BACKGROUND: The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients since the results have varied. PURPOSE: This study aimed to investigate the clinical outcome of PEDC compared to PED in treating intracranial aneurysms. DATA SOURCES: We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024. STUDY SELECTION: We selected studies comparing PEDC vs. PED to treat intracranial aneurysms. Patients treated with PEDC but using dense coiling were excluded from the study. DATA ANALYSIS: The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤ 2), complete occlusion rate, and retreatment rate. Forest plot was used to analyze pooled Odds Ratio (OR) of clinical outcomes. DATA SYNTHESIS: A total of 3001 subjects from nine observational studies were included. PEDC was mainly used to treat larger aneurysms. PEDC has a significantly higher complete occlusion rate at 6 months [OR= 2.66, 95% CI(1.26, 5.59), p= 0.01], a lower retreatment rate [OR= 0.18, 95% CI(0.05, 0.07), p= 0.010], higher stroke-related complications [OR= 1.66, 95% CI(1.16, 2.37), p= 0.005], and higher hemorrhage-related complications [OR= 1.98, 95% CI(1.22, 3.21), p = 0.005]. There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study. LIMITATIONS: No randomized controlled trials have been performed comparing PEDC and PED. Considering that all the included studies were observational, the patients9 baseline characteristics were not completely balanced. CONCLUSIONS: This meta-analysis study showed that PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms. ABBREVIATIONS: F = female; FDDs = flow-diverter devices; M = male; NOS = Newcastle-Ottawa Scale; PED = pipeline embolization device; PEDC = pipeline embolization device in combination with coils.

Bevacizumab (BEV) is known to improve progression-free survival (PFS) but not overall survival (OS) for newly diagnosed glioblastoma (ndGBM). Here, we evaluated the survival outcomes between temozolomide (TMZ)-only and TMZ + BEV treatments stratified based on the cyclooxygenase-2 (COX-2) expression, a rate-limiting enzyme involved in the cancer development. Fifty IDH-wildtype ndGBM patients treated between 2012 and 2023 were enrolled in this study. Pretreatment levels of COX-2 protein and mRNA expression were quantified, and survival analyses were performed based on the immunoreactivity score (IRS). Patients with high COX-2 expression (IRS ≥ 3, determined by its median) also exhibited higher COX-2 mRNA levels (∆Ct 6.43 ± 1.64 vs. 7.67 ± 0.81; p = 0.020). In patients with high COX-2 expression, TMZ + BEV had significantly longer median PFS and OS than those receiving TMZ-only (PFS: 22 vs. 8 months, p < 0.001; OS: 25 vs. 18 months, p = 0.009). In contrast, these benefits were not found in patients with low COX-2 expression (PFS: 12 vs. 15 months, p = 0.875; OS: 24 vs. 26 months, p = 0.775). Altogether, this study suggests that patients with high, but not low, COX-2 expression demonstrate survival benefits from the addition of BEV in ndGBM.

Background: The global COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), experienced a surge in cases with the emergence of the Omicron variant. Despite increasing vaccination coverage, Indonesia witnessed peaks in COVID-19 cases. Variant screening and whole genome sequencing (WGS) play a crucial role in identifying SARS-CoV-2 variants and monitoring their spread.Objective: The objective of this study was to compare variant screening results with WGS data, assess the prevalence of subvariants, and analyze their correlation with demographic and cycle threshold (CT) values.Methods: Between November 7th and 18th, 2022, variant screening and WGS were conducted on samples with CT values below 30. Variant screening utilized the mBioCov-19+ VarScreen assay, while WGS was performed on the Oxford Nanopore Technologies (ONT) platform. Bioinformatics analysis was performed using epi2melabs. Demographic data and CT values were analyzed. Results: Out of 89 subjects, all tested positive for the Omicron variant through variant screening. The variant screening identified two subvariants: Omicron BA.2 (64%) and Omicron B.1.1.529.1 (36%). WGS revealed that the XBB subvariant was the most dominant (52.8%), followed by BQ.1 (22.5%) and BA.5 (13.5%). When VarScreen indicated BA.2, the majority of WGS results showed XBB (82.5%), while for B.1.1.529.1, the majority of WGS results were BQ.1 (59.4%), followed by BA.5 (37.5%). XBB was the most prevalent variant in both females and males, while BQ.1 was more dominant in females (80%). No infections were detected among children aged 1-5 years. All variants had CT values below 24.Conclusion: Variant screening provides accurate and quick results for detecting the Omicron variant in laboratories without WGS capacity. However, it is important to continuously update the screening methodology based on the prevailing circulating variants. During the study period, XBB emerged as the predominant subvariant of the Omicron variant.

Background: Pituitary adenomas (PAs) are the most prevalent neuroendocrine tumour. Inflammation, both within the tumour microenvironment and systemically, plays a role in tumour biology. Haematological laboratory data serves as an initial and cost-effective approach. This study explores the association between haematological indices (e.g., NLR, PLR, LMR) and PA characteristics (tumour size, sellar erosion, cavernous sinus invasion). Methods: A retrospective study (2018–January 2023) analysed preoperative haematological data (such as neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte ratio [PLR], and lymphocyte to monocyte ratio [LMR]) from PA patients. The haematological data was analysed based on tumour characteristic with p 0.05 considered significant. Results: Among 64 patients (mean age 45.55±14.67), 20–40% had elevated NLR, PLR, and LMR. Tumour characteristics included 60.9% macroadenomas and 39.1% giant PAs, with 43.8% showing sellar erosion and 42.2% cavernous sinus invasion. Monocyte counts were significantly higher in giant PAs vs. macroadenomas (7.48 ± 1.91 vs. 6.49 ± 1.95, p=0.040), and platelet counts were higher in sellar erosion vs. enlargement (336,710 ± 90,460 vs. 284,720 ± 89,766, p=0.016). Conclusion: Our study found that patients with giant PAs had significantly higher monocyte counts.