MTHFR基因多态性与中国北方人群脑膜瘤发病的相关性分析

目的:探讨亚甲基四氢叶酸还原酶(MTHFR)基因多态性与中国北方人群脑膜瘤发病的相关性。方法:选择2012年1月-2013年12月在黑龙江省哈尔滨医科大学附属第二医院的第一、三病房接受手术治疗的脑膜瘤患者317例(实验组)及320例非脑膜瘤患者(对照组)为研究对象,利用聚合酶链反应限制性多态性片段长度(PCR-RFLP)检测和比较两组MTHFR两个单核苷酸多态性位点(C677T、A1298C)各种基因型(CC、CT、TT)的分布情况及等位基因的频率。结果:两组MTHFR的C677T中CC基因型的频率和TT基因型的频率比较有显著性差异(CC:OR=2.012,95%CI=1.460-2.772;TT:OR=0.399,95%CI=0.254-0.628,P0.05),实验组MTHFR的(0.450)C677T中的T等位基因频率明显高于对照组(0.320)(OR=0.529,95%CI=0.420-0.666,P0.05)。两组A1298C的等位基因分布比较没有统计学差别(P0.05)。结论:MTHFR基因的C677T中TT等位基因提示潜在的易患脑膜瘤的风险,而CC等位基因会降低中国北方人群患脑膜瘤的风险。     

影响侧脑室脑膜瘤手术疗效的多因素分析

目的：探讨影响侧脑室脑膜瘤手术疗效的因素,从而更好的促进侧脑室脑膜瘤的手术治疗。方法：回顾性分析侧脑室脑膜瘤显微手术30例的临床病理特征与顸后情况,其中KPS〉70分表示为预后良好,KP懿70分表示为预后不良。对各性别、年龄、部位、肿瘤大小、病理分型及术后有无并发症因素与预后进行χ^2检验与用Logistic回归分析其影响因素。结果：单因素分析表明肿瘤部位、病理分型及术后有无并发症对侧脑室脑膜瘤的预后有明显影响,P〈0．05,差异有统计学意义。经Logistic回归分析,最终进入模型的影响因素有2个,它们分别是肿瘤部位和术后有无并发症,其P值均小于0．05。结论：在显微手术下,侧脑室脑膜瘤大部分可以全切并取得了较好的远期疗效。肿瘤部位和术后有无并发症是影响预后的一个重要因素,及时处理并发症能显著地改善预后。     

Caspase-3 immunohistochemical expression is a marker of apoptosis,increased grade and early recurrence in intracranial meningiomas

Caspase-3 is the ultimate executioner caspase that is essential for the nuclear changes associated with apoptosis. We investigated caspase-3 immunohistochemical expression in 58 primary intracranial meningiomas, using one monoclonal antibody detecting both precursor and cleaved caspase-3 (CPP32) and a second recognizing only the cleaved activated form (ASP175). Caspase-3 expression was analyzed in relation to baseline apoptosis—as illustrated by the expression of anti-single stranded DNA (ss-DNA), the antiapoptotic protein bcl-2, proliferation indices (Ki-67, PCNA, topoisomerase IIa, mitosin C), hormonal status (estrogen, progesterone, androgen receptors), standard clinicopathological parameters and patients’ disease-free survival. Caspase-3 immunostaining was observed in 62% of cases for CPP32 and in 24% for ASP175. In both instances, the labeling index (LI) was significantly correlated with ss-DNA LI (p=0.038 and p=0.018). CPP32 but not ASP175 LI positively correlated with the mitotic index (p=0.001) and PCNA LI (p=0.004). Both CPP32 and ASP175 LIs were increased in nonbenign meningiomas (p<0.0001 and p=0.0035 respectively). In univariate and multivariate survival analyses, caspase-3 predicted meningioma recurrence, independently affecting disease-free survival (p=0.011 and p=0.047 respectively for CPP32; p<0.0001 and p=0.012 respectively for ASP175). Caspase-3 may prove to be a useful predictor of early recurrence in a group of neoplasms characterized by the frequent discordance between histology and clinical behavior.     

盐酸右旋美托咪定对脑膜瘤切除术患者围拔管期应激反应的影响

目的：观察不同剂量的盐酸右旋美托咪定对脑膜瘤切除术患者全麻围拔管期应激反应的影响。方法：60 例ASAI～Ⅱ级,年 龄25-65 岁脑膜瘤切除术患者,随机分为四组,NS、D1、D2 和D3 组,NS 组:静脉泵入等量的生理盐水,D1、D2 和D3组静脉泵注 负荷量均为0.6 滋g/kg 的盐酸右旋美托咪定,各组泵注时间均为10 分钟,输注结束后随之给予维持量,D1组：盐酸右旋美托咪定 维持量0.2 滋g·kg-1·hr-1;D2 组：盐酸右旋美托咪定维持量0.4 滋g·kg-1·hr-1;D3组：盐酸右旋美托咪定维持量0.6 滋g·kg-1·hr-1。观察 并记录拔管时的耐管评分、呛咳程度、警觉/ 镇静评分(OAA/S）、拔管时间及拔管即刻和拔管后3 min 的平均动脉压(MAP)、心率 (HR)及恶心、寒战等不良反应。结果：D3 组患者耐管评分高于D1 组、D2 组和NS 组,呛咳程度轻于D1 组、D2 组和NS 组（P<0. 05）;D2、D3 组患者拔管即刻和拔管后3 min 的MDP、HR 均明显低于D1 组（P<0.05）;D1、D2 和D3 组不良反应少于NS 组;四组 拔管时间无明显差异。结论：盐酸右旋美托咪定降低脑膜瘤切除术患者全麻围拔管期的应激反应,增强患者对气管导管的耐受 性。     

Biopsy proven metastatic meningioma: A case report and review of the literature

Meningiomas are the most common type of benign tumor found in the brain and are typically benign, slow-growing lesions. The current standard of care consists of surgical resection and subsequent postoperative radiotherapy to prevent local recurrence. Because of their indolent nature, meningiomas are rarely found to spread extracranially and develop distant metastases. We present the clinical, imaging, and pathologic features of a patient who had meningioma with multiple local recurrences, who was incidentally found to have metastatic disease in the lungs. In addition, we discuss details of this case in the context of the previously reported literature.     

Ganglioside Composition in Human Meningiomas

The ganglioside composition in meningioma specimens from 20 patients was analyzed to find potential meningioma-associated structures. The characterization was performed by immunological staining with specific monoclonal antibodies to ganglioside antigens and fast atom bombardment-mass spectrometry. The major gangliosides were GM3 and GD3, and most of the meningioma specimens could be divided into a "GM3-rich" or a "GD3-rich" group. Gangliosides of the gangliotetraose series were represented by GM1, GD1a, GD1b, and GT1b, which were found in minor amounts in all the specimens. The ratios of GM1/GD1a and GD1a/GD1b differed from that in normal brain, and therefore existence of this series could not be explained by contamination with brain material. Ganglioside 3'-isoLM1, found in human malignant glioma, could not be detected in any meningioma specimen.     

Identification and Characterization of Cysteinyl-Leukotriene Formation in Tissue Slices from Human Intracranial Tumors: Evidence for Their Biosynthesis Under In Vivo Conditions

In previous studies, it had been shown that human gray and white matter tissue slices have the capacity to synthesize large amounts of cysteinyl-leukotrienes (cysteinyl-LT) in vitro. This study was initiated to investigate cysteinyl-LT formation by tissue slices from intracranial tumors in comparison with cyclooxygenase products such as prostaglandin (PG) F2 alpha and thromboxane (TX) B2. Tissue slices from meningiomas and astrocytomas were found to release large amounts of cysteinyl-LT spontaneously and even higher amounts after ionophore A 23187 stimulation, which could not be accounted for by blood possibly remaining in the tissue slices. Cysteinyl-LT were identified by their immunoreactive characteristics, their biological activity in the guinea pig ileum bioassay, and their retention time on reversed-phase HPLC. With increasing malignancy, astrocytomas were shown to have an increasing biosynthetic capacity for cysteinyl-LT and TXB2 in vitro. In comparison with meningioma patients, malignant astrocytoma patients had an enhanced urinary excretion of LTE4, the major urinary metabolite of cysteinyl-LT in humans, which dropped in level within 7 days after operation by 79%. A correlation exists between the in vivo cysteinyl-LT production in patients with malignant astrocytomas and that observed under basal conditions in the tissue slices in vitro. The results provide evidence that in malignant astrocytoma patients, the tumor tissue produces large amounts of cysteinyl-LT, which may be detected in the patients' urine.     

Incidence,mortality and outcome of meningiomas: A population-based study from Germany

BackgroundMeningiomas are mostly benign tumors that originate from the coverings of the brain and spinal cord. Compared to malignant glial tumors, meningiomas are relatively understudied with regard to their risk factors and epidemiology. In particular, population-based data on cancer burden and patient outcomes are scant.MethodsPopulation-based data from Saarland, a federal state in South-Western Germany, were used; the data included 992 patients diagnosed with a first meningioma between 2000 and 2015. Incidence and mortality rates—as well as estimates of observed and relative survival and cumulative incidence of tumor recurrence up to 10 years after diagnosis—were derived by sex, age, WHO grade, and whether or not the patient had undergone surgery.ResultsThis population-based study not only included patients treated in the regional university hospital but also those treated elsewhere or patients without any surgical treatment. The mean age of the patients at diagnosis was 63 years, and 70%, 28% and 3% had WHO grade I, II and III meningiomas, respectively. Ten-year observed and relative survival of all patients combined was 72% and 91% respectively. Tumor-related mortality varied by sex and increased with age at diagnosis and the WHO grade of the tumor. The overall 10-year cumulative incidence of meningioma recurrence was 9%.ConclusionThis analysis represents the first modern population-based analysis of meningioma incidence and mortality and outcomes of patients with such neoplasms in Germany. Derived from an unselected sample of patients, this study may fill a hitherto existing gap in the literature on meningiomas.     

Epidemiology of meningiomas. A nationwide study of surgically treated tumours on French medico-administrative data

BackgroundTo describe the epidemiology of surgically treated meningiomas and compare the results with previously published studies.MethodsWe processed the French medico-administrative national hospital discharge summary database, Programme de Médicalisation des Systèmes d’Information (PMSI) using an algorithm combining the type of surgical procedure and codes from the International Classification of Diseases to retrieve appropriate cases of meningiomas operated between 2008 and 2016.ResultsThis nationwide study found 25,737 cases of operated meningiomas. Global incidence of operated meningiomas equals 4.51, 95%CI[4.46–4.57] for 100 000 person-years and increased over the last 9 years. Benign neoplasms account for 91.3%, neoplasms of uncertain or unknown behaviour for 6.2% and malignant for 2.5%. There is a decrement of female over male ratios as the malignancy potential progresses. Incidence of operated meningiomas was 3 times more frequent in women than men. Mean age at surgery was 57.6 years for women and 59.5 for men. The incidence of meningioma surgery increases with age and is maximal for the 60–64 years category. Only 0.4% of operated patients were under 18 years.Meningioma surgeries of the cranial convexity and the middle skull base are the most common.ConclusionThe PMSI database is a reliable and effective source for studying the epidemiology of surgically treated meningiomas, including the precise location of the tumour. Our findings comfort previous studies and are comparatively correlated. This may assert the usefulness of such a database to investigate the patients’ outcome after meningioma surgery.     

60例颅内外脑膜瘤的临床病理分析

目的:探讨脑膜瘤的组织发生、病理学特点、分型与临床预后。方法:采用全自动免疫组化Ventana法对60例(包括2例特殊部位)脑膜瘤的组织发生、病理学特点、分型与临床预后的关系进行回顾性分析。结果:60例脑膜瘤中WHOⅠ级有57例,其中皮细胞型19例,纤维型23例,过渡型10例,化生型2例,砂砾体型2例,血管瘤型1例,WHOⅡ级有3例,均为非典型性脑膜瘤。肿瘤发生在大脑凸面者占53.3%(32/60例),大脑镰旁16.7%(10/60例),小脑桥脑角及其它部位共占30%(18/60例)。免疫组化检测显示:Vimentin、EMA阳性表达率均为96.7%(58/60例),PR阳性表达率69.2%(42/60例);S-100阳性表达率47.4%(28/60例);CK阳性表达率10%(6/60例);GFAP阳性表达率8.3%(5/60例);Ki-67阳性表达指数在WHOⅠ级中平均为4.9%,WHOⅡ级中平均为13.3%。其中,鼻窦脑膜瘤EMA、Vimentin及S-100均为阳性,PR少数细胞阳性。侧脑室脑膜瘤Vimentin和S-100阳性,EMA和PR灶状阳性。结论:脑膜瘤的组织学分级大部分为WHO Ⅰ级,少部分为Ⅱ级(非典型性)和Ⅲ级(间变型),共15种组织学亚型。颅外与颅内脑膜瘤的组织学形态基本相同。该肿瘤大部分预后良好,但部分术后可复发,且有肿瘤病理分级越高,复发率越高的现象。