Enhancing Visualization of the Foramen Ovale in Percutaneous Microcompression: A Preoperative Image Simulation Technique.

OBJECTIVE: Introducing a preoperative image simulation technique to streamline the visualization of the foramen ovale in percutaneous microcompression. METHODS: Twenty-five trigeminal neuralgia patients were included in the study. Preoperative cranial CT scans were processed with 3D Slicer software to create simulated fluoroscopic skulls. The angulations required for precise visualization of the foramen ovale were established via simulated anteroposterior imaging. These simulations informed the C-arm's angulations for foramen ovale targeting during surgery. RESULTS: The preoperative simulations accurately forecasted skull rotation angulations, aligning closely with intraoperative observations with negligible discrepancies (0-2 degrees). In 17 patients, the foramen ovale was distinctly visible, while in 8 patients, it was partially obscured yet discernible using the simulated angles. Non-visible of the foramen ovale did not occur. Postoperative pain relief and complications were recorded. CONCLUSION: Based on our initial findings, the application of preoperative image simulation shows significant referential value in achieving accurate visualization of the foramen ovale in percutaneous microcompression for trigeminal neuralgia.

Predicting balloon shape in percutaneous microcompression : an observational comparative analysis of Meckel's cave imaging and balloon morphology.

Achieving a pear-shaped balloon holds pivotal significance in the context of successful percutaneous microcompression procedures for trigeminal neuralgia. However, inflated balloons may assume various configurations, whether it is inserted into Meckel's cave or not. The absence of an objective evaluation metric has become apparent. To investigate the relationship between the morphology of Meckel's Cave and the balloon used in percutaneous microcompression for trigeminal neuralgia and establish objective criteria for assessing balloon shape in percutaneous microcompression procedures. This retrospective study included 58 consecutive patients with primary trigeminal neuralgia. Data included demographic, clinical outcomes, and morphological features of Meckel's cave and the balloon obtained from MRI and Dyna-CT imaging. MRI of Meckel's cave and Dyna-CT of intraoperative balloon were modeled, and the morphological characteristics and correlation were analyzed. The reconstructed balloon presented a fuller morphology expanding outward and upward on the basis of Meckel's cave. The projected area of balloon was strongly positively correlated with the projected area of Meckel's cave. The Pearson correlation coefficients were 0.812 (P<0.001) for axial view, 0.898 (P<0.001) for sagittal view and 0.813 (P<0.001) for coronal view. Similarity analysis showed that the sagittal projection image of Meckel's cave and that of the balloon had good similarity. This study reveals that the balloon in percutaneous microcompression essentially represents an expanded morphology of Meckel's cave, extending outward and upward. There is a strong positive correlation between the volume and projected area of the balloon and that of Meckel's cave. Notably, the sagittal projection image of Meckel's cave serves as a reliable predictor of the intraoperative balloon shape. This method has a certain generalizability and can help providing objective criteria for judging balloon shape during percutaneous microcompression procedures.

Efficacy and safety of Dyna CT-assisted percutaneous balloon compression in the treatment of tumor-related trigeminal neuralgia: A single-center retrospective analysis.

BACKGROUND: Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia (TN). Patients with tumor-related TN are typically treated by tumor resection. However, when craniotomy is not feasible, PBC may serve as a simple and effective method for pain relief. Currently, there is limited literature on the use of this technique in treating patients with tumor-related TN. In this study, we aim to evaluate the efficacy and safety of Dyna CT-assisted PBC in the treatment of tumor-related TN. METHODS: From January 2018 to December 2023, a total of 19 patients with tumor-related TN underwent Dyna CT-assisted PBC at our institution. The modified Barrow Neurological Institute Pain Intensity Grading Scale and sensory reduction scores were employed to assess treatment outcomes. A retrospective analysis was conducted on the clinical characteristics, surgical efficacy, postoperative complications, and follow-up results of all patients. RESULTS: Immediate and complete pain relief was observed in 18 patients following PBC, with one patient experiencing delayed recovery. Follow-up periods ranged from 4 to 62 months, revealing only 4 patients with pain recurrence at the last follow-up, and tumor-related TN patients with involvement of Meckel's cave were more prone to recurrence. No severe complications occurred throughout the follow-up period. Although facial numbness was reported in all 15 patients, jaw weakness in 8 patients, and postoperative headache in 7 patients, these symptoms resolved within a short period. There were no statistically significant differences in postoperative facial numbness and jaw weakness between tumor-related TN patients with or without Meckel's cave involvement. However, patients with Meckel's cave involvement were more likely to experience postoperative headaches. Patient satisfaction scores indicated a significant improvement in postoperative quality of life. CONCLUSION: For patients with tumor-related TN, when craniotomy is not feasible, Dyna CT-assisted PBC proves to be a safe and effective alternative treatment. Additionally, we observed varying postoperative clinical outcomes based on the different sites of tumor compression on the trigeminal nerve. Patients with tumor-related TN not involving Meckel's cave exhibited more enduring clinical efficacy compared to those with Meckel's cave involvement.

Efficacy and safety of percutaneous balloon compression for bilateral trigeminal neuralgia: a retrospective study.

BACKGROUND: Percutaneous balloon compression (PBC) of the Gasserian ganglion is steadily gaining traction within the trigeminal neuralgia (TN) community. Bilateral trigeminal neuralgia (BTN) is a rare condition, and its treatment remains challenging. As far as we know, there are currently no research reports on the treatment outcomes of PBC for BTN.The purpose of this study is to meticulously evaluate the efficacy and safety of PBC for BTN in our medical institution. METHODS: In this retrospective study, we collected and analyzed the medical records of all patients with BTN who underwent the PBC procedure at the Department of Neurosurgery at Hebei General Hospital from July 2017 to July 2023. After undergoing PBC therapy, all patients were promptly assessed for treatment efficacy based on the modified Barrow Neurological Institute (BNI) pain intensity grading scale. RESULTS: All 37 patients with BTN experienced significant pain relief (BNI I-IIIb) immediately following unilateral PBC treatment. Among these patients, 25 reported relief from pain on the non-operative side, which was effectively managed with medication. Out of the 12 patients who did not experience improvement in contralateral symptoms, 11 received contralateral PBC. Out of the 48 treated sides, 47 sides (97.9%) achieved excellent pain control following a single PBC procedure. The follow-up times ranged from 2 to 62 months. At the 1-year follow-up, 94.6% of the patients maintained excellent therapeutic outcomes.Three recurrent patients underwent repeated unilateral PBC, and all of them maintained excellent pain control postoperatively. At the last follow-up, satisfaction was at 91.7% (measured using the Likert scale), with no severe complications occurring. CONCLUSIONS: The results indicate that PBC is an effective and relatively safe method for treating BTN, offering a valuable option for pain control in these rare cases of TN.

Diagnostic Value of Blink Reflex Combined with Trigeminal Somatosensory Evoked Potential in Trigeminal Neuralgia.

Objective: To explore the diagnostic value of blink reflex combined with trigeminal somatosensory evoked potential (TSEP) in trigeminal neuralgia. Methods: A total of 147 patients with trigeminal neuralgia were enrolled as the research objects between February 2022 and February 2023. After admission, all underwent blink reflex on affected/healthy sides and TSEP examinations. The diagnostic value of the blink reflex combined with TSEP was analyzed. Results: The latency of R1, R2, and R2' waves (refers to the different nerve signal waveforms that are recorded when a facial nerve conduction speed test is performed) on the affected side was significantly longer than that on the healthy side (t = 26.324, 18.391, 20.801,Ps < .001), and latency of W1, W2 and W3 waves was also significantly longer than that on the healthy side (t = 16.045, 10.814, 10.349, P < .001). The results of Pearson correlation analysis showed that the latency of R1, W1, W2, and W3 waves was positively correlated with the VAS score (r = 0.539, 0.611, 0.577, 0.586, P < .001). The results of receiver operating characteristic (ROC) curves analysis showed that area under the curve (AUC) values of R1, R2, R2', W1, W2, and W3 waves latency on the affected side in the diagnosis of trigeminal neuralgia were 0.753, 0.634, 0.651, 0.748, 0.756 and 0.736, respectively. The AUC of combined detection was 0.926, significantly greater than that of the single index (P < .001). Conclusion: Blink reflex combined with TSEP monitoring can improve the diagnostic value of trigeminal neuralgia, and the latency is related to pain.

Performance of Endoscopic Ultrasound-Guided Versus Percutaneous Liver Biopsy in Diagnosing Stage 3-4 Fibrosis.

BACKGROUND: Percutaneous liver biopsy (P-bx) is the gold standard for diagnosing advanced fibrosis. Despite the proven technical feasibility of EUS-guided liver bx (EUS-bx) as a novel alternative way of liver biopsy, the clinical applicability remains to be determined. AIMS: The primary aim of this study is to evaluate if EUS-bx, compared to P-bx, can effectively and safely obtain adequate specimen and accurately predict hepatic fibrosis. METHODS: This is a single center, retrospective chart review among patients with liver diseases at a tertiary endoscopy center from February 2011 to March 2020. We assessed the EUS-bx versus P-bx outcomes by success rate, performance, and safety profile. The primary outcome was the association between EUS-bx clinical variables and the presence of histologic liver fibrosis stage ≥ 3. The secondary outcomes were the associations between EUS-bx and variables indicative of fibrosis. RESULTS: Fifty-nine patients underwent EUS-bx; and 59, P-bx. All EUS-bx procedures were successfully completed. All 56/56 (100%) of EUS-bx vs. 50/52 (96.2%) P-bx were considered adequate samples. Tissue lengths were significantly longer in the EUS-bx cohort (p < 0.0001) with a trend towards a greater number of portal tracts. 46/56 (82.1%) cases of EUS-bx vs. 32/52 (61.5%) of P-bx had > 10 portal tracts; 21/56 (37.5%) cases of EUS-bx vs. 14/52 (26.9%) of P-bx had > 15 portal tracts. There were 6 (10.2%) EUS-bx vs. 1 (1.7%) P-bx related complication leading to a phone call (p = 0.061). CONCLUSIONS: EUS-bx can safely performed and accurately predict liver fibrosis stage as the standard P-bx without being influenced by procedure-related factors.

Effective Control of Postoperative Cerebrospinal Fluid Leakage by Modified Microvascular Decompression in Patients with Hemifacial Spasm.

Objective: This study aimed to compare the clinical outcomes of a modified microvascular decompression (MVD) with a traditional MVD in hemifacial spasm. Methods: A tota1 of 120 patients with hemifacial spasm who received a modified MVD (modified MVD group) and 115 patients who received a traditional MVD (traditional MVD group) from January 2013 to March 2021 were retrospectively reviewed. The surgery efficiency rate, surgery time and postoperative complications in both groups were recorded and analyzed. Results: There was no significant difference between the 2 groups regarding surgery: efficiency rate (modified MVD group VS traditional MVD group: 92.50% vs 92.17%, respectively; P = .925). The intracranial surgery time and postoperative complications rate in the modified MVD group were significantly lower than in the traditional MVD group (31.00 ± 1.78 min vs 48.00 ± 1.74 min, respectively; P < .05; 8.33% vs 20.87%; P = .006, respectively). There was no statistical difference between open skull time and close skull time between the 2 groups (modified MVD group vs traditional MVD group: 38.50 ± 1.76 min vs 40.00 ± 1.78 min, respectively; P = .055; 38.50 ± 1.76 min vs 36.00 ± 1.78 min, respectively; P = .086). Conclusion: The modified MVD for hemifacial spasm can achieve satisfactory clinical outcomes and reduce intracranial surgery time and postoperative complications.

The Effect of Trigeminal Ganglion Block on Trigeminocardiac Reflex in Elderly Patients with Trigeminal Neuralgia Undergoing Percutaneous Balloon Compression: A Randomized Controlled Study.

Background: Trigeminal neuralgia (TN) is a facial neuropathic pain, which is defined as unilateral brief shock-like paroxysmal pain. Percutaneous balloon compression (PBC) was widely used to treat TN under general anesthesia. However, trigeminocardiac reflex (TCR) as a brainstem reflex can induce bradycardia or even cardiac arrest during PBC, which may result in catastrophic consequences in elderly patients. The aim of the present study was to investigate the effect of trigeminal ganglion block on TCR in elderly patients with TN during PBC. Materials and Methods: Eighty-two elderly patients undergoing PBC were recruited to this randomized controlled study. The participants were randomly allocated to the control group (C group, n=41) and study group (S group, n=41). After anesthesia induction, 2% lidocaine 0.5 mL or an equal volume of normal saline was injected into Meckel's cave. HR and MAP were recorded at seven time-points, and the TCR incidence was compared. Results: HR decreased in the C group at the time of foramen ovale puncture (T5) and at the time of ganglion compression (T6) compared with that at the moment of needle puncture (T4) (P<0.05), but almost no change in the S group. HR was lower in the C group compared with the S group at T5 and T6 (P<0.05). MAP increased significantly at T5 and T6 compared with that at T4 in the C group (P<0.05), but almost no increase in the S group. Compared with the C group, MAP was lower at T5 and T6 in the S group (P<0.05). There were no significant differences in HR and MAP between the two groups at T1, T2, T3, T4 and T7. The incidence of bradycardia was higher in the C group than that in the S group (P<0.05). Conclusion: Trigeminal ganglion block was an effective approach to prevent TCR in elderly patients during PBC.

The preoperative evaluation value of 3D-slicer program before microsurgical vascular decompression in patients with hemifacial spasm.

BACKGROUND: To compare the diagnostic accuracy of 3D fast imaging employing steady-state acquisition (FIESTA) combined with 3D-time-of-flight (TOF) MR angiography (MRA) sequences (FTMS) and 3D-reconstuction synthesized by 3D-slicer program in evaluation the neurovascular relationships and offending vessels preoperatively in patients with hemifacial spasm (HFS). METHODS: Clinical data of HFS patients who underwent microsurgical vascular decompression (MVD) were analyzed. All patients underwent MRA scans with FTMS and 3D-reconstruction before surgery. The neurovascular relationship and offending vessels were evaluated and compared with intraoperative findings. RESULTS: Forty patients were included in this study, 18 (45%) of them were male. The mean age was 49.6 years. The Kappa identity tests identified the agreement between the FTMS and intraoperative findings in evaluating the neurovascular relationship and offending vessel was 0.263 and 0.643, respectively. The agreement between the 3D-reconstruction and intraoperative findings was 0.633 and 0.921 respectively. There was borderline significant difference between the two methods in predicting neurovascular relationship (χ2 = 9.363, P = 0.053), and there were significant differences between the two methods in predicting offending vessels (χ2 = 188.408, P < 0.001). The sensitivity and specificity of FTMS in evaluating the neurovascular relationship were 89.7% and 100%, respectively, while those with 3D-reconstruction were both 100%. Moreover, the correct 3D- reconstruction examinations in predicting vessel and nerve relationships (r = 0.634, P = 0.034) and offending vessels (r = 0.652, P = 0.028) were significantly correlated with completely symptoms remission. CONCLUSIONS: The 3D-reconstuction synthesized by 3D-slicer program was more accurate than FTMS in preoperative evaluation of neurovascular relationship and offending vessel. The technique is expected to be helpful in preoperative evaluation. AVAILABILITY OF DATA AND MATERIAL: The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion.

BACKGROUND: The classic puncture method of percutaneous microcompression using fluoroscopy might be difficult to precisely locate and visualize the foramen ovale. Various new surgical tools to increase the accuracy of finding the foramen ovale location have been introduced. However, all of these systems require some complicated operating steps and/or advanced devices to complete the work. OBJECTIVE: To describe the use of a simple method for foramen ovale puncture by percutaneous microcompression based on preoperative image simulation. METHODS: Forty-five patients were included in the study. All patients underwent a computed tomography examination. Among them, the simulated preoperative puncture pathway was reconstructed on the basis of computed tomography scan examination for 22 patients. Procedures were performed by 2 surgeons: one experienced surgeon and another young surgeon with surgical qualification. The puncturing time and cumulative radiation exposure dose, from start of the puncturing until reaching the foramen ovale, were recorded. Postoperative pain relief, facial hypoesthesia, masticatory muscle weakness, and other complications were recorded. RESULTS: In all cases, the procedure of cannulation was completed successfully. The puncturing time for both the experienced and young surgeon with the use of preoperative image simulation seemed to be time-saving. The young surgeon had less cumulative radiation exposure with the use of preoperative image simulation. Moreover, the intraoperative puncture pathways were almost consistent with the preoperative simulated images. The rest of the process went smoothly. Short-term outcomes of all the 45 patients were satisfactory. CONCLUSION: Based on our preliminary experience, the preoperative image simulation-guided technique is useful during these cases.

Endoscopic Ultrasound-Guided Porto-systemic Pressure Gradient Measurement Correlates with Histological Hepatic Fibrosis.

BACKGROUND AND AIMS: Endoscopic ultrasound is a novel diagnostic approach to chronic liver diseases (CLDs), and EUS-guided porto-systemic pressure gradient measurement (EUS-PPG) is an important expansion with a well-developed technique. However, the clinical value and applicability of EUS-PPG measurement in predicting histologically advanced hepatic fibrosis remain unknown. METHODS: This was a single-center retrospective study on patients with various CLDs undergoing EUS-PPG and EUS-guided liver biopsy (EUS-bx) to assess if EUS-PPG measurements correlate with histological fibrosis stage and various surrogate markers for severity of CLDs and its safety. Cases with EUS-PPG were identified at the University of California Irvine, a tertiary endoscopy center, between January 2014 and March 2020. RESULTS: In 64 patients, the mean age was 57.5; 40 (62.5%), males; mean Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, 5.9 and 10.4, respectively. The procedure success rate was 100%. Twenty-nine (45.3%) had EUS-PPG ≥ 5 mmHg that was associated with clinical cirrhosis (p < 0.0001), clinical portal hypertension (p = 0.002), hepatic decompensation (p = 0.013), MELD-Na > 10 (p = 0.036), PLTs ≤ 120 × 109/L (p = 0.001), INR ≥ 1.05 (p = 0.007), presence of EV, GV, or PHG (p < 0.0001), biopsy-proven fibrosis stage ≥ 3 (p = 0.002), APRI > 2 (p = 0.001), and FIB-4 > 3.25 (p = 0.001). Multivariable analysis confirmed that EUS-PPG ≥ 5 mmHg was significantly associated with liver biopsy-proven fibrosis stage ≥ 3 (LR 27.0, 95% CI = 1.653-360.597, p = 0.004), independent of C-cirrhosis, C-PHTN, thrombocytopenia, splenomegaly, and APRI score > 2, and FIB-4 score > 3.25. There were no serious complications related to EUS-PPG procedures. CONCLUSIONS: EUS-PPG measurements provide excellent correlation with histological hepatic fibrosis stage and various clinical, laboratory, endoscopic and imaging variables indicative of advanced liver disease without serious adverse events.

Prognosis of Patients With Brainstem Glioblastoma Based on "age, surgery and radiotherapy": A SEER Database Analysis.

Introduction: Primary brainstem glioma is a rare tumor with a dismal prognosis that poses significant treatment challenges. The purpose of the current study is to identify and determine prognostic factors associated with survival in high-grade brainstem glioma patients. Methods: We gathered the data from the SEER database for the duration of years from 1973 to 2016 to examine the survival of patients particularly reported with the high-grade brainstem glioma and subsequently ascertained the potential impact of demographic features, tumor, and clinical characteristics on the overall survival of these patients. The survival patterns were assessed using Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching (PSM) analysis was performed between patients with or without radiation therapy based on age and surgical resection to investigate the effect of radiotherapy on overall survival (OS). Results: A total 232 patient's data were obtained from the SEER database and included in this study. The median overall survival was 8 months. Kaplan-Meier survival analysis delineated that the patients who were in younger age (P = .001) and underwent surgery (P = .001) exhibited typically a better prognosis. Among 232 patients, a total of 204 patients were categorized as radiotherapy group (RG) received radiation therapy whereas 28 patients were considered as nonradiotherapy group (NRG), who were not receiving radiotherapy. Radiotherapy was associated with an improvement in the overall survival without statistical significance (P = .104). PSM was performed between RG and NRG based on age and surgical resection. After the PSM, 56 patients were included. Overall Survival was significantly different between both groups (P = .038). Conclusion: Furthermore, the patients with high-grade brain glioma who received "both radiotherapy and chemotherapy" exhibited significantly longer survival compared to the patients who received chemotherapy alone. Multivariate analysis showed that treatment with surgery and radiotherapy were considered as the independent prognostic factors (P < .05).

Gray matter volume reduction with different disease duration in trigeminal neuralgia.

PURPOSE: Structural magnetic resonance imaging is widely used to explore brain gray and white matter structure in trigeminal neuralgia (TN) but has yielded conflicting findings. This study investigated the relationship between disease duration as a clinical feature of TN and changes in brain structure. METHODS: We divided 49 TN patients into three groups (TN1-TN3) based on disease duration (TN1 = 1.1 ± 0.7 (0-2) years, TN2 = 4.8 ± 1.5 (3-7) years, TN3 = 15.1 ± 5.5 (10-30) years). We used voxel-based morphometry (VBM) to compare the gray matter volume (GMV) across groups and between TN patients and 18 matched healthy control subjects. RESULTS: The TN1 group showed reduced GMV of pain-related regions in the cerebellum; the TN2 group showed reduced GMV in the thalamus and the motor/sensory cortex; and the TN3 group showed reduced GMV in the emotional and reward circuits compared with healthy controls. Similar brain regions, including bilateral hippocampi, caudate, left insular cortex, and medial superior frontal cortex, were affected in TN2 and TN3 compared with TN1. CONCLUSION: Disease duration can explain differences in structural alterations-especially in pain-related brain regions-in TN. These results highlight the advanced structural neuroimaging method that are valuable tools to assess the trigeminal system in TN and may further our current understanding of TN pathology.

A limited panel of INSM1 and LEF1 immunostains accurately distinguishes between pancreatic neuroendocrine tumor and solid pseudopapillary neoplasm.

Solid pseudopapillary neoplasm (SPN) and well differentiated pancreatic neuroendocrine tumor (PNET) can show significant cytomorphological overlap. In this study, we evaluated the role of INSM1 and LEF1 immunohistochemical stains in distinguishing between these two tumors. 22 SPN and 25 PNET surgically resected cases were stained for both INSM1 and LEF1. All the 22 cases of SPN showed strong and diffuse nuclear staining for LEF1 (in >95 % of tumor cells), while all 25 PNET were negative for LEF1. All 25 PNET cases were positive for INSM1 (moderate to strong intensity nuclear staining in >50 % of the tumor cells), while all 22 cases of SPN were negative for INSM1. The results of our study show that a limited panel comprising of INSM1 and LEF1 immunostains accurately distinguishes between SPN and PNET.

Comparison of Two Specialized Histology Needles for Endoscopic Ultrasound (EUS)-Guided Liver Biopsy: A Pilot Study.

BACKGROUND: EUS-guided liver biopsy (EUS-LB) has been shown to be a safe and effective alternative to percutaneous liver biopsy. The optimal needle device and technique for EUS-LB is still evolving. The aim of this study was to compare the efficacy of two second-generation 19G fine-needle biopsy (FNB) (Franseen- and Fork-tip) devices for EUS-LB. METHODS: This is a repeated-measure crossover study with a prospectively maintained cohort of patients. We performed EUS-LB with a one-pass and single-actuation method using two 19G FNB needles in 22 consecutive patients between 10/2018 and 9/2019. Patients were randomized to left vs right liver lobes to be biopsied as well as the needle sequence. The specimens obtained were evaluated for adequacy for histologic diagnosis. The primary outcome was number of complete portal tracts (CPTs), post-fix aggregate, and longest specimen length. Secondary outcomes were prefix aggregate specimen length and the specimen adequacy judged by two expert pathologists. RESULTS: A total of 44 liver biopsies were performed in 22 patients. The CPTs were higher in the Franseen-tip needle group compared to the Fork-tip needle group (14.4 vs 9.5, p = 0.043). Post-fix aggregate specimen length (44.9 mm vs 34.6 mm, p = 0.097), the post-fix longest specimen length (19.9 mm vs 13.7 mm, p = 0.175), and prefix aggregate specimen length (51.7 mm vs 45 mm, p = 0.265) were not significantly different. Both needles showed similarly high histologic adequacy (100% vs 95.5%, p = 0.312). Interestingly, the right of the liver showed higher yield of CPTs with both needles (Franseen, 16.2 vs. 12.8, p = 0.003, the Fork-tip, 12.8 vs. 7.0, p < 0.0001). CONCLUSION: EUS-guided liver biopsy using the 19G Franseen-tip needle may provide more CPTs than 19G Fork-tip needle on a single-pass, single-actuation comparison.

Incidence and significance of GATA3 positivity in gallbladder adenocarcinoma.

GATA3 immunostaining is a sensitive marker for mammary and urothelial carcinomas. It is routinely used in surgical pathology during workup of carcinomas of unknown origin. To the best of our knowledge, this is the first focused study of GATA3 expression in gallbladder adenocarcinomas. In this study, we evaluated GATA3 expression in 38 gallbladder adenocarcinomas. Eight of 38 (21%) gallbladder adenocarcinomas were positive for GATA3. The expression of GATA3 tended to be moderate to strong when present. It was patchy (<50% positivity) in 4 cases, characterized by discrete clusters or groups of malignant cells with areas of intervening negative tumor cells, whereas it was diffuse (>50% positivity) in the other 4 cases. GATA3 expression did not show any significant correlation with clinicopathologic features such as sex, histologic grade, perineural invasion, vascular invasion, pathologic stage, or distance metastasis. The results of our study show that a subset of gallbladder adenocarcinomas (21%) can be GATA3 positive. Awareness of this phenomenon is important while working up GATA3-positive carcinomas immunohistochemically.

HSP90 Inhibitor Encapsulated Photo-Theranostic Nanoparticles for Synergistic Combination Cancer Therapy.

Photodynamic therapy (PDT) is a promising non-invasive therapeutic modality that has been proposed for treating prostate cancer, but the procedure is associated with limited efficacy, tumor recurrence and photo-toxicity. In the present study, we proposed to develop a novel multifunctional nano-platform for targeted delivery of heat, reactive oxygen species (ROS) and heat shock protein 90 (Hsp90) inhibitor simultaneously for combination therapy against prostate cancer. This new nano-platform combines two newly developed entities: 1) a unique organic and biocompatible nanoporphyrin-based drug delivery system that can generate efficient heat and ROS simultaneously with light activation at the tumor sites for dual-modal photothermal- and photodynamic- therapy (PTT/PDT), and 2) new nano-formulations of Hsp90 inhibitors that can decrease the levels of pro-survival and angiogenic signaling molecules induced by phototherapy, therefore, further sensitizing cancer cells to phototherapy. Furthermore, the nanoparticles have activatable near infrared (NIR) fluorescence for optical imaging to conveniently monitor the real-time drug delivery in both subcutaneous and orthotopic mouse models bearing prostate cancer xenograft. This novel multifunctional nano-platform has great potential to improve the care of prostate cancer patients through targeted combination therapy.

Ginsenoside Rh2 inhibits growth of glioblastoma multiforme through mTor.

Being the most malignant primary brain tumor in humans, glioblastoma multiforme (GBM) has a fairly poor patient survival after current combined treatment with chemotherapy, radiation, and surgery. Ginsenoside Rh2 (GRh2) has been reported to have a therapeutic effect on some tumors, and we recently reported its inhibitory effect on GBM growth in vitro and in vivo, possibly through an epidermal growth factor receptor (EGFR) signaling pathway. Here, using specific inhibitors, we found that the activation of EGFR signaling promoted GBM growth through PI3k/Akt/mTor signaling pathways. Moreover, GRh2 efficiently inhibited activation of this pathway at the receptor level. Together with our previous findings, these data suggest that GRh2 may suppress GBM growth through its competition with EGFR ligands for binding to the EGFR, and binding to EGFR by GRh2 does not lead to receptor phosphorylation. Thus, our data highlight a previous unappreciated role for GRh2 to inhibit EGFR signaling. GRh2 thus appears to be a promising therapy for cancers that require EGFR signaling to growth.