On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI.

Primary glioblastoma (GBM), IDH-wildtype, especially with multifocal appearance/growth (mGBM), is associated with very poor prognosis. Several clinical parameters have been identified to provide prognostic value in both unifocal GBM (uGBM) and mGBM, but information about the influence of radiological parameters on survival for mGBM cohorts is scarce. This study evaluated the prognostic value of several volumetric parameters derived from magnetic resonance imaging (MRI). Data from the Department of Neurosurgery, Leipzig University Hospital, were retrospectively analyzed. Patients treated between 2014 and 2019, aged older than 18 years and with adequate peri-operative MRI were included. Volumetric assessment was performed manually. One hundred and eighty-three patients were included. Survival of patients with mGBM was significantly shorter (p < 0.0001). Univariate analysis revealed extent of resection, adjuvant therapy regimen, residual tumor volume, tumor necrosis volume and ratio of tumor necrosis to initial volume as statistically significant for overall survival. In multivariate Cox regression, however, only EOR (for uGBM and the entire cohort) and adjuvant therapy were independently significant for survival. Decreased ratio of tumor necrosis to initial tumor volume and extent of resection were associated with prolonged survival in mGBM but failed to achieve statistical significance in multivariate analysis.

Cartilage degradation by stimulated human neutrophils: elastase is mainly responsible for cartilage damage.

Although neutrophilic granulocytes are assumed to contribute to cartilage degradation during rheumatic diseases, there is still a discussion whether reactive oxygen species (ROS) or proteolytic enzymes that are both released by the neutrophils are most relevant to cartilage degradation. To gain further insight into these processes, an in vitro approach to study the interaction between the products of stimulated neutrophilic granulocytes and cartilage was used: Neutrophils from the blood of healthy volunteers were treated with different stimulators (e.g., Ca(2+) ionophores) in order to induce degranulation. Supernatants of neutrophils were afterward incubated with thin slices of pig articular cartilage. Some experiments were also performed in the presence of selected enzyme inhibitors. Supernatants of cartilage were subsequently assayed by one- and two-dimensional high-resolution proton NMR spectroscopy, and the content of soluble carbohydrates in the supernatant was additionally determined by biochemical methods. The selective inhibition of elastase decreased most significantly the extent of cartilage degradation, whereas all other inhibitors had much smaller effects. These results were additionally confirmed by measuring the effect of isolated elastase on articular cartilage in the absence and presence of different inhibitors. It is concluded that elastase released [EC 3.4.21.37] by neutrophils is the most relevant enzyme for cartilage degradation.