Objective To analyze the CT findings of tuberculous lymphadenitis in parotid gland, so as to improve the diagnostic accuracy of tuberculosis of parotid gland. Methods Nine cases with tuberculous lymphadenitis in parotid gland confirmed by surgical pathology and acid-fast bacilli after preoperative spiral CT plain scan and two phases dynamic enhancement scan were retrospectively analyzed.Imaging findings of CT were reviewed and compared with surgical pathology. Results Seven of the 9 cases of tuberculosis of the parotid gland occurred in the left side, and 2 in the right side, and superficial lobe involvement occurred in 8 cases and deep lobe in 1 ease. The lesion was classified as tumour type (8 cases)and infiltration type (1 case). In tumour type, the number of lesion was from 1 to 4, and the size was from 2.7 to 5.3 cm in diameter. One case of infiltration type measured 3.4 cm in diameter. On CT plain scan,the lesions showed homogeneous slight high-density with regular edge in 5 cases and irregular low-density in 4 cases, and 2 of them with partly blurred edge. On CT enhanced scan, uniform moderate enhancement was seen in 3 cases, circular enhancement in 4 cases, inhomogeneous enhancement in 1 case, and lace-like enhancement in 1 case. Local infiltration occurred in 6 cases. Lymphadenovarix in the same side of lesion occurred in 2 cases. Conclusion CT findings of tuberculous lymphadenitis in parotid gland present diversification, which correlate well with pathological changes. Understanding of characteristic CT findings of tuberculous lymphadenitis in parotid gland is helpful for differential diagnosis, but final diagnosis still depends on pathology and acid-fast baeilli.

Objective To explore the effect of sodium valproate (SV) on reducing high-sensitivity C-reactive protein (hsCRP) and attenuating cerebrovascular spasm damage in rats after subarachnoid hemorrhage (SAH).Methods Seventy-two male rats,weighting 300-400 g,were randomized to following experimental groups:sham-operated group,SAH group,SAH+saline treatment group,and SAH+SV treatment group (n=18).The SAH models in the later three groups were induced by injection of autologous blood into the cistern magna.Saline or SV (2 mg/100 g) was given to the rats in the SAH+saline treatment group and SAH+SV treatment group every day via intraperitoneal injection.Serum hsCRP level was measured on 1,3,5 and 10 day.Neurological deficit scale scores were assessed on 3 and 5 day.Results On 1,3,5 and 10 day,HsCRP level in the sham-operated group was (0.09± 0.02) mg/L,(0.09±0.02) mg/L,(0.09±0.02) mg/L and (0.09±0.01) mg/L;that in SAH group was (0.29± 0.01) mg/L,(0.32±0.02) mg/L,(0.35±0.02) mg/L and (0.32±0.02) mg/L;that in SAH+saline treatment group was (0.28±0.02) mg/L,(0.31 ±0.02) mg/L,(0.34±0.02) mg/L and (0.31 ±0.02) mg/L;that in SAH+SV treatment group was (0.15 ±0.02) mg/L,(0.21 ±0.02) mg/L,(0.24±0.02) mg/L and (0.15 ±0.03) mg/L;HsCRP level in the SAH group and SAH+saline treatment group was significantly higher than that in the sham-operated group (P＜0.05);HsCRP level in the SAH+SV treatment group was significantly increased as compared with that in the sham-operated group,but significantly decreased as compared with that in the SAH+saline treatment group and SAH group (P＜0.05).The neurobehavior scale scores on 3 and 5 day in SAH+SV treatment group (23.0±0.8 and 21.8±1.4) were significantly increased as compared with those in the SAH group (14.1±0.8 and 11.9±0.9) and SAH+saline treatment group (13.9± 0.7 and 11.1±1.4,P＜0.05);those in the SAH+SV treatment group (23.0±0.8 and 21.8±1.4) were significantly decreased as compared with that in the sham-operated group,but significantly increased as compared with that in the SAH+saline treatment group and SAH group (P＜0.05).Conclusion SV decreases the inflammatory injury by reducing the hsCRP level and improve the neurological outcome in SAH rat models.

Objective:To investigate the differences of integral alpha 3 (ITGA3) mRNA and protein expressions in gliomas of different grades and different cell lines, and gliomas tissues of different clinical and molecular characteristics, and evaluate their prognostic values in brain glioma patients.Methods:(1) ITGA3 mRNA expression data in the brain gliomas and clinical data of these glioma patients were obtained from The Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA). The differences of ITGA3 mRNA expressions in glioma patients with different gender, ages, WHO grading, isocitrate dehydrogenase 1 ( IDH) mutation statuses, and 1p/19q co-deletion statuses were compared. Kaplan-Meier method was used to plot and compare the survival curves of patients with ITGA3 mRNA high expression and ITGA3 mRNA low expression. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficiency of ITGA3 mRNA expression in survival rate of gliomas. Univariate and multivariate Cox regression analyses were used to explore the independent influencing factors for prognoses in glioma patients. The independent influencing factors for prognosis were used to construct nomograms and the calibration diagram was used to verify the reliability of nomograms in predicting the prognoses of these patients. (2) Intracellular localization of ITGA3 and ITGA3 protein expression in low- and high-grade gliomas were determined by on-line database of Human Protein Atlas (HPA). (3) Brain glioma cells U87, U118, U251 and human astrocytes SVG were cultured in vitro, and the ITGA3 mRNA and protein expressions in cells were detected by Western blotting and reverse transcription (RT)-PCR, respectively. Results:(1) In TCGA database, the ITGA3 mRNA expressions in gliomas of WHO grading II, III and IV increased successively, with significant differences (P<0.05). In CGGA database, the ITGA3 mRNA expression in glioma of WHO grading IV was statistically higher than that in glioma of WHO grading II and III ( P<0.05). In TCGA and CGGA databases, the ITGA3 mRNA expressions in glioma patients aged ≤40 years and >40 years, patients with IDH wild-type and IDH mutation, and patients with chromosome 1p/19q deletion and chromosome 1p/19q non-deletion were statistically different ( P<0.05). The survival rate of patients with low ITGA3 mRNA expression was significantly higher than that of patients with high ITGA3 mRNA expression, no matter in low-grade glioma, glioblastoma, or entire glioma samples ( P<0.05). ROC curve showed that, in TCGA database, the area under the curve (AUC) of ITGA3 mRNA in predicting 1, 3, and 5 years survival was 0.791, 0.786, and 0.708 in glioma patients; in CGGA database, the AUC of ITGA3 mRNA in predicting 1, 3, and 5 years survival was 0.661, 0.667, and 0.659. Multivariate Cox regression analysis showed that, in TCGA database, age, WHO grading, IDH mutation, chromosome 1p/19q deletion and ITGA3 mRNA expression ( HR=1.018, 95%CI: 1.006-1.030, P=0.0.003) were independent influencing factors for prognoses of glioma patients ( P<0.05); and in CGGA database, WHO grading, IDH mutation, chromosome 1p/19q deletion, and ITGA3 mRNA expression ( HR=1.445, 95%CI: 1.132-1.844, P=0.003) were independent influencing factors for prognoses of glioma patients ( P<0.05). Nomograms showed that age had the greatest influence in survival, followed by ITGA3 mRNA expression. Calibration plots showed that nomogram was reliable in predicting 1-, 3-, and 5-year survival in glioma patients. (2) Immunofluorescence localization showed that ITGA3 protein mainly aggregated in cell membrane and vesicles. Immunohistochemical staining showed that the ITGA3 protein expression in high-grade glioma tissues was obviously higher than that in low-grade glioma tissues. (3) The results of RT-PCR and Western blotting revealed that the ITGA3 mRNA and protein expressions in glioma cell lines U87, U118 and U251 were significantly higher than those in SVG cells ( P<0.05). Conclusion:The ITGA3 mRNA and protein expression levels are correlated with the malignant degrees of glioma; patients with ITGA3 mRNA low expression tend to have a high overall survival; ITGA3 mRNA expression can be used as an index to evaluate the prognoses of glioma patients.

Objective:To explore the feasibility and clinical efficacy of watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma.Methods:Fourteen patients with tuberculum sellae meningioma accepted expanded endoscopic endonasal excision of tuberculum sellae meningioma in Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical University from January 2018 to May 2022 were chosen. During reconstruction of skull base, femoral fascia was used to repair the dural defect of sellar base with watertight suture, and then the sellar base was covered with a larger layer of femoral fascia for reinforcement; no nasal septum mucosal flap was used. The clinical data and treatment efficacy of these patients were retrospectively analyzed.Results:Total resection showed by imaging was achieved in all 14 patients. During the surgery, Valsalva ventilation test confirmed that at least 12 stitches were needed to achieve watertight suture status; watertight suture status was achieved in 13 of the 14 patients, without cerebrospinal fluid (CSF) leakage; watertight suture status was not achieved in one patient due to tumor invasion of the sella floor dura and having an extensive excision, and CSF leakage appeared transiently after surgery but disappeared 2 weeks after surgery (bed rest). Among the 11 patients with visual damage and optic field defect, 9 patients improved obviously and 2 patients did not improve. Follow-up was performed for 5-53 months, with an average of (26.8±8.4) months; no tumor recurrence or CSF leakage were found in these patients; up to the last follow-up, the 2 patients with visual damage and optic field defect did not improve.Conclusion:Skull base reconstruction using watertight suture technique after expanded endoscopic endonasal excision of tuberculum sellae meningioma is reliable.

Objective:To explore the feasibility and clinical efficacy of resection of jugular foramen schwannomas via anterolateral approach. Methods:A retrospective analysis was conducted on clinical data of 15 patients with jugular foramen schwannomas admitted to Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical College from January 2018 to July 2022. Three patients had Samii type B, 7 had type C and 5 had type D. Resection of the schwannomas was performed via anterolateral approach. After surgery, regular follow-up was performed through outpatient review, telephone, or WeChat to evaluate tumor progression and neurological functions. Results:Adequate surgical exposure was obtained in all 15 patients. Total resection was obtained in 14 patients and subtotal resection in 1 patient. Posterior cranial nerve palsy was worsened in 1 patient and new-onset facial paralysis (House-Brackmann grading Ⅲ) was noted in 1 patient, without cerebrospinal fluid leakage, subcutaneous effusion or death. Choking and cough during drinking water, and dysphagia disappeared or relieved 3 months after surgery in patients with aggravated posterior cranial nerve palsy, but no significant recovery from hoarseness was noted 6 months after surgery. A patient with new-onset facial paralysis improved to House-Brackmann grading I 3 months after surgery. Up to the last follow-up, no tumor recurrence was observed in 15 patients.Conclusion:Resection via anterolateral approach is effective in jugular foramen schwannomas for its adequate surgical exposure, high total resection rate, and low postoperative complications.

Objective To study the effect of soluble amyloid precursor protein α (sAPPα) on nerve cell apoptosis and neurological function in subarachnoid hemorrhage (SAH) rats.Methods Sixty male SD rats were randomly divided into control group (n=20),SAH+saline group (n=20) and SAH+sAPPα group (n=20).A SAH model was established by injecting autologous blood into cistern magna in rats.After a SAH model was established for SAH + saline group and SAH + sAPPα group by injecting saline and sAPPα respectively into the cistern magna of rats,the apoptotic cells were detected by immunofluorescene with TUNEL staining and the neurological function was scored in 10 rats from each group on day 3 after injection of sAPPα and saline.Results The number of apoptotic cells in brain tissue was significantly greater in SAH+saline group than in control group (P＜0.05) and was significantly smaller in SAH+sAPPα group than in SAH+ saline group (P＜0.05).The neurological function score was 26.7±0.5,13.9±0.7 and 23.0±0.8 respectively in control group,SAH + saline group and SAH + sAPPα group.Conclusion sAPPα alleviates secondary damage of neurological function by inhibiting the apoptosis of nerve cells in rats after SAH and can thus improve their neurological function.

Objective To identify the reasons and treatment strategies of epidural fluid collection (EFC) secondary to cranioplasty in patients with traumatic brain injury after decompressive craniectomy.Methods From June 2013 to July 2017,a retrospective analysis was performed on clinical data of 150 patients with traumatic brain injury after decompressive craniectomy in our hospital.A total of 47 patients experienced EFC following cranioplasty and 103 not.Risk factors of EFC after cranioplasty were analyzed by multiple factor Logistic regression.Results For the 47 EFC patients,32 patients had no obvious clinical symptoms and EFC was absorbed gradually through conservative therapy;15 patients had clinical symptoms,such as mental deterioration,headache,or limb weakness.EFC disappeared through vacuation in 4 patients and subcutaneous drainage in 11.The proportions of patients with skull defect＞80 cm2,dural defect and dural calcification in patients with EFC were significantly higher as compared with those without EFC (P＜0.05).Multiple factor Logistic regression analysis showed that skull defect＞80 cm2 and dural mater calcification were independent risk factors for EFC after cranioplasty.Conclusions Patients with large skull defect＞80 cm2 and dural calcification are prone to have EFC after cranioplasty.Careful evaluation of imaging data,good surgical skills and strengthening postoperative management can reduce incidence of EFC after cranioplasty.