BackgroundFunctional near-infrared spectroscopy （fNIRS） is a new generation of imaging tool that can be used to assist the diagnosis of psychiatric disorders. However， whether the patterns of prefrontal cortex activation observed by fNIRS are specific for different psychiatric disorders remains to be explored. ObjectiveTo investigate the characteristics of prefrontal cortex activation in patients with depression， anxiety disorder， bipolar disorder and schizophrenia in verbal fluency task （VFT） using fNIRS. MethodsFrom September to December 2021， 39 patients with schizophrenia， 205 patients with depressive disorder， 212 patients with anxiety disorder and 77 patients with bipolar disorder meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited in the outpatient and inpatient department of West China Hospital， Sichuan University. fNIRS was used to monitor the prefrontal cortex hemodynamic changes of patients under VFT， and the clinical symptoms of patients were assessed by Symptom Checklist 90 （SCL-90） and Hypomania Checklist-32 items（HCL-32）. Differences in mean oxyhemoglobin （HbO₂） concentration and the initial slope from 2 to 7 second during VFT were compared among patients with different diseases， and the correlation between mean HbO₂ concentration/initial slope and clinical symptoms was analyzed by partial correlation analysis. ResultsThe concentration of HbO₂ in channel 4 （Z=2.828， P=0.028） and channel 6 （Z=2.912， P=0.022） in patients with depression were significantly higher than those in patients with schizophrenia. Patients with anxiety had significantly higher changes in mean HbO₂ concentration in channel 4 （Z=3.154， P=0.010）， channel 5 （Z=3.021， P=0.015）， channel 6 （Z=2.980， P=0.017） and of all channels （Z=2.881， P=0.024） than those of schizophrenia patients. There was a statistically significant difference in the initial slope of channel 3 between patients with depressive disorder and those with bipolar disorder （Z=2.691， P=0.039）. Among patients with bipolar disorder， the anger-hostility scores of SCL-90 were negatively correlated with the mean HbO₂ concentration changes in channel 4 （r=-0.505， P=0.004）， channel 6 （r=-0.390， P=0.004）， channel 15 （r=-0.546， P=0.002）， channel 16 （r=-0.550， P=0.002） and the mean HbO₂ concentration changes of all channels （r=-0.491， P=0.006）. ConclusionPatients with schizophrenia had lower activation in frontopolar and orbitofrontal region than patients with depression and anxiety disorder， and the initial slope of the right frontopolar， inferior frontal and orbitofrontal region in patients with depression is higher than patients with bipolar disorder. In addition， patients with bipolar disorder had less activation in the frontopolar and orbitofrontal lobe， the insular cover of Broca's area and the upper outer frontal cortex， and were more irritable and hostile. ［Funded by 1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project， West China Hospital， Sichuan University （number， ZYJC21083）］

OBJECTIVE: To construct a polylactic acid-glycolic acid-polyethylene glycol (PLGA-PEG) nanocarrier (N-Pac-CD133) coupled with a CD133 nucleic acid aptamer carrying paclitaxel for eliminating lung cancer stem cells (CSCs). METHODS: Paclitaxel-loaded N-Pac-CD133 was prepared using the emulsion/solvent evaporation method and characterized. CD133⁺ lung CSCs were separated by magnetic bead separation and identified for their biological behaviors and gene expression profile. The efficiency of paclitaxel-loaded N-Pac-CD133 for targeted killing of lung cancer cells was assessed in vitro. SCID mice were inoculated with A549 cells and received injections of normal saline, empty nanocarrier linked with CD133 aptamer (N-CD133), paclitaxel, paclitaxel-loaded nanocarrier (N-Pac) or paclitaxel-loaded N-Pac-CD133 (n=8, 5 mg/kg paclitaxel) on days 10, 15 and 20, and the tumor weight and body weight of the mice were measured on day 40. RESULTS: Paclitaxel-loaded N-Pac-CD133 showed a particle size of about 100 nm with a high encapsulation efficiency (>80%) and drug loading rate (>8%), and was capable of sustained drug release within 48 h. The CD133⁺ cell population in lung cancer cells showed the characteristic features of lung CSCs, including faster growth rate (30 days, P=0.001) and high expressions of tumor stem cell markers OV6(P < 0.001), CD133 (P=0.001), OCT3/4 (P=0.002), EpCAM (P=0.04), NANOG (P=0.005) and CD44 (P=0.02). Compared with N-Pac and free paclitaxel, paclitaxel-loaded N-Pac-CD133 showed significantly enhanced targeting ability and cytotoxicity against lung CSCs in vitro (P < 0.001) and significantly reduced the formation of tumor spheres (P < 0.001). In the tumor-bearing mice, paclitaxel-loaded N-Pac-CD133 showed the strongest effects in reducing the tumor mass among all the treatments (P < 0.001). CONCLUSION CD133 aptamer can promote targeted delivery of paclitaxel to allow targeted killing of CD133⁺ lung CSCs. N-Pac-CD133 loaded with paclitaxel may provide an effective treatment for lung cancer by targeting the lung cancer stem cells.
Animals ; Cell Line, Tumor ; Drug Carriers ; Lung ; Mice ; Mice, SCID ; Nanoparticles ; Neoplasms ; Neoplastic Stem Cells ; Paclitaxel/pharmacology* ; Polyethylene Glycols/pharmacology*

The diagnosis and treatment of traumatic brain injury (TBI) are basic skills that should be mastered by neurosurgery specialists during the standardized training. In view of the lack of TBI patients in our center, TBI training was entrusted to a joint base with more TBI patients. Based on clinical training and practice experience of the authors in recent years, including joint base introduction, basic requirement, theory and skill training, research training, humanity accomplishment improvement, inter-base communication and evaluation standard, we discuss the appropriate joint base training mode of TBI in standardized training of neurosurgery specialists, so as to provide reference for cultivating qualified and comprehensively developed neurosurgery specialists.

Objective:To explore the association between suboptimal health status (SHS) and plasma IgG N-glycans levels among undergraduates in a college in Shandong Province.Methods:A case-control study was conducted from September to November 2017, 100 college students who underwent physical examinations at Weifang University in Shandong, were selected as study participants based on the inclasion and exclusion criteria of the study. According to the criteria of SHS, the participants were divided into an SHS group ( n=50) and a health control group ( n=50). Plasma IgG N-glycosylaton levels were analyzed by means of ultra-high liquid chromatography (UPLC), and 24 glycan peaks were obtained. The Mann-Whitney U-test and binary logistic regression analysis were performed to investigate the association between IgG N-glycans and SHS. P<0.05 was considered statistically significant. Receiver operating characteristic (ROC) curve analyses were used to evaluate the possibility of plasma IgG N-glycans being a biomarker of SHS. Results:The results of univariate and multivariate analysis showed that GP17 was associated with SHS ( P<0.05), and the relative abundance of initial glycan peaks (GP17) was higher in the SHS group compared with the control group. ROC curve analysis showed that the area under the curve (AUC) of the baseline model was 0.826 (95% confidence interval [ CI]: 0.747-0.905, P<0.001); the AUC of the glycan-based model was 0.631 (95% CI: 0.519-0.744, P=0.002), and the AUC of the combined model was 0.848 (95% CI: 0.763-0.912, P<0.001). Compared with the baseline model, the diagnostic efficiency of the combined model revealed a trend of improvement. Conclusions:The SHS of the students in a college in Shandong Province was associated with an IgG N-glycan level of GP17, which was significantly higher than that of the control group.

In the stomatognathic system, a stable jaw position is influenced by occlusion, the temporomandibular joint and neuromuscular stability. The condylar position in the glenoid fossa is closely related to the jaw position, while no consensus has been reached on the optimum jaw position and its corresponding condylar position in oral therapy. This paper summarizes the controversial opinions regarding the selection of jaw position and the corresponding condylar position in prosthetics and orthodontics, including antero-superior, antero-inferior, and therapeutic positions. Their indications, theoretical bases and clinical applications are also included. The literature review results suggest that, the antero-superior position, in other words, centric relation, should be chosen when the patient has a stable jaw position without TMD. In cases where finding an ideal antero-superior position is difficult due to hyperplasia or deformation or disarrangement of the articular disc, the antero-inferior position is recommended to alleviate symptoms and facilitate reconstruction of the TMJ to obtain good stability. Moreover, for high-angle patients with Class Ⅱ malocclusion or for patients with mild skeletal malocclusion, camouflaged orthodontic treatment combined with antero-inferior jaw repositioning through the potential of condyle remodeling can be an alternative to orthognathic surgery and can simplify the treatment plan. While the therapeutic position is specifically proposed for coping with complicated situations related to cranio-mandibular dysfunction, such as maximal intercuspal position abnormalities or deflection, muscle and TMJ dysfunction, unstable jaw position, in which changes in the original occlusion or abnormal TMJ guidance are induced, and a new intercuspal position can be established and stabilized on the basis of occlusal support and modified guidance. The therapeutic position put aside the debate regarding condylar position, however, the specific position of the condyle has not been reported in this case. This review suggests that different jaw positions and condylar positions have different scopes of application, and their clinical selection should be based on based on whether the patient′s joints have organic changes and the stability of the jaw positions should be comprehensively considered. However, the long-term effects of oral therapy based on different jaw positions need to be further verified by controlled clinical trials in the future.

AIM: To investigate the PI3K/AKT/GSK-3β signaling pathway involved in the protective effect and mechanism of propofol on the cerebral ischemia-reperfusion injury in rats. METHODS: There were 72 healthy male SD rats. All rats established a model of focal cerebral ischemia-reperfusion injury according to the Zea Longa method and were randomly divided into six groups (n=12), A-sham operation group, B-model group (MCAO), C-Propofol group, D-Propofol+adenosine A1R antagonist group (DPCPX), E-Propofol group+PI3K specific inhibitor (LY294002), F-Propofol+GSK3β inhibitor group (SB216763). The neurological scores of rats 24 h after operation, LDF monitors changes in cerebral blood flow before and after embolization were observed. The TTC staining method was used to detect the cerebral infarction volume of rats in each group; HE staining method was used to observe the morphological changes of the rat brain tissue; Immunohistochemical method was used to detect Bcl-2 positive cells expression; TUNEL was used to detect cerebral cortex ischemia in each group. The percentage of neuronal apoptotic cells. RESULTS: Compared with group A, the behaviors, cerebral infarction volume, apoptosis rate, and Bcl-2 protein expression of rats in groups B, C, D, E, and F all increased (P<0.05); compared with group C, the behavioral scores, cerebral infarction volume and apoptosis rate of rats in groups B, D and E all increased significantly, and the expression of Bcl-2 protein was decreased significantly (P<0.01), but the expression of Bcl-2 protein in group F was increased, cell apoptosis rate decreased (P<0.05), behavior score and infarcts decreased (P<0.05). CONCLUSION: The neuroprotective effect of propofol mediated by adenosine A1R on ischemia-reperfusion injury in rats may be related to the PI3K/AKT/GSK-3β signal transduction pathway.

The training of neurocritical care is an important component in standardized training of neurosurgical specialists. As a subspeciality of neurosurgery, as well as with the characteristics of critical care medicine, neurocritical care carries its own discipline features. Based on clinical training and practice experiences, the training mode and practice experience were summarized, including basic requirement, theory training, skill training, research training, humanity accomplishment improvement and evaluation stan-dard, in order to discuss the appropriate training mode of neurocritical care in standardized training of neurosurgical specialists, improve the training methods and advance the training effectiveness, and provide reference for cultivating qualified and comprehensively developed neurosurgical specialists.

Objective To analyze the independent risk factors and complications for perioperative hyperbilirubinemia in Stanford type A aortic dissection undergoing operation and investigate the management strategy of perioperative hyperbilirubi-nemia. Methods Between January 2013 and January 2018 from the department of great vessel surgery of heart centre of,290 cases of patients with Stanford type A aortic dissection undergoing operation were collected consecutively,male 210 cases,fe-male 80 cases. The related data and perioperative peak hyperbilirubinemia were recorded. According to the perioperative peak hyperbilirubinemia,patients were divided into 2 groups:≥51. 3 μmol/ L group and < 51. 3 μmol/ L group. Univariate and lo-gistic regression analysis were used to identify the independent risk factors. The perioperative complications were also recorded. Results Preoperative total bilirubin ≥ 17. 1 μmol/ L(OR = 2. 105,95％ CI: 1. 153 - 3. 125,P = 0. 016),cardiopulmonary bypass time > 3. 5 h(OR = 1. 103,95％ CI: 1. 316 - 6. 151,P = 0. 031),a large number of hemolysis(OR = 1. 503,95％CI: 1. 506 - 6. 651,P = 0. 029),the input amount of 24 h allogeneic red blood cell > 2000 ml(OR = 1. 381,95％ CI:0. 956 - 2. 552,P = 0. 036)were the independent risk factors for perioperative hyperbilirubinemia. The incidence rate of post-operative acute hepatic failure(2. 5％ vs. 0,P = 0. 021)and artificial liver therapy(2. 5％ vs. 0,P = 0. 021)in≥51. 3μmol/ L group were significantly increased. The incidence rate of postoperative acute lung injury(37. 5％ vs. 25. 2％,P =0. 039)and acute kidney injury(38. 7％ vs. 19. 5％,P = 0. 035)in 51. 3 μmol/ L group were also significantly increased. The duration of mechanical ventilation[(4. 1 ± 1. 6)days vs. (2. 8 ± 1. 3)days,P < 0. 05]and ICU stay time[(5. 1 ± 2. 3)days vs. (3. 9 ± 1. 8)days,P = 0. 035]and hospitalization time[( 19. 3 ± 3. 1)days vs. ( 17. 3 ± 2. 5)days,P = 0. 035]were sig-nificantly prolonged. Temporary nerve dysfunction(52. 5％ vs. 32. 6％,P = 0. 002)and in-hospital mortality( 17. 5％ vs. 8. 1％,P = 0. 037)were significantly increased. Conclusion Preoperative total bilirubin ≥ 17. 1 μmol/ L,cardiopulmonary bypass time > 3. 5 h,a large number of hemolysis,the input amount of 24 h allogeneic red blood cell > 2000 ml were the in-dependent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection. The perioperative complications in≥51. 3 μmol/ L group were significantly increased. Therefore,more attention should be paid to the independent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection,hyperbilirubinemia and its clearance should be moni-tored more actively and dynamically,the cause should be found more precisely,the treatment be more comprehensive to achieve to control the level of bilirubinemia and improve the prognosis.

Objective To investigate the effect of using selective indocyanine green videoangiography in the surgical treatment of craniocervical junction dural arteriovenous fistulas.Methods From June 2014to January 2017,the clinical data of 24 patients (26 sides) with craniocervical junction dural arteriovenous fistula treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 15 with subarachnoid hemorrhage,8 with venous hypertensive myelopathy,and 1 with medullary compression symptom.The selective indocyanine green fluorescence technique was used to temporarily clip the origin of the arterilized draining vein,and the drainage vein was opened after the indocyanine green fluorescent arterial phase,and thus to determine the sites of arteriovenous fistulas.DSA examination was performed again after the operation,and the clinical efficacy was evaluated with the modified Rankin scale (mRS).Results The dural arteriovenous fistulas of 24 patients (26 sides) were separated from the fistulas during the operation.Intraoperative indocyanine green fluorescence development and postoperative DSA follow-up confirmed that the fistulas were separated.The follow-up time was 4-30 months.The mRS score in 21 patients was 0-1,the Hunt-Hess grade Ⅲ subarachnoid hemorrhage in 2 patients was mRS score 2,and mRS score in 1 patients with preoperative brainstem compression symptom was mRS score 3.Conclusion The selective indocyanine green fluorescence technique is a safe,simple,and effective technique for the treatment of dural arteriovenous fistulas at the junction of craniocervical junction.

BACKGROUND: The clinical application of neural stem cells (NSCs) in combination with gene therapy could be used to treat a variety of nervous system hereditary and acquired diseases. However, nervous system diseases are varying. Nerve tissue internal environment of distinctive diseases is also different. All these factors affect the therapeutic effect of NSCs. Moreover, interaction and regulation of a variety of exogenous genes in NSC gene therapy would greatly promote continued regeneration of nerve tissue.OBJECTIVE: To review application of NSCs in the nervous system diseases.METHODS: A computer-based online search of Medline database (2000-01/2009-08) and Tongfang database (2000-01/2009-08) was performed for related articles with key words "neural stem cells, gene, nervous system diseases". RESULTS AND CONCLUSION: A total of 88 English articles were collected. By reading the title and summary, 20 unrelated articles and 28 repetitive articles were excluded. Finally, 40 were reviewed. NSC as a new-type treatment has been used for somatic cell or transgenic vector, and has achieved a certain effect for cerebrovascular disease, brain damage disease, spinal cord injuries, neurodegenerative diseases, brain tumors, and genetic metabolic diseases. However, many key issues such as NSC proliferation, differentiation, migration and control mechanism have not been resolved. In addition, the microenvironment in nerve tissues with different diseases also influences NSC therapy.