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Objective To investigate the clinical effectiveness of magnetic resonance spectroscopy (MRS) combined with sodium fluorescein(FL) in the treatment of high grade gliomas(HGG). Methods From August 2013 to 2015 November,the clinical data of 72 supratentorial HGG(WHO grade Ⅲ-Ⅳ) patients who had received surgical treatment in our hospital were retrospectively studied,among whom 43 cases received MRS combined with intra-perative FL navigation(observation group),and 29 cases only received conventional surgery(control group). Post-operative radiotherapy and chemotherapy were applied for more than 3 months. Routine enhanced MRI were performed 24-48 hours after the operation to investigate the extent of tumor resection. Six months after the operation,the quality of life of patients was evaluated by using the Karnofsky score,and 1-year postoperative survival rate and progression-free survival(PFS) were observed. Results Postoperative MRI showed that the rate of gross total resection(GTR) in observation group was significantly higher than that in control group(72.09%vs.51.72%;χ=23.88,P=0.001),and the GTR rate of WHO grade Ⅳ tumors was significantly higher than that of WHO grade Ⅲ tumors in observation group(92.86% vs.62.07%;χ=6.06,P=0.042). The postoperative Karnofsky score in the observation group was significantly higher than that in control group(μ=2.34,P=0.021). The mean time of follow-up was(16.4±2.4) months(8-21 months) and there was no statistical significant difference between observation group and control group in 1-year survival rate(74.07% vs.77.50%;χ=4.90,P=0.165) and PFS [(13.2±1.2) months vs.(12.7±2.0) months;χ=7.26,P=0.067]. In observation group,the PFS of WHO grade Ⅳ patients was significantly higher than that in control group [(14.2±0.3) months vs.(10.0±1.1) months;χ=11.03,P=0.031]. There was also no statistical significant difference between WHO grade Ⅳ tumors in two groups in terms of 1-year survival rate(71.43% vs.72.54%;χ=5.33,P=0.089),and there was no statistical significant difference between WHO grade Ⅲ tumors in two groups in 1-year survival rate(75.86% vs. 72.22%;χ=3.78,P=0.250) and in PFS [(13.7±1.4) months vs.(12.4±0.8) months;χ=4.85,P=0.083]. Conclusions MRS combined with intraoperative FL navigation technology can improve the resection rate and improve survival quality of patients,and there is no evidence that MRS combined with intraoperative FL navigation prolong the overall survival of patients with high-grade gliomas. Different outcome may be found with longer follow-up and increased simple size.
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Objective To compare the intraoperative major metabolite level of preoperative proton magnetic resonance spectroscopy(H-MRS)and fluorescence intensity marked with fluorescein sodium(FLs)in glioblastoma(GBM)and thus provide an objective basis for fluorescence surgical treatment of GBM. Methods All newly diagnosed patients by plain and enhanced magnetic resonance imaging from the April 1,2014 to December 31,2015 were enrolled in this study.All of them receivedH-MRS and marked with FLs.The expression of Ki67 in tumor boundary were confirmed by postoperative pathology and determined by immunostaining assay.The relationship betweenH-MRS metabolite levels and tumor fluorescence intensity was analyzed. Results Totally 33 patients were included in the study.PreoperativeH-MRS revealed high-grade gliomas in 25 cases.The N-acetylaspartate(NAA)decreased significantly and choline(Cho)increased significantly in high-grade gliomas.The ratios of Cho/NAA,NAA/creatine(Cr),and Cho/Cr significantly differed in different tumor regions(P=0.02,P=0.01,and P=0.00,respectively).Surgical results were marked with FLs intraoperatively.Tissue fluorescence were clearly seen.There were 29 patients undergoing total resection and 4 cases undergoing subtotal resection.No acute encephalocele occured after operation,while 2 patients suffered from epilepsy.Postoperative pathology results included:28 cases were diagnosed as GBM(22 cases consistent withH-MRS diagnosis).The results of GBM fluorescence imaging included:the level of fluorescence intensity in tumor parenchyma was significantly higher than that in tumor boundary and peritumoral edema(P=0.01).The result ofH-MRS metabolite analysis included:The kurtosis of NAA and of Cho and the ratio of Cho/NAA were significantly different according the fluorescence intensity in tumor parenchyma(P=0.01,P=0.02,and P=0.01).While there was no difference in the kurtosis of NAA,the kurtosis of Cho and the ratio of Cho/NAA were significantly different according the fluorescence intensity in tumor boundary(P=0.02, P=0.00).In peritumoral edema,there was no significant different in kurtosis of NAA and of Cho and in the ratio of Cho/NAA(P=0.23,P=0.09,P=0.14).Immunohistochemistry in GBM tumor boundary showed different Ki67 expressions according to different fluorescence imaging(P=0.03). Conclusions The fluorescence intensity in GBM parenchyma is higher than that in other tumor regions,and there are different metabolic levels in different fluorescence intensity.The metabolic information marked by FLs and provided byH-MRS before operationis are important,and the correlation between them should be further investigated.
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Objective To investigate the inhibitory effect of RNA interference (RNAi) on Gli1,Bcl-2, Bax and cycin D1 gene expressions in U251 cell line and the proliferation of U251 cells.Methods Small interfering RNA (siRNA, at locus of 58, 59, 60 and 61) targeted for Gli1 gene was designed and transfected into U251 cells. RT-PCR was emplyed to detect the mRNA expression of Gli1 gene to select the siRNA interference fragment (siRNA-Gli1) that could most efficiently inhibit the mRNA expression of Gli1 gene. The mRNA and protein expressions of Gli1 gene at different times after siRNA-Gli1 transfection were detected to determine the time law of this interference. U251 cells at logarithmic phase were divided into 3 groups: siRNA-Gli1 group (transfection of selected siRNA-Gli1 fragments), siRNA-NC (transfection of siRNA fragments) and siRNA-N group (blank controls). The mRNA and protein expressions of Bcl-2, Bax and cycin D1 gene were assessed by RT-PCR and Western blotting. Proliferation of cells was measured by MTT assay, and cell apoptosis and cell cycles were detected by flow cytometry (FCM). Results Transfection efficiency of interference fragments (at locus of 58, 59, 60 and 61, and NC) reached 69.2％; RT-PCR indicated that no obvious Gli1 mRNA expression was noted at U251-60 cells 48 h after the transfection therefore, locus 60 was the best interference fragment and 48 h was the best time. The mRNA and protein expressions of Bcl-2 and cycin D1 genes were obviously suppressed by siRNA, and the mRNA and protein expressions of Bax gene were significantly up-regulated in the siRNA-Gli1 group as compared with those in the siRNA-N and siRNA-NC groups 48 h after transfection (P＜0.05). Silencing Gli1 by RNAi significantly inhibited the proliferation and induced the apoptosis of U251 cells as compared with siRNA-N and siRNA-NC groups 24, 48 and 72 h after transfection (P＜0.05). Cells at G0 and G1 phases were obviously increased and those at S phase were significantly decreased in the siRNA-Glil group as compared with those in the siRNA-N and siRNA-NC groups (P＜0.05). Conclusion Expression of Gli1 gene can be effectively inhibited by specific siRNA targeting Gli1 gene in U251 cells and the proliferation of U251 cells can be significantly inhibited, which may possibly be related to that siRNA-Gli1 decreases the expressions of Bcl-2 and cycin D1 and alters the ratio of Bcl-2/Bax.
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<p><b>OBJECTIVE</b>To investigate the correlation between the expression of tumor O (6)-methylquanine DNA methyl-tranferase(MGMT) and pathological grade,and the influence of racial factors on tumor MGMT expression levels for glioma patients.</p><p><b>METHODS</b>Compare and analysis the correlation between the pathological grade and MGMT levels and the racial factors on MGMT expression levels by the immunohistochemical staining on the tumor specimens of 33 Uygur and 61 Han.</p><p><b>RESULTS</b>The positive rate of 61 Han gliomas pations with MGMT is 45.90% and 33 cases of the Uygur is 30.30% , there's no clear correlation between the racial factors and the tumor MGMT levels. (P >0.05). Comparative the 94 patients with pathological level and tumor MGMT level, there is no clear correlation between pathologic level and MGMT pression in tumor tissues (P >0.05).</p><p><b>CONCLUSION</b>There's no clear correlation of tumor MGMT expression and pathological levels; and there's no significant effect between racial factors and expression of glioma MGMT.</p>