Glioma-related edema: new insight into molecular mechanisms and their clinical implications / 癌症

Glioma-related edema (GRE) is a significant contributor to morbidity and mortality from glioma. GRE is a complicated process involving not only peritumoral edema but also the water content of the tumor body. In terms of etiology, this condition derives from both GRE in the untreated state and GRE secondary to clinical intervention, and different cell types contribute to distinct components of GRE. Peritumoral edema was previously believed to loosen glioma tissue, facilitating tumor-cell invasion; however, the nutrition hypothesis of the tumor microecosystem suggests that tumor cells invade for the sake of nutrition. Edema is the pathologic consequence of the reconstructed trophic linkage within the tumor microecosystem. Glioma cells induce peritumoral brain edema via an active process that supplies a suitable niche for peritumoral invasive cells, suggesting that glioma-related peritumoral brain edema is determined by the invasive property of tumor cells. There are differences between pivotal molecular events and reactive molecular events in the development of GRE. Molecular therapy should target the former, as targeting reactive molecular events will produce undesired or even adverse results. At present, brain glioma angiogenesis models have not been translated into a new understanding of the features of brain images. The effect of these models on peritumoral brain edema is unclear. Clinical approaches should be transformed on the basis of new knowledge of the molecular mechanism underlying GRE. Exploring clinical assessment methods, optimizing the existing control strategy of GRE, and simultaneously developing new treatments are essential.

Influence of surgery with the guideline of minimally invasive concept in prognosis of patients with hypertensive basal ganglia hematomas: a report of 57 cases / 中华神经医学杂志

Objective To investigate the influence of surgery with the guideline of minimally invasive concept in prognosis of patients with hypertensive basal ganglia hematomas. Methods Fifty-seven patients with hypertensive intra-cerebral hemorrhage were randomly divided into 2 groups:Group A (admitted to our hospital from January 2007 to December 2008 and performed surgery under the condition that the content of hematoma reached the level for surgery,n=26) and Group B (admitted to our hospital from January 2009 to June 2011 and received surgery with the guideline of minimally invasive concept once noting the tendency ofexpanded hematoma,n=31).We evaluated the influence of surgery (total removal of the hematoma and proper stopping the bleeding) according to the condition that tendency of expanded hematoma appeared and with the guideline of minimally invasive concept in the prognosis of these patients. Results No significant differences in consciousness classification and hematoma volume before surgery were noted between the 2 groups (P＞0.05).Responsible vessels were noted in 15 patients from Group A and 27 patients from Group B, and significant difference was noted between these 2 groups (P＜0.05).The hematoma clearance rate was 75％ in Group A,and re-bleeding was noted in 4 patients (15.4％) after the surgery; while that was higher than 90％ in Group B, and re-bleeding was only noted in 2 patients (6.5％) whose responsible vessels could not be found.The good recovery rate in Group A was 46.2％ 3 months after surgery, while that in Group B was 74.2％, which indicated that the effect in group B was obviously better than that in group A (P＜0.05). Conclusion Tendency of expanded hematoma should be paid attention in patients with hypertensive basal ganglia cerebral hemorrhage; it is important to quickly identify the cases showing clear indications for surgery and to perform the procedures at the earliest time; the procedures, including completely removal of the hematoma and properly stopping the stanch bleeding under direct vision with the guideline of minimally invasive concept can improve the recovery fiom hypertensive basal ganglia cerebral hemorrhage.

Patterns in the occurrence and development of tumors / 中华医学杂志(英文版)

Although we have made great progress in understanding tumor pathogenesis through studies on gene mutation and cancer stem cells, the clinical outcome continues to be unfavorable for many cancers. The biological characteristics of cancers including autonomous proliferation, invasion, metastasis, and post-treatment recurrence result from interactions between cancers and their microenvironment, which involves complex molecular interactions. However, the patterns underlying these complex mechanisms are still unclear. In this review, several potential patterns in the occurrence and development of cancers were elucidated. The core relationship between a tumor and its host microenvironment is the nutritional and signal interactions between cancer stem cells and endothelial cells. The nutritional interaction between the cancer and the host triggers the invasion and metastasis of cancers; the imbalance between tissue responses of cancer stem cells and the feedback regulation of self-renewal or post-injury repair leads to the autonomous proliferation of cancers. Cancers can restore the growth balance and maintain homeostasis, depending on residual nutritional factors, and these abilities are the determinants of therapeutic efficacy. These findings have been beneficial to developing novel strategies for cancer therapies.

Effects of endostatin on C6 glioma-induced edema / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Glioma-induced edema is considered as one of the most pathological characteristics of glioma and a significant source of morbidity and mortality. New strategies are needed for the treatment of peritumoral edema in glioma. Endostatin has been proven to be beneficial as an anti-angiogenic agent in experimental gliomas, but the effects are unclear. This study aimed to investigate the effects of endostatin on C6 glioma-induced edema.</p><p><b>METHODS</b>Tumorigenic mice were established by subcutaneous injection of three glioma cell lines, C6-null cells and stable transfected-C6 cells overexpressing mock vector (C6-mock cells) and endostatin (C6-endo cells). Endostatin expression in xenograft C6 glioma was determined by immunostaining and Western blotting. Glioma-induced edema and tumor vessel permeability were assayed. The effect of endostatin on vascular enodothelial growth factor (VEGF) expression in vivo was analyzed by quantitative polymerase chain reaction (Q-PCR) and enzyme-linked immunosorbent assay (ELISA). The number of vesiculo-vascuolar organelles (VVOs) formed in tumor endothelia was calculated using electron microscopy. Data were analyzed by using one-way analysis of variance (ANOVA) followed by Dunnett's post hoc test for multiple comparisons to the control groups.</p><p><b>RESULTS</b>Overexpression of endostatin (C6-endo cells) significantly suppressed tumor growth and reduced tumor edema and vessel permeability. ELISA analysis showed that the level of VEGF protein was markedly decreased in tumor from C6-endo cells compared with tumor from C6-null cells and C6-mock cells. Similar results were obtained by Q-PCR. Furthermore, the number of VVOs observed in tumor from C6-endo mice was significantly reduced compared with tumor from C6-null cells or C6-mock cells.</p><p><b>CONCLUSIONS</b>Our data provide primary evidence that endostatin reduces glioma-induced edema and vascular permeability. Using endostatin may be an effective strategy for treating glioma edema.</p>

Activated vascular endothelia regulate invasion of glioma cells through expression of fibronectin / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous researches have indicated that glioma invasion may occur within a tumor-host microecology, and that fibronectin may be involved in glioma invasion as an important component of the extracellular matrix. However, how the interaction between tumor cells and vascular endothelial cells affects glioma invasion is poorly understood. The aim of this study was to investigate the effects of the interaction between tumor cells and vascular endothelial cells on glioma invasion, and the relationship of this interaction to fibronectin.</p><p><b>METHODS</b>The localization of fibronectin in different brain astrocytoma tissues was determined by immunohistochemistry. Then, vascular endothelial cells and glioma cells were co-cultured in a Transwell co-culturing system. Fibronectin expression was detected by reverse transcriptase-polymerase chain reaction, immunocytochemistry, and enzyme-linked immunosorbent assay. Additionally, the influence of the interaction between tumor cells and vascular endothelial cells on glioma cell invasion was determined by an in vitro rapid invasion test.</p><p><b>RESULTS</b>In brain astrocytoma tissues, fibronectin was present on the endothelial cells, in the extracellular matrix. Fibronectin expression was greater in higher grade tumors than in lower grade tumors. The interaction of glioma cells and vascular endothelial cells in vitro induced fibronectin release from vascular endothelial cells, which in turn stimulated glioma cell migration. This effect was inhibited by fibronectin blocking antibody.</p><p><b>CONCLUSION</b>Glioma cells may induce vascular epithelial cells to express fibronectin, and in turn fibronectin could promote glioma cell invasion.</p>

Aquaporin 4 and vascular endothelial growth factor participate in the formation of peritumoral edema of gliomas and brain metastases / 中华神经医学杂志

Objective To investigate the expression of vascular endothelial growth factor (VEGF) and aquaporin 4 (AQP4) in giiomas and brain metastases, and explore the role of VEGF and AQP4 in the histopathology and formation of peritumoral edema of primary and metastatic gliomas. Methods Immunohistocbemical method was used to examine the protein expression of VEGF and AQP4 in 73 paraffin-embeded, pathologically confirmed glioma and 15 metastatic tumor specimens collected between 1999 and 2001. Eight normal brain tissue specimens were used as the control. Results VEGF protein was not detected in normal brain tissues. VEGF expression was detected in gliomas and the expression level increased obviously along with the histological grade of the tumor. Significant differences were found in VEGF expression between malignant and low-grade gliomas, between low-grade gliomas and normal brain tissues, and between intracranial metastatic tumors and normal brain tissues and low-grade gliomas (P<0.05), but not between intracranial metastatic tumors and malignant gliomas (P>0.05). AQP4 protein expression was found in all the collected samples, and its expression differed significantly between normal brain tissues and malignant gliomas or intracranial metastatic tumors, and also between low-grade gliomas and malignant gliomas or intracranial metastatic tumors (P<0.05), but not between normal brain tissues and low-grade gliomas or between intracranialmetastatic tumors and malignant gliomas (P>0.05). VEGF protein expression showed a significant positive correlation to AQP4 protein expression (r=0.516, P<0.05). Conclusion As important molecular biological factors, VEGF and AQP4 participate in the formation peritumoral brain edema of gliomas and exhibit a synergie effect in this process.

Research advancement on measuring scale and influential factor of quality of life in patients with nasopharyngeal carcinoma / 国外医学(肿瘤学分册)

The quality of life(QOL) in patients with nasopharyngeal carcinoma ( NPC ) has attracted people' s attention increasingly. Most of the studies focus on measuring scale and influential factor. Both the disease itself and many non-somatic factors can affect the patients' quality of life. In this review, we summarize these research advancements on measuring scales and influential factors, considering that it need more studies regard to quality of life in NPC patients, and it is very urgent and important to work out the special measuring scale of NPCQOL that suits Chinese culture and value system.

Effects of Deanxit Associated with Illumination on the Depressed Patients with Chronic Pain / 中国康复理论与实践

@#ObjectiveTo study the effects of Deanxit associated with illumination on the depressed patients with chronic pain in open psychology ward in general hospitals.Methods41 patients were assigned into two groups:study group included 21 patients,who received the treatment of Deanxit(1 mg/d),even more with the treatment of illumination;control group included 20 patients,who only received the treatment of Deanxit(1 mg/d).Assessments of the efficacy were performed with Beck depression inventory(BDI) and Hamilton depression scale(HAMD) before and in the 2nd,4th,8th week during treatment.In addition,Symptom Checklist-90(SCL-90) was also used before and after treatment,as well as six month after discharge.ResultsThe efficacy was consistent with study group's superiority versus control group.ConclusionThe treatment consisting of Deanxit associated with illumination is effective on depression and helpful to prevent relapsing.

Possibility of psychotic patients treated in open wards in general hospital / 中国康复理论与实践

@#ObjectiveTo explore the possibility and significance that psychotic patients treated in open wards in general hospital,a new managing model for psychosis cases.Methods1 200 psychotic cases were treated in the open ward,that was a new managing model for psychotic patients.ResultsNew managing model had following advantages: a. free for patients to communicate with outsides and keep their secret and human rights; b. having better effective,shorter housing days,and more economy compared with controlled cases.ConclusionSetting up open managing psychosis wards in general hospital can help treatment of psychotic patients,and it is the tendency of modern mental health.