BACKGROUND AND OBJECTIVES:Assessment of postoperative outcomes on pediatric hydrocephalus is critical for adjusting treatment strategies. The aim of this work was to investigate the ability of MRI metrics to predict postoperative outcomes. METHODS:A total of 55 children with hydrocephalus who underwent MRI and ventriculoperitoneal shunt surgery were prospectively enrolled. MRI was also performed at 6 months postoperatively in 33 of the 55 children. A total of 92 controls matched for age and sex were enrolled and divided into preoperative and postoperative control groups. We calculated the diffusion tensor imaging along the perivascular space (DTI-ALPS) index, Evans index, and diffusion tensor imaging metrics. The ability of various metrics to predict postoperative outcomes was assessed using receiver operating characteristic curve analysis. RESULTS:The DTI-ALPS index was significantly lower in patients with hydrocephalus than in controls. The abnormal DTI-ALPS index trended toward the normal range after surgery. Patients with lower preoperative DTI-ALPS index, lower fractional anisotropy (FA), and higher radial diffusivity in association fibers had less favorable short-term outcomes. Patients with worse long-term outcomes had lower postoperative DTI-ALPS index, higher postoperative Evans index, and lower FA and higher radial diffusivity in association fibers. Predictive performance was better when the DTI-ALPS index and FA in association fibers were used in combination than when either of these metrics was used alone. CONCLUSION:The DTI-ALPS index and FA in association fibers provided complementary information for prognostic assessment after the ventriculoperitoneal shunt surgery on pediatric hydrocephalus. A combination of DTI-ALPS index and FA would improve our ability to predict postoperative outcomes in these patients.

OBJECTIVE:This study mainly explores (2R,6R; 2S,6S)-HNK and its compounds whether there are antidepressant effects. METHODS:Four HNK compounds were obtained from 2-(Chlorophenyl) Cyclopentylmethanone. Forced swimming test, locomotor sensitization test, and conditioned location preference test were used to screen the antidepressant activity of the synthesized target compounds. RESULTS:In the case of 10 mg HNK treatment, compared with saline, the immobile time of mice in the HNK group, I5 group and I6 group at 1 h and 7 days had statistical significance. In the case of 10 mg HNK treatment, compared with saline, the immobile time of compound C and D groups in the glass cylinder area was significantly different. In the locomotor sensitization test, the movement distance of compound C and D groups on day 15 and day 7 mice increased significantly compared with the first day. In the conditioned place preference experiment, compound C and compound D induced conditioned place preference in mice compared with the Veh group. CONCLUSION:The results of the forced swimming test, locomotor sensitization test, and conditioned location preference test showed that compounds C and D may have certain anti-depressant activity. However, HNK exerts a rapid and significant antidepressant effect within 1 week, but the duration is short.

Background Anaplastic ependymoma and H3K27M-mutant diffuse midline glioma are two common subtypes of brain tumors with poor long-term prognosis. The present study analyzed and compared the differences in cell types between two tumors by single-cell RNA sequencing (scRNA-seq) technology. Methods ScRNA-seq was performed to profile cells from cancer tissue from anaplastic ependymoma patient and H3K27M-mutant diffuse midline glioma patient. Cell clustering, marker gene identification, cell type annotation, copy number variation analysis and function analysis of differentially expressed genes were then performed. Results A total of 11,219 cells were obtained from anaplastic ependymoma and H3K27M mutant diffuse midline glioma, and these cells categorized into 12 distinct clusters. Each cell cluster could be characterized with specific cell markers to indicate cellular heterogeneity. Five cell types were annotated in each sample, including astrocyte, oligodendrocytes, microglial cell, neural progenitor cell and immune cell. The cluster types and proportion of cell types were not consistent between the two brain tumors. Functional analyses suggest that these cell clusters are involved in tumor-associated pathways, with slight differences in the cells of origin between the two tumors. In addition, cell communication analysis showed that the NRG3-ERBB4 pair is a key Ligand-receptor pair for anaplastic ependymoma, while in H3K27M-mutant diffuse midline glioma it is the PTN-PTPRZ1 pair that establishes contact with other cells. Conclusion There was intratumor heterogeneity in anaplastic ependymoma and H3K27M mutant diffuse midline glioma, and that the subtype differences may be due to differences in the origin of the cells.

Ependymoma (EPN) is a type of tumor that occurs in the central nervous system of children and adults. EPN produces resistance to chemotherapy, and there are no targeted drugs available as a proper cure. Therefore, the use of high-throughput sequencing technologies to elucidate pathogenic mechanisms is of prime importance to identify potential tumor target genes helpful for developing effective therapeutic approaches against EPN. With this objective, we used RNA-seq analysis to identify differentially expressed genes (DEGs) and pathways in 4 pairs of EPN tissues and adjacent tissues. In total, we found 5,445 differentially expressed genes. The synaptic vesicle cycle and extracellular matrix (ECM) receptor interaction pathways were highly enriched in the ependymoma group. Nine differentially expressed genes (SNAP25, GRM4, CELSR1, LAMA1, WNT5A, ROR2, CCND1, EPHB2, FOXJ1) were randomly verified by RT-qPCR, supporting the authenticity of our sequencing results. This study provides global gene information and some new potential biomarkers for the diagnosis and therapeutic targets of ependymoma.

Objective:To study the clinical effect and influencing factors of cryopreserved autologous skull bone repair in children.Methods:The clinical data of 62 children who underwent autologous skull bone repair with cryopreservation from July 2013 to December 2020 were analyzed retrospectively. The CT examination was performed within 1 week, 3, 6, 12 months after operation, and the follow-up was conducted for 3 years. The complications of autocraniectomy were summarized and the related risk factors were analyzed.Results:The infection rate was 0% after cryopreservation and terminal disinfection preservation autologous skull bone. Eleven cases were repaired with artificial materials due to skull bone flap resorption. The average time of second repair was 18 months after the operation. The results of risk factors analysis at 6 months after the operation showed that age, bone flap area and large area of cerebral malacia were the risk factors affecting the resorption of autologous skull bone (P<0.05).Conclusion:Cranioplasty with cryopreserved autologous skull bone in the treatment of children with secondary skull defect has good effect and low infection rate, which can avoid or delay the secondary repair of artificial materials. The risk factors of autogenous bone flap resorption were young children, large area of bone flap and large area of encephalomalacia.

Objective To explore the clinical efficacies of deep hypothermic preservation of autologous cranioplasty for children aged under 6 years and to examine the influencing factors of its complications .Methods From 2015 to 2017 ,clinical data were reviewed for 18 children aged under 6 years undergoing deep hypothermic preservation and autogenous cranioplasty .The cause of removing bone flap was severe craniocerebral injury or spontaneous intracranial hemorrhage .Repair was all performed within 3 months .Cranial CT examination was performed at 1 week ,3 months and 12 months ,24 months postoperatively .During a follow-up period of over 12 months ,clinical efficacy was evaluated by post-operative complications .Results No postoperative infection or intracranial hemorrhage was found .Bone flap could form a bone connection with the surrounding bone window . All of them showed bone resorption of varying degrees ,including bone resorption<5％ (n=3) ,bone resorption between 5％ and 25％ (n=8) ,bone resorption>25％ (n=5) and complete resorption (n=2) .The degree of bone absorption in children aged under 3 years was higher than that of those aged over 3 years .Conclusions Deeply cryopreserved bone flap remains bioactive after replantation . Standard sterilization procedure can effectively avoid postoperative infection .Bone flap resorption is the biggest complication of this method and it is more pronounced under 3 years .

Background: Since the external ventricular drainage (EVD) were introduced into clinical practice, it has been proven to be an efficacious treatment of cerebrospinal fluid (CSF) diversion, which results from intracranial hypertension, hydrocephalus, etc. But, this operation is prone to fail or lead to various complications, such as infection and intracerebral hemorrhage, especially for pediatric patients. Objective: This research aimed to retrospectively investigate the potential influence factors that affect the accuracy of lateral ventricle puncture in pediatric patients, as well as the efficacy of 3D-computed tomography (3D-CT) guidance during lateral ventricular puncture. That is, it is to determine how the success rate of lateral ventricle puncture could be improved for pediatric patients. Methods: 95 patients under the age of 18 years were identified into this retrospective analysis. All of them ever received lateral ventricle puncture, by the means of 3D-CT guidance or conventional CT. And then they also underwent conventional CT scanning after puncture in order to make sure the accuracy of catheterization. The distance between puncture point and interventricular foramen was measured in each case. The difference of 0.5 CM was adopted as a cut-off point, and the accuracy and depth of puncture were statistically analyzed. At last, logistic regression analysis was carried out to investigate the potential influence factors that affect the accuracy of lateral ventricle puncture. Results: On the basis of age and sex, these included pediatric patients were well matched between groups. And the primary disease covered hydrocephalus (46/95, 48.42%), spontaneous hemorrhage (19/95, 20%), head trauma (21/95, 22.11%), central nervous system malignancy (8/95, 8.42%), and postoperative observation (1/95, 1.05%). The success rate of catheterization was 81.2%, most catheter positions were good, and the CSF could be pumped out smoothly. The pivotal factors of lateral ventricle puncture included operator, age, sex, Glasgow coma scale score, disease categories. It can be included that pre-operative CT guidance contribute to promote the accuracy of lateral ventricle puncture significantly. Conclusions: These above results show that the success rate of lateral ventricle puncture can be affected by various factors, and CT guidance could significantly improve the success rate of catheterization, compared with freehand operation. Further studies evaluating external equipment guided ventricle puncture are still needed, especially for pediatric patients.

Objective To investigate the possible pathogenesis of infantile spasm (IS) by analyzing the changes of resting-state fMRI (rs-fMRI) regional homogeneity (ReHo) in preoperative IS patients.Methods From January 2014 to December 2015,a total of 11 patients of intractable IS were admitted to Neurosurgery Department of Shenzhen Children Hospital for presurgical evaluation.Besides the patients,35 age-and sex-matched healthy subjects were enrolled into this retrospective study.In order to identify the pattern of regional synchronization in IS patients,all the children in this study received rs-fMRI scan and were analyzed by the software DPARSFV1.0.Results Compared with healthy subjects,in the IS group,decreased ReHo were shown in bilateral precunei,bilateral middle occipital gyri,right middle temporal gyrus,right inferior parietal lobule,right cryptocalcarine gyrus,left central posterior gyrus,left precentral gyrus and left angular gyrus while increased ReHo were demonstrated in the right anterior cingulate gyrus,bilateral brain stems,bilateral hippocampi,bilateral thalami,right caudate nucleus,left cerebellum,left pars opercularis,bilateral insula lobes,right accessory motor area and right olfactory region (both P ＜0.05).Correlation analysis showed that lower ReHo values of the right precuneus (r value:-0.973) and left superior parietal lobule (r value:-0.978) were associated with longer duration of epilepsy (both P ＜0.01).Conclusion Our results suggest that IS may cause significant damage to children's brain areas related to motion,execution and cognition.

Objective: The purpose of this study is to analyse the image features and complication of early cranioplasty using titanium mesh in both infants and children. Methods: A total of 35 infants or children with craniocerebral trauma or hypertensive cerebral hemorrhage were selected and randomly divided into 2 groups. According to the size of the bone window, we design the titanium mesh using a computerized 3D shaping technology. Titanium mesh was used to cover titanium window mesh on the bone window margin. Then, 0.05% chlorhexidine and 10% povidone iodine were applied before saline solution with gentamicin was repeatedly irrigating the field during operation. Results: No significant difference was found in the gender, age, size of the bone flap between 2 groups (P > 0. 05). There were no statistically significant differences between CP group and WCP group of patients with regards to the rate of complications, with the exception of subscalp effusion. In the CP group, no incidences of surgical site infection, intracerebral hemorrhage and wound dehiscence were recorded; In the WCP group, no incidences of intracerebral hemorrhage and wound dehiscence were recorded. Demographic trait, including sex, age, and size of bone flap had no statistically significant risk factors for surgical site infection. Conclusion: Cranioplasty using titanium mesh has lower incidence of subscalp effusion as compared with cranioplasty without titanium mesh. On the other hand, the other complications, such as surgical site infection, epidural hematoma, intracerebral hemorrhage, wound dehiscence, and epileptic seizure, has no significant differences between groups. No surgical site infection related factors were found in our study.

Objective: To analyze the adverse drug reactions (ADRs) of Aidi injection and the corresponding influencing factors. Methods: All clinical studies and ADR reports on Aidi injection were searched from EMBASE, VIP, CBM and CNKI, etc., from inception to January 2016, as well as tracing relevant references, etc. Data was reviewed and extracted independently by 2 reviewers. Results: 602 studies involving 377 patients were included, and 588 literatures were clinical researches (97.7%). Among these 588 literatures, 494 studies (84.2%) did not mention whether ADRs had happened, 94 studies (15.9%) reported relative information of ADRs, 76 studies (12.9%) described ADRs more detailedly (363 patients). 14 case reports included 14 patients with ADRs. The inherent fact that lacking of data on the total amount of product output and clinical usage, resulted in calculation difficultly with respect to the incidence rate of ADRs. Conclusion: The occurrence rate of ADRs was low in clinical practice, and the mild ADRs could be tolerant after regular treatments. But several problems on ADRs should be neglected, including lack of integrated key information, fewer articles and small samples of ADRs, etc. Hence, we could not calculate ADRs rate, and the reporting quality also remained to be improved.

Infantile spasm (IS) syndrome is an age-related epileptic encephalopathy that occurs in children. The purpose of this study was to investigate regional homogeneity (ReHo) changes in IS patients. Resting-state fMRI was performed on 11 patients with IS, along with 35 age- and sex-matched healthy subj ects. Group comparisons between the two groups demonstrate that the pattern of regional synchronization synchronization in IS patients is changed. Decreased ReHo values were found in default mode network, bilateral motor-related areas and left occipital gyrus of the patient group. Increased ReHo was found in regions of cingulum, cerebellum, supplementary motor area and brain deep nucleus, such as hippocampus, caudate, thalamus and insula. The significant differences might indicate that epileptic action have some injurious effects on the motor, executive and cognitive related regions. In addition, ReHo values of left precuneus and right superior frontal gyrus were associated with the epilepsy duration in the IS group. The correlation results indicate that the involvement of these regions may be related to the seizure generation. Our results suggest that IS may have an injurious effect on the brain activation. The findings may shed new light on the understanding the neural mechanism of IS epilepsy.

We performed a dynamic study of arachnoid cysts (ACs) using magnetic resonance cisternography (MRC) and proposed a classification of ACs. Twenty-three suitable patients in our hospital entered into this study according to our inclusion criteria. MRC images were collected in all the subjects at 1 and 24 hours after the administration of intrathecal gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA). We allocate the enrolled patients into 2 groups, MRC group and surgery group. The MRC results were considered before treatment in 1 group (MRC group, 13 patients), whereas another group was surgically treated without considering the MRC results (surgery group, 10 patients). We calculated the enhanced area of cyst using modified MacDonald Criteria from the images and measured the surrounding subarachnoid area as the reference. We found that it was practically useful to quantify 3 types of ACs, complete communicating, incomplete communicating, and noncommunicating, according to MRC results in this study. All the subjects in both groups are closely observed before the treatment and the follow-up using the MRI examination. In the surgery group, 5 patients were found that the area of cysts shrank in the follow-up stage. However, there was no significant difference in the percentage shrinkage area between the 2 groups. We concluded that MRC with Gd-DTPA as a contrast agent is of significant clinical value for the diagnosis and treatment of children with intracranial ACs. This classification based on dynamic MRC is useful for making surgical recommendations.

We performed a dynamic study of arachnoid cysts (ACs) using magnetic resonance cisternography (MRC) and proposed a classification of ACs.Twenty-three suitable patients in our hospital entered into this study according to our inclusion criteria. MRC images were collected in all the subjects at 1 and 24hours after the administration of intrathecal gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA). We allocate the enrolled patients into 2 groups, MRC group and surgery group. The MRC results were considered before treatment in 1 group (MRC group, 13 patients), whereas another group was surgically treated without considering the MRC results (surgery group, 10 patients). We calculated the enhanced area of cyst using modified MacDonald Criteria from the images and measured the surrounding subarachnoid area as the reference.We found that it was practically useful to quantify 3 types of ACs, complete communicating, incomplete communicating, and noncommunicating, according to MRC results in this study. All the subjects in both groups are closely observed before the treatment and the follow-up using the MRI examination. In the surgery group, 5 patients were found that the area of cysts shrank in the follow-up stage. However, there was no significant difference in the percentage shrinkage area between the 2 groups.We concluded that MRC with Gd-DTPA as a contrast agent is of significant clinical value for the diagnosis and treatment of children with intracranial ACs. This classification based on dynamic MRC is useful for making surgical recommendations.

目的 研究以钆喷酸葡胺为造影剂的MRI脑池造影术在儿童颅内蛛网膜囊肿的诊断价值.方法 回顾性分析13例颅内蛛网膜囊肿病人的临床资料.通过腰椎穿刺术或侧脑室穿刺术,将稀释后的钆喷酸葡胺注入蛛网膜下腔.造影前、注药后1h和24 h分别进行MRI扫描,评估囊肿内外脑脊液交通情况.结果 13例病人中,造影后仅有1例出现一过性头痛,其他病人未出现明显的并发症.根据造影结果,囊肿早期显影10例,延迟显影1例,不显影2例.延迟显影和不显影的病人采取手术治疗,其他病人非手术治疗.随访13例,时间平均6.5个月,接受手术者蛛网膜囊肿的体积有缩小,非手术治疗的病人未出现囊肿增大.结论 以钆喷酸葡胺为造影剂的MRI脑池造影对儿童颅内蛛网膜囊肿的诊断和治疗有重要的临床意义.

目的 探讨本地早发型新生儿败血症(EONS)与晚发型新生儿败血症(EONS)的临床特征、病原菌分布情况,为早期诊断及治疗提供指导.方法 回顾性分析深圳市儿童医院普外科新生儿病区及NICU 2008年6月～2013年7月133例新生儿败血症患儿的临床资料、血常规结果及血培养结果.按发病时间分为EONS组及LONS组,比较两组临床特征的异同.结果 EONS组的出生胎龄、体重大于LONS组,早产儿、低出生体重儿发生率低于LONS组,胎膜早破、羊水污染发生率高于LONS组,差异有统计学意义(P＜0.05).EONS组的呼吸暂停、喂养不耐受、化脓性脑膜炎、坏死性小肠结肠炎、血小板减少发生率低于LONS组,感染性休克发生率高于LONS组,差异有统计学意义(P＜0.05).LONS组主要致病菌为凝血酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌,EONS组主要致病菌为肺炎克雷伯菌、大肠埃希菌及B族溶血性链球菌.结论 LONS多发生于早产儿及低出生体重儿,EONS多发生于伴有胎膜早破、羊水污染的足月儿;两组败血症患儿在临床表现、实验室检查及病原菌方面存在一定差异,根据不同特点可指导临床早期诊断和治疗.

>随着脑室镜第三脑室底造瘘术（endoscopic third ventriculostomy,ETV）经验的积累,越来越多的脑积水患者采用ETV治疗。目前已有研究证实,ETV成功实施的影像学证据不但有侧脑室和第三脑室变小,也包括经过第三脑室底的流空信号,但是这些变化并不总是与临床症状好转相一致,尤其在ETV术后早期（如6个月）,医师难以通过常规的脑室形态学测量方法来判断手术是否有效 [1-3] 。手术

Objective To investigate the function of 3D-constructive interference in the steady state (3D-CISS) in the diagnosis of membranous obstruction in children with hydrocephalus. Methods MRI examination was performed in 41 patients with hydrocephalus, including conventional and 3D-CISS sequences. The differences in diagnosing membranous obstruction of the cistern and ventricle between 3D-CISS and conventional sequences were compared, and the difference in diagnosing hydrocephalus between the two sequences was analyzed. Results Twenty-nine communicating hydrocephalus and 12 non-communicating hydrocephalus were found by conventional sequence, while 25 communicating hydrocephalus and 16 non-communicating hydrocephalus were found by 3D-CISS, and there was no statistical difference between the two sequences in diagnosing hydrocephalus (P>0.05). Among the 41 patients, the surgery with ventriculoscope was selected in 18 patients after the assessment by 3D-CISS, including 16 non-communicating hydrocephalus and 2 communicating hydrocephalus with membranous obstruction of the cistern. Eighteen patients were followed more than half year, no hydrocephalus recurred. Conclusions 3D-CISS sequence can clearly show the membranous obstruction of inside and outside ventricle in patients with hydrocephalus, which can help to exactly classify the type of hydrocephalus and choose the suitable surgical plan.

目的 综合评价RET基因C135G＞A,C1296A＞G,-5G＞A三个位点多态性与先天性巨结肠易感性的关系.方法 通过全面检索中英文数据库,收集有关RET基因多态性与先天性巨结肠易感性相关的病例-对照研究,运用Stata11.0软件以不同合并模型对原始数据进行meta分析.经筛选本研究共纳入12篇中英文文献,其中C135G＞A位点9篇[1,9],C1296A＞G位点3篇[5,6,10],-5G＞A位点5篇[6,7,9,11,12].结果 RET原癌基因中,C135G＞A、C1296A＞G、-5G＞ A位点的突变均与先天性巨结肠的易感性升高有关,但C1296A＞G中GA+ GG/AA(OR=3.768,95％ CI=0.942-15.069)与先天性巨结肠发病未见明显关联.结论 RET原癌基因C135G＞A、C1296A＞G、-5G＞A位点的突变与先天性巨结肠的易感性升高有关.

Objective: To observe and evaluate the expression of Endothelin-1(ET-1),Vascular endothelial growth factor(VEGF),Tumor necrosis factor-alpha(TNF-α) in portal vein and its peripheral tissues that is involved in cavernous transformation of the portal vein(CTPV) in rats after inhibition of nuclear factor κB(NF-κB) activation by pyrrolidine carbodithioic acid(PDTC).Methods: A total of 80 Sprague-Dawley(SD) rats were randomly divided into four groups: control group,sham operation group、model group(CTPV group) and NF-κB inhibitor group(PDTC group),the last two groups of CTPV model animals which induced in rats by partial portal vein ligation.Control group,sham operation group、CTPV group rats were given normal saline by hypodermic injection 4 weeks after operation or not,PDTC group rats were given PDTC 100 mg / kg by hypodermic injection 4 weeks after operation.The expression of ET-1,TNF-α、VEGF and content of NF-κBp65 in nucleus that in portal vein and its peripheral tissues,portal vein pressure were investigated after treatment 6 weeks.Results: Partial constriction of portal could make typical cavernous transformation animal model after 6 weeks;Compared with sham operation and control group rats,the portal vein pressure,the expression of ET-1,TNF-α,VEGF and the content of NF-κBp65 in nucleus which in portal vein and its peripheral tissues were significantly elevated in CTPV group and PDTC group rats(P 0.01);Model making rats(PDTC group) given PDTC 4 weeks could significantly degrade the portal vein pressure,the expression of ET-1,TNF-α,VEGF and the content of NF-κBp65 in nucleus in CTPV rats’s portal vein and its peripheral tissues(P 0.01).Conclusions: NF-κB,ET-1,TNF-α and VEGF involved in pathophysiological process of cavernous transformation of the portal vein,the mechanism may be by regulation of ET-1,TNF-α,VEGF expression;PDTC could inhibit NF-κB induced expression of ET-1,TNF-α,VEGF in CTPV rats.

Motivation: Whether there exist association between glymphatic/white matter impairment and postoperative outcomes of paediatric hydrocephalus. Goal(s): We tried to investigate the glymphatic and white matter abnormalities in paediatric hydrocephalus using MRI metrics. Approach: Fifty-five children with hydrocephalus who underwent MRI and ventriculoperitoneal shunt surgery were prospectively enrolled. DTI metrics were analyzed. Results: Compared with controls, DTI-ALPS index decreased before surgery and recovered after surgery. The preoperative and postoperative DTI-ALPS index and FA in association fibres could predict the short-term motor and long-term cognition outcomes, respectively. Impact: The DTI-ALPS index and FA could be a sensitive biomarker of underlying neuroanatomical changes and developmental outcomes, which would benefit the decision-making of treatment plans.