PURPOSE Radiation dose received by the neural stem cells of the hippocampus during whole-brain radiotherapy has been associated with neurocognitive decline. The key concern using hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) in patients with small-cell lung cancer (SCLC) is the incidence of brain metastasis within the hippocampal avoidance zone. METHODS This phase III trial enrolled 150 patients with SCLC (71.3% with limited disease) to standard prophylactic cranial irradiation (PCI; 25 Gy in 10 fractions) or HA-PCI. The primary objective was the delayed free recall (DFR) on the Free and Cued Selective Reminding Test (FCSRT) at 3 months; a decrease of 3 points or greater from baseline was considered a decline. Secondary end points included other FCSRT scores, quality of life (QoL), evaluation of the incidence and location of brain metastases, and overall survival (OS). Data were recorded at baseline, and 3, 6, 12, and 24 months after PCI. RESULTS Participants' baseline characteristics were well balanced between the two groups. The median follow-up time for living patients was 40.4 months. Decline on DFR from baseline to 3 months was lower in the HA-PCI arm (5.8%) compared with the PCI arm (23.5%; odds ratio, 5; 95% CI, 1.57 to 15.86; P = .003). Analysis of all FCSRT scores showed a decline on the total recall (TR; 8.7% v 20.6%) at 3 months; DFR (11.1% v 33.3%), TR (20.3% v 38.9%), and total free recall (14.8% v 31.5%) at 6 months, and TR (14.2% v 47.6%) at 24 months. The incidence of brain metastases, OS, and QoL were not significantly different. CONCLUSION Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC. No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.

The interaction of ultrashort, high intensity laser pulses with thin foil targets leads to ion acceleration on the target rear surface. To make this ion source useful for applications, it is important to optimize the transfer of energy from the laser into the accelerated ions. One of the most promising ways to achieve this consists in engineering the target front by introducing periodic nanostructures. In this paper, the effect of these structures on ion acceleration is studied analytically and with multidimensional particle-in-cell simulations. We assessed the role of the structure shape, size, and the angle of laser incidence for obtaining the efficient energy transfer. Local control of electron trajectories is exploited to maximize the energy delivered into the target. Based on our numerical simulations, we propose a precise range of parameters for fabrication of nanostructured targets, which can increase the energy of the accelerated ions without requiring a higher laser intensity.

In experimental models, growth factors (GFs) such as vascular endothelial growth factor (VEGF), Angiopoietin 1 (Ang-1), or granulocyte-colony stimulating factor (G-CSF) mediate brain recovery after intracerebral hemorrhage (ICH). Our aim was to study the association between serum levels of GF and clinical outcome in patients with ICH. A total of 95 patients with primary ICH (male, 66.3%; mean age, 67.8 ± 9.8 years) were prospectively included in the study within 12 h from symptoms onset. The main outcome variable was good functional outcome at 3 months (modified Rankin scale p2). Median serum levels of GF at 72 h from stroke onset were significantly higher in patients with good outcome (n = 39) compared with those with poor outcome (all P < 0.0001). Serum levels of VEGF X330 pg/mL, G-CSF X413 pg/mL, and Ang-1 X35 ng/mL at 72 h were independently associated with good functional outcome (odds ratio (OR), 11.2; 95% confidence interval (CI): 2.9 to 43.0; OR, 19.6; 95% CI: 3.9 to 97.9; and OR, 14.7; 95% CI: 3.6 to 60.0, respectively), neurologic improvement (all P < 0.0001) and reduced residual cavity at 3 months (all P < 0.01). These results illustrate that high serum levels of GF are associated with good functional outcome and reduced lesion volume in ICH.

SUMMARY:We present the case of a patient with a fusiform aneurysm of the M1 segment of the middle cerebral artery (MCA) in which endovascular stent placement without coiling was performed. A 3.5-mm ϫ 25-mm LEO self-expanding stent was deployed along the fusiform aneurysm of the horizontal MCA M1 segment. Digital subtraction angiography showed progressive thrombosis at 6 months and complete thrombosis of the fusiform MCA aneurysm at 12 months.T he introduction of the Guglielmi detachable coil in 1991 [1][2] radically changed the approach to intracranial aneurysms, and endovascular treatment became a frequent choice for many ruptured intracranial aneurysms. Recently, new techniques and materials have widened the range of aneurysms susceptible to endovascular treatment. However, the management of fusiform intracranial aneurysms remains controversial. We present the case of a 52-year-old man with a fusiform aneurysm of the middle cerebral artery (MCA), who was successfully treated with the placement of a Leo stent. To our knowledge, this is the first fusiform MCA aneurysm successfully treated using the placement of a neurovascular dedicated stent. Case ReportA 52-year-old man was referred to our hospital for a partially thrombosed fusiform large aneurysm of the M1 segment of the MCA. The aneurysm was diagnosed after the patient had undergone MR imaging at another institution because of acute-onset aphasia and right hemiparesis. The patient's medical and family history was unremarkable. MR imaging examination revealed a partially thrombosed MCA aneurysm and a subacute infarction in the left MCA territory (lenticulostriate branches). Digital subtraction angiography showed a large fusiform aneurysm (1.7 ϫ 1.5 ϫ 1.4 cm) that extended over the horizontal segment of the MCA (Fig. 1).The patient experienced a marked neurologic improvement. Because of the persistent risk for thromboembolism, endovascular treatment was performed. The patient was pretreated for 3 days with aspirin 325 mg/day and clopidogrel (Plavix) 75 mg/day. After induction of general anesthesia, a 6F Envoy guiding catheter (Cordis, Miami Lakes, Fla) was placed in the internal carotid artery. The patient was anticoagulated with intravenous administration of heparin; the activated clotting time at 2.5 times the basal level was maintained. The aneurysm was bypassed with a Prowler microcatheter (Cordis) distal to the neck of the aneurysm. A 300-cm, 0.0014-inch exchange wire was placed through the microcatheter. The microcatheter was removed, and a Vasco (Balt, Montmorency, France) microcatheter 21 was advanced over the wire to the intended site for the distal end of the stent. The wire was then removed. Thereafter, the LEO stent delivery system was advanced inside the Vasco, and a LEO stent (Balt; 3.5 ϫ 25 mm) was deployed easily over the neck of the aneurysm in a satisfactory position (Fig 2). The patient was maintained on daily aspirin (200 mg) and clopidogrel (75 mg) for 3 months after stent placement, after which the patient was switched to a single antipl...