Diagnostic value of real-time PCR of brain mass lesion in HIV-associated toxoplasmic encephalitis: a case series.

BACKGROUND: Toxoplasmic encephalitis (TE) is a leading cause of brain mass lesions (BML) in human immunodeficiency viruses (HIV)-infected patients. Yet, so far, no accurate diagnostic approach for TE has been developed. Herein, we presented a case series (9 HIV-infected patients with TG confirmed by RT-PCR of BML) to assess the diagnostic value of reverse transcription-polymerase chain reaction (RT-PCR) on TE. METHODS: A total of 9 HIV-infected patients with TE confirmed by RT-PCR of BML were included in this study. Clinical data, including clinical symptoms, blood and CSF analysis, neuroimaging features, histopathological characteristics, treatment, and prognosis, were assessed in all patients. According to the results of RT-PCR of BML, all the patients received oral administration of trimethoprim-sulfamethoxazole combined with antiretroviral therapy (ART). Patients were followed up by telephone or outpatient service. RESULTS: There were 8 male and 1 female patients; their age ranged from 26 to 56 years-old. The main symptom was intracranial hypertension (6/9). Six patients presented multiple brain lesions, which were mainly located in the supratentorial area (7/9). CD4+ count ranged from 11 to 159 cells/µl (median 92 cells/µl), and serological HIV viral load 0-989190 copies/ml (median 192836 copies/ml). IgG and IgM against serum TG were positive in 7 and 1 patients, respectively. Moreover, regarding CSF, IgG against TG was positive in 3 patients, while all patients were negative for IgM. The neuroimaging features on MRI showed no specificity. Four patients were diagnosed with TE by histopathological findings. After receiving anti-Toxoplasma therapy, 8 (8/9) patients improved clinically to a considerable extent. CONCLUSIONS: The application of RT-PCR of BML, together with conventional methods, may significantly improve the diagnostic efficiency of TE.

Prognostic implications of resection extent for patients with glioblastoma multiforme: a meta-analysis.

INTRODUCTION: Surgery is the primary treatment of glioblastoma multiforme (GBM), and a greater extent of resection (EOR) has been shown to be associated with improved survival. Our objective was to perform a meta-analysis comparing the 1-year overall survival (OS) and 1-year progression-free survival (PFS) of GBM patients who receive total resection, incomplete resection, or biopsy only. EVIDENCE ACQUISITION: PubMed and the Cochrane databases were searched until May 19th, 2015 using the terms "glioblastoma/glioblastoma multiforme," "extent of resection," "surgery prognosis/prognostic," "survival rate." Randomized controlled trials (RCTs), two-arm prospective studies, retrospective studies, and cohort studies reporting OS and/or PFS data were included. One-year OS and 1-year PFS were compared. EVIDENCE SYNTHESIS: Three prospective/RCTs, and 3 retrospective studies were included. The 6 studies included 1618 patients: 523 underwent total resections, 857 underwent incomplete resections, and 238 had biopsies. Total resection was associated with greater 1-year OS than incomplete resection (pooled odds ratio [OR] 1.89, 95% confidence interval [CI]: 1.35-2.64, P<0.001), and greater 1-year PFS than incomplete resection (pooled OR 2.11, 95% CI: 1.44-3.09, P<0.001). Analysis by study type (RCT or retrospective) produced similar results, although only one RCT provided 1-year PFS data and there was no significant difference between total resection and incomplete resection in that study. All analyses showed that total resection was associated with greater survival than biopsy only. CONCLUSIONS: Total resection of GBM is associated with improved OS and PFS as compared to incomplete resection or biopsy.