Intradural osteomas: Report of two cases.

BACKGROUND: Intradural osteoma is very rarely located in the subdural or subarachnoid space. Unfortunately, intradural osteoma lacks specificity in clinical manifestations and imaging features and there is currently no consensus on its diagnosis method or treatment strategy. Moreover, the pathogenesis of osteoma without skull structure involvement remains unclear. CASE SUMMARY: We describe two cases of intradural osteomas located in the subdural and subarachnoid spaces, respectively. The first case involved a 47-year-old woman who presented with a 3-year history of intermittent headache and dizziness. Intraoperatively, a bony hard mass was found in the left frontal area, attached to the inner surface of the dura mater and compressing the underlying arachnoid membrane and brain. The second case involved a 56-year-old woman who had an intracranial high-density lesion isolated under the right greater wing of the sphenoid. Intraoperatively, an arachnoid-covered bony tumor was found in the sylvian fissure. The pathological diagnosis for both patients was osteoma. CONCLUSION: Surgery and pathological examination are required for diagnosis of intradural osteomas, and craniotomy is a safe and effective treatment.

Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery.

BACKGROUND: Spinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected. CASE PRESENTATION: This case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique. CONCLUSIONS: The real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.

Effect of the topical application of calcipotriol on the expression levels of zinc finger protein A20 and nuclear factor-κB in the skin lesions of patients with psoriasis vulgaris.

The aim of the present study was to explore the effect of the topical application of calcipotriol on the expression levels of zinc finger protein A20 and nuclear factor-κB (NF-κB) in the skin lesions of patients with psoriasis vulgaris. The calcipotriol ointment was topically applied twice a day for 6 weeks by 26 patients with psoriasis vulgaris. At the end of weeks 2, 4 and 6 after the first application of calcipotriol ointment, the clinical efficacy and Psoriasis Area and Severity Index (PASI) score were compared with those prior to treatment. The expression of zinc finger protein A20 and NF-κB in the skin lesions prior to and following treatment with calcipotriol was measured by immunohistochemical staining and western blotting. At the end of week 6, the clinical effectiveness rate of calcipotriol was higher compared with that at the end of weeks 2 and 4 (χ2=8.12 and 9.06, respectively; P<0.05). The PASI score declined significantly at the end of weeks 2, 4 and 6 (t=9.37, 10.54 and 12.43; P<0.05, 0.05 and 0.001, respectively). At the end of week 6, the expression levels of zinc finger protein A20 and NF-κB were significantly lower compared with those prior to treatment (χ2=3.65 and 4.17, respectively; P<0.01). The expression levels of the two proteins were higher in the skin lesions of patients with psoriasis vulgaris prior to the initiation of treatment than in the skin of a normal control group. Following the 6-week treatment with calcipotriol, the expression levels of the two proteins in the psoriasis skin lesions were significantly lower than they were prior to treatment (P<0.01). Thus, the present study found that in addition to the typical pathway of NF-κB being targeted in the treatment of psoriasis with calcipotriol, the zinc finger protein A20 may also modulate the inflammatory response of psoriasis.

Self-control study of combination treatment of 308 nm excimer laser and calcipotriene ointment on stable psoriasis vulgaris.

OBJECTIVE: This study aims to compare the differences of clinical efficacy and safety of treatment of stable psoriasis vulgaris with calcipotriene ointment in combination with 308 nm excimer laser to 308 nm excimer laser alone. METHODS: Randomized, open and self-control trial was conducted in 36 selected patients. The skin lesions from these patients with stable psoriasis vulgaris were divided into two sides along the midline of torso, one side was treated with 308 nm excimer laser, 2 times/week, at meantime Calcipotriene was applied externally, 2 times/day (treatment group); the other side was given 308 nm excimer laser alone, 2 times/week, the treatment period was 6 weeks (control group). Skin lesion area, PASI scores and cumulative doses of 308 nm excimer laser in patients with psoriasis were assessed before treatment and on weeks 2, 4 and 6 after treatment. RESULTS: 32 of 36 patients with stable psoriasis vulgaris completed study, effective rates in two groups were better on week 6 (84.37%, 56.25%) than on week 4 (53.12%, 37.5%) and on week 2 (31.25%, 18.75%) (P < 0.05). Effective rate on week 6 in control group (56.25%) was lower than treatment group (84.37%) (P < 0.05). The two groups showed that PASI scores on weeks 2 and 4 after treatment were significantly lower than before treatments (P < 0.05), and PASI scores on week 6 in treatment group was significantly lower than control group (P < 0.05). The average cumulative laser doses in treatment group at the end of trial was 4.69 (2.03) J/cm(2), which was significantly lower than in control group 8.41 (2.42) J/cm (P < 0.05). Treatment efficacies in the head, folds, back, abdomen and limbs were similar and no serious adverse effects, however the number of treatment and irradiation doses in the head and folds were significantly less than in back, abdomen and limbs (P < 0.05). CONCLUSIONS: Treatment of psoriasis vulgaris with 308 nm excimer laser in combination with external application of Calcipotriene ointment can improve long-term treatment efficacy, decrease cumulative laser doses, and reduce adverse effects induced by laser irradiations.

Zinc finger A20 and NF-κB correlate with high-risk human papillomavirus of squamous cell carcinoma patients.

Genital human papillomavirus (HPV) is associated with the development of cutaneous malignant tumors, and differences in HPV subtypes are found in several cancers by histology. NF-κB is persistently activated in most cancers and confers a survival advantage to cancer cells, while A20 is a critical negative regulator of NF-κB and is an important tumor suppressor inactivated in B cell lymphomas. This study was undertaken to identify HPV types in cutaneous squamous cell carcinoma (SCC) as well as to determine whether the crosstalk of A20/NF-κB was involved in HPV-induced SCC. Overall, HPV positivity was observed to be 66.2 %, with HPV16 being most common followed by infection with HPV18. Out of 43 HPV-positive samples, 35 samples were positive for one or more high-risk HPV (HR-HPV) types, suggesting a high association of SCC with HR-HPV infection, while only five HPV infections were detected in 21 normal skin samples and low-risk HPV (LR-HPV) infection was the most common. Both A20 and NF-κB were overexpressed in HPV-positive SCC samples (56 vs 87.4 %) and were closely correlated with TNM stage and lymph node transfer, respectively. More interestingly, the expression of A20 and NF-κB was much higher in HR-HPV samples than in LR-HPV samples. These results suggest that the crosstalk of A20 and NF-κB may contribute to HR-HPV-associated tumor growth and metastasis of SCC and may be a novel therapeutic target for SCC in the future.

AZD1480 can inhibit the biological behavior of ovarian cancer SKOV3 cells in vitro.

OBJECTIVE: To study the mechanism of effects of AZD1480 on the SKOV3 ovarian cancer cell line. METHODS: The MTT method was used to assess cellular proliferation, flow cytometry for cellular apoptosis, the scratch test to determine migration, transwell chamber assays to detect cellular invasion, plate clone experiments to detect the clone forming ability and Western blotting to determine p-STAT3 protein levels. RESULTS: The proliferation rate, migration ability, invasiveness and the clone forming ability of SKOV3 cells were reduced after treatment with AZD1480, while apoptosis rate and chemotherapeutic susceptibility were increased. After treatment with AZD1480 plus cisplatin, the apoptosis rate increased significantly while the expression level of p-STAT3 protein was decreased. CONCLUSION: AZD1480 can inhibit the proliferation, invasion, metastasis and clone formation of SKOV3 cells, induce cellulsar apoptosis, increase the chemotherapeutic sensitivity and reduce the expression level of p-STAT3 protein.

[Di-(2-ethylhexyl) phthalate activates the apoptosis Caspase pathway in rat Leydig cells in vitro].

OBJECTIVE: To investigate the effects of di-(2-ethylhexyl) phthalate (DEHP) on the expressions of Caspase-3 and Caspase-9 genes in rat Leydig cells and the apoptosis of the cells in vitro. METHODS: Leydig cells were isolated from male SD rats, primarily cultured and treated with DEHP at a low (10 nmol/L), a medium (50 nmol/L) and a high dose (100 nmol/L) for 24 hours. Then the mRNA expressions of Caspase-3 and Caspase-9 genes in the Leydig cells were detected by real time PCR, their protein expressions determined by Western blot, and the apoptosis of the Leydig cells measured by flow cytometry. RESULTS: Compared with the DMSO control group, the low-, medium- and high-dose DEHP groups showed significantly upregulated expressions of Caspase-3 mRNA (1.69 +/- 0.38 vs 3.82 +/- 0.39, 6.91 +/- 0.40 and 15.47 +/- 0.40, P < 0.05), Caspase-3 protein (0.18 +/- 0.0.09 vs 0.32 +/- 0.10, 0.61 +/- 0.08 and 0.89 +/- 0.09, P < 0.05), Caspase-9 mRNA (2.24 +/- 0.41 vs 5.16 +/- 0.43, 9.61 +/- 0.45 and 19.22 +/- 0.43, P < 0.05) and Caspase-9 protein (0.26 +/- 0.07 vs 0.40 +/- 0.08, 0.68 +/- 0.09 and 0.96 +/- 0.08, P < 0.05), as well as increased apoptosis rate of Leydig cells (4.36 +/- 1.11 vs 7.52 +/- 1.09, 12.72 +/- 1.10 and 24.59 +/- 1.11, P < 0.05), all in a dose-dependent manner. CONCLUSION: DEHP can induce the apoptosis of rat Leydig cells by activating the apoptosis Caspase pathway, and consequently affect the function of Leydig cells.

The incidence of cerebral amyloid angiopathy in surgically treated intracranial hemorrhage in the Chinese population.

Despite being widely accepted as an important cause of spontaneous intracranial hemorrhage (ICH), cerebral amyloid angiopathy (CAA) has seldom been studied in the Chinese population. The current study aims to investigate the incidence and features of CAA in surgically treated ICH patients in China. From May 2006 to April 2011, 974 patients admitted to 71 hospitals throughout China for acute spontaneous ICH were studied. Craniotomy for hematoma evacuation was performed. Brain tissue from the superficial side of the suspected residual hematoma cavity, as well as from the cortex and subcortex, was obtained. Congo Red stain and ß-amyloid immunohistochemistry were used for the diagnosis. Each case was assigned a pathological severity score. Of the 974 involved patients, 37.7% were identified with CAA of different degrees. CAA had positive correlation with age and was independent of sex. Most patients had mild CAA with only the superficial vessels involved in lobes instead of the basal ganglia; the patients ≥65 years had more severe pathological score of CAA than those <65 years and had more lobes and cerebellum involved than the latter. More than one third of the surgically treated Chinese ICH patients may have CAA of different degrees.

Synthesis and antimicrobial activity of polyhalo isophthalonitrile derivatives.

A series of polyhalo isophthalonitrile derivatives (3 and 4) that incorporate a variety of substituents at the 2-, 4-, 5- and/or 6-positions of the isophthalonitrile moieties have been designed and synthesized. These derivatives were evaluated for their antimicrobial activity against Staphylococcus aureus, Bacillus cereus (Gram-positive bacteria), Escherichia coli, Pseudomonas aeruginosa (Gram-negative bacteria); and Candida albicans (Fungi). Compounds 3 and 4 showed stronger inhibition of Gram-positive bacteria and fungi growth, and the antimicrobial ability of compound 3j (a 4-(benzylamino)-5-chloro-2,6-difluoro analog, MIC[SA] = 0.5 µg/mL; MIC[BC] = 0.4 µg/mL; MIC[CA] = 0.5 µg/mL) were close to nofloxacin and fluconazole and identified as the most potent antimicrobial agents in the series. The preliminary analysis of structure-activity relationships is also discussed.

Severe pathological manifestation of cerebral amyloid angiopathy correlates with poor outcome from cerebral amyloid angiopathy related intracranial hemorrhage.

BACKGROUND: Cerebral amyloid angiopathy (CAA) is one of the main causes of spontaneous intracranial hemorrhage (ICH). No established link is available between pathological scores of CAA and its outcome. This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population. METHODS: Between May 2006 and April 2011, 367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study. Twelve months after surgery, we evaluated these patients' outcomes according to the modified Rankin Scale (mRS) and statistically correlated risk factors (demographics, medical history, pathological results, and surgical details) that are associated with a favorable (mRS < 3) and poor (mRS ≥ 3) outcome groups. RESULTS: Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age (OR 1.034, 95%CI 1.001 - 1.067, P = 0.042), CAA pathology severity (OR 2.074, 95%CI 7.140 - 16.25, P < 0.001), lobar hematoma (OR 0.225, 95%CI 0.104 - 0.486, P < 0.001), presence of intraventricular hemorrhage (OR 0.478, 95%CI 0.229 - 1.001, P = 0.050), and/or subarachnoid hemorrhage (OR 2.629, 95%CI, 1.051 - 6.577, P = 0.039). CONCLUSIONS: Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors. Prior ischemia may present an early stage of CAA.

[The study of association between spontaneous intracranial hemorrhage and cerebral amyloid angiopathy].

OBJECTIVE: To get the general situation of the cerebral amyloid angiopathy (CAA) incidence in spontaneous intracranial hemorrhage (SICH) patients receiving surgical treatment in Chinese people. METHODS: During the period May 2008 and March 2009, 105 patients admitted to 30 hospitals throughout China for acute SICH were studied, including 68 male and 37 female mean aged (55 +/- 13). The patients were suffered from SICH proved by computed tomography scan (CT). Emergent craniotomies for hemorrhage evacuation were performed for these patients within 72 h after hemorrhage onset and brain tissue of the cortex was also obtained meanwhile. A further histological study, Congo red stained and Abeta immunochemistry included was followed to verify the existence of CAA. RESULT: Fifteen out of the 105 cases is identified as CAA positive, and the total ratio is 14.29%. As to age groups, about 20.83% (5/24) of the cases of the 40-49 years old group have been diagnosed as CAA, 17.14% (6/35) of the 50-59 years old group, 4.17% (1/24) of the 60-69 group, and for those older than 70 years, the ratio is 8.00% (2/25). CONCLUSION: We come to the conclusion that 14.29% of the surgically treated SICH events might be closely related to CAA.

Surgical resection of a rare giant intracranial arteriovenous fistula.

BACKGROUND: It is an occasional giant case we came to recently. The young patient had no special presentation except for transient epilepsy. It was difficult to get the first impression with either CT or MRI because the mass was huge that it was difficult to locate where its root was. A careful DSA examination further gave us a probable diagnosis-AVF, which was identified through surgery. According to our literature work on PUBMED, few cases have ever been reported with such giant size. CASE DESCRIPTION: A 23-year-old man presented with transient epilepsy, and routine computer topography scan only showed a giant mass with clear rounding edge, about 9 cm in diameter, significantly enhanced with contract. The radiologist's diagnosis was an intracranial aneurysm. A draining vein connecting to the superior sagittal sinus was discovered on DSA, which further confirmed the AVF. A tough yet successful operation was performed to totally remove the intracranial mass, and the patient recovered to normal. CONCLUSION: The widely accepted treatment of AVF includes endovascular coiling, surgical resection, burning or blockage of the fistulae, or the combination of endovascular and surgical treatments. Comparing to general cases, the size of the AVF in our case is rare. We successfully surgically removed the giant mass, and the patient has totally recovered.

[Application of individually designed trans-fissure approach in brain surgery: analysis of 90 cases].

OBJECTIVE: To explore the feasibility and value of trans-fissure approaches in brain surgery through individually designed craniotomy. METHODS: Ninety patients with intracranial space-occupying lesions, 47 males and 58 females, aged (43 +/- 14) (1 - 68), were treated by individualized trans-fissure approach surgeries. Linear scalp incision or "horseshoe shape" scalp incision were designed to perform the operation, with a bone flap 3 - 4 cm in diameter. The shortest approach to reach the lesion was decided under the guidance of neuro-navigation and real-time B-mode ultrasonography. Then the lesions were removed through natural cortical fissures. Another 79 patients with intracranial space-occupying lesions, 53 males and 51 females, aged (42 +/- 11) (15 -73), undergoing classical surgeries in the same period were used as control group. The average operation time, size of bone flap, amount of blood loss, hospitalization time, and hospitalization cost were compared between these 2 groups. RESULTS: The operation time of the individually designed trans-fissure approach group was (3.1 +/- 1.6) hours (1.33 - 10.83 hours), significantly shorter than that of the control group [(4.8 +/- 1.9) hrs, P < 0.05]. The amount of blood loss of the individually designed trans-fissure approach group was (173 +/- 168) ml (20 m - 500 ml), significantly less than that of the control group [(410 +/- 61) ml, P < 0.01]. The size of bone flap of the individually designed trans-fissure approach group was (12 +/- 5) cm2 [(1 - 25) cm2], significantly smaller than that of the control group [(20. +/- 9) cm2, P < 0.01]. Four of the 90 patients of the individually designed trans-fissure approach group received retransfusion, compared to 15 in the control group, during operation. No infection or other significant complications occurred after operation in the individually designed trans-fissure approach group. The hospitalization time of the individually designed trans-fissure approach group was (20 +/- 6) days (9 - 39 days), significantly shorter than that of the control group [(24 +/- 7) days, P < 0.01]. The average hospitalization cost of the individually designed trans-fissure approach group was (23171 +/- 7280) yuan RMB; significantly lower than that of the control group [(28096 +/- 10822) yuan, P < 0.01]. CONCLUSIONS: One of the land markers of minimally invasive neurosurgery, individualized trans-fissure approach has been proved to be an effective minimally invasive approach that leads to better outcome and fewer complications after operation.