lncRNA MEG3 inhibits pituitary tumor development by participating in cell proliferation, apoptosis and EMT processes

Pituitary tumors do not pose a threat to life but can cause visual disturbances and serious clinical syndromes, such as infertility and metabolic syndrome. Therefore, screening of key genes involved in the occurrence and development of pituitary tumors can provide new targets for the treatment of pituitary tumors. The aim of the present study was to investigate the molecular mechanism of long non‑coding (lnc.) RNA maternally expressed 3 (MEG3) in cell proliferation, apoptosis and epithelial‑mesenchymal transition (EMT) processes of pituitary tumor. Tissue samples were obtained from 34 patients who underwent surgical treatment of pituitary tumors. Pituitary tumor cells (GH3 and MMQ) were transfected with pcDNA3.1(+)‑MEG3, short hairpin (sh)MEG3, microRNA (miR)‑23‑3p inhibitor or their controls using Lipofectamine^® 2000. Reverse transcription‑quantitative PCR and western blot analyses were used to detect the levels of MEG3, miR‑23b‑3p and FOXO4, as well as proliferation‑, apoptosis‑ and EMT‑associated genes and proteins. Cell Counting Kit‑8 and flow cytometry assays were performed to detect proliferation and apoptosis, and Transwell assay was undertaken to assess invasion and migration. Luciferase reporter and RNA pulldown assays were performed to verify the binding between lncRNA MEG3, miR‑23b‑3p and FOXO4. Pearson's correlation analysis was used to analyze the correlation between expression levels of MEG3, miR‑23b‑3p and FOXO4. lncRNA MEG3 was expressed at lower levels in pituitary tumor tissues and cells. Overexpression of lncRNA MEG3 inhibited proliferation, invasion and migration and accelerated apoptosis of pituitary tumor cells. lncRNA MEG3 negatively regulated miR‑23b‑3p expression levels, while miR‑23b‑3p negatively regulated FOXO4 expression levels. Overexpression of lncRNA MEG3 inhibited the EMT process in pituitary tumor cells. miR‑23‑3p inhibitor rescued the effect of shMEG3 on proliferation, invasion, migration, apoptosis and the EMT process in pituitary tumor cells. lncRNA MEG3 inhibited pituitary tumor development by participating in cell proliferation, apoptosis and the EMT process, which may present a novel target for pituitary tumor treatment.

Nonketotic hyperglycemia-related epileptic seizures

Nonketotic hyperglycemia-related seizures (NKH) are rare. We report a case of NKH-related seizures in a patient following a traumatic brain injury.

Anatomical study on Meckel cave with endoscopic endonasal, endo-maxillary sinus, and endo-pterygoid process approaches

Objective

To study anatomical structures related to Meckel cave with endonasal endoscopic approach and to provide an anatomical basis for endoscopic surgery in Meckel cave.

Methods

Meckel cave of 5 adult skulls (10 sides) were fixed with 10% formalin. The anatomical structures of Meckel cave and the related zones adjacent to Meckel cave were observed and measured with endoscopic endonasal approach.

Results

Endoscopic endonasal, endo-maxillary sinus, and endo-pterygoid process approaches were successfully applied in observation of the anatomical structures of meckel cave and the rerated zones adjacent to Meckel cave and in measurement of distances between related anatomical structures for each case of samples. The relevant data were obtained. The distance between the front mouth of palatovaginal canal and vidian canal was 21.4±7 mm, the distance between opening of sphenoid sinus to the upper margin of the choana was 22.3±2.8 mm, the distance between the opening of vidian and foramen rotundum was 7.57±0.7 mm and the length of the pterygoid canal was 13.3±1.2 mm. Based on these data, the positions of the related important structures can be roughly located during surgical operation and various important structures in Meckel cave and its adjacent zones can be found out in a convenient and safe way.

Conclusion

1) It is feasible to use endonasal endoscopic approach to perform surgical operation in Meckel cave; 2) Use of endonasal endoscopic approach can protect and fully take the advantage of the vidian nerve to locate the position of foramina lacerum of the internal carotid artery during surgical operation; and 3) the observational and experimental data obtained with this approach can provide the rational basis for clinical operation procedures.

Middle Turbinate Mucosal Flap in Endoscopic Skull Base Reconstruction

AIM

To explore the indications, operation techniques and benefits of pedicled middle turbinate mucosal flap in endoscopic skull base reconstruction.

MATERIAL AND METHODS

The patients, who underwent endonasal endoscopic surgery from October 2009 to June 2010 in our department, were involved in this study. Multi-layer skull base reconstruction was performed in four cases by pedicled middle turbinate mucosal flap combined with fascia lata, artificial dura mater, fat and other reconstruction materials. The results of surgery were assessed in the follow-up period.

RESULTS

No reconstruction-associated complications, such as cerebrospinal fluid leakage or infection were observed in four cases during the follow-up period for more than one year. All patients showed excellent recovery.

CONCLUSION

Pedicled middle turbinate mucosal flap for skull base reconstruction has the advantages of fast healing and low incidence of cerebrospinal fluid leakage. It provides satisfactory skull base reconstruction.

Unusual imaging appearance of a huge intracranial dermoid cyst located across the anterior and middle skull base

Intracranial dermoid cysts are rare congenital neoplasms. Typical dermoid cysts are well-circumscribed fat-density masses with no associated contrast enhancement. We report a woman with a dermoid cyst across the anterior and middle skull base of unusual imaging appearance. This report highlights the challenge facing the diagnosis and management of intracranial dermoid cysts with unusual primary imaging findings.

Clinical Research of Early Hyperbaric Oxygen Therapy on Patients with Hypertensive Cerebral Hemorrhage After Craniotomy

AIM

To observe the effect of early hyperbaric oxygen (HBO) therapy on the improvement of consciousness and prognosis of patients with severe brain damages after craniocerebral craniotomy.

MATERIAL AND METHODS

Eighty-one patients who had cerebral hemorrhage and underwent clearance of hematoma and decompressive craniectomy from August 2013 to August 2016 were retrospectively analyzed. The patients were divided into HBO and non-HBO therapy groups. The treatment effects were scored and subjected to corresponding statistical analysis.

RESULTS

There were significant differences in the Glasgow coma scale (GCS) scores at 3 and 5 weeks (t=2.293 and t=3.014, respectively, p < 0.05), and in Glasgow outcome scale (GOS) scores at 5 weeks and 3 months between the two groups (p < 0.05).

CONCLUSION

Early HBO therapy could improve the consciousness and prognosis of patients with cerebral hemorrhage after craniotomy.

Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report

BACKGROUND

This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst (IEAC) at the posterior cranial fossa.

CASE SUMMARY

The clinical information of a patient with an IEAC was reported, and the related literature was reviewed. A female patient with nausea presented to our hospital. Computed tomography demonstrated an IEAC located at the posterior cranial fossa, which was large and required surgical intervention. After operation, postoperative intraparenchymal hemorrhage was detected. She had a good recovery with conservative treatment 1 mo later.

CONCLUSION

Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC, more attention should be paid to such a complication.

Image-Guided Endoscopic Endonasal Transmaxillary Transpterygoid Approach to Meckel's Cave

The aim of this report was to summarize our preliminary experience on the resection of tumors located in Meckel's cave via the endoscopic endonasal transmaxillary transpterygoid approach with image-guided system and to investigate the feasibility and efficacy of this approach. Two patients who had tumors in left Meckel's cave underwent surgical treatment using the image-guided endoscopic endonasal transmaxillary transpterygoid approach. This particular technique has advantages of no brain retraction, direct vision of tumor resection and protection of surrounding neurovascular structures. Neuronavigation increases the safety of the endoscopic approach.

Clinical Study of Dexmedetomidine in Combination with Butorphanol for the Treatment of Traumatic Brain Injury (TBI)

AIM

To explore whether the combination of dexmedetomidine (Dex) and butorphanol (But) could benefit patients with traumatic brain injury (TBI).

MATERIAL AND METHODS

A total of 208 TBI patients admitted from February 2018 to January 2020 were randomly divided into four groups as follows: control group (A), Dex group (B), But group (C), and combination of dexmedetomidine and butorphanol group (D). Four groups of patients were treated and studied clinically. Statistical analysis was performed to assess the changes in signs of life, oxygen saturation, serum neuroendocrine data, pain, and agitation scores.

RESULTS

The statistical data of signs of life and blood oxygen saturation of the four groups were compared, and the differences between group A and group D were statistically significant (p < 0.05), indicating that a combination of sedative and analgesic agents at low doses could improve the signs of life of TBI patients, and the safety was relatively good. The Glasgow Coma Scale (GCS) score of the group D on the 5th day post-surgery was improved compared with the control group (A group), suggesting that the combination of sedative and analgesic agents could improve patients' consciousness. The neuroendocrine data of the combination group showed little fluctuation, indicating that a combination of sedative and analgesic agents could significantly reduce the stress response. The scores of pain and agitation in the combination group were significantly improved on the 3rd and 5th days, suggesting that the combination group was better compared with the control group.

CONCLUSION

The combination of Dex and But was more stable for the treatment of vital signs. Compared with the individual treatment groups, the patients in the combination group had a rapid improvement. The time from treatment to stabilization was shortened, and the prognosis was significantly better compared with the control group. A combination of Dex and But at low doses could significantly maintain neuroendocrine stability. Meanwhile, a combination of sedative and analgesic agents had obvious synergistic effects on enhancing sedation and analgesia as well as anti-muscle tension. Collectively, the combination of Dex and But could significantly benefit the prognosis of TBI.

Effect of Dezocine on Hemodynamic Indexes of Postoperative Patients With Traumatic Brain Injury (TBI)---A Pilot Study

Background: Due to pain and other stimuli, patients with traumatic brain injury (TBI) after surgery show excited Sympathetic Nervous system, increased intracranial pressure, brain tissue swelling, intracranial hemorrhage, or reduced cerebral perfusion pressure, seriously threatening the life and prognosis of patients. The effect of dezocine on postoperative analgesia after TBI remains largely undetermined. Objective: In the present study, we aimed to investigate the efficacy and safety of dezocine in postoperative sedative and analgesic therapy for a craniocerebral injury. Methods: The patients were randomly divided into two groups (n = 40) as follows: dezocine group (Group A) and control group (Group B). Electrocardiography (ECG), heart rate (HR), blood pressure, and oxygen saturation (SpO2) were routinely monitored after postoperative return to the ward. Both groups were initially injected with 5 mg·kg-1·h-1 propofol to maintain sedation, and the dose was adjusted according to the patient's condition. Vital signs of patients were recorded at T1 (the base value when arriving at the ward), T2 (before the sedative agent was used) and T3 (use of dezocine or 0.9% saline solution for 8 h), T4 (use for 1 day), T5 (use for 3 days), T6 (termination of dezocine or 0.9% saline solution for 1 day), and T7 (termination for 3 days), and mean arterial pressure (MAP) and HR values were also recorded. The total amount of propofol, total fluid inflow, blood loss, and urine output were recorded within 24 h. The number of coughs of each patient was recorded within 1 day after entry, and the incidence of adverse events, such as insufficient oxygenation (SaO2 reduced by about 5% from the base value), hypotension, bradycardia, laryngospasm, bronchospasm, and so on, was assessed. Results: Compared with the control group (group B), the hemodynamics of the dezocine group (group A) was more stable, there were significant differences in MAP and HR (p < 0.05), and the stress response was milder. The total amount of propofol, total fluid inflow, blood loss, and urine volume of the dezocine group were significantly improved compared with the control group (p < 0.05). Moreover, the incidence of adverse events, such as cough, in the dezocine group was significantly reduced compared with the control group (p < 0.05). Conclusions: Dezocine, as a drug with a strong analgesic effect and obvious sedative effect, was suitable for craniocervical surgery, and it could significantly improve the stability of airway and hemodynamics in TBI patients during anesthesia recovery.

Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma: An observational study

BACKGROUND

Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. The traditional treatment methods include burr hole drainage, bone flap craniectomy and other surgical methods, and there are certain complications such as recurrence, pneumocephalus, infection and so on. With the promotion of neuroendoscopic technology, its treatment effect and advantages need to be further evaluated.

AIM

To study the clinical effect of endoscopic small-bone approach in CSDH.

METHODS

A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method: the neuroendoscopy group (n = 61 cases) and the burr hole drainage group (n = 61 cases). The clinical treatment effect of the two groups of patients with CSDH was compared.

RESULTS

At the early postoperative stage (1 d and 3 d), the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete re-expansion was higher in the neuroendoscopy group than in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). No intracranial hematoma, low cranial pressure, tension pneumocephalus or other complications occurred in the neuroendoscopy group.

CONCLUSION

The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up. The surgical effect is apparent with few complications and definite curative effect, which is worthy of clinical promotion and application.

Positioning and design by computed tomography imaging in neuroendoscopic surgery of patients with chronic subdural hematoma

BACKGROUND

Neuroendoscopy is a very useful technique to Chronic Subdural Hematoma (CSH). But how to achieve the goal of treatment more minimally invasive?

AIM

To develop a simple, fast and accurate preoperative planning method in our way for endoscopic surgery of patients with CSH.

METHODS

From June 2018 to May 2020, forty-two patients with CSH, admitted to our hospital, were performed endoscopic minimally invasive surgery; computed tomography (CT) imaging was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery. The clinical data and treatment efficacy were analyzed.

RESULTS

According to the learning of CT scanning images, the surgeon can accurately design the best minimally invasive neuroendoscopic surgical approach and realize the precise positioning and design of the drilling site of the skull and the size of the bone window, so as to provide the most effective operation space with the smallest bone window. In this group, the average operation time was only about 1 h, and the clearance rate of hematoma was about 95%.

CONCLUSION

Patients with CSH can achieve good therapeutic effect by using our way to positioning and design to assist the operation of CSH according to CT scan and image, and our way is very useful and necessary.

Case Report: Endoscopic trans-cerebellar medullary fissure approach for the management of brainstem hemorrhage

OBJECTIVE

Brainstem hematoma (BSH) is a high-risk condition that can lead to deadly and disabling consequences if not properly managed. However, recent advances in endoscopic techniques, employed for removing supratentorial intracerebral hemorrhage have shown significant improvements in operative morbidity and mortality rates compared to other approaches. In this study, we demonstrate the utility and feasibility of the endoscopic trans-cerebellar medullary fissure approach for the management of brain stem hemorrhage in carefully selected patients.

PATIENTS AND METHODS

A 55-year-old man presented to the emergency department in a comatose state with respiratory distress. A CT scan revealed the presence of a brainstem hemorrhage. Given the location of the hemorrhage and the need to quickly manage the associated developmental obstructive hydrocephalus and respiratory distress, an endoscopic trans-cerebellar medullary fissure approach was chosen as the most appropriate method of treatment.

RESULTS

Total resection was achieved, and the patient gradually improved postoperatively with no new neurological deficits. He is currently under routine follow-up and is conscious but has partial hemiplegia.

CONCLUSION

This approach provided direct visualization of the lesion and was minimally invasive. The endoscopic trans-cerebellar medullary fissure approach may be considered an alternative to open approaches for brainstem hemorrhage in carefully selected patients.