Volume 93  ·   Issue 31  ·  2013

Expert Consensus on Diagnosis and Treatment of Malignant Glioma of Central Nervous System in China (Simplified Edition)^[1](hereinafter referred to as the Consensus) since its publication in October 2009, it has been well received by everyone. In September 2011, the consensus writing group discussed and decided to further update the consensus and add relevant contents to meet the needs of the majority of clinical medical workers and patients, and renamed it "Chinese Guidelines for the Diagnosis and Treatment of Central Nervous System Glioma (2012)" (hereinafter referred to as the Guidelines). Added contents include: pilocytic astroglioma, dysembryogenic neuroepithelioma (DNET), ganglioma, ganglioglioma, World Health Organization (WHO) grade II glioma (such as diffuse astroglioma, oligodendroglioma and ependymoma, etc.), WHO grade III and IV gliomatosis, medulloblastoma and supratentorial neuroectodermal tumor, etc. Specialists in neuropathology, neuroimaging and rehabilitation therapy have been added to the authors of the guidelines. The preparation of the Guide remains in accordance with the consensus preparation process, namely: (1) multidisciplinary experts constituting the preparation team; (2) The issues and areas to be addressed by the guidelines proposed by the experts of the preparation group; (3) Information experts search literature evidence according to questions, emphasizing the search of Chinese literature in addition to foreign literature; (4) The experts of the compilation group read the literature and were classified according to the 5 levels of evidence-based medicine (Table 1), randomized controlled study "CONSORT" and guideline "AGREE" procedures, multiple people consult on questions, assess the quality of evidence in the literature, and reach the recommendation level (Table 2), and combine China's national conditions and actual situation, write guidelines and recommendations; (5) Finally coordinated and finalized by the preparation team leader.

To summarize the clinical manifestations, immunotherapeutic response and prognosis of anti-N-methyl-D-aspartic acid (NMDA) receptor encephalitis.

We analyzed the clinical features, tumor markers, serum/cerebrospinal fluid (CSF) antibodies of seven cases with anti-NMDA receptor encephalitis.And the prognosis of different treatments was observed.

Seven patients presented with significant psychiatric symptoms, memory loss, epilepsy, movement disorders and decrease consciousness.And some patients required assisted ventilation because of dysautonomia.All electroencephalographs showed slow wave activity without epileptic form discharges.Magnetic resonance imaging was normal or showed T2W and Flair-phase high signal in limbic system, cortex, thalamus.And CSF and serum anti-NMDA receptor antibodieswere positive (n=6).

Anti-NMDA receptor encephalitis is a kind of fatal but treatable condition.And timely diagnosis and treatment may yield a favorable prognosis.

To evaluate the diagnostic significance of Fascin protein in non-small cell lung cancer (NSCLC) patients.

Among 110 cases of NSCLC patients and 50 cases of healthy controls, double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was employed to measure the serum levels of Fascin protein,carcinoembryonic antigen (CEA),neuronspecific enolase (NSE),scaleslike squamous cell carcinoma (SCC) antigen,cytokeratin protein 21-1 (CYFRA21-1) and gastrin-releasing peptide (GRP) precursor.Fascin-positive rate (24.4%) in NSCLC patients was significantly higher than that in healthy controls (4%)(P<0.05).In different clinical stages of non-small cell lung cancer patients,Fascin-positive rate was statistically significant (P<0.05).The positive rates of Fascin for CEA,CYFRA21-1,NSE,SCC and Pro-GRP were 25.64%, 5.1%,5.1%,5.0% and 1.7% respectively.

As a new tumor marker,Fascin may be used for clinical screening and prognosis in lung cancer.

To discuss the model of reasonable dissection extent of mediastinal lymph nodes in non-small cell lung cancer of diameter less than 2 cm.

A study was carried on the clincal data of 192 patients with NSCLC of diameter less than 2 cm undergoing curative resection and mediastinal lymph nodes dissection, According to the size of tumor and the pathology quick report.

The survival rates of patient was statistically significant difference (P<0.01), prognostic factors included diameter of tumor,lymph node metastasis and visceral pleura invasion; 51.7% mediastinal lymph node metastasis of superior lobe tumor,28.8% transferingto surcarinal node| the mediastinal lymph node metastasic rate of adenocarcinom was32.2%,and squamous cell carcinom was 15.4% (P=0.0012).

If the patient′s cardiopulmonary function permitting, regardless of the size of focus,Regional mediastinal lymph nodal and surcarinal lymph nodal dissection should be routinely performed on patients with non-small cell lung cancer of diameter less than 2 cm, and improve survival rate.

To explore the expression pattern of inflammatory cytokines at various inflammatory levels of adamantinomatous craniopharyngioma by cytokine antibody array.

The inflammatory levels of adamantinomatous craniopharyngioma were evaluated on the basis of the number of inflammatory cells at the interface of tumor and normal tissues.And the expression of inflammatory cytokines was examined at various inflammatory levels of adamantinomatous craniopharyngioma by inflammatory cytokine antibody array and the results were verified by Western blot.

Compared with the mild inflammatory group, the levels of inflammatory cytokines of severe inflammatory group markedly increased, including pro-inflammatory cytokines, chemokines and cytokine receptors.

Antibody array demonstrates a significant change in cytokine profiles in adamantinomatous craniopharyngioma with severe inflammation, as compared with those with mild inflammation.

To compare the characteristics of lesions with consistent and inconsistent judgments of coronary stenosis on 320-slice dynamic volume computed tomography (DVCT) versus coronary angiography (CAG).

Ninety-two patients (265 lesions) with CAG and DVCT within 2 weeks from January 2011 to May 2012 were enrolled.According to the matching degree of stenotic judgment,all lesions were divided into consistent and inconsistent groups.The position of lesions,degree of bending,plaque morphology and calcification proportion were analyzed.

There were 236 lesions in consistent group versus 29 lesions in inconsistent group.In inconsistent group,there were more left circumflex artery,distal,ostial and tortuous lesions than that in consistent group (P<0.05).At the same time,the proportion of nubbly type plaque,calcified plaque,nubbly and nodular type calcification in the main plaque in inconsistent group was higher than those in consistent group (P<0.05).Segmental coronary calcium score (250±210 vs 82±66,P<0.05),number of calcifications and calcification proportion in main plaque (55%±28% vs 43%±30%,P<0.05) in inconsistent group were higher than those in consistent group (P<0.05).

When coronary lesion occurs in ostial,distal or tortuous position or its main plaque is of nubbly type with a heavy calcification load,the judgment of stenosis by CTA and CAG is more likely to be inconsistent.

To clarify the relationship between the expression of dual specificity phosphatase-1 (DUSP1) and the prognosis of endometrioid adenocarcinoma.

The expression of DUSP1 was determined by immunohistochemical staining in specimens from 81 patients with endometrial carcinoma undergoing surgical resection.The relationship between DUSP1 expression, clinicopathological factors and prognosis were further evaluated.

In 81 endometrioid carcinoma samples,59 (72.84%) cases were positive while 22 negative.Except for lymph node metastasis,the expression of DUSP1 was correlated with FIGO stage,tumor grade, myometrial invasion and the expressions of estrogen receptor (ER) and progesterone receptor (PR)(P<0.05).Kaplan-Meier analysis showed that patients with a positive DUSP1 expression had significantly prolonged 5-year disease-free survival rates of 98.2% and 76.0% respectively (P<0.05).And COX regression analysis revealed that the expressions of DUSP1 and PR were independent prognostic indicators of endometrioid carcinoma,the HR (hazard ratio) of DUSP1 negative expression was 21.2.Spearman analysis further showed that the expression of DUSP1 was positively correlated with PR (r=0.256,P<0.05).

DUSP1 may be a potential negative prognostic indicator for endometrioid adenocarcinoma.

To explore the efficacy and safety of megestrol acetate silicone vaginal ring.

A total of 165 healthy child-bearing age women were recruited to examine the efficacy, safety and satisfaction rate of megestrol acetate silicone vaginal ring.

The cumulative pregnancy rate of megestrol acetate silicone vaginal ring was 3.93%.And its discontinuation rate was 2.54%, the incidence of adverse events 11.52% and the incidence of adverse effects 1.81% while the symptoms were all slight.The bleeding pattern was similar to that of normal menstruation.Compared with baseline,the elevated level of triglycerides and the reduced level of low-density lipoprotein (LDL) were significantly different while no significant difference existed in high-density lipoprotein (HDL), cholesterol and hemoglobin, etc.The satisfaction rate of megestrol acetate silicone vaginal ring was 94.6% and increased with time.

Megestrol acetate silicone vaginal ring is an effective and safe option of contraceptives.

To explore the correlation of serum ferritin (SF) and systemic onset juvenile idiopathic arthritis (SOJIA) so as to determine the prognostic values of SF for SOJIA.

All samples were collected from 92 juvenile idiopathic arthritis (JIA) patients at Beijing Children′s Hospital between February 2005 to September 2012.Their age range was 2-15 years.There were macrophage activation syndrome (MAS, n=25), polyarticular JIA (n=33) and oligoarticular JIA (n=30).And 47 healthy children and another 30 with acute infective diseases were selected as control groups respectively.Blood samples were collected and SF was measured in different disease phases.Other parameters include leucocyte, hemoglobin, platelet, C-reactive protein and erythrocyte sedimentation rate.Statistics of SF level at different groups as well as at different disease phases were performed.

The SF level of active phase SOJIA patients was significantly higher (P<0.01) than that in Other groups.And its level in the active phase of SOJIA was significantly higher than that in patients during the recovery phase.The SF level in patients with MAS was significantly higher than that in those without MAS.

Correlated with the course of SOJIA, the level of SF may judge the disease activity and predict the outcomes of SOJIA.

To explore the effects of transcription factor ETS-1 mRNA and B lymphocyte-associated cytokines on the differentiation of B cells in systemic lupus erythematosus (SLE) patients and explore its pathogenic and clinical significance.

Thirty-one SLE patients (20 active and 11 inactive) and 15 healthy controls were enrolled.CD19+ B cells were isolated with magnetic beads.The levels of ETS-1 mRNA in B cells were determined by real-time polymerase chain reaction (PCR).Flow cytometry was used to detect the altered ratio of CD19-CD138+ plasma cells and CD19+ B cells.And enzyme-linked immunosorbent assay (ELISA) was performed to detect the serum levels of B cell differentiation-related cytokines interleukin-10 (IL-10) and APRIL.

Compared to the healthy controls,SLE patients showed decreased mRNA expression level of ETS-1 in B cells (Z=-4.218, P<0.01).Moreover, the expression level of ETS-1 mRNA was significantly negatively correlated with the proportion of CD19-CD138+ plasma cells (r=-0.359, P<0.05) and negatively correlated with the CD19-CD138+ B cells/CD19+ plasma cells ratio (r=-0.493, P<0.01).However, there was no correlation in normal controls.Significant negative correlation existed between the expression level of ETS-1 mRNA in B cells and the serum levels of IL-10 and APRIL in active SLE patients.But no correlation existed in inactive group.

ETS-1 may participate in the pathogenesis of SLE through its effects on the differentiation of B cells and cooperation with IL-10 and APRIL.

To explore the establishment of Schatzker classification digital model of tibial plateau fractures and its application in virtual surgery.

Proximal tibial of one healthy male volunteer was examined with 64-slice spiral computed tomography (CT).The data were processed by software Mimics 10.01 and a model of proximal tibia was reconstructed.According to the Schatzker classification criteria of tibial plateau fractures, each type of fracture model was simulated.Screen-captures of fracture model were saved from different directions.Each type of fracture model was exported as video mode.Fracture model was imported into FreeForm modeling system.With a force feedback device, a surgeon could conduct virtual fracture operation simulation.Utilizing the GHOST of FreeForm modeling system,the software of virtual cutting, fracture reduction and fixation was developed.With a force feedback device PHANTOM,a surgeon could manipulate virtual surgical instruments and fracture classification model and simulate surgical actions such as assembly of surgical instruments,drilling,implantation of screw,reduction of fracture, bone grafting and fracture fixation,etc.

The digital fracture model was intuitive,threedimensional and realistic and it had excellent visual effect.Fracture could be observed and charted from optional direction and angle.Fracture model could rotate 360°in the corresponding video mode.The virtual surgical environment had a strong sense of reality,immersion and telepresence as well as good interaction and force feedback function in the FreeForm modeling system.The user could make the corresponding decisions about surgical method and choice of internal fixation according to the specific type of tibial plateau fracture as well as repeated operational practice in virtual surgery system.

The digital fracture model of Schatzker classification is intuitive, threedimensional,realistic and dynamic.The virtual surgery systems of Schatzker classifications make the virtual surgery training more normalized,programmed and standardized.In addition,virtual surgery system can serve as a new tool for preoperative planning and surgeon-patient interactions.

To construct a recombinant lentiviral vector containing integrin β1 shRNA to provide an effective tool for integrin β1 gene effect and a possible mechanism of Sombati cell of clinical refractory epilepsy.

Four lentiviral vectors containing integrin β1 shRNA were constructed and transfected into 293T cells.PC12 cells were infected by concentrated lentivirus and the gene-silencing efficiency was verified.And the most effective lentivirus containing shRNA was selected with Western blot.Then neonatal rat hippocampal neurons and Sombati cells were infected by lentivirus containing shRNA and the gene-silencing efficiency was also monitored by Western blot.

RNAi lentivirus expression vectors targeting rat integrin β1 gene were successfully constructed and confirmed by DNA sequencing.The recombinant lentivirus particles were packaged successfully to produce a sufficient titer for subsequent experiments.The expression of protein significantly decreased in rat hippocampal neurons and rat Sombati cells after vector transfection.

The recombinant lentiviral vector containing integrin β1 sh RNA is constructed successfully.And the gene-silencing effects are effective and stable in neonatal rat hippocampal neurons and Sombati cells.