Objective To investigate the value of high frequency magnetoencephalography signals in the localization of refractory temporal lobe epilepsy. Methods Retrospective analysis was performed in 10 patients with refractory temporal lobe epilepsy admitted to and accepted surgery in our hospital from January 2015 to December 2015. Surgical approaches of these patients were determined according to the results of long-term video EEG monitoring (VEEG), MR imaging, and conventional and high-frequency magnetoencephalography (MEG). MEG positioning analysis was performed after the surgery; followed up for 12 months was performed to evaluate the surgical efficacies. Results The surgery was effective in all the 10 patients; 5 patients achieved Engel grading Ⅰ, 2 patients achieved Engel grading Ⅱ, and 3 patients achieved Engel grading Ⅲ. The results of high-frequency MEG analysis indicated that 8 lesions were consistent with the surgical sites, enjoying good results; while the positioning error of the 2 patients was large. Conclusions The localization analysis of high-frequency neuromagnetic signals has the potential to determine epileptogenic zones preoperatively for epilepsy surgery. High-frequency oscillation is a new biomarker for the diagnosis of epilepsy.

Objective To discuss the experience of surgical treatment for cerebral sparganosis and analyze the factors affecting the removal of live worms.Methods A retrospective analysis was performed on clinical data and treatment experience of 49 patients with cerebral sparganosis,admitted to and accepted surgery in our hospital from January 2001 to December 2017.These patients were divided into two groups according to whether the live worms were removed during the operation,namely live worms removal group and live worms non-removal group;factors affecting the removal of live worms were analyzed.Results A total of 36 live worms were removed from 49 patients,one of them took out two live worms in the same lesion.In 45 patients with seizures before surgery,39 of them had seizure-flee after surgery (Engel grading I).Re-examination MR imaging showed that lesions disappeared and no new lesions were found in the brains of the 39 patients.Another two with original lesion enhancement had shadow disappearance;however,new lesions appeared behind the lesion;one of them was re-operated in the contralateral temporal lobe of the original lesion,and the other one continued follow-up observation.No new hemorrhage lesion,infarction or meningitis after operation was noted in all patients.Statistical analysis showed that there were significant differences in times from lesion discovery to surgery and lesion locations between patients of the live worms removal group and the live worms non-removal group (P＜0.05).Conclusions Surgical treatment of cerebral sparganosis is safe and effective.Surgical treatment should be performed as soon as possible after the lesion is discovered.The times from lesion discovery to operation should be shortened to prevent the displacement of the worms.At the same time,it is necessary to select the specific surgical plan and timing of surgery in combination with lesion location to improve removal rate of live insects and reduce surgical complications.If necessary,surgery can be performed again.

Objective:To explore the clinical characteristics, diagnostic methods, treatment strategies, and curative efficacies of epilepsy secondary to cerebral sparganosis.Methods:A retrospective analysis on clinical data of 62 patients with epilepsy caused by cerebral sparganosis diagnosed in our hospital from July 2004 to May 2019 was performed. According to the treatment intention of the patients, these patients were divided into surgery group ( n=39) and drug deworming group ( n=23). Patients in the surgery group were treated with craniotomy assisted by navigation to remove worms and lesions, and patients without live worms were treated with lesion resection or cortical burning. Patients in the drug deworming group were treated with praziquantel at a dose of 60 mg/(kg·d) with 10 d as a course of treatment; the next course of treatment was followed at an interval of 2 months, and ended until the standard of cure was achieved. All patients were followed up for 1-8 years, and the prognoses were determined according to the imaging data, clinical symptom improvement and sparganosis antibody IgG detection results. The epilepsy control 1 year after treatment was assessed by modified Engel grading. Results:Live worms were removed from 34 patients of the surgery group, with a total of 35 worms; after 1-8 years of follow-up, 34 patients were cured and 5 patients were not cured in the surgery group; however, 7 patients were cured and 16 patients were not cured in the drug deworming group; the cure rate in the surgery group was signficantly higher than that in the drug deworming group ( P=0.000). Modified Engel grading I was achieved in 36 patients, grading II in 2 patients, grading III in 0, and IV in 1 patient of the surgery group; modified Engel grading I was achieved in 9 patients, grading II in 3, grading III in 5, and grading IV in 6 patients of the drug deworming group; significant differences were noted between the two groups ( Z=203.000, P=0.000); the mean rank suggested that the surgery group had better efficacy than the drug deworming group(25.21 vs. 42.17). Conclusion:The successful surgical removal of live worms with the help of modern neurosurgery technology has better efficacy than drug deworming treatment in the epilepsy secondary to cerebral sparganosis.

Objective:To investigate the effects of hemophagocytic syndrome also known as hemophagocytic lymphohistiocytosis (HLH) on the clinical features and therapeutic efficacy of patients with Epstein-Barr virus-positive T-cell lymphoma (EBV-TCL).Methods:The clinical data of patients with EBV-TCL diagnosed by pathological examination in the First Affiliated Hospital of Guangzhou Medical University from November 2015 to August 2020 were retrospectively analyzed. According to whether they were accompanied with HLH at the time of onset, patients were divided into HLH group (10 cases) and non-HLH group (13 cases), and the clinical features and prognosis of the two groups were compared. The curative effects of different treatment methods and patients with different plasma EBV-DNA titers were compared.Results:Among 23 patients, 3 cases (13.0%) were in Ann Arbor stage Ⅰ-Ⅱ, 20 cases (87.0%) were in stage Ⅲ-Ⅳ; the International Prognostic Index (IPI) score was 1 point in 3 cases (13.0%), 2 points in 4 cases (17.4%), 3 points in 8 cases (34.8%), 4 points in 8 cases (34.8%). In the HLH group, there were 2 cases of aggressive NK-cell leukemia and 3 cases of childhood systemic EBV-TCL. There were no cases of above two pathological types in the non-HLH group. In the HLH group, the proportions of patients with fever, bone marrow invasion, IPI score > 2 points, and EBV-DNA > 10 4 copies/ml were higher than those in the non-HLH group (all P < 0.05). The objective response rate (complete remission plus partial remission) of all patients after chemotherapy was 47.8% (11/23); there were 3 cases undergoing hematopoietic stem cell transplantation in both the HLH group and the non-HLH group, and all achieved objective remission. The objective remission of 7 patients and 10 patients who did not undergo hematopoietic stem cell transplantation in the HLH group and non-HLH group after lymphoma chemotherapy had 0 case and 5 cases, respectively, and the difference was statistically significant ( P = 0.044). In the chemotherapy alone group, 5 of 17 patients had objective remission, 6 patients in the chemotherapy plus transplantation group had objective remission, and the difference was statistically significant ( P = 0.039). Among 16 patients whose plasma EBV-DNA titers turned negative, 11 patients had objective remission, and 7 patients whose plasma EBV-DNA titers were continuously positive had no objective remission, and the difference was statistically significant ( P = 0.001). The 1-year overall survival rate of all patients was 69.3%, and the 2-year overall survival rate was 52.0%. In the HLH group, the 1-year and 2-year overall survival rates of 7 patients receiving chemotherapy alone and 3 patients receiving chemotherapy plus transplantation were 42.9% and 66.7%, respectively. In the non-HLH group, the 1-year overall survival rates of 10 patients receiving chemotherapy alone and 3 patients receiving chemotherapy plus transplantation were 80.0% and 100.0%, respectively; the 2-year overall survival rates were 26.7% and 100.0%,respectively. The overall survival of patients receiving chemotherapy plus transplantation was better than that of those receiving chemotherapy alone in both the HLH group and the non-HLH group, and differences were statistically significant (all P < 0.05). Conclusions:The general clinical stage of patients with EBV-TCL is later, and the prognosis of EBV-TCL patients with HLH is worse. The therapeutic efficacy may be related to plasma EBV-DNA titers. Hematopoietic stem cell transplantation can improve the remission rate.

Purpose: This study aimed to investigate the clinicopathologic features and mutational landscape of patients with hepatitis B virus (HBV)–related advanced hepatocellular carcinomas (HCC) undergoing transcatheter arterial chemoembolization (TACE). Materials and Methods: From January 2017 to December 2018, 38 patients newly diagnosed with HBV-related advanced HCC were enrolled in the final analysis. Their pathological tissues and corresponding blood samples before TACE treatment were collected for whole-exome sequencing. Response to TACE was evaluated at 1-3 months after two consecutive use of TACE. Predictive factors were analyzed by univariate and multivariate analyses in a bivariate Logistic regression model. Enrichment of related pathways of all driver genes were acquired using the gene set enrichment analysis (GSEA). Results: Among 38 patients, 23 (60.5%) exhibited TACE failure/refractoriness. Patients with TACE failure/refractoriness showed higher frequency of TP53 mutation than their counterparts (p=0.020). Univariate and multivariate analyses showed that only vascular invasion and TP53 mutation were significantly correlated with TACE failure/refractoriness in HBV-related advanced HCC. Of the 16 patients without vascular invasion, eight (50.0%) had TP53 mutations, and TP53 mutation was associated with TACE failure/refractoriness (p=0.041). Moreover, GSEA showed that mitogen-activated protein kinase and apoptosis pathways induced by TP53 mutation were possibly associated with TACE failure/refractoriness. Conclusion Our study suggested that TP53 mutation was independently related with TACE efficacy, which may work via mitogen-activated protein kinase and apoptosis pathways. These findings may provide evidence to help distinguish patients who will particularly benefit from TACE from those who require more personalized therapeutic regimens and rigorous surveillance in HBV-related advanced HCC.

Cryoablation (CRA) and microwave ablation (MWA) are two main local treatments for hepatocellular carcinoma (HCC). However, which one is more curative and suitable for combining with immunotherapy is still controversial. Herein, CRA induced higher tumoral PD-L1 expression and more T cells infiltration, but less PD-L1^highCD11b⁺ myeloid cells infiltration than MWA in HCC. Furthermore, CRA had better curative effect than MWA for anti-PD-L1 combination therapy in mouse models. Mechanistically, anti-PD-L1 antibody facilitated infiltration of CD8⁺ T cells by enhancing the secretion of CXCL9 from cDC1 cells after CRA therapy. On the other hand, anti-PD-L1 antibody promoted the infiltration of NK cells to eliminate PD-L1^highCD11b⁺ myeloid cells by antibody-dependent cell-mediated cytotoxicity (ADCC) effect after CRA therapy. Both aspects relieved the immunosuppressive microenvironment after CRA therapy. Notably, the wild-type PD-L1 Avelumab (Bavencio), compared to the mutant PD-L1 atezolizumab (Tecentriq), was better at inducing the ADCC effect to target PD-L1^highCD11b⁺ myeloid cells. Collectively, our study uncovered the novel insights that CRA showed superior curative effect than MWA in combining with anti-PD-L1 antibody by strengthening CTL/NK cell immune responses, which provided a strong rationale for combining CRA and PD-L1 blockade in the clinical treatment for HCC.