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Background: To investigate the effects of SES and geographic variations on survival for adult patients with glioma, we analyzed data from 30489 patients from the Cancer Registry in England and Wales., Methods: Median survival and CSRs for 8 variables (age, sex, morphology, World Health Organization [WHO] grade, tumor site, SES, geographic regions, and periods of diagnosis) are calculated using the Kaplan-Meier method. Distributions among different variables are compared using chi(2) test. Cox regressions are performed for estimating HRs to death., Results: The median survival and the 1-, 5-, and 10-year CSR in this population are 0.42 years, 29.1%, 12.0%, and 7.7%, respectively. There is a gradient in SES from the south to the north (chi(2) test, P < .001) and a gradual increment in higher SES from the early to the recent period (chi(2) test, P < .001). Mono- and multivariate analyses reveal that all the 8 variables influenced the survival (P < .05). Age (HR, 1.04 per year from 15 years, P < .001), WHO grade (1.21 per grade from grade I, P < .001), and morphology (HR from 1.23 to 1.89, compared with ependymoma, P < .05) are the most influential factors. However, there are also independent effects from SES (HR, 1.03 per quintile of deprivation, P < .001) and geographic regions (HR, 1.10 for outside southern England; P < .001) on the survival., Conclusions: Although age and tumor characteristics (morphology, WHO grade, tumor site) are well-known prognostic factors, SES and geographic variations also play a slight but significant role, and for more cost-effective allocation of health resources, alleviation on these 2 modifiable factors should be considered.

Background: With the introduction of CT, stereotactic techniques, and broad-spectrum antibiotics, the outcome for brain abscess has dramatically improved. The purpose of this study was to identify prognostic factors by reviewing data on 142 patients with brain abscess., Methods: Clinical data, including age, sex, medical history, duration of symptoms, initial neurological status, associated predisposing factors, laboratory data, treatment, and abscess characteristics, were considered as potential prognostic factors. A comparison was made between patients with favorable (GOS: moderate disability or good recovery) and those with unfavorable (GOS: death, persistent vegetative status, or severe disability) outcomes at discharge. Univariate (chi(2) analysis or Fisher's exact test) and multivariate logistic regression analyses were used to identify prognostic factors. Data were considered significant when the 2-tailed P value was lower than .05., Results: There were 98 male and 44 female patients (male/female ratio, 2.2). Their average age at diagnosis was 41.5 years (range, 2-84 years). There were 105 patients with a favorable outcome and 37 with an unfavorable outcome. Both univariate and multivariate analyses indicated that patients who were male, had an initial GCS score >12, had no other septic complication, or had Gram-positive cocci grown in abscess cultures had better outcomes. No association was found between outcome and other factors, including age, focal neurological deficits, seizures, laboratory findings, characteristics of the abscesses, associated factors, and treatment modalities., Conclusions: With the advancement of imaging studies and broad-spectrum antibiotic therapies, the outcome of brain abscess depends on prompt awareness of the diagnosis and effective infection control.

Primary spinal gliomas are rare. Most clinical studies are based on single centers with small numbers of patients and limited length of follow-up. Because data from the Cancer Registry cover larger numbers of patients and longer durations of follow-up, our objective was to define prognostic factors that might predict the survival at a national population level. From 1971 to 1995, data of 81 children (age < 15 years) with primary spinal gliomas from the Cancer Registry of England and Wales were analyzed. Median survival and crude survival rates in respect of 7 variables (age, sex, morphology, WHO grade, socioeconomic status, geographical region, and period of diagnosis) were calculated using the Kaplan-Meier method. The Cox regression was performed for estimating hazard ratios (HR) for death. Results showed that the 1-, 5-, and 10-year crude survival rates for this population were 72.84, 60.49, and 58.0%, respectively. Both univariate and multivariate analyses revealed that only morphology (HR 2.79 for nonependymoma, p = 0.05) and WHO grade (HR 6.74 for high grade, p = 0.01) were significant prognostic factors. Results from this population-based study are very helpful for comparison with other population-based studies and for public health purposes., (Copyright 2006 S. Karger AG, Basel.)

Primary malignant brain tumor is the second most common cancer in children. To investigate factors affecting children's survival at a population level, data of 3,169 patients (age<15 years) from the Cancer Registry in England and Wales were used. They were diagnosed during 1971-1990 and followed up until 1995. Variables including age, gender, morphology, WHO grade, tumor site, socioeconomic status, geographical region, and period of diagnosis were available for analysis using the Kaplan-Meier method and the Cox hazards ratio (HR) regression. Results showed that the median survival and the 1-, 5-, and 10-year crude survival rate for this population were 8.7 years, 72.4, 54.0, and 49.2% respectively. Survival was influenced by age (HR 0.88/5 years), morphology (ependymoma HR 2.43), WHO grades (HR 1.42/grade), tumor sites (brain stem HR 2.11), and periods of diagnosis (HR 0.88/5 years). Gender, socioeconomic status, and geographical region did not affect their survival. Results from this population-based data are very helpful for comparison with other hospital-based studies and for public health purposes., (Copyright (c) 2006 S. Karger AG, Basel.)

Background and Purpose: Statins may improve cerebral vasomotor reactivity through cholesterol-dependent and -independent mechanisms. A phase II randomized controlled trial was conducted to examine the hypothesis that acute pravastatin treatment could improve cerebrovascular autoregulation and reduce vasospasm-related complications after aneurysmal subarachnoid hemorrhage (SAH)., Methods: A total of 80 aneurysmal SAH (aSAH) patients (18 to 84 years of age) within 72 hours from the ictus were randomized equally to receive either oral pravastatin (40 mg) or placebo daily for up to 14 days. Primary end points were the incidence, duration, and severity of cerebral vasospasm, and duration of impaired autoregulation estimated from transcranial Doppler ultrasonography. Secondary end points were the incidence of vasospasm-related delayed ischemic deficits (DIDs) and disability at discharge., Results: Prerandomization characteristics were balanced between the 2 groups. No treatment-related complication was observed. The incidences of vasospasm and severe vasospasm were reduced by 32% (P=0.006) and 42% (P=0.044), respectively, and the duration of severe vasospasm was shortened by 0.8 days (P=0.068) in the pravastatin group. These measurements were maximal on the ipsilateral side of ruptured aneurysms. The duration of impaired autoregulation was shortened bilaterally (P< or =0.01), and the incidence of vasospasm-related DIDs and mortality were decreased by 83% (P<0.001) and 75% (P=0.037), respectively, in the pravastatin group., Conclusions: Acute treatment with pravastatin after aSAH is safe and ameliorates cerebral vasospasm, improves cerebral autoregulation, and reduces vasospasm-related DID. Unfavorable outcome at discharge was reduced primarily because of a reduction in overall mortality. This is the first demonstration of clinical benefits with immediate statin therapy for an acute cerebrovascular disorder.

Background: Over the past 2 decades, the diagnosis and treatment of brain abscess have been facilitated by a number of technological advancements, which have resulted in a significant improvement of outcome. The aim of this manuscript is to review our experience, to determine the factors related to the outcome, and to improve the therapeutic strategy for this disease., Methods: From 1986 to 2002, 178 consecutive patients with bacterial brain abscess were treated at the National Taiwan University Hospital, Taipei, Taiwan. We reviewed their clinical presentation, bacteriology, treatment, and outcome retrospectively. Groups were compared by chi2 test, Fisher exact test, or t test as appropriate. Multivariate logistic regression with backward selection was used to select the set of covariates that were independently associated with outcome., Results: One hundred eleven patients (62%) had favorable outcome, 14 patients (8%) had severe disability, 9 patients (5%) became vegetative, and 44 (25%) died during hospitalization. Patients with better Glasgow Coma Scale (GCS) on admission, no underlying disease, positive culture, or surgical treatment were more likely to have a good outcome. Patients with nasopharyngeal carcinoma, acquired immunodeficiency syndrome, hematologic disease, deep-seated abscess, or medical treatment alone were more likely to have a poor outcome. Multivariate analysis revealed that only GCS, immunodeficiency, and presence of underlying disease related with outcome., Conclusions: The poor prognostic factors of brain abscess are poor GCS, immunodeficiency, and presence of underlying disease. Aggressive treatment with surgery when indicated and careful management of specimen for culture might improve outcome.

Background and Purpose: To investigate factors influencing survival for adult glioma at the national population level, data from the Cancer Registry in England and Wales were analyzed. Glioma was diagnosed in 32,267 patients during 1971-1990 and follow-up data were available for these patients until 1995., Methods: Median survival and crude survival rates (CSR) for 8 variables (age, gender, International Classification of Diseases for Oncology [ICD-O] morphology, World Health Organization [WHO] grade, tumor site, deprivation, geographical region, and period of diagnosis) were calculated and tested using the Kaplan-Meier method and the log-rank test. Relative survival rates (RSR) were calculated using the life table of 1981. Cox multivariate regression was performed for estimating hazards ratios (HR) and tested using the log likelihood ratio test., Results: The median survival and the 1-, 5-, and 10-year CSR for this population were 0.42 years, 29.1%, 12.0%, and 7.7%, respectively. The 1- and 5-year RSR were 29.6% and 12.3%, respectively. Survival was influenced by all 8 variables tested (p

Following aneurysmal subarachnoid haemorrhage (SAH), cerebral blood flow (CBF) may be reduced, resulting in poor outcome due to cerebral ischaemia and subsequent stroke. Hypertonic saline (HS) is known to be effective in reducing intracranial pressure (ICP). We have previously shown a 20-50% increase in CBF in ischaemic regions after intravenous infusion of HS. This study aims to determine the effect of HS on CBF augmentation, substrate delivery and metabolism. Continuous monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), brain tissue oxygen (PbO2), middle cerebral artery flow velocity (FV), and microdialysis was performed in 14 poor grade SAH patients. Patients were given an infusion of 23.5% HS, and quantified xenon computerised tomography scanning (XeCT) was carried out before and after the infusion in 9 patients. The results showed a significant increase in ABP, CPP, FV and PbO2, and a significant decrease in ICP (p < 0.05). Nine patients showed a decrease in lactate-pyruvate ratio at 60 minutes following HS infusion. These results show that HS safely and effectively augments CBF in patients with poor grade SAH and significantly improves cerebral oxygenation. An improvement in cerebral metabolic status in terms of lactate-pyruvate ratio is also associated with HS infusion.

In order to obtain particulate methane monooxygenase (pMMO)-enriched membranes from Methylococcus capsulatus (Bath) with high activity and in high yields, we devised a method to process cell growth in a fermentor adapted with a hollow-fiber bioreactor that allows easy control and quantitative adjustment of the copper ion concentration in NMS medium over the time course of cell culture. This technical improvement in the method for culturing bacterial cells allowed us to study the effects of copper ion concentration in the growth medium on the copper content in the membranes, as well as the specific activity of the enzyme. The optimal copper concentration in the growth medium was found to be 30 to 35 micro M. Under these conditions, the pMMO is highly expressed, accounting for 80% of the total cytoplasmic membrane proteins and having a specific activity as high as 88.9 nmol of propylene oxide/min/mg of protein with NADH as the reductant. The copper stoichiometry is approximately 13 atoms per pMMO molecule. Analysis of other metal contents provided no evidence of zinc, and only traces of iron were present in the pMMO-enriched membranes. Further purification by membrane solubilization in dodecyl beta-D-maltoside followed by fractionation of the protein-detergent complexes according to molecular size by gel filtration chromatography resulted in a good yield of the pMMO-detergent complex and a high level of homogeneity. The pMMO-detergent complex isolated in this way had a molecular mass of 220 kDa and consisted of an alphabetagamma protein monomer encapsulated in a micelle consisting of ca. 240 detergent molecules. The enzyme is a copper protein containing 13.6 mol of copper/mol of pMMO and essentially no iron (ratio of copper to iron, 80:1). Both the detergent-solubilized membranes and the purified pMMO-detergent complex exhibited reasonable, if not excellent, specific activity. Finally, our ability to control the level of expression of the pMMO allowed us to clarify the sensitivity of the enzyme to NADH and duroquinol, the two common reductants used to assay the enzyme.

Background and Purpose: The goal of this study was to examine the effects of hypertonic saline on cerebral blood flow (CBF) in poor-grade patients with subarachnoid hemorrhage., Methods: We administered 23.5% hypertonic saline (2 mL/kg IV) 1 time to 10 patients, 2 times to 7 patients, and 3 times to 1 patient. All patients had transcranial Doppler (TCD), intracranial pressure (ICP) monitoring, and analysis of serum sodium and osmolality; 6 had xenon CT (XeCT). Data were used to characterize the changes in CBF, cerebral vascular resistance (CVR), ICP, cerebral perfusion pressure (CPP), and potential rheological mechanisms of action., Results: In the first treatment episode, CPP increased 26.8% (P=0.0003, at 28.3 minutes) from a rise in mean arterial blood pressure (ABP) of 10.5% (P=0.02, at 22.2 minutes) and a fall in ICP (-74.7%, P=0.002, at 60.0 minutes). Flow velocity (FV) of the middle cerebral artery increased 70.8% (P=0.00005, at 20.0 minutes), resulting in a corresponding fall in estimated CVR (-26.6%, P=0.01, at 16.3 minutes). The half-lives of effects on ABP, CPP, ICP, FV, and estimated CVR were 20.0, 53.6, 139.1, 42.7, and 27.1 minutes, respectively. In the second treatment episode, all these parameters had the same response except estimated CVR, which did not reach statistical significance. XeCT confirmed the increase in CBF (22.9%, P=0.02) without regional differences. A fall in CBF after hypertonic saline was identified in only a single region of interest in a patient in whom baseline flow was low but not infarcted. Serum sodium rose by 11.4 and 8.8 mmol/L, and osmolality rose by 26.7 and 16.3 mosm/L in the first and second treatment episodes, respectively. Hemoglobin decreased by 0.7 and 0.6 g/L and hematocrit decreased by 1.9% and 2.4% in the first and second treatment episodes, respectively., Conclusions: We found that 23.5% hypertonic saline increases CBF in poor-grade patients with subarachnoid hemorrhage. These effects are associated with improved indexes of blood rheology. Potential therapeutic benefits are discussed.

Desmoplastic infantile gangliogliomas (DIGs) are rare tumors during infancy. They often occur as huge cystic tumors in the frontal and parietal lobes, with their solid component being adjacent to the leptomeningeal membrane. This report presents a patient with DIG and intractable epilepsy. Due to hesitation by the patient's family in allowing surgery, this is the first time that the chronological changes in DIG have been observed on imaging studies. During the follow-up, the tumor changed from a pure solid tumor to a cystic one, which is a typical picture of DIG. Surgical pathology confirmed the diagnosis of DIG. However, for a patient with epilepsy, it is recommended that this condition should be treated immediately with surgery., (Copyright 2002 S. Karger AG, Basel)

Palmar hyperhidrosis, probably caused by an over-reactivity of sympathetic nerves passing through the second and the third thoracic sympathetic ganglia (T2 & T3 ganglia), can only be cured by sympathectomy. Such sympathetic denervation may also alter pulmonary function. Previous studies have shown that open sympathectomy can cause significant deterioration in pulmonary function, however, the surgical procedure itself may contribute to the change. Recently thoracoscopic sympathectomy has been developed as a minimally invasive but effective treatment for palmar hyperhidrosis. In order to investigate the effect of sympathectomy, pulmonary function was compared before and four weeks after operation in 20 patients. Forced vital capacity (FVC) (-2.3%), forced expiratory volume in one second (FEV1) (-6.1%), and FEV1/FVC (-4.6%) were all slightly but significantly decreased four weeks after thoracoscopic sympathectomy. Also the instantaneous forced expiratory flow at 75%, 50% and 25% of the FVC (Vmax25, Vmax50, Vmax75) in flow-volume curves were decreased (-1.6%, -8.4%, and -20% respectively). Therefore, thoracoscopic sympathectomy minimises pulmonary restrictive effects but allows subclinical small airway obstructive effects to become more evident.

A right sided endoscopic retroperitoneal lumbar sympathectomy was performed on a 23 year old female who had plantar hyperhidrosis. After the operation, the right foot temperature increased and the plantar hyperhidrosis was relieved. During the follow up period, both feet were warm and dry, although only the right side lumbar sympathectomy had been performed. The outcome appeared to be compatible with that of an open procedure but with minimal invasiveness., (Copyright 2001 Harcourt Publishers Ltd.)

This longitudinal study was designed to explore the discharge needs and needs satisfaction of frail elders' family caregivers during the discharge transition. A total of 131 pairs of frail elders and their family caregivers from neuro-medical wards in a teaching hospital in northern Taiwan were interviewed using a structured questionnaire. Descriptive statistics, paired t-test, and repeated measure ANOVA were used to analyze the data. The results showed that: (1) The total needs and specific needs were higher before discharge than one week and one month after discharge. The rank order of the discharge needs, from high to low, was health care information services, health care services, emotional support services, and manpower support services. (2) The needs satisfaction at one week after discharge was the same as at one month after discharge. The rank order of needs satisfaction, from high to low, was health care services, health care information services, manpower support services, and emotional support services. The findings of this study suggest that during the discharge transition before discharge is the time of most needs and is an important time for developing nursing interventions. The "caregiver discharge needs and satisfaction assessment tool" can be used in clinical for practice assessment of the discharge needs and needs satisfaction of frail elders' family caregivers during the dis-charge transition.

Potential injury to the neurovascular structures within the cavernous sinus often prohibits aggressive removal of tumours involving it, however, fully understanding the anatomy and selecting an appropriate surgical approach can often resolve this problem with acceptable morbidity. Moreover, a tumour may originate from different anatomical structures of the cavernous sinus which will influence the difficulty and outcome of the surgery. In general, tumours in this region can be classified as intradural, intracavernous and invasive types. The strategy of surgical treatment varies among these different anatomical types. Therefore, preoperative evaluation of tumours in the cavernous sinus is critical for the selection of an appropriate microsurgical approach. During the past 5 years, 12 tumours involving the cavernous sinus have been operated upon which included four neuromas, three meningiomas, three cavernous haemangiomas, one plasmacytoma and one chondroma. Nine of these twelve tumours were totally resected after one or two operations. There was no surgical mortality and the most common morbidity was transient cranial nerve palsy. At 2 months after surgery there was no additional postoperative cranial nerve deficit in all the patients; however, one patient developed a postoperative middle cerebral artery infarct due to accidental injury to the internal carotid artery during surgery. The respectability of the tumour mostly depends on its consistency and the involvement of the adjacent anatomy. The pathoanatomical features of the tumours and the clinicoradiological findings, as well as the selection of the microsurgical approach, are discussed., (Copyright 2000 Harcourt Publishers Ltd.)

Cerebral amyloid angiopathy frequently causes recurrent intracerebral hemorrhages in elderly patients who do not have systemic hypertension. Surgery should be reserved for conditions which cannot be controlled by medical treatment. When surgery is needed, potential complications (such as bleeding near the operation site or remote area) should be kept in mind. A case study of a 66-year-old woman with cerebral amyloid angiopathy and recurrent intracerebral hemorrhages is presented.

Intracranial leptomeningeal tuberculoma without evidence of systemic tuberculosis is rarely encountered and is often difficult to diagnose because there are no specific signs or symptoms. A 49-year-old woman, without any past history of tuberculosis, presented with weakness and focal seizures in the right hand. Cranial magnetic resonance imaging revealed a leptomeningeal lesion in the left frontoparietal region. All conventional examinations demonstrated no evidence of tuberculous infection. The patient underwent biopsy, and histopathologic examination showed caseating granulomas compatible with tuberculomas. The culture of the surgical specimen grew Mycobacterium tuberculosis 4 weeks later. The patient was then actively treated with antituberculous agents for 1 year. Subsequent clinical features and image studies showed the intracranial lesion in resolution. The findings of this case argue in favor of surgical biopsy when intracranial tuberculosis is clinically suspected, even without evidence of systemic tuberculous infection.

Eleven patients with primary central nervous system lymphoma (PCNSL) proven with biopsy between January 1991 and September 1995 were analysed according to the location of lesions, pathological studies, treatment and outcome. The ages of these patients ranged from 25 to 74 years with an average of 51.4 years. The male to female sex ratio was 6 to 5. The most frequent sites of lesions were frontal lobes. One patient had only leptomeningeal involvement. All intracranial PCNSL in this report arose from B cells; the leptomeningeal PCNSL case was the only one which arose from T cells. All patients received chemotherapy with or without radiotherapy, except two patients who did not receive any treatment. The results of treatment were generally poor. The survival time of patients who died ranged from 2.5 months to 45 months with a median of about 12.5 months. If a combined treatment is to be considered, the possibility of complications such as leucoencephalopathy should be taken in account.

Site-specific cleavage of mRNA has been identified in vivo for the polycistronic colicin E7 operon (ColE7), which occurs between G and A nucleotides located at the Asp52 codon (GAT) of the immunity gene (ceiE7). In vitro, this specific cleavage occurs only in the presence of the ceiE7 gene product (ImmE7). The crystal structure of dimeric ImmE7 has been determined at 1.8 A resolution by X-ray crystallographic analysis. We found that several residues located at the interface of dimeric ImmE7 bear surprising resemblance to the active sites of some RNases. These results suggest that dimeric ImmE7 may possess a novel RNase activity that cleaves its own mRNA at a specific site and thus autoregulates translational expression of the downstream celE7 gene as well as degradation of the upstream ceaE7 mRNA.

Using PCR with a set of specific oligonucleotide primers to detect cryI-type genes, we were able to screen the cry-type genes of 225 Bacillus thuringiensis soil isolates from Taiwan without much cost in time or labor. Some combinations of cry genes (the cry-type profile) in a single isolate were unique. We identified five distinct profiles of crystal genes from the B. thuringiensis soil isolates from Taiwan. The cry genes included cryIA(a), cryIA(b), cryIA(c), cryIC, cryID, and cryIV. Interestingly, 501 B. thuringiensis isolates (93.5% of the total number that we identified) were isolated from areas at high altitudes. The profiles of cry-type genes were distinct in all isolation areas. The distribution of cry-type genes of our isolates therefore depended on geography. Using PCR footprinting to detect cryIC-type genes, we identified two distinct cryIC footprints from some of our isolates, indicating that these isolates may contain novel cryIC-type genes. B. thuringiensis isolates containing cryIA(a)-, cryIA(b)-, and cryIA(c)-type genes exhibited much greater activity against Plutella xylostella than did other isolates, indicating that multiple cry-type genes may be used as markers for the prediction of insecticidal activities.

The expression of an insecticidal crystal protein gene of Bacillus thuringiensis under the control of the alpha-amylase gene promoter was investigated. The cryIC gene, which encodes a protein known to have a unique activity against Spodoptera (armyworm) species, was used in this investigation. The cryIC gene was placed, along with the alpha-amylase promoter from B. subtilis, in a B. thuringiensis-derived cloning vector, generating a pair of recombinant plasmids, pSB744 and pSB745. The cloning vector that contains the minimal replicon of B. thuringiensis subsp. kurstaki HD73 is stably maintained in a variety of B. thuringiensis strains, as previously reported by Gamel and Piot (Gene 120:17-26, 1992). The present study confirmed that the recombinant plasmids are also stably maintained in B. thuringiensis subsp. kurstaki Cry-B and HD73 growing in media without selection pressure for at least 48 h. The cryIC gene on the recombinant plasmids were notably expressed at high levels in both recombinant strains. Expression of the introduced cryIC gene on the recombinant plasmid in B. thuringiensis subsp. kurstaki HD73 did not impair expression of the resident cryIA(c) gene. The CryIA(c) protein is known to have a high level of activity against loopers such as Trichoplusia ni (the cabbage looper). As a result of coexpression of the introduced cryIC gene and the resident cryIA(c) gene, recombinant strain HD73 acquired an additional insecticidal activity against Spodoptera exigua (the beet armyworm) whereas the original activity level against T. ni was maintained.