Objective:To investigate the computed tomography (CT) imaging features of patients with chronic hydrocephalus after intracerebral hemorrhage surgery and the difference between endoscopic third ventriculostomy (ETV) and ventricular peritoneal shunt (VPS).Methods:A total of 158 patients with intracerebral hemorrhage who received surgical treatment in the Department of Neurosurgery of the People′s Hospital of Jinan from January 2021 to June 2023 were retrospectively selected as the study objects, including 78 patients with chronic hydrocephalus after surgery as the hydrocephalus group, and 80 patients with no hydrocephalus after surgery as the non-hydrocephalus group, and the CT imaging data of the patients were statistically analyzed. Hydrocephalus group was divided into ETV group (42 cases) and VPS group (36 cases) according to different treatment methods. The efficacy and quality of life of the two groups were compared, and the incidence of complications in the two groups were counted.Results:There was no significant difference between hydrocephalus group and non-hydrocephalus group in the site of cerebral hemorrhage, hematoma morphology and the proportion of patients with mixed signs, lobular signs and black hole signs (all P>0.05). The proportion of patients with ventricular dilation and hematoma enlargement in hydrocephalus group was significantly higher than that in non-hydrocephalus group (all P<0.05). The National Institute of Health Stroke Scale (NIHSS) scores of hydrocephalus patients in the two groups were measured continuously at different time points, and there was no significant difference in NIHSS scores between the ETV group and the VPS group before treatment, at 2 weeks and 4 weeks of treatment (all P>0.05). There was no significant difference between the ETV group and the VPS group ( P>0.05). The recurrence rate of the ETV group was lower than that of the VPS group ( P<0.05). The quality of life scores of patients in ETV group were higher than those in the VPS group at 3 months and 6 months after surgery ( P<0.05). Conclusions:CT examination of patients with chronic hydrocephalus after intracerebral hemorrhage will show obvious characteristics of hematoma enlargement and ventricle enlargement. The efficacy of ETV and VPS in the treatment of chronic hydrocephalus after intracerebral hemorrhage surgery is similar, but the former has a lower recurrence rate and a higher postoperative quality of life.

Objective:To investigate the computed tomography (CT) imaging features of patients with chronic hydrocephalus after intracerebral hemorrhage surgery and the difference between endoscopic third ventriculostomy (ETV) and ventricular peritoneal shunt (VPS).Methods:A total of 158 patients with intracerebral hemorrhage who received surgical treatment in the Department of Neurosurgery of the People′s Hospital of Jinan from January 2021 to June 2023 were retrospectively selected as the study objects, including 78 patients with chronic hydrocephalus after surgery as the hydrocephalus group, and 80 patients with no hydrocephalus after surgery as the non-hydrocephalus group, and the CT imaging data of the patients were statistically analyzed. Hydrocephalus group was divided into ETV group (42 cases) and VPS group (36 cases) according to different treatment methods. The efficacy and quality of life of the two groups were compared, and the incidence of complications in the two groups were counted.Results:There was no significant difference between hydrocephalus group and non-hydrocephalus group in the site of cerebral hemorrhage, hematoma morphology and the proportion of patients with mixed signs, lobular signs and black hole signs (all P>0.05). The proportion of patients with ventricular dilation and hematoma enlargement in hydrocephalus group was significantly higher than that in non-hydrocephalus group (all P<0.05). The National Institute of Health Stroke Scale (NIHSS) scores of hydrocephalus patients in the two groups were measured continuously at different time points, and there was no significant difference in NIHSS scores between the ETV group and the VPS group before treatment, at 2 weeks and 4 weeks of treatment (all P>0.05). There was no significant difference between the ETV group and the VPS group ( P>0.05). The recurrence rate of the ETV group was lower than that of the VPS group ( P<0.05). The quality of life scores of patients in ETV group were higher than those in the VPS group at 3 months and 6 months after surgery ( P<0.05). Conclusions:CT examination of patients with chronic hydrocephalus after intracerebral hemorrhage will show obvious characteristics of hematoma enlargement and ventricle enlargement. The efficacy of ETV and VPS in the treatment of chronic hydrocephalus after intracerebral hemorrhage surgery is similar, but the former has a lower recurrence rate and a higher postoperative quality of life.

Objective:To explore the efficacy and safety of Neuroform Atlas stent-assisted coil embolization in ruptured anterior communicating wide-necked aneurysms.Methods:Thirty-two patients with ruptured anterior communicating wide-necked aneurysms accepted Neuroform Atlas stent assisted coil embolization in Department of Neurosurgery, People's Hospital Affiliated to Shandong First Medical University from January 2022 to June 2023 were chosen. DSA was performed immediately after surgery, and aneurysm embolization was assessed using Raymond grading. Prognoses were assessed by modified Rankin Scale (mRS, mRS scores≤2 as good prognosis and mRS scores>2 as poor prognosis) at last follow-up. DSA was performed again 6 months after surgery to assess the aneurysm healingResults:Neuroform Atlas stents were successfully implanted in all 32 patients; Postoperative DSA showed that aneurysm embolization reached Raymond grading I in all 32 patients(100%). No such complications as in-stent thrombosis, cerebral vasospasm, or poor opening of the stent were noted excepted for one with intraoperative aneurysm rupture hemorrhage. At the last follow-up, 31 patients had good prognosis and 1 had poor prognosis; in 22 patients underwent DSA re-examination, Raymond grading I was noted in 20 patients (90.91%) and grading II in 2 (9.09%).Conclusion:Neuroform Atlas stent-assisted coil embolization for ruptured anterior communicating wide-necked aneurysms seems safe and effective.

Objective:To analyze the disease burden of Parkinson's disease (PD) in China from 1990 to 2021 and predict the disease burden of PD from 2022 to 2030.Methods:Based on the data of PD incidence in China from the Global Burden of Disease Study 2021 (GBD 2021), changes in PD disease burden from 1990 to 2021 were analyzed. Age-period-cohort model was used to analyze the independent influences of age, period and cohort in PD incidence (according to age group of 5 years, patients were divided into 15 groups: group of 20-24 years, group of 25-29 years..., and group of 90-94 years; according to a 5-year period, patients were divided into 6 groups: group of 1992-1996, group of 1997-2001..., and group of 2017-2021; because of birth cohort=period-age, patients were divided into 20 birth cohorts: birth cohort of 1897-1906, birth cohort of 1902-1911..., and birth cohort of 1992-2001). Nordpred model was used to predict the disease burden of PD from 2022 to 2030.Results:(1) From 1990 to 2021, number of PD patients, and PD incidence and standardized incidence in China showed upward trends. The standardized incidence increased by 89.68% for the total population, 89.71% for males, and 77.64% for females. (2) PD incidence was low in young subjects and increased obviously in subjects aged 60 years. PD incidence in subjects aged 20-24 years or 90-94 years was 0.07/100 000 and 643.31/100 000, respectively. Compared with female subjects, male subjects aged 60-94 years had higher PD incidence. (3) The onset relative risk increased from 0.71 (95% CI: 0.69-0.73) in group of 1992-1996 to 1.17 (95% CI: 1.16-1.19) in group of 2017-2021 in the total population, increased from 0.68 (95% CI: 0.66-0.70) to 1.18 (95% CI: 1.16-1.21) in males, and increased from 0.75 (95% CI: 0.73-0.77) to 1.14 (95% CI: 1.12-1.16) in females. (4) Onset relative risk was 0.40 (95% CI: 0.33-0.48) in the earliest birth cohort (1897-1906), which increased to 1.81 (95% CI: 0.95-3.43) in the latest birth cohort (1992-2001). (5) Number of PD patients in males, females and total population in China would increase to 455 010, 301 173 and 756 183, respectively, and the standardized incidence would increase to 56.45/100 000, 32.28/100 000 and 43.40/100 000, respectively, till 2030. Conclusion:PD disease burden in China from 1990 to 2021 is severe, particularly among males and the elderly; the disease burden is projected to continue rising up till 2030.

Objective:To analyze the disease burden of Parkinson's disease (PD) in China from 1990 to 2021 and predict the disease burden of PD from 2022 to 2030.Methods:Based on the data of PD incidence in China from the Global Burden of Disease Study 2021 (GBD 2021), changes in PD disease burden from 1990 to 2021 were analyzed. Age-period-cohort model was used to analyze the independent influences of age, period and cohort in PD incidence (according to age group of 5 years, patients were divided into 15 groups: group of 20-24 years, group of 25-29 years..., and group of 90-94 years; according to a 5-year period, patients were divided into 6 groups: group of 1992-1996, group of 1997-2001..., and group of 2017-2021; because of birth cohort=period-age, patients were divided into 20 birth cohorts: birth cohort of 1897-1906, birth cohort of 1902-1911..., and birth cohort of 1992-2001). Nordpred model was used to predict the disease burden of PD from 2022 to 2030.Results:(1) From 1990 to 2021, number of PD patients, and PD incidence and standardized incidence in China showed upward trends. The standardized incidence increased by 89.68% for the total population, 89.71% for males, and 77.64% for females. (2) PD incidence was low in young subjects and increased obviously in subjects aged 60 years. PD incidence in subjects aged 20-24 years or 90-94 years was 0.07/100 000 and 643.31/100 000, respectively. Compared with female subjects, male subjects aged 60-94 years had higher PD incidence. (3) The onset relative risk increased from 0.71 (95% CI: 0.69-0.73) in group of 1992-1996 to 1.17 (95% CI: 1.16-1.19) in group of 2017-2021 in the total population, increased from 0.68 (95% CI: 0.66-0.70) to 1.18 (95% CI: 1.16-1.21) in males, and increased from 0.75 (95% CI: 0.73-0.77) to 1.14 (95% CI: 1.12-1.16) in females. (4) Onset relative risk was 0.40 (95% CI: 0.33-0.48) in the earliest birth cohort (1897-1906), which increased to 1.81 (95% CI: 0.95-3.43) in the latest birth cohort (1992-2001). (5) Number of PD patients in males, females and total population in China would increase to 455 010, 301 173 and 756 183, respectively, and the standardized incidence would increase to 56.45/100 000, 32.28/100 000 and 43.40/100 000, respectively, till 2030. Conclusion:PD disease burden in China from 1990 to 2021 is severe, particularly among males and the elderly; the disease burden is projected to continue rising up till 2030.

Objective:To analyze the characteristics of patients with Takayasu arteritis (TA) in the east China Takayasu arteritis (ECTA) cohort and their subgroups, and evaluate the disease characteristics.Methods:Patients diagnosed with TA in ECTA cohort from January 2009 to October 2019 were enrolled and their data were analyzed. The characteristics were analyzed and compared within subgroups using t-test or Wilcoxon rank sum test or Chi-square test. Results:A total of 454 patients were included, with the male to female ratio of 1∶4.75(79/375), and the main complaint were dizziness/headache, fatigue, and chest tightness/pain. The type Ⅴ and Ⅰ were the most common angiographic pattern, among which the subclavian artery and carotid artery were most vulnerable, manifested as vascular stenosis. Hypertension, tuberculosis and hepatitis B were common complications. In subgroup comparison, symptoms and inflammation index were much more evident in the active group, female group, <40 years old, and newly diagnosed group. C-reactive protein (CRP)[10(2, 33) mg/L vs 3(1, 14) mg/L, Z=-4.49, P<0.01), erythrocyte sedimentation rate (ESR) [(45±33) mm/1 h vs (25±23) mm/1 h, t=-5.82, P<0.01), in the active group were significantly higher than those in the inactive group, while the ESR in female patients was only higher than that in males, but without statistical significant difference. SAA in the young age group, ESR in the newly diagnosed group was significantly higher than that in the other subgroups [19(6, 95) mg/L vs 10(4, 39) mg/L, Z=2.06, P<0.05] [(44±34) mm/1 h vs (32±28) mm/1 h, t=3.77, P<0.01]. Conclusion:The TA patients are mainly young women, and are in active disease when first being diagnosed. The type Ⅴ and Ⅰ are the most common artery involve-ment pattern. Hypertension and tuberculosis are the most frequent complications.

Objective:To perform a prospective cohort study to identify individual susceptibility of glucocorticoid (GC) -associated osteonecrosis of the femoral head (GA-ONFH) and their clinical and genetic risk factors. Methods:The present prospective cohort study enrolled patients who received their first GC therapy between July 2015 and January 2018 at Zhongshan Hospital. All patients did not receive any GC treatment before enrollment. Further, they planned to start GC treatment with the dose (equivalent prednisone) of ≥30 mg/d, lasted ≥3 weeks, or pulse dose ≥200 mg/d, lasted ≥3 d. Blood samples were collected before GC treatment to evaluate bone metabolism and its released factors. Hip MRI was performed at the 1st, 3rd, 6th, 12th and 24th month to diagnose GA-ONFH. All patients were followed-up for ≥2 years. The endpoint was regarded as diagnosis of GA-ONFH or completion of 2 years follow-up. Lasso regression was performed to determine which clinical features were associated with GA-ONFH. A nested case-control sub-cohort (A, n=12) was established prospectively based on the main cohort by 1∶1 matching. Whole exome sequencing was performed to screen differential and functional candidate single nucleotide polymorphisms and insertion-deletions (SNP/InDels). Another sub-cohort (B, n=50) was constructed retrospectively in patients with GA-ONFH and non-ONFH patients received standard high dose GC treatment for more than two years. The candidate SNP/InDels were verified by Sanger sequencing based on the patients from sub-cohort B. Results:A total of 96 patients were enrolled of which 88 of them (32 males and 56 females, mean age 42.30 years) completed follow-up. Eight cases (9.1%) were diagnosed with GA-ONFH. The median time from the start of GC therapy to the diagnosis of ONFH was 53.00(34.00,13.50) days. The baseline characteristics, such as age, sex and body mass index, indicated no significant difference between the ONFH group and the non-ONFH group. The cumulative GC dose of the ONFH patients in the first month was higher than that of non-ONFH [32.74(29.55, 47.05) mg/kg vs. 24.00(21.10, 29.45) mg/kg, Z=-2.410, P=0.016]. However, there was no significant difference of patients who underwent pulse therapy (37.5% vs. 10.0%, adjusted χ 2=2.829, P=0.093). The ratio of serum apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) in patients with ONFH was higher than that in non-ONFH group before GC use [0.95(0.80, 1.50) vs. 0.70(0.60, 0.80), Z=-2.875, P=0.000]. Due to the multicollinearity, Lasso regression model was performed to reduce overfitting. All variables were included in the model. The results suggested that higher ApoB/ApoA1 ratio, lower serum β-c-terminal telopeptide (β-CTX) and higher cumulative GC dose in the first month were the top three risk factors of GA-ONFH. This model had an accuracy of 0.982 in internal validation. Seven differential candidate SNP/InDels were found by whole exome sequencing of sub-cohort A. We further verified these SNP/InDels in sub-cohort B. The patients with COLEC12 mutation (rs2305027, G1816A) were at risk of GA-ONFH ( OR=6.00, 95% CI: 1.17, 30.73). Conclusion:Higher first-month GC dose, lower serum β-CTX level before treatment, higher ApoB/ApoA1 ratio and COLEC12 mutation (rs2305027, G1816A) could increase the risk of GA-ONFH.

Objective:To investigate the effect and mechanism of bone marrow mesenchymal stem cell (BMSC)-derived exosomal microRNA-1297 (miR-1297) on hippocampal neuron damage in depressed rats.Methods:BMSCs and BMSCs-derived exosomes were prepared and identified. Rats were first injected with corticosterone to establish the model of depression, and then injected with BMSCs-derived exosomes. Superoxide dismutase (SOD), malondialdehyde (MDA), lactate dehydrogenase (LDH), TNF-α and IL-1β in rat serum samples, hippocampal tissues and neurons were detected. Expression of miR-1297 in hippocampal tissues and neurons was detected by RT-qPCR. A rat hippocampal neuron injury model was established to investigate the role of BMSC-derived exosomes and miR-1297 in neuronal apoptosis and proliferation. The targeting relationship between miR-1297 and connective tissue growth factor (CTGF) was analyzed using dual luciferase reporter genes.Results:In the hippocampus of depressed rats, the expression of miR-1297 was low, while the expression of CTGF was elevated. Exosomes derived from BMSCs can inhibit the expression of CTGF by up-regulating the level of miR-1297, thereby inhibiting neuronal cell apoptosis in the hippocampus of depressed rats, while increasing the level of SOD, and reducing inflammatory damage, and ultimately improving the behavioral function of depressed rats.Conclusions:Depressed rats showed decreased expression of miR-1297 and increased expression of CTGF. BMSC-derived exosomes inhibited CTGF expression through up-regulating miR-1297, thereby improving hippocampal neuron damage in rats with depression.

Objective:To investigate the effect of lenalidomide (LEN) combined with temozolomide (TMZ) on proliferation, invasion, drug resistance and O6-methylguanine-DNA methyltransferase ( MGMT) gene epigenetic modification of TMZ-resistant human glioblastoma cell line U251/TR. Methods:A TMZ-resistant human glioma cell line, U251/TR, was successfully established by stepwise exposure of U251 parental cells to TMZ. U251/TR cells were divided into dimethyl sulfoxide (DMSO) group, LEN group, TMZ group and LEN+TMZ group (DMSO group: without any drug intervention; LEN group, TMZ group, and LEN+TMZ group were pretreated with 100 μmol/L LEN, 200 μmol/L TMZ, 100 μmol/L LEN+200 μmol/L TMZ, respectively; the drugs were administered once every 24 h). The proliferation rate of these cells in each group was detected by sulfonylrhodamine B colorimetric assay at different time points (24, 48, 72, and 96 h after treatment). At 96 h after treatment, the invasion and migration abilities of cells in each group were detected by Transwell assay; the proliferation cycle of cells in each group was detected by flow cytometry; Western blotting, immunohistochemical staining and immunofluorescence staining were used to detect the MGMT protein expression, and the MGMT mRNA expression in cells of each group was detected by reverse transcription-PCR; methylation specific PCR was used to detect the MGMT gene promoter methylation in each group of cells. Results:The cell proliferation rate of LEN+TMZ group was significantly decreased as compared with TMZ, LEN, and DMSO groups at 24, 48, 72 and 96 h after treatment ( P<0.05). At 96 h after treatment, LEN+TMZ group had significantly decreased number of transmembrane cells, and significantly increased ratio of cells at G0/G1 phase as compared with the other 3 groups ( P<0.05); the MGMT protein and mRNA expression levels in TMZ group and LEN+TMZ group were significantly lower than those in LEN group and DMSO group ( P<0.05); and the number of cells with strong or moderate MGMT expression in TMZ group and LEN+TMZ group was obviously less than that in LEN group and DMSO group, and the MGMT fluorescence intensity in TMZ group and LEN+TMZ group (+) was obviously lower than that in LEN group (+++) and DMSO group (+++). The MGMT gene promoter was unmethylated in all groups. Conclusion:LEN alone does not obviously inhibit the proliferation and invasion of U251/TR cells; but LEN combined with TMZ could inhibit the proliferation and invasion of U251/TR cells and co-reverse the drug resistance of U251/TR cells, whose mechanism is not related to the changes of MGMT gene promoter methylation.

Objective:To summarize the characteristics and treatment outcomes of immunoglobulin G4-related disease (IgG4-RD) overlapped with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods:The clinical data of four patients with AAV overlaped with IgG4-RD from Zhongshan Hospital of Fudan University from August 2018 to July 2019 were collected and the related literature were reviewed.Results:Four patients were included, in which two were diagnosed with IgG-RD and granulomatosis with polyangiitis (GPA), one was probable IgG4-RD and microscopic polyangiitis (MPA), and one was probable IgG4-RD and GPA. All patients were female, with an average age of (42±12) (26-56) years, and disease duration was (7±4) (4-13) months. The manifestations were ocular inflammatory pseudotumor, sinusitis, otitis media, mastoiditis, parotitis, meningitis, lung and kidney involvement. After treatment with glucocorticoid and immunosuppressants (including cyclophosphamide, methotrexate, azathioprine, leflunomide), 2 patients failed to achieve remission, and 2 patients relapsed 8-15 months after treatment. One patient was treated withglucocorticoid pulse therapy combined with rituximab and one was treated with glucocorticoid combined with methotrexate and rituximab, and the patient was relieved.Conclusion:AAV and IgG4-RD may be a new overlap syndrome. Hypertrophic meningitis, orbital mass, chronic periaortic inflammation and interstitial glomerulonephritis are reported in the literature. The pathological changes of orbit, nasopharynx, parotid gland and lung are common. Glucocorticoids and immunosuppressive agents have poor treatment response, which indicates that AAV is refractory when combined with elevated IgG4. The induced remission rate is low, and easy to relapse. Glucocorticoid pulse therapy and rituximab treatment are effective.