Using a 3D Navigation Template to Increase the Accuracy of Thoracic Pedicle Screws in Patients with Scoliosis.

This study compares the accuracy and safety of pedicle screw placement using a 3D navigation template with the free-hand fluoroscopy technique in scoliotic patients. Fifteen scoliotic patients were recruited and divided into a template group (eight cases) and a free-hand group (seven cases). All patients received posterior corrective surgeries, and the pedicle screw was placed using a 3D navigation template or a free-hand technique. After surgery, the positions of the pedicle screws were evaluated using CT. A total of 264 pedicle screws were implanted in 15 patients. Both the two techniques were found to achieve satisfactory safety of screw insertion in scoliotic patients (89.9% vs. 90.5%). In the thoracic region, the 3D navigation template was able to achieve a much higher accuracy of screw than the free-hand technique (75.3% vs. 60.4%). In the two groups, the accuracy rates on the convex side were slightly higher than on the concave side, while no significance was seen. In terms of rotational vertebrae, no significant differences were seen in Grades I or II vertebrae between the two groups. In conclusion, the 3D navigation template technique significantly increased the accuracy of thoracic pedicle screw placement, which held great potential for extensively clinical application.

Treatment strategies for traumatic cervico-cranial pseudoaneurysms: A single institution experience.

AIM: Limited clinical and angiographic data exists for patients with traumatic cervico-cerebral pseudoaneurysms. In this paper, we present our limited experience with various management strategies for traumatic cervico-cranial pseudoaneurysms. MATERIALS AND METHODS: We retrospectively analyzed 37 consecutive cases of traumatic pseudoaneurysms involving the cervico-cranial or the cerebral arteries diagnosed at our center from September 2009 to December 2014. The demographic data, etiology, clinical presentation, lesion location, treatment modality, and follow-up outcomes of these patients were reviewed. Among these 37 patients, 5 patients were treated by surgery, while 29 patients were treated by the endovascular approach and 3 received conservative treatment. RESULTS: During the study period, 42 pseudoaneurysms were identified in 37 patients with a history of head or neck injury. Five patients underwent surgical exploration of the lesion with an uneventful postoperative course. Twenty-nine patients were treated by endovascular interventions with various embolization materials including coils, stents, detachable balloons, liquid embolic agents, and a combination of these agents. The angiographic follow-up imaging demonstrated complete exclusion of the aneurysm from the circulation with the patient being free from any additional neurological deficits. CONCLUSION: Proper selection of an appropriate approach is essential to address the management of traumatic cervico-cerebral pseudoaneurysms. The treatment of traumatic cervico-cerebral pseudoaneurysms should be selected according to the location and the clinical features of the pseudoaneurysms. The endovascular treatment is a safe and effective modality and should be the first-line choice for treatment of traumatic pseudoaneurysms.

Spontaneous arteriovenous fistula of the superficial temporal artery: Diagnosis and treatment.

OBJECTIVES: Despite the increasing reports of traumatic and iatrogenic arteriovenous fistulas (AVFs) of the superficial temporal artery (STA), the spontaneous origination of fistulas is extremely rare, and very little is known about their natural development. Spontaneous AVFs of the STA have the characteristic findings of an expanding, painless pulsatile mass and a palpable thrill with or without a vascular murmur. PATIENTS AND METHODS: This article describes five patients with AVFs of the STA with no history of a head injury. Four of them were treated successfully either by surgical resection or by endovascular embolization. These five illustrative cases with their medium-term follow-up results are reported. RESULTS: In two patients, we successfully used a single-balloon alone to occlude the fistula without any complications; the patients experienced no recurrences during the clinical follow-up. In the other two patients, we carefully identified and ligated all of the involved feeding arteries and draining veins, which was followed by an excision of the lesion. At the 6-month follow-up, the patients were doing very well, with no evidence of AVF recurrences or new neurological complaints. CONCLUSIONS: AVFs of the STA can be detected via a computed tomography angiogram (CTA) or by intra-arterial angiography alone. Intra-arterial angiography, however, remains the definitive type of investigation. AVF may be treated either by surgical ligation and excision under a local or general anesthetic or by endovascular embolization. The former modality has been the most common method of treating the lesion in the vast majority of reports. However, endovascular embolization also appears to be suitable for treating this condition.

Therapeutic targeting of EGFR in malignant gliomas.

IMPORTANCE OF THE FIELD: Despite the improved prognosis for many cancer patients, the survival of those with malignant gliomas (MGs) remains dismal. Even with aggressive intervention, including surgery, chemotherapy and radiotherapy, the overall 2-year survival rate is only 25% in the most optimistic series, and 5-year survival rates are consistently in the low single digits. Therefore, it is evident that novel therapeutic paradigms are necessary to overcome the inherent limitations of conventional treatments. EGFR gene overexpression can be found in 40 - 50% of patients with MGs, whereas its expression is very low in normal brain. Therapeutic targeting of EGFR has indicated clinical success in the treatment of MGs. AREAS COVERED IN THIS REVIEW: The purpose of this review is to discuss the current status of several EGFR-targeted therapies in MGs patients and address the efficacy of these drugs as monotherapy or in combination with other drugs and/or treatments. We also emphasize the lessons learned and the future perspectives in the development of EGFR-targeted therapies for MGs. WHAT THE READER WILL GAIN: A more comprehensive understanding of the molecular, structural and biological characteristics of EGFR and the mechanisms of action of EGFR-targeted antagonists will most likely contribute to the successful use of strategies of EGFR-targeted therapy in the clinic. TAKE HOME MESSAGE: Therapeutic targeting of EGFR include anti-EGFR mAbs, small-molecule EGFR tyrosine kinase inhibitors, peptide vaccination therapy and other therapeutic strategies. Each EGFR antagonist has its own advantages and limitations in terms of BBB crossing, ease of delivery, combination therapies and potential toxicity. Therefore, a multiple approach combining different agents that target EGFR signaling at multiple levels seems to have potential as future therapeutics for MGs, once the technical and safety issues unique to each of the approaches are overcome.

Effect of RNAi-mediated LRIG3 gene silencing on proliferation of glioma GL15 cells and expression of PCNA and Ki-67.

BACKGROUND AND OBJECTIVE: Leucine-rich repeats and immunoglobin-like domains 3 (LRIG3), a member of LRIG gene family, is down-regulated in various human cancers, but its functions are still unclear. This study was to explore the effect of RNA interference (RNAi)-mediated LRIG3 gene silencing on the proliferation of glioma GL15 cells and the expression of proliferating cell nuclear antigen (PCNA) and Ki-67, and investigate possible mechanisms. METHODS: The plasmids pGenesil2-LRIG3-shRNA1 and pGenesil2-LRIG3-shRNA2 which containing U6 promoter and LRIG3-specific short hairpin RNA (shRNA) and the plasmid pGenesil2-negative-shRNA containing unspecific shRNA were transfected into GL15 cells. Stable cell clones were selected by G418. The mRNA and protein levels of LRIG3 were measured by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. Cell proliferation was detected by MTT assay. The expression of PCNA and Ki-67 in GL15 cells were examined by SABC immunohistochemistry. RESULTS: Compared with those in control cells, the mRNA levels of LRIG3 transcripts were reduced by 52.4% and 63.8% in shRNA1- and shRNA2-transfected cells, respectively; its protein levels were reduced by 50.9% and 67.4%, respectively. Cell proliferation was enhanced by LRIG3 shRNA transfection. The positive rate of PCNA was significantly higher in shRNA1- and shRNA2-transfected cells than in control cells [(72.13 +/- 5.64)% and (81.93 +/- 5.23)% vs. (35.40 +/- 5.69)%, p < 0.01]. The positive rate of Ki-67 was also significantly higher in shRNA1- and shRNA2-transfected cells than in control cells [(82.27 +/- 5.50)% and (88.67 +/- 3.52)% vs. (49.73 +/- 5.73)%, p < 0.01]. PCNA expression was positively correlated to Ki-67 expression (r =0.932, p < 0.001). CONCLUSION: Down-regulating LRIG3 gene expression can improve the proliferation of glioma GL15 cells.