Objective To explore the clinical application value of semiconductor laser combined with flat-panel CT guidance in foramen ovale puncture for trigeminal neuralgia(TN).Methods A total of 86 patients with primary TN were selected and randomly divided into control group(n=43)and observation group(n=43).The control group used empirical manual puncture,and the observation group used semiconductor laser combined with flat-panel CT-guided radiofrequency ablation.The first puncture success rate,puncture success time,total operation time,and intraoperative flat-panel CT scan times were carefully evaluated.Results The puncture success time,total operation time,and intraoperative flat-panel CT scan times in the observation group were significantly lower than those in the control group(P＜0.05).In addition,the first puncture success rate and surgical efficiency 12 months after surgery were significantly improved(P＜0.05).The incidence of facial congestion in the observation group was significantly lower than that in the control group(P＜0.05),but there was no statistically significant difference in the incidence of chewing weakness,cerebrospinal fluid leakage,and intracranial infection between the two groups(P＞0.05).Conclusion Minimally invasive foramen ovale puncture under the guidance of semiconductor laser combined with flat-panel CT for the treatment of TN has the advantages of simple operation,accurate positioning,low risk,and few complications,with important clinical application value.

Objective To explore the mechanism of the effect of itraconazole ethanolamine tablets on the CD40/CD40L axis in children with idiopathic thrombocytopenic purpura(ITP).Methods 80 children with ITP were selected as the study subjects.They were divided into a control group(n=40)and a study group(n=40)using a digital random table method.The control group was treated with cyclosporine,while the study group was treated with itraconazole ethanolamine tablets.Both groups were treated continuously for 3 months.Compare the clinical efficacy of two groups of patients T lymphocyte subpopulation levels[CD3+CD4+and CD4+/CD8+,as well as adverse reactions.Detect CD40 on the surface of lymphocyte membrane and platelet membrane in two groups of patients CD40L level,plasma sCD40 and sCD40L levels were detected using ELISA.Results The total effective rate of the study group(92.50%)was significantly higher than that of the control group(75.00%)(P<0.05).CD3+CD4+,CD4+/CD8+,The expression levels of sCD40 in plasma were higher than before treatment,CD8+and peripheral blood CD19+CD40+The expression levels of CD3+,CD40L+cells,and plasma sCD40L were lower than before treatment;Research group CD3+CD4+,CD4+/CD8+,The expression level of sCD40 in plasma was higher than that in the control group,CD8+,And peripheral blood CD19+CD40+The expression levels of CD3+CD40L+cells and plasma sCD40L were lower than those of the control group(P<0.05).The CD40L+cells on the surface of peripheral blood platelet membranes after two treatment groups were lower than before treatment;The CD40+on the surface of peripheral blood platelet membrane in the study group was higher than that in the control group,CD40L+cells were lower than those in the control group(P<0.05).The total adverse rate of the study group(15.00%)was lower than that of the control group(22.50%),but there was no significant difference between the two groups(P>0.05).Conclusion The treatment of ITP in children with eltrombopag olamine tablets has good clinical effi-cacy,regulates the level of T lymphocyte subsets,and is safe.

Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

【Objective】 To investigate the relationship between cerebrospinal fluid exosome-derived miR-630 and the function of brain microvascular endothelial cells （BMECs）. 【Methods】 The subarachnoid hemorrhage endothelial cell model was established to evaluate the effect of hemorrhagic cerebrospinal fluid （BCSF） on BMECs’ proliferation by MTT assay and cell cycle analysis. qRT-PCR and immunofluorescence staining were used to detect the expressions of endothelial cell tight junction protein （ZO-1） and adhesion molecule （ICAM-1 and VCAM-1）. Changes in NOx concentration were detected by radioimmunoassay. The cerebrospinal fluid exosomes in the experimental group （co-incubated with BCSF） and the control group （normal cerebrospinal fluid） were isolated and identified， and differences in the expressions of cerebrospinal fluid exosomal miR-630 between the two groups were compared. BMECs work changes after the intervention with miR-630 analogue were observed. 【Results】 The proliferation of BMECs was significantly inhibited in the experimental group； the mRNA and protein levels of ICAM-1， VCAM-1 and ZO-1 were significantly decreased， and the function of endothelial cells was significantly inhibited （P<0.05）. After the successful separation and identification of cerebrospinal fluid exosomes， the expression of miR-630 was significantly lower in the experimental group than in the control group （P<0.05）. The function of BMECs was significantly improved with miR-630 mimics. 【Conclusion】 The low expression of miR-630 in cerebrospinal fluid exosomes after subarachnoid hemorrhage is closely related to BMECs injury.

Pituitary adenoma is a common neuroendocrine tumor, and its complex pathogenesis makes its treatment a clinical problem. Recently, studies have shown that long non-coding RNA (LncRNA), as a class of endogenous RNA with a length of more than 200 nucleotides and basically no protein-coding function, plays an important regulatory role in various forms in multiple tumors including pituitary adenoma, and is closely related to the proliferation, invasion and metastasis of pituitary adenoma. Based on the latest research status at home and abroad, this paper summarizes the research progress of LncRNA in pituitary adenoma, hoping to provide new ideas for the diagnosis, treatment and prognosis of pituitary adenoma.

Chronic subdural hematoma (cSDH) occurs in acute subdural hemorrhage after head trauma or converts from effusion. Traditional treatment is based on conservative treatment and surgical drainage. The effective rate of conservative treatment is only 3%-18%; even with drilling drainage treatment, the recurrence rate is as high as 33%. Recently, the middle meningeal artery embolization technique based on pathological analysis can greatly reduce the recurrence rate, and the operation is simple and curative effect is exact. This article reviews the pathogenesis of cSDH and progress of interventional therapy.

Objective: To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty. Methods: The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods, 97 cases were treated with thread suture to the galea aponeurotica combined with general drainage(the general drainage group), and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group). The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture, and the drainage tube was placed outside the metal titanium plate under the skin, and removed after 48-72 hours.The postoperative complications of the two groups were compared. Results: The incidence rates of subcutaneous hemorrhage, knotting reaction, infection of incision in the negative pressure drainage group were 1.3%(1/78), 0.0%(0/78), and 0.0%(0/78), respectively, which were significantly lower than those in the average drainage group[11.3%(11/97), 20.6%(20/97), 7.2%(7/97)], the differences were statistically significant(χ²=6.85, 18.16, 4.13, all P<0.05). Conclusion The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.

Exosomes are a type of nanoscale vesicles that are actively secreted by various type of cells, and are considered as a new way of cell communication. The exosomes can shuttle bioactive molecules including proteins, lipids, miRNAs and mRNAs from one cell to another, resulting in the exchange of genetic information between cells and the reprogramming of recipient cells. Many evidences show that tumor cells can secrete a large amount of exosomes and regulate tumor progression,metastasis,immune escape, resistance and many other aspects through a variety of ways. In the tumor microenvironment, exosomes transmit between tumor cells,immune cells,and stromal cells,contributing to the escape from immune surveillance.This review summarizes recent advances in exosomes in tumor immune escape.

Objective To explore the relationship between Toll-like receptor 2(TLR2) and autophagy marker protein in glioma. Methods Glioma tumors of a total of 74 patients from June 2012 to December 2017 were surgically resected, including WHO gradeⅠtoⅡ32 cases, grade Ⅲ 20 cases, gradeⅣ22 cases. Immunohistochemistry and Western blot were used to detect the expression of TLR2, autophagy related protein LC3B, Beclin 1 and apoptosis related protein Bax and Bcl-2. The correlation between TLR2 and autophagy related protein LC3B and Beclin 1 were analyzed. Results In high grade glioma (HGG) tissue and low grade glioma (LGG) tissue, the TLR2 positive expression rates were 92.9％(39/42) and 75.0％(24/32), and there was significant difference (P<0.05). In HGG tissue, autophagy related protein LC3B, Beclin1 protein was strongly positive and the positive expression rates were 45.2％(19/42) and 52.4％(22/42). In LGG tissue, LC3B and Beclin1 protein positive expression rates were 18.8％(6/32) and 15.6％(5/32), and there were significant differences (P<0.05). Spearman correlation analysis showed that TLR2 protein was closely related to autophagy related protein LC3B (r=0.5638, P<0.05) and Beclin1 (r=0.6101, P<0.05). Conclusions TLR2 is highly expressed in HGG tissue, and its expression level may be related to autophagy, which has potential value as a targeted therapy.

Glioma is a serious health threat for humans,so we urgently need to develop a more accurate,efficient and durable method to fight it.Immunotherapy is a fashionable treatment,which can stimulate the body's own immune system stimulation.And finding a reliable therapeutic target becomes the essential for glioma immunotherapy.The toll-like receptor 2 is form Ⅰ transmembrane receptor,which can be highly expressed in a variety of tumors and is closely linked to the aggressiveness and prognosis of the tumors.This article aims to explore the TLR2 expression and its association with tumors to provide new therapeutic targets for glioma immunotherapy.