[Evaluation of classification of petroclival meningiomas and proposed selection of microsurgical approach: a single center experience of 179 cases].

Objective: To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes. Methods: Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom(M(QR)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results: The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS(t=-1.356,P=0.125). As for each type, there were statistically significant differences in brain stem edema(χ2=3.482,P=0.038), gross total resection(χ2=9.127,P=0.001), surgical duration(F=8.954, P=0.013), postoperative length of stay(F=3.652, P=0.025), postoperative complications(χ2=1.550,P=0.024), postoperative KPS(F=2.856, P=0.042) and tumor recurrence/progress(χ2=4.824,P=0.013). Conclusion: The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

[Pollution characteristics and health risk assessment of heavy metals in PM(2.5) in Lanzhou].

Objective: To understand the pollution characteristics and assess the pollution health risks of heavy metals in atmospheric PM(2.5) in Lanzhou. Methods: According to the regional characteristics of air pollution and industrial distribution characteristics in Lanzhou, atmospheric PM(2.5) was sampled monthly in Chengguan and Xigu Districts from January, 2015 to December, 2016. Detected the concentration of PM(2.5) and 12 kinds of elements (Sb, Al, As, Be, Cd, Cr, Hg, Pb, Mn, Ni, Se and Tl) by weighing method and inductively coupled plasma mass spectrometry. Enrichment factor and geo-accumulation index were used to describe the pollution characteristics, while health risk assessment was conducted using the recommended United States Environmental Protection Agency (USA EPA) model. The health risks of non-carcinogens were evaluated by non-cancer hazard quotient (HQ), the non-carcinogenic risk was considered to be negligible when HQ<1, HQ>1 meant a health risk. With a single contaminant cancer Risk value to evaluate the health risks of carcinogens, when the Risk value between 10(-6) to10(-4) as an acceptable level. Results: The daily average concentrations of PM(2.5) was 83.0 µg/m(3), 77.0 µg/m(3) in Chengguan and Xigu Districts, respectively, during the sampling periods, and the concentration of PM(2.5) in winter/spring was higher than summer/fall in both districts. The concentration of Al in PM(2.5) was the highest and other elements in descending order: Pb, Mn, As, Sb/Cd, Tl in both districts. Enrichment factor results showed that Al and Mn were mainly affected by natural factors, the rest of five elements were all typical man-made pollution elements and according to geo-accumulation index pollution level of Cd was the strongest in the winter. The results of health risk assessment showed that Mn had the highest non-cancer risks (HQ>1) and affected the health of the children seriously. HQ reached up to 2.44 and 1.79 in Chengguan and Xigu Districts, respectively. Pb, As, Sb, Cd had slight health impact (HQ<1), could be negligible. The cancer risks range of As, Cr were 6.33×10(-6) to 6.46×10(-5) between the acceptable level of risk (10(-6) to 10(-4)), which indicated that As and Cd had potential cancer-risks. Conclusions: The pollution level of atmospheric PM(2.5) and the heavy metals in it was still grim;the non-cancer risks caused by multiple metals on children deserved attention. Although the cancer risks of As and Cd were between the acceptable level of risk, the potential cancer risk still shall not be ignored.

[Paracondylar-lateral cervical approach for resection of jugular foramen schwannomas: a retrospective analysis of 15 cases].

Objective: To explore the effects of paracondylar-lateral cervical approach for resection of the jugular foramen schwannoma(JFS). Methods: A total of 15 patients with JFS operated via the paracondylar-lateral cervical approach between December 2011 and March 2016 at Department of Neurosurgery in Xiangya Hospital of Central South University were retrospectively analyzed. There were 7 males and 8 females, aging from 22 to 77 years with a mean age of (41.9±15.8) years.There were 12 patients who accepted primary surgery, 3 patients who accepted secondary surgery. There were 10 patients with tinnitus or hearing loss, 8 patients with dysphagia, 9 patients with hoarseness, 7 patients with tongue hemiparesis, 8 patients with ataxia, 1 patient with Pyramidal signs, 2 patients with facial hypesthesia or pain, 1 patient with facial paresis. According to Samii JFS grading system, 2 patients were type B, 4 were type C and 9 were type D. All patients were followed-up through outpatient and telephone by MRI in 3, 9, 12 months postoperation. Results: Gross total removal of tumors were achieved in 14 patients and subtotal removal in 1 patient. Two patients had new hoarseness, 2 had new dysphagia and 3 had more serious dysphagia, 1 patient had more serious facial paresis after the operation. There were 2 patients with intracranial infection, 2 with pneumonia, 1 with subcutaneous effusion, 1 with cerebrospinal fluid rhinorrhea, 5 with gastric intubation during perioperative period. There were no death, intracranial hematoma and decreased hearing patients. All patients were followed up, the follow-up time were 3 to 33 months with a mean of (26.9±11.2) months. Till to the latest follow up, dysphagia improved in 2 cases, hoarseness and tongue hemiparesis improved in 3 cases, hearing loss and tinnitus improved in 9 cases, balance function improved in 7 cases, facial hypesthesia and pain improved in 2 cases, pyramidal signs disappeared in 1 case, facial nerve function improved to normal in 1 case. There was no recurrence and progressed case. Conclusion: Paracondylar-lateral cervical approach is an alternative approach for both intracranial and extracranial JFS.

Induction effect of MicroRNA-449a on glioma cell proliferation and inhibition on glioma cell apoptosis by promoting PKCα.

OBJECTIVE: This study aimed to investigate the expression of microRNA-449a in brain tissue and plasma of patients with glioma and its mechanism of action on glioma cell proliferation and apoptosis. PATIENTS AND METHODS: 30 cases of gliomas patients were recruited in the study, 12 cases in which with brain tissues excision due to decompression or exposure during the brain surgery were selected as the control group. RT-PCR was used to detect the microRNA-449a expression in brain tissue and peripheral blood of the two groups. Cell proliferation and apoptosis level were further determined after high or low expression of microRNA-145 in human glioma cell line U-251. RT-PCR and Western blotting were used to detect PKCαmRNA and protein level in U-251. RESULTS: The expression of microRNA-449a in brain tissue or peripheral blood of patients with brain glioma was significantly lower than that of normal people, and the differences were statistically significant (p < 0.05). Upon interfering with microRNA-449a, the glioma cell proliferation was significantly increased while apoptosis was significantly reduced, the PKCα protein levels were increased significantly and the differences were statistically significant (all p < 0.05); after overexpression of microRNA-449a, the glioma cell proliferation was significantly decreased while the cell apoptosis was significantly increased, the PKCα protein levels were decreased significantly and the differences were statistically significant (all p < 0.05). CONCLUSIONS: The expression of microRNA-449a is low in patients with glioma, which may inhibit the proliferation of glioma and promote its cell apoptosis via affecting the expression of PKCα.

[Experimental study on effect of sanmiao mixture capsules on prostate hyperplasia in mice and rats].

OBJECTIVE: To observe the effect of Sanmiao Mixture Capsules(SMC) on prostate hyperplasia in mice and rats. METHOD: The model of prostate hyperplasia was made by injecting testosterone propionate in to male mice(5 g.kg-1.d-1, 21 d) and rats(3 g.kg-1.d-1, 14 d). The treated group was administered SMC(mice: 36.3 g.kg-1 and 18.2 g.kg-1; rats: 25.2 g.kg-1 and 12.6 g.kg-1), the normal control group 1.9 g.kg-1, and the model control group NS. hours after the last administration serum tests were carried out on E2, AKP and Zn2+. Then the animals were killed, prostates taken out and weighed, index of prostate was calculated and pathological examination performed. RESULT: In the SMC treated group, the prostate weight and index were lowered(P < 0.01) the mean activation of E2 was raised, and the mean concentration of AKP and Zn2+ was inhibited (P < 0.01). CONCLUSION: SMC are helpful in checking prostate hyperplasia in mice and rats, the mechanism being probably related to the raising of activation of E2 as well as to the inhibition of concentration of AKP and Zn2+.

[Inhibitory effects of three opioid receptor agonists on synaptic transmission].

AIM: To compare the inhibitory effects of 3 opioid receptor agonists, (D-Ala2, NMe-Phe4, Gly-ol)-enkephalin (DAGO), (D-Pen2,5)-enkephalin (D-PEN), and trans-(+/-)-3, 4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl) cyclohexyl]-benzeneacetamide methanesulfonate (U-50488H) in different concentrations on synaptic transmission. METHODS: The excitatory postsynaptic potentials (EPSP) in slice preparation of nucleus accumbens of rats were recorded using electric stimulation of the olfactory tubercle area and intracellular micropipettes filled with potassium acetate (3 mol.L-1). RESULTS: Superfusion of DAGO, D-PEN, and U-50488H (1 mumol.L-1) reduced the amplitude of EPSP and the inhibitory effect on EPSP were reversed by superfusing naloxone (Nal, 1 mumol.L-1), in which the DAGO-induced reduction of synaptic transmission was the most effective. The depolarizing responses to microiontophoretic injection of glutamate were reduced by superfusing DAGO in 19 neurons of slice preparation of nucleus accumbens. CONCLUSION: The inhibitory effects of DAGO, D-PEN, and U-50488H on EPSP were in a concentration-dependent manner, and the mechanism of opioid agonists (at least DAGO) reducing EPSP was related to a decrease of postsynaptic transmission mediated by glutamate.

[The effects of opioid peptides on postsynaptic potentials in slice preparation of nucleus accumbens of rats].

Behavioral studies indicate that nucleus accumbens (NAcc) is a key brain area for the rewarding effects of opiate and for opiate addiction. To find out the cellular correlates of opiate addiction, the effects of three kinds of opiate peptides on membrane potential and postsynaptic potentials (PSPs) in a slice preparation of NAcc were studies by intracellular recording and current-clamp technique. The results indicated that superfusion of opioid 7 peptides did not affect membrane potential and input resistance of NAcc neurons, but significantly reduced postsynaptic potentials. Naloxone superfusion significantly reversed the depressant effects of mu and sigma receptor agonist (DAGO, D-Pen) on PSPs, but not on those of kappa agonist (U-50). These results suggest that opioid peptides predominantly reduce synaptic transmission in NAcc.

[Role of nucleus accumbens in cardiovascular activities and its relationship with opioid peptides in rats].

In this study, electrical stimulation and microinjection in nucleus accumbens in urethane-anesthetized rats were conducted to observe the effect of electrical stimulation of nucleus accumbens on blood pressure and heart rate. The following results were observed: (1) Electrical stimulation of the nucleus accumbens of rat resulted in significant hypotension and bradycardia. (2) Kainic acid microinjected into the nucleus accumbens, could abolish the effects mentioned above. (3) Naloxone administered to the nucleus accumbens could block the cardiovascular inhibitory effect evoked by electrical stimulation of nucleus accumbens. The intra-accumbens injection of mu-receptor agonist, DAGO could also elicit hypotension and bradycardia to an extent comparable to that of the effect due to electrical stimulation, whereas kappa-receptor agonist, U-50 had no such an effect. (4) When the cardiovascular inhibitory effect elicited by electrical stimulation of the nucleus accumbens was observed, the discharge activity in locus ceruleus was also decreased. (5) Bilateral vagotomy could abolish the change in heart rate elicited by the electrical stimulation of nucleus accumbens, but not the hypotension. It is suggested that the mu-opioid receptors of neurons in nucleus accumbens are involved in cardiovascular activity.

Opioid peptides reduce synaptic transmission in the nucleus accumbens.

Behavioral studies implicate the nucleus accumbens (NAcc) as a brain area pivotal for the rewarding effects of opiates like heroine and morphine. Therefore, we studied the effect of a variety of opioids on membrane properties and responses to synaptic stimulation in a slice preparation of the NAcc using intracellular recording. Superfusion of opioid peptides did not affect the membrane potential or input resistance of NAcc neurons, but significantly reduced both depolarizing and hyperpolarizing synaptic potentials. Naloxone superfusion significantly reversed the depressant effects of the mu and delta receptor agonists (but not those of the kappa agonist) on synaptic transmission, suggesting involvement of opiate receptors. These results imply that the predominant effect of opiates in NAcc is a reduction of synaptic transmission.