Survey of treatment recommendations for elderly patients with glioblastoma.

INTRODUCTION: Glioblastoma, which is the most commonly diagnosed primary CNS neoplasm, is more frequent in individuals aged 65 years or more. Our purpose is to identify how glioblastoma diagnosed in elderly population is treated by Spanish oncologists. MATERIAL AND METHODS: A survey was emailed to all members of Spanish Group for Neuro-oncology Research (GEINO). RESULTS: Twenty-six neuro-oncologists from 26 hospitals completed the survey. The answers were different depending on the age, performance status, and MGMT methylation status. Patients between 65 and 70 years of age are mainly treated with Stupp treatment. For patients between ages of 70 and 80 years, 46.2% made recommendations for Perry regimen, for both methylated and non-methylated patients. For patients older than 80  years, monotherapy treatment is considered more frequently. In cases of non-MGMT promoter methylation, systemic therapy with temozolomide is still recommended in many hospitals. CONCLUSION: Our research demonstrates there is no uniform approach to the management of elderly patients with glioblastoma among academic neuro-oncologists.

SEOM clinical guidelines for diagnosis and treatment of glioblastoma (2017)

Glioblastoma (GB) is the most common brain malignancy and accounts for over 50% of all high-grade gliomas. Radiotherapy (RT) with concomitant and adjuvant temozolomide (TMZ) chemotherapy is the current standard of care for patients with newly diagnosed GB up to age 70. Recently, a new standard of care has been adopted for elderly patients (≥ 65 years) based on short course of RT and TMZ. Several clinically relevant molecular markers that assist in diagnosis and prognosis have recently been identified. The treatment for recurrent GB is not well defined, and decision-making is usually based on prior strategies as well as several clinical and radiological factors. The presence of neurologic deficits and seizures can significantly impact quality of life (AU9

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SEOM clinical guidelines for diagnosis and treatment of glioblastoma (2017).

Glioblastoma (GB) is the most common brain malignancy and accounts for over 50% of all high-grade gliomas. Radiotherapy (RT) with concomitant and adjuvant temozolomide (TMZ) chemotherapy is the current standard of care for patients with newly diagnosed GB up to age 70. Recently, a new standard of care has been adopted for elderly patients (≥ 65 years) based on short course of RT and TMZ. Several clinically relevant molecular markers that assist in diagnosis and prognosis have recently been identified. The treatment for recurrent GB is not well defined, and decision-making is usually based on prior strategies as well as several clinical and radiological factors. The presence of neurologic deficits and seizures can significantly impact quality of life.

Coupling ultracold atoms to a superconducting coplanar waveguide resonator.

Ensembles of trapped atoms interacting with on-chip microwave resonators are considered as promising systems for the realization of quantum memories, novel quantum gates, and interfaces between the microwave and optical regime. Here, we demonstrate coupling of magnetically trapped ultracold Rb ground-state atoms to a coherently driven superconducting coplanar resonator on an integrated atom chip. When the cavity is driven off-resonance from the atomic transition, the microwave field strength in the cavity can be measured through observation of the AC shift of the atomic hyperfine transition frequency. When driving the cavity in resonance with the atoms, we observe Rabi oscillations between hyperfine states, demonstrating coherent control of the atomic states through the cavity field. These observations enable the preparation of coherent atomic superposition states, which are required for the implementation of an atomic quantum memory.

High resolution core level spectroscopy of hydrogen-terminated (1 0 0) diamond.

Synchrotron-based photoelectron spectroscopy experiments are presented that address a long standing inconsistency in the treatment of the C1s core level of hydrogen terminated (1 0 0) diamond. Through a comparison of surface and bulk sensitive measurements we show that there is a surface related core level component to lower binding energy of the bulk diamond component; this component has a chemical shift of [Formula: see text] eV which has been attributed to carbon atoms which are part of the hydrogen termination. Additionally, our results indicate that the asymmetry of the hydrogen terminated (1 0 0) diamond C1s core level is an intrinsic aspect of the bulk diamond peak which we have attributed to sub-surface carbon layers.

Charge transfer doping of silicon.

We demonstrate a novel doping mechanism of silicon, namely n-type transfer doping by adsorbed organic cobaltocene (CoCp2*) molecules. The amount of transferred charge as a function of coverage is monitored by following the ensuing band bending via surface sensitive core-level photoelectron spectroscopy. The concomitant loss of electrons in the CoCp2* adlayer is quantified by the relative intensities of chemically shifted Co2p components in core-level photoelectron spectroscopy which correspond to charged and neutral molecules. Using a previously developed model for transfer doping, the evolution in relative intensities of the two components as a function of coverage has been reproduced successfully. A single, molecule-specific parameter, the negative donor energy of -(0.50±0.15) eV suffices to describe the self-limiting doping process with a maximum areal density of transferred electrons of 2×1013 cm-2 in agreement with the measured downward band bending. The advantage of this doping mechanism over conventional doping for nanostructures is addressed.

Charge-induced distortion and stabilization of surface transfer doped porphyrin films.

The interaction between zinc-tetraphenylporphyrin (ZnTPP) and fullerenes (C60 and C60F48) are studied using ultraviolet photoelectron spectroscopy (UPS) and scanning tunneling microscopy (STM). Low temperature STM reveals highly ordered ZnTPP monolayers on Au(111). In contrast to C60, a submonolayer coverage of C60F48 results in long-range disorder of the underlying single ZnTPP layer and distortion of individual ZnTPP molecules. This is induced by substantial charge transfer at the organic-organic interface, revealed by the interface energetics from UPS. However, a second layer of ZnTPP prevents C60F48 guests from breaking the self-assembled porphyrin template. This finding is important for understanding the growth behaviour of "bottom-up" functional nanostructures involving strong donor-acceptor heterojunctions in molecular electronics.

Surface transfer doping of hydrogen-terminated diamond by C60F48: energy level scheme and doping efficiency.

Surface sensitive C1s core level photoelectron spectroscopy was used to examine the electronic properties of C(60)F(48) molecules on the C(100):H surface. An upward band bending of 0.74 eV in response to surface transfer doping by fluorofullerene molecules is measured. Two distinct molecular charge states of C(60)F(48) are identified and their relative concentration determined as a function of coverage. One corresponds to ionized molecules that participate in surface charge transfer and the other to neutral molecules that do not. The position of the lowest unoccupied molecular orbital of neutral C(60)F(48) which is the relevant acceptor level for transfer doping lies initially 0.6 eV below the valence band maximum and shifts upwards in the course of transfer doping by up to 0.43 eV due to a doping induced surface dipole. This upward shift in conjunction with the band bending determines the occupation of the acceptor level and limits the ultimately achievable hole concentration with C(60)F(48) as a surface acceptor to values close to 10(13) cm(-2) as reported in the literature.

[Aneurysmal subarachnoid hemorrhage: group of study of cerebrovascular pathology of the Spanish society of neurosurgery management guideline]. / Hemorragia subaracnoidea aneurismática: guía de tratamiento del grupo de patología vascular de la sociedad Española de neurocirugía.

An actualized revision of the most important aspects of aneurismal subarachnoid hemorrhage is presented from the guidelines previously published by the group of study of cerebrovascular pathology of the Spanish Society of Neurosurgery. The proposed recommendations should be considered as a general guide for the management of this pathological condition. However, they can be modified, even in a significant manner according to the circumstances relating each clinical case and the variations in the therapeutic and diagnostic procedures available in the center attending each patient.

Hemorragia subaracnoidea aneurismática: guía de tratamiento del Grupo de Patología Vascularde la Sociedad Española de Neurocirugía / Aneurysmal subarachnoid hemorrhage: group of study of Cerebrovascular Pathology of the Spanish Society of Neurosurgery management guideline

Se realiza una actualización sobre los aspectos másimportantes de la hemorragia subaracnoidea aneurismáticarespecto a las guías previamente publicadaspor el grupo de trabajo de la SENEC. Las recomendacionespropuestas deben considerarse como una guíageneral de manejo de esta patología. Sin embargo,pueden ser modificadas, incluso de manera significativapor las circunstancias propias de cada casoclínico, o las variaciones en los recursos diagnósticosy terapéuticos del centro hospitalario que reciba alpaciente (AU)

An actualized revision of the most important aspectsof aneurismal subarachnoid hemorrhage is presentedfrom the guidelines previously published by the groupof study of cerebrovascular pathology of the SpanishSociety of Neurosurgery. The proposed recommendationsshould be considered as a general guide for themanagement of this pathological condition. However,they can be modified, even in a significant manneraccording to the circumstances relating each clinicalcase and the variations in the therapeutic and diagnosticprocedures available in the center attending eachpatient (AU)

[Spinal granuloma in a patient receiving a spinal infusion of morphine and clonidine]. / Granuloma intradural en un paciente con infusión espinal de morfina y clonidina.

Patients treated with long-term spinal infusion of high doses of morphine develop a granuloma at the location of the catheter tip. Diagnosis is based on a steady increase in intrathecal morphine dosage after a relatively prolonged period of stability, on the gradual development of neurologic signs and symptoms suggesting radicular or spinal cord compression, and on magnetic resonance images. We describe a man with central neuropathic pain after removal of a tumor. The presence of all 3 of the aforementioned diagnostic criteria led to suspicion of a spinal granuloma.

Granuloma intradural en un paciente con infusión espinalde morfina y clonidina / Spinal granuloma in a patient receiving a spinal infusion of morphine and clonidine

Los pacientes en tratamiento con infusión espinal demorfina a dosis elevadas presentan como efecto adversoa largo plazo la formación de un granuloma en la puntadel catéter intradural. La subida ininterrumpida de lasdosis de morfina intratecales tras un periodo relativamenteprolongada de estabilidad, la aparición progresivade una sintomatología neurológica característica decompresión radicular o medular, y las imágenes de resonanciamagnética llevan al diagnóstico de este fenómeno.Se presenta un caso clínico de un paciente con dolor neuropáticocentral tras exéresis tumoral, que reúne los tresprincipios mencionados que llevan al diagnóstico de sospechade granuloma intradural (AU)

Patients treated with long-term spinal infusion of highdoses of morphine develop a granuloma at the locationof the catheter tip. Diagnosis is based on a steadyincrease in intrathecal morphine dosage after arelatively prolonged period of stability, on the gradualdevelopment of neurologic signs and symptomssuggesting radicular or spinal cord compression, and onmagnetic resonance images. We describe a man withcentral neuropathic pain after removal of a tumor. Thepresence of all 3 of the aforementioned diagnosticcriteria led to suspicion of a spinal granuloma (AU)

Brain abscess due to Panton-Valentine leukocidin-positive Staphylococcus aureus.

Panton-Valentine leukocidin (PVL) is a cytotoxin produced by Staphylococcus aureus that exhibits highly specific lytic activity against polymorphonuclear cells, monocytes, and macrophages. A 34-year-old man admitted for right parietal brain abscess and thickened dura mater in close proximity to a lytic bone lesion is presented. The abscess culture yielded methicillin-sensitive S. aureus that produced PVL. The patient did well after surgery and antibiotic treatment. A hematogenous infection, route of bone infection with progression to dura mater and brain parenchyma was hypothesized. To our knowledge this is the first reported case of a brain abscess due to PVL-positive S. aureus.

[How is iron prescribed in French ICUs: a practice survey]. / La prescription martiale en réanimation aujourd'hui : une enquête de pratique.

OBJECTIVE: To evaluate the practice concerning the iron prescription by French intensivists. TYPE OF STUDY: Survey during an intensive care-national congress. METHODS: Interviewed practitioners were separated in two groups (prescribing [P] iron once time or more per week; or not [NP] less than one time per month). Iron-treatments (iv or oral) efficacy and tolerance were quoted from 1 to 10. RESULTS: All the 128 interviewed intensivists (73% male; mean age 36+/-8 years) considered having anaemic patients and 94% considered having patients with iron deficiency. For 72% of them, the iron deficiency was judged frequent (concerning >10% of their patients) and 25% were P. Intravenous iron, oral iron or both were used by, respectively, 20, 35 and 44% of the interviewed intensivists. Intravenous iron was considered more efficient (7+/-2 versus 6+/-2; p<0.001) and better tolerated (7+/-2 versus 6+/-2; p<0.001) than oral iron. There was no demographic difference between P and NP. P answered more often having patients with iron deficiency (p=0.04), but they did not perform biological tests for diagnosis of iron deficiency more often and did not consider iron-treatment efficacy or tolerance higher than NP. CONCLUSION: Intensive-care anaemia and iron deficiency were considered to be frequent and iron treatments to be efficient and quite well tolerated. But only 25% of the interviewed intensivists were frequent-iron prescribers. This survey underscore that iron prescription in ICU seems to rely more on clinical feeling than on strong evidence: it's time to investigate!

Transclival cerebrospinal fluid fistula in a patient with Marfan's syndrome.

Marfan's syndrome is a disease associated with reduced structural integrity of connective tissues. We report a 36-year-old patient with Marfan's syndrome who presented with rhinorrhoea, occipital headache and vomiting. Physical examination revealed typical Marfan's syndrome features including dolicocephalous, mandibular micrognathia, tall stature, disproportionately long limbs and digits, and hypermobility of the joints. A high-resolution CT scan demonstrated pneumoencephalous, cerebrospinal fluid (CSF) filling the sphenoidal sinus, and a small bone defect of the clivus. Surgery performed through a transsphenoidal approach revealed the sphenoid sinus to be filled with CSF and a small fenestration in the clivus. The arachnoid diverticulum and the fenestration were repaired and covered with a graft of abdominal fat. In this patient, a deficiency in bone development associated with Marfan's syndrome gave rise to a clival fenestration and a transclival CSF fistula. Although abnormalities of the spinal meningeal membranes have been reported in Marfan's syndrome, to our knowledge, this is the first report of a fistula located in the cranial base in this condition.

[Neurological complication after the "tailor posture" during labour with epidural analgesia]. / Complication neurologique après posture obstétricale "en tailleur" lors d'un travail sous analgésie péridurale.

Obstetrical positioning is used more and more often because of the supposed or proven benefits although side effects are not well known. We therefore report the case of a patient who presented with a postpartum neurological deficit after a seven hour hip-flexed posture during labour under epidural analgesia. The parturient did not complain of pain or discomfort during labour. The neurological injury was suspected because of delayed recovery of epidural analgesia-induced motor block. Neurological examination disclosed sensory and motor abnormalities in the left femoral and sciatic nerve distribution areas. The early performed lumbar CT-scan did not show any complication and electromyographic evaluation performed on the ninth postpartum day was normal. Three months after delivery, some degree of neuropathic pain in the sciatic nerve distribution remained. The risk of neurological injury directly related to obstetrical positioning is discussed. Prolonged positioning using a posture which can induce nerve stretching should be avoided. This is especially true when the patient is receiving epidural analgesia which can mask pain or discomfort.

Serum anticholinergic activity in patients following cardiac surgery and healthy individuals following amitriptyline application.

The serum anticholinergic activity (SAA) is used as a marker for cognitive impairment. Here, two studies have been performed characterizing the SAA profile. In Study 1 the endogenous SAA in relation to the total serum protein concentration was monitored for 24 h in five healthy individuals and compared with that in four inpatients following cardiac surgery. In Study 2 the SAA of seven healthy individuals was assessed following a single amitriptyline dose. In both studies SAA was assessed by an ex vivo assay. In Study 1, the absolute SAA varied in a wide range of 1.2 and 14.5 atropine equivalents (AEs) over 24 h. A circadian pattern was not observed. The mean total serum protein concentration, but not the SAA, was significantly lower in inpatients than in healthy individuals. In Study 2, the SAA increased following amitriptyline to a maximum. The mean SAA increased by 6.39 AE at the amitriptyline peak concentration. High SAA variability showed a low statistical relation to amitriptyline concentrations. Both studies characterize the SAA as an individual parameter not affected per se by surgery or clinical care and poorly correlated with the total serum protein concentration. The relation with amitriptyline concentration helps to quantify SAA values towards a better understanding of the clinical implications and limitations of SAA changes.

[Neurological complication after hip-flexed posture during labour with epidural analgesia]. / Complication neurologique après posture obstétricale "en tailleur" lors d'un travail sous analgésie péridurale.

Obstetrical positioning is used more and more often because of the supposed or proven benefits although side effects are not well known. We therefore report the case of a patient who presented with a postpartum neurological deficit after a seven hour hip-flexed posture during labour under epidural analgesia. The parturient did not complain of pain or discomfort during labour. The neurological injury was suspected because of delayed recovery of epidural analgesia induced-motor block. Neurological examination disclosed sensory and motor abnormalities in the left femoral and sciatic nerve distribution areas. The early performed lumbar CT scan did not show any complication and electromyographic evaluation performed on the ninth postpartum day was normal. Three months after delivery, some degree of neuropathic pain in the sciatic nerve distribution remained. The risk of neurological injury directly related to obstetrical positioning is discussed. Prolonged positioning using a posture which can induce nerve stretching should be avoided. This is especially true when the patient is receiving epidural analgesia which can mask pain or discomfort.

Pharmacodynamic effects of 3-day intravenous treatment with pantoprazole or ranitidine after 10 days of oral ranitidine.

Tachyphylaxis (drug tolerance) is an undesirable condition in drug therapy with histamine-2-receptor antagonists (H2RAs). The concept of overcoming tachyphylaxsis via intravenous (i.v.) administration of proton-pump inhibitors (PPIs) or H2RAs is of significant interest to physicians. In the present study, 32 healthy Helicobacter pylori negative male volunteers were evaluated for the ability of i.v. pantoprazole or i.v. ranitidine to overcome oral ranitidine tachyphylaxis. After 10 days of oral treatment with enteric-coated 300-mg ranitidine tablets once daily in the evening, two groups of 16 volunteers each were randomized to receive either i.v. pantoprazole or i.v. ranitidine for up to 72 h. The primary variable was defined as the increase in 24-h gastric pH median after 1 day of i.v. treatment; the secondary variable was median percentage of time that 24-h gastric pH was <4, as calculated by Hodges-Lehman shift estimators. After 10 days of oral ranitidine treatment, tachyphylaxis was present in all volunteers. Within 1 day of continuous i.v. pantoprazole or i.v. ranitidine administration, 24-h median gastric pH increased from pH 1.45 to pH 3.50 (241%) and from pH 1.50 to pH 2.35 (157%), respectively. I.v. pantoprazole was found to be significantly more effective (p<0.05) than i.v. ranitidine in increasing the 24-h gastric pH after oral ranitidine tachyphylaxis.