Neurocognitive changes after awake surgery in glioma patients: a retrospective cohort study

PURPOSE: Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. In order to minimize the harmful effects of surgery, an increasing number of patients undergo awake craniotomy. To investigate whether we can indeed preserve cognitive functioning after state-of-the art awake surgery and to identify factors determining postoperative NCF, we performed a retrospective cohort study. METHODS: In diffuse glioma (WHO grade 2-4) patients undergoing awake craniotomy, we studied neurocognitive functioning both pre-operatively and 3-6 months postoperatively. Evaluation covered five neurocognitive domains. We performed analysis of data on group and individual level and evaluated the value of patient-, tumor- and treatment-related factors for predicting change in NCF, using linear and logistic regression analysis. RESULTS: We included 168 consecutive patients. Mean NCF-scores of psychomotor speed and visuospatial functioning significantly deteriorated after surgery. The percentage of serious neurocognitive impairments (- 2 standard deviations) increased significantly for psychomotor speed only. Tumor involvement in the left thalamus predicted a postoperative decline in NCF for the domains overall-NCF, executive functioning and psychomotor speed. An IDH-wildtype status predicted decline for overall-NCF and executive functioning. CONCLUSIONS: In all cognitive domains, except for psychomotor speed, cognitive functioning can be preserved after awake surgery. The domain of psychomotor speed seems to be most vulnerable to the effects of surgery and early postoperative therapies. Cognitive performance after glioma surgery is associated with a combination of structural and biomolecular effects from the tumor, including IDH-status and left thalamic involvement

Tumor-related neurocognitive dysfunction in patients with diffuse glioma : a systematic review of neurocognitive functioning prior to anti-tumor treatment

Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. Data about the role of the tumor are scarce, because NCF has mostly been studied postoperatively. We aimed to summarize data on pre-treatment NCF in glioma patients and to determine the overall and domain-specific prevalence of neurocognitive dysfunction. We searched PubMed and Embase according to PRISMA-P protocol for studies that evaluated pre-treatment NCF in glioma patients (1995-November 2016) and extracted information about NCF. We performed analysis of data for two main outcome measures; mean cognitive functioning of the study sample (at group level) and the percentage of impaired patients (at individual level). We included 23 studies. Most studies were small observational prospective cohort studies. In 11 (47.5%) studies, patient selection was based on tumor location. NCF was analyzed at the group level in 14 studies, of which 13 (92.9%) found decreased NCF at group level, compared to normative data or matched controls. The proportion of individuals with decreased NCF was reported in 15 studies. NCF was impaired (in any domain) in 62.6% of the individuals (median; interquartile range 31.0–79.0). Cognitive impairments were more common in patients with high-grade glioma than with low-grade glioma (OR 2.50; 95% CI 1.71–3.66). Cognitive impairment occurs in the majority of treatment-naive glioma patients, suggesting that neurocognitive dysfunction is related to the tumor. However, the literature about pre-treatment NCF in glioma patients is characterized by small-scale studies and strong heterogeneity in patient selection, resulting in high risk of bias

Tumor-related neurocognitive dysfunction in patients with diffuse glioma : a systematic review of neurocognitive functioning prior to anti-tumor treatment

Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. Data about the role of the tumor are scarce, because NCF has mostly been studied postoperatively. We aimed to summarize data on pre-treatment NCF in glioma patients and to determine the overall and domain-specific prevalence of neurocognitive dysfunction. We searched PubMed and Embase according to PRISMA-P protocol for studies that evaluated pre-treatment NCF in glioma patients (1995-November 2016) and extracted information about NCF. We performed analysis of data for two main outcome measures; mean cognitive functioning of the study sample (at group level) and the percentage of impaired patients (at individual level). We included 23 studies. Most studies were small observational prospective cohort studies. In 11 (47.5%) studies, patient selection was based on tumor location. NCF was analyzed at the group level in 14 studies, of which 13 (92.9%) found decreased NCF at group level, compared to normative data or matched controls. The proportion of individuals with decreased NCF was reported in 15 studies. NCF was impaired (in any domain) in 62.6% of the individuals (median; interquartile range 31.0-79.0). Cognitive impairments were more common in patients with high-grade glioma than with low-grade glioma (OR 2.50; 95% CI 1.71-3.66). Cognitive impairment occurs in the majority of treatment-naive glioma patients, suggesting that neurocognitive dysfunction is related to the tumor. However, the literature about pre-treatment NCF in glioma patients is characterized by small-scale studies and strong heterogeneity in patient selection, resulting in high risk of bias

Hochtemperatur-Supraleiter-Systeme in der Satellitenkommunikation. Leistungstaugliche Hochfrequenz-Resonatoren und -Filter in planarer HTSL-Technologie Abschlussbericht

Goal of the R and D project was the development of miniaturized HTSC resonators and filters. The work was divided into two main packages: (#alpha#) Systematic investigations of thin film samples, manufactured by partners of the common project as well as the development of characterization methods. (#beta#) Considerations of all relevant topics related to the design and manufacturing of high power filters with given specifications. The power handling capability of thin films is the most challenging issue in film production. A large variation in film quality could be observed that can cause problems in the realization of HTSC components. Employing the introduced concept of edge current free disk and ring resonators, high power HTSC filters can be realized with an improvement of 400 in power handling capability compared to other HTSC resonator types. During optimization of the unloaded quality factor, dielectric losses were identified to be the limiting factor. Two-pole, four-pole Chebyshev and four pole elliptic filters were developed and characterized and showed low loss and high power handling capability. (orig.)Die Zielsetzung des F und E-Vorhabens war es, stark miniaturisierte leistungstaugliche Resonatoren und Filter auf der Basis von Hochtemperatur-supraleitenden Duennfilmen zu entwickeln. Die Arbeiten gliederten sich in zwei Teilbereiche: Einerseits wurden Methoden zur Hochfrequenz-Charakterisierung der zugrundeliegenden HTSL-Schichten entwickelt und systematische Untersuchungen an Proben schichtherstellender Verbundpartner durchgefuehrt. Andererseits wurden alle relevanten Teilprobleme zur Entwicklung hochleistungstauglicher Filter bearbeitet und entsprechende Problemloesungen entwickelt. Bei der Schichtherstellung stellte sich die geforderte Leistungstragfaehigkeit der HTSL-Schichten als besondere Herausforderung dar. Es wurde eine grosse Streuung der Filmqualitaet beobachtet, wodurch die Realisierung von Bauelementen erschwert werden kann. Die Realisierung leistungstauglicher Filter ist mit dem vorgeschlagenen Scheibenresonator-Konzept moeglich, welche eine um den Faktor 400 hoehere Energiespeicherung im Vergleich zu anderen HTSL-Strukturen erlauben. Bei der Optimierung der Leerlaufguete stellten sich dielektrische Verluste als begrenzender Faktor heraus. Es wurden sukzessive Zweipolfilter, 4-polig Tscherbyscheff-Filter und 4-polige quasi-elliptische Filter entwickelt und charakterisiert. (orig.)Available from TIB Hannover: F99B1258+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung und Forschung (BMBF), Bonn (Germany)DEGerman

Tumor-related molecular determinants of neurocognitive deficits in patients with diffuse glioma

BACKGROUND: Cognitive impairment is a common and debilitating symptom in patients with diffuse glioma, and is the result of multiple factors. We hypothesized that molecular tumor characteristics influence neurocognitive functioning (NCF), and aimed to identify tumor-related markers of NCF in diffuse glioma patients. METHODS: We examined the relation between cognitive performance (executive function, memory, and psychomotor speed) and intratumoral expression levels of molecular markers in treatment-naive patients with diffuse glioma. We performed a single-center study in a consecutive cohort, through a two-step design: (1) hypothesis-free differential expression and gene set enrichment analysis to identify candidate oncogenetic markers for cognitive impairment. Nineteen molecular markers of interest were derived from this set of genes, as well as from prior knowledge; (2) correlation of cognitive performance to intratumoral expression levels of these nineteen molecular markers, measured with immunohistochemistry. RESULTS: From 708 included patients with immunohistochemical data, we performed an in-depth analysis of neuropsychological data in 197, and differential expression analysis in 65 patients. After correcting for tumor volume and location, we found significant associations between expression levels of CD3 and IDH-1 and psychomotor speed; between IDH-1, ATRX, NLGN3, BDNF, CK2Beta, EAAT1, GAT-3, SRF, and memory performance; and between IDH-1, P-STAT5b, NLGN3, CK2Beta, and executive functioning. P-STAT5b, CD163, CD3, and Semaphorin-3A were independently associated after further correction for histopathological grade. CONCLUSION: Molecular characteristics of glioma can be independent determinants of patients' cognitive functioning. This suggests that besides tumor volume, location, and histological grade, variations in glioma biology influence cognitive performance through mechanisms that include perturbation of neuronal communication. These results pave the way towards targeted cognition improving therapies in neuro-oncology