Objective: To investigate the relationship between hypoxia and in vitro “stemness” of cancer stem cells (CSCs). Methods: U87 cells, U251 cells and primary glioma cells (n=3) experienced hypoxia. Transmission electron microscopy was done to detect the ultrastructure of these cancer cells; MTT assay to detect the cell growth; flow cytometry to detect cell cycle and CD133 expression; Transwell chamber assay was carried out to detect the cell migration; colony-forming assay to detect the colony-forming efficiency; real-time quantitative PCR and Western blot were carried out to detect the mRNA and protein expression of markers of stem cells and their differentiation, respectively. Results: Hypoxia maintained the undifferentiated state of primary glioma cells, slowed down the growth of glioma cells which were in a relatively quiescent stage, increased the colony forming efficiency and migration of glioma cells, and elevated the expression of markers of stem cells, but the expression of markers for stem cell differentiation was reduced after hypoxia treatment. Conclusion: Hypoxia may induce the "dedifferentiation" of differentiated glioma cells which then acquire the stemness.

Tim-3 acts as a negative regulatory molecule and plays a critical role in immune tolerance. The purpose of this study was to investigate the expression of Tim-3 on peripheral CD4⁺ and CD8⁺ T cells in glioma. A total of 30 newly diagnosed glioma patients and 30 healthy controls were recruited and leukocytes from peripheral blood mononuclear cells were analyzed for Tim-3 surface expression by flow cytometry. Plasma tumor necrosis factor-alpha (TNF-α) was also measured. Data showed that expression of Tim-3 was significantly increased in both CD4⁺ and CD8⁺ T cells in glioma patients than in controls (p<0.001 and p<0.001, respectively). Patients with a higher tumor grade revealed further elevated Tim-3 expression in CD8⁺ T cells compared with those with a lower tumor grade. Also, the Karnofsky score of patients was negatively correlated with the percentage of Tim-3⁺CD8⁺ T cells in glioma patients (p=0.007). In addition, an inverse correlation was observed between the plasma level of TNF-α and Tim-3⁺CD4⁺ T cells (p=0.005) or Tim-3⁺CD8⁺ T cells (p<0.001) in glioma patients. Our results suggested that Tim-3 may be involved in the development of glioma.

Since the 1990s, China has experienced a boom in epilepsy surgery. Five cities have established epilepsy centers, and at least one hospital in each of the 32 provinces provides epilepsy surgical services. Epilepsy surgery in China has benefited from the availability of advanced non‐invasive diagnostic tools to delineate epileptogenic lesions and epilepsy functional deficits, increased medical and social acceptance of epilepsy surgery, and collaborations with the International League Against Epilepsy, the International Bureau for Epilepsy, and international epilepsy centers. However, national demand for epilepsy surgery still far exceeds supply, and epilepsy surgery is underutilized in many economically underdeveloped provinces. This paper analyzes the current progress of epilepsy surgery in China and details necessary steps for future development. Specifically, the growing need for standardized quality control, multidisciplinary research, and continued worldwide collaboration is addressed. Surgical therapy for epilepsy has experienced rapid growth in recent years, but many patients with active epilepsy did not receive appropriate treatment in China. Improved epilepsy education remains an important tool to correct the treatment gap. Epilepsy surgery has rapidly grown in China. The establishment of additional epilepsy centers, enhancement of multidisciplinary cooperation, standardization of surgical indications and techniques, increased public education, and government recognition of epilepsy treatment as a medical priority are interventions that will improve the surgical treatment of people with epilepsy in China.

BackgroundMultiple basilar skull fracture and cerebrospinal leak are common complications of traumatic brain injury, which required a surgical repair. But due to the complexity of basilar skull fracture after severe trauma, preoperatively an exact radiological location is always difficult. Multi-row spiral CT and MRI are currently widely applied in the clinical diagnosis. The present study was performed to compare the accuracy of cisternography by multi-row spiral CT and MRI in the diagnosis of cerebrospinal leak.MethodsA total of 23 patients with multiple basilar skull fracture after traumatic brain injury were included. The radiological and surgical data were retrospectively analyzed. 64-row CT (mm/row) scan and three-dimensional reconstruction were performed in 12 patients, while MR plain scan and cisternography were performed in another 11 patients. The location of cerebrospinal leak was diagnosed by 2 experienced physicians majoring neurological radiology. Surgery was performed in all patients. The cerebrospinal leak location was confirmed and repaired during surgery. The result was considered as accurate when cerebrospinal leak was absent after surgery.ResultsAccording to the surgical exploration, the preoperative diagnosis of the active cerebrospinal leak location was accurate in 9 out of 12 patients with CT scan. The location could not be confirmed by CT because of multiple fractures in 2 patients and the missed diagnosis occurred in 1 patient. The preoperative diagnosis was accurate in 10 out of 11 patients with MRI examination.ConclusionsMRI cisternography is more advanced than multi-row CT scan in multiple basilar skull fracture. The combination of the two examinations may increase the diagnostic ratio of active cerebrospinal leak.

Rationale:Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA.Patient concerns:A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported.Diagnosis:Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA.Interventions:The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique.Outcomes:No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches.Lessons:Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.