治疗提供参考.

目的 探讨早期颅骨修补对创伤性颅脑损伤去骨瓣减压术后患者日常生活能力和神经功能的影响.方法 选取昆明市第一人民医院神经外科2016-01—2019-10收治的121例创伤性颅脑损伤去骨瓣减压术后患者为研究对象,根据颅骨修补的时机,将其分成早期组(术后≤3个月,50例)与晚期组(术后>3个月,71例).比较2组患者术前、术后6个月功能独立性评定量表(FIM)评分、简明精神状态量表(MMSE)评分,同时比较术后并发症发生率、住院时间、术中失血量.结果 早期组术后FIM评分、MMSE评分[120.0(115.0,124.2)分和27.0(24.5,29.0)分]较术前[114.0(90.0,116.5)分和23.0(15.8,25.3)分]均有所提高,同时晚期组术后FIM评分、MMSE评分[117.0(110.0,120.0)分和26.0(18.0,27.0)分]较术前[115.0(105.0,119.0)分和24.0(16.0,26.0)分]均有提高,差异具有统计学意义(均P<0.05).术后早期组FIM评分、MMSE评分[120.0(115.0,124.2)分和27.0(24.5,29.0)分]较晚期组[117.0(110.0,120.0)分和26.0(18.0,27.0)分]提高更明显,差异具有统计学意义(均P<0.05);本组无死亡和感染病例,早期组和晚期组硬膜外血肿和积液发生率[8％(4/50)和9.9％(7/71)],癫痫发生率[10％(5/50)和19.7％(14/71)],脑积水的发病率[4％(2/50),2.8％(2/71)],术后住院时间[(8(7,9)d和8(7,9)d]和术中失血量[300(300,400)mL和300(250,350)mL]差异均无统计学意义(均P>0.05).结论 早期颅骨修补(≤3个月)并未增加术后并发症的发生率和住院时间及术中失血量,且更有助于日常生活能力的改善和神经功能的恢复.

Objective Hyperbaric oxygen (HBO) is an emerging complementary alternative medical approach in glioma treatment. However, its mode of action is unknown, so this was investigated in the present study. Methods We constructed an intracranial glioma model of congenic C57BL/6J mice. Glioma growth under HBO stimulation was assessed by bioluminescent imaging and magnetic resonance imaging. Flow cytometry assessed direct effects of HBO on reactive oxygen species (ROS) signaling of transplanted glioma cells and organs, and quantified mature T cells and subgroups in tumors, the brain, and blood. Results HBO promoted the growth of transplanted GL261-Luc glioma in the intracranial glioma mouse model. ROS signaling of glioma cells and brain cells was significantly downregulated under HBO stimulation, but thymus ROS levels were significantly upregulated. CD3+ T cells were significantly downregulated, while both Ti/Th cells (CD3+CD4+) and Ts/Tc cells (CD3+CD8+) were inhibited in tumors of the HBO group. The percentage of regulatory T cells in Ti/Th (CD3+CD4+) cells was elevated in the tumors and thymuses of the HBO group. Conclusion HBO induced ROS signaling in the thymus, inhibited CD3+ T cell generation, and facilitated malignant glioma cell growth in vivo in the intracranial glioma mouse model.

目的 探讨后颅窝减压并植骨融合内固定术治疗复杂Chiari畸形的效果.方法 2010年2月至2014年11月收治复杂Chiari畸形17例,均采用后颅窝减压并植骨融合内固定术治疗,术中均行颅骨牵引+后路窝小骨窗减压植骨融合并内固定.结果 复位成功5例,未打开硬脊膜;复位不成功12例,行枕大池重建.术后出现颅内感染1例、切口感染伴脑脊液漏1例.术后5d因呼吸衰竭死亡1例,其余16例术后随访3个月～3.5年,采用Tator等方法评价术后效果,16例均有效,有效率为94.1％(16/17).结论 对复杂Chiari畸形,术前需明确诊断畸形的种类和性质,术中麻醉下牵引辅助治疗很有必要,后颅窝小骨窗减压并植骨融合并内固定是治疗复杂Chiari畸形的一种有效方法.