Establishment of a Scale for Predicting Early Hematoma Enlargement of Spontaneous Intracerebral Hemorrhage Based on Non-Contrast CT Signs.

AIM: To optimize the Spontaneous intracerebral hemorrhage (sICH) early hematoma expansion prediction scoring table to adopt appropriate clinical treatment plans and improve the prognosis of sICH patients. MATERIAL AND METHODS: A total of 150 patients with sICH were enrolled, and 44 had early hematoma expansion. According to the selection and exclusion criteria, the study subjects were screened, their NCCT characteristic signs and clinical data were analyzed statistically. The established prediction score was applied to the follow-up study cohort to conduct a pilot study, and the t-test and ROC curve were used to evaluate its predictive ability. RESULTS: Statistical analysis found that initial hematoma volume, GCS score, and NCCT special signs were independent risk factors for early hematoma expansion after sICH (p < 0.05). Thus, a score table was established. Subjects with ≥10 were divided into high-risk group, 6-8 comprised the medium-risk group, and ≤4 were divided into low-risk group. Among 17 patients with acute sICH, 7 developed early hematoma enlargement. The prediction accuracy was 92.41% in the low-risk group, 98.06% in the medium-risk group, and 84.61% in the high-risk group. CONCLUSION: This optimized prediction score table based on the special signs of NCCT shows the high prediction accuracy of sICH early hematoma.

[Comparison of differences between hip and lumbar bone mineral density in dual energy X-ray absorptiometric data].

OBJECTIVE: To explore the changes and regulations in T-scores of hip and lumbar vertebrae in different aged people through retrospective data analyses of dual energy X-ray absorptiometry (DXA) and improve their reference values. METHODS: With the aid of DXA, the bone densities of hip (femoral neck) and lumbar (L1-L4) bones were measured in 3662 males and females over 45 years old. There were 9 female and 9 males groups based upon the stratifications of gender and 5-year age intervals (> 85-year-olds combined as one group). After ruling out the "single-part test" data, the T-score averages were calculated and their differences analyzed by t-test. RESULTS: In females, T-scores of hip and lumbar bone mineral density were basically the same before 50 years old. Significant differences existed between 51 and 75 years old females. The lumbar T-scores were lower than their hip counterparts. In some age groups, T-scores of lumbar vertebrae showed decreased bone mass while those of hip remained normal. However, T-scores of lumbar vertebrae might be diagnosed by osteoporosis but decreased bone mass of hip was absent in the other age groups. After 75 years, no obvious differences existed between hip and lumbar bone T-scores; in all male groups, hip T-scores were lower than lumbar counterparts. There were small changes in T-scores of lumbar vertebrae with aging while the hip ones decreased gradually; each group had a single measurement rate of skeletal site. In females, the minimal and maximal values of single site measurement rate were 12.50% and 63.98% versus 16.68% and 44.50% in males. CONCLUSION: Differences of lumbar and hip T-scores exist in some age groups. Thus some normal T-scores of one skeletal site may be abnormal at another site. While evaluating one particular site, one should consider these differences to avoid an incorrect diagnosis.

[Expression of SV40Tag, Rb and IRS-1 in glioma detected by tissue microarray and their relation with tumorigenesis and progression of gliomas].

OBJECTIVE: To determine the expression of SV40Tag, Rb and IRS-1 in gliomas and to identify their function in gliomagenesis and progression. METHODS: Tissue microarrays were constructed containing 118 samples including human glioma and meningioma, experimental glioma, and normal human brain tissue. The expression of SV40Tag, Rb, IRS-1, SV40Tag combined with Rb, and SV40Tag combined with IRS-1 were assayed by immunofluorescence or immunohistochemical techniques. The expression ratio and level were analyzed. RESULTS: The expressions of SV40Tag, Rb and IRS-1 were detected in gliomas and benign brain tumors. Their positive expression rate in glioma was 65.9%, 64.6% and 48.8%, respectively, with a statistically non-significant difference between the malignant and benign brain tumors. The malignant degree was positively correlated with SV40Tag and IRS-1, but negatively correlated with Rb expression. The combined expression rate of SV40Tag and Rb was 51.2%, and the combined expression rate of SV40Tag and IRS-1 was 40.2%. In the normal human brain tissue only the expression of Rb (77.8%, 7/9) and IRS-1 (22.2%, 2/9) were detected, but expression of SV40Tag could not be observed. CONCLUSION: Our findings that no expression of SV40Tag was observed in normal human brain tissue indicates that expression of SV40Tag may play an important role in the pathogenesis of glioma. It may be assumed that after SV40 virus invading human body, Rb disfunction and IRS-1 activation promote the malignant transformation of cells, which could be one of important factors in pathogenesis and procession of glioms.

[Expression and significance of ABCG2 in human malignant glioma].

BACKGROUND & OBJECTIVE: ATP-binding cassette transporter protein ABCG2 is a marker derived from hematopoietic stem cells. However, its role in tumorigenesis and malignant progression of glioma is unclear. This study was to investigate the expression and significance of ABCG2 in gliomas of different malignant grades. METHODS: A microarray chip containing glioma tissues of different malignant grades, implanted glioma xenografts in nude mice, spheroids of glioma cell lines and glioma stem cells was prepared and examined for the expression of ABCG2 with immunohistochemical staining. RESULTS: The positive rate of ABCG2 was 26.8% in the 71 specimens of human glioma tissues, with 11.1% in grade I gliomas, 8% in grade II gliomas, 43.5% in grade III gliomas, and 42.9% in grade IV gliomas; it was significantly higher in grade III-IV gliomas than in grade I-II gliomas (chi2=10.710, P=0.001). The positive rate of ABCG2 was 100% in implanted glioma xenografts in nude mice, gliomas stem cells, and neural stem cells. It was also expressed in some normal tissues. The positive cells surrounded and invaded into vessels in glioma tissues. CONCLUSIONS: ABCG2 is overexpressed in glioma stem cells, glioma tissues of higher grades, and implanted glioma xenografts. The positive cells distribute around vessels in glioma tissues.

[Microsurgical treatment of complex intracranial aneurysms via keyhole approaches].

OBJECTIVE: To explore the feasibility and effect of microsurgical treatment of complex intracranial aneurysms via keyhole approaches. METHODS: Operation via keyhole approach was performed on thirty-one patients with 42 complex intracranial aneurysms were operated on, including 2 internal carotid artery bifurcation aneurysms, 1 anterior cerebral artery aneurysm, 12 posterior communicating artery aneurysms, 2 anterior choroids artery aneurysms, 7 middle cerebral artery aneurysms, 6 anterior communicating artery aneurysms, 2 basilar artery aneurysms, 2 vertebral artery aneurysms, 4 posterior cerebral artery aneurysms and 4 ophthalmic artery aneurysms, among which were 10 cases with multiple intracranial aneurysms, 14 with giant aneurysms, and 7 with posterior circulation aneurysms, and 4 aneurysms clipped by drilling off anterior clinoid process. Six of the 31 patients who had giant aneurysms came to hospital because of the symptoms, such as dizziness, headache, oculomotor paralysis, loss of vision, etc, and the other 25 patients were grouped according to the subarachnoid hemorrhage (SAH) Grade: 5 in grade I, 12 in grade II, 7 in grade III and 1 in grade IV. Eight patients were operated on after SAH in the early-phase, while 8 in the middle-phase and 9 in the late-phase. The supraorbital subfrontal keyhole approach was used 25 times, the pterional approach 5 times, the subtemporal approach 3 times, and both the suboccipital lateral approach and the retromastoid approach once. RESULTS: 31 of the 42 aneurysms were clipped, 2 mini-aneurysms wrapped, 5 giant aneurysms clipped and resected, 2 aneurysms trapped with thrombotic aneurysm partially resected, 1 aneurysm trapped, while 1 ruptured before operation and untreated. Short-term Glasgow outcome scoring showed good recovery in 27 patients, moderate disability in 2, and death in 2. CONCLUSION: Operation via keyhole approaches effectively controls the immature rupture of intracranial aneurysm, removes anterior clinoid process, respects giant aneurysm, and reconstructs the parent artery of wide-neck aneurysm. Based on individualized surgical approaches and excellent microsurgical skills, the complex intracranial aneurysms can be treated safely, directly and effectively via minimally invasive keyhole approaches.

[Microsurgical treatment of posterior cranial fossa tumors via keyhole approaches].

OBJECTIVE: To explore the surgical outcome and skills of keyhole approaches to posterior cranial fossa tumors. METHODS: A retrospective analysis of the clinical data of 43 consecutive patients with posterior cranial fossa tumors, including acoustic neurinoma, petroclival meningioma, pons tumor, fourth ventricular tumor, etc. was conducted. Subtemporal, retromastoid, or middle suboccipital keyhole approach was chosen respectively according to the anatomic positions of those different tumors. The length of the incision was about 4 cm, and the diameter of bone window was 2.0 - 2.5 cm. Normally dura was sutured tightly and no catheter was placed in the surgical fields. RESULTS: The tumors were totally removed in 37 of the 43 patients (86.0%), subtotally removed in 5 (11.6%) and mostly removed in 1 (2.3%). There were no complications obviously related to the limited exposure resulting from keyhole approaches. All of the 18 acoustic neurinomas (100%) were totally removed and the facial nerves of 15 patients (83.3%) were preserved anatomically, however, one patient died of brain stem edema on the 2nd postoperative day. Out of the 8 petroclival meningiomas, 5 (62.5%) were resected totally, 2 (25%) subtotally, and 1 (12.5%) grossly. Postoperatively, 2 patients still remained slight hemiparesis, and 1 presented with mild facial paralysis. Among the 6 pons tumors 3 were removed totally and 3 subtotally. There were no postoperative neurological deficits. All the other tumors were resected completely without neurological dysfunction observed, however, one patient with a cholesteatoma failed to demonstrate apparent improvement in his diplopia. CONCLUSION: Microsurgical treatment of posterior cranial fossa tumors via keyhole approaches, with safe, succinct and minimally invasive property, is one of the promising directions in modern neurosurgery.