Registration, incidence patterns, and survival trends of central nervous system tumors among children in Germany 1980-2019: An analysis of 40 years based on data from the German Childhood Cancer Registry.

BACKGROUND: Tumors of the central nervous system (CNS) are the second most common type of pediatric cancer in Germany. We aimed to describe registration practice, incidence, and survival patterns for childhood CNS tumors in Germany for the past 40 years. PROCEDURE: Including all CNS tumor cases in children diagnosed at ages 0-14 years registered at the German Childhood Cancer Registry (GCCR) in 1980-2019 (for survival analysis 1980-2016), we calculated age-specific and age-standardized incidence rates (ASIR) over time, average annual percentage changes (AAPC), and 1- and 5-year overall survival. RESULTS: While we observed a pronounced increase in ASIR after the establishment of the GCCR during the 1980s, ASIR for all pediatric CNS tumors combined continued to increase markedly from 28.6 per million in 1990-1999 to 43.3 in 2010-2019 (AAPC = 2.7% in 1991-2010, AAPC = 0.3% in 2010-2019). The 5-year overall survival from CNS tumors improved from 63% in the 1980s, 70% in the 1990s to 79% in 2010-2016. These improvements have occurred across all age groups. Children diagnosed with ependymomas and choroid plexus tumors experienced the strongest increase (from 54% to 81%). CONCLUSIONS: Observed increases in incidence rates for pediatric CNS tumors are likely only partially caused by actual increasing case numbers. The majority is a function of improved registration and, to a minor extent, improvements in diagnostics. Survival from pediatric CNS tumors has, by and large, improved consistently, leading to a growing population of childhood cancer survivors with diverse health biographies and risk of lifelong adverse impact on health and wellbeing.

VersKiK qualitative study design: actual follow-up needs of paediatric cancer survivors, their informal caregivers and follow-up stakeholder perceptions in Germany.

INTRODUCTION: This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survivors and their informal caregivers, gaps in current follow-up care provision and trajectories of cancer survivors' transition from paediatric to adult healthcare. METHODS AND ANALYSIS: We will conduct up to 30 interviews with survivors of childhood and adolescence cancer and their informal caregivers with up to 20 participant observations of follow-up appointments. The results of these will be discussed in up to four focus groups with healthcare professionals and representatives of self-help groups. The study design aims to evaluate follow-up care after childhood cancer considering perspectives from survivors, their informal caregivers as well as healthcare providers. The combination of different data sources will allow us to get an in-depth understanding of the current state of follow-up care after paediatric cancer in Germany and to suggest recommendations for care improvement. ETHICS AND DISSEMINATION: The VersKiK study was approved by the Ethics Committee Otto von Guericke University on 2 July 2021 (103/21), by the Ethics Committee of Johannes Gutenberg University Mainz on 16 June 2021 (2021-16035), by the Ethics Committee University of Lübeck on 10 November 2021 (21-451), by the Ethics Committee University of Hospital Bonn on 28 February 2022 (05/22). For each part of the qualitative study, a separate written informed consent is prepared and approved accordingly by the ethics committees named above. TRIAL REGISTRATION NUMBER: Registered at German Clinical Trial Register, ID: DRKS00026092.

Subsequent primary neoplasms after childhood cancer therapy - design and description of the German nested case-control study STATT-SCAR.

BACKGROUND: Subsequent primary neoplasms (SPN) are among the most severe late effects and the second most frequent cause of death in childhood cancer patients. In this paper we introduce method and properties of the STATT-SCAR study (Second Tumor After Tumor Therapy, Second Cancer After Radiotherapy), which is a joint nested matched case-control study to evaluate the impact of chemotherapy (STATT) as well as radiotherapy (SCAR) on the risk of developing a SPN. METHODS: Based on the cohort of the German childhood cancer registry (GCCR), we selected patients diagnosed with a first neoplasm before age 15 or younger between 1980 and 2014. We selected those with a SPN at least half a year after the first neoplasm, and matched up to four controls to each case. Therapy data were acquired from various sources, including clinical study centers and treating hospitals. To analyze the impact of radiotherapy, organ doses were estimated by using reconstructed treatment plans. The effect of chemotherapy was analyzed using substance groups summarized after isotoxic dose conversion. RESULTS: 1244 cases with a SPN were identified and matched with 4976 controls. Treatment data were acquired for 83% of all match groups (one case and at least one control). Based on preliminary analyses, 98% of all patients received chemotherapy and 54% of all patients were treated with radiotherapy. CONCLUSIONS: Based on our data, detailed analyses of dose response relationships and treatment element combinations are possible, leading to a deeper insight into SPN risks after cancer treatments. TRIAL REGISTRATION: The study is registered at the German clinical trial register (DRKS) under number DRKS00017847 [45].

Equivalent doses for anticancer agents used in pediatric oncology: A literature review and evaluation of a novel approach for conversion factors.

BACKGROUND: Epidemiological research on late effects of therapy shows the necessity to aggregate chemotherapy agents to substance classes. This requires using conversion factors by substance classes. AIMS: The aim of this study was to identify previously used conversion factors from the literature, to present a novel approach for additional factors, and to compare these approaches. METHODS AND RESULTS: A literature review was performed, which identified two main principles of deriving conversion factors: effect-equivalence and equimolar. Thirty-five articles presenting effect equivalence-based factors in the widest sense were found in the literature. Ten articles presented the equimolar approach which can be applied to almost all chemotherapy substances. Based on a comprehensive list of treatment protocols used in German pediatric oncology, we derived alternative conversion factors from typical doses. We compared the conversion factors using Pearson correlation coefficients and linear regression. At least two types of conversion factor were available for each of the 49 substances included. The equivalent effect-based and the typical dose-based factors were highly correlated with a regression coefficient close to 1. The equimolar factors are independent. CONCLUSIONS: For substances for which no conversion factor based on some type of effect equivalence has been published so far, a factor based on a typical doses-approach may be used in epidemiological late effects research. Doses aggregated based on the equimolar approach may not be compatible with doses aggregated based on equivalent effects.

Pharmacological and optical activation of TrkB in Parvalbumin interneurons regulate intrinsic states to orchestrate cortical plasticity.

Elevated states of brain plasticity typical for critical periods of early postnatal life can be reinstated in the adult brain through interventions, such as antidepressant treatment and environmental enrichment, and induced plasticity may be critical for the antidepressant action. Parvalbumin-positive (PV) interneurons regulate the closure of developmental critical periods and can alternate between high and low plasticity states in response to experience in adulthood. We now show that PV plasticity states and cortical networks are regulated through the activation of TrkB neurotrophin receptors. Visual cortical plasticity induced by fluoxetine, a widely prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant, was lost in mice with reduced expression of TrkB in PV interneurons. Conversely, optogenetic gain-of-function studies revealed that activation of an optically activatable TrkB (optoTrkB) specifically in PV interneurons switches adult cortical networks into a state of elevated plasticity within minutes by decreasing the intrinsic excitability of PV interneurons, recapitulating the effects of fluoxetine. TrkB activation shifted cortical networks towards a low PV configuration, promoting oscillatory synchrony, increased excitatory-inhibitory balance, and ocular dominance plasticity. OptoTrkB activation promotes the phosphorylation of Kv3.1 channels and reduces the expression of Kv3.2 mRNA providing a mechanism for the lower excitability. In addition, decreased expression and puncta of Synaptotagmin2 (Syt2), a presynaptic marker of PV interneurons involved in Ca2+-dependent neurotransmitter release, suggests lower inputs onto pyramidal neurons suppressing feed-forward inhibition. Together, the results provide mechanistic insights into how TrkB activation in PV interneurons orchestrates the activity of cortical networks and mediating antidepressant responses in the adult brain.

The effects of socioeconomic conditions on old-age mortality within shared disability pathways.

OBJECTIVE: How disability manifests itself in an individual is a highly complex process influenced by a wide range of individual and environmental factors. Its complexity makes the search for generalizable characteristics of the disablement process a challenging task. Consequentially, little is known about how the effect on other health outcomes such as life expectancy are modified after the onset of chronic ailments. In this paper we posit an alternative approach to generalize health trajectories of older people with disability and then analyze how socioeconomic conditions affect the longevity within these trajectory groups. METHODS: Individual level information about the first three successive onsets of chronic disability after age 50 is transformed into state-sequences. We extract trajectory groups based on onset time and the time spent in a certain state. Mortality hazards are then estimated with a Gompertz proportional hazards model to compare effects of different socioeconomic measures within the trajectory groups. RESULTS: Three distinct trajectory groups are identified, the mild (1), the early severe (2), and late severe (3) pathway. Estimates of the mortality analysis suggest that social inequalities in longevity are less pronounced after onset of old-age disability. We found a consistent survival prolonging effect for individuals who engage in daily activities (such as meeting with friends, walking) that ranged between 33.2% and 77.3%. The importance of other variables varies between trajectory groups. DISCUSSION: This study shows how health trajectories of individuals with disability can be generalized when information on the onset and severity of single conditions is available. Such an approach may help us to better predict health and care expenditures and help families and individuals with their personal care planning. The findings from the subsequent survival analysis suggest a substantial reduction of socioeconomic mortality differences after onset of old-age disability, which appears to be independent of its nature.

The in-air auditory thresholds of the eurasian otter (Lutra lutra, L. 1758) as determined by auditory brainstem responses.

As of yet there is no literature record of the hearing range of the Eurasian otter (Lutra lutra, L. 1758), a key species for natural conservation efforts in Europe. We recorded in-air pure tone hearing thresholds of anaesthetized otters using auditory brainstem responses (ABR) and report the results of the Eurasian otter. The recorded potentials showed the typical mammalian auditory brainstem response consisting of 5 distinct positive peaks during the first 10 ms after stimulus onset. At 80 dB SPL the hearing ranged from around 200 Hz to 32 kHz, with lowest thresholds around 4 kHz.

Categorical processing of fast temporal sequences in the guinea pig auditory brainstem.

Discrimination of temporal sequences is crucial for auditory object recognition, phoneme categorization and speech understanding. The present study shows that auditory brainstem responses (ABR) to pairs of noise bursts separated by a short gap can be classified into two distinct groups based on the ratio of gap duration to initial noise burst duration in guinea pigs. If this ratio was smaller than 0.5, the ABR to the trailing noise burst was strongly suppressed. On the other hand, if the initial noise burst duration was short compared to the gap duration (a ratio greater than 0.5), a release from suppression and/or enhancement of the trailing ABR was observed. Consequently, initial noise bursts of shorter duration caused a faster transition between response classes than initial noise bursts of longer duration. We propose that the described findings represent a neural correlate of subcortical categorical preprocessing of temporal sequences in the auditory system.

Cathodic-leading pulses are more effective than anodic-leading pulses in intracortical microstimulation of the auditory cortex.

OBJECTIVE: Intracortical microstimulation (ICMS) is widely used in neuroscientific research. Earlier work from our lab showed the possibility to combine ICMS with neuronal recordings on the same shank of multi-electrode arrays and consequently inside the same cortical column in vivo. The standard stimulus pulse shape for ICMS is a symmetric, biphasic current pulse. Here, we investigated the role of the leading-phase polarity (cathodic- versus anodic-leading) of such single ICMS pulses on the activation of the cortical network. APPROACH: Local field potentials (LFPs) and multi-unit responses were recorded in the primary auditory cortex (A1) of adult guinea pigs (n = 15) under ketamine/xylazine anesthesia using linear multi-electrode arrays. Physiological responses of A1 were recorded during acoustic stimulation and ICMS. For the ICMS, the leading-phase polarity, the stimulated electrode and the stimulation current where varied systematically on any one of the 16 electrodes while recording at the same time with the 15 remaining electrodes. MAIN RESULTS: Cathodic-leading ICMS consistently led to higher response amplitudes. In superficial cortical layers and for a given current amplitude, cathodic-leading and anodic-leading ICMS showed comparable activation patterns, while in deep layers only cathodic-leading ICMS reliably generated local neuronal activity. ICMS had a significantly smaller dynamic range than acoustic stimulation regardless of leading-phase polarity. SIGNIFICANCE: The present study provides in vivo evidence for a differential neuronal activation mechanism of the different leading-phase polarities, with cathodic-leading stimulation being more effective, and suggests that the waveform of the stimulus should be considered systematically for cortical neuroprosthesis development.

Intracortical Microstimulation Modulates Cortical Induced Responses.

Recent advances in cortical prosthetics relied on intracortical microstimulation (ICMS) to activate the cortical neural network and convey information to the brain. Here we show that activity elicited by low-current ICMS modulates induced cortical responses to a sensory stimulus in the primary auditory cortex (A1). A1 processes sensory stimuli in a stereotyped manner, encompassing two types of activity: evoked activity (phase-locked to the stimulus) and induced activity (non-phase-locked to the stimulus). Time-frequency analyses of extracellular potentials recorded from all layers and the surface of the auditory cortex of anesthetized guinea pigs of both sexes showed that ICMS during the processing of a transient acoustic stimulus differentially affected the evoked and induced response. Specifically, ICMS enhanced the long-latency-induced component, mimicking physiological gain increasing top-down feedback processes. Furthermore, the phase of the local field potential at the time of stimulation was predictive of the response amplitude for acoustic stimulation, ICMS, as well as combined acoustic and electric stimulation. Together, this was interpreted as a sign that the response to electrical stimulation was integrated into the ongoing cortical processes in contrast to substituting them. Consequently, ICMS modulated the cortical response to a sensory stimulus. We propose such targeted modulation of cortical activity (as opposed to a stimulation that substitutes the ongoing processes) as an alternative approach for cortical prostheses.SIGNIFICANCE STATEMENT Intracortical microstimulation (ICMS) is commonly used to activate a specific subset of cortical neurons, without taking into account the ongoing activity at the time of stimulation. Here, we found that a low-current ICMS pulse modulated the way the auditory cortex processed a peripheral stimulus, by supra-additively combining the response to the ICMS with the cortical processing of the peripheral stimulus. This artificial modulation mimicked natural modulations of response magnitude such as attention or expectation. In contrast to what was implied in earlier studies, this shows that the response to electrical stimulation is not substituting ongoing cortical activity but is integrated into the natural processes.

Intracortical microstimulation differentially activates cortical layers based on stimulation depth.

BACKGROUND: Intracortical microstimulation is one of the most common techniques to causally interfere with neuronal processing, but neuronal recordings spanning the whole cortical depth during stimulation are exceptionally rare. OBJECTIVE/HYPOTHESIS: Here we combined layer-specific intracortical microstimulation with extracellular recordings on the same shank of a linear multi-electrode array to study the effects of electrical stimulation in different cortical depths on intracortical processing in the auditory cortex in vivo. METHODS: Population responses (local field potentials and multi-unit activity) were recorded from the auditory cortex of 8 guinea pigs under ketamine/xylazine anesthesia while single current pulses (charge-balanced, biphasic, square-wave, 0.1-45 µA, 200 µs/phase) were delivered in different cortical depths. RESULTS: The cortical responses differed with a change in the stimulation parameters, with significant factors being the stimulating current (p < 0.0001), stimulation depth (p = 0.03) and the recording depth (p = 0.002) considering the local field potential amplitude. A cross-correlation analysis between responses evoked by intracortical microstimulation and physiological auditory stimuli revealed the closest match when stimulating the middle granular layer (p < 0.05). CONCLUSION: Intracortical response profiles to low-current intracortical microstimulation were layer specific. The most natural cortical response was achieved by stimulation in the thalamo-recipient layer. These findings contribute to a basis for designing cortical neuroprosthetics.

Arterial microcalcification in atherosclerotic patients with and without chronic kidney disease: a comparative high-resolution scanning X-ray diffraction analysis.

Vascular calcification, albeit heterogeneous in terms of biological and physicochemical properties, has been associated with ageing, lifestyle, diabetes, and chronic kidney disease (CKD). It is unknown whether or not moderately impaired renal function (CKD stages 2-4) affects the physiochemical composition and/or the formation of magnesium-containing tricalcium phosphate ([Ca,Mg](3)[PO(4)](2), whitlockite) in arterial microcalcification. Therefore, a high-resolution scanning X-ray diffraction analysis (European Synchrotron Radiation Facility, Grenoble, France) utilizing histological sections of paraffin-embedded arterial specimens derived from atherosclerotic patients with normal renal function (n = 15) and CKD (stages 2-4, n = 13) was performed. This approach allowed us to spatially assess the contribution of calcium phosphate (apatite) and whitlockite to arterial microcalcification. Per group, the number of samples (13 vs. 12) with sufficient signal intensity and total lengths of regions (201 vs. 232 µm) giving rise to diffractograms ("informative regions") were comparable. Summarizing all informative regions per group into one composite sample revealed calcium phosphate/apatite as the leading mineral phase in CKD patients, whereas in patients with normal renal function the relative contribution of whitlockite and calcium phosphate/apatite was on the same order of magnitude (CKD, calcium phosphate/apatite 157 µm, whitlockite 38.7 µm; non-CKD, calcium phosphate/apatite 79.0 µm, whitlockite 94.1 µm; each p < 0.05). Our results, although based on a limited number of samples, indicate that chronic impairment of renal function affects local magnesium homeostasis and thus contributes to the physicochemical composition of microcalcification in atherosclerotic patients.

Fibroblast growth factor (FGF)-23 and fetuin-A in calcified carotid atheroma.

AIMS: Human atheroma calcification occurs secondary to repetitive injury/remodelling of the vessel wall and might be initiated by adherence of mineral-loaded fetuin-A whether or not professional matrix mineralizing cells are present. The aim was to investigate the contribution of fibroblast growth factor (FGF)-23 to ectopic mineralization. METHODS AND RESULTS: Serial sections of formalin-fixed paraffin-embedded human carotid atheroma (n = 54) were investigated with respect to (i) size and distribution of calcific deposits, (ii) indicators of chondrogenic/osteogenic transformation, and (iii) expression of fetuin-A and FGF-23. All specimens were calcified and SOX-9, collagen type II, cathepsin-K, fetuin-A and FGF-23 expression was seen in 46, 53, 53, 54 and 48 specimens, respectively. The intracellular detection of FGF-23 (45/48) indicates local synthesis. Whereas fetuin-A expression was seen also within areas of vascular smooth muscle actin-positive cells adjacent to calcific deposits, FGF-23 expression was apparently restricted to the mineralization-prone areas. Both local expression and FGF-23 serum concentrations were significantly associated with the degree of atheroma calcification. CONCLUSIONS: Besides the induction of bone islets and subsequent mineral deposition, severe remodelling of the vessel wall is sufficient to create a mineralizable fetuin-A-attracting microenvironment. FGF-23 might contribute to the formation of proper mineral, i.e. control local phosphate concentration.

Weight gain in pregnancy according to maternal height and weight.

Weight gain during pregnancy is of great importance for the health of mother and child. There is considerable individual variability with regard to the weight gain, with maternal height and pre-pregnancy body weight being important determinants. We aim to assess the usefulness of the maternal body mass index (BMI) and other ways of combining maternal weight and height in predicting weight gain during pregnancy. We analyzed data of more than 2.2 million pregnancies taken from the German perinatal statistics of 1995-2000. We found that BMI is not useful as a predictor of weight gain during pregnancy. We developed an alternative system of using maternal weight and height to predict weight gain by classifying pregnant women according to their weight and height. This allows an assessment of weight gain by comparing a given pregnant woman to other women with similar weights and heights.