Objective To investigate the changes of non-motor symptoms and quality of life in patients with Parkinson's disease (PD) after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). Methods Questionnaires were conducted among a convenience sample of 45 PD patients who met the indications of STN-DBS in the Functional Neurosurgery Center of Ruijin Hospital,Shanghai JiaoTong University School of Medicine in Shanghai from June 1,2020 to August 31,2020.The Non-motor Symptom Scale (NMSS) and 8-item Parkinson's Disease Questionnaire (PDQ-8) were used to evaluate the patients' non-motor symptoms and quality of life preoperatively and at 3,6,12 and 24-month postoperative visits. Results Generalized estimation equation analysis showed a significant overall change of PDQ-8 and levodopa equivalent daily dose (LEDD) over five follow-up visits ( P＜0.05).Sleep/fatigue,Mood/apathy,Attention/memory,Gastrointestinal,Urinary,Sexual function and Miscellaneous subscores showed a statistically significant decreasing trend ( P＜0.05),while Cardiovascular and Perceptual subscores of NMSS were unchanged ( P>0.05). Conclusion Bilateral STN-DBS has a long-term benefit on sleep/fatigue and urinary symptoms and a short-term benefit on Sleep/fatigue,Mood/apathy,Attention/memory,Gastrointestinal,Urinary,Sexual function and Miscellaneous symptoms in PD patients.Moreover,it can reduce the medication intake and improve the patients' quality of life.

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 study the distribution characteristics of cerebral blood vessels in mice and the spatial relationship with adjacent nerve cells using fast three-dimensional microscopic imaging technology. Methods The adult Tie2-Cre::Ai9 hybrid transgenicmice(C57BL/6) with fluorescent protein labeled vascular endothelial cells were perfused with 4% paraformaldehyde in the heart to obtain complete brain tissue,clearing tissue,andstained the nerve cells of the whole brain.The rapid three-dimensional imaging system (VISoR) was used to obtain the microscopic images of the whole brain vessels and nerve cells in mice with 1×1×3.5 μm ³ voxel resolution,and the two-dimensional image sequence was reconstructed into a three-dimensional whole brain image.Part of cortex,hippocampus and thalamus were selected to segment and extract blood vessels and analyze their morphological characteristics;Automatically identify nerve cells and quantitatively analyze the distribution characteristics of the distance between nerve cells and the nearest blood vessels. Results The three-dimensional images of the distribution of blood vessels and nerve cells in the whole brain of mice were successfully collected.The whole brain view of C57BL/6 mouse's complex vascular network was provided through high-resolution brain atlas.The analysis showed that the density of bifurcation points and the volume fraction of blood vessels in hippocampus were smaller than those in cortex and thalamus,and the difference was statistically significant.The staining of neurons with Nissl stain showed that there were differences in the distribution of blood vessels and nerve cells in different brain regions.In the regions of interest of different brain regions,the distance between neurons and blood vessels was counted,and the results were statistically different. Conclusion The whole brain vessels and neurons of mice can be imaged by fast 3D microscopic imaging technology.Through the quantitative analysis of regional blood vessels and nerves,it was found that there were regional distribution characteristics between blood vessels and nerves in mice.

Objective To investigate the important factors affecting the early prognosis of patients over 75 years old after embolization of ruptured intracranial aneurysm. Methods A retrospective collection of 78 patients with intracranial aneurysm who were admitted to the Department of Neurosurgery of Xiamen Third Hospital from January 2016 to January 2022,all cases were over 75 years old,and relevant clinical data of embolization treatment,including gender,Weight,smoking history,hypertension,diabetes,hyperlipidemia,atrial fibrillation,cerebrovascular disease history,aneurysm location,Hunt-Hess classification,WFNSS classification,CT Fisher classification,etc.The prognosis results were divided into a good outcome group (mRS grade I-II) and a poor outcome group (mRS grade III-V) using the modified Rankin scale (mRS) scale.Statistical analysis of clinical data,screening of independent risk factors that affect the poor prognosis of patients. Results Tatistical univariate analysis showed that,compared with the good prognosis group,the higher the GCS grade,WFNSS grade and Hunt-Hess grade of the poor prognosis group,the worse the relative prognosis,and the difference was statistically significant ( P＜0.05).Logistic regression analysis showed that GCS classification (OR=1.024,95%CI:0.214~4.914, P=0.976),WFNSS classification (OR=9.021,95%CI:2.557~31.824, P=0.001) and Hunt-Hess classification (OR=6.848,95%CI:1.435~32.682, P=0.016) was a prognostic factor.ROC curve analysis showed that the combination of Hunt-Hess classification and WFNSS classification could be used as an important influencing factor for neurological recovery (AUC=0.855),When taking the best cut-off point,the sensitivity was 89.6% and the specificity was 70.0%. Conclusion For the short-term prognosis of ruptured intracranial aneurysm interventional embolization in people over 75 years old,the combination of Hunt-Hess classification and WFNSS classification is more valuable than other factors.

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 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 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 observe the effect of 3D-slicer software combined with microscope small bone window operation on hypertensive basal ganglia intracerebral hemorrhage. Methods The clinical data of 66 patients with hypertensive basal ganglia intracerebral hemorrhage treated in our hospital from August 2019 to August 2021 were analyzed retrospectively.According to the treatment plan,they were divided into 3D-slicer software combined with microscope group small bone window operation group(observation group n=35) and microscope small bone window operation group(control group n=31).According to the analysis of the results,the operation time,intraoperative bleed loss,incidence of postoperative complications,hematoma clearance rate,length of hospital stay and GOS,GCS and ADL scores 90 days after operation were compared between the two groups. Results The operation time,intraoperative blood loss,length of hospital stay and incidence of postoperative complications in observation group were significantly lower than those in control group ( P<0.05).The hematoma clearance rate of observation groupwas better than thatincontrol group ( P<0.05);90 days after operation,the GOS,GCS and ADLscores of observation group were better than those incontrol group ( P<0.05). Conclusion 3D-slicer software can better help locate the hematoma,clarify the blood vessels and nerve conduction bundle around the hematoma,and guide the operation to avoid important blood vessels and nerve conduction bundle.3D-slicer software can help operators find the shortest and optimal surgical path,effectively shorten the operation time,reduce the amount of intraoperative bleeding,reduce the length of hospital stay,reduce the incidence of postoperative complications,Improve the prognosis 90 days after operation,improve the clinical prognosis,and better restore self-care.

Objective Exploring the therapeutic effects,imaging,and therapeutic mechanisms of a rechargeable and remotely programmable 3.0T MRI compatible deep brain stimulation system in patients with Parkinson's disease after subthalamic nucleus stimulation surgery. Methods Analyze the clinical data of one Parkinson's patient treated with the world's first rechargeable and remote 3.0T MRI compatible deep brain stimulation system at the Neurosurgery Department of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) on October 10,2022.Follow up data for one year will be analyzed.3.0T cranial magnetic resonance imaging was performed 1 week and 1 year postoperatively to evaluate clinical symptoms,magnetic resonance imaging,and stability of electrode impedance. Results From 4 weeks after surgery to 1 year of follow-up,the improvement rates of exercise (UPDRS-III and UPDRS-IV were 95.31% and 75.00%,respectively) and non exercise symptoms (NMSS,PDSS,PDQ39,MoCA,HAMA,HAMD,CCS improvement rates were 85.42%,24.53%,91.23%,7.14%,84.61%,100.00%,57.14%,respectively) were significantly improved,and the dosage of medication was reduced (LED decreased by 34.61%),with stable stimulation parameters.3.0T magnetic resonance imaging examination (T1,T2,3DT1,DTI,rs fMRI) showed normal imaging,and the structural image could clearly display the position of electrodes and nuclei.Functional magnetic resonance imaging indicated increased local neuronal activity and enhanced brain functional connectivity in the turned on state.The electrode impedance during the inspection process is stable and no adverse events have occurred. Conclusion The application of 3.0T MRI compatible deep brain stimulation equipment in the surgical treatment of Parkinson's disease patients has a definite effect,while improving the accuracy of postoperative imaging evaluation.It is of great value for exploring the imaging mechanism of deep brain stimulation treatment for Parkinson's disease.

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 study the effect of neuroendoscopy on postoperative neurological function after surgical treatment of cerebral hemorrhage. Methods This study selected 60 patients with cerebral hemorrhage admitted to our hospital from January 2023 to January 2024 as the research subjects.They were randomly divided into a control group and an observation group,with 30 patients in each group.The control group received surgical treatment,while the observation group received neuroendoscopic intracranial hematoma removal surgery. Results When using neuroendoscopy to treat patients with cerebral hemorrhage,the neurological function scores of the observation group were better than those of the control group at 1 month and 3 months after surgery ( P＜0.05).The incidence of postoperative complications (intracranial infection,postoperative rebleeding,and communicating hydrocephalus) in the observation group was lower than that in the control group,and the difference was statistically significant.The ADL (daily living ability) score of the observation group was also better than that of the control group at 1 and 3 months after surgery ( P＜0.05). Conclusion Neuroendoscopic removal of intracranial hematoma has achieved significant results in improving the postoperative neurological function of patients.