MR perfusion of a glioblastoma and a metastatic brain tumor.

<p>The upper panel shows the contrast-enhanced MPRAGE (A), CBV (B), corrected CBV (C) and K₂ (D) images of a necrotic glioblastoma in the left medial parietal region, and the lower panel (E, F, G and H) shows the corresponding images of a cystic metastatic brain tumor in the right occipital lobe.</p

ROC analysis of CBV and corrected CBV of enhancing rim in differentiating abscesses from glioblastomas and/or metastases.

<p>Note. – ACC, accuracy; CI, confidence interval; CV, cutoff value; GB, glioblastomas; Mets, metastasis; SEN, sensitivity; SPE, specificity; Data of sensitivity, specificity and accuracy are in percentage; *p<0.05.</p><p>ROC analysis of CBV and corrected CBV of enhancing rim in differentiating abscesses from glioblastomas and/or metastases.</p

ROC curve analysis of CBV and corrected CBV in differentiating abscesses from glioblastomas (A), abscesses from metastases (B), and abscesses from glioblastomas and metastases.

<p>ROC curve analysis of CBV and corrected CBV in differentiating abscesses from glioblastomas (A), abscesses from metastases (B), and abscesses from glioblastomas and metastases.</p

Quantitative comparisons of perfusion parameters among abscesses, glioblastomas and metastases.

<p>Note. – Data are mean ± standard deviation; CBV and corrected CBV are in ratios to corresponding NAWM, GB, glioblastomas; Mets, metastasis; *p<0.05.</p><p>Quantitative comparisons of perfusion parameters among abscesses, glioblastomas and metastases.</p

Measurements of perfusion parameters in a 47-year-old man with pyogenic brain abscess.

<p>Axial contrast-enhanced MPRAGE (A) and T2W image (B) show a rim-enhancing mass with perifocal edema in the right temporal lobe. (C) On contrast-enhanced MPRAGE, three ROIs are placed over the enhancing rim (red), perifocal edema (blue) most adjacent to the enhancing rim and the contralateral NAWM (green) for the measurements of CBV (D), corrected CBV (E) and K₂ (F), respectively.</p

The molecular mechanism of reduction of meningioma cell survival by TGM2 inhibitor.

<p>(A) Cell viability was assessed by using the MTT assay and was expressed as percentage of control. Meningioma cell survival was measured at 24- and 48-hour after application of cystamine in 1, 10, 100, 1000 µM concentration. Meningioma cell viability was reduced to 39.6% of control 48 hours after cystamine treatment. (B) Western blotting for cleaved caspase-3 and p-Akt. Quantification of immunoblotting assay showed that cystamine resulted in (C) a 1.5-fold increase in caspase-3 activation relative to controls and (D) a 30% reduction in Akt phosphorylation (quantification of data from 4 independent experiments).</p

TGM2 inhibition by siRNA treatment induces cell apoptosis.

<p>(A) Quantitative RT-PCR using SYBR Green was used to assay <i>TGM2</i> mRNA expression in siRNA-treated cells. Meningioma cells treated with <i>TGM2</i> siRNA exhibited reduced TGM2 expression in a dose-dependent manner (>80% in 5 nM siRNA). (B) Cell viability assessed using the MTT assay showed 30% decrease of cell survival following 5 nM siRNA exposure. (C) and (D) TUNEL assays were used to measure apoptosis following 5 nM siRNA treatment. Quantification expressed by the number of TUNEL-positive per high power field, demonstrated that <i>TGM2</i> siRNA treatment increased meningioma cell apoptosis (unpaired Student's t-test, p = 0.0021).</p

Microarray analysis of human meningiomas.

<p>(A) Expression profiles of 24 samples, including 3 samples from arachnoid membranes (green; Ara, WHO = 0), 18 samples from benign meningiomas (pink; grade I, WHO = 1), and 3 samples from atypical meningiomas (purple; grade II, WHO = 2). The heat map generated by hierarchical clustering revealed that the samples from arachnoid membranes clustered together. (type: A =  Arachnoid membrane, T =  Meningioma; WHO: WHO grades; NF2: H =  normal expression, L =  low expression; SEX: M =  male, F =  female; AGE: 1<60, 2≧60 y/o) (B) Comparison between arachnoid membranes and meningiomas identified 20 genes with significantly differential expression (fold change >4; corrected p (FDR) <0.05). (C) <i>NF2</i> gene expression levels were different, with low expression in 13 meningiomas. (Group: Ara, Arachnoid membrane; NF2-H and NF2-L, meningiomas with normal and low <i>NF2</i> expression, respectively) (D) TGM2 expression was inversely correlated with <i>NF2</i> gene expression. (Pearson correlation coefficient r = −0.5313, r2 = 0.2823, p = 0.0132).</p

Validation of TGM2 by immunohistochemical study.

<p>TGM2 immunohistochemistry (IHC) was performed on 82 meningiomas from a different cohort (n = 82, WHO grade I = 58, grade II = 21, and grade III = 3). The IHC images represented high (A) and low (B) expression of TGM2, respectively. Scale bar  = 50 µm. (C) The quantification of TGM2 expression was expressed by percentage of TGM2-immunopositive cell per high power field (%HPF). The dot plot showed that TGM2 expression was abundant (positive in >50% of cells) in all grade II and III meningiomas. The TGM2 expression level was correlated with increased WHO malignancy grade (ANOVA, p = 0.0046). (D) The dot blot for TGM2 expression in grade I meningiomas revealed that those tumors with recurrence had high TGM2 expression (positive in >70% of cells).</p

The Impact of Surgical Experience on Major Intraoperative Aneurysm Rupture and Their Consequences on Outcome: A Multivariate Analysis of 538 Microsurgical Clipping Cases

<div><p>The incidence and associated mortality of major intraoperative rupture (MIOR) in intracranial aneurysm surgery is diverse. One possible reason is that many studies failed to consider and properly adjust the factor of surgical experience in the context. We conducted this study to clarify the role of surgical experience on MIOR and associated outcome. 538 consecutive intracranial aneurysm surgeries performed on 501 patients were enrolled in this study. Various potential predictors of MIOR were evaluated with stratified analysis and multivariate logistic regression. The impact of surgical experience and MIOR on outcome was further studied in a logistic regression model with adjustment of each other. The outcome was evaluated using the Glasgow Outcome Scale one year after the surgery. Surgical experience and preoperative Glasgow Coma Scale (GCS) were identified as independent predictors of MIOR. Experienced neurovascular surgeons encountered fewer cases of MIOR compared to novice neurosurgeons (MIOR, 18/225, 8.0% vs. 50/313, 16.0%, P = 0.009). Inexperience and MIOR were both associated with a worse outcome. Compared to experienced neurovascular surgeons, inexperienced neurosurgeons had a 1.90-fold risk of poor outcome. On the other hand, MIOR resulted in a 3.21-fold risk of unfavorable outcome compared to those without it. Those MIOR cases managed by experienced neurovascular surgeons had a better prognosis compared with those managed by inexperienced neurosurgeons (poor outcome, 4/18, 22% vs. 30/50, 60%, P = 0.013).</p></div