MicroRNA-7 targets T-Box 2 to inhibit epithelial-mesenchymal transition and invasiveness in glioblastoma multiforme.

The dysregulation of microRNA expression in cancer has been associated with the epithelial-mesenchymal transition (EMT) that triggers invasive ability and increases therapeutic resistance. Here, we determined the microRNA expression profile of seven tumor tissues from patients with glioblastoma multiforme (GBM) by use of microRNA array analysis. We discovered that microRNA-7 (miR-7) is consistently downregulated in all tumor samples. Using the microRNA.org algorithm, the T-box 2 gene (TBX2) was identified as a candidate gene targeted by miR-7. In contrast to miR-7, TBX2 had an increased expression in GBM tumors and was linked to poor prognosis. We confirmed that TBX2 mRNA and protein production are significantly repressed by overexpressing miR-7 in GBM cells in vitro. The reporter assay showed that miR-7 significantly represses the signal from luciferase with the 3' UTR of TBX2. Furthermore, TBX2 overexpression decreased E-cadherin expression and increased Vimentin expression, causing an increasing number of invaded cells in the invasion assay, as well as pulmonary metastasis in vivo. Our findings demonstrated that overexpression of TBX2 in GBM tumors via the downregulation of miR-7 leads to EMT induction and increased cell invasion.

Cortical Bone Trajectory Instrumentation with Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture.

BACKGROUND: Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes. METHOD: We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months. RESULT: The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was -3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up. CONCLUSIONS: Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment.

Minimal invasive surgical technique in midline lumbar inter-body fusion: A technique note.

Midline lumbar inter-body fusion (MIDLF) surgery with cortical bone trajectory (CBT) screw insertion is a modern fusion technique for spinal surgery. The difference in entry point of this trajectory from conventional pedicle screw surgery offers the potential benefits of less soft tissue dissection and reduced blood loss, post-operative wound pain, and infection risks. Because this is a newly developed technique first announced by Santoni in 2009, most surgeons perform this surgery in a mini-open fashion and require more intra-operative fluoroscopy and ionizing radiation exposure during screw placement. In this article, we demonstrate a minimally invasive midline lumbar interbody fusion (MIS-MIDLF) technique with percutaneous CBT screw placement. Using a designed cannulated awl, we only need a single dimensional fluoroscopy view from anterior to posterior (AP view) to achieve an accurate trajectory and therefore reduce radiation exposure. We report our first ten consecutive patients with degenerative spondylolithesis who underwent MISS-MIDLF and were followed up for more than 18 months. The procedure required a single wound of about 3 cm in length in one to two level fusion surgery and only three to four shots of fluoroscopy were needed for each screw placement. There were no screws malpositioned in subsequent plain films or computer tomography scans. We demonstrate a case with detailed surgical procedures and provide this technique as an alternative approach for surgeons performing MILDF surgery.

Intramuscular Migration of Venous Catheter as a Rare Complication of Ventriculoatrial Shunt: Case Report and Literature Review.

The most common procedure to manage hydrocephalus is a ventriculoperitoneal shunt. Other alternatives include a ventriculoatrial (VA) shunt, ventriculopleural shunt, lumboperitoneal shunt, or ventriculocisternal shunt. The VA shunt is a relatively rare procedure for hydrocephalus. As reported, several complications of VA shunt include obstructions, malposition, shunt infections, endocarditis, heart failure, tricuspid regurgitation, intra-atrial thrombus, and pulmonary hypertension. In this case report and literature review, we discuss a rare case of intramuscular migration of a venous tube 1 year after VA shunt implantation. We also report all the possible locations of migration after placement of VA shunt.

Transsylvian-transinsular approach for the removal of basal ganglia hemorrhage under a Modified Intracerebral Hemorrhage score.

BACKGROUND: Spontaneous intracerebral hemorrhages account for 20% of all strokes. The Modified Intracerebral Hemorrhage (MICH) score provides a simple, reliable system for decision making regarding surgical treatment. The transsylvian-transinsular approach had previously been neglected because of the dependence on great surgical experience. We believe this approach not only compares favorably with the minimally invasive surgery concept but also preserves most of the cerebral functional cortex with a maximum hematoma evacuation rate. METHODS: From May 2007 to September 2008, a single surgeon treated 32 patients with basal ganglia hemorrhage using the transsylvian-transinsular approach. Of these, 20 had MICH scores of 2 to 3; 5 had MICH scores of 4; and 7 had MICH scores of 5. After 24 postoperative hours, we evaluated the hematoma evacuation rate by a computed tomography scan. The functional recovery was evaluated by the Barthel Index at 1, 3, and 6 months postoperatively. RESULTS: All data were analyzed according to MICH score. The hematoma evacuation rates were in the following order: MICH scores 2 to 3 (97%) > MICH score 4 (92%) > MICH score 5 (90%). Surgery-related mortality was MICH2, 3 (0%) < MICH4 (20%) < MICH5 (43%). The Barthel Index of the MICH2, 3 patients (n = 18) improved from 16.9 at 1 postoperative month to 41.94 at 6 postoperative months. CONCLUSIONS: The transsylvian-transinsular approach for the removal of an ICH was not difficult, and it was found to be a safe method for treating a spontaneous basal ganglion ICH. In addition, this approach conformed with the spirit of minimally invasive surgery.