Determination of the UGT1A1 polymorphism as guidance for irinotecan dose escalation in metastatic colorectal cancer treated with first-line bevacizumab and FOLFIRI (PURE FIST).

Aim: Uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) polymorphism plays a crucial role in the increased susceptibility of patients to irinotecan and its toxicity. This study is a multicenter, randomised clinical trial comparing the clinical outcomes and adverse events (AEs) in metastatic colorectal cancer (mCRC) patients treated with bevacizumab plus FOLFIRI with or without UGT1A1 genotyping and irinotecan dose escalation as the first-line therapy.

Methods: The control group received conventional biweekly FOLFIRI plus bevacizumab without UGT1A1 genotyping, whereas the study group received the same regimen with irinotecan dose escalation based on UGT1A1 genotyping.

Transfemoral Approach for Intraoperative Angiography in the Prone or Three-quarter Prone Position : A Revisited Protocol for Intracranial Arteriovenous Malformation and Fistula Surgery.

Purpose: Among the different arterial accesses, the femoral access is the main approach for intraoperative angiography (IOA) performed in a prone position. Without a standardized protocol, however, the application of prone IOAs in intracranial arteriovenous malformation (AVM) or arteriovenous fistula (AVF) surgery remains limited by its procedural complexity. This study describes the detailed protocol for prone IOA through a transfemoral approach and highlights several refinements in preparing this procedure.

Observational study of dronedarone in Taiwanese patients with atrial fibrillation.

Background/purpose: Currently, data on the real-world use of dronedarone, an antiarrhythmic drug for atrial fibrillation (AF), are contradictory and often based on patient populations comprised of Caucasians. We prospectively investigated the efficacy and safety of dronedarone and risk factors related to treatment outcomes in a real-world use setting.

Methods: The prospective, observational, single-arm, multi-center study included a total of 824 Taiwanese patients with a diagnosis of paroxysmal or persistent AF and receiving dronedarone treatment.

Drainage outflow restriction as a parameter associated with cortical venous reflux in craniofacial arteriovenous malformations with cavernous sinus drainage.

Purpose: Craniofacial arteriovenous malformations (CF-AVMs) are locally aggressive extracranial lesions. When CF-AVMs involve cavernous sinus (CS) as their draining vein, they represent a special subgroup which may interfere intracranial venous system. In this study, we aimed to analyze the venous drainage patterns of CF-AVMs with CS drainage and to demonstrate how it affected our treatment strategy.

Impact of Intraoperative 3-Dimensional Volume-Rendering Rotational Angiography on Clip Repositioning Rates in Aneurysmal Surgery.

Objective: Three-dimensional (3D) rotational angiography (RA), a gold standard imaging tool for the evaluation of cerebral aneurysms after clipping, can currently be performed intraoperatively in a hybrid operating room (OR). However, its role in intraoperative aneurysmal surgery is unclear. We aimed to study the value of intraoperative 2-dimensional digital subtraction angiography (2D-DSA) and 3D-RA for the evaluation of aneurysms after clipping, in terms of clip repositioning.

Stress stimuli induce cancer-stemness gene expression via Sp1 activation leading to therapeutic resistance in glioblastoma.

It has been suggested that stress stimuli from the microenvironment maintain a subset of tumor cells with stem-like properties, including drug resistance. Here, we investigate whether Sp1, a stress-responsive factor, regulates stemness gene expression and if its inhibition sensitizes cancer cells to chemotherapy. Hydrogen peroxide- and serum deprivation-induced stresses were performed in glioblastoma (GBM) cells and patient-derived cells, and the effect of the Sp1 inhibitor mithramycin A (MA) on these stress-induced stem cells and temozolomide (TMZ)-resistant cells was evaluated.

Rendering a ruptured arteriovenous malformation more susceptible to spontaneous obliteration as a possible treatment strategy for cerebral AVM.

Spontaneous regression of cerebral arteriovenous malformation (AVM) is a rare phenomenon, but its occurrence is an important consideration in treatment planning. A 58-year-old male was found to have a high-flow AVM of Spetzler-Martin Grade III. Before his scheduled treatment, the AVM ruptured with a large parenchymal hemorrhage.

Accurate Localization of Aneurysm Neck Margins in Clipping of a Carotid Cave Aneurysm Using Intraoperative Dual-Volume 3-Dimensional Volume-Rendering Rotational Angiography.

Background: Full visualization of the aneurysm neck is usually impossible in a classical pterional craniotomy when a paraclinoid aneurysm is located on the opposite side of the internal carotid artery. Optic nerve (ON) retraction is required for better aneurysmal exposure, but ON injuries may occur.

Clinical Description: In a case of a 70-year-old female harboring a carotid cave aneurysm, we introduced a new method to delineate better the margins of the aneurysm neck by using intraoperative 3-dimensional (3D) rotational angiography (RA) with dual-volume reconstruction.

4D-CT angiography with arterial- and venous-phase anatomical pre-surgical approaches in cases with head and neck neoplasms.

Purpose: The relationship between neoplasm and its surrounding vascular structure is essential to the following clinical treatment plan. In this study, 4D computed tomography angiography (4D-CTA) with a wide scan range and dynamic phases of arteriography and venography was used to describe detailed anatomical information for pre-surgical approaches.

Materials And Methods: From January 2011 to February 2012, we subjected 13 patients with head and neck neoplasms to 4D-CTA.

Regression of moyamoya-associated weak spots on the distal anterior choroidal artery following surgical revascularization.

A 20-year-old female with moyamoya disease presented with acute intraventricular hemorrhage. Cerebral angiography demonstrated that the anterior choroidal artery (AChA) was responsible for the bleeding, but the precise point of rupture was unpredictable, because multiple angiographic weak spots were found on the artery. As direct targeting of the rupture point was unfeasible, we performed encephalo-duro-arterio-synangiosis to decrease the hemodynamic overload on the AChA.

Low-flow direct carotid-cavernous fistula caused by rupture of an intracavernous carotid aneurysm.

Direct carotid-cavernous fistulas (CCFs) secondary to a ruptured intracavernous carotid aneurysm (ICCA) are usually high-flow lesions. On very rare occasions, a ruptured ICCA may present as a low-flow CCF, which poses a diagnostic and therapeutic dilemma whether the aneurysm and the observed fistula are causally related. Herein, we describe a rare case in which a ruptured ICCA resulted in a low-flow CCF.

Percutaneous vertebroplasty performed with an 18-gauge needle for treatment of metastatic severe compression fracture of the cervical vertebral body.

Percutaneous vertebroplasty (PVP) is considered technically difficult in patients with severe vertebral body compression, especially in the cervical spine. In this study, PVP was successfully performed with the use of an 18-gauge angiographic needle in four patients with severe cervical compression fractures from metastatic disease. There were no complications, and relief of pain was immediate in all patients.

Establishing a rabbit spinal tumor model for nonvascular interventional therapy through CT-guided percutaneous puncture inoculation.

Background And Purpose: An animal spinal tumor model is needed to better simulate the clinical situation and to allow percutaneous puncture, which may provide an experimental platform for the new nonvascular interventional therapies. We established a rabbit spinal tumor model through a CT-guided percutaneous puncture inoculation technique for nonvascular interventional therapy.

Materials And Methods: VX2 tumor cells were inoculated into the lumbar vertebrae of 32 rabbits through a CT-guided percutaneous puncture technique; then, the development of hind limb paraparesis was observed in the rabbits twice a day.

Factors determining the success of endovascular treatments among patients with spinal dural arteriovenous fistulas.

Introduction: Despite improvements of embolization agents and techniques, endovascular treatment of spinal dural arteriovenous fistula (SDAVF) is still limited by inconsistent success. The aim of embolization is to occlude initial portion of the draining vein by liquid embolic materials. This study investigates factors that contribute to the success of embolization treatments among SDAVF patients.

Magnetic resonance evolution of de novo formation of a cavernoma in a thrombosed developmental venous anomaly: a case report.

Background And Importance: Mechanisms that lead to de novo formations of nonfamilial-type cavernomas are not well understood. One of the interesting hypotheses is the causative relationship between developmental venous anomaly (DVA) and cavernoma formation. We report a unique case in which serial imaging demonstrated the evolution of de novo formation of a cavernoma in association with a thrombosed DVA.

Vitamin D in chronic kidney disease.

Vitamin D deficiency is widespread in both the pediatric and adult chronic kidney disease (CKD) population. CKD is characterized by dysregulation of vitamin D and mineral metabolism. Secondary hyperparathyroidism and its management puts patients with CKD at increased cardiovascular risk.