Effects of hemoglobin level on the early postsurgical cerebral metabolism in patients with severe traumatic brain injury.

OBJECTIVE: The study aims to explore the effects of different levels of haemoglobin (Hb) on early cerebral metabolism in patients with postoperative severe traumatic brain injury (TBI) . METHOD: Fifty-nine patients were randomly divided into catheter oxygen group and ventilator-assisted respiratory group. Each group was subsequently divided into three subgroups basing on different Hb level: Hb ≤ 70 g/L subgroup, 71 g/L ≤ Hb≤90 g/L subgroup and Hb ≥ 91 g/L subgroup. The blood samples from the femoral artery and the affected side internal jugular vein were, respectively, taken at the same time from the patient after postoperative 3 days. RESULTS: The incidence of anaemia after severe TBI operation was 88.14%. The VADL and cerebral glucose uptake (CMRglu) in both Hb ≤ 70 g/L and 71 g/L ≤ Hb≤90 g/L patients of oxygen catheter group were less than that in Hb ≥ 91 g/L patients. In the ventilator-assisted breathing group, the VADL and CMRglu of 71 g/L ≤ Hb≤90 g/L patients and Hb ≥ 91 g/L patients were lower than those in Hb ≤ 70 g/L patients. The result from comparing the two 71 g/L ≤ Hb ≤ 90 g/L subgroups showed that the brain metabolic indexs in the ventilator-assisted breathing group were better than those in the catheter oxygen group. CONCLUSIONS: In severe TBI postoperative patients, Hb≤90 g/L induced decrease in aerobic oxidation in brain tissue. Moreover, for the same Hb level of 71 g/L ≤ Hb≤90 g/L, ventilator-assisted breathing significantly improved cerebral metabolism.

Feasibility of tissue similarity map-based relative cerebral blood volume assessment in the evaluation of gliomas.

OBJECTIVE: To investigate the feasibility of tissue similarity map (TSM)-based relative cerebral blood volume (rCBV) assessment in evaluating the hemodynamic characteristics of gliomas and in differentiating high-grade gliomas from low-grade ones without concentration time curve (CTC). MATERIALS AND METHODS: TSM-based rCBV (rCBV TSM ) and conventional rCBV (rCBV PWI ) maps were generated (n = 35). The differences in percentage and concordance correlation coefficient (CCC) of the rCBV TSM and rCBV PWI ratios were calculated. The Mann-Whitney test and the receiver operating characteristic (ROC) curve analysis were also performed to examine the relationships of rCBV ratios between high- and low-grade gliomas. The improvement factors of signal to noise ratio (SNR) of rCBV TSM maps were also calculated. RESULTS: The mean difference in percentage between rCBV TSM and rCBV PWI ratios was 4.29 ± 2.62%. The CCC of rCBV TSM and rCBV PWI ratios was 0.9974, with 95% confidence interval of 0.9948, 0.9987, which implied a high agreement between them. The Mann-Whitney test suggested that the rCBV TSM and rCBV PWI ratios of high-grade gliomas were significantly different from those of low-grade gliomas (P < 0.001). The improvement factors of SNR of the rCBV TSM map were 1.31 ± 0.24 for glioma and 1.28 ± 0.24 for normal white matter. CONCLUSION: It is feasible to use rCBV TSM in the evaluation of hemodynamic characteristics of gliomas and differentiation of high- and low-grade gliomas without CTC. Moreover, rCBV TSM maps possess a higher SNR, which allows potentially more accurate diagnosis compared with the conventional ones.

Growth hormone therapy and risk of recurrence/progression in intracranial tumors: a meta-analysis.

Growth hormone deficiency is common in intracranial tumors, which is usually treated with surgery and radiotherapy. A number of previous studies have investigated the relationship between the growth hormone replacement therapy (GHRT) and risk of tumor recurrence/progression; however, the evidence remains controversial. We conducted a meta-analysis of published studies to estimate the potential relation between GHRT and intracranial tumors recurrence/progression. Three comprehensive databases, PUBMED, EMBASE, and Cochrane Library, were researched with no limitations, covering all published studies till the end of July, 2014. Reference lists from identified studies were also screened for additional database. The summary relative risks (RR) and 95% confidence intervals (CI) were calculated by fixed-effects models for estimation. Fifteen eligible studies, involving more than 2232 cases and 3606 controls, were included in our meta-analysis. The results indicated that intracranial tumors recurrence/progression was not associated with GHRT (RR 0.48, 95% CI 0.39-0.56), and for children, the pooled RR was 0.44 and 95% CI was 0.34-0.54. In subgroup analysis, risks of recurrence/progression were decreased for craniopharyngioma, medulloblastoma, astrocytoma, glioma, but not for pituitary adenomas, and non-functioning pituitary adenoma (NFPA), ependymoma. Results from our analysis indicate that GHRT decreases the risk of recurrence/progression in children with intracranial tumors, craniopharyngioma, medulloblastoma, astrocytoma, or glioma. However, GHRT for pituitary adenomas, NFPA, and ependymoma was not associated with the recurrence/progression of the tumors. GH replacement seems safe from the aspect of risk of tumor progression.

Analysis of isocitrate dehydrogenase 1 mutation in 97 patients with glioma.

The objective of this study is to investigate the expression and significance of isocitrate dehydrogenase 1 (IDH1) mutation in different subtypes of human gliomas. Direct DNA sequencing, western blot, and immunohistochemistry were used to detect IDH1 mutation and IDH1 gene expression levels in 97 cases of glioma and 9 cases of other CNS tumors. IDH1 mutation was heterozygous, with wild-type arginine 132 replaced by histidine (R132H). Expression in different glioma subtypes was (1) 0 out if 5 in pilocytic astrocytoma; (2) 15 out of 22 in diffuse astrocytoma, 6 out of 9 in oligodendroglioma, 4 out of 6 in oligoastrocytoma, and 0 out of 4 in ependymoma; (3) 11 out of 19 in anaplastic astrocytoma, 4 out of 7 in anaplastic oligodendroglioma, 3 out of 4 in anaplastic oligoastrocytoma, and 0 out of 3 in anaplastic ependymoma; and (4) 1 out of 6 in primary glioblastoma, 8 out of 10 in secondary glioblastoma, and 0 out of 2 in medulloblastoma. IDH1 mutation is a somatic mutation that is found only in some glioma subtypes. It can be used as a molecular marker for glioma subtypes. For example, it can be used to distinguish primary glioblastoma from secondary glioblastoma, combining TP53 mutation and loss of heterozygosity involving 1p/19q. It can also be used as a marker for some gliomas. For example, it can be used to distinguish pilocytic astrocytoma from diffuse astrocytoma, combining detected BRAF proto-oncogene mutations.