Diffuse pediatric-type high-grade glioma (pHGG), H3- and isocitrate dehydrogenase (IDH)-wild-type, is a World Health Organization (WHO) grade 4 diffuse glioma with malignant histological features, which typically affects in children and adolescents. This multidisciplinary treatment case involves a 24-year-old young female patient initially diagnosed via biopsy. After concurrent chemoradiotherapy reduced the tumor size, complete resection was achieved, followed by adjuvant therapy with temozolomide and regorafenib. After recurrence, the tumor was resected again, and a second course of radiotherapy was administered, but the disease ultimately progressed rapidly, with an overall survival exceeding 32 months. pHGGs are highly malignant, aggressive, and associated with poor prognosis. Accurate diagnosis and targeted intervention require close collaboration among a multidisciplinary team, which highlights the critical value of multidisciplinary manage-ment in clinical practice.

BACKGROUND: It has been proved that the application of basic fibroblast growth factor (bFGF) combined with Brucea Javanica oil emulsion can accelerate wound healing and inhibit scar formation.OBJECTIVE: To observe the effects of bFGF plus Brucea Javanica oil emulsion cream on accelerating the skin wound healing of rabbits.DESIGN: A randomized controlled observation.SETTING: Center of Biotechnological Research and Development, Jinan University; College of Pharmacy, Jinan University.MATERIALS:The experiment was carried out in the College of Pharmacy, Jinan University from June to September in 2004. Eight Beijing big-ear white rabbits (4 males and 4 females) of 2.0-2.5 kg were provided by the experimental animal center of Southern Medical University (certification number: SoKx-2002-010). bFGF sterile freeze dried powder agent,provided by Guangzhou Changsheng Gene Pharmaceutical Co.,Ltd (batch number: 20040219; specific activity was 6 000 U/bottle), was prepared to solution with water for injection before application. Brucea Javanica oil emulsion (manufactured by Zhejiang 999 Bang'erkang Pharmaceutical Co.,Ltd.) was provided by Professor Yao from staff Room of Pharmacy, Shenyang Pharmaceutical University.METHODS: The rabbits were anesthetized and disinfected, 5 round wounds with diameter of 1.8 cm and area of 2.54 cm2were induced from front to back by bilateral incision at 1.5 cm from middle spine of rabbit. The 5 wounds of each rabbit were randomly divided into bFGF-treated group (90 U/cm2), bFGF+Brucea Javanica oil emulsion group [the wound was smeared with Brucea Javanica oil emulsion (30 mg/cm2) 30 minutes after bFGF (90 U/cm2)], Brucea Javanica oil emulsion treated group [the wound was smeared with Brucea Javanica oil emulsion (30 mg/cm2)], blank emulsion group (30 mg/cm2) and blank control group (the wound was smeared with saline). The medication was give immediately after injury, and changed once a day for 16 days. At 4, 8, 12 and 16 days after injury, the wound areas were recorded with the method of hyaline membrane tracing (the wound was covered with clean saran wrap, the size of wound was traced,and then sheared to be weighed, and converted to calculate the area), and the volume of wounded cavity was measured by infusing water. At 8 and 16 days, the wound tissue was removed, stained after routine tissue sections, and the conditions of growth of granulation tissue and reepithelization on the wound surface were observed.MAIN OUTCOME MEASURE: The wound area, volume of wounded cavity, and the conditions of growth of granulation tissue and reepithelization on the wound surface were obviously at different time points after injury in each group.RESULTS:All the 8 rabbits were involved in the analysis of results. ① Wound areas at different time points in each group: The wound areas in the bFGF+Brucea Javanica oil emulsion group at 4, 8 and 12 days after medication were smaller than those in the blank control group at corresponding time points [(2.05±0.35), (1.59±0.25), (0.55±0.25) cm2;(2.53±0.30), (2.41±0.19), (1.09±0.34) cm2, P＜0.05-0.01]. The wound areas in the bFGF group at 8 and 12 days after medication were (1.71±0.31) and (0.51±0.10) cm2, which were significantly smaller than those in the blank control group at corresponding time points (P＜0.05-0.01). ② Volume of the wounded cavity in each group: The wound volume in the bFGF group at 4 days after injury was markedly smaller than that in the blank control group at corresponding time point [(0.49±0.12), (0.59±0.1) mL, P＜0.05]. The wound volumes in the bFGF+Brucea Javanica oil emulsion group at 4 and 8days after injury were significantly smaller than those in the blank control group at corresponding time points [(0.47±0.12), (0.30±0.08) mL; (0.59±0.1), (0.41±0.07) mL, P＜0.05, 0.01]. ③ Growth of granulation tissue and reepithelization on the wound surface in each group: At 8 days after injury, the inflammatory reaction was milder and fibroblasts proliferated significantly in the bFGF+Brucea Javanica oil emulsion group, and the numbers of capillary plumules and fibroblasts were significantly more than those in the blank control group. The conditions in the blank control group and blank emulsion group were generally the same that there were severe inflammatory reactions, obvious increase of granulation tissue, fewer new capillaries, and unobvious proliferation of epidermic cells. At 16 days after injury, the contraction and reepithelization on the wound surface were obvious, and the new epithelia went towards the wound center rapidly in the bFGF+Brucea Javanica oil emulsion group.CONCLUSION : The application of Brucea Javanica oil emulsion plus bFGF can obviously accelerate the repair of incised wound on the back of rabbits.