Epidemiology, Characteristic, and Prognostic Factors of Primary Sporadic Intradural Malignant Peripheral Nerve Sheath Tumor in the Spinal Canal: A Systematic Literature Review.

Purpose: Primary sporadic intradural malignant peripheral nerve sheath tumor (MPNST) in the spinal canal is a type of rare neoplasm with challenging diagnosis and therapy. The overall prognosis of this tumor is markedly different from that of the usual spinal intradural tumors. The purpose of this systematic review is to reduce the misdiagnosis and enhance the prognosis of the disease by reviewing the literature. Methods: PubMed, Medline, and Embase databases were searched for articles in English language published from 1980 to May 2021, yielding 500 potentially relevant articles. The keywords were as follows: "spinal", "malignant peripheral nerve sheath tumor", "neurosarcoma", "malignant schwannoma", and "malignant neurofibroma". Thirteen papers met the eligibility criteria, including 55 cases with spinal intradural primary sporadic MPNSTs, which were confirmed by post-operation pathology. We further analyzed the clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis. Results: Fifty-five spinal intradural primary sporadic MPNSTs from 30 (54.5%) male and 25 (45.5%) female patients with an average age at diagnosis of 40 years (range, 3-70 years) were included in the study. The most common clinical manifestations were local or radicular pain and motor disturbance. All tumors had significant enhancement and heterogeneous enhancement was more common. Out of 18 lesions, 14 were diagnosed as high grade and the remaining 4 were diagnosed as low grade. The ki-67 labeling index ranged from 5% to 60%. The median recurrence and survival time were 36 and 72 months, respectively. The log-rank tests indicated that significant predictors of OS were patient age (≤30 vs. >30 years) at the time of diagnosis and the presence of metastatic disease, and similar analyses for RFS demonstrated that the presence of metastatic disease was the only significant predictor (60 vs. 10 months). The multivariate Cox proportional hazards regression analysis revealed that absence of metastasis was an independent factor for predicting a favorable prognosis. Conclusions: Spinal intradural primary sporadic MPNSTs are challenging malignant tumors without a systematic treatment plan. The factors affecting its prognosis are not clear. Even after surgical treatment and adjuvant treatment, the recurrence rate and mortality rate are still high. Clinicians should be alert to the possibility of this disease and achieve early detection and treatment.

A Comprehensive Meta-analysis of Genetic Associations Between Key Polymorphic Loci in DNA Repair Genes and Glioma Risk.

Genetic variants found in DNA repair genes (ERCC1, rs3212986; ERCC2, rs13181; ERCC4, rs1800067; ERCC5, rs17655; XRCC1, rs1799782, rs25487, rs25489; XRCC3, rs861539) have been reported to have an ambivalent association with the development of glioma. In the present study, a meta-analysis was conducted to confirm the relationship, taking heterogeneity of population into consideration. We analyzed 21 articles of 6 genes along with 8 single nucleotide polymorphisms (SNPs) (24,078 cases and 30,926 healthy individuals), which assessed the relationship between nucleotide excision, base excision, double-strand break repair gene, and the development of glioma under five models. All statistical analysis was implemented by the software of R 3.2.1, and the relationships between key polymorphic loci in DNA repair genes and glioma were quantified by the pooled odds ratio (OR) and 95 % confidential intervals. Overall, the synthesized evidence demonstrated that the SNP of rs13181 and rs1799782 significantly increased the risk of glioma whereas SNP of rs1800067 were significantly associated with a decrease in the risk of glioma. Additionally, subgroup analyses of 8 SNPs by ethnicity indicated that the mutation of rs13181, rs1800067 were apparently protective factors of glioma among Asians, while the mutation of rs13181 was a risk factors of glioma in Caucasians. Furthermore, the mutation of rs1799782 significantly raises the risk of glioma for Asian. Our study suggested that rs13181*C and rs1799782*A are risk alleles for glioma; rs1800067*A are beneficial alleles for decreased susceptibility to glioma. Future studies with large sample size and other races are strongly recommended to confirm the results from this study.

CD163 promotes hematoma absorption and improves neurological functions in patients with intracerebral hemorrhage.

Clinical outcomes are positively associated with hematoma absorption. The monocyte-macrophage scavenger receptor, CD163, plays an important role in the metabolism of hemoglobin, and a soluble form of CD163 is present in plasma and other tissue fluids; therefore, we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage. Patients with intracerebral hemorrhage were divided into high- and low-level groups according to the average CD163 level (1,977.79 ± 832.91 ng/mL). Compared with the high-level group, the low-level group had a significantly slower hematoma absorption rate, and significantly increased National Institutes of Health Stroke Scale scores and modified Rankin Scale scores. These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.

Schidandrin B kills tumor cells by initiating apoptosis in glioma SHG-44 cells.

OBJECTIVE: To observe the proliferation inhibition, cell cycle, and apoptosis of human glioma cell line SHG-44 treated with different concentration of Schidandrin B and explore the effect of Schidandrin B on glioma SHG-44 cells. METHODS: Glioma SHG-44 cells were treated with Schidandrin B (0, 50, 100 or 200 µg/mL) for 24, 48, 72 and 96 h, and cells were treated with vehicle as control. Viability of cells were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) analysis; cell cycle was examined with flow cytometry assay; apoptosis was detected with annexin V assay. Bax and caspase-3 proteins expression were checked by Western blot. RESULTS: MTT analysis showed that viability of glioma SHG-44 cells significantly decreased after exposure to Schidandrin B for the indicated time. Flow cytometry revealed that the number of cells in the sub G1 phase was increased, however, the number of cells in G0/G1, S and G2/M phases were decreased after treatment with 50, 100 or 200 µg/mL Schidandrin B, compared with the respective control group. Annexin V analysis confirmed that apoptosis rates of the control group, 50, 100, and 200 µg/mL Schidandrin B group were 1.76%±0.47%, 13.98%±5.05%, 19.64%±5.53% and 63.28%±6.88% respectively, apoptotic rate increased significantly with dose-dependent manner, and apoptosis of cells were observed under the inverted microscope after 100 µg/mL Schidandrin B treatment. Bax and caspase-3 protein were highly expressed in Schidandrin B group compared with the control group. CONCLUSION: The apoptosis could be induced by different concentration of Schidandrin B on glioma SHG-44 cells, and the mechanism may be directly excited by Schidandrin B in glioma SHG-44 cells through activating mitochondrial pathway.

[Microsurgical treatment regimens of cavernous sinus hemangioma].

OBJECTIVE: To analyze the microsurgical treatment regimens of cavernous sinus hemangioma. METHODS: The microsurgical experiences were reviewed and analyzed for 17 cases of operatively and pathologically confirmed cavernous sinus cavernous hemangioma at our hospital from January 2008 to January 2012. There were 6 males and 11 females with an average age of 48.5 years. RESULTS: Among them, there were total (n = 14) and subtotal (n = 3) resection. And there was no occurrence of postoperative mortality. According to the results of imaging follow-up, total resection cases had no recurrence while subtotal residual tumor was progression-free after radiotherapy. Oculomotor, abducens and trigeminal nerves retained varying degrees of neurological function at 3-6 months postoperation. CONCLUSION: Based on the size of tumor and growth direction, appropriate surgical approaches may be selected. And a combination of skilled microsurgical techniques and proper resection may reduce bleeding and facilitate total tumor removal so as to reduce the degree of neurological deficits and improve the long-term postoperative quality-of-life.

[Perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass].

OBJECTIVE: To retrospectively review the perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass. METHODS: The data of 6 patients with primary tracheal malignant tumors who underwent surgery under cardiopulmonary bypass from December 1999 to August 2003 were reviewed. Cardiopulmonary bypass was established through right femoral vessels in 2 patients for emergency operation, through right atrium and ascending aorta in 4 patients. Sleeve tracheal resections in 3 patients, carinal resections and carina reconstructions in 2, and local enucleation in 1 were performed. Respiratory airway was kept patent by coughing and expectorating sputum. RESULTS: All patients' dyspnea were relieved remarkably. The postoperative mechanic ventilation assistance lasted from 10 hours to 7 days. There was no perioperative mortality. CONCLUSION: Resection of primary tracheal malignant tumors with severe tracheal obstruction under cardiopulmonary bypass is practicable. Keeping respiratory airway patent perioperatively is very important and helpful to postoperative recovery.

Non-invasive imaging of coronary artery with 16-slice spiral computed tomography.

OBJECTIVE: To evaluate the value of 16-slice spiral CT in the demonstration of coronary artery and in the diagnose of coronary artery stenosis. METHODS: Plain and enhanced CT scans were performed with a 16-slice CT scanner (Sensation 16, Siemens, Germany) in 230 patients with suspected coronary heart disease (CHD). Parameters of the plain scan were: 120 kV, 133 mA, slice collimation 16 mm x 1.5 mm, rotation time 0.42 seconds, increment 1.5 mm, and slice width 3 mm. Parameters of the enhanced scan were: 120 kV, 500 mA, slice collimation 16 mm x 0.75 mm, rotation time 0.42 seconds, increment 0.5 mm, and slice width 1 mm. Enhanced CT scan was performed with a rapid intravenous injection of 100 mL iothalamate meglumine (Ultravist) (370 mgI/mL) or Omnipaque (350 mgI/mL) and 30 mL 0.9% NaCl chaser bolus at a flow rate of 3.5 mL/s. Calcium scoring with plain scan images and two and three dimensional reconstruction with enhanced scan images were made in all cases, among which 30 cases underwent conventional coronary angiography. Demonstration of coronary arteries and their stenosis were evaluated and the factors that might influence the image quality were analyzed. RESULTS: Coronary calcium scores were calculated and coronary artery was demonstrated in our study. In the evaluation of image quality with volume rendering technique (VRT) images, 78.3% of the images were of the first class, 12.2% the second class, and 9.6% the third class. Multi-planar reconstruction (MPR) and maximal intensity projection (MIP) were better than VRT in the demonstration of small branches. The image quality was related to the heart rate, with or without arrhythmia, and breath-hold ability of patients. Comparative study of the stenosis of coronary arteries in 30 cases showed that the sensitivity and specificity of 16-slice coronary CT angiography (CTA) to diagnose significant stenosis were 95.8% and 94.8% respectively. CONCLUSION: As a non-invasive and quick method, 16-slice coronary CTA is sensitive and specific to diagnose the stenosis of coronary arteries and can be used as a screening method in the diagnosis of CHD.

[Coronary angiography with sixteen-slice spiral CT: an initial study].

OBJECTIVE: To evaluate the scanning technique and primary clinical value of sixteen-slice spiral CT coronary angiography. METHODS: Plain and enhanced sixteen-slice spiral CT imaging was performed in 69 patients, including 64 cases of suspected coronary heart disease and 5 cases of coronary stent. Calcium scoring with plain scan images and MPR, MIP and VRT reconstruction with enhanced scan images were made in all cases, among which 10 underwent conventional coronary angiography. The demonstration and stenosis of coronary arteries were evaluated. The factors influencing the image quality were analyzed. Additional MPR and MIP reconstruction of slices perpendicular to the stent and virtual endoscopy of stent were made in 7 stents of the 5 cases of coronary stent. The patency of the stents was evaluated. RESULTS: A four-step scanning procedure was devised. Coronary calcium score could be got by plain scanning with sixteen-slice spiral CT angiography. All of the primary, most of the secondary and tertiary, and part of the fourth level branches of coronary artery could be shown isotropically with MPR, MIP and VRT reconstruction images of enhanced scanning. MPR and MIP were better than VRT in demonstrating small branches. Evaluated by VRT image, the image quality of 79.7% of the patients were first class, 10.1% second class, and 10.1% third class. The image quality was correlated to the contrast concentration in the root of aorta, heart rate, existence or absence of arrythmia, and the patient's breath-holding ability. Stenosis of coronary arteries was evaluated by sixteen-slice spiral CT imaging in 10 cases, with a result comparable to that by conventional coronary angiography. The stents were well shown, six stents being evaluated as patent, while one not. CONCLUSION: Sixteen-slice spiral CT coronary angiography is a noninvasive, simple and good method. Coronary calcium score and coronary artery stenosis can be evaluated with one study. The patency of stents can also be evaluated.

[Surgical management of metastatic disease in the conjunctive area between neck and thorax].

OBJECTIVE: To study the surgical management of metastatic disease in the conjunctive area between the neck and thorax and its efficacy. METHODS: Fourteen cases with metastatic node disease in the area between neck and thorax were collected and analysed. Eleven tumors were from the thyroid cancer, and the other three were from the hypopharyngeal cancer, esophagual cancer and malignant pheochromocytoma, respectively. The clavicle was displaced or resected, and the upper half of the manubrium might also be resected when necessary. The recurrent laryngeal nerve and phrenic nerve were exposed and protected. The metastatic disease was completely removed with the internal jugular and/or the brachiocephalic vein resected or spared, depending on the disease condition. RESULTS: In 10 cases with metastases from the thyroid, no local recurrence was found within the follow-up period from 2 to 5 years. In contrast, no patient with metastatic disease from hypopharyngeal or esophageal cancer survived more than 11 months. No serious complications were found in this group. CONCLUSIONS: The surgical treatment of node metastases in the conjunctive area between neck and thorax from the well-developed thyroid cancer has promising effect and is comparatively safe.