Cognitive MRI-TRUS fusion-targeted biopsy without concurrent systematic biopsy can detect significant prostate cancer in patients with previous negative systematic biopsy results and persistently elevated PSA levels. Noncancer-yield patients should undergo active surveillance and further follow-ups.

The major issue in selecting patients for transarterial chemoembolization (TACE) lies in determining the optimal number of TACE sessions that may benefit patients before switching to other therapies. This is often a subjective decision not based on any standardized protocol. The ART (Assessment for Retreatment with Transarterial chemoembolization) score was recently developed to determine patients who may benefit from multiple sessions of TACE for treatment of hepatocellular carcinoma. The primary aim of the study was to validate the ART score in a Taiwanese cohort. The secondary aims were to evaluate overall survival and clinical determinants of improved survival in patients treated with multiple TACE sessions. The ART score, clinical characteristics, and outcomes of 82 patients with hepatocellular carcinoma who received multiple TACE sessions at Taipei Veterans General Hospital from September 2007 to July 2013 were analyzed. Among the 82 patients evaluated, 69.5% (n = 57) had an ART score of 0 to 1.5 and 34.1% (n = 25) had a score of ≥2.5. The median overall survival was 23.1 months and the overall mortality rate was 62.2% (n = 51). The ART score was not associated with survival (P = 0.58). Multivariate Cox regression analysis revealed that tumor size >7.2 cm (hazard ratio 4.44, P < 0.001), aspartate transaminase (AST) level above 95 IU/L (hazard ratio 2.18, P = 0.02), AST increase more than 25% (hazard ratio 2.13, P = 0.02), 2nd/1st (pre-TACE) alpha-fetoprotein ratio (hazard ratio 1.40, P = 0.001), and lack of radiological response to TACE (hazard ratio 2.21, P = 0.02) were independent clinical determinants of survival. The ART score was not found to be effective in selecting patients for TACE retreatment in our Taiwanese cohort. Large tumor size, high AST level, high 2nd/1st (pre-TACE) alpha-fetoprotein ratio, AST increase >25%, and lack of radiological response to TACE were independently associated with shorter survival after TACE therapy.

Patient: Male, 66Final Diagnosis: Nonbifurcating carotid arterySymptoms: No symptomsMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Congenital defects/diseasesBackground:Vascular anomalies of the carotid vessels can be attributed to false embryogenesis. A rare variant called a nonbifurcating carotid artery (NBCA) exists, where typical carotid bifurcation is not recognizable with its typical branches of the external carotid artery (ECA) and internal carotid artery (ICA). This paper describes a case of this anomaly and reviews the embryogenesis of the carotid arteries for explanation.Case Report:A 66-year-old man received a routine health examination at our hospital. Initial carotid ultrasound indicated an absence of bifurcation in the right cervical carotid artery, and magnetic resonance imaging of the brain indicated an absence of the proximal cervical segment of the right ICA, with a remnant arterial stump at the expected bifurcation level. No evidence of the carotid bulb was identified. The common carotid artery seemed to continue cranially in the trunk of the ECA, where it exhibited extracranial branches. After distributing these branches, the carotid artery coursed medially at the C2 level, where it ascended into the carotid canal to become the petrosal segment of the ICA. This carotid anomaly was labelled an NBCA. No aberrant intracranial arteries were derived from the NBCA in this case.Conclusions:In this case, the arterial stump was considered a remnant from agenesis of the right ICA. We assumed that the NBCA most likely developed because of false regression of the third embryogenic aortic arch with persistence of the second aortic arch.

Computed tomography-guided percutaneous cryoablation is a safe and effective technique for treating renal tumors with excellent renal function preservation.

Objectives Elderly acute ischemic stroke (AIS) patients (≥80 years) would have dismal clinical outcomes even after successful endovascular revascularization for large vessel occlusion (LVO) in the anterior circulation. We aimed to identify predictors of 30-day mortality after endovascular thrombectomy (EVT) in the elderly. Materials and Methods We included older patients who underwent EVT for AIS due to LVO within 6 h after stroke onset in the anterior circulation between 2017 and 2019. Patients due to posterior circulation stroke, with intracerebral hemorrhage (ICH) or pre-stroke modified Rankin Scale (mRS) score of 4 and 5 were excluded. The primary outcome was mortality within 30 days of EVT. The association between clinical, imaging, procedural, follow-up imaging and mortality were analyzed. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3. Possible predictors of 30-day mortality were assessed by univariate and multivariable logistic regression. Results Total 238 AIS patients eligible for EVT were identified with 58 patients aged 80 years or more. 48 patients met inclusion criteria. Median age was 86 years (age range, 82–102 years). Successful reperfusion was achieved in 38 (79.2%) patients. The 30-day and 90-day mortality rate were 25% and 33.3%, respectively. The independent predictors of 30-day mortality were collateral scores <3 on mCTA (adjusted OR, 16.571; 95% CI, 1.041–263.868; p = 0.047) and number of passes (adjusted OR, 2.475; 95% CI, 1.047–5.847; p = 0.039). Conclusions Lower collateral scores on mCTA and higher number of passes in thrombectomy were independently predictive of 30-day mortality in the elderly.