Intracranial malignant meningioma with cerebrospinal fluid dissemination: a case report

Malignant meningiomas are uncommon intracranial tumors. The metastasis of malignant meningiomas to distant extracranial sites are well known. However, dissemination of the tumours in the cerebrospinal fluid (CSF) is rare and few cases have been reported. We present a case of histologically proven malignant meningioma with CSF dissemination at the remote intracranial area and into the spinal canal detected with magnetic resonance imaging.

     

Oncol2012: 2001至2010年十年单中心脑膜瘤手术病例病理分型、部位分布资料分析

Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of cases. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010. Methods This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization (WHO) classification. The location of the meningiomas was also determined. Results The female:male ratio of the 7084 cases was 2.34:1. The mean age was 51.4 years (range 11 months–86 years). The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas (P < 0.001, Fisher’s Least Significant Digit test). There was a significantly higher female:male ratio in WHO grade I meningiomas than in grade II (P < 0.001, χ2 test) or grade III (P < 0.001, χ2 test) meningiomas. The ratio for WHO grade III meningioma was 0.76. Meningothelial (n=2061) and fibrous meningiomas (n=3556) were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site (38.33%, n=2722). Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series. Conclusion Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade I meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common meningioma location.     

Large and giant medial sphenoid wing meningiomas involving vascular structures: clinical features and management experience in 53 patients

Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection hard to achieve.Also,this kind of meningiomas is often accompanied by a series of severe complications.Therefore,it was regarded as a formidable challenge to even the most experienced neurosurgeons.This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.Methods In this study,53 patients （33 female and 20 male,mean age of 47.5 years） with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012,with their clinical features analyzed,management experience collected,and treatment results investigated retrospectively.Results In this study,gross total resection （Simpson Ⅰ and Ⅱ） was applied in 44 patients （83％）.Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation.Their performance showed surgical complications of vascular lesions and helped us evaluate patients＇ conditions,respectively.Meanwhile,the drugs resisting cerebral angiospasm,such as Nimodipine,were infused in every postoperative patient through vein as routine.As a result,11 patients （21％） were found to have secondary injury of cranial nerves Ⅱ,Ⅲ,and Ⅳ,and nine patients got recovered during the long-term observing follow-up period.Temporary surgical complications of vascular lesions occurred after surgery,such as cerebral angiospasm,ischemia,and edema;24 patients （45％） appeared to have infarction and dyskinesia of limbs.Overall,visual ability was improved in 41 patients （77％）.No patient died during the process.Conclusions Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas.The surgical strategy should focus on survival and postoperative living quality.     

Intracerebellar meningioma with peritumoral cyst in an adult: case report

Meningiomas without attachment to the dura are rare. .These meningiomas are more common in children than in adults, and are found more often in the supratentorial region than in the infratentorial region. Thus, adult meningiomas contained entirely within the brain parenchyma and located in the posterior fossa are extremely rare. Previously, only Teo et al3 have reported an intraparenchymal meningioma occurred in the brainstem. Here, we present a case of adult transitional meningioma located entirely in the right cerebellum. This diagnosis was confm-ned by detailed radiological, surgical, and pathological analyses.     

Lipid signal in evaluation of intracranial meningiomas

Background Using magnetic resonance imaging, diagnosis of malignant meningioma from benign meningioma with atypical features is uncertain. We evaluated the value of lipid signal in differentiating intracranial meningiomas.
Methods ^1H-magnetic resonance spectroscopy （MRS） using a point resolved spectroscopy （TR/TE 1000/144 ms） sequences were performed on 34 patients on a 3.0 T scanner. Lipid peak located at 1.3 ppm was evaluated. MRS data from these tumours were compared with histopathological findings （including hematoxylin and eosin staining and KP-1 staining）.
Results Twenty-nine meningiomas were histologically benign （eleven meningothelial, thirteen fibrous, four transitional and one microcystic）, three were atypical, and two were anaplastic. Lipid signal was detected in ten cases： two anaplastic three atypical, two fibrous and three rneningothelial meningiomas. All voxels with lipid peak in the spectrum from the tumour were evaluated. With creatinine peak in the normal white matter chosen as internal standard, lipid/creatinine ratios of anaplastic, atypical and benign meningiomas were 0.844±0.027 （range from 0.725 to 0.994）, 0.465±0.023 （range from 0.239 to 0.724）, and 0.373±0.016 （range from 0.172 to 0.571） respectively. Highly significant differences were noted between anaplastic and the other two subtypes. Patchy necrosis was observed in anaplastic meningioma, while focal necrosis was noted in atypical meningioma with HE stain. However, no necrosis was found in benign group. KP-1 stain demonstrated histocytes containing lipids in the necrotic region of anaplastic and atypical meningioma.
Conclusion The lipid signal at 1.3 ppm is a useful marker in evaluating the malignancy of intracranial meningiomas, especially in the differential diagnosis of anaplastic meningioma.     

Histopathological classification and location of consecutively operated meningiomas at a single institution in China from 2001 to 2010

Background  Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010.

Methods  This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization (WHO) classification. The location of the meningiomas was also categorized.

Results  The female:male ratio of the 7084 cases was 2.34:1. The mean age was 51.4 years (range, 11 months–86 years). The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas (P <0.001, Fisher’s Least Significant Digit test). There was a significantly higher female:male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas (2.57, 1.03 and 0.76, respectively; P <0.001, χ² test). Meningothelial (n=2061) and fibrous meningiomas (n=3556) were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site (38.33%, n=2722). Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series.

Conclusions  Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade I meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common meningioma location.

     

Chordoid meningioma: a report of two cases

Although meningiomas are common rumors in adults, the chordoid variant is very rare. According to the World Health Organization Classification of Tumors of the Nervous System （Lyon, 2000）,chordoid meningioma together with another rare variant, lymphoplasmacyterich meningioma, usually contain abundant lymphoplasmacytic infiltration, and are associated even with hematological abnormalities, especially in young adults. Few cases of chordoid meningioma have been reported in detail until Couce and his colleagues reported a sizable series of forty-two cases. Even then, the clinical and pathological features of these tumors were not well characterized, because of variations in different papers. In the present article, we report two adult patients with chordoid meningioma.     

Primary diffuse intraosseous meningioma

Primary intraosseous meningiomas are a subset of primary extradural meningiomas that arise in bones,and represent about two thirds of primary extradural meningiomas.1 Here we present a case of primary intraosseous meningioma with diffuse and symmetrical invasion of skull and scalp,which was preoperatively diagnosed as fibrous dysplasia.We described the clinical and radiological characteristics,discussed the potential pathogenesis of the diffuse lesion,and presented surgical management. A 32-year-old man was referred for neurosurgical consultation due to an 8-year history of painless,slowly growing huge scalp mass.The patient denied any past surgical history and head trauma.The patient did not present any neurological deficts.Computed tomography (CT) scans (Figure 1A and 1B) revealed diffuse thickening of the cranial vault,especially in the bilateral frontal-temporal-parietal bone.     

Sphenoid wing meningioma en plaque: report of 37 cases

Background Sphenoid wing meningioma en plaque is a special morphological subgroup of intracranial meningiomas, defined by a carpet-like, soft tissue component that infiltrates the dura and invades the sphenoid wing and orbit associated with a significant hyperostosis. This report summarized our experiences in 37 patients with sphenoid wing meningioma en plaque who had been treated with transcranio-orbital approach surgery. Methods A retrospective study was made on clinical manifestations, neuroradiological features, and operative techniques in 37 patients undergoing transcranio-orbital approach from Sep. 1998 to Apr. 2009. Patients ages： 16 years to 67 years, 45.5 years in average; sex： 15 males, 22 females. Chief complaints were progressive proptosis and visual acuity deficits. All patients were operated on using a fronto-temporal approach with orbital decompression. The extent of tumor resection and postoperative complications were investigated. Results Simpson grade Ⅱ resection was achieved in 9 patients, Simpson grade Ⅲ in 22 patients and Simpson grade Ⅳ in 6 patients. Pathological examination showed 27 （73%） patients were meningothelial meningiomas. After surgery, proptosis improved in all patients, visual acuity improved in 18 patients （69%）. Temporary ophthalmoplegia was found in 8 patients, cerebrospinal fluid leak was found in 1 patient. Duration of follow up was from 3 months to 9 years, tumor recurred in 7 patients, and 5 patients underwent second surgery, including two trans-nasal endoscopic surgeries to resect sphenoid sinus-involved tumor. There were no operation-related deaths or other significant complications. Conclusions Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are more likely to produce adjacent hyperostosis and have characteristic radiological appearances. All the hyperostosis bone of the great wing of sphenoid bone should be removed to prevent recurrence. Extensive tumor removal with bony decompression at the orbital apex can produce satisfactory cosmetic and functional outcome. Close co-operation between the neurosurgeons and the ophthalmologists is important.     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor，EGFR-TKI）分子靶向治疗研究为肇始，转化性研究使基础实验和临床实践间的鸿沟迅速填平，改变着人们认识治疗肺癌的视角。无可否认，EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段，但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度，     

中医疗法治疗运动性疲劳的研究进展

随着竞技体育的发展，运动员经常承受着大负荷、超强度的体力训练，因此极易产生运动性疲劳。疲劳的出现使肌内压增高，局部缺血，造成氧化代谢、H^＋排出率与pH值降低，血乳酸增高，从而影响肌纤维神经传导速度和肌内收缩力量，减弱了肌肉保护能力。致使较多的冲击力传到骨骼上，故易导致疲劳骨折的发生,严重影响了运动员的训练和比赛成绩，对运动员身心产生不必要的伤害。运动性疲劳消除手段的研究一直是竞技体育工作和运动医学关注和研究的焦点。     

Effects of tacrolimus and cyclosporine treatment on metabolic syndrome and cardiovascular risk factors after renal transplantation: a meta-analysis

Background The therapeutic success of renal transplantation has been largely attributable to the development of effective and balanced immunosuppressive treatment regimens.This study provides a meta-analysis of a series of randomized controlled trials that compared the effects of tacrolimus and cyclosporine on metabolic syndrome （MetS） and cardiovascular risk factors after renal transplantation.Methods We searched various electronic databases and bibliographies,including MEDLINE,the Cochrane Central Register of Controlled Trials,and EMBASE,for relevant studies published prior to October 2012.Results Our meta-analysis included five randomized controlled trials that examined a total of 923 patients.The tacrolimus group and the cyclosporine group exhibited no significant differences in MetS incidence after renal transplantation; risk ratio （RR）：1.06,95％ confidence interval （C/）：0.73-1.55,P=0.76.Cyclosporine treatment was associated with a higher incidence of hyperlipidemia （RR：0.50,95％ CI：0.39-0.64,P ＜0.01）.Although there were no statistically significant differences,cyclosporine treatment was associated with a higher incidence of hypertension （RR：0.91,95％ CI：0.83-1.00,P=0.06） after renal transplantation compared to tacrolimus treatment,and tacrolimus treatment was associated with a higher incidence of diabetes after renal transplantation （RR：1.79,95％ CI：0.98-3.27,P=0.06） compared to cyclosporine treatment.Conclusions Compared to tacrolimus treatment,cyclosporine treatment was associated with a higher incidence of hyperlipidemia.Future large-scale studies are expected to be conducted to further confirm our findings.     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.     

郭振球教授高血压病辨治特色

郭振球教授是湖南中医药大学教授,从事临床、科研、教学工作六十一年,积累了丰富的临床经验,在学术上治学严谨。学验俱丰。1986年人选我国首批中医学博士研究生导师．1990年被评为我国首批全国继承老中医学术经验指导老师,开创了微观证治学,系世界传统医学诊断学学科奠基人。     

Bias in multiple-treatments meta-analysis: a case on comparative efficacy and tolerability of 15 antipsychotic drugs for schizophrenia

Multiple-treatments meta-analysis is thought to be a feasible method to compare the efficacy and safety among different treatments, especially when there was no head-to-head research among some treatments. But sometimes some conclusions are inconsistent with the clinical experience. Recently, we read a multiple-treatment meta-analysis finished by Stefen Leucht et al, which was published in Lancet） The authors summarized the results of the RCT studies on 15 antipsychotics commonly used in practice; they also horizontally compared the efficacy and safety profile by the recta-analysis. We believe that the results provide more solid evidence for the rational usage of antipsychotics to the psychiatrists, also for the government to distribute health resources in a more reasonable way.     

Comparison of result judgment algorithm of test for interfering factors in the bacterial endotoxins test among Chinese, Japanese, European, American, and Indian pharmacopeias

Background The bacterial endotoxins test （BET） is a method used to detect or quantify endotoxins （lipo-polysaccharide,LPS） and is widely used in the quality control of parenteral medicines/vaccines and clinical dialysis fluid.It is also used in the diagnosis of endotoxemia and in detection of environment air quality control.Although BET has been adopted by most pharmacopoeias,result judgment algorithms （RJAs） of the test for interfering factors in the BET still differ between certain pharmacopoeias.We have evaluated RJAs of the test for interfering factors for the revision of BET described in the Chinese Pharmacopoeia 2010 （CHP2010）.Methods Original data from 1 748 samples were judged by RJAs of the Chinese Pharmacopoeia 2010,the Japanese Pharmacopoeia 2011 （JP2011）,the European Pharmacopoeia 7.0 （EP7.0）,the United States Pharmacopoeia 36 （USP36）,and the Indian Pharmacopoeia 2010 （IP2010）,respectively.A SAS software package was used in the statistical analysis.Results The results using CHP2010 and USP36,JP2011,EP7.0,and IP2010 had no significant difference （P=-0.7740）.The results using CHP2010 of 1 748 samples showed that 132 samples （7.6%） required an additional step; nevertheless there was no such requirement when using the other pharmacopeias.The kappa value of two RJAs （CHP2010 and EP7.0） was 0.6900 （0.6297-0.7504） indicating that the CHP2010 and other pharmacopoeias have good consistency.Conclusions The results using CHP2010 and USP36,JP2011,EP7.0,and IP2010 have different characteristics.CHP2010 method shows a good performance in Specificity,mistake diagnostic rate,agreement rate,predictive value for suspicious rate,and predictive value for passed rate.The CHP2010 method only had disadvantages in sensitivity compared with other pharmacopeias.We suggest that the Chinese pharmacopoeia interference test be revised in accordance with the USP36,JP2011,EP7.0,and IP2010 judgment model.     

Norcantharidin inhibits tumor growth and vasculogenic mimicry of human gallbladder carcinomas by suppression of the PI3-K/MMPs/Ln-5T2 signaling pathway

Background：Vasculogenic mimicry （VM） is a novel tumor blood supply in some highly aggressive malignant tumors. Recently,we reported VM existed in gallbladder carcinomas （GBCs） and the formation of the special passage through the activation of the PI3K/ MMPs/Ln-5γ2 signaling pathway. GBC is a highly aggressive malignant tumor with disappointing treatments and a poor prognosis. Norcantharidin （NCTD） has shown to have multiple antitumor activities against GBCs, etc; however the exact mechanism is not thoroughly elucidated. In this study, we firstly investigated the anti-VM activity of NCTD as a VM inhibitor for GBCs and its underlying mechanisms. Methods ： In vitro and in vivo experiments to determine the effects of NCTD on proliferation, invasion, migration, VM formation, hemodynamic and tumor growth of GBC-SD cells and xenografts were respectively done by proliferation, invasion,migration assays,HE staining and CD31-PAS double staining, optic/electron microscopy, tumor assay, and dynamic micro- MRA. Further, immunohistochemistry, immunofluorescence, Western blotting and RT-PCR were respectively used to examine expression of VM signaling-related markers PI3-K,MMP-2 ,MT1-MMP and Ln-5γ2 in GBC-SD cells and xenografts in vitro and in vivo. Results： After treatment with NCTD, proliferation, invasion, migration of GBC-SD cells were inhibited; GBC-SD ceils and xenografts were unable to form VM-like structures; tumor center-VM region of the xenografts exhibited a decreased signal in intensity; then cell or xenograft growth was inhibited. Whereas all of untreated GBC-SD cells and xenografts formed VM-like structures with the same conditions; the xenograft center-VM region exhibited a gradually increased signal; and facilitated cell or xenograft growth （Figure 1-6 ）. Furthermore, expression of MMP-2 and MT1-MMP products from sections/supemates of 3-D matrices and the xenografts, and expression of PI3-K, MMP-2, MM1-MMP and Ln-5γ2 proteins/mRNAs of the xenografts were all decreased in NCTD or TIMP-2 g