Neurogenesis by Activation of Inherent Neural Stem Cells in the Rat Hippocampus after Cerebral Infarction

Objective To investigate the changes of neural stem cells (NSCs) in the rat hippocampus after cerebral infarction (CI) and to evaluate the neurogenesis caused by the activation of NSCs. Methods CI models of rats were made and rats were assigned to 6 groups: sham-operated, 1 day, 3 days, 7 days, 14 days, and 28 days after CI. The dynamic expression of bromodeoxyuridine (BrdU), polysialylated neural cell adhesion molecule (PSA-NCAM), glial fibrillary acidic protein (GFAP), and neuronal nuclear antigen (NeuN) were determined by immunohistochemistry and immunofluorescence staining. BrdU was used to mark the proliferated NSCs. PSA-NCAM was used to mark the plasticity of activated NSCs. GFAP and NeuN were used to mark the differentiated NSCs. Results Compared with the controls, the number of BrdU+ cells in the hippocampus increased significantly at 1 day after CI (P<0.05), reached peak at 7 days after CI (P<0.05), decreased but still elevated compared with the controls at 14 days after CI (P<0.05), and nearly unchanged at 28 days after CI. The number of BrdU+/PSA-NCAM+ cells increased significantly at 7 days after CI (P<0.05), reached peak at 14 days after CI (P<0.05), and decreased but still elevated compared with the controls at 28 days after CI (P<0.05). The number of BrdU+/PSA-NCAM+ cells was equal to 60% of the number of BrdU+ cells in all the same period. The number of BrdU+/NeuN+ cells in the hippocampus increased significantly at 14 days after CI (P<0.05) and reached peak at 28 day after CI (P<0.05). The number of BrdU+/GFAP+cells in the hippocampus nearly unchanged after CI. Conclusion CI can stimulate the proliferation of inherent NSCs, and most proliferated NSCs may differentiate into neurons and represent neural plasticity.

EXPERIMENTAL STUDY ON PLASTICITY OF PROLIFERATED NEURAL STEM CELLS IN ADULT RATS AFTER CEREBRAL INFARCTION

Objective To investigate whether there is endogenous neural stem cell proliferation and whether these proliferated neural stem cells represent neural plasticity in the adult rats after cerebral infarction. Methods Cerebral infarction models of rats were established and the dynamic expression of bromodeoxyuridine （BrdU）, BrdU/polysialylated neural cell adhesion molecule （PSA-NCAM） were determined by immunohistochemistry and immunofluorescence staining. BrdU was used to mark dividing neural stem cells. PSA-NCAM was used to mark the plasticity of neural stem cells. Results Compared with controls, the number of BrdU-positive cells in the subventricular zone （SVZ） and hippocampus increased significantly at 1st day after cerebral infarction （P 〈 0. 05 ）, reached maximum at 7th day, decreased markedly at 14th day, but it was still elevated compared with that of the controls （ P 〈 0. 05 ）. The number of BrdU-labeled with PSA-NCAM-positive cells increased significantly at 7th day （ P 〈 0. 05 ）, reached maximum at 14th day, markedly decreased at 28th day, but it was still elevated compared with that of the controls （P 〈 0. 05 ）. It was equal to 60% of the number of BrdU-positive cells in the same period. Conclusion Cerebral infarction may stimulate the proliferation of endogenous neural stem cells in situ and most proliferated neural stem cells represent neural plasticity.

Application of Preoperative CT/MRI Image Fusion in Target Positioning for Deep Brain Stimulation

Objective To explore the efficacy of target positioning by preoperative CT/MRI image fusion technique in deep brain stimulation.Methods We retrospectively analyzed the clinical data and images of 79 cases(68 with Parkinson's disease,11 with dystonia) who received preoperative CT/MRI image fusion in target positioning of subthalamic nucleus in deep brain stimulation.Deviation of implanted electrodes from the target nucleus of each patient were measured.Neurological evaluations of each patient before and after the treatment were performed and compared.Complications of the positioning and treatment were recorded.Results The mean deviations of the electrodes implanted on X,Y,and Z axis were 0.5 mm,0.6 mm,and 0.6 mm,respectively.Postoperative neurologic evaluations scores of unified Parkinson's disease rating scale(UPDRS) for Parkinson's disease and Burke-Fahn-Marsden Dystonia Rating Scale(BFMDRS) for dystonia patients improved significantly compared to the preoperative scores(P<0.001); Complications occurred in 10.1%(8/79) patients,and main side effects were dysarthria and diplopia.Conclusion Target positioning by preoperative CT/MRI image fusion technique in deep brain stimulation has high accuracy and good clinical outcomes.

Probiotics' Preventive Effect on Pediatric Food Allergy: A Meta-analysis of Randomized Controlled Trials

Objective To investigate the preventive effect of probiotics on pediatric food allergy. Methods From MEDLINE bibliographical database, we searched and reviewed all randomized controlled trials on the preventive effects of probiotics on pediatric food allergies up to September 2013 and excluded the studies that do not meet inclusion criteria and extracted the data. Meta-analysis for the results of homogenous studies was performed using RevMan 5.0 and the co-effect was pooled by using fixed-effects model of relative risk(RR) ratios. Results Ten trials published between 2007 and 2012 including 2701 cases were included. Meta-analysis based on included data showed that the preventive effect of prenatal and postnatal probiotic supplementation on food allergies was not significant with the RR=0.88(95% CI: 0.76-1.03). Conclusion Present evidences cannot show in unequivocal terms that prenatal and postnatal probiotic supplementation will prevent food allergic diseases.

Does Early Postsurgical Temozolomide Plus Concomitant Radiochemotherapy Regimen Have Any Benefit in Newly-diagnosed Glioblastoma Patients？ A Multi-center, Randomized, Parallel, Open-label, Phase II Clinical Trial

Background： The radiochemotherapy regimen concomitantly employing temozolomide （TMZ） chemotherapy and radiotherapy （RT） 4 weeks after surgery, followed by 6 cycles of TMZ is a common treatment for glioblastoma （GBM）. However, its median overall survival （OS） is only 14.6 months. This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen. Methods： A randomized, parallel group, open-label study of 99 newly diagnosed GBM patients was conducted at 10 independent Chinese neurosurgical departments from June 2008 to June 2012. Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide （early TMZ group） or standard concomitant radiochemotherapy regimen （control group）. Overall response was assessed based on objective tumor assessments, administration ofcorticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event （AE）, and neurological condition were measured for 24 months of tbllow-up. The primary efficacy endpoint of this study was overall survival （OS）. The secondary endpoint was progression free survival （PFS）. Results： The median OS time in the early TMZ group was 17.6 months, compared with 13.2 months in the control group （log-rank test P 0.021 ）. In addition, the OS rate in the early TMZ group was higher at 6, 12, and 18 months than in the control group, respectively （P 〈 0.05）. The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group （log-rank test P = 0.695）. AEs occurred in 29 （55.8%） and 31（73.8%） patients respectively in early and control groups, including nausea （15.4% vs. 33.3%）, vomiting （7.7% vs. 28.6%）, fever （7.7% vs. 11.9%）, and headache （3.8% vs. 23.8%）. Only 30.8% and 33.3% were drug-related, respectively. Conclusions： Addition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated and significantly improved the OS of the GBM patients, compared with standard concomitant radiochemotherapy regimen. However, a larger randomized trial is warranted to verify these results.

Demographic Characterization of Patients Enrolled in the China Pituitary Disease Register Network

To the Editor:Pituitary disease is a group of pituitary gland disorders, including pituitary adenoma and other lesions,in the sellar region.[1] Typical endocrine symptoms and mass effects are likely to have harmful results on patients,families,and society.Pituitary databases of various sizes and focuses have been established in the USA and Europe.[2-4]

Three acquired immunodeficiency syndrome patients with central nervous system infection: diagnostic approach and outcome of treatment

The patients w让h acquired immunodeficiency syndrome(AIDS)are prone to opportunistic infections due to immune deficiencies.Because the AIDS virus is neuropathic,10%of AIDS patients first manifested central nervous system(CNS)symptoms.111 More than 40% of untreated AIDS patients will develop CNS diseases.121 The diagnosis and treatment for AIDS complicated with intracranial lesions are mainly based on clinical experience and laboratory tests.If necessary,brain biopsies were taken into consideration to help to diagnose and choose a suitable therapy.In clinic practice,to get a specific diagnosis is very difficult.To further analyze the clinical features of such patients and to provide some suggestions for the clinical diagnosis and treatments,we retrospectively analyzed three AIDS cases with CNS infection who attended the Peking Union Medical College Hospital.

Symptomatic Rathke＇s Cleft Cyst with Rapid Enlargement Masquerading as Rathke＇s Cleft Cyst Apoplexy

To the Editor： A 35-year-old Chinese woman was admitted to our hospital complaining of a 1-year history of bilateral temporal chronic intermittent moderate headache which used to be alleviated by ibuprofen tablets or rest and had increased in intensity in the past 1 month. The patient also presented with the slow development of visual deficit. In January 2012, the patient presented with polyuria and polydipsia suggestive of central diabetes insipidus. Endocrine studies showed no clinically significant results.

Establishment and Application of China Pituitary Disease Register Network

To the Editor： China is the most populous country and has the largest number of clinical cases of pituitary diseases in the world. However, in the past few years, the work of clinical data collection and analysis was very weak, which lagged very far behind the developed country. To fiirther obtain the complete infornlation about Chinese patients with pituitary disease, the China Pituitary Disease Register Network （CPDRN） was established by Peking Union Medical Hospital in 2015. The CPDRN not only provides a perfect database for clinical data collection and infornlation sharing but also raises people＇s attention to the collection of clinical intb,＇mation.

A Case of Intracranial Solitary Fibrous Tumor

To the Editor：Intracranial solitary fibrous tumor （SFT） is a kind of rare tumor.It was first identified as a distinct entity in 1996 and included by the 2000 World Health Organization classification of tumors of the nervous system.

A case of subdural hematoma with a medical history of hemophilia a and a review of related literature

Background: Intracranial hemorrhage is the most common emergency in the neurology department, and patients with a medical history of hemophilia have a risk of severe bleeding. Case presentation: A 56-year-old man was admitted to the emergency department in our hospital. He was diagnosed with hemophilia A and subdural hematoma. We administered an infusion of factor VⅢ to decrease the risk of bleeding and improve the prognosis. Factor VⅢ infusion is the most important factor in treating hemophilia A patients. Conclusion: We recommend carefully checking coagulation function and the medical history once these patients are admitted, especially in the emergency department.

Xanthogranuloma of the Sellar Region

To the Editor： A 36-year-old female patient was admitted to Peking Union Medical College Hospital complaining of 6 years of headache. Magnetic resonance imaging （MRI） showed an intrasellar lesion with homogeneous hyperintense on T 1-weighted images and T2-weighted images and inhomogeneous contrast enhancement by the gadolinium administration [Figure l a and lb]. Rathke＇s cleft cyst was initially diagnosed preoperatively, and the tumor was totally resected by transsphenoidal surgery. Histopathology revealed that granulomatous tissue consisted of cholesterol clefts, lymphoplasmacellular infiltrates, marked hemosiderin deposits, and multinucleated foreign body giant cells around cholesterol clefts [Figure 1 e- 1 g].

Diabetes Insipidus as Initial Presentation of Rathke＇s Cleft Cyst

To the Editor： A 56-year-old Chinese man was referred to Peking Union Medical College Hospital because of polydipsia （9000 ml/24 h） and polyuria （7000 ml/24 h） for over 20 days accompanied with intermittent moderate headache in frontal and temporal areas of both sides for about 2 weeks. The patient underwent a brain magnetic resonance imaging （MRI） with contrast in a local healthy facility, revealing that there was an irregular pituitary lesion measuring 1.1 cm× 1.4 cm× 2.2 cm. Apparently, the diagnosis of central diabetes insipidus （DI） was made, but the pituitary lesion remained to be elucidated. The patient received desmopressin acetate tablets （1.2 mg, q.n.） to ameliorate polydipsia （5000 ml/24 h） and polyuria （4000 ml/24 h）.