Most meningiomas are benign and the indications for surgery are determined by size and symptoms, but some are malignant and have a high recurrence rate. Currently, no preoperative prognostic factors have been established. The purpose of this study was to investigate whether Tumor doubling time (Td) is useful in predicting tumor prognosis. MethodsPatients who underwent surgery for newly diagnosed meningioma at our hospital between 2007 and 2021 with preoperative magnetic resonance (MR) imaging evaluation over a period of six months were included in this study. We calculated the Td from the preoperative MR images and examined the correlation between Td and WHO grade, MIB-1 SI and other conditions. ResultsA total of 269 newly diagnosed meningiomas were operated in the period, of which 62 met inclusion criteria. The median Td was 1082 days (54-8579 days) and MIB-1 SI was 2.45% (0.7-14.6%). Td and MIB-1 SI had a negative correlation (r=-0.319, p = 0.0122). MIB-1 SI was higher in patients with Td < 3 years than in patients with Td > = 3 (p = 0.005), and the incidence of high WHO grade (grade2) was higher in patients with Td < 1 year than in patients with Td > = 1 (p = 0.014). ConclusionsMeningiomas with Td of less than 3 years had signi cantly higher MIB-1 SI, and tumors with Td of less than 1 year had higher likelihood of malignancy. Therefore, early treatment should be considered for the patients with short Td meningioma even if asymptomatic and further consideration could be given to radical resection at the time of surgery.

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To examine the effectiveness of a newly developed emergency room (ER) protocol to treat patients with stroke and control the spread of SARS-CoV-2 by evaluating the door-to-picture time.Methods: We retrospectively enrolled 126 patients who were transported to our ER by ambulance with suspected stroke between April 15 and October 31, 2020 (study group). A risk judgment system named the COVID level was introduced to classify the risk of infection as follows: level 0, no infection; I, infection unlikely; II, possible; III, probable; and IV, definite. Patients with COVID levels 0, I, or II and a Glasgow Coma Scale (GCS) score >10 were placed in a normal ER (nER) without atmospheric pressure control; the medical staff wore standard personal protective equipment (PPE) in such cases. Patients with COVID level II, III, or IV, and a GCS score of ≤10 were assigned to the negative pressure ER (NPER); the medical staff wore enhanced PPE for these cases. The validity of the protocol was assessed. The door-to-picture time of the study group was compared with that of 114 control patients who were transported with suspected stroke during the same period in 2019 (control group). The difference in the time for CT and MRI between the two groups was also compared. In the study group, the time spent in the nER and NPER was evaluated.Results: In all, 118 patients (93.7%) were classified as level I, 6 (4.8%) as level II, and 2 (1.6%) as level III. Only five patients (4.0%) were treated with NPER. Polymerase chain reaction tests were performed on 118 out of 126 patients (93.7%) and were negative. No significant differences were observed in age, sex, neurological severity, modalities of diagnostic imaging, and diagnosis compared with the control group. The median door-to-picture time was 18 (11-27.8) min in the study group and 15 (10-25) min in the control group (p = 0.08). No delay was found on vs. 14 [9-21] min, p = 0.24). In contrast, there was an 8-min delay for MRI (30 [21.8-50] vs. 22 [14-30] min, p = 0.01). The median door-to-picture time was 29 min longer in patients treated with NPER than in those treated with nER, although the difference was not significant due to the small number of patients (47 [27-57] vs. 18 [11-26] min, p = 0.07). Conclusion:Our protocol could optimize the use of medical resources with only a 3-min delay in the door-to-picture time in an area without explosive outbreak. Unfortunately, the effectiveness of the protocol in preventing infection could not be verified because of the low incidence of COVID-19. When developing and modifying an institutional protocol, recognizing the outbreak status surrounding each institution is important.

Objective Most meningiomas are benign and the indications for surgery are determined by size and symptoms, but some are malignant and have a high recurrence rate. Currently, no preoperative prognostic factors have been established. The purpose of this study was to investigate whether Tumor doubling time (Td) is useful in predicting tumor prognosis. Methods Patients who underwent surgery for newly diagnosed meningioma at our hospital between 2007 and 2021 with preoperative magnetic resonance (MR) imaging evaluation over a period of six months were included in this study. We calculated the Td from the preoperative MR images and examined the correlation between Td and WHO grade, MIB-1 SI and other conditions. Results A total of 269 newly diagnosed meningiomas were operated in the period, of which 62 met inclusion criteria. The median Td was 1082 days (54-8579 days) and MIB-1 SI was 2.45% (0.7–14.6%). Td and MIB-1 SI had a negative correlation (r=-0.319, p = 0.0122). MIB-1 SI was higher in patients with Td < 3 years than in patients with Td > = 3 (p = 0.005), and the incidence of high WHO grade (grade2) was higher in patients with Td < 1 year than in patients with Td > = 1 (p = 0.014). Conclusions Meningiomas with Td of less than 3 years had significantly higher MIB-1 SI, and tumors with Td of less than 1 year had higher likelihood of malignancy. Therefore, early treatment should be considered for the patients with short Td meningioma even if asymptomatic and further consideration could be given to radical resection at the time of surgery.