Lianshu Ding

Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms causes significant morbidity and mortality. Although prophylactic lumbar cerebrospinal fluid (CSF) management is widely used, the relative benefits of continuous lumbar cerebrospinal fluid drainage compared to intermittent lumbar puncture remain undefined. This study compared clinical outcomes between these two approaches in patients with aneurysmal SAH. This single-center retrospective study included 222 patients with aneurysmal SAH treated between January 2023 and December 2023. Patients were assigned to continuous lumbar cerebrospinal fluid drainage (n = 103) or intermittent lumbar puncture (n = 119). The primary outcome was the modified Rankin Scale (mRS) score at 6 months, categorized as good (0–2) or poor (3–6). Secondary outcomes included secondary infarcts, intracranial infections, hydrocephalus, and mortality. At 6 months, the lumbar drainage group exhibited significantly better outcomes (79% vs. 58%, relative risk [RR] 1.36, 95% CI [0.70, 0.85], p = 0.002) and lower rates of intracranial infection (0% vs. 11%, p = 0.002) and hydrocephalus (6.8% vs. 23.5%, RR 0.29, 95% CI [0.03, 0.13], p = 0.001) compared to the lumbar puncture group. Secondary infarcts occurred in 17.4% of the lumbar drainage group versus 28% of the lumbar puncture group (RR 0.63, 95% CI [0.11, 0.26], p = 0.099). No significant difference in mortality was observed between the groups (5.8% vs. 7.5%, RR 0.79, 95% CI [-1.35, 0.79], p = 0.608). Continuous lumbar cerebrospinal fluid drainage was associated with improved clinical outcomes, fewer intracranial infections, and reduced hydrocephalus incidence compared to intermittent lumbar puncture in patients with aneurysmal SAH. These findings advocate for the early adoption of continuous lumbar cerebrospinal fluid drainage in clinical practice.

Cerebral syphilitic gumma, a rare form of neurosyphilis, poses significant diagnostic challenges due to its imaging similarities to gliomas and brain metastases. This report details the diagnostic and therapeutic journey of a patient with cerebral syphilitic gumma admitted to the Department of Neurosurgery, Nanjing Medical University Affiliated Huaian First Hospital in February 2025. Initially misdiagnosed with a brain malignancy, the accurate diagnosis was established intraoperatively and confirmed postoperatively through histopathological examination. This case highlights the importance of considering neurosyphilis in differential diagnoses of intracranial lesions, especially when conventional imaging and clinical presentations are inconclusive.

Aneurysmal subarachnoid haemorrhage (aSAH) represents a subtype of stroke with a high incidence of morbidity and mortality. Astrocytes, the most abundant cell type in the central nervous system, play a pivotal role in brain injury and recovery following aSAH. They participate in synaptic remodelling, blood-brain barrier injury and the activation of the glial-mesenchymal-cervical lymphatic system. In this paper, we review the physiopathological functions and pathological changes of astrocytes after aSAH, exploring their mechanism of action in aSAH. We also summarise the evidence of therapeutic approaches to modulate astrocyte function after aSAH complications, and provide some new clues for future translational therapies to mitigate injury after aSAH.

Glioma is the most common and malignant tumor of the central nervous system. Glioblastoma (GBM) is the most aggressive glioma, with a poor prognosis and no effective treatment because of its high invasiveness, metabolic rate, and heterogeneity. The tumor microenvironment (TME) contains many tumor-associated macrophages (TAMs), which play a critical role in tumor proliferation, invasion, metastasis, and angiogenesis and indirectly promote an immunosuppressive microenvironment. TAM is divided into tumor-suppressive M1-like (classic activation of macrophages) and tumor-supportive M2-like (alternatively activated macrophages) polarized cells. TAMs exhibit an M1-like phenotype in the initial stages of tumor progression, and along with the promotion of lysing tumors and the functions of T cells and NK cells, tumor growth is suppressed, and they rapidly transform into M2-like polarized macrophages, which promote tumor progression. In this review, we discuss the mechanism by which M1- and M2-polarized macrophages promote or inhibit the growth of glioblastoma and indicate the future directions for treatment.

Diabetes can exacerbate myocardial ischemia/reperfusion (IR) injury. However, the sensitivity to IR injury and the underlying mechanisms in diabetic hearts remain unclear. Inhibition of PH domain leucine-rich repeating protein phosphatase (PHLPP1) could reduce myocardial IR injury, our previous study demonstrated that the expression of PHLPP1 was upregulated in diabetic myocardial IR model. Thus, this study aimed to investigate the mechanism of PHLPP1 in diabetic myocardial IR injury. Nondiabetic and diabetic C57BL/6 mice underwent 45 min of coronary artery occlusion followed by 2 h of reperfusion. Male C57BL/6 mice were injected with streptozotocin for five consecutive days to establish a diabetes model. H9c2 cells were exposed to normal or high glucose and subjected to 4 h of hypoxia followed by 4 h of reoxygenation. Diabetes or hyperglycemia increased postischemic infarct size, cellular injury, release of creatine kinase-MB, apoptosis, and oxidative stress, while exacerbating mitochondrial dysfunction. This was accompanied by enhanced expression of PHLPP1 and decreased levels of p-STAT3 and p-Akt. These effects were counteracted by PHLPP1 knockdown. Moreover, PHLPP1 knockdown resulted in an increase in mitochondrial translocation of p-STAT3 Ser727 and nuclear translocation of p-STAT3 Tyr705 and p-STAT3 Ser727. However, the effect of PHLPP1 knockdown in reducing posthypoxic cellular damage was nullified by either Stattic or LY294002. Additionally, a co-immunoprecipitation assay indicated a direct interaction between PHLPP1 and p-STAT3 Ser727, but not p-STAT3 Tyr705. The abnormal expression of PHLPP1 plays a significant role in exacerbating myocardial IR injury in diabetic mice. Knockdown of PHLPP1 to activate the STAT3 signaling pathway may represent a novel strategy for alleviating myocardial IR injury in diabetes.

Mucosa‑associated lymphoid tissue (MALT) lymphoma involving meningeal tissue is rare condition, easily mistaken for meningiomas upon imaging. In this report, a case of primary left temporal lobe MALT lymphoma that was initially misdiagnosed as temporal meningioma is presented, with subsequent investigation into the mechanism and treatments. Clinically, MALT lymphomas can be easily confused with meningiomas based solely on imaging and clinical manifestations. MALT lymphomas are indolent, localized lesions that can be cured through surgical resection and radiotherapy. Currently, radiotherapy is the most commonly used treatment; however, the patient in the present report did not receive any chemotherapy or radiotherapy after surgery, and recent related examinations revealed a recurrence of lymphomas that had metastasized throughout the body. As a result, future patients may benefit from chemotherapy or radiotherapy, and clinicians should be more meticulous regarding patient follow‑up.