Association of body mass index with clinical outcome of primary WHO grade 4 glioma.

Background: The prognostic value of body mass index (BMI) in primary WHO grade 4 gliomas is not widely acknowledged. This study aims to assess the survival outcomes of patients with different BMIs. Methods: Real-world data of patients diagnosed with primary WHO grade 4 (2021 version) glioma was assessed. All 127 patients admitted in this study were administered with standard-of-care from September 2018 to September 2021. The outcomes of overall survival and progression-free survival were analyzed. Results: The baseline characteristics of clinical features, molecular features, and secondary treatment in BMI subsets showed no significant difference. The survival analyses showed a significantly superior overall survival (OS) in the overweight group compared to the normal weight group. A trend of better OS in the overweight group compared to the obesity group was observed. The univariate Cox regression demonstrated patients of round-BMI 25 and 26 had superior OS outcomes. Conclusion: In this real-world setting, patients with a BMI between 24 and 28 have superior overall survival. Patients in the proper BMI range may acquire survival benefits undergoing standard-of-care of primary WHO grade 4 gliomas. The prospective studies on a larger scale on these subsets of patients are necessary to solve the paradox of BMI in glioma.

Dynamically tunable multifunctional terahertz absorber based on hybrid vanadium dioxide and graphene metamaterials.

In this work, in pursuit of a multifunctional device with a simple structure, high absorption rate, and excellent bandwidth, a tunable broadband terahertz (THz) absorber based on vanadium dioxide (V O 2) and graphene is proposed. Due to the phase transition of V O 2 and the electrically tunable properties of graphene, the structure realizes single broadband and dual-band absorption characteristics. When graphene is in the insulating state (E f=0e V) and V O 2 is in the metallic state, the developed system has more than 90% absorption and a wide absorption band from 1.36 to 5.48 THz. By adjusting the V O 2 conductivity, the bandwidth absorption can be dynamically varied from 23% to more than 90%, which makes it a perfect broadband absorber. When graphene is in the metallic state (E f=1e V), V O 2 is in the insulating state, and the designed device behaves as a tunable and perfect dual-band absorber, where the absorptivity of the dual-band spectrum can be continuously adjusted by varying the Fermi energy level of graphene. In addition, both the broad absorption spectrum and the dual-band absorption spectrum maintain strong polarization-independent properties and operate well over a wide incidence angle, and the designed system may provide new avenues for the development of terahertz and other frequency-domain tunable devices.

Identification of MGMT promoter methylation as a specific lipid metabolism biomarker, reveals the feasibility of atorvastatin application in glioblastoma.

BACKGROUND: Glioblastoma is one of the deadliest tumors, and limited improvement in managing glioblastoma has been achieved in the past decades. The unmethylated promoter area of 6-O-Methylguanine-DNA Methyltransferase (MGMT) is a significant biomarker for recognizing a subset of glioblastoma that is resistant to chemotherapy. Here we identified MGMT methylation can also work as a specific biomarker to classify the lipid metabolism patterns between methylated and unmethylated glioblastoma and verify the potential novel therapeutic strategy for unmethylated MGMT glioblastoma. METHODS: Liquid Chromatograph Mass Spectrometer has been applied for non-targeted metabolome and targeted lipidomic profiling to explore the metabolism pattern correlated with MGMT promoter methylation. Transcriptome has been performed to explore the biological differences and the potential mechanism of lipid metabolism in glioblastoma samples. In vivo and ex vivo assays were performed to verify the anti-tumor activity of atorvastatin in the administration of glioblastoma. RESULTS: Multi-omics assay has described a significant difference in lipid metabolism between MGMT methylated and unmethylated glioblastoma. Longer and unsaturated fatty acyls were found enriched in MGMT-UM tumors. Lipid droplets have been revealed remarkably decreased in MGMT unmethylated glioblastoma. In vivo and ex vivo assays revealed that atorvastatin and also together with temozolomide showed significant anti-tumor activity, and atorvastatin alone was able to achieve better survival and living conditions for tumor-hosting mice. CONCLUSIONS: MGMT promoter methylation status might be a well-performed biomarker of lipid metabolism in glioblastoma. The current study can be the basis of further mechanism studies and implementation of clinical trials, and the results provide preclinical evidence of atorvastatin administration in glioblastoma, especially for MGMT unmethylated tumors.

An Infrared Near-Sensor Reservoir Computing System Based on Large-Dynamic-Space Memristor with Tens of Thousands of States for Dynamic Gesture Perception.

To efficiently process the massive amount of sensor data, it is demanding to develop a new paradigm. Inspired by neurobiological systems, an infrared near-senor reservoir computing (RC) system, consisting of infrared sensors and memristors based on single-crystalline LiTaO3 and LiNbO3 (LN) thin film respectively, is demonstrated. The analog memristor is used as a reservoir in the RC system to process sensor signals with spatiotemporal characteristics. LN crystal structure stacked with oxygen octahedra provides favorable conditions for reliable Mott variable-range hopping conduction, which provides the memristor with tens of thousands of reservoir states within a large dynamic range. With the characteristics, the analog sensor signals with high data fidelity can be directly fed to the memristive reservoir, and the spatiotemporal features can be separated and mapped. The system demonstrated a dynamic gesture perception task, achieving an accuracy of 99.6%, which highlights the great application potential of the memristor in signal sensor processing and will advance the application of artificial intelligence in sensor systems. Crystal ion slicing techniques are used to fabricate a single-crystalline thin film for both the memristor and sensor, which opens up the possibility of realizing monolithic integration of a memristor-based near-sensor computing system.

Comparison of the Novel Digital Multi-dimension Botong Score with the Brief Pain Inventory for Evaluating Cancer-Related Pain: A Randomized Crossover Trial.

INTRODUCTION: Pain is a common symptom in patients with cancer, and comprehensive assessments of pain are crucial for decision-making of treatment regimens. This study aimed to compare the practicality of the novel digital multi-dimension Botong score (BTS) and the brief pain inventory (BPI) for evaluating cancer-related pain. METHODS: This randomized crossover trial enrolled patients with cancer-related pain at the Affiliated Cancer Hospital of Shandong First Medical University between July and December 2022. The participants were randomized 1:1 to BTS evaluation followed by BPI or vice versa. The consistency of BTS and BPI was analyzed, including pain score and the impact of pain on emotions and sleep. The convenience, patient preference, and the filling time of the two tools were compared. The accuracy of BTS in detecting breakthrough pain and neuropathic pain was analyzed. RESULTS: A total of 308 patients with cancer-related pain were screened and 233 were finally included in the analysis. The Pearson correlation coefficients of pain score for BTS and BPI (4 relevant questions) were 0.583 for the worst pain score within 24 h, 0.394 for the mildest pain score within 24 h, 0.551 for the average pain score within 24 h, and 0.511 for the current pain score, respectively (all P < 0.01), indicating a positive correlation between the BTS and BPI pain scores. BTS was superior to BPI for filling time, convenience, and patient preference (191.03 vs. 256.76, 7.70 vs. 6.78, 7.58 vs. 6.70; all P < 0.01). The accuracy of BTS in detecting breakthrough pain and neuropathic pain was 98.28% and 97.42%, respectively. CONCLUSION: Pain scores evaluated by BTS have a positive correlation with those evaluated by BPI. BTS reduces the filling time, is more convenient to use, and is more favored by patients. In addition, BTS could help identify breakthrough pain and neuropathic pain. CLINICAL TRIAL REGISTRATION: Chictr.org.cn, identifier: ChiCTR220062624.

Controllable modulation of the oxygen vacancy-induced adjustment of memristive behavior for direct differential operation with transistor-free memristor.

To achieve the goal of neuromorphic computing hardware implementation with extremely high efficiency, low power consumption, and high density, it is necessary to develop transistor-free memristors and implement differential operation without subtraction circuits. In this study, argon ion irradiation was used during the fabrication process of a single crystalline LiNbO3 (LN) thin film to controllably introduce oxygen vacancies (OVs) into the bottom surface, which realized the modulation of OVs based on the excellent environment provided by a single-crystalline thin film. The memristive behavior of memristors was then modulated by regulating the distribution of OVs, and the effect of OVs distributed near the bottom surface of the single crystalline LN thin film on the memristive behavior was analyzed. In this way, two transistor-free memristors with opposite memristive behavior directions were fabricated. Two transistor-free memristors exhibit excellent synaptic plasticity and reliable multilevel resistance states. Based on two transistor-free memristors, a novel differential pair was constructed. Hardware implementations of direct differential operation without subtraction circuits were achieved. This study provides a new pathway to develop a transistor-free memristor and achieve differential operation without subtraction circuits in neuromorphic computing, which will simplify the peripheral circuits, improve integration density, and reduce power consumption and latency.

Label-Free Raman Spectromicroscopy Unravels the Relationship between MGMT Methylation and Intracellular Lipid Accumulation in Glioblastoma.

Temozolomide (TMZ) is considered a first line chemotherapy drug for glioblastoma (GBM). Unfortunately, the GBM without methylation of O6-methylguanine-DNA methyltransferase (MGMT), accounting for about 70% of all GBM, shows an inherent resistance to TMZ treatment. Aberrant accumulation of neutral lipids, primarily triglycerides (TGs) and cholesteryl esters (CEs), in lipid droplets (LDs) has been recognized as metabolic vulnerability for GBM therapy. However, it is not known whether MGMT methylation affects lipid accumulation in GBM. Herein, we employed label-free Raman spectromicroscopy, which integrated stimulated Raman scattering (SRS) microscopy and confocal Raman spectroscopy, to quantitatively analyze both the amount and composition of intracellular LDs in intact GBM tissues obtained from patients who had undergone resection surgery. Our results showed significant reductions in both the LD amount and the CE percentage in MGMT unmethylated GBMs (MGMT methylation < 15%) compared to MGMT methylated ones (MGMT methylation ≥ 15%). Due to a big variation of lipid accumulation in the MGMT methylated GBMs, these patients were further divided into hypermethylated group (MGMT methylation ≥ 50%) and intermediate-methylated group (MGMT methylation 15∼50%), according to the significantly different median survival rates of these two groups. Remarkable differences in LD amount, CE percentage, and also lipid saturation degree were found between the hypermethylated group and the other two groups, but not between the unmethylated and intermediate-methylated groups. To elucidate the possible underlying mechanism, we analyzed the differential expression of lipid metabolism-related genes in GBM with different levels of MGMT methylation using The Cancer Genome Atlas Program (TCGA) dataset. It was shown that the genes related to lipid oxidation and lipid efflux were upregulated, and the genes related to lipid synthesis were downregulated in unmethylated group. These findings unravel the relationship between MGMT methylation and lipid accumulation in GBM, which may offer new opportunities for the diagnosis and treatment of TMZ-resistant GBM.

Methylprednisolone is related to lower incidence of postoperative bleeding after flow diverter treatment for unruptured intracranial aneurysm.

Background and objectives: Regarding the anti-inflammatory effect, methylprednisolone is a candidate to prevent patients with unruptured intracranial aneurysms (UIAs) from postoperative bleeding (PB) after flow diverter (FD) treatment. This study aimed to investigate whether methylprednisolone is related to a lower incidence of PB after FD treatment for UIAs. Methods: This study retrospectively reviewed UIA patients receiving FD treatment between October 2015 and July 2021. All patients were observed until 72 h after FD treatment. The patients receiving methylprednisolone (80 mg, bid, for at least 24 h) were considered as standard methylprednisolone treatment (SMT) users, otherwise as non-SMT users. The primary endpoint indicated the occurrence of PB, including subarachnoid hemorrhage, intracerebral hemorrhage, and ventricular bleeding, within 72 h after FD treatment. This study compared the incidence of PB between SMT users and non-SMT users and investigated the protective effect of SMT on PB after FD treatment using the Cox regression model. Finally, after controlling the potential factors related to PB, we performed subgroup analysis to further confirm the protective effect of SMT on PB. Results: This study finally included 262 UIA patients receiving FD treatment. PB occurred in 11 patients (4.2%), and 116 patients (44.3%) received SMT postoperatively. The median time from the end of surgery to PB was 12.3 h (range: 0.5-48.0 h). SMT users had a lower incidence of PB comparing with non-SMT users (1/116, 0.9% vs. 10/146, 6.8%, respectively; p = 0.017). The multivariate Cox analysis demonstrated that SMT users (HR, 0.12 [95%CI, 0.02-0.94], p = 0.044) had a lower risk of PB postoperatively. After controlling the potential factors related to PB (i.e., gender, irregular shape, surgical methods [FD and FD + coil] and UIA sizes), the patients receiving SMT still had a lower cumulative incidence of PB, comparing with patients receiving non-SMT (all p < 0.05). Conclusion: SMT was correlated with the lower incidence of PB for patients receiving FD treatment and may be a potential method to prevent PB after the FD treatment.

Neuroform atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms.

Objective: To investigate the safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of tiny wide-necked intracranial aneurysms and evaluate risk factors associated with procedure-related complications. Methods: We retrospectively examined 46 patients with 46 tiny wide-necked aneurysms who were treated using Atlas stent-assisted coiling at our institution from August 2020 to May 2022. Patient and aneurysm characteristics, procedural details, procedure-related complications, and angiographic and clinical outcomes were analyzed. Results: A total of 10 patients presented with aneurysmal rupture. Atlas stent placement was successful in all patients. Angiography immediately after the procedure showed complete occlusion in 38 patients (82.6%), neck remnant in 7 (15.2%), and partial occlusion in 1 (2.2%). The mean angiographic follow-up was 8.4 months (range, 6-16). At the last follow-up, angiography showed complete occlusion in 41 patients (89.1%) and neck remnant in 5 (10.9%). No aneurysm recurrence or in-stent stenosis occurred. Incidence of procedure-related complications was 10.8% (intraprocedural aneurysm rupture, two cases; acute thrombosis, two cases; and coil migration, one case); only one patient (2.2%) experienced procedural neurological morbidity. The mean clinical follow-up was 9.7 months. A favorable outcome was achieved in 45 patients (97.8%). In univariate logistic regression analysis, aneurysm size (odds ratio, 4.538; P = 0.045) was significantly associated with procedure-related complications. However, multivariate analysis found no independent risk factors. Conclusion: Atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms is feasible and effective. Outcomes and occlusion rates are favorable and morbidity is low. The complication rate may be higher in larger tiny aneurysms.

Stent-assisted coiling using the Neuroform Atlas stent for treatment of aneurysms that recur after coil embolization.

Objective: To evaluate the safety and efficacy of stent-assisted coiling (SAC) using the Neuroform Atlas stent for aneurysms that recur after coil embolization. Methods: We retrospectively reviewed patients who underwent SAC using the Neuroform Atlas stent to treat aneurysms that recurred after coil embolization from November 2020 to November 2021. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical follow-up outcomes were recorded and analyzed. Results: Eleven patients with 11 recurrent aneurysms were included for analysis. Atlas stent deployment was successful in all cases. Angiography immediately after the SAC procedure and at last follow-up showed complete occlusion in 10 patients (90.9%) and a residual neck in one (9.1%). Mean angiographic and clinical follow-ups were 9.2 and 10 months, respectively. A single procedure-related complication occurred, mildly blurred vision in the left eye, which recovered completely. No permanent morbidity or mortality occurred. Conclusion: SAC using the Atlas stent to treat aneurysms that recur after coil embolization is safe and effective. Large-scale studies with long-term follow-up are warranted to confirm our results.

Endovascular Treatment for Aneurysms Located in the Posterior Communicating Artery (PCoA) by the Swinging-Tail Technique: A Technical Note.

PURPOSES: A stent-assisted coil (SAC) is a safe and effective treatment modality for some complex intracranial aneurysms, especially for wide neck aneurysms. However, some wide neck aneurysms with a tough angle and located in the posterior communicating artery (PCoA) are challenging to treat with a SAC. This study aimed to examine and discuss the swinging-tail technique for treating wide neck aneurysms located in the PCoA using a SAC by Prof. Lv. MATERIALS AND METHODS: We retrospectively reviewed our institutional clinical database and identified nine patients with neck aneurysms located in the PCoA, and these patients underwent the swinging-tail technique by Prof. Lv, which is a novel technique of releasing a stent, from June 2016 to September 2021. RESULTS: In this study, nine patients underwent SAC treatment using the swinging-tail technique by Prof. Lv. Aneurysmal complete occlusion was observed in every patient without any complications, as shown by immediate postoperative angiography. Additionally, the modified Rankin scale was monitored for clinical outcomes in the follow-up. One patient died postoperatively due to severe SAH with an intraventricular hemorrhage. Four of nine patients underwent imaging follow-up, demonstrating the complete occlusion of aneurysms; eight patients underwent clinical follow-up and achieved a favorable clinical outcome (modified Rankin scale score: 0-2). CONCLUSION: The SAC treatment for wide neck aneurysms located in the PCoA can be challenging for operators because of the specific location, resulting in inadequate vessel wall apposition by antegrade stenting via the ipsilateral vessel. In this circumstance, the swinging-tail technique may be a feasible and effective choice.

Subgroup Analysis by Liver Metastasis in the FRESCO Trial Comparing Fruquintinib versus Placebo Plus Best Supportive Care in Chinese Patients with Metastatic Colorectal Cancer.

OBJECTIVE: The aim of the present subgroup analysis of the FRESCO trial is to determine the efficacy and hepatotoxicity of fruquintinib in Chinese patients with metastatic CRC with liver metastasis (CRLM) who were receiving third-line or posterior-line therapy. METHODS: Overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier method. Hazard ratio (HR) was estimated through Cox proportional hazards model. Hepatotoxicity was coded using the standardized MedDRA queries of hepatic failure, fibrosis, cirrhosis, and other liver injury-related conditions and graded using the Common Terminology Criteria Adverse Events grades. The efficacy of fruquintinib in patients with CRLM was evaluated in various subgroups. RESULTS: A total of 287 (69.0%) patients with metastatic CRC had liver metastasis (LM, fruquintinib: 185 and placebo: 102). Median OS in patients with CRLM was significantly prolonged with fruquintinib compared with placebo (8.61 months vs 5.98 months; HR=0.59, 95% CI, 0.45-0.77, P<0.001). In patients with CRLM, the incremental median PFS for patients in the fruquintinib-treated group was significantly higher than in the placebo group (median PFS: 3.71 vs.1.84 months; HR=0.22, 95% CI: 0.17-0.30; P<0.001). Compared with placebo, significant improvements in OS were observed with fruquintinib in LM patients regardless of lung metastasis, prior target therapy, and K-RAS status. In patients with CRLM, treatment-emergent hepatotoxicities of any grade occurred in 7 (3.8%) patients in the fruquintinib group vs 2 (2.0%) in the placebo group. CONCLUSION: Fruquintinib demonstrated a statistically significant increase in OS and PFS as compared with placebo in Chinese patients with CRLM. The hepatotoxicity of fruquintinib was less reported, and comparable with placebo in patients with CRLM. CLINICALTRIALSGOV IDENTIFIER: NCT02314819.

Treatment of Unruptured Vertebral Artery Aneurysm Involving Posterior Inferior Cerebellar Artery With Pipeline Embolization Device.

Background: Treatment of unruptured vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA) is challenging. The experience of pipeline embolization device (PED) therapy for these lesions is still limited. Objective: To evaluate the safety and efficacy of the PED for unruptured vertebral artery aneurysm involving PICA. Methods: Thirty-two patients with unruptured vertebral artery aneurysm involving PICA underwent treatment with PED were retrospectively identified. Procedure-related complications, PICA patency, clinical, and angiographic outcomes were analyzed. Results: Thirty-two aneurysms were successfully treated without any procedure-related complications. Images were available in 30 patients (93.8%) during a period of 3-26 months follow-up (average 8.4 months), which confirmed complete occlusion in 17 patients (56.5%), near-complete occlusion in 9 patients (30%), and incomplete occlusion in one patient (3.3%). Parent artery occlusion (PAO) was occurred in 3 patients (10%). Twenty-eight of 30 PICA remained patent. The two occlusions of PICA were secondary to PAO. At a mean of 20.7 months (range 7-50 months) clinical follow-up, all the patients achieved a favorable outcome without any new neurological deficit. Conclusion: PED seems to be a safe and effective alternative endovascular option for patients with unruptured vertebral artery aneurysm involving PICA.

Embolization of Cavernous Sinus Dural Arteriovenous Fistula (CSDAVF) via transvenous approaches: Practice, experience summary and literature review.

OBJECTIVE: To evaluate the safety and efficacy of embolization via transvenous approaches in patients diagnosed with Cavernous Sinus Dural Arteriovenous Fistula (CSDAVF). We also hope to further summarize our preliminary experiences with transvenous approaches. MATERIAL AND METHODS: We retrospectively collected data from patients who were diagnosed with CSDAVF and were treated with embolization via transvenous approaches from June 2014 to November 2020 at Beijing Tiantan Hospital. We evaluated the safety and efficacy of this treatment using radiological results and clinical follow-up. RESULTS: A total of 83 patients were included in this study. Complete occlusion was obtained in 76 (89.4%) patients. Sub-total occlusion was obtained in eight (9.4%) patients. Partial occlusion was obtained in one (1.2%) patient. There was no recurrence. Seventy-six patients (91.5%) were cured, and seven patients showed symptom improvement (8.5%). There were no cases of worsening symptoms following embolization, and only ten (12.0%) cases had mild complications. CONCLUSION: There was a high occlusion rate and a low complication rate in our study. Thus, completing embolization of CSDAVF via transvenous approaches may be safe and effective. However, this operation is more difficult than those via transarterial approaches. Transvenous embolization should therefore be performed in an experienced medical center.

Prevalence and coprevalence of modifiable risk factors for upper digestive tract cancer among residents aged 40-69 years in Yangzhong city, China: a cross-sectional study.

OBJECTIVES: To describe the prevalence of modifiable risk factors for upper digestive tract cancer (UDTC) and its coprevalence, and investigate relevant influencing factors of modifiable UDTC risk factors coprevalence among residents aged 40-69 years in Yangzhong city, China. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 21 175 participants aged 40-69 years were enrolled in the study. 1962 subjects were excluded due to missing age, marital status or some other selected information. Eventually, 19 213 participants were available for the present analysis. MAIN OUTCOMES MEASURES: Prevalence and coprevalence of eight modifiable UDTC risk factors (overweight or obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food) were analysed. RESULTS: The prevalence of overweight/obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food in this study was 45.3%, 24.1%, 16.2%, 66.1%, 94.5%, 68.1%, 36.0% and 88.4%, respectively. Nearly all (99.9%) participants showed one or more UDTC risk factors, 98.6% of the participants showed at least two risk factors, 92.2% of the participants had at least three risk factors and 69.7% of the participants had four or more risk factors. Multivariate logistic regression analysis revealed that men, younger age, single, higher education, higher annual family income and smaller household size were more likely to present modifiable UDTC risk factors coprevalence. CONCLUSIONS: The prevalence and coprevalence of modifiable UDTC risk factors are high among participants in Yangzhong city. Extra attention must be paid to these groups who are susceptible to risk factors coprevalence during screening progress. Relative departments also need to make significant public health programmes that aim to decrease modifiable UDTC risk factors coprevalence among residents aged 40-69 years from high-risk areas of UDTC.

Case Report: Persistent Primitive Hypoglossal Artery Accompanied by a Basilar Bifurcation Aneurysm Treated by Y-Stent-Assisted Coil Embolization.

Successful embolization of a basilar bifurcation aneurysm associated with a persistent primitive hypoglossal artery (PPHA) using Y-stent-assisted coiling.

Subgroup analysis by prior anti-VEGF or anti-EGFR target therapy in FRESCO, a randomized, double-blind, Phase III trial.

Background: FRESCO study demonstrated efficacy and safety of fruquintinib in metastatic colorectal cancer patients. Impact of prior targeted therapy (PTT) on efficacy and safety of fruquintinib was evaluated. Materials & methods: In this subgroup analysis of FRESCO trial, patients were divided into PTT and non-PTT subgroups, and efficacy and safety of fruquintinib were assessed, respectively. Results: In non-PTT subgroup, fruquintinib significantly prolonged overall survival (OS) and progression-free survival (PFS) of patients compared with placebo. In PTT subgroup, the median OS and PFS of patients in fruquintinib arm was significantly higher than those in placebo. Treatment-emergent adverse events (TEAEs) rates were similar in both subgroups. Conclusion: Fruquintinib demonstrated clinically meaningful improvement in OS, PFS, objective response rate, and disease control rate with manageable TEAEs in both subgroups. Clinical trial registration: NCT02314819 (ClinicalTrials.gov).

Lay abstract In this analysis of the FRESCO trial, we evaluated the efficacy and safety of fruquintinib in two different groups of patients (subgroups) with metastatic colorectal cancer - patients who received prior targeted therapy (PTT) and patients who did not (non-PTT). Of the 278 patients treated with fruquintinib, 111 patients received PTT. Patients treated with fruquintinib had longer overall survival and it took longer for their disease to worsen in both PTT and non-PTT subgroups compared with placebo. Patients in both subgroups treated with fruquintinib showed measurable reduction in their tumor size and disease control with similar side effects in patients of both the subgroups. These results suggest that fruquintinib is safe and effective in patients with metastatic colorectal cancer in both subgroups.

Evaluating the Tubridge™ flow diverter for large cavernous carotid artery aneurysms.

BACKGROUND: The Tubridge™ flow diverter (TFD) was recently developed in China; however, its safety and efficacy in treating large cavernous carotid artery aneurysms (LCCAs) are unclear. Our objective was to evaluate the safety and efficacy of the TFD in patients receiving TFDs to treat LCCAs (10-25 mm). METHODS: Between June 2013 and May 2014, seven patients with LCCAs were enrolled in our study, and all seven patients underwent TFD implantation combined with coils. RESULTS: Angiographic follow-up images were available for all seven patients at a median of 57.5 ± 16.7 (range, 6-69) months. Seven patients obtained favorable angiographic results defined as O'Kelly-Marotta Scale C and D. Clinical follow-up data were available for all seven patients at a median of 73.32 ± 3.6 (range, 66-78) months. No patients developed new neurological deficits. Six patients achieved a modified Rankin scale score of 0, and diplopia improved in the remaining patient. CONCLUSIONS: The results were excellent for the aneurysms treated with TFDs in our patients with LCCAs. TFDs are feasible for the treatment of LCCAs, but a multicenter, controlled clinical trial is needed to evaluate the long-term safety and efficacy of the TFD to treat LCCAs.

Pediatric Patient With a Giant Vertebrobasilar Dissecting Aneurysm Successfully Treated With Three Pipeline Embolization Devices.

Pediatric intracranial dissecting aneurysms are rare (1), and treating this type of aneurysm in the vertebrobasilar circulation is more difficult. As an off-label application, pipeline embolization devices (PEDs) for posterior circulation dissecting aneurysms are reported to have good therapeutic effect (2). However, studies have found that PEDs for large or giant vertebrobasilar dissecting aneurysms have a poor effect and are associated with disastrous consequences for patients (3). PEDs are feasible for vertebrobasilar dissecting aneurysms (4); however, few reports discuss using PEDs to span the entire segment of the basilar artery. Because there are more perforating arteries in the basilar artery, it is more prudent to use PEDs in this artery. We report a case of a pediatric patient with a giant vertebrobasilar dissecting aneurysm successfully treated with three PEDs combined with right vertebral artery occlusion, without complications. The patient's headache symptoms resolved fully 3 months after the procedure, and the aneurysm was completely healed and excellent reconstruction of the left vertebral artery was seen 4 months post-procedure, using digital subtraction angiography.

Endovascular Treatment of Large or Giant Non-saccular Vertebrobasilar Aneurysms: Pipeline Embolization Devices Versus Conventional Stents.

BACKGROUND: Endovascular treatment of large or giant non-saccular vertebrobasilar aneurysms (VBAs) by conventional stents is difficult and has unsatisfactory outcomes. OBJECT: This study was performed to retrospectively analyze the safety and efficacy of a flow diverter in treating large and giant non-saccular VBAs. METHODS: We identified 78 patients with 83 large or giant non-saccular VBAs who accepted endovascular treatment with a pipeline embolization device (PED) or conventional stent from January 2014 to June 2018. The technical details of the procedure, procedure-associated complications, angiographic outcomes, and clinical outcomes were evaluated. RESULTS: Forty-two patients (53.8%, 42/78) with 44 aneurysms (53.0%, 44/83) underwent endovascular treatment with PEDs. Thirty-six patients (46.2%, 36/78) with 39 aneurysms (47.0%, 39/83) underwent endovascular treatment with conventional stents. The complication rate of PED group and conventional stent group was 7.1% (3/42) and 5.6% (2/36), respectively (odds ratio, 0.765; 95% confidence interval, 0.121-4.851; P = 0.776). During a median follow-up time of 28.8 months, the complete occlusion rate in the PED group and conventional stent group was 90.2% (37/41) and 70.3% (26/37), respectively (odds ratio, 3.913; 95% confidence interval, 1.122-13.652; P = 0.032). CONCLUSION: Endovascular treatment with a PED is a promising and safe modality for large and giant non-saccular VBAs, and the complication rate is acceptable, compared with conventional endovascular treatment.