Is brain invasion sufficient as a stand-alone criterion for grading atypical meningioma?

OBJECTIVE: Despite the controversy surrounding brain invasion (BI) as the sole indicator used to diagnose atypical meningioma, this criterion was still incorporated in the 2021 WHO classification scheme. In this study, the authors investigated the reproducibility of this prognostic effect and the impact of BI on the prognosis in otherwise benign meningioma (benign meningioma with BI). METHODS: Patients (n = 1006) with a pathological diagnosis of benign or atypical meningioma according to the latest WHO classification criteria were enrolled in this study. In patients with atypical meningioma, the cases were further categorized as benign meningioma with BI and classical atypical meningioma. Clinical, pathological, and follow-up data were collected. Kaplan-Meier curves were compared with a log-rank test, and univariate and multivariate analyses were performed. RESULTS: The study patient cohort included 282 (28.0%) individuals who were pathologically confirmed as having BI among all 1006 patients with benign or atypical meningioma. A significant difference in recurrence-free survival was observed between patients who had benign meningioma with BI and those who had classical atypical meningioma (p < 0.001), as well as between patients with benign meningiomas and those without BI (p = 0.003). Multivariate Cox analysis indicated that BI was independently associated with increased risk of relapse in the entire population (HR 1.46, 95% CI 1.01-2.12, p = 0.049) and in the atypical meningioma subcohort (HR 2.21, 95% CI 1.32-3.71, p = 0.003), as well as the benign meningioma with and without BI subcohorts (HR 1.89, 95% CI 1.01-3.56, p = 0.049). Moreover, patients with classical atypical meningiomas had a risk of relapse four times higher than those who had benign meningioma with BI (p < 0.001). CONCLUSIONS: The findings demonstrate that benign meningioma with BI typically has an intermediate prognosis and can be differentiated from benign meningioma and classical atypical meningioma, which suggests that the importance of the diagnostic effect of BI is insufficiently accounted for in grading of atypical meningioma. Increased emphasis on the presence of BI in patients with atypical meningioma may be helpful in postsurgical decision-making and facilitating improvements in individual therapy.

[Effect of Intergenerational Support from Children on Older Adults' Healthcare Seeking Behaviors].

Objective: To investigate the impact of intergenerational support from children on older adults' healthcare seeking behaviors and to provide suggestions to help promote sensible healthcare seeking behaviors in older adults. Methods: Based on the data from the 2016 baseline data and the 2018 national tracking survey of China Family Panel Studies (CFPS), a total of 5690 respondents aged 60 years and older with surviving children were selected for the study. Logistic regression was used to analyze the effect of children's intergenerational support on older adults' healthcare seeking behavior. Results: The probability of seeing a doctor in the last two weeks was relatively higher among older adults whose children provided financial support (odds ratio [ OR]=1.129, 95% confidence interval [ CI]: 1.004-1.271, P<0.05), but the effect of whether children provided financial support on one-year hospitalization was not significant ( P>0.05). Daily care support from children contributed positively to both seeing a doctor in the last two weeks and one-year hospitalization among older adults ( OR=1.155, 95% CI: 1.021-1.307, P<0.05; OR=1.204, 95% CI: 1.053-1.378, P<0.01), while whether or not older adults saw their children daily had no significant effect on either seeing a doctor in the last two weeks or one-year hospitalization among older adults ( P>0.05). Conclusion: Intergenerational support from children has an important influence on the healthcare seeking behaviors of older adults. The advantageous role of children's intergenerational support should be made full use of. In addition, formal channels of social support should be improved to alleviate the pressure on children to provide intergenerational support and suggestions should be provided to promote sensible healthcare seeking behaviors in older adults, so as to further improve the overall health level of older adults.

[Quality of Life and Its Influencing Factors Among Schizophrenia Patients Living in Urban and Rural Areas].

Objective: To investigate the status quo of the quality of life of schizophrenia patients in a city in Sichuan Province and to explore, thereof, the urban-rural differences in the factors influencing their quality of life. Methods: A total of 824 schizophrenia patients were selected for the study through multistage stratified cluster random sampling method. All the subjects were selected from a pool of patients covered by the Sichuan Provincial Information System for the Comprehensive Management of Severe Mental Disorders. Questionnaire surveys were conducted with the Schizophrenia Quality of Life Scale (SQLS), the Social Support Rating Scale (SSRS), the general circumstance questionnaire, and the lifestyle questionnaire. In addition, univariate and multiple linear regression models were used to analyze the influencing factors of quality of life among schizophrenia patients living in urban areas and those in rural areas. Results: Rural patients had poorer quality of life than urban patients did in all measurement domains ( P<0.05). Marital status, vocational skills, physical exercise, and social support were influencing factors of the quality of life among urban patients ( P<0.05). Age, marital status, annual household income, vocational skills, participation in community rehabilitation activities, and the time required to walk to the nearest medical institution were influencing factors of the quality of life among rural patients ( P<0.05). Conclusion: Targeted measures for the enhancement of the quality of life of schizophrenia patients should be formulated on the basis of urban and rural characteristics in terms of economic support, vocational skills training, input in mental health services, community rehabilitation services, and social support.

[Analysis of Nursery Services for Children under 3 in Sichuan Province Based on the Theory of Supply and Demand Adaptability].

Objective: To analyze the supply and demand adaptation of nursery care services for children under 3 in Sichuan Province and to provide strategic suggestions for optimizing nursery care services in Sichuan Province. Methods: Data on the supply and demand of nursery school services in all 21 cities (prefectures) of Sichuan Province were collected with questionnaires for nursery care institutions and family needs questionnaires. Applying the theory of supply and demand adaptability, we analyzed the adaptability of nursery care services in Sichuan Province in four dimensions, including relevance, adaptability, accessibility and quality. Results: A total of 6883 valid institutional questionnaires and 41081 valid family questionnaires were collected. The analysis of the adaptability of supply and demand showed that there was insufficient adaptability in all four dimensions of relevance, adaptability, accessibility, and quality of nursery care services for children under 3 in Sichuan Province, which was characterized by the coexistence of insufficient supply and underutilization of services, the mismatch between the structure of services provided and the needs of families with children under 3, low economic accessibility for the general population, and low quality of services. Conclusion: There is insufficient adaptability in the supply and demand of nursery care services for children under 3 in Sichuan Province. Demand-oriented supply-side reforms should be implemented to promote the construction of a system of government-subsidized affordable nursery care services, reinforced support for the care of infants and toddlers for families, standardized management of infant and toddler care institutions, and the implementation of various supportive policies so as to comprehensively meet the diversified needs of infant and toddler care and promote their healthy growth.

[Impact of Social Capital on Residents' Choice of Medical Institutions: A Study Based on Classification Tree Model and Logistic Regression].

Objective: To explore the influence of social capital on the local residents' choice of medical institutions and to provide a reference basis for promoting diagnosis and treatment services available at different tiers. Methods: A classification tree model was established using the exhaustive chi-square automatic interaction detection (Exhaustive CHAID) method to screen for factors influencing the residents' choice of medical institutions, and a logistic regression model was used to quantitatively analyze the interaction effect of the influencing factors. Results: The classification tree model showed that there were four layers and eight terminal nodes, identifying a total of six influencing factors, including individual social capital, self-reported physical health, education, community social capital, chronic disease prevalence, and self-reported mental health. Logistic regression analysis showed that education (odds ratio [OR]=0.660, 95% confidence interval [CI]: 0.502-0.869), community social capital (OR=0.746, 95% CI: 0.589-0.943), and individual social capital (OR=0.405, 95% CI: 0.287-0.572) (P<0.001) had an impact on residents' choice of medical institution. There was an interaction between individual social capital and self-reported physical health on residents' choice of medical institution (OR=1.872, 95% CI: 1.180-2.969, P<0.05). Conclusion: Interventions in terms of social capital factors should be considered in order to promote the rational use of medical resources.

[Correlation Study of Community Social Environment and Self-Rated Health of Middle-Aged and Older Adults].

OBJECTIVE: To analyze the impact of the social environment of a community on the self-rated health of middle-aged and older adults living in the community, and to provide a basis for building favorable community social environment that promotes the health of middle-aged and older adults. METHODS: Using the community and individual survey data from China Health and Retirement Longitudinal Study (CHARLS) done in 2011, 7822 middle-aged and older adults living in 397 communities were selected as the subjects of the study. Community social environment under study included community socioeconomic status, community social security and community services. Self-rated health was measured with a five-level score. A three-level hierarchical generalized linear model (HGLM) was used to analyze the impact of community social environment on the self-rated health of middle-aged and older adults. RESULTS: The proportion of subjects who reported self-rated poor health was 28.8%. According to the results of the three-level HGLM, the self-rated health of middle-aged and older adults showed differences at both the city and the community levels, and the variance reduction ratio reached 35.71% at the community level. The self-rated health status of residents in the communities with medium and high net per capita income was better than that in the communities with low net per capita income ( OR=0.84, P<0.05; OR=0.70, P<0.05). The self-rated health status of residents in the communities with secondary and higher education levels was better than that in the communities with low education level ( OR=0.78, P<0.05; OR=0.73, P<0.05). The self-rated health of middle-aged and older adults in the communities with unemployment subsidies was much better ( OR=0.77, P<0.05). The self-rated health status of middle-aged and older adults with chronic diseases was worse ( OR=4.46, P<0.05). Middle-aged and older adults living in cities had better self-rated health status ( OR=0.67, P<0.05). CONCLUSION: Community socioeconomic status and community unemployment subsidy are positively correlated with the self-rated health of middle-aged and older adults living in the community. It is necessary to pay special attention to the health status of middle-aged and older adults in communities of low socioeconomic status, improve unemployment insurance policies, and promote the health of middle-aged and older adults.

[Sleep Duration and Abdominal Obesity in Elderly in China].

OBJECTIVE: To determine the relationship between sleep duration and abdominal obesity in elderly in china. METHODS: Data were drawn from the 2013 China Health and Retirement National Investigation (China Health and Retirement Longitudinal Study, CHARLS). The prevalence of abdominal obesity in the elderly who had a normal range of sleep duration was compared with those who had a shorter or longer sleep duration using Chi-square tests and binary logistic regression models. RESULTS: Higher odds of abdominal obesity were found in the elderly male with a shorter (OR=1.627, 95%CI: 1.286-2.060, P<0.05) or longer (OR=1.499, 95%CI: 1.009-2.228, P<0.001) sleep duration, compared with those with a normal range of sleep duration. Statistical significances were found in the prevalence of abdominal obesity among those with different characteristics in education, smoking, chronic conditions, and social participation. CONCLUSION: Both long and short sleep durations are associated with increased risk of obesity, which is more evident in older men. Bad living habits and mental state will increase the risk of abdominal obesity.

[Urban-Rural Differences in the Role of Family Support in Physical and Mental Health of Elderly People in China].

OBJECTIVES: To investigate social support for elderly in urban and rural settings, and determine its role in physical and psychological health of the elderly populations. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Physical health was measured by the ADL/IADL scale. Mental health was measured by the CES-D scale. Family support included financial support, daily care and emotional care. Binary logistic models were established to test the associations between family support and physical and mental health. RESULTS: For the rural elderly people, financial support from children was positively associated with physical health (P <0.05); whereas, emotional comfort from children was associated with better mental health (P <0.01). Daily care from children was associated with physical and mental health of the elderly in both urban and rural settings (P <0.01). CONCLUSION: An urban-rural difference exists in the role of family support in physical and mental health of the elderly. Rural elderly people are more dependent on family support than their urban counterparts. Social support needs to be strengthened to reduce the urban-rural gap. Meanwhile, family support will continue to play a role in improving the health of elderly populations.

[Prevalence and Associated Factors of Arthritis in Middle- and Old-aged Populations in China].

OBJECTIVES: To determine the prevalence of arthritis in middle- and old-aged populations in China and associated factors. METHODS: Data were drawn from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Binary logistic regression analyses were performed to examine the associations of arthritis with social economic status (age, gender, areas, education), comorbidity (hypertension, dyslipidaemia, diabetes, cancer, chronic lung disease, liver disease, heart disease, stroke, kidney disease, digestive disease, asthma), lifestyle (smoking, drinking, sleeping) and mental health (depression symptoms). RESULTS: About 30.8% of respondents reported arthritis. Those who resided in rural areas, drank regularly, and had depression symptoms, hypertension, chronic lung disease, liver disease, heart disease, stroke, kidney disease, digestive disease and asthma had higher prevalence of arthritis than others. CONCLUSION: The prevalence of arthritis is high in middle- and old-aged populations in China, which deserves increasing attention.

Ultrastructure of Pericystic or Intracystic Blood Vessels in Epidermoid Cysts-A Transmission Electron Microscopy Study: Laboratory Investigation.

OBJECTIVES: Recently, we reported a tendency toward spontaneous hemorrhage in both the preoperative and postoperative periods in patients with intracranial epidermoid cyst (EC). According to our experience, this tendency for spontaneous hemorrhage was partly caused by the pathologic blood vessels adjacent to the EC. This study was designed to testify this hypothesis. METHODS: Twenty-three removable pericystic or intracystic blood vessels from 17 patients with EC were collected during surgery and were then examined by transmission electron microscopy. The microvascular structure in gliomas was chosen as the control. RESULTS: Under electron microscopy, variant pathologic changes of vessels were found in all patients with EC. In the tunicae intima, we found vacuolization, apoptosis, necrosis, and intralumenal protrusion of endothelial cells, as well as swollen basement and highly flexed and discontinued elastic plate. In the tunicae media, vacuolization and swollen mitochondria were found in muscular cells. In the tunicae adventitia, extravascular erythrocytes, edema or apoptosis of pericytes, collagen predominance, and inflammatory cell infiltration and destruction were found. Neuron denature and necrosis were found in the peripheral brain tissue. In the microvascular structure of 5 glioma specimens, we found enlargement and hyperplasia of endothelial cells, swollen basement membrane, swollen pericytes, and astrocytic hyperplasia and neuron denature in adjacent brain tissues. CONCLUSIONS: Our findings provide strong evidence for the hypothesis that intracystic or pericystic vascular degeneration or destruction accounts for the spontaneous hemorrhage tendency before and after surgical resection of ECs.

[Regional Differences and Determinants of Self-rated Health in Elderly].

OBJECTIVE: To determine differences of self-rated health in elderly people across geographic regions of China, and to identify factors influencing self-rated health of elderly. METHODS: Ordered logistic modeling was performed using the China Health and Retirement Longitudinal Study (CHARLS) data in 2013. RESULTS: Elderly people resided in Eastern China had better self-rated health than their counterparts residing in Middle (partial regression coefficient 0.252, P < 0.01) and Western (partial regression coefficient 0.338, P < 0.001) China. Sex, residency, education, per capita consumption expenditure, smoking and drinking, social participation, chronic diseases, and life satisfaction were identified as associated with self-rated health of elderly. CONCLUSION: There are regional differences in self-rated health of elderly. Policy priorities should be given to Middle and Western China, with more health resources being allocated to those regions. Regional economic and educational inequalities need to be addressed. Healthy lifestyle should be promoted.

[Depressive Symptoms in the Mid- and Old-aged People in China].

OBJECTIVES: To determine the prevalence and determinants of depressive symptoms in the mid- and old-aged people in China. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study (CHARLS),which containthe Center Epidemiologic Studies-Depression scale(CES-D). Binary logistic regression models were developed to identify factors associated with the prevalence of depression symptoms. These included socio-economic status of the respondents (gender, age, education),health-related factors (chronic diseases, disability, accident injury, and fall in recent two years),and family events over the past two years (deaths of a parent, spouse or child). RESULTS: About 31.9% of respondents had depressive symptoms, with a mean CES-D score of 8.0±4.9.Women and those who were younger than 75 years, widowed, resided in a rural area, had low levels of education, and suffered from multiple chronic conditions were more likely to have depressive symptoms than the others. CONCLUSIONS: High prevalence of depressive symptoms in the mid- and old-aged population in China is evident, which is associated with the health and socio-economic status of the population.

Vagus Nerve Stimulation for Pediatric and Adult Patients with Pharmaco-resistant Epilepsy.

BACKGROUND: Over past two decades, vagus nerve stimulation (VNS) has been widely used and reported to alleviate seizure frequency worldwide, however, so far, only hundreds of patients with pharmaco-resistant epilepsy (PRE) have been treated with VNS in mainland China. The study aimed to evaluate the effectiveness of VNS for Chinese patients with PRE and compare its relationship with age cohort and gender. METHODS: We retrospectively assessed the clinical outcome of 94 patients with PRE, who were treated with VNS at Beijing Fengtai Hospital and Beijing Tiantan Hospital between November 2008 and April 2014 from our database of 106 consecutive patients. The clinical data analysis was retrospectively examined. RESULTS: Seizure frequency significantly decreased with VNS therapy after intermittent stimulation of the vagus nerve. At last follow-up, we found McHugh classifications of Class I in 33 patients (35.1%), Class II in 27 patients (28.7%), Class III in 20 patients (21.3%), Class IV in 3 patients (3.2%), and Class V in 11 patients (11.7%). Notably, 8 (8.5%) patients were seizure-free while ≥50% seizure frequency reduction occurred in as many as 60 patients (63.8%). Furthermore, with regard to the modified Engel classification, 12 patients (12.8%) were classified as Class I, 11 patients (11.7%) were classified as Class II, 37 patients (39.4%) were classified as Class III, 34 patients (36.2%) were classified as Class IV. We also found that the factors of gender or age are not associated with clinical outcome. CONCLUSIONS: This comparative study confirmed that VNS is a safe, well-tolerated, and effective treatment for Chinese PRE patients. VNS reduced the seizure frequency regardless of age or gender of studied patients.

[Impact of urbanization on the residents' health service needs and utilization based on the urban and rural integration development].

OBJECTIVE: To explore the impact of urbanization on the residents' health service needs and utilization for the purpose of providing references for health making-decision by analyzing the difference of health service needs and utilization in semi-urban residents, urban residents and rural residents. METHODS: The residents in the three economic zones of Chengdu were selected by stratified ration sampling and interviewed with the questionnaire. RESULTS: The two-week morbidity rate, hospitalization rate, and non clinical visit rate of semi-urban residents were higher than those of other people, and the chronic disease prevalence rate of urban residents was higher. Age, employment status, and the urban-rural identification were the main influential factors of two-week morbidity rate and chronic illness prevalence. After the related factors were controlled, the urban-rural identification was not the impact factor of the health service utilization. CONCLUSION: The urban-rural integration development has promoted the health service accessibility and narrowed the disparity of health to some extent between urban and rural residents. However, the semi-urban residents should be caught a great deal of attention as a special group, and given more employment assistance.

Differential molecular genetic analysis in glioblastoma multiforme of long- and short-term survivors: a clinical study in Chinese patients.

This study was designed to find whether long-term survivors (LTSs) exhibit molecular genetic differences compared with short-term survivors (STSs) in patients with GBM. Tumors from 12 patients initially diagnosed with GBM and survived longer than 36 months (LTSs) were compared with 30 patients with GBM and STSs (survival <18 months) for detecting of MGMT promoter methylation, 1p/19q LOH and IDH1 mutation. IDH1 mutation and MGMT promoter methylation were significantly more frequent in the LTSs group (P = 0.039 and 0.017, respectively). The incidence of 1p/19q co-deletion was not significantly different (P = 1.0). IDH1 mutation and MGMT promoter methylation might be independent, significant, and favorable factors for LTSs with GBM.

[The dose-response relationship of chrysotile asbestos exposure and lung cancer in cohort study].

OBJECTIVE: To clarify the dose-response relationship between asbestos dust exposure and lung cancer incidence in chrysotile asbestos miners by fixed cohort study and to investigate the incidence rates of lung cancer in exposure to different concentrations of asbestos dust. METHODS: A retrospective cohort study was conducted in 1932 asbestos miners who registered from January 1, 1981 to December 31, 1988, had worked for at least 1 year, and had no obvious cardiopulmonary diseases; the cohort study began in July 2009 and covered a time span of 29 years (1981 - 2009). The personal information, occupational history, disease history, and health data of these miners were recorded, and the monitoring data on dust concentrations in the mine over the years were collected. The dose-response relationship between asbestos dust concentration and lung cancer incidence was established by the method of life table; a regression equation was fitted to predict the excess incidence rates of lung cancer under the conditions of different working years and dust concentrations. RESULTS: A significant dose-response relationship was observed between cumulative exposure (Ce) and cumulative probability (Px) of lung cancer incidence, and the smokers hada higher Px than nonsmokers. When Ce was less than 2000 mg/m(3)·each year, Px reached 6.58/10000; when Ce was not less than 2000 mg/m(3)·and less than 3000 mg/m(3)·each year, Px reached 91.72/10000; when Ce was more than 5000 mg/m(3)·each year, Px was as high as 141.02/10000. The three models were fitted to obtain the optimal regression equation: Px = -0.0004Ce(2) + 0.0052Ce - 0.0011 (r(2) = 0.9387). In the workshop of asbestos mine in this study, the average dust concentration was 85 times higher than the limit in 2009, so the excess incidence rate of lung cancer was 112.598/10000 if the miners worked under this condition for 40 years, according to the equation. CONCLUSION: There is a significant dose-response relationship between cumulative asbestos exposure and lung cancer incidence in chrysotile asbestos miners. The risk for lung cancer rises as asbestos exposure increases.

[Iconographic analysis for pituitary adenoma, craniopharyngioma and Rathke cleft cyst involving both intrasellar and suprasellar regions].

OBJECTIVE: To explore the iconographic differences for pituitary adenoma, craniopharyngioma and Rathke cleft cyst involving both intrasellar and suprasellar regions. METHODS: A total of 99 eligible pathologically confirmed patients (pituitary adenoma, n = 49; craniopharyngioma, n = 35; Rathke cleft cyst, n = 24) were selected during January 2008 and January 2012. The following characteristics were evaluated: (1) calcification or not and density of tumor on computed tomography (CT); (2) shape, size, extent and component characteristics, signal intensities of solid portions on T2-weighted images, signal intensities of cystic portions on T1-weighted images and enhancement patterns of solid portions and cyst walls and complicated hydrocephaly or not. A flowchart for differential diagnosis for three tumors was constructed based on statistical analysis of the results. RESULTS: A snowman shape, solid characteristics and homogeneous enhancement of solid portion were more common in pituitary adenomas; a lobulated shape, third ventricle compression by superior tumor extension, mixed solid and cystic characteristics, reticular enhancement of solid portion, calcification on CT scan and complicated hydrocephalus were more common in craniopharyngioma; an ovoid shape, small tumor size, cystic characteristics and none or thin cyst wall enhancement were more common in Rathke cleft cysts. CONCLUSION: The above iconography characteristics are helpful in the differential diagnosis of three tumors involving both intrasellar and suprasellar regions.

[A molecular classification system for anaplastic glioma].

OBJECTIVE: To project a new molecular classification system for anaplastic gliomas based on the molecular biomarkers. METHODS: There were 161 patients with histological diagnosis of primary anaplastic gliomas after operation and complete and reliable follow-up data were enrolled in the study from May 2009 to June 2011. A total of 100 male and 61 female patients with a median age of (43 ± 12) years (range: 17-68 years). After the pathology review by 2 experienced neuro-pathologists, 36 anaplastic oligodendroglioma (AO), 66 anaplastic oligoastrocytoma (AOA) and 59 anaplastic astrocytoma (AA) were confirmed. There were 116 patients underwent gross-total resection, 37 sub-total resection and 8 partial resection. Molecular biomarkers evaluated included 1p/19q, IDH1 gene and O6-methylguanine-DNA-methyltransferase (MGMT). Kaplan-Meier plots were compared by Log-rank method. RESULTS: The survival analysis results showed that the 6-month, 12-month, 18-month and 24-month progression-free survival (PFS) and overall survival (OS) rates of AO was significantly longer than AOA(χ(2) = 12.812 and 6.557, P < 0.05) and AA (χ(2) = 19.125 and 10.206, P < 0.05), but no significant difference of prognosis was observed between AOA and AA (P > 0.05). According to the status of biomarkers, AOA was reclassified into two subgroups-AOA1 and AOA2. AOA1 with 1p/19q co-deletion, IDH1 mutation and/or negative MGMT expression showed similar prognosis with AO (P > 0.05). AOA2 without any biomarkers showed similar prognosis with AA (P > 0.05). Besides, the 6-month, 12-month, 18-month and 24-month PFS and OS rates of patients with AO and AOA1 was significantly longer than patients with AA and AOA2 (PFS:χ(2) = 25.180, P < 0.001; OS: χ(2) = 15.649, P < 0.001). Multivariate analysis showed that the moecular pathology subtypes classified was an independent prognostic factor (PFS: OR = 0.499, 95% CI:0.381-0.653, P < 0.001; OS:OR = 0.605, 95% CI:0.450-0.814, P = 0.001). CONCLUSIONS: The molecular classification system for anaplastic gliomas will be helpful in estimating patients' prognosis and guiding reasonable therapy for patients with anaplastic gliomas.

Comparison of Spinal Block Levels between Laboring and Nonlaboring Parturients Using Combined Spinal Epidural Technique with Intrathecal Plain Bupivacaine.

Background. It was suggested that labor may influence the spread of intrathecal bupivacaine using combined spinal epidural (CSE) technique. However, no previous studies investigated this proposition. We designed this study to investigate the spinal block characteristics of plain bupivacaine between nonlaboring and laboring parturients using CSE technique. Methods. Twenty-five nonlaboring (Group NL) and twenty-five laboring parturients (Group L) undergoing cesarean delivery were enrolled. Following identification of the epidural space at the L3-4 interspace, plain bupivacaine 10 mg was administered intrathecally using CSE technique. The level of sensory block, degree of motor block, and hemodynamic changes were assessed. Results. The baseline systolic blood pressure (SBP) and the maximal decrease of SBP in Group L were significantly higher than those in Group NL (P = 0.002 and P = 0.03, resp.). The median sensory level tested by cold stimulation was T6 for Group NL and T5 for Group L (P = 0.46). The median sensory level tested by pinprick was T7 for both groups (P = 0.35). The degree of motor block was comparable between the two groups (P = 0.85). Conclusion. We did not detect significant differences in the sensory block levels between laboring and nonlaboring parturients using CSE technique with intrathecal plain bupivacaine.