Martin Hsiu-Chu Lin

Foramen ovale cannulation guided by intra-operative computed tomography with integrated neuronavigation for the treatment of trigeminal neuralgia

BackgroundRadiofrequency rhizotomy of the Gasserian ganglion for the treatment of trigeminal neuralgia via percutaneous cannulation of the foramen ovale is facilitated by various localization modalities. In our preliminary study, we described the feasibility of computed tomography (CT) using an integrated neuronavigation system to cannulate the foramen ovale.MethodsAnalysis was performed on 42 consecutive patients who underwent cannulation of the foramen ovale for radiofrequency trigeminal rhizotomy guided by CT using an integrated neuronavigation system. The reproducibility and safety of the neuronavigation-guided procedure were evaluated.ResultsOverall, the average dimension of the foramen ovale was 7.1 (1.5) × 4.7 (1.1) mm, and it was successfully cannulated by neuronavigation guidance in 31 (73.8%) patients with a mean cannulation time of 3.1 (0.7) min and an overall procedure time of 68.2 (16.4) min. The remaining 11 (26.2%) patients required subsequent CT guidance for successful puncture of the foramen ovale.ConclusionsThese data demonstrate that neuronavigation-guided cannulation of the foramen ovale can be executed both quickly and safely on an outpatient basis. Additionally, the use of CT with integrated neuronavigation technology provides superior visual-spatial information compared to conventional fluoroscopy, the process of CT scanning, object planning, and neuronavigation-guided intervention can be completed in the same locale, and its application is easy to master and has the potential to enhance procedure tolerability of awake patients.

Dexamethasone reduces brain cell apoptosis and inhibits inflammatory response in rats with intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) is associated with high rates of mortality and morbidity. Thus, the identification of novel therapeutic agents for preventing strokes and attenuating poststroke brain damage is crucial. Dexamethasone (DEX) is used clinically to reduce edema formation in patients with spinal cord injury and brain tumors. In this study, we sought to elucidate the effects of DEX treatment on apoptosis and inflammation following ICH in rats. A high dose of DEX (15 mg/kg) was administered immediately following ICH induction and again 3 days later. The inflammatory and apoptotic responses in the rat brains were evaluated by using hematoxylin‐eosin, terminal deoxynucleotidyl transferase dUTP nick end labeling, Nissl, and neurofilament‐H staining. Levels of phosphorylated neurofilaments and apoptosis‐related proteins such as B‐cell lymphoma 2 (Bcl‐2), Bcl‐2 associated X protein (Bax), caspase‐3, and P53 were analyzed by Western blotting. This study shows that rats without ICH that received DEX treatment had a fourfold higher expression of Bcl‐2 than sham‐operated rats. ICH causes an increase in Bax, cleaved caspase‐3, and P53 proteins from 4 hr to 7 days following ICH induction. In comparison with the ICH rats, the ICH/DEX rats showed significantly decreased apoptotic cell death and increased neuron survival and maintained neurofilament integrity in the perihematomal region. DEX increased the Bcl‐2/Bax ratio and lowered the expression of cleaved caspase‐3 at 12 hr and 5 days. The ICH rats were accompanied by activation of the inflammatory response, and DEX treatment modulated the expression of a variety of cell types and then decreased ICH‐induced apoptosis.

Comparison of Surface Markers between Human and Rabbit Mesenchymal Stem Cells

This study investigated whether there are marked differences in surface markers between rabbit and human mesenchymal stem cells (MSCs). Murine and rabbit MSCs have been reported to be CD90-negative. Rat MSCs have been reported to be CD71-negative. Our previous study also shows that rabbit MSCs are CD29-negative. However, human MSCs are generally considered to be CD29-, CD71-, and CD90-positive. Therefore, the surface markers of human MSCs might differ from those of other species. Rabbit bone marrow MSCs were obtained that had a multi-differentiation potential. The phenotype of these cells was studied using flow cytometry antibodies for 25 rabbit surface markers, namely, CD13, CD14, CD29, CD31, CD34, CD44, CD45, CD49d, CD49f, CD51, CD54, CD59, CD71, CD73, CD90, CD105, CD106, CD133, CD166, MHC I, MHC II, α-smooth muscle actin (α-SMA), cytokeratin, desmin, and vimentin. The phenotype of commercially available human MSCs was similarly studied using antibodies for human surface markers. CD14, CD31, CD34, CD45, CD49d, CD49f, CD51, CD54, CD71, CD106, CD133, MHC II, and cytokeratin were absent from both rabbit and human MSCs, while CD44, α-SMA, and vimentin were present on both cell lines. CD13, CD29, CD59, CD73, CD90, CD105, CD166, and MHC I were present on human MSCs, but not on rabbit MSCs. However, desmin was present on rabbit MSCs, but not on human MSCs. In total, the surface expression of nine markers differed between human and rabbit MSCs, whereas the surface expression of 16 markers was the same in the two cell lines.

Hydrocephalus following decompressive craniectomy for malignant middle cerebral artery infarction

OBJECTIVE The aim of this study was to evaluate the incidence of hydrocephalus and understand the influence of hydrocephalus on the functional outcome of patients undergoing decompressive craniectomy for malignant middle cerebral artery (MCA) infarction. METHODS We retrospectively analyzed data of consecutive patients who underwent decompressive craniectomy for malignant MCA infarction. Clinical and imaging data were reviewed to confirm the incidence of hydrocephalus and evaluate the impact of hydrocephalus on functional outcome. The functional outcomes of patients were estimated with the Glasgow outcome score at 1year after stroke onset. RESULTS Seventeen patients who received decompressive craniectomy for malignant MCA infarction from January 2003 to December 2006 were enrolled. Persistent hydrocephalus developed in 5 patients. The functional outcomes in these patients were uniformly poor regardless of cerebrospinal fluid diversion surgery. Our data revealed that functional outcome was related to patient age and the duration from infarction to craniectomy. CONCLUSIONS Persistent hydrocephalus is common in patients who receive decompressive craniectomy for malignant MCA infarction. However, the shunt procedure does not significantly improve the patients clinical condition. The timing of operation in relation to the functional outcome may be critical.

Feasibility of Intraoperative Computed Tomography Navigation System for Pedicle Screw Insertion of the Thoracolumbar Spine

Study Design: A retrospective analysis of feasibility of intraoperative computed tomography (iCT) navigation for pedicle screw insertion of the thoracolumbar spine. Objectives: This study assessed the feasibility of an iCT navigation system by evaluating the screw insertion time, screw revision time, and learning curve of the iCT surgical team in patients who underwent thoracolumbar pedicle screw surgery using this navigation system. Summary of Background Data: The iCT navigation system has been reported to improve the accuracy and safety of pedicle screw insertion. However, the assessment of the feasibility of spinal instrumentation guided by iCT navigation system is limited. Materials and Methods: From the time iCT navigation system was set-up to a period covering 16 months, consecutive patients who underwent thoracic or lumbar spinal pedicle screw surgery were enrolled. The screw insertion and screw revision times were estimated using the system’s automatic time recording between the iCT scans. The insertion time per screw of the first 50 patients not requiring screw revision was also analyzed to evaluate the learning curve of the iCT surgical team. Results: There were 178 patients with a total of 932 pedicle screws. The cortical breach rate was 3.2% and the screw revision rate was 1.4%. The insertion time per screw was 10.2±6.3 minutes and the screw revision time was 13.8±9.9 minutes. The learning curve of the iCT surgical team for pedicle screw insertion guided by this navigation system was not steep, and experience from <10 patients was adequate to provide familiarity with this system. Conclusions: The iCT navigation system is clinically feasible for thoracolumbar pedicle screw surgery. It provides high-level safety and accuracy, as well as ease of screw revision when required.

Calvatia lilacina Protein-Extract Induces Apoptosis through Glutathione Depletion in Human Colorectal Carcinoma Cells

This paper reports that a novel protein extract isolated from Calvatia lilacina (CL) can induce cell death against four types of human colorectal cancer cells. Importantly, CL was shown to be free of apoptotic effects against normal rat liver cells. We have also identified that CL-induced glutathione (GSH) depletion is the major contributor responsible for the apoptotic cell death induction of SW 480 cells, as evidenced by the observation that exogenously added N-acetylcysteine (NAC), or GSH, but not vitamin C, could offer a near complete protection of CL-treated cells against apoptotic cell death. Furthermore, the participation of reactive oxygen species (ROS) evoked a drop in the transmembrane potential (Delta Psi(m)) in the CL-induced apoptotic cell death. This observation can only be deemed as a minor pathway due to the fact that cyclosporine A (CyA) could only partially rescue the CL-treated cells from apoptotic cell death. Likewise, despite the fact that CL could induce the upregulation of Bax, its knockdown via siRNA (48 h) failed to completely mitigate apoptotic cell death, indicating that its role in this apoptotic process was insignificant. To further explore the possible underlying mechanism associated with CL-induced GSH depletion, we proceeded to determine the effect of CL on the cellular gamma-glutamylcysteine synthetase (gamma-GCS), a rate-limiting enzyme responsible for GSH biosynthesis, and demonstrated that indeed gamma-GCS could be repressed by CL. Taken together, we report here for the first time that the anticancer effect of CL on human colorectal cancer cells is mediated through GSH depletion mechanism rather than a ROS-mediated killing process. This functional attribute of CL can thus provide the basis for the strategic design of a treatment of colorectal cancer.

Motor function improvement in patients undergoing surgery for spinal epidural abscess.

BACKGROUNDSpinal epidural abscess (SEA) is a rare and devastating clinical entity. Definitive diagnosis is usually delayed because most patients present initially with minor or variable symptoms resulting in poor outcome. The clinical outcome of SEA has been associated with various prognostic factors; however, reports on factors relating to motor function improvement after surgical treatment are limited. OBJECTIVEThe aim of this study is to elucidate which clinical factors may affect motor function recovery after surgical treatment of SEA. PATIENT AND METHODSThe clinical features of patients with SEA undergoing surgical drainage and antibiotics treatment were reviewed, and their outcomes were identified and analyzed. RESULTSThe most common presenting symptoms were neck or back pain, motor deficits, and urinary incontinence. The most common underlying medical condition was diabetes mellitus. Leukocytosis (P = .036; odds ratio [OR] = 0.754; confidence interval [CI] = 0.579–0.982), elevated C-reactive protein level (P = .017; OR 0.96; CI = 0.965–0.994), poor glycemic control (P = .012; OR = 23.33; CI = 1.992–273.29), and duration of motor deficit at the time of operation (P = .005; OR = 40.50; CI = 3.093–530.293) were found to have a strong influence on motor function improvement after surgical treatment. CONCLUSIONInfection control and the prevention of further neurological deterioration in time are paramount in the treatment of SEA for optimal recovery. Patients with rapid neurological deterioration or higher white blood cell count or C-reactive protein level on presentation warrant aggressive surgical intervention; even in those who are completely paralyzed, an improvement in muscle power may still be possible.

Brain-Derived Neurotrophic Factor Loaded PS80 PBCA Nanocarrier for In Vitro Neural Differentiation of Mouse Induced Pluripotent Stem Cells

Brain derived neurotrophic factor (BDNF) can induce neural differentiation in stem cells and has the potential for repair of the nervous system. In this study, a polysorbate 80-coated polybutylcyanoacrylate nanocarrier (PS80 PBCA NC) was constructed to deliver plasmid DNAs (pDNAs) containing BDNF gene attached to a hypoxia-responsive element (HRE-cmvBDNF). The hypoxia-sensing mechanism of BDNF expression and inductiveness of the nano-formulation on mouse induced pluripotent stem cells (iPSCs) to differentiate into neurons following hypoxia was tested in vitro with immunofluorescent staining and Western blotting. The HRE-cmvBDNF appeared to adsorb onto the surface of PS80 PBCA NC, with a resultant mean diameter of 92.6 ± 1.0 nm and zeta potential of −14.1 ± 1.1 mV. HIF-1α level in iPSCs was significantly higher in hypoxia, which resulted in a 51% greater BDNF expression when transfected with PS80 PBCA NC/HRE-cmvBDNF than those without hypoxia. TrkB and phospho-Akt were also elevated which correlated with neural differentiation. The findings suggest that PS80 PBCA NC too can be endocytosed to serve as an efficient vector for genes coupled to the HRE in hypoxia-sensitive cells, and activation of the PI3/Akt pathway in iPSCs by BDNF is capable of neural lineage specification.

Trans-foramen ovale biopsy of a parasellar lesion guided by intraoperative CT neuronavigation with MRI fusion: a case report.

Abstract A 23-year-old male presented with a parasellar lesion which was suspected as disseminated intracranial germ cell tumour. The diagnosis of germinoma was made using immunohistochemistry from percutaneous trans-foramen ovale biopsy. This report describes the role of neuronavigation-guided biopsy through the foramen ovale for lesions in the parasellar region.