Glioma is the most common malignant tumor in the central nervous system with a poor median survival. Valproic acid (VPA), a widely used antiepileptic drug, has been found to have antitumor effects on gliomas, but its role still has not been determined. In this study, we investigated VPA-induced apoptotic and autophagic effects on human U251 and SNB19 cells by cell counting kit-8 assay, flow cytometry, terminal deoxynucleotidyl transferase-mediated nick end labeling staining, western blots, and immunofluorescence assay in vitro, and then we further explored the role of autophagy in apoptosis by using the selective antagonist MHY1485. The data showed that VPA inhibited U251 and SNB19 glioma cells viability in a dose-dependent and time-dependent manner and induced apoptosis through the mitochondria-dependent pathway in vitro. In addition, VPA activated the Akt/mTOR pathway by decreasing their protein phosphorylation to promote cellular apoptosis. Surprisingly, the mTOR agonist MHY1485, causing a strong elevation of mTOR activity, partially reduced apoptosis ratio, which supposing that the autophagy of VPA is involved in the regulation of apoptosis. These findings suggest that VPA enhanced apoptosis by promoting autophagy via Akt/mTOR signaling in glioma, which could be further evaluated as a reliable therapy for glioma.

Penetrating brain injury (PBI) can be caused by several objects ranging from knives to chopsticks. However, an assault with long and electric screwdriver is a peculiar accident and is relatively rare. Because of its rarity, the treatments of such injury are complex and nonstandardized. We presented a case of a 54-year-old female who was stabbed with a screwdriver in her head and accompanied by loss of consciousness for 1 h. Computer tomography (CT) demonstrated that the screwdriver passed through the right zygomatic bone to posterior cranial fossa. Early foreign body removal and hematoma evacuation were performed and the patient had a good postoperative recovery. In this study, we discussed the clinical presentation and successful management of such a unique injury caused by a screwdriver. Our goal is to demonstrate certain general management principles which can improve patient outcomes.

Delayed epidural hematoma (DEH) following evacuation of traumatic acute subdural hematoma (ASDH) or acute epidural hematoma (EDH) is a rare but devastating complication, especially when it occurs sequentially in a single patient. A 19-year-old man who developed contralateral DEH following craniotomy for evacuation of a traumatic right-side ASDH and then developed a left-side DEH of the posterior cranial fossa after craniotomy for evacuation of the contralateral DEH. He was immediately returned to the operating room for additional surgeries and his neurological outcome was satisfactory. Although DEH occurring after evacuation of ASDH or acute EDH is a rare event, timely recognition is critical to prognosis.

The purpose of this study was to investigate the risk factors for in-hospital death in elderly patients with surgically treated traumatic acute subdural hematoma (ASDH) and to construct a nomogram model for in-hospital death risk prediction. We analyzed 104 elderly patients who underwent decompressive craniotomy (DC) for isolated traumatic ASDH between May 2013 and May 2021 in our department. Independent factors for in-hospital death were identified via univariate and multivariate logistic regression analyses, and a nomogram model was constructed and validated. The overall in-hospital mortality rate was 58.7% (61/104). Sex (odds ratio [OR] = 11.94), dilated pupils (bilateral vs absent; OR = 194.16) and subarachnoid hemorrhage (SAH) (OR = 16.01) were independent risk factors for in-hospital death. A nomogram model for in-hospital death risk prediction was constructed based on these variables. Statistical analysis revealed that this model had good predictive performance, and receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the nomogram model was 0.916 (95% confidence interval [CI] = 0.861–0.970). The calibration plot, which compared the predicted effective rate and observed effective rate, revealed the accurate predictive ability of the model. The model was internally validated via 200 bootstrap samples to calculate the discrimination accuracy, and the concordance index was 0.891. Decision curve analysis (DCA) demonstrated that the nomogram was clinically beneficial. The most important risk factors for in-hospital death in elderly patients with surgically treated traumatic ASDH were sex, dilated pupils, and SAH. The nomogram constructed from these data could be a promising and convenient tool to predict in-hospital death risk, but further external validation is needed.

Objective: To investigate the value of admission blood routine and coagulation function parameters in predicting acute symptomatic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods: This retrospective study included 423 patients with aSAH admitted to the Department of Neurosurgery of the Third Affiliated Hospital of Soochow University from November 2013 to September 2020. Demographic, clinical and laboratory data were collected. The patients were divided into hydrocephalus group (n = 96) and non-hydrocephalus group (n = 327) according to the presence of hydrocephalus on the first head CT. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for acute symptomatic hydrocephalus after aSAH.Results: Among the 423 aSAH patients, 96 (22.70%) developed acute symptomatic hydrocephalus. Multivariate logistic regression analysis showed that, after adjusting for confounding factors, white blood cells (WBC) (OR = 1.121, 95% CI = 1.067–1.181), monocytes (M) (OR = 2.812, 95% CI = 1.183–6.699), and thrombin time (TT) (OR = 0.843, 95% CI = 0.729–0.948) were independently associated with the development of hydrocephalus. Further analysis of the area under the receiver operating characteristic (ROC) curve indicated that, compared to basic clinical data, the combined prediction model of “basic clinical data + WBC + M + TT” performed better (AUC = 0.728, 95% CI = 0.682–0.769, P = 0.004).Conclusions: The WBC, M and TT within 24 h of admission in aSAH patients can be used to predict the occurrence of acute symptomatic hydrocephalus.