Trends in glioblastoma: outcomes over time and type of intervention: a systematic evidence based analysis.

INTRODUCTION: Despite aggressive treatment with chemoradiotherapy and maximum surgical resection, survival in patients with glioblastoma (GBM) remains poor. Ongoing efforts are aiming to prolong the lifespan of these patients; however, disparities exist in reported survival values with lack of clear evidence that objectively examines GBM survival trends. We aim to describe the current status and advances in the survival of patients with GBM, by analyzing median overall survival through time and between treatment modalities. METHODS: A systematic review was conducted according to PRISMA guidelines to identify articles of newly diagnosed glioblastoma from 1978 to 2018. Full-text glioblastoma papers with human subjects, ≥ 18 years old, and n ≥ 25, were included for evaluation. RESULTS: The central tendency of median overall survival (MOS) was 13.5 months (2.3-29.6) and cumulative 5-year survival was 5.8% (0.01%-29.1%), with a significant difference in survival between studies that predate versus postdate the implementation of temozolomide and radiation, [12.5 (2.3-28) vs 15.6 (3.8-29.6) months, P < 0.001]. In clinical trials, bevacizumab [18.2 (10.6-23.0) months], tumor treating fields (TTF) [20.7 (20.5-20.9) months], and vaccines [19.2 (15.3-26.0) months] reported the highest central measure of median survival. CONCLUSION: Coadministration with radiotherapy and temozolomide provided a statistically significant increase in survival for patients suffering from glioblastoma. However, the natural history for GBM remains poor. Therapies including TTF pooled values of MOS and provide means of prolonging the survival of GBM patients.

A Novel Case of Legionnaire's Disease after Staying at Home Rentals.

Case of a 44-year-old woman with past medical history of dermatomyositis who had been on Methrotexate therapy who became infected with Legionella pneumophila after staying at a home rental, known commercially as an Airbnb. The patient presented to the ER with complaints of general malaise and subsequently developed sepsis with respiratory failure requiring intubation. CT scan confirmed the diagnosis of pneumonia and through extensive research L. pneumophila was identified using a pneumonia panel that works by identifying nucleic acids of fastidious organisms that are difficult and take long to grow by culture. As the patient's pneumonia progressed to ARDS and her clinical impression worsened, pronation technique was begun in addition to her course of antibiotics that were already being administered. The patient began showing significant improvement in her clinical picture and was extubated with progressive recovery.

Intraoperative Direct Stimulation Identification and Preservation of Critical White Matter Tracts During Brain Surgery.

The study of brain connectomics has led to a rapid evolution in the understanding of human brain function. Traditional localizationist theories are being replaced by more accurate network, or hodologic, approaches that model brain function as widespread processes dependent on cortical and subcortical structures, as well as the white matter tracts (WMTs) that link these areas. Recent surgical literature suggests that WMTs may be more critical to preserve than cortical structures because of the comparably lower capacity of recovery of the former when damaged. Given the relevance of eloquent WMTs to neurologic function and thus quality of life, neurosurgical interventions must be tailored to maximize their preservation. Direct electric stimulation remains a vital tool for identification and avoidance of these critical tracts. Neurosurgeons therefore require proper understanding of the anatomy and function of WMTs, as well as the reported contemporary tasks used during intraoperative stimulation. We review the relevant tracts involved in language, visuospatial, and motor networks and the updated direct electric stimulation-based mapping tasks that aid in their preservation. The dominant-hemisphere language WMTs have been mapped using picture naming, semantic association, word repetition, reading, and writing tasks. For monitoring of vision and spatial functions, the modified picture naming and line bisection tasks, as well as the recording of visual evoked potentials, have been used. Repetitive movements and monitoring of motor evoked potentials and involuntary movements have been applied for preservation of the motor networks.

α3ß1 Integrin Suppresses Prostate Cancer Metastasis via Regulation of the Hippo Pathway.

Existing anticancer strategies focused on disrupting integrin functions in tumor cells or tumor-involved endothelial cells have met limited success. An alternative strategy is to augment integrin-mediated pathways that suppress tumor progression, but how integrins can signal to restrain malignant behavior remains unclear. To address this issue, we generated an in vivo model of prostate cancer metastasis via depletion of α3ß1 integrin, a correlation observed in a significant proportion of prostate cancers. Our data describe a mechanism whereby α3ß1 signals through Abl family kinases to restrain Rho GTPase activity, support Hippo pathway suppressor functions, and restrain prostate cancer migration, invasion, and anchorage-independent growth. This α3ß1-Abl kinase-Hippo suppressor pathway identified α3 integrin-deficient prostate cancers as potential candidates for Hippo-targeted therapies currently under development, suggesting new strategies for targeting metastatic prostate cancer based on integrin expression. Our data also revealed paradoxical tumor suppressor functions for Abl kinases in prostate cancer that may help to explain the failure of Abl kinase inhibitor imatinib in prostate cancer clinical trials. Cancer Res; 76(22); 6577-87. ©2016 AACR.