Data_Sheet_1_Optimal therapeutic strategies for pineal region lesions.docx

BackgroundThe removal of pineal region lesions are challenging, and therapeutic strategies for their removal remain controversial. The current study was conducted to identify the characteristics and the optimal therapeutic strategies for pineal region lesions.MethodsThis retrospective study reviewed the treatments of 101 patients with pineal region lesions, and different characteristics and therapeutic strategies were observed.ResultsThere were no statistical differences in the total resection ratio, complications, and prognosis outcomes between the hydrocephalus group and non-hydrocephalus group, except patients in the hydrocephalus group were younger and pediatric patients had an increased level of intracranial infections. Treatments of lesions and hydrocephalus secondary to pineal region lesions were two integral parts to therapeutic strategies. For the management of lesions, germinoma or non-germinoma were diagnosed preoperatively, and resection or diagnostic radiation were chosen to deal with pineal region lesions. Endoscopic-assisted surgery provided a higher total resection rate. For the management of hydrocephalus, endoscopic third ventriculostomy (ETV) had the better therapeutic effect. Additionally, cerebrospinal fluid (CSF) diversion before radiotherapy or resection did not improve prognosis outcome, but it was necessary for patients with severe hydrocephalus. Logistical regression analysis indicated that age, lesion size, reoperation ratio, and intracranial complications were predictors of prognosis outcome.ConclusionMore attention should be paid to intracranial infections in pediatric patients with hydrocephalus secondary to pineal region lesions, and CSF diversion before radiotherapy or resection did not promote prognosis outcome, but it was necessary for patients with severe hydrocephalus. Age, lesion size, reoperation ratio, and intracranial complications may be the predictors of prognosis outcome. Most importantly, the surgical algorithm for pineal region lesions which was based on preoperatively diagnosis (non-germinoma and germinoma) is useful, especially for developing countries.</p

Sequences of PCR primers.

<p>Sequences of PCR primers.</p

The cell injury in the brain was assessed by detecting the DNA fragmentation using TUNEL staining.

<p>Panel 1. It was shown that the cells have a normal structure and are light blue-stained. In the SAH group, the dystrophic and brown-stained TUNEL-positive cells are observed in the cortex. And the TUNEL-positive cells in the PDTC group are less than that in the SAH group. Panel 2. Quantification of the TUNEL staining showed that the TUNEL-positive cells are significantly increased in the SAH group compared with that in the control group. In the PDTC group, the TUNEL-positive cells are significantly decreased compared with that in the SAH group. **P<0.01 vs. control group, #P<0.05 vs. SAH group.</p

The time course of NF-κB DNA-binding activity detected by EMSA after SAH and the effects of PDTC on NF-κB activation.

<p>A. The representative autoradiogram showed the NF-κB DNA-binding activity in each group. B. The time course of NF-κB DNA-binding activity after SAH. Quantification of the DNA-binding activity of NF-κB was performed by densitometric analysis. The NF-κB DNA-binding activity was up-regulated significantly after SAH, especially on day 3 and 5, while restored on day 7. C. the effects of intracisternal administration of PDTC on NF-κB DNA-binding activity. It was shown that NF-κB DNA-binding activity was suppressed after treatment with PDTC. 1 stands for the control group. 2, 3 and 4 stand for the D-3, 5 and 7 SAH groups. 5 stands for the PDTC groups. Results are represented as means ± SEM from five independent experiments in each group. *P<0.05 vs. control group, **P<0.01 vs. control group, #P<0.05 vs. D-5 SAH group.</p

Localization of activated NF-κB detected by immunohistochemistry.

<p>NF-κB p65 immunoactivity was mainly presented in neurons in the SAH group. Furthermore, NF-κB p65 immunoactivity mainly located in the nuclei of neurons.</p

The gene expressions of TNF-α, IL-1β, and ICAM-1 in the brain.

<p>The representative autoradiograms of the RT-PCR results of TNF-α, IL-1β, ICAM-1. B) Relative amount of TNF-α, IL-1β and ICAM-1 mRNA. The levels of TNF-α, IL-1β and ICAM-1 mRNA increased after SAH and was suppressed in the PDTC group. **P<0.01 vs. control group, ##P<0.01 vs. SAH group.</p