Gene therapy for high-grade glioma.

High-grade glioma is the most frequently occurring primary brain tumor and is associated with a poor prognosis. Current treatment regimens have had only a modest effect on the progressive course despite recent advances in surgery, radiotherapy, and chemotherapy. Gene therapy for brain tumors represents a novel and promising therapeutic approach and has been investigated clinically for the last two decades. The strategies of gene therapy include suicide gene therapy, immune gene therapy, oncolytic viral therapy, tumor suppressor gene therapy, and antisense therapy. Here, we review gene therapy approaches considering the clinical results, limitations, and future directions.

[Bilateral thalamic glioma in an adult: a case report and review of the literature].

We report a case of a 36-year-old woman who had a rare bilateral thalamic glioma (BTG). She complained of memory disorder T1-weighted magnetic resonance imaging revealed enlarged bilateral thalami with homogenous isointensity and no contrast enhancement. Histological examination of the biopsy specimen identified diffuse astrocytoma (WHO grade II). BTG is a rare variant of thalamic neoplasms, which can be distinguished clinically and radiologically from other gliomas. In most of the reported cases, the presenting symptoms were cognitive impairment varying from personality changes to frank dementia. Death usually occurs within two years after onset, independently of adjuvant therapy such as radiotherapy and chemotherapy. On neuroimaging, all of the BTG had a similar appearance, with both thalami being symmetrically enlarged. Our patient has been given radiotherapy and concominant and adjuvant temozolomide in Stupp's regimen. At the time of this writing (5 months after the consultation), there are no neurological symptoms, and no changes on neuroimaging.

Chordoid glioma with calcification and neurofilament expression: case report and review of the literature.

BACKGROUND: Chordoid glioma of the third ventricle is a rare type of brain tumor that was recently categorized as a novel tumor entity. Despite low-grade histologic features, the clinical outcome in reported cases was poor. CASE DESCRIPTION: A 61-year-old woman presented to our institution with a history of syncope. On presentation, she was alert and oriented, and her systemic examination was unremarkable. Computed tomographic scan showed a well-circumscribed, slightly hyperdense mass with calcification and a cystic component in the anterior part of the third ventricle. The mass was homogenously enhancing after the intravenous administration of contrast material, and its maximum diameter was 3.5 cm. The preoperative diagnosis was craniopharyngioma. Because the tumor seemed to invade the hypothalamus bilaterally, the operative plan was to reduce the tumor volume, followed by radiosurgery. The patient underwent partial removal of the tumor via a bifrontal basal interhemispheric approach. The histologic and immunohistochemical findings indicated CG. Surprisingly, tumor cells showed NFP expression. The residual tumor was treated by GKRS and showed no regrowth at 1-year follow-up. CONCLUSIONS: Chordoid glioma is considered a glial neoplasm with distinct morphological and clinicopathologic features, but there may also be other unknown characteristics because of its rarity. To the best of our knowledge, this is the second reported case of CG with calcification and, at the same time, the second case with NFP expression in the English literature. Calcification and expression of NFP should not exclude CG in the differential diagnosis of a third ventricular tumor. The authors also suggest that the combination of microsurgery and GKRS is a safe and effective treatment strategy for CG.

[Cranial surgery without shaving: practice and results in our hospital].

Hair removal or shaving, even if partial, increases mental anguish of patients, especially in female. Several reports demonstrating successful cranial surgery without hair removal led us to start cranial surgery with completely preserving hair. The purpose of this study was to demonstrate our methods and tips of cranial surgery without hair removal and to evaluate the rate of postoperative infection in these patients. We performed 82 procedures without shaving, including craniotomy for brain tumors, trauma, intracranial aneurysms and so on (n = 70), ventriculo-peritoneal shunt placement (n = 5), and other miscellaneous procedures (n = 7). All the patients were highly satisfied with the cosmetic results keeping their hair. We observed 5 patients whose wounds took relatively long time to be cured (6.1%), and 2 patients whose wounds were infected (2.4%). All infections were superficial and cured by the application of antibiotic ointment. There was no significant difference between the rate of wound complication in patients whose heads were shaven (5/82) and the rate in those whose head were not shaven (7/82). So we suggest that neurosurgery without shaving is safe, and does not increase the risk of severe wound infection. In addition, it helps patients to look normal and to start their routine earlier.

Roles of toll-like receptors in C-C chemokine production by renal tubular epithelial cells.

Pyelonephritis, in which renal tubular epithelial cells are directly exposed to bacterial component, is a major predisposing cause of renal insufficiency. Although previous studies have suggested C-C chemokines are involved in the pathogenesis, the exact source and mechanisms of the chemokine secretion remain ambiguous. In this study, we evaluated the involvement of Toll-like receptors (TLRs) in C-C chemokine production by mouse primary renal tubular epithelial cells (MTECs). MTECs constitutively expressed mRNA for TLR1, 2, 3, 4, and 6, but not for TLR5 or 9. MTECs also expressed MD-2, CD14, myeloid differentiation factor 88, and Toll receptor-IL-1R domain-containing adapter protein/myeloid differentiation factor 88-adapter-like. Synthetic lipid A and lipoprotein induced monocyte chemoattractant protein 1 (MCP-1) and RANTES production in MTECs, which strictly depend on TLR4 and TLR2, respectively. In contrast, MTECs were refractory to CpG-oligodeoxynucleotide in chemokine production, consistently with the absence of TLR9. LPS-mediated MCP-1 and RANTES production in MTECs was abolished by NF-kappaB inhibition, but unaffected by extracellular signal-regulated kinase inhibition. In LPS-stimulated MTECs, inhibition of c-Jun N-terminal kinase and p38 mitogen-activated protein kinase significantly decreased RANTES, but did not affect MCP-1 mRNA induction. Thus, MTECs have a distinct expression pattern of TLR and secrete C-C chemokines in response to direct stimulation with a set of bacterial components.