Endoscopic Third Ventriculostomy vs. Ventriculoperitoneal Shunt for Obstructive Hydrocephalus: A Meta-Analysis of Randomized Controlled Trials.

AIM: To conduct a meta-analysis for investigating the safety and efficacy of endoscopic third ventriculostomy (ETV) and extracranial shunting for patients with obstructive hydrocephalus. MATERIAL AND METHODS: Randomized controlled trials (RCTs) of ETV and ventriculoperitoneal shunting (VPS) for obstructive hydrocephalus were analyzed systematically by using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also perused. Postoperative infection, postoperative cerebrospinal fluid (CSF) leakage, mortality and surgical success were the main outcomes of the analysis. RESULTS: Among 841 selected studies, 6 RCTs evaluated ETV and VPS. Compared to VPS, ETV had lower postoperative infection incidence (risk ratio [RR]: 0.19, 95% confidence interval [CI]: 0.08-0.43, p=0.0001), postoperative CSF leakage (RR: 5.10, 95% CI: 1.19-21.89, p=0.03) VPS. VPS had no mortality as compared to ETV (RR 0.64, 95% CI: 0.26-1.56, p=0.32). CONCLUSION: While VPS had no mortality in comparison to ETV, the latter showed lower incidences of major complications, such as postoperative infection and CSF leakage, than those of the former for patients with obstructive hydrocephalus.

Effect of docosahexaenoic acid on traumatic brain injury in rats.

The present study aimed to investigate the protective effects of docosahexaenoic acid (DHA) on traumatic brain injury (TBI) in rats. A model of TBI was induced by lateral fluid percussion injury in adult rats and rats were randomly divided into the TBI-model group, TBI-low DHA group and TBI-high DHA group, while other healthy rats were assigned to the sham-operated group. Motor recovery was tested with beam-walking trials at 2, 7 and 15 days post-TBI. Cognitive recovery was tested with Morris water maze trials at 15 days post-TBI. The expression levels of caspase-3, B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) were measured by western blotting. DHA protected against motor deficits induced by TBI in beam walking tests. All TBI-model groups had longer escape latency and swimming distances than the sham groups. Compared with the TBI-low DHA group, the TBI-high DHA group demonstrated shorter escape latency and swimming distances. DHA inhibited the expression of caspase-3 and the inhibition effect was more obvious at a high dosage. Furthermore, DHA dose-dependently rescued neurons by upregulating the Bcl-2:Bax ratio. DHA supplementation was a viable strategy to mitigate injury from TBI.

Amyloid-ß immunization enhances neurogenesis and cognitive ability in neonatal mice.

Whether Aß actually has a physiological as well as a pathological role is not known. In order to investigate the effect of endogenous Aß, wild type C57BL/6 mice were immunized with human or mouse derived Aß1-42. The anti-Aß antibody concentrations were increased in both treated groups. Compared to the human Aß1-42 treated group, level of serum Aß significantly decreased in mouse Aß1-42 treated group. Western blot results revealed that these two derived Aß1-42 had no cross-reaction. The new dentate granule survival cells increased in Aß1-42 immunization groups, indicated by more BrdU+/NeuN+ and BrdU+/DCX+ cells as compared to PBS-treated group, accompanied by behavioral performance improving in a hippocampus-dependent learning task. Immunohistochemical analysis showed that BrdU+/Iba1+ cells also increased, however new born astrocytes (BrdU+/GFAP+) were unaffected in all treated mice. Interestingly, according the results of ELISA analysis both vaccines up-regulated IL-4 and IFN-γ levels in the brains and sera, but the TNF-α level did not changed. Of note, human Aß1-42 immunization in neonatal mice enhanced neurogenesis and cognitive ability, might via Aß immune response rather than cleaning endogenous Aß.

Regulator of telomere elongation helicase 1 (RTEL1) rs6010620 polymorphism contribute to increased risk of glioma.

Regulator of telomere elongation helicase 1 (RTEL1) is critical for genome stability and tumor avoidance. Many studies have reported the associations of RTEL1 rs6010620 with glioma risk, but individually published results were inconclusive. This meta-analysis was performed to quantitatively summarize the evidence for such a relationship. The PubMed, Embase, and Web of Science were systematically searched to identify relevant studies. The odds ratio (OR) and 95 % confidence interval (95 % CI) were computed to estimate the strength of the association using a fixed or random effects model. Ten studies were eligible for meta-analysis including data on glioma with 6,490 cases and 9,288 controls. Overall, there was a significant association between RTEL1 rs6010620 polymorphism and glioma risk in all four genetic models (GG vs. AA: OR=1.87, 95 % CI=1.60-2.18, P heterogeneity=0.552; GA vs. AA: OR=1.30, 95 % CI=1.16-1.46, P heterogeneity=0.495; dominant model-GG+GA vs. AA: OR=1.46, 95 % CI=1.31-1.63, P heterogeneity=0.528; recessive model-GG vs. GA+AA: OR=1.36, 95 % CI=1.27-1.46, P heterogeneity=0.093). Subgroup analyses by ethnicity showed that RTEL1 rs6010620 polymorphism resulted in a higher risk of glioma among both Asians and Caucasians. In the stratified analysis by ethnicity and source of controls, significantly increased risk was observed for Asians and Europeans in all genetic models, population-based studies in all genetic models, and hospital-based studies in three genetic models (heterozygote comparison, homozygote comparison, and dominant model). Our meta-analysis suggested that RTEL1 rs6010620 polymorphism is likely to be associated with increased glioma risk, which lends further biological plausibility to these findings.

Enhancement of antitumor activity by combination of tumor lysate-pulsed dendritic cells and celecoxib in a rat glioma model.

Using dendritic cell (DC)-based vaccines for treatment of gliomas has emerged as a meaningful and feasible treatment approach for inducing long-term survival, but this approach so far has failed to generate significant clinical responses. In the present study, we demonstrated that glioma lysate-pulsed DCs in combination with celecoxib, a selective cyclooxygenase 2 (COX-2) inhibitor, showed more significantly enhanced antitumor activity with increased apoptosis of tumor cells, reduced neovascularization, and developed a strong cytotoxic T lymphocyte (CTL) response in tumor-bearing rats. Celecoxib may reduce production of prostaglandin E2 and modulate the balance between T helper 1 (Th1) cytokines and T helper 2 (Th2) cytokines by increasing the pivotal Thl cytokine interleukin-12 and reducing Th2 cytokine interleukin-10. Taken together, our results demonstrated that selective inhibition of COX-2 using celecoxib combined with DC-based immunotherapy could act as an important novel strategy for improving future treatment of malignant gliomas.