Radiotherapy results in a modest improvement in survival, without reducing the quality of life or cognition, in elderly patients with glioblastoma. (ClinicalTrials.gov number, NCT00430911 [ClinicalTrials.gov].).

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Purpose: The blood-brain barrier (BBB) limits the efficacy of drug therapies for glioblastoma (GBM). Preclinical data indicate that low-intensity pulsed ultrasound (LIPU) can transiently disrupt the BBB and increase intracerebral drug concentrations.Patients and Methods: A first-in-man, single-arm, singlecenter trial (NCT02253212) was initiated to investigate the transient disruption of the BBB in patients with recurrent GBM. Patients were implanted with a 1-MHz, 11.5-mm diameter cranial ultrasound device (SonoCloud-1, CarThera). The device was activated monthly to transiently disrupt the BBB before intravenous carboplatin chemotherapy.Results: Between 2014 and 2016, 21 patients were registered for the study and implanted with the SonoCloud-1; 19 patients received at least one sonication. In 65 ultrasound sessions, BBB disruption was visible on T1w MRI for 52 sonications. Treatment-related adverse events observed were transient and manageable: a transient edema at H1 and at D15. No carboplatin-related neurotoxicity was observed. Patients with no or poor BBB disruption (n ¼ 8) visible on MRI had a median progression-free survival (PFS) of 2.73 months, and a median overall survival (OS) of 8.64 months. Patients with clear BBB disruption (n ¼ 11) had a median PFS of 4.11 months, and a median OS of 12.94 months.Conclusions: SonoCloud-1 treatments were well tolerated and may increase the effectiveness of systemic drug therapies, such as carboplatin, in the brain without inducing neurotoxicity. NOTE: Data are median (range). Idbaih et al. NOTE: The occurrence of each AE is listed as well as the total number of patients affected, as some patients might have experienced the same AE multiple times over the course of therapy.Blood-Brain Barrier Disruption by Ultrasound in GBM www.aacrjournals.org

This study suggests that stereotactic EEG-guided radiofrequency thermocoagulations can be proposed only as a palliative procedure, able to bring a substantial improvement of seizure frequency, to drug-resistant patients with epilepsy for whom conventional resection surgery is risky or contraindicated on the basis of invasive presurgical evaluation.

The aim of this study was to evaluate the efficacy of helical CT using a combination of CT-attenuation values and visual assessment of stone density as well as discriminant linear analysis to predict the chemical composition of urinary calculi. One hundred human urinary calculi were obtained from a stone-analysis laboratory and placed in 20 excised pig kidneys. They were scanned at 80, 120 and 140 kV with 3-mm collimation. Average, highest and lowest CT-attenuation values and CT variability were recorded. The internal calculus structure was assessed using a wide window setting, and visual assessment of stone density was recorded. A stepwise discriminant linear analysis was performed. The following three variables were discriminant: highest CT-attenuation value, visual density, and highest CT-attenuation value/area ratio, all at 80 kV. The probability of correctly classifying stone composition with these three variables was 0.64, ranging from 0.54 for mixed calculi to 0.69 for pure calculi. The probabilities of correctly classifying calculus composition were: 0.91 for calcium oxalate monohydrate and brushite, 0.89 for cystine, 0.85 for uric acid, 0.11 for calcium oxalate dihydrate, 0.10 for hydroxyapatite, and 0.07 for struvite calculi. When the first two ranks of highest probability for the accurate classification of each calculus type were taken into account, 81% of the calculi were correctly classified. Assessment at 80 kV of the highest CT-attenuation value, visual density and the highest CT-attenuation value/area ratio accurately predicts the chemical composition of 64-81% of urinary calculi. When the first two ranks of highest probability for the accurate classification of each calculus type were taken into account, all cystine, calcium oxalate monohydrate and brushite calculi were correctly classified.

The criteria for acetabular cup positioning during total hip replacement are a matter of considerable discussion, particularly with regards to the optimal degree of anteversion. "Anatomical anteversion" is defined in the transverse plane, and "surgical anteversion" in the sagittal plane. Computed tomography measurements of anteversion are characteristic of a given transverse section plane and fail to take into account the position of the pelvis. We suggest a simple method for evaluating acetabular cup position in both the transverse and sagittal planes during standing and sitting. By shedding new light on the relationships between the pelvis and the spine, this method may help to understand some cases of impingement, instability or abnormal wear.

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