[The efficacy and safety of domestic magnetic resonance-guided laser interstitial thermotherapy in the treatment of recurrent high-grade glioma]

Sixteen patients with recurrent high-grade glioma who were treated by domestic magnetic resonance-guided laser interstitial thermotherapy (MRgLITT) in the Neurosurgery Department of Xuanwu Hospital of Capital Medical University from 1st January 2021 to 31st December 2021 were prospectively included, with 11 males and 5 females, and aged 27-74 (50±16) years. The duration of surgery, the rate of ablation after surgery, and perioperative complications were assessed. The patients were followed up every 3 months to assess survival and progression. A total of 5 WHO grade Ⅲ patients and 11 WHO grade Ⅳ patients were included. The operation time was 144 (109, 176) min, 28 targeted lesions were detected, and the ablation rate [M (Q1, Q3)] was 91.0% (87.4%, 93.3%). After surgery, 2 patients (2/16) had decreased limb muscle strength, and no perioperative death or other serious complications occurred. The median time to a complete response was 12 (5, 14) months in WHO Grade Ⅲ patients, and one died 12 months after surgery, while the median time to a complete response was 3 (1, 8) months in 11 WHO Grade Ⅳ patients, with a total of 8 deaths at the last follow-up. Therefore, domestic MRgLITT has certain efficacy and safety in the treatment of recurrent high-grade glioma, providing a new option for patients with recurrent glioma.

[Observation of efficacy and safety of stereotactic-EEG-guided three-dimensional radiofrequency thermocoagulation for the treatment of drug-resistant insular epilepsy]

Objective: To investigate the safety and efficacy of stereotactic-EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) with three-dimensional lesioning in the treatment of drug-resistant insular epilepsy. Methods: Seven patients with drug-resistant insular epilepsy who underwent SEEG-guided RF-TC with three-dimensional ablation at the Department of Neurosurgery of Xuanwu Hospital, Capital Medical University from February 2017 to June 2019 were retrospectively enrolled. Presurgical evaluation including semiology, EEG and imaging results suggested that the epileptogenic zone was located in the insular lobe. All patients underwent SEEG recording and three-dimensional RF-TC. Postoperative follow-up was conducted by outpatient visits or telephone, the clinical efficacy was evaluated based on Engel classification and the relevant complications were documented. Results: Seven patients were followed up at 18 months after surgery. Among them, 4 were seizure free (Engel ⅠA), 2 had nondisabling simple partial seizures (Engel ⅠB) and 1 achieved 75% decrease (Engel ⅢA) in seizure frequency. Postoperative complications occurred in 3 patients which included decreased sensation in the right lower extremity, decreased strength in the right upper extremity, glossolalia, decline in memory and comprehension. No permanent neurological dysfunction was detected. Conclusion: SEEG-guided RF-TC with three-dimensional lesioning is minimally invasive, safe and effective in the treatment of drug-resistant insular epilepsy and can serve as a complementary method for resection surgery.

[Safety and short-term efficacy of domestic magnetic resonance-guided laser interstitial thermotherapy in the treatment of drug-resistant epilepsy]

Objective: To investigate the safety and short-term efficacy of domestic magnetic resonance-guided laser interstitial thermotherapy (MRgLITT) in the treatment of drug-resistant epilepsy. Methods: Patients with drug-resistant epilepsy treated with a domestic MRgLITT system in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from October 2020 to April 2021 were prospectively enrolled. The damage volume ratio was assessed immediately after surgery, and perioperative complications were recorded and followed up. The clinical safety and short-term efficacy were evaluated using the Engel classification. Results: A total of 22 patients were included, including 12 males and 10 females, aged from 3 to 45 years old [(24±13) years]. There were 5 cases of medial temporal lobe epilepsy (MTLE), 3 cases of hypothalamic hamartoma (HH), 7 cases of focal cortical dysplasia (FCD), and 7 cases of other types, respectively. The mean operation time and blood loss was (173±49) min and (3.7±1.6) ml. The postoperative length of hospital stay was (5.5±1.8) days, and the average damage volume ratio was 92.6%. Among them, only 2 patients (FCD of the parietal lobe) showed transient contralateral limb weakness, without any serious complications such as symptomatic intracranial hemorrhage and cerebral infarction. The follow-up time was 14 to 168 days. There were 13 Engel class Ⅰ cases (59.1%), 2 Engel class Ⅱ cases (9.1%), 2 Engel class Ⅲ cases (9.1%) and 5 Engel class Ⅳ cases (22.7%), respectively. Short-term incident-free rates were MTLE 5/5and FCD4/7, respectively. Conclusion: Domestic MRgLITT system is stable, reliable and safe in the treatment of drug-refractory epilepsy, and has better short-term efficacy in MTLE and FCD patients.

[Epilepsy precision treatment towards brain-networks oriented epilepsy surgery]

Epilepsy is a common neurological disease that seriously affects the health of the human population. The treatment of epilepsy has always been an important direction in the field of neurosurgery. New epilepsy theories and surgical treatment techniques contribute new direction of epilepsy surgical treatment in the future. This article aims to review the therapeutic advances in the treatment of epilepsy, including project of the brain networks, epileptic networks, the construction of epilepsy brain networks, and to explore the new branch of epilepsy surgery (brain-networks oriented epilepsy surgery), thereby providing a new precision treatment method for epileptic patients.

[Studies on asymmetric synthesis of R-phenylethanolamine by whole cells of Arachnia sp. P163]

Effects of various factors on asymmetric synthesis of R-phenylaminoethanol from aminoacetophenone by the whole cells of Arachnia sp. P163 producing alcohol dehydrogenase for phenylethanol amine was investigated. It found that, although the reduction was inhibited by the substrate and the product, but it has the very high stereoselectivity. The reduction was normaly carried out with 2% glucose for reproduction of coenzyme in the reaction system without oxygen. The conversion yield and ee value of the product achieved 65% and 100%, respectively.

Urethral obstruction and bilateral ureteral hydronephroses secondary to fecal impaction

We present a case report of the first adult woman reported to suffer from both urethral obstruction and bilateral ureteral hydronephroses secondary to fecal impaction. The work-up suggested that hypothyroidism might be the cause for fecal impaction. Urinary tract obstruction caused by hypothyroidism-induced fecal impaction has never been reported. Fecal impaction should be considered as one of the causes for urinary tract obstruction.

Cytomegalovirus pneumonitis as an initial presentation in an HIV-infected patient

Human immunodeficiency (HIV) infection often presents with an unusual symptom complex. Although cytomegalovirus (CMV) is a frequent opportunistic infection in the late stage of acquired immunodeficiency syndrome (AIDS), CMV pneumonitis as an initial manifestation of HIV infection is not documented in the medical literature. We report a previously healthy patient with bilateral interstitial pulmonary infiltrates who was found to have CMV pneumonitis; only later was HIV virus infection diagnosed. Cytomegalovirus is a frequently isolated pathogen from respiratory secretions in AIDS patients. The role of CMV as a sole pulmonary pathogen is controversial. After exclusion of other pathogens, CMV was demonstrated by histological changes and viral culture in our case. This case indicates that pulmonary infiltrates presenting as the first manifestation of HIV infection can be caused by CMV infection.

[Non-operative regions extradural hematoma: a review of 5 cases]

The authors report five patients who developed non-operative regions extradural hematoma following removal of intracranial tumors (3 cases) or cystiform diseases (2 cases). 3 cases developed on the left hemicerebrum. 2 cases formed on the bilateral. 4 cases were supratentorial operations, one inferior tentorial. The causative mechanisms of hematoma formation were attributed to a rapid fall in intracranial pressure, an increased blood velocity and the patient's position during the operation. Unexplained cerebral swelling during operation or delayed post-operative recovery should be intensely investigated by CT scanning. An emergency operation is indicated when the hematoma volume is more than 30ml.

[Observation of the ultrastructure of smooth-muscle cells in the narrow segment of the ureter in children with congenital hydronephrosis]

The smooth-muscle cells of narrow segment in the ureter with congenital hydronephrosis in 5 cases were studied by transmission electron microscope. The result showed that the smooth-muscle cells of the narrow segment lack of myofilaments, dense body and dense patch in cells membrane. The above mentioned structures are functional deficient basis of the smooth-muscle cells in the ureter. Its deficiency results in the poor peristalsis function of the narrow segment of the ureter in congenital hydronephrosis. The cause and treatment principle in congenital hydronephrosis were discussed.