The aneurysmal subarachnoid hemorrhage is a major public health problem described as a sudden drastic event with no warning symptoms and high morbidity and mortality rates. The role of the endothelial isoform of nitric oxide synthase gene polymorphism in intracranial aneurysms (IAs) is still a matter of controversy with divergent findings among European, American, and Asian populations. Our study purposed to test the association between intracranial aneurysms formation and nitric oxide gene polymorphisms through a systematic review and meta-analysis. Systematic search on Medline, Lilacs, and EMBASE was performed. The primary search resulted in 139 papers, out of which 9 met our inclusion criteria after a full text analysis. The dominant T786C model found a significant association with IA (OR 1.22, 95 % CI 1.04-1.44, p = 0.01), so did studies of the recessive T786C model (OR 0.37, 95 % CI 0.30-0.45, p < 0.0001) but with opposite effect. Our findings support the presence of the T786C polymorphism as a predictor for the development of intracranial aneurysm in the cerebral vascular system. More studies are necessary in order to elucidate the pathways of the endothelial nitric oxide synthase (eNOS) in cerebrovascular diseases and in defining how different allelic combinations of the eNOS gene single-nucleotide polymorphism (SNP) could favor this pathological process.

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New studies show a possible benefit of combining Gemcitabine, Oxaliplatin and Cetuximab for the treatment of intrahepatic tumors. However, there is currently no consensus in the literature. Hence, this article contributes to the debate by presenting a case of cholangiocarcinoma (biliary tract cancer), treated with a modified Gemcitabine, Oxaliplatin and Cetuximab protocol, which evolved to a considerable regression of the tumor and a complete radiologic response assessed by PET-CT Scan. The case report is of a female adult, who presented with a cholangiocarcinoma extending to hepatic segments V and VIII which met unresectable criteria. She was submitted to chemotherapy, consisting of a combination of Gemcitabine, Oxaliplatin and Cetuximab for a prolonged period, followed by a maintenance interval of Cetuximab monotherapy. After the 8th cycle, the patient presented better hepatic biomarker levels; after 15 months of treatment, our team achieved optimal partial radiologic response assesed by PET-CT scan as shown; after 15 months of treatment, a MRI scan showed a reduced and resectable tumor. Our case report suggests use of the Gemcitabine + Oxaliplatin (GEMOX) plus Cetuximab protocol as a neoadjuvant setting for patients with unresectable cholangiocarcinoma. Additionally, our case report confirms the GEMOX plus Cetuximab protocol can be modified according to clinical response so patients can obtain maximum therapeutic gain despite minor or adverse reactions.