[Evaluation of classification of petroclival meningiomas and proposed selection of microsurgical approach: a single center experience of 179 cases]

Objective: To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes. Methods: Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom(M(QR)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results: The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS(t=-1.356,P=0.125). As for each type, there were statistically significant differences in brain stem edema(χ2=3.482,P=0.038), gross total resection(χ2=9.127,P=0.001), surgical duration(F=8.954, P=0.013), postoperative length of stay(F=3.652, P=0.025), postoperative complications(χ2=1.550,P=0.024), postoperative KPS(F=2.856, P=0.042) and tumor recurrence/progress(χ2=4.824,P=0.013). Conclusion: The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

[Establishment of index system for population based SARS-CoV-2 nucleic acid screening]

Objective: To establish an index system of population based SARS-CoV-2 nucleic acid screening, and provide reference to determine the screening coverage appropriately. Methods: The literature review and brain storming sessions were used to develop the basic frame and index system of population based SARS-CoV-2 nucleic acid screening. Based on Delphi method and Analytic Hierarchy Process, 21 domestic experts were selected for two rounds of consultation to determine the index system of population based SARS-CoV-2 nucleic acid screening and its weight. Results: The positive indexes of experts in two rounds of consultations were both 100%. The experts' authority coefficients (Cr) were 0.88±0.08 and 0.89±0.07, respectively. And the range of coefficient of variation (CV) were (0.08, 0.24), (0.09, 0.25). The Kendall's W coordination coefficients were 0.34 and 0.22 respectively, which were statistically significant. The index system of population based SARS-CoV-2 nucleic acid screening was established, which had 4 first-level indexes, 11 second-level indexes and 58 third-level indexes. Besides, the weight of each index was determined. Conclusion: The index system of population based SARS-CoV-2 nucleic acid screening has been established, which can provide scientific reference for the health administration to determine the coverage of population based SARS-CoV-2 nucleic acid screening when local COVID-19 epidemic occurs.

Acceleration of Brain TOF-MRA with Compressed Sensitivity Encoding: A Multicenter Clinical Study

BACKGROUND AND PURPOSE

The clinical practice of three-dimensional TOF-MRA, despite its capability in brain artery assessment, has been hampered by the relatively long scan time, while recent developments in fast imaging techniques with random undersampling has shed light on an improved balance between image quality and imaging speed. Our aim was to evaluate the effectiveness of TOF-MRA accelerated by compressed sensitivity encoding and to identify the optimal acceleration factors for routine clinical use.

MATERIALS AND METHODS

One hundred subjects, enrolled at 5 centers, underwent 8 brain TOF-MRA sequences: 5 sequences using compressed sensitivity encoding with acceleration factors of 2, 4, 6, 8, and 10 (CS2, CS4, CS6, CS8, and CS10), 2 using sensitivity encoding with factors of 2 and 4 (SF2 and SF4), and 1 without acceleration as a reference sequence (RS). Five large arteries, 6 medium arteries, and 6 small arteries were evaluated quantitatively (reconstructed signal intensity, structural similarity, contrast ratio) and qualitatively (scores on arteries, artifacts, overall image quality, and diagnostic confidence for aneurysm and stenosis). Comparisons were performed among the 8 sequences.

RESULTS

The quantitative measurements showed that the reconstructed signal intensities of the assessed arteries and the structural similarity consistently decreased as the compressed sensitivity encoding acceleration factor increased, and no significant difference was found for the contrast ratios in pair-wise comparisons among SF2, CS2, and CS4. Qualitative evaluations showed no significant difference in pair-wise comparisons among RS, SF2, and CS2 (P > .05). The visualization of all the assessed arteries was acceptable for CS2 and CS4, while 2 small arteries in images of CS6 were not reliably displayed, and the visualization of large arteries was acceptable in images of CS8 and CS10.

CONCLUSIONS

CS4 is recommended for routine brain TOF-MRA with balanced image quality and acquisition time; CS6, for examinations when small arteries are not evaluated; and CS10, for fast visualization of large arteries.

Krüppel-like factor 6 promotes odontoblastic differentiation through regulating the expression of dentine sialophosphoprotein and dentine matrix protein 1 genes

AIM

To investigate the potential role of Krüppel-like factor 6 (KLF6) in the odontoblastic differentiation of immortalized dental papilla mesenchymal cells (iMDP-3) cells.

METHODOLOGY

Alizarin Red S (ARS) and Alkaline phosphatase (ALP) staining was used to examine the mineralization effect of iMDP-3 cells after odontoblastic induction. Real-time PCR and Western blotting were employed to analyse dentine sialophosphoprotein (DSPP), dentine matrix protein 1 (DMP1), RUNX family transcription factor 2 (RUNX2), ALP and KLF6 expression during this process. Co-expression of the KLF6 with DMP1, DSPP and RUNX2 was detected by double immunofluorescence staining to explore their local relationship in the cell. To further investigate KLF6 functions, Klf6 gain- and loss-of-function assays followed by ARS and ALP stainings, real-time PCR and Western blotting were performed using Klf6-overexpression plasmids and Klf6 siRNA to investigate whether changes in Klf6 expression affect the odontoblastic differentiation of iMDP-3 cells. Dual-luciferase reporter assays were used to elucidate the mechanistic regulation of Dspp and Dmp1 expression by Klf6. Means were compared using the unpaired t-test and Kruskal-Wallis one-way anova with P < 0.05 and P < 0.01 defined as statistical significance levels.

RESULTS

The expression levels of Klf6 (P < 0.01), Dspp (P < 0.05), Dmp1 (P < 0.01), Runx2 (P < 0.01) and Alp (P < 0.01) were significantly elevated during odontoblastic differentiation of iMDP-3 cells. KLF6 was co-localized with DSPP, DMP1 and RUNX2 in the cytoplasm and nucleus of iMDP-3 cells. Overexpression of Klf6 promoted the odontoblastic differentiation of iMDP-3, whereas the inhibition of Klf6 prevented this procession. Dual-luciferase assays revealed that Klf6 upregulates Dspp and Dmp1 transcription in iMDP-3 cells during odontoblastic differentiation.

CONCLUSION

Klf6 promoted odontoblastic differentiation by targeting the transcription promoter of Dmp1 and Dspp. This study may offer novel insights into strategies for treating injuries to dental pulp tissue.

[Clinical analysis of 11 cases of sub-acute arsenic poisoning]

Objective: To investigate the clinical manifestations, treatments and prognosis of subacute arsenic poisoning. Methods: In January 2020, a retrospective analysis was carried out on 11 patients hospitalized with subacute arsenic poisoning caused by arsenic contaminated drinking water. We observed manifestations, treatments and prognosis. Results: The main clinical presentations of subacute arsenic poisoningin were gastroenteritis in early phase, some of them had other organ damage, such as skin, blood, liver, kidney, cardiovascular and so on. The later phase was mainly peripheral nervous system damage. The treatment was mainly to chelate arsenic, protect target organs and treat toxic peripheral neuropathy. Most were significantly recoveried, but the recovery of severe toxic peripheral neuropathy was tardy. Conclusion: Acute gastroenteritis is the mainly early manifestation of subacute arsenic poisoning caused by digestive tract, and toxic peripheral neuropathy in the later phase. The prognosis is good, but the recovery of severe toxic peripheral neuropathy is tardy.

[Epidemiological characteristics of imported COVID-19 cases in Guangzhou]

Objective: To understand the epidemiological characteristics of imported COVID-19 cases in Guangzhou and provide scientific basis for the prevention and control of the disease. Methods: The data of imported COVID-19 in Guangzhou reported as of April 1, 2020 were collected from National Notifiable Disease Report System of China. The software Excel 2010 and SPSS 19.0 were applied for data cleaning and statistical analysis. Results: As of April 1, 2020, a total of 103 imported COVID-19 cases had been reported in Guangzhou, in which 92 were confirmed cases and 11 were asymptomatic infection cases. The number of the confirmed imported cases accounted for 11.4% (92/806) in of the total in China at the same time. The male to female ratio of the cases was 1.58∶1 (63∶40). The median age of the cases was 31 years (P(25)-P(75):22-40 years), range of age was 11-63 years. The main occupational distributions of the cases were business services (41/103, 39.8%) and students (36/103, 35.0%). The imported cases whose destinations were 19 provinces and municipalities rather than Guangdong after entering the country accounted for 43.7%. The main source countries of infections were the United Kingdom (27/103, 26.2%), the Philippines (13/103, 12.6%), the United States (13/103, 12.6%) and Nigeria (7/103, 6.8%). There were 34 inbound flights from which the imported COVID-19 cases were detected, in which 10 flights (10/34, 29.4%) were found to carry more than 3 cases, with an average voyage time of (11.14±0.53) hours. A total of 29 imported cases(28.2%) showed symptoms before entering the country, and 65 cases (63.1%) had been isolated before the onset of the disease. The mean free activity time of the isolated cases after the onset was (6.76±0.79) days. The average number of the imported cases' close contacts was 53. There were 13 clusters of COVID-19 caused by the imported cases, involving 36 cases (including 1 imported associated case). Conclusions: The sources of the imported COVID-19 cases in Guangzhou were widely distributed, and no cases had been found to be infected on the flights. In the early stage of the imported epidemic, there was high risk for the spread of the epidemic. Strengthened prevention and control of imported COVID-19 effectively reduced the of transmission risk of COVID-19 in communities.

[Risk prevention of plague and suggestions for coping in China]

Plague is listed by the WHO as one of 20 infectious diseases that have re-emerged. Plague was prevalent in the world, bringing great disaster to the people around the world. Nowadays, great achievements have been made in the prevention and control of plague in our country. Human plague in China is currently sporadic, but there are still risks of resurgence spread and importation. This paper reviews the incidence of human plague globally and in China in the past ten years, summarizes the characteristics of current plague epidemic globally and in China, analyzes the current risks of plague prevention in China, and puts forward relevant countermeasures.

MicroRNA-579-3p promotes the progression of osteoporosis by inhibiting osteogenic differentiation of mesenchymal stem cells through regulating Sirt1

OBJECTIVE

To explore whether microRNA-579-3P was involved in the development of osteoporosis, and to investigate the possible molecular mechanisms.

PATIENTS AND METHODS

The messenger RNA (mRNA) expression levels of microRNA-579-3P, alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2) and bone sialoprotein (BSP) in serum samples of osteoporosis patients and normal controls were detected by quantitative Real-time polymerase chain reaction (qRT-PCR), respectively. Meanwhile, the expressions of the above genes during osteogenic differentiation of human bone marrow mesenchymal stem cells (hMSCs) were examined as well. To investigate the effect of microRNA-579-3P on osteogenesis, microRNA-579-3P was overexpressed and knocked down in hMSCs. Subsequently, the mRNA and protein expression levels of osteogenesis-related genes, such as ALP, RUNX2 and BSP, were detected by qRT-PCR and Western blot, respectively. In addition, ALP activity and mineralization forming ability were evaluated by ALP staining and alizarin red staining. Bioinformatics predicted that Sirt1 was the target gene of microRNA-579-3P. Subsequent luciferase reporter gene assay was performed to verify the binding relationship of microRNA-579-3P to Sirt1. Meanwhile, qRT-PCR and Western blot were used to detect the changes in the mRNA and protein expression levels of Sirt1, respectively. After overexpression of microRNA-579-3P and Sirt1, qRT-PCR, Western blot, ALP staining and alizarin red staining assays were performed to detect the osteogenic differentiation of hMSCs.

RESULTS

The expression of microRNA-579-3P in serum of patients with osteoporosis was significantly higher than that of normal controls. Meanwhile, the expression of microRNA-579-3P decreased gradually during osteogenic differentiation of hMSCs. Overexpression of microRNA-579-3P significantly reduced the expressions of osteogenic related genes, including ALP, RUNX2 and BSP. Besides, ALP activity and mineralized nodule formation ability decreased obviously as well. Luciferase reporter gene assay showed that microRNA-579-3P could bind to Sirt1. After overexpression of microRNA-579-3P, the mRNA and protein expression levels of Sirt1 were significantly reduced, which were reversed after silence of microRNA-579-3P. Simultaneous overexpression of microRNA-579-3P and Sirt1 could reverse the inhibition of osteogenic differentiation of hMSCs caused by overexpression of microRNA-579-3P alone.

CONCLUSIONS

MicroRNA-579-3P could inhibit osteogenic differentiation of hMSCs by regulating Sirt1, thereby promoting the development of osteoporosis.

Rate of radiation-induced microbleed formation on 7T MRI relates to cognitive impairment in young patients treated with radiation therapy for a brain tumor

BACKGROUND

Radiation therapy (RT) is essential to the management of many brain tumors, but has been known to lead to cognitive decline and vascular injury in the form of cerebral microbleeds (CMBs).

PURPOSE

In a subset of children, adolescents, and young adults recruited from a larger trial investigating arteriopathy and stroke risk after RT, we evaluated the prevalence of CMBs after RT, examined risk factors for CMBs and cognitive impairment, and related their longitudinal development to cognitive performance changes.

METHODS

Twenty-five patients (mean 17 years, range: 10-25 years) underwent 7-Tesla MRI and cognitive assessment. Nineteen patients were treated with whole-brain or focal RT 1-month to 20-years prior, while 6 non-irradiated patients with posterior-fossa tumors served as controls. CMBs were detected on 7T susceptibility-weighted imaging (SWI) using semi-automated software, a first use in this population.

RESULTS

CMB detection sensitivity with 7T SWI was higher than previously reported at lower field strengths, with one or more CMBs detected in 100% of patients treated with RT at least 1-year prior. CMBs were localized to dose-targeted brain volumes with risk factors including whole-brain RT (p = 0.05), a higher RT dose (p = 0.01), increasing time since RT (p = 0.03), and younger age during RT (p = 0.01). Apart from RT dose, these factors were associated with impaired memory performance. Follow-up data in a subset of patients revealed a proportional increase in CMB count with worsening verbal memory performance (r = -0.85, p = 0.03).

CONCLUSIONS

Treatment with RT during youth is associated with the chronic development of CMBs that evolve with memory impairment over time.

[Comparison of epidemic characteristics between severe acute respiratory syndrome and coronavirus disease 2019]

Objective: To compare epidemic characteristics between severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19). Methods: The general information, including epidemiological and clinical data of the confirmed cases during the epidemic period of the two infectious diseases was collected. The data of SARS in Guangzhou was derived from the technical files of Guangzhou Center for Disease Control and Prevention (GZCDC), including the statistical report and brief report of the epidemic situation (from January 2 to May 11, 2003);The data of COVID-19 in Wuhan was derived from the epidemic data published by Wuhan health and Health Committee's official website and other publicly reported documents (from December 9, 2019 to March 11, 2020). Descriptive analysis was used for a comparativeanalysis of the time and age characteristics, the number of cases, basic reproduction number (R0), proportion of medical staff in confirmed cases (%), crude mortality, etc. Results: A total of 1 072 cases of SARS in Guangzhou were included in the study. The incidence ratio of male to female was 1∶1.26. 43 cases of death were reported with a mortality rate of 4.01%. The median age was 36 years old. The proportion of medical staff in the early stage of the epidemic was 29.04% (88 cases). As to COVID-19 in Wuhan, a total of 49 978 cases were included, The incidence ratio of male to female was 1.04∶1. The 2 423 cases of death were reported with a mortality rate of 4.85%. The median age was 56 years old. The proportion of medical staff in the early stage of the epidemic was 30.43% (42 cases). Conclusion: The COVID-19 in Wuhan has the characteristics of high incidence and wide population. However, the epidemic situation is falling rapidly, and the prevention and control strategy needs to be adjusted timely. The prevention and control of nosocomial infection should be addressed in future.