Neuro-cancer crosstalk plays an important role in the development and progression of Glioblastoma (GBM), but its specific mechanisms remain incompletely elucidated. This study aims to systematically identify key genes related to neuro-cancer crosstalk in GBM and construct a prognostic risk model through integrating single-cell RNA sequencing (scRNA-seq), bulk RNA-seq, and machine learning algorithms. The GSE273274 dataset was obtained from the GEO database for single-cell data analysis to investigate differences in intercellular communication. GBM transcriptomic data were obtained from TCGA and GTEx databases for differential expression analysis, and WGCNA was used to identify co-expressed gene modules. LASSO Cox regression was employed to screen out key prognostic genes and construct a prognostic risk model. Immune infiltration, drug sensitivity analysis and molecular docking validation were conducted. Finally, the expression of key genes was validated through immunohistochemistry experiments. Single-cell analysis identified 15 cell types and revealed significantly elevated proportions of CD44+ astrocytes and oligodendrocyte progenitor cells in the GC group. Intercellular communication analysis showed key COL6A2-GP6 and L1CAM-ERBB3 interactions between pericytes and mature excitatory neurons. Transcriptomic analysis identified 6680 differentially expressed genes and 8636 WGCNA hub genes. Integrated analysis identified 7 key neuro-cancer crosstalk genes, among which NGFR and L1CAM were further selected to construct the prognostic risk model. This model demonstrated good predictive performance in both training and validation sets. Immune infiltration analysis showed significantly elevated M0 macrophage proportions in the high-risk group. GSEA analysis revealed enrichment of axon guidance and RAS-ERK signaling pathways in the high-risk group. Drug sensitivity analysis identified betamethasone acetate as a potential therapeutic agent, and molecular docking showed good binding capacity with L1CAM and NGFR. Immunohistochemistry confirmed high NGFR expression and low L1CAM expression in GBM. This study identified NGFR and L1CAM as potential key genes associated with neuro-cancer crosstalk in GBM through multi-omics integrated analysis, and demonstrated that the constructed prognostic risk model has utility for medium- to long-term survival prediction. The research findings provide new perspectives for understanding the mechanisms of neuro-cancer crosstalk in GBM and offer important theoretical foundations and potential targets for developing personalized treatment strategies.

The association between the atherogenic index of plasma (AIP), its modified indices (such as AIP-waist circumference [AIP-WC], AIP-waist-to-height ratio [AIP-WHtR], AIP-body mass index[AIP-BMI]), and incident stroke in individuals with cardiovascular-kidney-metabolic (CKM) stages 0–3 remains understudied. This study investigated these associations and their utility for risk stratification. Data from 3697 China Health and Retirement Longitudinal Study (CHARLS) participants (≥ 45 years, CKM stages 0–3) were analyzed. Baseline, cumulative, and changes in AIP and its modified indices (AIP-WC, AIP-WHtR, AIP-BMI) were calculated. Logistic regression, Delong's test, integrated discrimination improvement (IDI), weighted quantile sum (WQS) regression, and mediation analysis were used to assess associations, predictive performance, component contributions, and mediation effects. Stroke occurred in 4.8

Objective: This study evaluates the effectiveness of multimodal image fusion (MIF) using silent and time-of-flight (TOF) magnetic resonance angiography (MRA) and computed tomography (CT) for preoperative planning in patients with intracranial aneurysms who have contraindications to contrast media. Materials and Methods: A retrospective study included 40 patients with intracranial aneurysms, diagnosed using three-dimensional computed tomography angiography (CTA). These patients underwent both Silent and TOF MRA scans, followed by a CTA scan. The multi-image fusion (MIF) technique, applied using 3DSlicer software, integrated the silent/TOF-MRA with CT images for preoperative assessment. This study compared the image quality, aneurysm detection sensitivity, and anatomic accuracy of the MIF images with those of three-dimensional CTA. Results: Silent-MRA-CT fusion images demonstrated higher sensitivity (95.5%) and lower false negative rates (4.5%) compared with TOF-MRA-CT. Furthermore, silent-MRA-CT fusion images outperformed TOF-MRA-CT in terms of signal homogeneity, venous signal interference suppression, and aneurysm visibility (all P < 0.05). The interclass correlation coefficient and kappa values for aneurysm morphology and shape indicated superior measurement consistency and shape concordance of silent-MRA-CT with CTA compared with TOF-MRA-CT (all P < 0.01). Conclusion: This study supports the use of silent/TOF-MRA-CT fusion imaging as a reliable alternative to CTA, noting that silent-MRA-CT closely mirrors CTA. Contrast-free MRA-CT fusion images have the potential to be used for preoperative planning in patients with intracranial aneurysms who have contraindications to contrast.

Objective: Some patients with intracranial aneurysms (IAs) cannot undergo three-dimensional computed tomography angiography (3D-CTA) or digital subtraction angiography due to contraindications to contrast agents or radiation. Time-of-flight magnetic resonance angiography (TOF-MRA) offers a contrast-free alternative but lacks cranial bone detail critical for surgical planning. This study evaluates the feasibility of using 3D Slicer to fuse TOF-MRA with thin-section CT images to generate synthetic images resembling CTA for surgical clipping planning. Methods: This prospective study included 22 patients with unruptured IAs and 8 with ruptured IAs undergoing aneurysm clipping surgery (>= 3 mm). TOF-MRA and CT/3D-CTA scans were fused using 3D Slicer. Neuroradiologists and neurosurgeons independently assessed 3D-CTA and synthetic TOF-MRA-CT images for aneurysm detection rates, morphology, and dimensions. Evaluation metrics included dice similarity coefficient and 95% Hausdorff distance. Results: Evaluation of aneurysm detection rates, morphology, and dimensions showed no significant differences between synthetic TOF-MRA-CT fusion images and 3D-CTA (all P > 0.05). Neuroradiologist assessments revealed strong concordance in aneurysm morphology between synthetic TOF-MRA-CT fusion images and 3D-CTA (kappa = 0.867, P < 0.001). The dice similarity coefficient (0.937 +/- 0.012) and Hausdorff distance (4.54 +/- 0.26) indicated a high degree of image overlap between synthetic TOF-MRA-CT fusion images and 3D-CTA. Surgeons rated the consistency of aneurysm morphology between synthetic TOF-MRA-CT fusion images and intraoperative findings as strongly concordant (kappa = 0.873, P < 0.001). Conclusions: Synthetic TOF-MRA-CT fusion images closely match 3D-CTA for >= 3 mm aneurysms, demonstrating comparable diagnostic and surgical clipping planning effectiveness. They represent a promising alternative for personalized preoperative planning, particularly when contrast agents are contraindicated.

Background: Decreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)-guided stereotactic localization of hematomas in elderly patients diagnosed with ICH. Methods: The study sample included 78 elderly patients (> 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clear-ance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were com-pared between the two groups. Results: No significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical dura-tion were observed between the two groups (all p-values > 0.05). However, the pre-operative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in sur-gical duration, postoperative hematoma clearance rate, rebleeding rate, postopera-tive GCS and mRS scores between the two groups (all p-values > 0.05). Conclusions: A combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplify-ing MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.(c) 2023 Elsevier Inc. All rights reserved.

Occlusion of an intracranial arterial branch, resulting in a false positive aneurysm on vascular imaging, is extremely rare, with only a few reports in the literature and mostly in the posterior circulation artery or the middle cerebral artery (MCA) bifurcation. We report a case of a 69 years-old woman with a subacute infarct lesion in the left frontal lobe, for whom both computed tomographic angiography (CTA) and digital subtraction angiography (DSA) of the cerebral vessels showed aneurysms in the anterior segment of the M1 bifurcation of the middle cerebral artery (MCA) and in the bifurcation of the MCA. The aneurysm in the MCA bifurcation was found during craniotomy, whereas the anterior segment of the M1 bifurcation had intact branch vessels with severe atherosclerosis and no aneurysm was present. The branch vessel of M1 was presumed to be atherosclerotic occlusion resulting in the distal vessels without contrast filling on CTA and DSA, and only the occluded stump at the beginning of the vessel was filled with contrast, showing an aneurysm-like morphology, which was very confusing. This case highlights to neurologists that the diagnosis of aneurysm by cerebrovascular CTA or DSA must be carefully differentiated to avoid misdiagnosis, especially if the unruptured aneurysm is in an uncommon location in combination with ischemic cerebrovascular disease.

Extracerebral tumors often occur on the surface of the brain or at the skull base. It is important to identify the peritumoral sulci, gyri, and nerve fibers. Preoperative visualization of three-dimensional (3D) multimodal fusion imaging (MFI) is crucial for surgery. However, the traditional 3D-MFI brain models are homochromatic and do not allow easy identification of anatomical functional areas. In this study, 33 patients with extracerebral tumors without peritumoral edema were retrospectively recruited. They underwent 3D T1-weighted MRI, diffusion tensor imaging (DTI), and CT angiography (CTA) sequence scans. 3DSlicer, Freesurfer, and BrainSuite were used to explore 3D-color-MFI and preoperative planning. To determine the effectiveness of 3D-color-MFI as an augmented reality (AR) teaching tool for neurosurgeons and as a patient education and communication tool, questionnaires were administered to 15 neurosurgery residents and all patients, respectively. For neurosurgical residents, 3D-color-MFI provided a better understanding of surgical anatomy and more efficient techniques for removing extracerebral tumors than traditional 3D-MFI ( P < 0.001). For patients, the use of 3D-color MFI can significantly improve their understanding of the surgical approach and risks ( P < 0.005). 3D-color-MFI is a promising AR tool for extracerebral tumors and is more useful for learning surgical anatomy, developing surgical strategies, and improving communication with patients.

目的:分析治疗脑卒中偏瘫患者时,采取康复护理联合血液循环驱动泵的价值.方法:择本院2020年4月至2022年4月收治的80例脑卒中偏瘫患者,均采取血液循环驱动泵治疗,随机数字表法分对照组(行基础护理)、观察组(行康复护理),比较效果.结果:观察组下肢深静脉血栓发生率低于对照组,P＜0.05;观察组NIHSS评分低于对照组,P＜0.05;观察组SS-QOL总分高于对照组,P＜0.05.结论:脑卒中偏瘫患者采取康复护理联合血液循环驱动泵,具有高临床价值,能够提高护理效果,改善患者的偏瘫情况.

Objective:To explore the effect of minimally invasive hematoma puncture and drainage in the treatment of elderly patients with cerebral hemorrhage by using 3D slicer and Sina software to conduct 3D reconstruction and preoperative localization of intracerebral hematoma.Methods:A total of 74 elderly patients with a first-onset intracerebral hematoma aged ≥75 years, having surgical indications and stable vital signs were grouped into 3D slicer plus Sina software localization group(as group A, n=40)or CT localization group(as group B, n=34). Based on the localization, hematoma puncture and drainage were performed after local anesthesia.Preoperative preparation time, hematoma location, puncture success rate, postoperative hematoma clearance rate, postoperative re-bleeding rate and GCS score were statistically analyzed.Glasgow coma scale(GCS)scores were used in predicting the mortality.Results:The preoperative preparation time was significantly shorter in group A than in group B[(5.5±3.4)min vs.(8.5±2.7)min, t=3.337, P=0.001]. The success rate of hematoma puncture and drainage(90.0% and 70.6%, χ2=4.51, P=0.034)and postoperative hematoma clearance rate[(87.5±3.4)% and(80.3±2.7)%, t=10.10, P=0.000]were higher in group A than in group B. There were no significant differences in operative time, the accuracy of hematoma localization, re-bleeding rate and GCS score between the two groups( P>0.05). Conclusions:3D slicer plus Sina software can precisely locate the intracerebral hematoma, and minimally invasive hematoma puncture and drainage of intracerebral hematoma under local anesthesia were safe and effective in the treatment of elderly patients with intracerebral hemorrhage.

Cerebral ischemia/reperfusion (I/R) injury remains a leading cause of death and disability. Long noncoding RNAs (lncRNAs) exert key functions in cerebral I/R injury. Here, we sought to elucidate the mechanism underlying the regulation of H19 in cerebral I/R cell injury. An in vitro model of cerebral I/R injury was created using oxygen–glucose deprivation/reoxygenation (OGD/R). The levels of H19, miR-1306-5p and B cell lymphoma-2 (Bcl-2)-like 13 (BCL2L13) were assessed by quantitative real-time polymerase chain reaction (qRT-PCR) or western blot. Cell viability and apoptosis were determined by the Cell Counting-8 Kit (CCK-8) assay and flow cytometry, respectively. The levels of lactate dehydrogenase (LDH) and cytokines were evaluated by enzyme-linked immunosorbent assays (ELISA). Direct relationships among H19, miR-1306-5p and BCL2L13 were verified by dual-luciferase reporter, RNA immunoprecipitation (RIP) and RNA pulldown assays. Our data showed that H19 and BCL2L13 were highly expressed in the cerebral I/R injury rats and OGD/R-triggered SK-N-SH and IMR-32 cells. The knockdown of H19 or BLC2L13 alleviated OGD/R-triggered injury in SK-N-SH and IMR-32 cells. Moreover, H19 silencing protected against OGD/R-triggered cell injury by down-regulating BCL2L13. H19 acted as a sponge of miR-1306-5p and BCL2L13 was a direct target of miR-1306-5p. H19 mediated BCL2L13 expression by sequestering miR-1306-5p. Furthermore, miR-1306-5p was a molecular mediator of H19 function. These results suggested that H19 silencing alleviated OGD/R-triggered I/R injury at least partially depending on the regulation of the miR-1306-5p/BCL2L13 axis.

Normal brain segmentation is available via FreeSurfer, Vbm, and Ibaspm software. However, these software packages cannot perform segmentation of the brain for patients with brain tumors. As we know, damage from extracerebral tumors to the brain occurs mainly by way of pushing and compressing while leaving the structure of the brain intact. Three-dimensional (3D) imaging, augmented reality (AR), and virtual reality (VR) technology have begun to be applied in clinical practice. The free medical open-source software 3D Slicer allows us to perform 3D simulations on a computer and requires little user interaction. Moreover, 3D Slicer can integrate with the third-party software mentioned above. The relationship between the tumor and surrounding brain tissue can be judged, but accurate brain segmentation cannot be performed using 3D Slicer. In this study, we combine 3D Slicer and FreeSurfer to provide a novel brain segmentation method for extracerebral tumors. This method can help surgeons identify the "real" relationship between the lesion and adjacent brain tissue before surgery and improve preoperative planning.

OBJECTIVES:Pituitary apoplexy (PA)-induced oculomotor palsy, although rare, can be caused by compression on the lateral wall of the cavernous sinus. This study aimed to visualize PA-induced oculomotor nerve damage using diffusion tensor imaging (DTI) tractography. MATERIALS AND METHODS:We enrolled 5 patients with PA-induced isolated oculomotor palsy (patient group) and 10 healthy participants (control group); all underwent DTI tractography preoperatively. Fractional anisotropy (FA) and mean diffusion (MD) values of the cisternal portion of the bilateral oculomotor nerve were measured. DTI tractography was repeated after the recovery of oculomotor palsy. RESULTS:While no statistical difference was observed in FA and MD values of the bilateral oculomotor nerve in the control group (P>0.05), the oculomotor nerve on the affected side was disrupted in the patient group, with a statistical difference in FA and MD values of the bilateral oculomotor nerve (P<0.01). After the recovery of oculomotor palsy, the FA value of the oculomotor nerve on the affected side increased, whereas the MD value decreased (P<0.01). Meanwhile, no significant difference was observed in FA and MD values of the bilateral oculomotor nerve (P>0.05). DTI tractography of the oculomotor nerve on the affected side revealed restoration of integrity. Furthermore, the symptoms of oculomotor palsy improved in all patients 7 days postoperatively. CONCLUSION:DTI tractography could be a helpful adjunct to the standard clinical and paraclinical ophthalmoplegia examinations in patients with PA; thus, this study establishes the feasibility of DTI tractography in this specific clinical setting.

Background. - The surgical management of giant invasive spinal schwannomas (GISSs) has been discussed previously, and most cases are treated via the posterior approach. However, when the tumor grows beyond the spine and greatly pushes the surrounding tissues, the combined anterior-posterior approach may be a better choice. However, the anterior approach can be challenging when there is a lack of knowledge regarding the surrounding abdominal structures. Case description. - A 67-year-old male suffered from slight scoliosis and an unstable spine due to GISS, which led to a long history of lower back pain and abnormal gait. Here, we report a novel method combining the use of 3D Slicer and the Sina application to help surgeons locate such lesions and better understand the three-dimensional (3D) relationship between the tumor and surrounding tissues. The proposed method promotes complete excision, shortens operation time, and reduces related complications. Conclusion. - We recommend using the combination of 3D Slicer and Sina to assist surgeons in handling accurate 3D information of GISS while simultaneously simulating the surgery. (C) 2020 Elsevier Masson SAS. All rights reserved.

枕动脉真性动脉瘤少见.作者通过文献复习,发现自发性枕动脉真性动脉瘤仅有3例报告, 包括2例枕动脉远端动脉瘤和1例枕动脉近端动脉瘤[1-3]. 本文通过1例自发性枕动脉远端动脉瘤的临床及影像学表现, 同时结合相关文献加深对该疾病的认识.

Objective: To explore the main points of the diagnosis and treatment of high-grade cerebral arteriovenous malformations (AVM) by analyzing the experience in microsurgical treatment of 21 cases of high-grade cerebral AVM. Methods: 21 cases of high-grade cerebral AVM treated with direct microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, 14 cases were grade IV and 7 cases were grade V. Magnetic resonance imaging, computed tomography angiography (CTA), and/or digital subtraction angiography (DSA) were performed before surgery; conventional computed tomography, CTA, and/or DSA were performed after surgery. Followup was performed on a regular basis, and the therapeutic efficacy was assessed according to the Glasgow Outcome Score (GOS). Results: Seventeen (85％) patients had total resection of lesions, and 3 (15％) patients had residual tangles of abnormal blood vessels. There was 1 case of mortality (4.8％), 3 cases of disability (15％), and 1 case of severe disability (5％) after surgery. Twenty cases had a follow-up period from 3 to 52 months. The GOS was 5 in 17 cases (85％), 4 in 2 cases (10％), and 3 in 1 case (5％). No case of rebleeding or death was observed during the follow-up period. Conclusion: Microsurgical resection is an effective treatment for high-grade cerebral AVM. Accurate preoperative diagnosis and intraoperative localization and particularly careful and precise operation are the key factors for a successful surgery.

目的 研究磁共振扩散张量成像(DTI)在判断高血压性壳核出血视辐射(OR)损伤中的作用.方法 纳入36例经保守治疗的高血压性壳核出血病人作为脑出血组,并选取30例健康成人(志愿者)作为对照组,均行DTI检查,重建双侧OR,将OR损伤类型分为Ⅰ、Ⅱ、Ⅲ型,测定OR-FA值、OR-ADC值,并对检测数据进行统计学分析.结果 对照组左、右两侧OR-FA值、OR-ADC值差异无统计学意义(P＞0.05).脑出血组病侧与健侧OR-FA值、OR-ADC值差异显著(P＜0.05),病侧OR明显受损;血肿体积与病侧OR-FA值、OR-ADC值均不相关(P＞0.05).脑出血组OR损伤Ⅰ、Ⅱ、Ⅲ型分别为10、12、14例,3种损伤类型间OR-FA值、OR-ADC值差异有统计学意义(P＜0.05);与发病3～5 d时比较,3个月后复查OR-FA值明显升高,OR-ADC值明显下降(P＜0.05),病人OR损伤情况明显改善.结论 高血压性壳核出血OR损伤率高,血肿体积与OR损伤程度无关,DTI可观察血肿与OR三维关系,判断OR受损程度,对评估病人视野缺损有重要价值.

目的 探讨DTI技术在单侧高血压性壳核出血(HPH)手术入路选择中的应用.方法 63例单侧HPH病人按随机数字表分为经外侧裂岛叶入路组31例和经颞叶皮质入路组32例,利用DTI技术比较两组病人视辐射损伤程度,ADL分级评价预后.结果 经外侧裂岛叶入路组术后再出血率为12.9％,经颞叶皮质人路组为21.8％,差异无统计学意义钎=0.367,P=0.545);经外侧裂岛叶入路组术后视辐射损伤分型Ⅰ、Ⅱ、Ⅱ型分别有9、14、8例,经颞叶皮质入路组术后视辐射损伤分型Ⅰ、Ⅱ、Ⅲ型分别有6、9、17例,两组差异显著(U=362.00,P=0.049);经外侧裂岛叶入路组术后预后良好24例(77.4％),经颞叶皮质人路组预后良好15例(46.9％),差异有统计学意义(x2=6.229,P=0.019).结论 经外侧裂岛叶入路在HPH术中保护视辐射及术后恢复均优于经颞叶皮质入路.

Objective We attempted to investigate optic radiation (OR) injury and visual field mean defect (MD) in patients with hypertensive putaminal hemorrhage by using diffusion tensor imaging (DTI). Methods Thirty-three first onset of patients with hypertensive putaminal hemorrhage and 30 normal healthy control subjects were recruited. DTI data were acquired between 3 and 5 days as well as 3 months after onset. DTI-Studio software was used to reconstruct the OR and examine the degree of OR injury (typeⅠ, Ⅱ, and type Ⅲ). Fractional anisotropies (FA) and apparent diffusion coefficient (ADC)values of the ORs were measured. Statistical analysis was performed to calculate hematoma volume, MD,OR-FA and ADC values by using SPSS 17.0 software. Results FA and ADC values of ORs were not significantly different between the two hemispheres in normal control groups (student t-test, P>0.05). Compared with MD values in control group, the visual field was significantly impaired in patients group (P<0.01). FA and ADC values of ORs were significantly different between two hemispheres in patient group (student t-test, P<0.01). There was no correlation of hematoma volume with OR-FA nor with ADC values nor with MD values (P>0.05). The MD values were correlated with OR-FA and ADC values after onset(P<0.05). MD, FA and ADC values of ORs in the affected hemisphere of the patient group were significantly different for the three OR types between 3 and 5 days as well as 3 months after onset (P<0.01). Conclusion DTI can examine the three-dimensional relationship between hematoma and OR, reflect the changes of OR morphology and predict the degree of visual-field defects.