Objective To explore the techniques and clinical effects of surgical treatment for supratentorial hypertensive intracerebral hematoma (HICH) by modified minicraniotomy approach and bone fragment reduction.Methods The clinical data of 87 patients with supratentorial HICH in our department from April,2009 to April,2011 who received modified minicraniotomy approach and reduction of bone fragment were retrospectively reviewed.Results Of the 87 patients,three died,and the remaining 84 cases were followed up.According to the ADL( activities of daily living) scale,the patients were classified:Twenty-six cases in grade Ⅰ,28 in grade Ⅱ,22 in grade Ⅲ,6 in grade Ⅳ and 2 in grade Ⅴ.Conclusion The surgical procedure of modified minicraniotomy approach and reduction of bone fragment for treatment of supratentorial HICH has some advantages such as miniinvasion,good exposure,wide visual field,complete clearance of hematoma,integrated skull,and less complications.It is a perfect surgical procedure for supratentorial HICH.

Objective To evaluate effects of ropivacaine combined with different concentrations of fentanyl for epidural labor analgesia. Methods In this multicenter double-blinded randomized study 128 parturients at full term and 2-3 cm of cervical dilatation who requested epidural analgesia were randomly allocated to one of 4 groups: group F0 received epidural ropivacaine alone (n = 33); group F1 received epidural ropivacaine with fentanyl 1 ?g?ml-1 (n = 30) ; group F2 epidural ropivacaine + fentanyl 2?g?ml-1(n = 33) and group F3 epidural ropivacaine + fentanyl 3 ?g?ml-1(n = 32). Epidural catheter was placed at L2,3 and advanced 4 cm into the epidural space in cephalad direction. A bolus of 15 ml of ropivacaine alone or with fentanyl was given after correct epidural placement was confirmed. EC50 of epidural ropivacaine was determined by up-and-down sequential experiment. The initial concentration of epidural ropivacaine was 0. 12% . If effective the next parturient received ropivacaine of lower concentration; if ineffective the ropivacaine concentration was increased. Each time the concentration of epidural ropivacaine increased/decreased by 0.01% . The analgesia was assessed using VAS score (0-10 0 = no pain, 10 = worst pain) . If VAS score was less than 3 within 30 min of ropivacaine administration, analgesia was defined as effective. EC50 of ropivacaine was calculated according to Dixon and Massey. Results Four of the 128 parturients enrolled were excluded because of uncertain results of interrupted observation. The EC50 of epidural ropivacaine for labor analgesia and the 95% confidence interval (95% CI) of EC50 were 0.110% (95% CI 0.109 0%-0.111 6%) in group F0; 0.089% (95% CI 0.087 7%-0.091 1%) in group F1; 0.073% (95% CI 0. 071 7%-0.0744%) in group F2 and 0.060% (95% CI 0.056 0%-0.634%) in group F3 respectively. The EC50 was significantly higher in group F0 than in group F1, F2 and F3 (P0.05) . The incidence of side-effect was significantly higher in group F3 than in group F0(P

ObjectiveTo explore the applied effects of microsurgical treatment on mesial temporal lobe epilepsy(MTLE)under the guidance of the intraoperative magnetic resonance imaging neuronavigation system.MethodsThe anterolateral temporal lobe,hippocampus and amygdala was resected by microsurgery under the guidance of the intraoperative magnetic resonance imaging neuronavigation system in 26 patients with intractable MTLE,with the help of electrocorticography monitoring during operation.ResultsAnterolateral temporal lobes were all resected in postoperative MRI and mesial structures certified to have atrophy or cirrhosis by pathology.All the patients were followed up from 3 to 6 months after the surgery.In 26 patients,twenty-three cases (88.5％) belonged in Engel grade I,two cases (7.7％) in grade Ⅱ and 1 case (3.8％) in gradeⅢ.No severe complications occurred and nervous functions were preserved well.ConclusionMicrosurgical treatment on MTLE under the guidance of the intraoperative magnetic resonance imaging neuronavigation system is effective due to epileptic focus all resected and protection for nervous functions,resulting in an accurate and safe improvemention of operation.

Objective To evaluate the clinical application value of motor evoked potential (MEP) combined with somatosensory evoked potential (SEP) and electroencephalogram (EEG) in carotid endarterectomy (CEA) in prevention of cerebral ischemia.Methods The clinical data of 62 patients accepted CEA in our hospital from June 2014 to July 2016 were analyzed retrospectively.During the operation,MEP,SEP and EEG were examined,and the bypass rube would be considered when SEP/MEP amplitude was decreased by 50％,latency was delayed by 10％,or frequency of EEG was changed by 50％.The predictive effects of each method and combined application of 3 methods were compared.Results In 62 patients,MEP changes occurred in 11 patients,SEP changed in 15 patients and EEG changed in 8 patients.Six patients applied bypass tube during operation and a transient neurological dysfunction occurred in 5 patients.The specificity of EEG mode showed no statistical differences as compared with that of SEP+MEP,EEG+MEP,and SEP+EEG modes (P＞0.05),while that of SEP mode or MEP mode was significantly lower as compared with that of SEP+MEP,EEG+MEP,and SEP+EEG modes (P＜0.05).The specificity of SEP+MEP+EEG mode showed no statistical differences as compared with that of SEP+MEP,EEG+MEP,and SEP+EEG modes (P＞0.05).Conclusion Multi-mode neural electrophysiological monitoring is safer and more effective than single mode in CEA;MEP+SEP monitoring mode is the preferred monitoring program in CEA.

Objective: To evaluate the clinical value and outcomes of technical improvement of hybrid operatical clipping for large paraclinoid internal carotid artery aneurysms. Methods: A review was conducted on 18 cases of large paraclinoid internal carotid artery aneurysm which were clipped by balloon non-fluoroscopic occlusion of the parent artery via a micro-bone window frontolateral approach in hybrid operating room at Neurosurgery Department of Tianjin Medical University General Hospital from June 2014 to December 2017. There were 8 males and 10 females with age of (63±4) years. There were 6 cases of unruptured aneurysm and 12 cases of ruptured aneurysm of subarachnoid hemorrhage (6 cases of grade Ⅱ, 4 cases of grade Ⅲ and 2 cases of grade Ⅳ in Hunt-Hess classification). Frontolateral approach incision (average length of about 5 cm) and bone window about 3 cm×3 cm were performed. No incision of the neck was needed to expose the internal carotid artery for temporary occlusion. In the operation, the balloon was slowly pushed to the preset position of the internal carotid artery under non-fluoroscopy. The balloon was expanded to block the blood flow of internal carotid artery. Then aneurysm was clipped. The balloon was loosened and retraced to the guiding catheter after clipping. The clipping condition was examined by cerebral angiography. If there was residual aneurysm neck or stenosis of the parent artery, the balloon was pushed under non-fluoroscopy again to temporary occlusion and the clip was adjusted until the aneurysm neck was clamped satisfactorily. Results: Eighteen aneurysms were successfully clipped in hybrid operating room. Fourteen aneurysms showed complete occlusion of the aneurysm neck and no stenosis of the parent artery. Four cases showed residual aneurysm neck after clipping by intraoperative angiography, then aneurysms were clipped satisfy by adjusting the aneurysm clip. The patients were followed up for 3 months to 1 year. Ten patients recovered well (modifed Rankin score (mRS): 0), and 3 patients had no obvious disability (mRS: 1). Two patients with Hunt-Hess grade Ⅲ were slightly disabled (mRS: 2). 1 patients with Hunt-Hess grade Ⅲ were moderately disabled (mRS: 3). 1 patients with Hunt-Hess grade Ⅳ were severely disabled (mRS: 4). One elderly patients with Hunt-Hess grade Ⅳ were seriously disabled (mRS: 5). Conclusions Application of balloon non-fluoroscopic occlusion clipping for large paraclinoid internal carotid artery aneurysm via a micro-bone window frontolateral approach is safe, effective and minimally invasive.

Periodontitis is a common chronic inflammatory disease that causes the periodontal bone destruction and may ultimately result in tooth loss.With the progression of periodontitis,the osteoimmunology microenvironment in periodontitis is damaged and leads to the formation of pathological alveolar bone resorption.CD301b+macrophages are specific to the osteoimmunology microenvironment,and are emerging as vital booster for conducting bone regeneration.However,the key upstream targets of CD301b+macrophages and their potential mechanism in periodontitis remain elusive.In this study,we concentrated on the role of Tim4,a latent upstream regulator of CD301b+macrophages.We first demonstrated that the transcription level of Timd4(gene name of Tim4)in CD301b+macrophages was significantly upregulated compared to CD301b-macrophages via high-throughput RNA sequencing.Moreover,several Tim4-related functions such as apoptotic cell clearance,phagocytosis and engulfment were positively regulated by CD301b+macrophages.The single-cell RNA sequencing analysis subsequently discovered that Cd301b and Timd4 were specifically co-expressed in macrophages.The following flow cytometric analysis indicated that Tim4 positive expression rates in total macrophages shared highly synchronized dynamic changes with the proportions of CD301b+macrophages as periodontitis progressed.Furthermore,the deficiency of Tim4 in mice decreased CD301b+macrophages and eventually magnified alveolar bone resorption in periodontitis.Additionally,Tim4 controlled the p38 MAPK signaling pathway to ultimately mediate CD301b+macrophages phenotype.In a word,Tim4 might regulate CD301b+macrophages through p38 MAPK signaling pathway in periodontitis,which provided new insights into periodontitis immunoregulation as well as help to develop innovative therapeutic targets and treatment strategies for periodontitis.

Objective:The clinical characteristics of patients with primary central nervous system lymphoma-diffuse large B-cell lymphoma (PCNSL-DLBCL) and the effects of different treatment schemes on their survival and prognosis were analyzed retrospectively.Methods:A total of 49 patients with PCNSL-DLBCL who presented at the Tianjin Medical University General Hospital from July 2014 to December 2020 were included, and their clinical data were retrospectively analyzed. They were divided into four groups: the MTX group, the R-CDOP group, the BTKi-R-MTX group, and the RLZT group. The median overall survival (OS) and progression-free survival (PFS) were calculated, and the survival prognosis was compared by univariate and multivariate prognostic analysis.Results:The median OS time of the MTX group, the R-CDOP group, the BTKi-R-MTX group, and the RLZT group was 16.5 months, 4.5 months, 42 months, and not reached, respectively ( P<0.001) . The median PFS time of the MTX group, the R-CDOP group, the BTKi-R-MTX group, and the RLZT group was 7 months, 1.5 months, 20 months, and 5 months, respectively ( P=0.005) . Multivariate prognostic analysis showed that double expressor lymphoma, IESLG risk grade, and different treatment methods were the prognostic factors of PCNSL-DLBCL. Conclusion:The survival and prognosis of PCNSL-DLBCL are affected by different treatment schemes. The role of CD20 monoclonal antibody in the treatment of PCNSL-DLBCL is still controversial. The treatment scheme containing BTKi has great potential for PCNSL-DLBCL. RLZT scheme has a good prospect for elderly patients who cannot tolerate high-dose chemotherapy and radiotherapy.

Objective:To assess the ultrasonographic features and potential diseases of fetal abnormal sylvian fissure(SF), and to explore the value of whole-genome sequencing (WGS) in prenatal detection.Methods:A total of 28 fetuses with a sonographic diagnosis of abnormal SF in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University between October 2018 and October 2020 were prospectively included. The fetal brain was evaluated by neuroultrasound and intrauterine MRI in detail. Amniotic fluid/cord blood obtained by amniocentesis or tissue samples from umbilical cord after birth were collected for WGS. Pregnancy outcomes and postnatal MRI were recorded, and neurodevelopment of live-born infants was followed up for more than 24 months after delivery.Results:During the study period, 28 fetuses with abnormal SF were identified, with a gestational age of 21.3-30.0 (24.8±2.0) weeks. Abnormal SF presented in MCD ( n=15, 53.6%), chromosomal anomalies ( n=3, 10.7%) or single-gene genetic syndromes ( n=3, 10.7%) with the affected fetuses showing developmental delay, hydrocephalus or leukomalacia ( n=4, 14.2%), corpus callosal agenesis with large interhemispheric cysts ( n=1, 3.6%), benign subarachnoid space enlargement with arachnoid cysts ( n=1, 3.6%), and multiple malformations ( n=1, 3.6%). Among the 15 cases with MCD, the most common pathology was lissencephaly/pachygyria, followed by schizencephaly, severe microcephaly, hemimegalencephaly with paraventricular heterotopia, and polymicrogyria. Abnormal SF presented bilaterally in 23 fetuses and unilaterally in 5. All cases were categorized into six types depending on SF morphology in the transthalamic section: no plateau-like or a small insula, linear type, irregular corrugated SF, Z-shaped, and cyst occupying type. In addition to abnormal SF, associated anomalies or mild variations were identified in all fetuses. There were 17 cases underwent intrauterine MRI, and 13 cases underwent postnatal MRI examination.And 25 pregnancies were terminated; 3 were born alive, and 2 had typical syndromic changes with poor neurodevelopmental prognosis. A related pathogenic genetic variant was detected in 57.1% (16/28) fetus, and the incidence of single nucleotide variants(SNVs) was 42.9% (12/28), among which de novo SNVs accounted for 91.7% (11/12). Conclusions:Fetal abnormal SF could be classified based on the ultrasonographic features of transthalamic section. Fetal abnormal SF may indicate MCD, some chromosomal abnormalities or single-gene genetic syndromes that may lead to poor neurodevelopmental outcomes, and may be affected by extra-cortical factors. It is suggested to carry out targeted prenatal genetic diagnosis for fetuses with abnormal SF.

Urea transporters (UT) play a vital role in the mechanism of urine concentration and are recognized as novel targets for the development of salt-sparing diuretics. Thus, UT inhibitors are promising for development as novel diuretics. In the present study, a novel UT inhibitor with a diarylamide scaffold was discovered by high-throughput screening. Optimization of the inhibitor led to the identification of a promising preclinical candidate,