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Lauren M. Burke, Warren D. Yu, Anthony Ho, Timothy Wagner and Joseph R. O'Brien

Object

Anatomical variability of the C-2 pedicle poses a challenge for C-2 fixation. The use of multidimensional CT scanning is not widely used but might be an asset to preoperative planning. Careful preoperative planning is imperative for instrumentation at C-2. Fine-cut, noncontrast CT scanning is a useful tool for delineating anatomy; however, the axis of the images is not always along the anatomical axis of the vertebra in question. The authors evaluated the suitability of C-2 pedicles for screw placement by using OsiriX (Pixmeo) software to change the gantry angle of CT angiograms to measure the anatomical dimensions of the C-2 pedicle.

Methods

The authors conducted a retrospective review of CT angiograms of the head and neck from 47 trauma patients seen consecutively at George Washington University Hospital. For each patient, 3 independent observers determined length and width of each C-2 pedicle (94 samples) by using OsiriX. OsiriX is a DICOM viewer that enables navigation and visualization in multidimensional imaging, such as 3D imaging, which was used for this study. Sex-specific measurements were also determined. Vertebral anatomy was studied to determine whether aberrant anatomy would preclude pedicle fixation. Statistical analyses were performed.

Results

Of the 47 patients, 27 were male. Overall mean C-2 pedicle widths and lengths were 8.272 ± 1.364 mm and 27.052 ± 3.471 mm, respectively. The average widths and lengths of the pedicle in female patients were 8.040 ± 1.262 mm and 27.241 ± 2.731 mm, respectively, and those in male patients were 8.444 ± 1.414 mm and 26.913 ± 3.933 mm, respectively. The sex difference was statistically significant for width (p = 0.012) but not for length (p = 0.41). On the basis of width, the percentages of pedicles that could tolerate a 3.5-mm and 4.0-mm screw were 98% and 97%, respectively. Vertebral anatomy precluded screw length greater than 14 mm for only 3 patients.

Conclusions

Using multidimensional CT or 3D imaging, the authors found that C-2 pedicles in over 90% of patients could tolerate 3.5-mm and 4.0-mm pedicle screws. Vertebral anatomy precluded use of screw lengths greater than 14 mm for only 3 (6%) of 47 patients. Therefore, the C-2 pedicle might be more tolerant of fixation than previously reported.

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Aaron J. Clark, Joy L. Ware, Mike Y. Chen, Martin R. Graf, Timothy E. Van Meter, Wagner G. Dos Santos, Helen L. Fillmore and William C. Broaddus

Object

Wilms tumor 1 (WT1) is overexpressed in many human cancers, including glioblastoma multiforme (GBM). In another study, the authors showed that transient WT1 silencing increases the radiosensitivity of glioma cells. Studies of nonglioma cell lines have demonstrated that WT1 promotes cell proliferation and survival; however, this ability has not been rigorously analyzed in human GBM.

Methods

The authors tested the efficacy of 2 sequences of short hairpin RNA (shRNA) directed against WT1 in U251MG human GBM cells and found that 1 sequence was capable of stably silencing WT1 expression. They then evaluated the effect of WT1 silencing on cellular proliferation, invasion, and in vivo tumor formation.

Results

Stable WT1-shRNA expression significantly decreased the proliferation of U251MG cells in vitro as demonstrated by both an adenosine 5′-triphosphate–based viability assay and tritiated thymidine uptake. Furthermore, stable WT1 silencing caused significantly slower growth after the subcutaneous inoculation of tumor cells in the flanks of athymic nude mice and was associated with an increased latency period.

Conclusions

Data in this study provide proof of the principle that downregulation of WT1 causes decreased tumorigenicity of a GBM cell line in vitro and in vivo and suggest that WT1 is a promising target for novel molecular GBM therapies, perhaps in combination with standard treatment modalities.

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Aaron J. Clark, Wagner G. Dos Santos, Jessica Mccready, Mike Y. Chen, Timothy E. Van Meter, Joy L. Ware, Sharon B. Wolber, Helen Fillmore and William C. Broaddus

Object

The WT1 gene is overexpressed in many types of human cancer. It has been demonstrated that Wilms tumor 1 (WT1) promotes tumor cell proliferation and survival in some cell lines by inhibiting p53-mediated apoptosis; however, this relationship has not been investigated in gliomas. The goal in this study was to characterize the expression pattern of WT1 in human gliomas and to determine if a correlation exists between WT1 expression and p53 status.

Methods

The authors screened nine malignant glioma cell lines, 50 glioblastoma multiforme (GBM) samples, and 16 lower-grade glial tumors for WT1 expression.

Results

Five of nine cell lines, 44 of 50 GBM samples, and 13 of 16 lower-grade gliomas expressed WT1 mRNA on reverse transcriptase polymerase chain reaction (PCR) analysis. Expression of WT1 was not detected in normal astrocytes. Two WT1 isoforms, +/+ and −/+, were expressed in the majority of these samples. Real-time PCR analysis of the GBM cell lines revealed that the level of WT1 mRNA ranged from 6.33 to 214.70 ng per ng 18S ribosomal RNA. The authors screened the GBM samples for p53 mutation by using PCR and single-stranded conformational polymorphism analysis, and they demonstrated an association between WT1 expression and p53 status. Tumors that contained wild-type p53 were significantly more likely to express WT1 than tumors that contained mutant p53.

Conclusions

The presence of WT1 in glioma cell lines and the majority of primary tumor samples and its absence in normal astrocytes support the suggestion that WT1 expression is important in glioma biology.