The role of glial scar after intracerebral hemorrhage(ICH)remains unclear.This study aimed to inves-tigate whether microglia-astrocyte interaction affects glial scar formation and explore the specific function of glial scar.We used a pharmacologic approach to induce microglial depletion during different ICH stages and examine how ablating microglia affects astrocytic scar formation.Spatial transcriptomics(ST)analysis was performed to explore the potential ligand-receptor pair in the modulation of microglia-astrocyte interaction and to verify the functional changes of astrocytic scars at different periods.During the early stage,sustained microglial depletion induced disorganized astrocytic scar,enhanced neutrophil infiltration,and impaired tissue repair.ST analysis indicated that microglia-derived insulin like growth factor 1(IGF1)modulated astrocytic scar formation via mechanistic target of rapamycin(mTOR)signaling activation.Moreover,repopulating microglia(RM)more strongly activated mTOR signaling,facilitating a more protective scar formation.The combination of IGF1 and osteopontin(OPN)was necessary and sufficient for RM function,rather than IGF1 or OPN alone.At the chronic stage of ICH,the overall net effect of astrocytic scar changed from protective to destructive and delayed microglial depletion could partly reverse this.The vital insight gleaned from our data is that sustained microglial depletion may not be a reasonable treatment strategy for early-stage ICH.Inversely,early-stage IGF1/OPN treatment combined with late-stage PLX3397 treatment is a promising therapeutic strategy.This prompts us to consider the complex temporal dynamics and overall net effect of microglia and astrocytes,and develop elaborate treatment strategies at precise time points after ICH.

Objective:To evaluate the results of butterfly cartilage myringoplasty for anterior quadrant tympanic perforation under endoscope.Methods:Thirty-eight patients with anterior quadrant tympanic perforations who were subjected to endoscopic butterfly cartilage myringoplasty from April 2016 to October 2018 were included in this study, including 16 males and 22 females, with an average age of (34.5±14.2) years. The patients were reviewed retrospectively, and the pre-and post-operative pure tone audiometry (PTA) thresholds, pre-and post-operative air-bone gaps (ABG), post-operative graft success rates and complications were evaluated. SPSS 23.0 was used to analyze data.Results:Mean post-operative follow-up duration was (9.4±3.1) months (range 6-18 months). The graft survival rate was 94.7% (36/38) . The preoperative and postoperative mean PTA was (30.9±8.9) dB HL and (21.4±7.7) dB HL respectively. Preoperative and postoperative mean ABG was (18.4±6.3) dB and (10.8±6.0) dB respectively. There was significant difference between pre-and postoperative PTA and ABG ( t=5.353 and 4.162, P<0.05 for both). A postoperative ABG reduction of (8.3±1.5) dB was reached. Two (4.7%) patients had postoperative myringitis, two (4.7%) had recurrent perforation, and one (2.4%) had lateral healing of transplanted tympanic membrane in the postoperative follow-ups. No intratympanic cholesteatoma was observed. Conclusions:Endoscopic butterfly inlay myringoplasty is a reliable, minimally invasive alternative method to repair anterior tympanic membrane perforations, with high closure rate and low risk of complications.

Objective:To understand the molecular characteristics and correlation among isolated strains of Brucella melitensis (BM) so as to improve the strategies on prevention and control of the disease in Jiangxi province. Methods:A total of 25 strains of BM isolated from human in 17 counties of Jiangxi province were analyzed by multiple locus variable-number tandem repeat analysis (MLVA) method.Results:A total of 25 strains of BM were classified into 24 independent genotypes with similarities between 67.00% and 100.00% and Simpson index between 0.000 and 0.773. There were 3 genotypes in MLVA8, including 60.00% (15/25) as 42 genotype, 32.00% (8/25) as 43 genotype, and 8.00% (2/25) as 63 genotype, respectively. There were 7 genotypes in MLVA11 identified, with 116 genotype and 125 genotype the main genotypes, accounting for 56.00% (14/25) of all the identified strains.Conclusions:Genes from all the 25 strains of BM that isolated from human being were with high genetic diversities, and various, genotypes. However, no obvious epidemiological correlation was noticed among these strains, indicating the complexity of the source of infection on Brucella in Jiangxi province.

Objective: To introduce a self-developed bone dust collector designed by the authors and evaluate its efficiency in mastoid obliteration following mastoidectomy. Methods: Consecutive patients, from April 2017 to March 2018, who prepared to receive mastoidectomy were randomly divided into two groups, and in each group the bone dust was harvested by self-developed bone dust collector or by conventional used method respectively in mastoidectomy. The amount of the harvested bone dust and the time consumed in the collecting procedure were compared between two groups. The infection of the bone dust after mastoid obliteration was also evaluated during follow up. Results: 33 patients were recruited in bone dust collector group, and 31 patients in conventional method group.There is no significance of difference between two groups in sex ratio, age and pneumatization of mastoid cells (P>0.05 for all). The median amount of bone dust harvested by bone dust collector was significantly larger than that collected by conventional method (1.8 g vs 1.1 g, P<0.05). The median time spent in bone dust collector group was significantly shorter than that spent in conventional method group (4 minutes vs 6 minutes, P<0.05). No bone dust infection was found in the follow-up in all patients. Conclusion The present self-developed bone dust collector is a easy and useful apparatus which can significantly improve the efficiency of collecting bone dust in mastoidectomy.

Objective To investigate the effect of using pterional approach combined with partial orbital roof and zygomatic process resection (modified orbitopterional approach)for the management of ruptured anterior communicating artery aneurysms. Methods From October 2013 to October 2016,36 consecutive patients with ruptured anterior communicating artery aneurysm admitted to the Department of Neurosurgery,Binzhou Medical University Hospital were enrolled retrospectively. They were all confirmed by DSA or CT angiography. The orbitopterional approach was used,only part of the orbital roof was removed and the structures of lateral orbital wall and the wings of sphenoid bone were not removed. The clinical manifestations,imaging data,surgical methods,and surgical results of ruptured anterior communicating artery aneurysms were summarized. Results All 36 patients with anterior communicating artery aneurysm in this group were treated with the modified orbitopterional approach. There was no obvious brain retraction injury on CT scan after procedure. At the time of discharge,the Glasgow outcome scale score was 5 in 25 cases, 4 in 8 cases,and 3 in 3 cases. No patients died. The patients were followed up for 3 to 24 months;no rebleeding and recurrence were observed. No complications occurred,such as enophthalmos,damage to the eyeballs, and cranial nerve injury. Conclusion The modified orbitopterional approach increased the operation space,avoided the distraction of brain tissue,significantly shortened the operation distance,and increased the deep observation angle through the removal of part of the orbital roof and the zygomatic process. It is suitable for the treatment of anterior communicating artery aneurysms,especially the rear direction,upper direction and high positioned aneurysms. There was no bone loss in the procedure,no need for orbital roof reconstruction. The gyri rectus was retained anatomically,and it may be helpful to protect the postoperative cognitive function of the patients.

Hepatocellular carcinoma (HCC) is one of the most common malignancies.Current radiological examination is quite limited in diagnosing early HCC.Various treatments for HCC have definite indications,and there is still no effective treatment and prevention for recurrence and metastasis.Based on the recent development of molecular targeting nanotechnology for specific molecules in liver cancer cells,early diagnosis and the monitoring of recurrence and metastasis for HCC can be improved,and the specificity of drug in targeting cancer cells and the therapeutic effect on HCC can be significantly enhanced.The article reviewed the application and significance of molecular targeting nanotechnology in HCC diagnosis and treatment.

Objective To evaluate the application of three-dimensional measurement and computer-aided navigation system in treatment of orbitozygomatic complex fiacture.Methods Pre-and post-operative three-dimensional measurements were taken by Mimics software to locate the zygomatic bones of 15 patients with orbitozygomatic complex ftacture to determine distance of optical foramen to zygomaticotemporal suture (On-Zm)/ zygomaticofrontal suture (On-Or)/zygomaticomaxillary suture (OnTz),horizontal angle of zygomatic arch,horizontal angle of the zygomatic process,and inferior angel of the frontal process of zygomatic bone.Preoperative design and simulation,intraoperative real time navigation and postoperative evaluation were applied using computer assisted navigation system.Results OnTz,On-Or,and On-Zm was (48.6-±4.5)mm,(42.5±2.2)mm,and (47.5±3.2)mmin the unaffected side,but was (50.4 ± 2.2) mm,(37.2 ± 1.0) mm,and (53.4 ± 3.6) mm in the affected side before operation (P ＜ 0.05).Whereas On-Tz,On-Or,and On-Zm improved to (46.4 ± 3.7) mm,(41.2 ± 1.8) mm,and (46.4 ± 2.5) mm in the affected side after operation,similar with the values in the unaffected side (P ＜ 0.05).Horizontal angle of zygomatic arch,horizontal angle of the zygomatic process,and inferior angel of the frontal process of zygomatic bone was (144.7 ±4.1)°,(132.5 ± 2.3)°,and (112.0 ± 3.4)° in the affected side,with significant differences from (150.3 ± 8.0)°,(141.1 ±4.2)°,and (114.9 ±5.1)° in the affected side before operation (P ＜0.05),but they were improved to almost the normal values (144.6 ± 4.1) o,(132.8 ± 2.0) °,and (111.9 ± 3.6) ° after operation.Satisfactory surgical outcomes,such as three dimensional symmetry and recovery of normal mouth-openingand occlusion,had been achieved.Conclusions Three-dimensional measurement is a quantitative study on the spatial displacement of orbitozygomatic complex.Combined with computer-assisted navigation system with preoperative design and simulation,intraoperative real time navigation and postoperative evaluation,three-dimensional measurement attains the overall management of orbitozygomatic complex fracture.

Objective To investigate the effects of sorafenib combined with dendritic cells and cytokine induced killer (DC-CIK) cells on the growth,invasion and metastasis of hepatocellular carcinoma.Methods CIK cells and dendritic cells from healthy adults were cultured in vitro.Mice models with H22 hepatic cancer were established,and randomly divided into the normal saline group,sorafenib group,DC-CIK group and the sorafenib + DC-CIK group according to the random number table.There were 40 rats in each group.All the mice received intragastric gavage with sorafenib of 100 μg/g once a day.DC-CIK cells were intraperitoneally injected into the mice every 3 days with 1 × 107 cells each time.Twenty mice bearing tumors in each group were sacrificed after treatment for 3 weeks,and the peripheral venous blood and hepatic tumor tissues were harvested.The levels of alphafetoprotein (AFP) were detected by ELISA,and the necrotic degree of tumor tissues was evaluated by hematoxylin and eosin staining.The protein expressions of Ki-67 and CD34 in the tumor tissues were determined by immunohistochemical method.The survival time of the other 20 mice bearing the tumor in each group were detected.All data were analyzed using the analysis of variance or LSD test.Results CIK cells and dendritic cells were successfully cultured.The levels of AFP in the peripheral venous blood of the normal saline group,sorafenib group,DC-CIK group and sorafenib + DC-CIK group were (0.675 ± 0.177) rg/L,(0.379 ± 0.052) ng/L,(0.415 ± 0.028) ng/L,(0.288 ± 0.012) ng/L,with significant difference between the 4 groups (F =0.415,P ＜ 0.05).The numbers of intrahepatic and peritoneal metastasis of the normal saline group,sorafenib group,DC-CIK group and sorafenib + DC-CIK group were 21.2 ± 1.3 and 29.7 ± 7.6,16.4 ± 1.6 and 17.4 ± 1.8,20.2 ± 1.7 and 26.4 ± 1.7,15.2 ± 1.3 and 15.2 ± 1.3,with significant difference between the 4 groups (F =2.137,3.271,P ＜0.05).The tumor inhibition rate of the normal saline group,sorafenib group,DC-CIK group and sorafenib + DC-CIK group were 0,21％ ± 3％,9％ ± 3％ and 24％ ± 5％,with significant difference between the 4 groups (F =3.715,P ＜0.05).The survival time of mice in the normal saline group,sorafenib group,DC-CIK group and sorafenib ± DC-CIK group were (18.2 ± 2.5) days,(21.6 ± 2.1) days,(24.3 ± 2.8) days and (25.4 ± 1.4) days,with significant difference between the 4 groups (F =6.247,P ＜ 0.05).Conclusions Sorafenib combined with immunotherapy can significantly increase the therapeutic effects of molecular targeted drug on hepatocellular carcinoma.

Objective To investigate the curative effects of the traditional surgical method of posterior pedicle Schanz screw fixa-tion with partially stripping injured paravertebral muscle in treating thoracolumbar fracture .Methods 52 cases with thoracolumbar fracture underwent posterior pedicle Schanz screw fixation to partially strip injured paravertebral muscle from January ,2010 to Jan-uary ,2012 .The patients were divided into partially stripping injured paravertebral muscle group (32 cases) and traditionally strip-ping injured paravertebral muscle group(20 cases) .The blood loss ,postoperative drainage ,kyphosis postoperative 3 d VAS scores , vertebral height correction rate ,Cobb angle correction ,Oswestry dysfunction indexes were copmared .Results Comparing with tra-ditionally stripping injured paravertebral muscle group ,the partially stripping injured paravertebral muscle group has better effect in transperative blood loss ,postoperative drainage and postoperative 3 d VAS scores ,the differences were statistically significant .But there was no statistical significance between the two groups in vertebral height correction rate ,kyphosis Cobb angle correction ,Os-westry dysfunction indexes .Conclusion Partially strip injured paravertebral muscle has less painful than traditional surgery does , being safe and effective with small invasion and easy to recover .

Objective To describe the MRI features of vanishing white matter disease (VWM).Methods Ten patients diagnosed as VWM between 2008-2013 were enrolled,with the mean age of(40 ±23)months.The clinical materials and MR images of them were reviewed retrospectively.The findings of MRI were analyzed by two experienced neuroradiologists in this study,including the location (cerebrum,cerebellum,brainstem,corpus callosum and internal/external capsule),size and signal intensity of the lesions,as well as the presence of cystic degeneration,cerebrum atrophy and the abnormal signal of the basal nuclei.Results MRI of brain typically showed extensive abnormal signal in the cerebral central white matter (10/10) and the focal lesion in subcortical white matter (9/10).The involvement of U-fibers was present in 7 cases.Cystic degeneration of the affected white matter was found in 7 cases.Abnormal signal also appeared in the white matter of posterior limb of the internal capsule (8/10),the external capsule (7/10),the inner rim (the callosal-septal interface) of the corpus callosum (8/10).The lesions of the thalamus and globus pallidus were detected in 2 cases.The white matter of the brainstem and cerebellum were involved in 6 and 7 cases respectively.Conclusion VWM typically shows a diffuse and symmetrical abnormal signal in the cerebral white matter with cystic degeneration on MRI,which is usually diagnostic.