Sella turcica anatomy by three-dimensional computed tomography for an endonasal transsphenoidal approach to pituitary adenoma

BACKGROUND

The aim of this study was to identify the anatomic landmarks of sella turcica on the surface of the head, and to investigate the feasibility of studying sella turcica anatomy individually by three-dimensional computed tomography (3D-CT) before an endonasal transsphenoidal operation.

PATIENTS AND METHODS

The three-dimensional anatomic structures of the heads of 49 patients were studied by 3D-CT using image reconstruction with surgical clip image registration. The tip of the nose and the apex of the ear helix were used as surface markers on the head, and the locations of the sphenoid sinus and sellar floor with respect to a line defined by these 2 markers were investigated. Using an endonasal transsphenoidal approach with a surgical trajectory guided by the nose tip-ear apex line and 3D-CT anatomic images of the sella turcica, 12 patients with pituitary adenoma were treated surgically.

RESULTS

The nose tip-ear apex line passed through the sphenoid sinus in 100% of the cases and through the sellar floor in 41.4% of the cases. The mean distance from the sellar floor clivus point perpendicularly to the nose tip-ear apex line was 3.5±2.0 mm. The 3D-CT imaging clearly showed the configuration of the sphenoid sinus, bone septum, optic protuberance, carotid protuberance and the sellar floor. 12 pituitary adenomas were resected totally.

CONCLUSION

The nose tip-ear apex line provides a precise, simple, and practical tool for orienting the sphenoid sinus, sellar floor and surgical trajectory of the endonasal transsphenoidal approach. 3D-CT images more clearly and intuitively display the sella turcica anatomy. Preoperative 3D-CT increases the surgeon's confidence in endonasal transsphenoidal operations and should be routinely performed in patients with pituitary adenomas.

A prospective study of early versus late craniectomy after traumatic brain injury

BACKGROUND

Decompressive craniectomy is an important method for managing traumatic brain injury (TBI). At present, controversies about this procedure exist, especially about the optimum operative time for patients with TBI.

METHODS

A prospective study was performed at the First Affiliated Hospital, College of Medicine, Zhejiang University. From January 2008 to December 2009, 25 patients who underwent early decompressive craniectomy were included in the study group, and 19 patients who underwent "late" decompressive craniectomy as a second-tier therapy for intracranial hypertension were included as a comparison group.

RESULTS

The 30-day mortality after the operation was 16% in the study group. The overall mortality rate was 20% at the 6-month follow-up. A total of 52% of the patients (13 patients) had good outcomes, and 7 patients remained in a severely disabled or vegetative state. In the comparison group, 4 patients died, and 12 had good outcomes at the 6-month follow-up. The remaining 3 patients had poor outcomes. The study group was well matched with the comparison group. However, the outcomes in the study group were not better than those in the comparison group, as evaluated by the 6-month GOS score.

CONCLUSION

Early decompressive craniectomy as a first-tier therapy for intracranial hypertension did not improve patient outcome when compared with "late" decompressive craniectomy for managing TBI.

Technical considerations in decompressive craniectomy in the treatment of traumatic brain injury

Refractory intracranial hypertension is a leading cause of poor neurological outcomes in patients with severe traumatic brain injury. Decompressive craniectomy has been used in the management of refractory intracranial hypertension for about a century, and is presently one of the most important methods for its control. However, there is still a lack of conclusive evidence for its efficacy in terms of patient outcome. In this article, we focus on the technical aspects of decompressive craniectomy and review different methods for this procedure. Moreover, we review technical improvements in large decompressive craniectomy, which is currently recommended by most authors and is aimed at increasing the decompressive effect, avoiding surgical complications, and facilitating subsequent management. At present, in the absence of prospective randomized controlled trials to prove the role of decompressive craniectomy in the treatment of traumatic brain injury, these technical improvements are valuable.

Giant enhancement of hydrogen transport in rutile TiO2 at low temperatures

Measurements of the O-H and O-D vibrational lifetimes show that the room-temperature hydrogen diffusion rate in rutile TiO2 can be enhanced by 9 orders of magnitude when stimulated by resonant infrared light. We find that the local oscillatory motion of the proton quickly couples to a wag-mode-assisted classical transfer process along the c channel with a jump rate of greater than 1 THz and a barrier height of 0.2 eV. This increase in proton transport rate at moderate temperatures provides new insight into hydrogen transport in solids, which could play a role in applications ranging from fuel cells to hydrogen production.

Translational Mini-Review Series on B Cell-Directed Therapies: B cell-directed therapy for autoimmune diseases

B cells play an important role in the pathogenesis of both systemic and organ-specific autoimmune diseases. Autoreactive B cells not only produce autoantibodies, but are also specialized to present specific autoantigens efficiently to T cells. Furthermore, these B cells can secrete proinflammatory cytokines and can amplify the vicious cycle of self-destruction. Thus, B cell-directed therapies are potentially an important approach for treating autoimmune diseases. On the other hand, like T cells, there are subsets of B cells that produce anti-inflammatory cytokines and are immunosuppressive. These regulatory B cell subsets can protect against and ameliorate autoimmune diseases. Thus targeting B cells therapeutically will require this balance to be considered. Here we summarize the roles of pathogenic and regulatory B cells and current applications of B cell-directed therapy in autoimmune diseases. Considerations for future development of B cell-directed therapy for autoimmune diseases have also been discussed.

Suppression of p53 activity by Siva1

The tumor suppressor p53 induces potent anti-proliferative responses in stressed cells; in unstressed cells this ability of p53 is restrained by Hdm2. Expression of Hdm2 is also induced by p53, thereby establishing feedback inhibition. Regulation of the p53-Hdm2 interaction and the feedback inhibition of p53 are not well understood. Here, we show that the p53-Hdm2 interaction in unstressed cells is promoted by Siva1, which, like Hdm2, is the product of a p53 target gene. Siva1 binds to both p53 and Hdm2 through distinct regions and enhances Hdm2-mediated p53 ubiquitination and degradation. Siva1 strongly inhibits p53-mediated gene expression and apoptosis. In xenograft mouse models, downregulation of Siva1 markedly inhibits tumor formation because of the activation of p53. On DNA damage, the interactions of Siva1 with both p53 and Hdm2 are diminished. The function of Siva1 seems to be related to its ability to form a homo-oligomer as the oligomerization defective splicing variant Siva2 fails to de-stabilize p53. These results identify Siva1 as an important adaptor promoting p53 degradation through Hdm2. Siva1 may be part of the negative feedback loop that inhibits p53 activity at the end of a non-lethal stress response.

MRI findings of intracranial cystic meningiomas

AIM

To report the magnetic resonance imaging (MRI) features of intracranial cystic meningiomas and compare these features in intra- and peritumoural cyst groups.

MATERIALS AND METHODS

Fourteen cases of peritumoural cystic meningiomas were compared with 18 cases of intratumoural cystic meningiomas. All patients were examined using non-enhanced and contrast-enhanced MRI. Tumour location, tumour size, signal intensity, enhancement characteristics, and cystic changes were assessed. The MRI features were compared between the intra- and peritumoural cyst groups.

RESULTS

Most cystic meningiomas comprised two or more cysts. The solid parts of the tumours showed moderate or marked enhancement after the injection of contrast material. An enhanced cyst wall was found in six out of 14 cases in the peritumoural cyst group, but not in the intratumoural cyst group. Peritumoural cystic meningiomas were predominately located in the cerebral falx, whereas the intratumoural cystic meningiomas were predominantly found in frontal convexity (X(2)=7.434, p=0.024). The cysts were larger in the peritumoural cyst group than in the intratumoural cyst group (t=5.274, p=0.0258). Peritumoural oedema was more commonly found in the intratumoural cyst group (X(2)=6.863, p=0.008). Cystic meningiomas with solid parts located inside the cyst are reported for the first time.

CONCLUSION

Cystic meningiomas, although uncommon, should be differentiated from other cystic intracranial lesions. Peri- and intratumoural cystic meningiomas have distinct MRI features. The present study provides the first report of two lesions with solid parts located inside the cyst, as well as one lesion with a calcified solid nodule and haemorrhage within the cyst.

Endotoxin tolerance of RAW264.7 correlates with p38-dependent up-regulation of scavenger receptor-A

Pre-exposure to lipopolysaccharide (LPS) leads to hyposensitivity to secondary LPS stimulation, known as endotoxin tolerance. The role of macrophage scavenger receptor-A (SR-A) in endotoxin tolerance is unknown. In this study, LPS was shown to induce SR-A expression in the mouse macrophage cell line, RAW264.7, in dose- and time-dependent manners, which correlated with inflammatory cytokine suppression in RAW264.7 on secondary LPS stimulation. Over-expression of SR-A in RAW264.7 suppressed tumour necrosis factor (TNF)-alpha release and nuclear factor (NF)-kappa B activation, demonstrating the involvement of SR-A in endotoxin tolerance. LPS-pre-treated RAW264.7 cells could bind and internalize more fluorescein isothiocyanate (FITC)-LPS than untreated cells and both the SR-A ligand, fucoidan, and anti-SR-A 2F8 antibodies completely suppressed LPS-induced binding and internalization of FITC-LPS by RAW264.7. LPS-induced SR-A expression on RAW264.7 was completely suppressed by the p38-specific inhibitor, SB203580, but not by inhibition of toll-like receptor 4 (TLR4) signalling with MTS510, demonstrating that p38- but not TLR4-dependent up-regulation of SR-A was involved in endotoxin tolerance through binding and internalization of LPS.

Comparison of three different methods for the detection of human papillomavirus infected in cervical lesions

e22166

Background: Several techniques are in use for HPV DNA detection: Hybrid Capture IIR(HCIIR) assay, PCR-based DNA microarray and Luminex-based assay. This study was aimed to examine the performances of three validated HPV assays. We compared the concordance between the three methods for detecting HPV in cervical specimen. Methods: Cervical samples of 189 Korean women (21∼77 ages, average 41.2 age) were tested for HPV detection in this study. We examined the performances of three validated HPV assays according to each method's instructions : 1) Hybrid Capture IIR (HCIIR) assay (HCIIR; Digene Corporation, USA) was used to test for detection of 18 types of HPV (high-risk types: HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and low-risk types types: HPV 6, 11, 42, 43, 44). 2) HPV DNA Chip, PCR-based DNA microarray system (MyGene Co., Seoul, South Korea) was used to test for genotyping of 24 types of HPV: 15 types of high-risk types (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68) and 9 types of low-risk types (HPV6, 11, 34, 40, 42, 43, 44, 54, 70). 3) Luminex-based HPV test (YBT, Seoul, Korea) was performed for genotyping 26 types of HPV including 15 high-risk HPV types (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68) and 11 low-risk types (HPV-6, 11, 34, 40, 42, 43, 44, 54, 55, 67, 70). Results: We compared HPV detection results obtained by the HC II assay with those from the Luminex assay. 51 cases were discordant: 29 samples were HC II negative/Luminex positive and 22 samples were HCII positive/Luminex negative. We also compared HPV detection results obtained by the DNA chip assay with those from the Luminex assay. 37 cases were discordant: 5 samples were DNA chip negative/Luminex positive and 32 samples were DNA chip positive/Luminex negative. Conclusions: The distribution of the HPV detection results obtained for 91 samples using three different methods suggested that the results of DNA chip assay are more often discordant (17.9% instead of 5.1% for Luminex assay and 5.1% for the HC II assay).

No significant financial relationships to disclose.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

The Pirh2-keratin 8/18 interaction modulates the cellular distribution of mitochondria and UV-induced apoptosis

Intermediate filaments (IFs) provide crucial structural support in higher eukaryotic cells. Accumulating evidences show that IFs also participate in various cellular activities including stress responses, cell growth, cell death and cell migration through dynamic interactions with various non-structure proteins. Here we report the identification of Pirh2, a RING-H2-type ubiquitin E3 ligase, as a novel binding partner of the cytoplasmic IF proteins keratin 8/18 (K8/18). Phosphorylation of either Pirh2 or K8/18 affects their association. Although Pirh2 was not found to influence the stability of K8/18, it displayed an unexpected role in regulating the organization of the network of K8/18 keratin filaments. Disruption of Pirh2-K8/K18 interaction by either UV irradiation or knockdown with Pirh2 or K18 led to the aggregation of K8/18 keratin filaments. It further induced mitochondrial redistribution, and this process is likely through a microtubule-mediated pathway. The abnormal localization of mitochondria in Pirh2-knockdown cells may partially account for its increased cell sensitivity to UV-induced apoptosis, probably through enhancing the release of pro-apoptotic proteins, such as cytochrome c and Smac/DIABLO to the cytosol. Overall, our data reveal the novel role of the Pirh2-K8/18 complex in governing the distribution of mitochondria.