Mixed craniopharyngioma: long-term results after gamma knife combined with stereotactic brachytherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for mixed cystic and solid craniopharyngiomas.</p><p><b>METHODS</b>Sixty-seven consecutive patients with mixed cystic and solid craniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic brachytherapy from October 1996 to December 2005 were selected for retrospective analysis. The inclusion criterion was the patients who survived for at least 5 years after combined treatment. There were 39 male and 28 female patients and the mean age was 31.5 years (ranged from 3 to 70 years). The clinical evaluations including neurological, neuro-ophthalmological, and neuro-endocrinological examinations, assessment of comprehensive quality of life and neuroimaging examinations were performed periodically. The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method. The rates were compared using the χ(2) test.</p><p><b>RESULTS</b>Follow-up period varied from 60 to 168 months, with an average of 114 months. The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9% respectively, and 89.6% in all. Mean survival after combination treatment was (110 ± 9) months. The mean survival of patients with predominantly solid and cystic craniopharyngioma were (97 ± 12) months and (120 ± 14) months and the actuarial 10-year survival rates were 7/12 and 69.1%. There was no statistics difference in tumor response rate and 10-year survival rate between 2 groups of patients with predominantly solid and cystic craniopharyngioma. The actuarial 5-, 6-, 7-, 8-, 9- and 10-year survival rates were 90.5%, 85.7%, 83.3%, 76.4%, 69.4% and 60.0% respectively. The decreased visual acuity had improved in 68.3% at 6 months postoperatively and in 70.0% in long term results. Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases(41.8%), good in 19 cases(28.4%), fair in 17 cases(25.4%) and poor in 3 cases(4.5%), respectively. The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity (4 patients), dysfunction of hypothalam (4 patients) and third nerve palsy was found in 1 patents 5 years after treatment. The rate of complications was 13.4%.</p><p><b>CONCLUSION</b>Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.</p>

Magnetic resonance spectroscopy-guided stereotactic biopsy for brain lesion / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of magnetic resonance spectroscopy (MRS) image in stereotactic biopsy for brain lesion.</p><p><b>METHODS</b>From April 2008 to April 2010, 126 cases (72 male and 54 female, aged from 10 to 82 years, mean 45 years) of brain lesion which were difficult to diagnose were divided into two groups by random number table, 62 cases were executed for MRI-guided frameless stereotactic biopsy (MRI group), 64 cases were executed for MRI and MRS-guided frameless stereotactic biopsy (MRS group). Operation used MRI and Three-dimensional MRS image to locate, and used frameless CAS-R-2 robots to carry out the positioning operating.</p><p><b>RESULTS</b>No surgery-related deaths and infections. Pathological diagnosis was 106 cases of brain tumors, 6 cases of inflammatory disease, 4 cases of tumor-like demyelinating disease and multiple sclerosis, 3 cases of neurodegenerative disease, 7 cases failed to obtain positive pathological diagnosis. The total rate of positive diagnosis was 94.4%, the positive rate in MRS-guided stereotactic biopsy group was 98.4% (63/64), the positive rate of conventional MRI-guided biopsy group was 90.3% (56/62), and there was statistically significant difference between the two groups (χ(2) = 3.92, P = 0.047). Four cases presented with postoperative complications, the complication rate was 3.2% (4/126); the complications were cerebral hemorrhage associated with aphasia, epilepsy, subcutaneous hematoma, gastrointestinal bleeding, which were improved after treatment.</p><p><b>CONCLUSIONS</b>MRS-guided stereotactic biopsy group has a higher positive rate than MRI-guided stereotactic biopsy group, indicating that this method can improve the positive rate of diagnosis, and thus will help to formulate treatment plan for brain lesion.</p>

Clinical experience of stereotactic biopsy for the brain lesions / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the methodology of diversified advanced image-guided stereotactic biopsy for the brain lesions, and its diagnostic significance and experience in nervous system diseases.</p><p><b>METHODS</b>Retrospectively reviewed 1187 cases of brain lesions underwent image-guided stereotactic biopsy from December 1987 to January 2009. There were 694 male (58.5%) and 493 female (41.5%) patients, aged from 1 to 85 years (average 39.7 years). There were 607 cases in CT-guided, including positron emission computed tomography (PET) guided stereotactic biopsy; 580 cases in MRI-guided, including proton magnetic resonance spectroscopy ((1)H-MRS) guided stereotactic biopsy. Routine frame was used in 726 cases and frameless stereotactic biopsy in 461 cases, including neuroendoscopic biopsy in 28 cases, guided by computer assisted surgery (CAS) computer-assistant robot. In the early 450 cases, CT/MRI images films were employed to measure the coordinates of the target by hand, while in the late 737 cases, computer-assistant planning software rebuilt the CT/MRI images and figured out the optimal neurosurgical path for biopsy.</p><p><b>RESULTS</b>The positive diagnosis rate of biopsy was 97.4%, 983 (82.8%) cases were diagnosed pathologically as brain tumors, and 173 (14.6%) cases as non-tumor diseases. The tumors mainly including neuroglioma, metastatic tumor, primary central nervous system lymphoma and germ cell tumors. In non-tumor diseases, mainly including multiple sclerosis, tumefactive demyelinating lesion, neurodegenerative disease, inflammation and parasite. The biopsy operation caused small hematoma without neurological deficits in 20 cases (1.7%), and caused large hematoma (> 10 ml) which need neurosurgical treatment (catheterization or craniotomy evacuation of hematoma) in 9 cases (0.8%). Hemorrhage associated with biopsy caused 3 cases (0.3%) death. There were no severe intracranial infection cases.</p><p><b>CONCLUSIONS</b>The stereotactic biopsy with advanced image-guided technique represents a safe, reliable and minimally invasive method for pathological diagnosis of intracranial lesions. Moreover, the developments of biochemical imaging gives a new concept to the stereotactic biopsy.</p>

Anatomic study of the medial pedis composite flaps with saphenous nerve and tendon and its application / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the anatomy of the medial pedis composite flaps with saphenous nerve and tendon and its application in the repair of tendo calcaneus and adjacent defects.</p><p><b>METHODS</b>10 cadavers (20 sides) were observed. The origin, course, size and the distribution of the medial plantar artery were studied. 12 cases with tendo calcaneus and adjacent defects were reconstructed with the medial pedis composite flaps with saphenous nerve. Donor site defects were covered with free skin graft.</p><p><b>RESULTS</b>The medial plantar artery gives off deep branch [diameter (1.5 +/- 0.3) mm] and superficial branch [diameter (1.0 +/- 0.2) mm]. In 18 sides, the deep branches give off the medial branches and lateral branches. While in 2 sides, the superficial branches give off the medial branches and lateral branches with no big branches from the deep branches. There are branches of saphenous nerve and medial dorsal cutaneous nerve in the flap. All the flaps were survived. 8 cases were followed up for one months to one years. Good color, texture and function of the flaps were achieved.</p><p><b>CONCLUSIONS</b>The medial pedis composite flaps with saphenous nerve can repair tendo calcaneus and adjacent defects. It is a easy and safe procedure with reliable anatomy and good results.</p>

Diagnosis and radiotherapy of germinomas arising in basal ganglia and thalamus / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristic and radiotherapeutic effect of germinomas arising in basal ganglia and thalamus.</p><p><b>METHODS</b>The clinical data of 13 cases were reviewed retrospectively. All cases were pathologic diagnosis through stereotactic biopsy. Gamma-knife or ordinary irradiation were 2 cases respectively and the combined therapy with interstitial brachytherapy as foundation were 9 cases.</p><p><b>RESULT</b>All cases were male, median age of 16.1 years. Hemiparesis and ataxia were major symptoms, some cases were accompanied with precocious puberty. Imaging manifested intratumoral cystic components represented 76.9% of all lesions, calcification represented 30.8%, ipsilateral cerebral and brain stem hemiatrophy represented 46.2%, cerebral white matter invasion through internal capsule or corpus callosum represented 30.8%. One case died because of late complication and 12 cases had achieved satisfied therapeutic effect (the mean followed-up period was 40.6 months). Tumor-control were effective.</p><p><b>CONCLUSIONS</b>The clinical manifestation and imaging characteristics are helpful to diagnosis. Stereotactic biopsy make the affirmatory diagnosis. Operative total-removal is impossible because of deep location, neighbour of vital structure and invasion. The combined therapy with interstitial brachytherapy was effective.</p>

Polyadenylation signal-deficient retroviruses transformation of human gastric epithelial GES-1 cells / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To verify if mutated polyadenylation signal retroviruses can produce viral-host readthrough transcripts (Rth) and have the ability to transform human gastric epithelial GES-1 cells, and to discuss the new functions of retroviruses in gastric cancer related gene research.</p><p><b>METHODS</b>The polyadenylation signal-deficient retrovirus vector mutated by PCR site-directed mutagenesis was used to make polyadenylation signal-deficient retroviruses by PA317 packaging cells. The GES-1 cells were infected by the viruses and selected by G418. Viral-host readthrough RNAs were checked by Northern blot. The cell growth and soft agar assay were run to test the transformed cells.</p><p><b>RESULTS</b>polyadenylation signal-deficient retroviruses could be packaged by PA317 packaging cells. The viruses had the ability to infect GES-1 cells. Northern blot analysis of viral RNA from infected pools and individual G418-resistant clones demonstrated that mutation of consensus LTR polyadenylation signals generated Rth viral RNA in the infected GES-1 cells. Phenotypic analysis results showed that the GES-1 cells infected with plyadenylation signal mutant viruses tended to grow in a cluster manner. Pools of PA317 cells infected with mutant viruses were able to form colonies in soft agar with a higher efficiency than control or uninfected cells.</p><p><b>CONCLUSION</b>Host readthrough transcripts generated by polyadenylation signal mutant viruses may contribute to transformation GES-1 cell phenotypes. The mutant vectors and the method described in the present work may be useful as tools to trap and identify genes involved in retroviral insertion mediated cell transformation.</p>

Cloning of human plasminogen activator inhibitor-1(PAI1)gene and preparation of its monoclonal antibodies as well as its application in detection of PAI1 expression in breast cancer cells / 中华检验医学杂志

Objective To clne huma PAIl gene and prepare its monoclonal antibodies(McAbs) for determination of its expression in breast cancer cells.Methods Human PAI1 gene eDNA was amplified by RT-PCR from human breast cancer cell line MDA231 and inserted into the prokaryotic expression vector, which expressed fusion protein of MS2-PAI1 in E.coli.Fusion protein of MS2-PAI1 was purified and used for immunizing BALB/C mouse.Traditional hybridoma technology was used to produce hybridoma cells for preparation of monoclonal antibodies.Western blot and immunohistochemistry were used to detect PAI1 expression in breast cancer.Results The 1209 bp full PAI1 gene was cloned.The two hybridoma cell lines that secreted specific monoclonal antibodies against human PAI1 were identified by ELISA.The immunoglobulin subclasses of the McAbs were IgG1.The McAbs can specifically recognize PAI1 but not other proteins.Western blot showed that the McAbs against PAI1 can specifically react with MS2-PAI1 fusion protein and endogenous proteins in cells.The positive reaction was found in breast cancer cell line MDA231 and breast cancer tissues by immunochemical staining.Conclusions The McAbs against human PAI1 are successfully prepared by hybridoma technology with MS2-PAI1 fusion protein expressed in E.coll.It has been shown that PAI1 can be expressed in MDA231 and breast cancer tissues.The McAbs against PAI1 could be a useful tool for the further study of the human PAI1 functions and detection of clinical tumor samples.