-
CNS Neuroscience & Therapeutics May 2024A bone-invasive pituitary adenoma exhibits aggressive behavior, leading to a worse prognosis. We have found that TNF-α promotes bone invasion by facilitating the...
AIMS
A bone-invasive pituitary adenoma exhibits aggressive behavior, leading to a worse prognosis. We have found that TNF-α promotes bone invasion by facilitating the differentiation of osteoclasts, however, before bone-invasive pituitary adenoma invades bone tissue, it needs to penetrate the dura mater, and this mechanism is not yet clear.
METHODS
We performed transcriptome microarrays on specimens of bone-invasive pituitary adenomas (BIPAs) and noninvasive pituitary adenomas (NIPAs) and conducted differential expressed gene analysis and enrichment analysis. We altered the expression of TNF-α through plasmids, then validated the effects of TNF-α on GH3 cells and verified the efficacy of the TNF-α inhibitor SPD304. Finally, the effects of TNF-α were validated in in vivo experiments.
RESULTS
Pathway act work showed that the MAPK pathway was significantly implicated in the pathway network. The expression of TNF-α, MMP9, and p-p38 is higher in BIPAs than in NIPAs. Overexpression of TNF-α elevated the expression of MAPK pathway proteins and MMP9 in GH3 cells, as well as promoted proliferation, migration, and invasion of GH3 cells. Flow cytometry indicated that TNF-α overexpression increased the G2 phase ratio in GH3 cells and inhibited apoptosis. The expression of MMP9 was reduced after blocking the P38 MAPK pathway; overexpression of MMP9 promoted invasion of GH3 cells. In vivo experiments confirm that the TNF-α overexpression group has larger tumor volumes. SPD304 was able to suppress the effects caused by TNF-α overexpression.
CONCLUSION
Bone-invasive pituitary adenoma secretes higher levels of TNF-α, which then acts on itself in an autocrine manner, activating the MAPK pathway and promoting the expression of MMP9, thereby accelerating the membrane invasion process. SPD304 significantly inhibits the effect of TNF-α and may be applied in the clinical treatment of bone-invasive pituitary adenoma.
Topics: Tumor Necrosis Factor-alpha; Pituitary Neoplasms; Humans; Adenoma; Neoplasm Invasiveness; Animals; Matrix Metalloproteinase 9; MAP Kinase Signaling System; Male; Cell Line, Tumor; Female; Mice; Mice, Nude; Autocrine Communication; Middle Aged; Bone Neoplasms; Adult; Rats; Cell Movement; Signal Transduction
PubMed: 38739004
DOI: 10.1111/cns.14749 -
Radiology Case Reports Aug 2024A 50-year-old man presented with headache and left hemiparesis. No noticeable preceding head trauma was observed. Computed tomography (CT) scans revealed a compressive...
A 50-year-old man presented with headache and left hemiparesis. No noticeable preceding head trauma was observed. Computed tomography (CT) scans revealed a compressive chronic subdural hematoma (CSDH). The patient underwent burr-hole irrigation, during which he was considerably restless. In addition, extensive avulsion was found in the parietal dura mater posterior to the burr hole. CT performed immediately after the surgery revealed the emergence of a thick epidural hematoma (EDH) located posterior to the burr-hole. During emergency craniotomy for the EDH, there was no identifiable injury to the dura mater or the meningeal vessels. However, a review of the CT scans confirmed well-developed diploic spaces just above the center of the EDH, with connecting channels between the diploic spaces and extracranial sites. Based on these observations, we assumed that the diploic vein might have caused the EDH. Diploic veins can cause AEDH after burr hole irrigation for CSDH. Appropriate intraoperative sedation and protective irrigation maneuvers can reduce the risk of such AEDH.
PubMed: 38737186
DOI: 10.1016/j.radcr.2024.04.026 -
ACS Materials Au May 2024Among thermoelectric materials, skutterudites are the most prominent candidates in the mid-temperature range applications. In the multiple-filled SrYbCoSb skutterudite,...
Multiscale Length Structural Investigation and Thermoelectric Performance of Double-Filled SrYbCoSb: An Exceptional Thermal Conductivity Reduction by Filler Segregation to the Grain Boundaries.
Among thermoelectric materials, skutterudites are the most prominent candidates in the mid-temperature range applications. In the multiple-filled SrYbCoSb skutterudite, with Sr and Yb as fillers, we have enhanced the thermoelectric performance of CoSb through the reduction of lattice thermal conductivity and the optimization of carrier concentration and electrical conductivity. The high-pressure synthesis of the double-filled derivative promotes filling fraction fluctuation. This is observed by high angular resolution synchrotron X-ray diffraction, showing a phase segregation that corresponds to an inhomogeneous distribution of the filler atoms, located at the 2 positions of the cubic space group Im3̅. In addition, scanning transmission electron microscopy (STEM) combined with EELS spectroscopy clearly shows a segregation of Sr atoms from the surface of the grains, which is compatible with the synchrotron X-ray powder diffraction results. Mean square displacement parameters analysis results in Einstein temperatures of ∼94 and ∼67 K for Sr and Yb, respectively, and a Debye temperature of ∼250 K. The strong effect on resonant and disorder scattering yields a significantly lower lattice thermal conductivity of 2.5 W m K at 773 K. Still, good weighed-mobility values were obtained, with high filling fraction of the Yb and Sr elements. This drives a reduced electrical resistivity of 2.1 × 10 Ω m, which leads to a peak of 0.26 at 773 K. The analysis and results performed for the synthesized (Sr,Yb)-double filled CoSb, shed light on skutterudites for potential waste-heat recovery applications.
PubMed: 38737123
DOI: 10.1021/acsmaterialsau.3c00107 -
The Journal of Medical Investigation :... 2024Augmented reality navigation is the one of the navigation technologies that allows computer-generated virtual images to be projected onto a real-world environment....
BACKGROUND
Augmented reality navigation is the one of the navigation technologies that allows computer-generated virtual images to be projected onto a real-world environment. Augmented reality navigation can be used in spinal tumor surgery. However, it is unknown if there are any pitfalls when using this technique.
CASE PRESENTATION
The patient in this report underwent complete resection of a cauda equina tumor at the L2-L3 level using microscope-based augmented reality navigation. Although the registration error of navigation was <1 mm, we found a discrepancy between the augmented reality navigation images and the actual location of the tumor, which we have called "navigation mismatch". This mismatch, which was caused by the mobility of the spinal tumor in the dura mater, seems to be one of the pitfalls of augmented reality navigation for spinal tumors.
CONCLUSIONS
Combined use of intraoperative ultrasound and augmented reality navigation seems advisable in such cases. J. Med. Invest. 71 : 174-176, February, 2024.
Topics: Humans; Augmented Reality; Cauda Equina; Peripheral Nervous System Neoplasms; Surgery, Computer-Assisted; Male; Female; Middle Aged
PubMed: 38735716
DOI: 10.2152/jmi.71.174 -
Surgical and Radiologic Anatomy : SRA May 2024The chordae Willisii (CWs), trabecular projections into the lumen of the dural sinuses, are not well understood. We aimed to explore them using magnetic resonance...
PURPOSE
The chordae Willisii (CWs), trabecular projections into the lumen of the dural sinuses, are not well understood. We aimed to explore them using magnetic resonance imaging (MRI).
METHODS
Eighty-five patients underwent volumetric contrast-enhanced MRI, while another 30 underwent a fluid-attenuated inversion recovery (FLAIR) sequence in the coronal section.
RESULTS
The CWs were detected as linear filling defects lying in the dural sinuses, adjacent to the surrounding dura mater. They were found in the superior sagittal sinus (SSS) in 68.2% of the patients, most frequently in the middle third, with laminar appearance. In 27.1% of the patients, the CWs divided the SSS lumen into separate channels. The CWs were identified in the transverse sinus, transverse-sigmoid sinus junctional area and sigmoid sinus, and straight sinus in 54.1, 47.1, and 8.2%, respectively. On the FLAIR images, dural septi partially dividing the SSS lumen were identified in all patients. In addition, in 73.3% of the patients, fine linear structures were observed in the lumen with inconstant arrangements.
CONCLUSIONS
The CWs may be constant structures distributed over the lumen of the intracranial dural sinuses. Contrast-enhanced MRI may be useful for detecting laminar CWs. The FLAIR sequence may be advantageous for delineating the dural septi projecting into the lumen of the dural sinuses.
PubMed: 38733404
DOI: 10.1007/s00276-024-03382-1 -
Child's Nervous System : ChNS :... May 2024Cerebrospinal fluid (CSF) leakage is a challenging complication of intradural cranial surgery, and children are particularly at risk. The use of dural sealants confers...
PURPOSE
Cerebrospinal fluid (CSF) leakage is a challenging complication of intradural cranial surgery, and children are particularly at risk. The use of dural sealants confers protection in adults, but pediatric studies are scarce. We evaluated the safety and efficacy of Evicel fibrin sealant as an adjunct to primary dural suturing in children undergoing cranial surgery.
METHODS
A multicenter trial prospectively enrolled pediatric subjects (< 18 years) undergoing cranial neurosurgery who, upon completion of primary sutured dural repair, experienced CSF leakage. As agreed by the EMA Evicel Pediatric Investigation Plan, 40 subjects were intra-operatively randomized 2:1 to Evicel or additional sutures ('Sutures'). Data analysis was descriptive. The efficacy endpoint was treatment success rate, with success defined as intra-operative watertight closure after provocative Valsalva maneuver (primary endpoint). Safety endpoints were postoperative CSF leakage (incisional CSF leakage, pseudomeningocele or both) and surgical site complications (secondary endpoints).
RESULTS
Forty subjects (0.6-17 years) were randomized to Evicel (N = 25) or Sutures (N = 15) (intention-to-treat). Intracranial tumor was the most common indication and procedures were mostly supratentorial craniotomies. Success rates were 92.0% for Evicel and 33.3% for Sutures, with a 2.76 estimated ratio of success rates (Farrington-Manning 95% CI [1.53, 6.16]). Sensitivity analyses in per-protocol and safety sets showed similar results. Despite a higher rescue treatment rate, the frequencies of postoperative CSF leakage and wound complications were higher for Sutures than for Evicel.
CONCLUSION
This small-scale prospective study shows Evicel treatment to be safe and effective as an adjunct to primary sutured dura mater closure in a pediatric population. Compared to additional sutures, Evicel was associated with reduced postoperative CSF leakage and surgical site complications. (Trial registration: The trial was registered as NCT02309645 and EudraCT 2013-003558-26).
PubMed: 38727726
DOI: 10.1007/s00381-024-06434-4 -
Leukemia Research Reports 2024Orbital plasmacytoma is rare and has only been reported in the context of the initial diagnosis of multiple myeloma. Moreover, isolated orbital plasmacytoma without any...
Orbital plasmacytoma is rare and has only been reported in the context of the initial diagnosis of multiple myeloma. Moreover, isolated orbital plasmacytoma without any signs of multiple myeloma is extremely rare. We report the case of a 59-year-old female patient diagnosed with IgA Kappa multiple myeloma. It was stage I ISS (International Staging System) and stage I R-ISS (Revised ISS). According to the Tunisian national protocol, the patient was included in the standard-risk group and was eligible for four cycles of CTD (Cyclophosphamide, Thalidomide, Dexamethasone) followed by autologous stem cell transplantation. Taking into account the partial response after the CTD cycles, the patient has benefited from two VTD cycles (Bortezomib, Thalidomide, Dexamethasone). Thus, complete remission was obtained. The patient refused autologous stem cell transplantation. Therefore, maintenance treatment based on Thalidomide only was started and received over a twelve-month period. Five months after the end of maintenance treatment, she reported frontal headaches that were resistant to symptomatic treatment, with ptosis in the right eye in physical examination. Brain MRI revealed the presence of a right cranio-orbital tissue mass with intra-orbital and extra-axial cerebral components. The mass measured 32/36 mm on axial sections and 47 mm in height. The patient underwent a complete resection of the cranio-orbital mass with cranioplasty. The histopathological examination of the mass with Immunohistochemistry staining confirmed the diagnosis of orbital plasmocytoma. An update of the multiple myeloma assessment did not reveal any biological, cytological or radiological signs in favor of multiple myeloma. Therefore the diagnosis of isolated orbital plasmacytoma without signs of multiple myeloma was made. Post-operative brain MRI showed complete disappearance of the right cranio-orbital tissue lesion. There was only a persistent meningeal enhancement of the dura mater at the surgical site, suggestive of post-operative changes. The patient was then referred for cranio-orbital radiotherapy.
PubMed: 38707773
DOI: 10.1016/j.lrr.2024.100460 -
Progress in Brain Research 2024The purpose of this chapter is to present how past surgeons have viewed the pericranium and how they have reacted to its appearances. In ancient times, the membrane was...
The purpose of this chapter is to present how past surgeons have viewed the pericranium and how they have reacted to its appearances. In ancient times, the membrane was considered formed by the dura through the sutures and it retained a relationship with the dura via vessels in the sutures. It was considered advisable to strip it totally from any area to be examined for fissure fractures and also for any area to be trepanned, as pericranial injury was thought to lead to fever and inflammation. In the 18th century, a new idea arose that posttraumatic spontaneous separation of the pericranium from the bone was a reliable indicator of the development of intracranial suppuration. This idea was subsequently refuted. For over two millennia, the pericranium was considered to be an important membrane requiring the close attention of the surgeon. It is no longer required to receive more than minimal attention.
Topics: Humans; Dura Mater; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval
PubMed: 38705714
DOI: 10.1016/bs.pbr.2024.02.021 -
Progress in Brain Research 2024The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical... (Review)
Review
The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical findings and meningeal damage. Galen proposed that the dura was attached only at the sutures, and he was the first to describe the pia in humans. In the Middle Ages, new interest in the management of meningeal injuries arose, with renewed interest in relating clinical changes to intracranial injuries. These associations were neither consistent nor accurate. The Renaissance brought little change. It was in the 18th century that it became clear that the indication for opening the cranium following trauma was to relieve pressure from hematomas. Moreover, the important clinical findings on which to base an indication for intervention were changes in the level of consciousness.
Topics: Humans; Meninges; History, Ancient; History, 19th Century; History, 18th Century; History, 17th Century; History, Medieval; History, 16th Century; History, 15th Century; History, 20th Century
PubMed: 38705713
DOI: 10.1016/bs.pbr.2024.02.020