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Immune thrombocytopenia (ITP) is an autoimmune disease caused by T-cell dysfunction. Recently, several studies have shown that a disturbed Th17/Treg balance contributes to the development of ITP. MicroRNAs (miRNAs) are small noncoding RNA moleculesthat posttranscriptionally regulate gene expression. Emerging evidences have demonstrated that miRNAs play an important role in regulating the Th17/Treg balance. In the present study, we found that miR-641 was upregulated in ITP patients. In primary T cells, overexpression of miR-641 could cause downregulation of its target genes STIM1 and SATB1, thus inducing a Th17 (upregulated)/Treg (downregulated) imbalance. Inhibition of miR-641 by a miR-641 sponge in primary T cells of ITP patients or by antagomiR-641 in an ITP murine model could cause upregulation of STIM1 and SATB1, thus restoring Th17/Treg homeostasis. These results suggested that the miR-641-STIM/SATB1 axis plays an important role in regulating the Th17/Treg balance in ITP. [ABSTRACT FROM AUTHOR]

Summary: Objective: China has the largest population of patients with epilepsy worldwide, which imposes a heavy burden on the public and health care systems. Several epidemiological surveys on epilepsy have been performed in China. Although these surveys grossly describe the prevalence and gap in treatment of epilepsy, the status of epilepsy centers is unclear. The number of epilepsy centers has increased substantially in recent decades. Therefore, a nationwide investigation of the scale and distribution, personnel, equipment, and epilepsy care capacity of each epilepsy center is of great value. Methods: In 2017–2018, a multicenter cross‐sectional survey was performed by the Commission on Standardized Development of Epilepsy Centers, China Association Against Epilepsy in 31 provinces, autonomous regions, and municipalities. The survey consisted of 74 questions divided into four sections: (1) overview, (2) personnel, (3) essential equipment and facilities, and (4) epilepsy care service capacity. The questions ranged from January 1, 2016 to December 31, 2016. The data were analyzed using descriptive statistics. Results: There were 358 epilepsy centers for the 1.38 billion national population in 2016. Three quarters were in the eastern and western regions, and >90% were in tertiary hospitals. There were 9688 doctors engaged in epilepsy care, and 4.8% of doctors and electrophysiological physicians/technicians passed the national test for electroencephalography technical accreditation. A total of 9667 patients underwent resective surgeries in 2016. There were 888 vagus nerve stimulation procedures and 275 deep brain stimulation procedures. Significance: This study is the first unique survey of epilepsy centers in China. Despite their rapid development, epilepsy centers cannot meet patients' needs at this stage. The results provide data‐based evidence for the formulation of policies related to epilepsy service planning. [ABSTRACT FROM AUTHOR]

Background: Surgery of parasagittal meningiomas (PSMs) is still technically challenging, for the balance between radical resection and preservation of venous circulation. In this article, we'd systemically introduce the technical nuances of a simplified strategy for radical resection of all types of PSMs. All the cases were operated by one single neurosurgeon from a single institution. Methods: Clinical charts of patients with PSMs between 2014 and 2020were retrospectively reviewed. A simplified classification method was adopted, which was based on the relationship between the tumor and superior sagittal sinus (SSS). Surgery aiming at radical resection and venous flow preservation was performed. Only in case of total occlusion of SSS, we performed tumor resection without reconstruction of the venous sinus. Results: Clinical data obtained in 55 consecutive patients (47 primary and 8 recurrent cases) were analyzed, among which 20 were with patent sinus, 27 were with partially occluded sinus and 8 were with completely occluded sinus. Forty-two (76.4%) and 13 patients (23.6%) had the same and improved functional status as compared to that of pre-operation, respectively. Four patients (7.3%) experienced transient neurological deterioration but improved to the normal level in the long-term follow-up. All patients achieved Simpson I/II radical resection. No patients suffered from post-operative recurrence in the follow-up duration of 27.05 ± 19.55 (2–91) months. Conclusion: Radical and safe resection of all types of PSMs is achievable and not difficult if the simplified surgical strategy mentioned in the article is adopted, no matter to which extent the sinus is invaded. [ABSTRACT FROM AUTHOR]

Background: Illicit drug use has become an increasing public health and social concern in the past decades worldwide. Intravenous injection has an elevated risk of infection. Needle embolism is a rare complication of intravenous drug users, Retained broken needles can lead to local complications, such as infection, but they also have the potential to embolize to heart or lung, and lead to serious complications.Method: We reported a rare case of an intravenous drug user which a retained broken needle fragments in the inferior wall of the right ventricle.Results: We performed a successful surgery and give our comments and recommendations for illicit drug use worldwide and in China.Conclusions: Illicit Drug use becomes a global problem because of its health and social harmfulness. To help drug addicts and provide prevention and treatment services are the obligations and responsibilities of all medical workers. [ABSTRACT FROM AUTHOR]

Background: Refractory epilepsy is a common and troublesome neurosurgical disease. This study is designed to compare seizure control and degrees in intellectual outcome in children with refractory epilepsy after surgical treatment., Methods: 20 children with refractory epilepsy were treated with tailored epilepsy surgery or vagus nerve stimulation (VNS). We used the Engel Epilepsy Surgery Outcome Scale to evaluate seizure control and the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV), to test the children's intellectual outcomes 7-day preoperative and 3-, 6-, and 12-month postoperative., Results: In total, 14 cases were seizure free (Engel I) and 2 cases to have suffered few attacks since surgery (Engel II). In two cases, the frequency of seizures decreased by >90% (Engel III). In the remaining two cases, the effects of surgery on seizure control were not obvious (Engel IV). All children completed the WISC-IV test. On average, postoperative intelligence quotient (IQ) increased by 6.35 points 12-month postsurgery compared with the results of the preoperative tests ( P < 0.01). Second, intellectual outcomes after surgery in the Engel I and II groups increased by >3.88 points compared with in the Engel III and IV groups ( P < 0.05). Finally, there were no fatal complications over the long-term follow-up except for intracranial infection of two cases; postoperative subcutaneous hematoma occurred in one case and hoarseness in one case., Conclusion: Individualized epilepsy surgery is safe and effective for children with refractory epilepsy. It can control or reduce the frequency of postoperative attacks as well as improve postoperative intellectual outcomes to different degrees., Competing Interests: There are no conflicts of interest.

Embolisation of irregular and complicated aneurysms is a great challenge for neuroradiologists. To overcome possible complications of endovascular treatment of these type of aneurysms, methods such as intracranial stents, balloon remodelling, and the double microcatheter technique have been developed. The aim of the study was to report our preliminary experience with endovascular treatment of irregular and complicated intracranial aneurysm with coils using double microcatheter technique, and evaluation of its feasibility and clinical advantages. In this retrospective study, 37 cases diagnosed with irregular and complicated intracranial aneurysms and treated using double microcatheter method from July, 2013 to May, 2015, were followed up for six months after discharge. All the aneurysms were successfully embolized using the double microcatheter technique. Immediate post-embolization angiography showed no residual contrast filling in 35 cases, and residual filling in 2 cases. At discharge, according to the modified Rankin Scale score, all the patients recovered without any complications or death. A follow-up of 24 cases with digital subtraction angiography for 6 months revealed no recanalization. In conclusion, the double microcatheter technique for irregular intracranial aneurysms is effective and simple with few complications.

Objective: To discuss the alterations of brain network efficiency in patients with post-concussion syndrome., Methods: A total of 23 patients from Anhui Provincial Hospital in the period from 2013/6 to 2014/3 who have had the concussion for 3 months were enrolled and 23 volunteers paired in sex, age and education were also enrolled as healthy controls. Comparisons of selective attention of both groups were conducted using Stroop Word-Color Test. The data of resting-state functional magnetic resonance imaging (fMRI) in both groups were collected and the data were dealt with Network Construction which is a part of GRETNA software to obtain the Matrix of brain network. Network analysis was used to obtain Global and Nodal efficiency, then independent t-test was used for statistical analyses of the value of Global and Nodal efficiency., Results: The difference in Global efficiency of two groups in every threshold value had no statistical significance. Compared with healthy controls, the Nodal efficiencies in patients with post-concussion syndrome were significantly different in the brain regions as below: left orbital middle frontal gyrus, left posterior cingulate, left lingual, left thalamus, left superior temporal gyrus, right anterior cingulate, right posterior cingulate, right supramarginalgyrus., Conclusions: Compared with healthy controls, there is no significant changes of Globe efficiency in patients with post-concussion syndrome, and the brain function deficits in these patients may be caused by changes of Nodal efficiency in their brain network.

Objective: To explore the functions of amygdala functional connectivity in the pathogenesis of refractory epilepsy with resting-state functional magnetic resonance imaging (RS-fMRI)., Methods: A total of 19 patients with refractory epilepsy were recruited from August 2013 to June 2014. And 19 healthy persons were selected as the controls.No obvious epileptogenic lesions of intracranial structures were found on multi-modal neuroimaging.Ictal and interictal epileptic activities on long-term video electroencephalogram (EEG) showed spine spread spike and wave in bilateral cerebral hemispheres. All fMRI data were preprocessed after RS-fMRI scanning. Then left and right amygdalas were selected as regions of interest (ROIs) for calculating the linear correlation between amygdala and whole brain. As relative to the control group, the changes of brain areas in functional connectivity were examined for the intractable epilepsy group., Results: Compared with the controls, left amygdala in refractory epilepsy group showed increased functional connectivity with bilateral fusiform gyrus, bilateral calcarine gyrus and right lingual, on the contrary decreased functional connectivity with bilateral cuneus, bilateral precuneus, bilateral caudatas and left thalamus.However, right amygdala demonstrated increased functional connectivity with bilateral calcarine gyrus and bilateral linguals, but decreased functional connectivity with bilateral caudatas and left putamen (P < 0.05)., Conclusion: Altered functional connectivity of amygdala reflects its dysfunction in refractory epilepsy patients. It suggested that amygdala is an important component of "epileptic network" participating in the occurrence and development of refractory epilepsy.