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

Objective The optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients. Methods We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors' institutional series of 24 patients were also included and reviewed in the analysis. Results A total of 19 East Asian studies involving 1,571 patients as well as our institution's retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively). Conclusion The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.

Objective. Meningiomas are one of the most common primary tumors of the central nervous system. Most of them are benign and can be cured by surgery, while a few meningiomas are malignant. Ferroptosis gene characteristics might be associated with drug therapy and survival in patients with clinically aggressive, unresectable meningiomas. This study explored the mechanism of differentially expressed miRNAs and ferroptosis in meningioma to provide a new reference to treat meningioma. Methods. Bioinformatics analysis of differential miRNA profiles and functions in patients with meningioma was performed. The contents of lactate dehydrogenase (LDH), malondialdehyde (MDA), and Fe2+ were determined. Reactive oxygen species (ROS) values, as well as cell cycle changes, were analyzed by flow cytometry. The targets of miR-127-5p and JAM3 were detected by dual luciferase assays. Cell counting kit-8 (CCK8) and Transwell assays were used to analyze cell activity. Ki67 expression was analyzed by immunohistochemistry. Expression levels of miR-127-5p and JAM3 were analyzed by RT-qPCR. GPX4 expression was quantified by western blotting. Results. miR-127-5p was expressed at low levels in IOMM-Lee cells, while JAM3 was highly expressed in IOMM-Lee cells. A dual luciferase assay demonstrated that miR-127-5p could target JAM3. Upregulation of miR-127-5p in IOMM-Lee cells resulted in cell cycle arrest and inhibition of cell activity. Upregulation of miR-127-5p increased LDH, MDA, and ROS levels and Fe2+ content and inhibited the expression of GPX4 protein. Upregulation of JAM3 reversed the results of miR-127-5p upregulation. Conclusion. miR-127-5p regulated meningioma formation and ferroptosis through JAM3, providing insights for the development of new treatments for meningioma.

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

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

目的 分析微小RNA-494(miR-494)、激活转录因子3信使RNA(ATF3 mRNA)在脑膜瘤组织中的表达及其意义.方法 选取2013年10月—2018年1月于首都医科大学附属北京友谊医院神经外科脑膜瘤切除患者79例为脑膜瘤组,另取因脑外伤切除脑组织患者79例为对照组.采用实时荧光定量PCR(qRT-PCR)法检测2组miR-494、ATF3 mRNA表达水平;分析脑膜瘤组织miR-494、ATF3 mRNA表达水平与脑膜瘤患者临床病理特征及预后的关系;Pearson法分析脑膜瘤组织miR-494表达水平与ATF3 mRNA的相关性;COX回归分析脑膜瘤患者预后的影响因素.结果 脑膜瘤组miR-494、ATF3 mRNA表达水平均显著高于对照组(t/P=7.038/0.000、8.271/0.000).脑膜瘤组织miR-494、ATF3 mRNA低表达亚组有淋巴结转移、WHO分级Ⅲ级、TNM分期Ⅲ～Ⅳ期患者比例低于高表达亚组(miR-494:χ2/P=5.346/0.021、6.627/0.010、12.381/0.000;ATF3 mRNA:χ2/P=12.868/0.000、14.799/0.000、12.166/0.000);脑膜瘤组织miR-494表达水平与ATF3 mRNA水平呈正相关(r/P=0.578/0.000);脑膜瘤患者miR-494、ATF3 mRNA低表达亚组术后36个月累积生存率分别明显高于miR-494、ATF3 mRNA高表达亚组(χ2/P=21.798/0.019、13.015/0.000).多因素分析结果显示,发生淋巴结转移、TNM分期增加及miR-494、ATF3 mRNA表达水平升高是影响脑膜瘤患者预后的独立危险因素[OR(95％CI)=2.572(1.582～4.182)、2.463(1.554～3.904)、2.257(1.478～3.447)、2.385(1.547～3.678)].结论 脑膜瘤组织中miR-494、ATF3 mRNA表达水平显著升高,两者可能相互作用共同影响脑膜瘤发生发展,检测miR-494、ATF3 mRNA水平有利于判定患者预后情况.

Excessive cerebral inflammation plays a key role in early brain injury (EBI) after subarachnoid hemorrhage (SAH). Berberine, an isoquinoline alkaloid isolated from Chinese herb Coptis chinensis, possesses anti-inflammatory, and neuroprotective effects. Here we evaluated the beneficial effects of berberine against SAH-induced inflammatory response and the subsequent brain injury. Our data showed that berberine treatment significantly inhibited microglia activation and proinflammatory cytokines release. Concomitant with suppressed cerebral inflammation, berberine mitigated the subsequent brain injury as demonstrated by improved neurological behavior, reduced brain edema, and decreased neural apoptosis. Moreover, berberine significantly inhibited high mobile group box 1 (HMGB1)/nuclear factor-κB (Nf-κB)-dependent pathway and enhanced sirtuin 1 (SIRT1) expression after SAH. Treatment with ex527, a selective SIRT1 inhibitor, reversed berberine-induced SIRT1 activation and inhibitory effects on HMGB1/Nf-κB activation. In addition, ex527 pretreatment abated the anti-inflammatory and neuroprotective effects of berberine on SAH. Taken together, these findings suggest that berberine provides beneficial effects against SAH-triggered cerebral inflammation by inhibiting HMGB1/Nf-κB pathway, which may be modulated by SIRT1 activation.

Objective To summarize the experience of anterolateral percutaneous vertebroplasty (PVP) in the treatment of cervical metastases in advanced lung cancer,and to evaluate its therapeutic effect on patients with cervical metastases in advanced lung cancer.Methods A total of 27 patients with advanced cervical spine metastases were enrolled from July 2009 to September 2018 in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University.A retrospective analysis was performed on 20 patients who underwent PVP and had complete follow-up data.There were 12 males and 8 females,aged (59.15±7.55) years.A total of 32 cervical metastases were performed.Bone cement leakage was observed by X-ray and CT after operation,and complications were recorded during and after operation.Follow-up visits were made by outpatient or telephone until the 3rd month after the operation.By comparing visual analogue scale (VAS),analgesic use score,cervical dysfunction index (NDI) and KPS before and after operation,the improvement of the quality of life of patients after operation was comprehensively evaluated.The measurement data were expressed as (Mean ± SD).The paired t test was used to test the normal distribution of the paired difference before and after the operation,and the paired rank sum test was used to test the difference before and after the operation which did not conform to the normal distribution.Results The preoperative Tokuhashi correction score was (7.15 ± 2.87) score in 20 patients and the Tomita score was (7.55 ± 2.21) score.The single-segment cervical vertebrae cement injection volume was (1.17 ± 0.25) ml.The postoperative cement leakage rate was 53.13％ (17/32),but no serious complications.VAS before surgery and 3 months after surgery [preoperative (8.30 ± 1.08) score,postoperative (3.60 ± 1.67) score,P =0.000)],analgesic use score [preoperative (3.35 ± 0.59) score,postoperative (1.70 ± 0.80) score,P =0.000],cervical dysfunction index [preoperative (63.10 ± 7.94) score,postoperative (42.55 ± 15.69) score,P =0.000)] and KPS [Preoperative (54.50 ± 6.86) score,postoperative (61.67 ± 12.95) score,P =0.011] were significantly improved,and the difference was statistically significant.Conclusion PVP via anterolateral approach is effective in the treatment of advanced cervical metastases of lung cancer,and can effectively improve the quality of life of patients with advanced cervical metastases,but the surgical leakage rate is high and needs attention.

Percutaneous vertebroplasty (PVP) has been shown to release spinal pain and stabilize the vertebral body. PVP is suggested as an alternative treatment in spinal metastasis. Although cervical metastases is less prevalent than thoracic and lumbar spine, PVP procedure in cervical vertebrae remains technical challenging. We retrospectively analyzed the data from patients (n=9) who underwent PVP using anterolateral approach to treat severe neck pain and restricted cervical mobility from metastatic disease. Patients were rated using modified Tokuhashi score and Tomita score before the procedure. Visual analog scale (VAS), neck disability index (NDI), analgesic use, and imaging (X-ray or CT) were evaluated before PVP and 3 days, 3 months, and 6 months after PVP. All patients were in late stage of cancer evaluated using modified Tokuhashi and Tomita score. The cement leakage rate was 63.6% (14 of the 22 vertebrae) with no severe complications. VAS, NDI, and analgesic use were significantly decreased 3 days after the procedure and remained at low level until 6 months of follow-up. Our result suggested PVP effectively released the pain from patients with cervical metastasis. The results warrant further clinical investigation.

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

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

Objective To develop an injective mixture of bone cement made with polymethylmethacrylate cement(PMMA) and calcium phosphate cement(CPC) and to become an ideal filling material for vertebroplasty and kyphoplasty based on the advantages of each material.Methods The experimental materials were injective bone cement PMMA and CPC.Firstly,the combined bone cement was made using the different mass ratio of PMMA and CPC,1∶2,1∶1,or 2∶1.Secondly,the standard test pieces with 6mm in diameter and 12mm in hight were made using the combined bone cement.Finally,a preliminary evaluation of physical and chemical properties of the mixed bone cement was carried out,i.e.,mechanical property,solidification temperature,solidification time,electron microscope scanning,X-ray diffraction,and animal muscle implantation experiment.Results The mixed bone cement(1∶1) had better physical and chemical properties than other proportions.Its compressive strength increased by about 120% higher than that of CPC.The solidification temperature was lower than 45 ℃,and solidification time was about 12-14 min.The microscopic structure of this mixed bone cement(1∶1) was similar to that of CPC.Seventy percent of the total pores were between 100-300μm and eyelet penetrations between the pores was mainly 10-20μm.The results of animal intramuscular implantation experiment demonstrated that the mixed bone cement(1∶1) had good biocompatibility,but the degeneration speed was slow.Conclusion The mixed bone cement(1∶1) can overcome the shortcomings of PMMA and CPC and have the advantage of each material.So this mixed bone cement is an ideal filling material for vertebroplasty and kyphoplasty.