Diagnostics and treatment of diffuse intrinsic pontine glioma: where do we stand?

INTRODUCTION: Diffuse intrinsic pontine glioma (DIPG) is a rare clinically, neuro-radiologically, and molecularly defined malignancy of the brainstem with a median overall survival of approximately 11 months. Our aim is to evaluate the current tendency for its treatment in Europe in order to develop (inter)national consensus guidelines. METHODS: Healthcare professionals specialized in DIPG were asked to fill in an online survey with questions regarding usual treatment strategies at diagnosis and at disease progression in their countries and/or their centers, respectively. RESULTS: Seventy-four healthcare professionals responded to the survey, of which 87.8% were pediatric oncologists. Only 13.5% of the respondents biopsy all of their patients, 41.9% biopsy their patients infrequently. More than half of the respondents (54.1%) treated their patients with radiotherapy only at diagnosis, whereas 44.6% preferred radiotherapy combined with chemotherapy. When the disease progresses, treatment strategies became even more diverse, and the tendency for no treatment increased from 1.4% at diagnosis to 77.0% after second progression. 36.5% of the healthcare professionals treat children younger than 3 years differently than older children at diagnosis. This percentage decreased, when the disease progresses. Most of the participants (51.4%) included less than 25% of their patients in clinical trials. CONCLUSION: This survey demonstrates a large heterogeneity of treatment regimens, especially at disease progression. We emphasize the need for international consensus guidelines for the treatment of DIPG, possible by more collaborative clinical trials.

No energetic cost of anthropogenic disturbance in a songbird.

Anthropogenic or natural disturbances can have a significant impact on wild animals. Therefore, understanding when, how and what type of human and natural events disturb animals is a central problem in wildlife conservation. However, it can be difficult to identify which particular environmental stressor affects an individual most. We use heart rate telemetry to quantify the energy expenditure associated with different types of human-mediated and natural disturbances in a breeding passerine, the white-eyed vireo (Vireo griseus). We fitted 0.5g heart rate transmitters to 14 male vireos and continuously recorded heart rate and activity for two days and three nights on a military installation. We calibrated heart rate to energy expenditure for five additional males using an open-flow, push-through respirometry system showing that heart rate predicted 74 per cent of energy expenditure. We conducted standardized disturbance trials in the field to experimentally simulate a natural stressor (predator presence) and two anthropogenic stressors. Although birds initially showed behavioural and heart rate reactions to some disturbances, we could not detect an overall increase in energy expenditure during 1- or 4-hours disturbances. Similarly, overall activity rates were unaltered between control and experimental periods, and birds continued to perform parental duties despite the experimental disturbances. We suggest that vireos quickly determined that disturbances were non-threatening and thus showed no (costly) physiological response. We hypothesize that the lack of a significant response to disturbance in vireos is adaptive and may be representative of animals with fast life histories (e.g. short lifespan, high reproductive output) so as to maximize energy allocation to reproduction. Conversely, we predict that energetic cost of human-mediated disturbances will be significant in slow-living animals.