Multiple surgical resections for progressive IDH wildtype glioblastoma-is it beneficial?

PURPOSE: The role of repeat resection for recurrent glioblastoma (rGB) remains equivocal. This study aims to assess the overall survival and complications rates of single or repeat resection for rGB. METHODS: A single-centre retrospective review of all patients with IDH-wildtype glioblastoma managed surgically, between January 2014 and January 2022, was carried out. Patient survival and factors influencing prognosis were analysed, using Kaplan-Meier and Cox regression methods. RESULTS: Four hundred thirty-two patients were included, of whom 329 underwent single resection, 83 had two resections and 20 patients underwent three resections. Median OS (mOS) in the cohort who underwent a single operation was 13.7 months (95% CI: 12.7-14.7 months). The mOS was observed to be extended in patients who underwent second or third-time resection, at 22.9 months and 44.7 months respectively (p < 0.001). On second operation achieving > 95% resection or residual tumour volume of < 2.25 cc was significantly associated with prolonged survival. There was no significant difference in overall complication rates between primary versus second (p = 0.973) or third-time resections (p = 0.312). The use of diffusion tensor imaging (DTI) guided resection was associated with reduced post-operative neurological deficit (RR 0.37, p = 0.002), as was use of intraoperative ultrasound (iUSS) (RR 0.45, p = 0.04). CONCLUSIONS: This study demonstrates potential prolongation of survival for rGB patients undergoing repeat resection, without significant increase in complication rates with repeat resections. Achieving a more complete repeat resection improved survival. Moreover, the use of intraoperative imaging adjuncts can maximise tumour resection, whilst minimising the risk of neurological deficit.

Reno-duodenal fistula as a complication of longstanding renal tract calculus.

We present a rare case detailing the investigations and subsequent treatment of a lady who presented with a reno-duodenal fistula and perinephric abscess as a complication of staghorn calculus and recurrent upper urinary tract infections. Treatment involved antibiotics, nephrostomy, endoscopic closure of the fistula tract with clips, radiological drain insertion and, ultimately, nephrectomy with primary omental patch closure of the duodenal defect. We discuss the incidence of fistula tract formation as a complication of staghorn calculi, as well as investigations and management strategies employed in the literature to treat such complications, which span from conservative treatment to nephrectomy and closure of the intestinal defect. We illustrate the post-operative complications such patients are prone to and discuss these in context of the case. Whilst such cases are rare clinicians should be vigilant for complications associated with chronic inflammatory processes occurring in the urinary tract and investigate accordingly.

Some Insults are Easier to Detect: The Embodied Insult Detection Effect.

In the present research we examined the effects of bodily experience on processing of insults in a series of semantic categorization tasks we call insult detection tasks (i.e., participants decided whether presented stimuli were insults or not). Two types of insults were used: more embodied insults (e.g., asswipe, ugly), and less embodied insults (e.g., cheapskate, twit), as well as non-insults. In Experiments 1 and 2 the non-insults did not form a single, coherent category (e.g., airbase, polka), whereas in Experiment 3 all the non-insults were compliments (e.g., eyeful, honest). Regardless of type of non-insult used, we observed facilitatory embodied insult effects such that more embodied insults were responded to faster and recalled more often than less embodied insults. In Experiment 4 we used a larger set of insults as stimuli, which allowed hierarchical multiple regression analyses. These analyses revealed that bodily experience ratings accounted for a significant amount of unique response latency, response error, and recall variability for responses to insults, even with several other predictor variables (e.g., frequency, offensiveness, imageability) included in the analyses: responses were faster and more accurate, and there was greater recall for relatively more embodied insults. These results demonstrate that conceptual knowledge of insults is grounded in knowledge gained through bodily experience.

The benefits of sensorimotor knowledge: body-object interaction facilitates semantic processing.

This article examined the effects of body-object interaction (BOI) on semantic processing. BOI measures perceptions of the ease with which a human body can physically interact with a word's referent. In Experiment 1, BOI effects were examined in 2 semantic categorization tasks (SCT) in which participants decided if words are easily imageable. Responses were faster and more accurate for high BOI words (e.g., mask) than for low BOI words (e.g., ship). In Experiment 2, BOI effects were examined in a semantic lexical decision task (SLDT), which taps both semantic feedback and semantic processing. The BOI effect was larger in the SLDT than in the SCT, suggesting that BOI facilitates both semantic feedback and semantic processing. The findings are consistent with the embodied cognition perspective (e.g., Barsalou's, 1999, Perceptual Symbols Theory), which proposes that sensorimotor interactions with the environment are incorporated in semantic knowledge.

Evidence for the activation of sensorimotor information during visual word recognition: the body-object interaction effect.

We examined the effects of sensorimotor experience in two visual word recognition tasks. Body-object interaction (BOI) ratings were collected for a large set of words. These ratings assess perceptions of the ease with which a human body can physically interact with a word's referent. A set of high BOI words (e.g., mask) and a set of low BOI words (e.g., ship) were created, matched on imageability and concreteness. Facilitatory BOI effects were observed in lexical decision and phonological lexical decision tasks: responses were faster for high BOI words than for low BOI words. We discuss how our findings may be accounted for by (a) semantic feedback within the visual word recognition system, and (b) an embodied view of cognition (e.g., Barsalou's perceptual symbol systems theory), which proposes that semantic knowledge is grounded in sensorimotor interactions with the environment.

Homophone effects in visual word recognition depend on homophone type and task demands.

This experiment examined how the characteristics of homophones and their mates influence homophone effects, as a function of task demands. Two types of homophones were presented: 1) low-frequency homophones with higher-frequency mates that are not animal names (e.g., maid--made), and 2) low-frequency homophones with mates that are, on average, of equivalent frequency and are animal names (e.g., foul--fowl). We observed a double dissociation: In the lexical decision task (LDT), there was a homophone effect for the first type of homophones but not for the second, whereas in the semantic categorization task (SCT) the opposite was true. These results suggest that in these tasks the effects of homophony arise when the homophone's mate creates competition in terms of the type of processing emphasized in the task, namely, orthographic processing in the LDT and semantic processing in the SCT.

FMRI of ventral and dorsal processing streams in basic reading processes: insular sensitivity to phonology.

Most current models of the neurophysiology of basic reading processes agree on a system involving two cortical streams: a ventral stream (occipital-temporal) used when accessing familiar words encoded in lexical memory, and a dorsal stream (occipital-parietal-frontal) used when phonetically decoding words (i.e., mapping sublexical spelling onto sounds). The models diverge, however, on the issue of whether the insular cortex is involved. The present fMRI study required participants to read aloud exception words (e.g., 'one', which must be read via lexical memory) and pseudohomophones (e.g., 'wun', which must be read via sublexical spelling to sound translation) to examine the processing streams as well as the insular cortex, and their relationship to lexical and sublexical reading processes. The present study supports the notion of independent ventral-lexical and dorsal-sublexical streams, and further suggests the insular cortex to be sensitive to phonological processing (particularly sublexical spelling-sound translation). These latter findings illuminate the nature of insular activity during reading, which must be explored further in future studies, and accounted for in models of the neurophysiology of reading.

A power analysis of tests for paired lifetime data.

A power analysis is used to compare tests developed for a new lifetime model applicable for certain paired-data experiments. Two pivotal quantities are available for exact parametric testing of the equality of the marginal survival distributions. Here, the power of each test will be calculated to find the more powerful test. The analysis leads to an interesting scenario where the two power curves are quite similar and less powerful test may actually be preferred for pragmatic considerations.

Neuroimaging of language processes: fMRI of silent and overt lexical processing and the promise of multiple process imaging in single brain studies.

OBJECTIVE: To implement and evaluate a multiple-process functional magnetic resonance imaging (fMRI) paradigm designed to effectively and efficiently activate several language-related regions for use with neurosurgical patients. Both overt and covert response conditions were examined. METHODS: The fMRI experiments compared the traditional silent word-generation condition versus an overt one as they engage frontal language regions (Experiment 1) and silent versus overt semantic association conditions as they engage multiple language processing regions (Experiment 2). RESULTS: In Experiment 1, the overt condition yielded greater magnitude of activation, but not volume of activation, in the left inferior frontal and insular cortices than did the silent condition for most, but not all, participants. Experiment 2 demonstrated that the activation of multiple established language processing regions (ie, orthographic, phonological, and semantic) can be achieved in a significant number of participants, particularly under overt semantic association conditions and that such activation varies in predictable ways. CONCLUSION: The traditional silent response condition cannot be considered as equivalent to the overt response condition during word generation or semantic association. The multiple-process imaging method introduced here was sensitive to processing robust orthographic, phonological, and semantic regions, particularly under the overt response condition.

FMRI of two measures of phonological processing in visual word recognition: ecological validity matters.

Previous functional magnetic resonance imaging (fMRI) studies have investigated the role of phonological processing by utilizing nonword rhyming decision tasks (e.g., Pugh et al., 1996). Although such tasks clearly engage phonological components of visual word recognition, it is clear that decision tasks are more cognitively involved than the simple overt naming tasks, which more closely map onto normal reading behavior. Our research aim for this study was to examine the advantages of overt naming tasks for fMRI studies of word recognition processes. Process models are presented to highlight the similarities and differences between two cognitive tasks that are used in the word recognition literature, pseudohomophone naming (e.g., pronounce BRANE) and rhyming decision (e.g., do LEAT and JEAT rhyme?). An fMRI study identified several differences in cortical activation associated with the differences observed in the process models. Specifically, the results show that the overt naming task involved the insular cortex and inferior frontal gyrus, whereas the rhyming decision task engaged the temporal-parietal regions. It is argued that future fMRI research examining the neuroanatomical components of basic visual word recognition utilize overt naming tasks.

Examining the interactivity of lexical orthographic and phonological processing.

The number and type of connections involving different levels of orthographic and phonological representations differentiate between several models of spoken and visual word recognition. At the sublexical level of processing, Borowsky, Owen, and Fonos (1999) demonstrated evidence for direct processing connections from grapheme representations to phoneme representations (i.e., a sensitivity effect) over and above any bias effects, but not in the reverse direction. Neural network models of visual word recognition implement an orthography to phonology processing route that involves the same connections for processing sublexical and lexical information, and thus a similar pattern of cross-modal effects for lexical stimuli are expected by models that implement this single type of connection (i.e., orthographic lexical processing should directly affect phonological lexical processing, but not in the reverse direction). Furthermore, several models of spoken word perception predict that there should be no direct connections between orthographic representations and phonological representations, regardless of whether the connections are sublexical or lexical. The present experiments examined these predictions by measuring the influence of a cross-modal word context on word target discrimination. The results provide constraints on the types of connections that can exist between orthographic lexical representations and phonological lexical representations.

Diagnostics of phonological lexical processing: pseudohomophone naming advantages, disadvantages, and base-word frequency effects.

Phonological lexical access has been investigated by examining both a pseudohomophone (e.g., brane) base-word frequency effect and a pseudohomophone advantage over pronounceable nonwords (e.g., frane) in a single mixed block of naming trials. With a new set of pseudohomophones and non-words presented in a mixed block, we replicated the standard finding in the naming literature: no reliable base-word frequency effect, and apseudohomophone advantage. However, for this and two of three other sets of stimuli--those of McCann and Besner (1987), Seidenberg, Petersen, MacDonald, and Plaut (1996), and Herdman, LeFevre, and Greenham (1996), respectively--reliable effects of base-word frequency on pseudohomophone naming latency were found when pseudohomophones were presented in pure blocks prior to nonwords. Three of the four stimulus sets tested produced a pseudohomophone naming disadvantage when pseudohomophones were presented prior to nonwords. When nonwords were presented first, these effects were diminished. A strategy-based scaling account of the data is argued to provide a better explanation of the data than is the criterion-homogenization theory (Lupker, Brown, & Colombo, 1997).

The role of the left hemisphere in motor control of touch: a functional magnetic resonance imaging analysis.

Previous research using a simple finger-touching task has shown greater blood oxygenation level dependent (BOLD) activation volume in the motor cortex of the right hemisphere for contralateral finger touching compared to ipsilateral finger touching, but no significant contralateral advantage for the left hemisphere. Such equal involvement of the left hemisphere for both contralateral and ipsilateral finger touching suggests a special role of the left hemisphere for finger touching. In contrast, we found a contralateral advantage in the motor cortex of both hemispheres in a majority of participants (14/16) when consistently activated BOLD volumes were examined. However, participants who did not show a clear contralateral advantage for the left hemisphere did show activation in the left inferior frontal gyrus (IFG; Broca's Area) and in the left insular cortex, which suggests that verbally mediated sequencing of finger movements can account for our less frequent result.