BackgroundThe successful treatment of malignant gliomas remains a challenge despite the current standard of care, which consists of surgery, radiation and temozolomide. Advances in the survival of brain cancer patients require the design of new therapeutic approaches that take advantage of common phenotypes such as the altered metabolism found in cancer cells. It has therefore been postulated that the high-fat, low-carbohydrate, adequate protein ketogenic diet (KD) may be useful in the treatment of brain tumors. We have demonstrated that the KD enhances survival and potentiates standard therapy in a mouse model of malignant glioma, yet the mechanisms are not fully understood.MethodsTo explore the effects of the KD on various aspects of tumor growth and progression, we used the immunocompetent, syngeneic GL261-Luc2 mouse model of malignant glioma.ResultsTumors from animals maintained on KD showed reduced expression of the hypoxia marker carbonic anhydrase 9, hypoxia inducible factor 1-alpha, and decreased activation of nuclear factor kappa B. Additionally, tumors from animals maintained on KD had reduced tumor microvasculature and decreased expression of vascular endothelial growth factor receptor 2, matrix metalloproteinase-2 and vimentin. Peritumoral edema was significantly reduced in animals fed the KD and protein analyses showed altered expression of zona occludens-1 and aquaporin-4.ConclusionsThe KD directly or indirectly alters the expression of several proteins involved in malignant progression and may be a useful tool for the treatment of gliomas.
OBJECTIVE The authors aimed to demonstrate the feasibility and advantages of carbon fiber–reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors. METHODS Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. RESULTS The study population included 14 females and 14 males with a mean age of 60 years (range 30–86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6–14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3–8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1–23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1–22 months). Eighteen patients received postoperative radiation at the authors’ institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware. CONCLUSIONS CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.
domains and have physical and economic consequences, such as absence from work, decreased neurologic function, and high healthcare costs. 3 This article describes the anatomy and pathophysiology of CTS and its treatment options so clinicians can better prepare patients and streamline referrals for improved outcomes. ANATOMYThe carpal tunnel is a narrow space located on the palmar surface that allows the passage of various structures such as the median nerve and various fl exor tendons (Figures 1 and 2). The borders of this tunnel include the fl exor retinaculum (roof), carpal bones (base), the hook of the hamate, pyramidal bone, pisiform bone (ulnar edge), scaphoid and trapezoid bones, as well as the tendon of the fl exor carpi radialis (FCR) muscle forming the radial edge. 11 The tendons passing through the carpal tunnel are the four fl exor digitorum superfi cialis, the four fl exor digitorum profundus, and the fl exor pollicis longus.The median nerve enters the hand through the carpal tunnel and divides into six branches (Table 1). Of these, the recurrent branch supplies the muscles of the thumb, which predominantly help with opposition, including the abductor pollicis brevis, opponens pollicis, and the superfi cial portion of the fl exor pollicis brevis.The proper palmar digital nerves compose the next three branches. These are cutaneous digital branches that innervate both the radial and ulnar sides of the thumb. The fi nal branch innervates the radial side of the index fi nger along with motor innervation to the fi rst lumbrical. The fi nal two branches, the common palmar digital branches, © PROSTOCK-STUDIO/SHUTTERSTOCK.COM C arpal tunnel syndrome (CTS) is the most common entrapment neuropathy, defi ned as nerve damage (specifi cally the median nerve) at narrow passage sites. [1][2][3] The fi rst case reports of compression of the median nerve were published by Paget in 1854. 4 Studies by Phalen in the 1950s became the foundational principles for understanding CTS. 5 The condition tends to affect patients ages 40 to 60 years; prevalence is estimated between 4% and 5% of the population. 6 Various studies have shown that CTS is more common in women than men (2.2 to 5.4 women to 1.1 to 3 men per 1,000 people). 7-10 Short-and long-term effects of these neuropathies span various ABSTRACT Carpal tunnel syndrome (CTS) is an entrapment neuropathy affecting the median nerve. Prevalence is estimated at 4% to 5% of the population. A solid understanding of the anatomy, presentation, and diagnostics is key to effi cient diagnosis and appropriate referral. Both surgical and nonsurgical interventions have led to improved clinical outcomes. Clinicians who have an in-depth knowledge of CTS symptoms and treatment options can prepare patients and streamline referrals for improved patient outcomes.
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