Objective:To explore the clinical characteristics of adrenal lesions in unilateral primary aldosteronism.Methods:This is a prospective study. Consecutive patients diagnosed with unilateral primary aldosteronism at the First Affiliated Hospital of Chongqing Medical University from December 2023 to November 2024 were included. Inclusion criteria：① Age is 18 to 80 years old；② The laboratory test indicators are in line with the diagnosis of primary aldosteronism；③ The auxiliary examination proved that only one side was involved；④ Patient undergo unilateral total adrenalectomy. The exclusion criteria are as follows：① Complete biochemical remission was not achieved during the 1-6 month follow-up after the surgery；② Postoperative loss to follow-up；③ No surgical specimens were received or the surgical specimens were incomplete，making continuous sectioning impossible. Patients meeting the inclusion criteria were recruited，and their clinical and biochemical data were recorded. The number of adrenal nodules visible on CT scans and the number of macroscopically visible nodules in the postoperative adrenal gross specimens were documented. Hematoxylin-eosin（HE）staining and aldosterone synthase CYP11B2 immunohistochemical staining were performed on the adrenal tissues after the operation. The number of nodules visible under the light microscope and the number of CYP11B2-positive nodules were recorded.Results:A total of 114 cases were included in this study. The age of the patients was（49.86 ± 9.80）years，the body mass index was（25.49 ± 3.40）kg/m2，the preoperative aldosterone level was 352（2012，556）pg/ml，and the direct renin concentration was 1.63（0.50，4.56）μIU/ml. The aldosterone/renin ratio was 224.9（57.1，641.6）（aldosterone concentration unit was pg/ml，renin concentration unit was μIU/ml），the minimum blood potassium concentration was 2.87（2.50，3.40）mmol/L，and the systolic blood pressure was（144.5 ± 19.5）mmHg. Among the 114 patients，105 had adrenal nodules detected by preoperative CT，of whom 2（1.75%）had multiple nodules. Postoperative gross adrenal specimen evaluation and CYP11B2 immunohistochemical staining revealed that 90 out of 114 cases were solitary nodules，2 cases had no nodules，and 22 cases（19.30%）had multiple nodules detected（17 cases had 2 nodules and 5 cases had 3 nodules）. Among them，12 cases（10.53%）presented as grossly visible multinodular lesions，while 10 cases（8.77%）appeared as solitary nodules macroscopically but demonstrated multinodular patterns on immunohistochemical staining. CYP11B2 staining showed that among the 22 patients with multiple nodules，13 had multiple CYP11B2-positive nodules，while the remaining had only one positive nodule. Among the 22 patients with multiple nodules，preoperative CT showed single nodules in 19 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（9.09%）. Among the 12 patients with grossly visible multinodular lesions，preoperative CT showed single nodules in 9 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（16.67%）.Conclusions:Multiple adrenal nodules associated with unilateral primary aldosteronism are relatively common，and are often not detected by preoperative CT examination. Partial adrenalectomy based solely on CT-visible nodules may fail to achieve complete remission of primary aldosteronism. This study provides evidence supporting total adrenalectomy as the preferred surgical approach for unilateral primary aldosteronism.

With the rapid development of neuroelectrophysiology, neuroimaging and other technologies, a large amount of evidence has shown that the occurrence and development of idiopathic generalized epilepsy (IGE) are closely related to the cortical-subcortical neural network. This article intends to review the relevant research on how the cerebral cortex and subcortical structures such as the thalamus, basal ganglia, and cerebellum are involved in the cognitive impairment of IGE, as well as the important subcortical neural nuclei targets currently targeted in the treatment of drug-resistant epilepsy by neuromodulation, to evaluate the feasibility of neuromodulation therapy in clinical practice.

Epilepsy is a chronic neurological disorder characterized by abnormal brain network function. The localization of the epileptogenic zone and feature analysis of the epileptic networks are key issues in clinical diagnosis and treatment as well as in research of disease mechanisms. In recent years, electroencephalography-functional magnetic resonance imaging (EEG-fMRI), by integrating the high temporal resolution of EEG and high spatial resolution of fMRI, has provided an important tool for localizing epileptogenic zones and researching epileptic networks. This article reviews the recent advance in EEG-fMRI in epilepsy, with a focus on its role in localizing the origin of epileptic seizures, exploring the epileptic networks of different modalities, analyzing the characteristics of epileptic networks, and studying the pathogenesis of epilepsy combined with cognitive impairment, in order to analyze pathophysiological mechanisms of epilepsy and provide new perspectives for clinical diagnosis and treatment.

LL-37 is a widely-distributed human antimicrobial peptide with antimicrobial activity.In recent years,it has been found that LL-37 not only has antibacterial effect,but also can exert comprehensive immune regulatory function on different immune cells in different microenvironments,and then play a pro-inflammatory or anti-inflammatory role in a series of autoimmune diseases.This article focuses on immunomodulatory effect of LL-37 and its possible role in autoimmune diseases.

LL-37 is a widely-distributed human antimicrobial peptide with antimicrobial activity.In recent years,it has been found that LL-37 not only has antibacterial effect,but also can exert comprehensive immune regulatory function on different immune cells in different microenvironments,and then play a pro-inflammatory or anti-inflammatory role in a series of autoimmune diseases.This article focuses on immunomodulatory effect of LL-37 and its possible role in autoimmune diseases.

Objective:To explore the clinical characteristics of adrenal lesions in unilateral primary aldosteronism.Methods:This is a prospective study. Consecutive patients diagnosed with unilateral primary aldosteronism at the First Affiliated Hospital of Chongqing Medical University from December 2023 to November 2024 were included. Inclusion criteria：① Age is 18 to 80 years old；② The laboratory test indicators are in line with the diagnosis of primary aldosteronism；③ The auxiliary examination proved that only one side was involved；④ Patient undergo unilateral total adrenalectomy. The exclusion criteria are as follows：① Complete biochemical remission was not achieved during the 1-6 month follow-up after the surgery；② Postoperative loss to follow-up；③ No surgical specimens were received or the surgical specimens were incomplete，making continuous sectioning impossible. Patients meeting the inclusion criteria were recruited，and their clinical and biochemical data were recorded. The number of adrenal nodules visible on CT scans and the number of macroscopically visible nodules in the postoperative adrenal gross specimens were documented. Hematoxylin-eosin（HE）staining and aldosterone synthase CYP11B2 immunohistochemical staining were performed on the adrenal tissues after the operation. The number of nodules visible under the light microscope and the number of CYP11B2-positive nodules were recorded.Results:A total of 114 cases were included in this study. The age of the patients was（49.86 ± 9.80）years，the body mass index was（25.49 ± 3.40）kg/m2，the preoperative aldosterone level was 352（2012，556）pg/ml，and the direct renin concentration was 1.63（0.50，4.56）μIU/ml. The aldosterone/renin ratio was 224.9（57.1，641.6）（aldosterone concentration unit was pg/ml，renin concentration unit was μIU/ml），the minimum blood potassium concentration was 2.87（2.50，3.40）mmol/L，and the systolic blood pressure was（144.5 ± 19.5）mmHg. Among the 114 patients，105 had adrenal nodules detected by preoperative CT，of whom 2（1.75%）had multiple nodules. Postoperative gross adrenal specimen evaluation and CYP11B2 immunohistochemical staining revealed that 90 out of 114 cases were solitary nodules，2 cases had no nodules，and 22 cases（19.30%）had multiple nodules detected（17 cases had 2 nodules and 5 cases had 3 nodules）. Among them，12 cases（10.53%）presented as grossly visible multinodular lesions，while 10 cases（8.77%）appeared as solitary nodules macroscopically but demonstrated multinodular patterns on immunohistochemical staining. CYP11B2 staining showed that among the 22 patients with multiple nodules，13 had multiple CYP11B2-positive nodules，while the remaining had only one positive nodule. Among the 22 patients with multiple nodules，preoperative CT showed single nodules in 19 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（9.09%）. Among the 12 patients with grossly visible multinodular lesions，preoperative CT showed single nodules in 9 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（16.67%）.Conclusions:Multiple adrenal nodules associated with unilateral primary aldosteronism are relatively common，and are often not detected by preoperative CT examination. Partial adrenalectomy based solely on CT-visible nodules may fail to achieve complete remission of primary aldosteronism. This study provides evidence supporting total adrenalectomy as the preferred surgical approach for unilateral primary aldosteronism.

With the rapid development of neuroelectrophysiology, neuroimaging and other technologies, a large amount of evidence has shown that the occurrence and development of idiopathic generalized epilepsy (IGE) are closely related to the cortical-subcortical neural network. This article intends to review the relevant research on how the cerebral cortex and subcortical structures such as the thalamus, basal ganglia, and cerebellum are involved in the cognitive impairment of IGE, as well as the important subcortical neural nuclei targets currently targeted in the treatment of drug-resistant epilepsy by neuromodulation, to evaluate the feasibility of neuromodulation therapy in clinical practice.

Epilepsy is a chronic neurological disorder characterized by abnormal brain network function. The localization of the epileptogenic zone and feature analysis of the epileptic networks are key issues in clinical diagnosis and treatment as well as in research of disease mechanisms. In recent years, electroencephalography-functional magnetic resonance imaging (EEG-fMRI), by integrating the high temporal resolution of EEG and high spatial resolution of fMRI, has provided an important tool for localizing epileptogenic zones and researching epileptic networks. This article reviews the recent advance in EEG-fMRI in epilepsy, with a focus on its role in localizing the origin of epileptic seizures, exploring the epileptic networks of different modalities, analyzing the characteristics of epileptic networks, and studying the pathogenesis of epilepsy combined with cognitive impairment, in order to analyze pathophysiological mechanisms of epilepsy and provide new perspectives for clinical diagnosis and treatment.

Primary aldosteronism (PA) mainly includes aldosteronoma (APA) and idiopathic aldosteronism (IHA). APA often presents as unilateral adrenal nodules, but can also be accompanied by non-functional adrenal nodules, which leads to difficulty of the identification. In this paper, the clinical characteristics, diagnosis and treatment process of two cases of PA with non-functional adrenal nodules were analyzed and discussed to provide some references for the accurate diagnosis and treatment of PA.

Objective To study the microanatomic structure of the subtemporal transtentorial approach to the lateral side of the brainstem,and to provide anatomical information that will assist clinicians to perform surgeries on the lateral,circumferential,and petroclival regions of the brainstem.Methods Anatomical investigations were conducted on 8 cadaveric head specimens(16 sides)using the infratemporal transtentorial approach.The heads were tilted to one side,with the zygomatic arch at its highest point.Then,a horseshoe incision was made above the auricle.The incision extended from the midpoint of the zygomatic arch to one third of the mesolateral length of the transverse sinus,with the flap turned towards the temporal part.After removing the bone,the arachnoid and the soft meninges were carefully stripped under the microscope.The exposure range of the surgical approach was observed and the positional relationships of relevant nerves and blood vessels in the approach were clarified.Important structures were photographed and the relevant parameters were measured.Results The upper edge of the zygomatic arch root could be used to accurately locate the base of the middle cranial fossa.The average distances of the star point to the apex of mastoid,the star point to the superior ridge of external auditory canal,the anterior angle of parietomastoid suture to the superior ridge of external auditory canal,and the anterior angle of parietomastoid suture to the star point of the 10 adult skull specimens were 47.23 mm,45.27 mm,26.16 mm,and 23.08 mm,respectively.The subtemporal approach could fully expose the area from as high as the posterior clinoid process to as low as the petrous ridge and the arcuate protuberance after cutting through the cerebellar tentorium.The approach makes it possible to handle lesions on the ventral or lateral sides of the middle clivus,the cistern ambiens,the midbrain,midbrain,and pons.In addition,the approach can significantly expand the exposure area of the upper part of the tentorium cerebelli through cheekbone excision and expand the exposure range of the lower part of the tentorium cerebelli through rock bone grinding technology.The total length of the trochlear nerve,distance of the trochlear nerve to the tentorial edge of cerebellum,length of its shape in the tentorial mezzanine,and its lower part of entering into the tentorium cerebelli to the petrosal ridge were(16.95±4.74)mm,(1.27±0.73)mm,(5.72±1.37)mm,and(4.51±0.39)mm,respectively.The cerebellar tentorium could be safely opened through the posterior clinoid process or arcuate protrusion for localization.The oculomotor nerve could serve as an anatomical landmark to locate the posterior cerebral artery and superior cerebellar artery.Conclusion Through microanatomic investigation,the exposure range and intraoperative difficulties of the infratemporal transtentorial approach can be clarified,which facilitates clinicians to accurately and safely plan surgical methods and reduce surgical complications.