Objective To analyze the occurrence of second primary malignancies (SPM) in patients with glioma and identify their risk factors. Methods Cases of glioma patients diagnosed from January 2000 to December 2021 were collected from the Surveillance,Epidemiology,and End Results (SEER) database.A retrospective analysis was performed on patients' demographic characteristics,clinical features,and SPM occurrence,using univariate and multivariate Cox regression analysis to identify risk factors. Results A total of 87,889 glioma patients were screened from the SEER database,with 1,043 developing SPM.The median overall survival (OS) for patients with SPM was 105.0 months.The most common sites for SPMs were the breast (34.08%),lung and bronchi (11.27%),and thyroid (10.99%).Multivariate Cox regression analysis showed that age (≥65 years:HR=3.047,95% CI:2.570~3.613, P＜0.001),pathology (glioblastoma:HR=2.091,95% CI:1.793~2.438, P＜0.001),and radiotherapy (HR=1.489,95% CI:1.276~1.736, P＜0.001) were independent risk factors for the occurrence of SPM. Conclusion Breast,lung and bronchi,and thyroid are the most common sites of SPM in glioma patients.Age,pathology,and radiotherapy are significant risk factors for SPM occurrence.Identifying these risk factors can guide personalized follow-up and screening for SPM in glioma patients.

Objective To investigate the expression changes of GLDN (Gliomedin) in glioblastoma (GBM) tissues and cell lines,and its impact on patient prognosis. Methods By conducting further mining and analysis of sequencing data from previously published studies on glioblastoma multiforme (GBM) drug resistance within our research group,we downloaded the GSE113510 mRNA sequencing data from the international GEO database,GLDN was identified as the gene with the most significant differential expression.The expression differences of GLDN between primary and recurrent GBM tissues were analyzed using the CGGA database.GLDN mRNA levels in GBM cell lines were measured by quantitative real-time PCR,and protein levels were detected by Western blotting.Survival analysis using the CGGA and TCGA databases was conducted to examine the relationship between GLDN expression and patient prognosis. Results Analysis of the GSE113510 dataset revealed that GLDN exhibited the most significant differential expression in drug-resistant GBM cell lines.GLDN expression was significantly higher in recurrent GBM tissues compared to primary GBM tissues ( P＜0.05).Additionally,GLDN expression was markedly elevated in drug-resistant cell lines 229R,251R,and HG7R compared to their non-resistant counterparts ( P＜0.05).Survival analysis showed that high GLDN expression was associated with poorer patient prognosis,with a significantly shorter survival time. Conclusion GLDN is highly expressed in glioblastoma and is closely associated with drug resistance and poor prognosis.It may serve as a potential therapeutic target in GBM treatment.

Objective To investigate the changing pattern of platelet activation indexes in hypertensive cerebral haemorrhage (HICH) patients and its correlation with prognosis. Methods A retrospective analysis of 113 patients with HICH who attended our hospital from August 2021 to October 2023 were divided into a good group ( n=70) and a poor group ( n=43) based on their prognosis at 3 months after admission.General data of patients were collected,and platelet activation indices [pgranule membrane protein 140 (CD62P),Circulating platelet membrane glycoproteins (CD42b),platelet membrane glycoprotein II b/III a fibrin original receptor (PAC-1),Lysosomal Associated Membrane Protein 3 (CD63),platelet-activating factor (PAF)],neurological function [neuron specific enolase (NSE),brain-derived neurotrophic factor (BDNF),neuropeptide Y (NPY)],neurological function [neuron specific enolase (NSE),brain-derived neurotrophic factor (BDNF),neuropeptide Y (NPY) ],neurological function [neuron-specific enolase (NSE),brain-derived neurotrophic factor (BDNF),neuropeptide Y (NPY)],and vascular endothelial function [nitric oxide (NO),endothelin-1 (ET-1)] levels.Pearson's correlation equation was used to analyse the correlation between platelet activation indices at admission and the levels of neurological and vascular endothelial function;logistic regression equations were used to analyse the risk factors affecting the prognosis of patients with HICH;and dose-response relationship between the prognosis of patients with HICH and the levels of platelet activation indices at admission was analysed using a restricted cubic spline model;ROC curve analysis was used to assess the predictive value of platelet activation indices at the time of patient admission for the prognosis of patients with HICH. Results CD62P,CD42b,PAC-1,CD63,PAF,NSE,BDNF,NPY,NO,and ET-1 were statistically significant between groups,time points,and interaction differences( P<0.05).With the growth of time,the levels of CD62P,PAC-1,CD63,PAF,NSE,and ET-1 showed a decreasing trend in the two groups,and the levels of CD62P,PAC-1,CD63,PAF,NSE,and ET-1 were significantly lower than those of the control group in the patients of the good group at all time points ( P<0.05);with the growth of time,the levels of CD42b,BDNF,NPY,and NO in the two groups showed an increasing trend,and the levels of CD42b,BDNF,NPY,and NO at all time points in the patients in the good group were significantly higher than those in the control group ( P<0.05).The results of logistic regression equations showed that bleeding site,CD62P,CD42b,PAC-1,CD63,PAF,NSE,BDNF,NPY,NO,and ET-1 levels at the time of admission of HICH patients were risk factors affecting the prognosis of HICH.Restricted cubic spline analysis showed a linear dose-response relationship between the levels of CD62P,CD42b,PAC-1,CD63,and PAF at admission and the prognosis of patients with HICH ( P<0.05).The results of ROC curve analysis showed that the levels of CD62P,CD42b,PAC-1,CD63,PAF at admission and the combination of the five had some predictive efficacy for the prognosis of HICH patients,and the diagnostic efficacy of the combination of the five was the best,with an AUC of 0.978;among the unifactorial predictions,the efficacy of PAC-1 was the best,with an AUC of 0.898. Conclusion The platelet activation level and the levels of neurological function and vascular endothelial function of HICH patients showed an improvement trend with the increase of treatment time,and the platelet activation level of HICH patients at the time of admission is a risk factor affecting the prognosis of the patients,which can be monitored during clinical diagnosis and treatment and may be helpful to improve the prognosis of HICH patients.

Objective To explore the safety and efficacy of propranolol,an adrenergic receptor inhibitor,in the treatment of severe traumatic brain injury(TBI) patients. Methods This study is a phase II,single center,double-blind,randomized controlled trial that enrolled patients with severe TBI(intracranial hemorrhage and Glasgow Coma Scale ≤8) within 24 hours of admission to our ICU from March 2022 to January 2024.The patient was randomly treated with propranolol or placebo for 7 days.The primary outcome was ventilator free days(VFDs) at 28 days.Secondary outcomes included catecholamine levels,ICU length of stay,and in-hospital mortality. Results There were no significant differences in gender distribution,age,Injury Severity Score(ISS),Sequential Organ Failure Assessment(SOFA),and Marshall CT grading distribution between the two groups,indicating comparability of baseline data.There was no significant difference in the average number of days without ventilators(VFD) between the treatment group and the placebo group(treatment group:14.2±5.3 days vs.placebo group:14.5±5.6 days)( t=0.277, P=0.783).In addition,there were no statistically significant differences in secondary outcomes such as plasma catecholamine levels,ICU length of stay(treatment group:20.5±7.3 days vs.placebo group:20.9±7.9 days)( t=0.264, P=0.792),and in-hospital mortality rate(treatment group:15.7% vs.placebo group:24.0%)( χ ²=1.099, P=0.295) between the two groups before and after treatment.The median survival time in the placebo group was 309 days,while the median survival time in the propranolol group was not achieved.There was significant difference in survival rate between the two groups(HR=0.453, P=0.043).During the treatment period,neither group experienced any cardiac complications or other serious adverse events.One patient in the treatment group developed temporary bradycardia,which did not require intervention and continued drug use.No patient withdrew from the study due to adverse reactions. Conclusion The use of propranolol for adrenergic blockade treatment of severe traumatic brain injury is safe and feasible,and brought significant survival benefits to patients.

Objective To explore the therapeutic effect of deep brain stimulation on non-motor symptoms and quality of life in patients with Parkinson's disease. Methods A total of 413 patients with Parkinson's disease admitted to our hospital from November 2021 to June 2024 were retrospectively selected and divided into the conservative group (201 cases) and the surgical group (212 cases) based on the treatment plan.The conservative group received conventional drug treatment,while the surgical group received deep brain stimulation on the basis of conventional drugs.The treatment effects were evaluated by comparing the non-motor symptoms,quality of life,and levels of biochemical indicators such as malondialdehyde and uric acid before and after treatment in both groups. Results Six months after treatment,the scores of non-motor symptoms such as depression and anxiety,dizziness and falls,cognition,and sleep fatigue in both groups were lower than those before treatment,and the improvement in the surgical group was significantly better than that in the conservative group ( P＜0.05).The PDQ-39 scores and the levels of MDA and UA in both groups were lower after treatment than before treatment,and the reduction in the surgical group was more significant than that in the conservative group ( P＜0.05). Conclusion The implementation of deep brain stimulation intervention in patients with Parkinson's disease can effectively alleviate non-motor symptoms,reduce oxidative stress levels,and improve quality of life,providing clinical evidence for the optimization of comprehensive management strategies for Parkinson's disease patients.

Objective To evaluate the safety and efficacy of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for focal epilepsy in a non-magnetic resonance (MR)-compatible operating room setting. Methods We retrospectively analyzed the clinical data of 62 patients with focal epilepsy who underwent MRgLITT in the Department of Neurosurgery at Tsinghua University Yuquan Hospital between November 2020 and January 2024.The cohort was stratified into four groups according to pre-LITT surgical history:Group 1 (direct MRgLITT),Group 2 (MRgLITT preceded only by intracranial electrode implantation),Group 3 (MRgLITT preceded only by resection of the epileptogenic zone),and Group 4 (MRgLITT preceded by both electrode implantation and resection).Follow-up continued until March 1,2025,with outcomes and complications analyzed. Results A total of 74 MRgLITT procedures were performed (53 patients underwent 1 session,9 underwent ≥2 sessions).Anesthesia included nerve block/local anesthesia (15 procedures) and intravenous anesthesia (59 procedures).At the last follow-up (median:32 months;range:13~48 months post-treatment),the seizure-free rate (ILAE Class 1) was 54.8%,and the responder rate (ILAE Classes 1-3) was 66.1%.Significant differences in seizure-free rates were observed among the four groups ( P＜0.001).After Bonferroni correction,Group 1 showed significantly higher seizure-free rates than Group 3 ( P=0.002) and Group 4 ( P＜0.001),but no statistically significant difference versus Group 2 ( P=0.023 > 0.0083).No significant difference in seizure-free rates was found between focal cortical dysplasia and tuberous sclerosis complex subgroups (56.7% vs.60.0%; χ ²=0.062, P=0.803).Complications included intraoperative fiber breakage (1 cases),transient hemiparesis (5 cases),asymptomatic hemorrhage (1 case,managed conservatively),transient hyponatremia (1 case),and transient hypoxemia (2 cases).No postoperative infections or deaths occurred. Conclusion MRgLITT can be safely and effectively performed for focal epilepsy in a non-MR-compatible operating room setting,with favorable outcomes in patients with well-defined,localized epileptogenic foci.

Objective To investigate the risk factors for cerebral infarction as the initial symptom in patients with ischemic moyamoya disease(MMD) so as to identify and prevent it early. Methods The clinical data and initial blood test indicators of 423 patients with ischemic MMD admitted to Anhui Provincial Hospital from May 2015 to January 2022 were retrospectively collected.The clinical data and blood test indicators of the patients were analyzed statistically by SPSS 26.0 and R 4.3.0 software,including univariate risk factor analysis and multivariate Logistic regression analysis to find the independent risk factors and establish a clinical prediction model. Results Smoking,platelet,systolic blood pressure,and high-density lipoprotein(HDL) were the independent risk factors for cerebral infarction as the initial symptom in patients with ischemic MMD.A logistic regression prediction model was established,and the area under the ROC curve was 0.712,which was further validated by ROC curve,calibration curve,and clinical decision curve(DCA).The prediction model has a certain predictive value for cerebral infarction as the initial symptom in patients with ischemic MMD. Conclusion The developed ROC chart has reference value and clinical application value for clinicians to predict the initial symptom of cerebral infarction in patients with ischemic moyamoya disease.

Objective To analyze the factors that may affect the cognitive status of patients with secondary-epilepsy with Sturge-Weber syndrome(SWS) and improve the understanding of this disease. Methods The clinical data of 10 patients who underwent preoperative evaluation with secondary epilepsy of SWS in the Epilepsy Center of Yuquan Hospital of Tsinghua University were retrospectively analyzed,including age at seizure onset,age at seizure onset,age at seizure onset,age at seizure onset,age at seizure onset,age at seizure onset,age at seizure onset,age at seizure onset.ASO),duration of epilepsy,type of SWS,range of leptomeningeal capillary malformation(LCM),type of epilepsy,history of epileptic state and cluster state,etc.According to the number of epileptoid discharges in the interseizure period,EEG scores were performed(0~3 points).The number of lobes involved in LCM was determined by Magnetic resonance imaging(MRI).Epileptic seizure status score(0~3) within 1 year prior to preoperative evaluation;All patients underwent cognitive assessment(0~3 points).Griffiths scale was used for those <8 years old at the time of preoperative assessment,and Wechsler Intelligence Scale for Children was used for those >8 years old. Results Ten patients were continuously included,and the median age of onset of epilepsy was 7.5 months.The correlation coefficient between age of onset of epilepsy and cognitive assessment was 0.36( P=0.31).The correlation coefficient between epilepsy duration and cognitive evaluation was -0.46( P=0.18).The correlation coefficient between the number of affected lobes and cognitive assessment was 0.66, P=0.04,indicating that the range of LCM was positively correlated with cognitive impairment.The correlation coefficient between seizure score and cognitive evaluation was 0.67( P=0.04),which was statistically significant,suggesting a positive correlation between seizure frequency and cognitive impairment. Conclusion Epilepsy in patients with SWS starts at an early age and is at a critical stage of nervous system development,which may adversely affect cognitive outcomes.The larger the LCM range and the higher the seizure frequency of SWS patients,the worse the cognitive outcomes of patients.Therefore,early control of seizures in SWS patients and reducing the frequency of seizures may play an important role in improving the cognitive level of patients.

Objective To investigate the changes and significance of resting EEG power spectral density and coherence in patients with migraine (MP). Methods 45 patients with interphase migraine without aura diagnosed in the outpatient of Neurology department of the First Affiliated Hospital of University of Science and Technology of China from January 2022 to June 2022 were included in the migraine group (MP) and 45 healthy subjects in our hospital during the same period were included in the control group (HC).The resting state EEG signals and related clinical indexes were collected.The EEG power spectral density and coherence at different frequency bands δ(1-3.9Hz),θ(4-7.9Hz),α(8-12.9Hz) and β(13-29.9Hz) of 19 channels in the two groups were calculated,and the statistical differences of the above indexes were compared between the two groups. Results Power spectrum analysis showed that compared with HC group,EEG power spectrum density of δ band in FP1 and FP2 channels in MP group decreased,and all channels in θ,α and β bands in MP group were decreased,and the differences were statistically significant (correction P＜0.05).Compared with HC group,the average EEG power spectral density of the whole brain in θ,α and β bands except for the δ band were significantly decreased in MP group,and the differences were statistically significant (correction P＜0.05).Coherence analysis showed that there are a large number of edges with weakened connection on the frontal parietal temporal occipitoparietal in θ,α and β bands in MP group,while there are a few weakened edges in δ band.The differences were statistically significant (correction P＜0.05).There is no edge with enhanced connection in δ,θ,α and β bands in MP group.(correction P＞0.05). Conclusion There are abnormalities of EEG power and coherence in migraine patients.It provides new insight for diagnosis and treatment of Migraine in future.

Objective To explore the spatio-temporal characteristics of electroencephalogram (EEG) in patients with focal epilepsy and its correlation with drug resistance. Methods A total of 123 patients with focal epileptic seizures who underwent electroencephalogram (EEG) examination in our hospital from January 2020 to July 2022 were selected for this study.According to whether they were resistant to drug,they were divided into a drug-resistant group (45 cases) and a sensitive group (78 cases).The clinical data and electroencephalogram (EEG) spatio-temporal characteristics were compared between the drug resistance group and the sensitive group.Multivariate logistic regression was used to analyze the influencing factors of drug resistance in patients with focal seizures.The structural equation prediction model was established and verified. Results The total EEG energy and the level of EEG seizures in the sensitive group were significantly higher than those in the resistant group ( P＜0.001).The proportion of α energy in the sensitive group was significantly lower than that in the drug-resistant group ( P=0.015),and the proportion of γ energy was significantly higher than that in the drug-resistant group ( P＜0.001).The course of disease ≥10 years,seizure frequency≥4 times/month,poor initial treatment effect,temporal lobe origin,stroke history,abnormal neurophysiological seizure,and epileptic discharge after treatment were independent risk factors for drug resistance in patients with focal epilepsy ( P<0.05).The overall fitness of the structural equation model was better,which could well reflect the relationship between various influencing factors and the occurrence of drug resistance in patients with focal epilepsy.The convergent validity and combined reliability of the model were good.The course of disease≥10 years,seizure frequency≥4 times/month,poor initial treatment effect,temporal lobe origin,stroke history,abnormal neurophysiological seizure,and epileptic discharges after treatment are independent risk factors for drug resistance in patients with focal epilepsy.There are characteristic differences in the power spectrum of EEG between drug-resistant focal epilepsy patients and sensitive focal epilepsy patients. Conclusion The course of disease≥10 years,seizure frequency≥4 times/month,poor initial treatment effect,temporal lobe origin,stroke history,abnormal neurophysiological seizure,and epileptic discharges after treatment are independent risk factors for drug resistance in patients with focal epilepsy.There are characteristic differences in the power spectrum of EEG between drug-resistant focal epilepsy patients and sensitive focal epilepsy patients.

Objective To reconstruct the corresponding structures of the lumbar spine and to demonstrate virtual simulation of lumbar puncture using a three-dimensional visualization model,aiming to provide a new learning method for lumbar puncture and thus improve the learning outcomes. Methods By downloading the original enhanced CT tomography dataset of a whole abdomen provided by An Image Open Data Collection and post-processing it by using the open-source 3D Slicer software.The structures of the spinal cord,spinal arachnoid membrane,spinal dura mater,vertebra and other structures were sequentially reconstructed,a virtual simulation of lumbar puncture was performed with the help of the virtual puncture module. Results The visualization model of the lumbar spine was successfully reconstructed,we can adjust the color and transparency of the model can clearly display the lumbar spine and its adjacent structures.With the help of the virtual puncture module,virtual simulation puncture of lumbar puncture surgery can be performed,dynamically displaying the structure and adjacent relationships of the puncture needles in sequence. Conclusion By utilizing open-source 3D Slicer software,a visualization model of the lumbar spine can be reconstructed,and in combination with the virtual puncture technique,the relationship between the virtual puncture needle and the adjacent structures can be demonstrated,and the insertion position,angle,depth and optimal puncture path of the virtual simulation puncture needle can be dynamically displayed.aiming to provide a new means of learning lumbar puncture and thus improve the learning effect.The aim is to provide a new learning method for lumbar puncture surgery,thereby improving the learning effect.

Objective To investigate the surgical outcome and its predictors in patients with cerebral cavernous malformation (CCM)-related epilepsy. Methods Patients with CCM-related epilepsy (CRE) who underwent resective surgery at our epilepsy center from January 2012 to December 2021 were collected,and their demographic and clinical data were retrospectively analyzed to identify potential predictors of surgical outcome using univariate analysis and multivariable logistic regression analysis. Results A total of 71 patients with CRE were included.Postoperative outcome was graded according to Engel class:78.9% (56/71) as Engel class I;21.1% (15/71) as Engel class II-IV,with a mean follow-up of 71.7±35.2 months (12~124 months).Univariate analysis showed that epilepsy duration,distribution of interictal epileptiform discharges and seizure frequency were associated with surgical outcome,whereas the location and number of CCMs were not associated with outcome,and multivariable logistic regression analysis showed that only epilepsy duration was an independent predictor of postoperative outcome (OR=0.928,95% CI 0.861-0.999, P=0.046). Conclusion Patients with CRE have good long-term surgical outcomes with resective surgery,and short epilepsy duration independently predicts good surgical outcomes;therefore,early surgical treatment of patients with CRE is recommended.