Decision making and management of gliomas: practical considerations

Over the last decade, diagnostic options and introduction of novel treatments have expanded the armamentarium in the management of malignant glioma. Combined chemoradiotherapy has become the standard of care in glioblastoma up to the age of 70 years, while treatment in elderly patients or with lower grade glioma is less well defined. Molecular markers define different disease subtypes and allow for adapted treatment selection. This review focuses on simple questions arising in the daily management of patient

A daily, 1 km resolution data set of downscaled Greenland ice sheet surface mass balance (1958–2015)

This study presents a data set of daily, 1 km resolution Greenland ice sheet (GrIS) surface mass balance (SMB) covering the period 1958–2015. Applying corrections for elevation, bare ice albedo and accumulation bias, the high-resolution product is statistically downscaled from the native daily output of the polar regional climate model RACMO2.3 at 11 km. The data set includes all individual SMB components projected to a down-sampled version of the Greenland Ice Mapping Project (GIMP) digital elevation model and ice mask. The 1 km mask better resolves narrow ablation zones, valley glaciers, fjords and disconnected ice caps. Relative to the 11 km product, the more detailed representation of isolated glaciated areas leads to increased precipitation over the southeastern GrIS. In addition, the downscaled product shows a significant increase in runoff owing to better resolved low-lying marginal glaciated regions. The combined corrections for elevation and bare ice albedo markedly improve model agreement with a newly compiled data set of ablation measurements

A daily, 1 km resolution data set of downscaled Greenland ice sheet surface mass balance (1958–2015)

This study presents a data set of daily, 1 km resolution Greenland ice sheet (GrIS) surface mass balance (SMB) covering the period 1958–2015. Applying corrections for elevation, bare ice albedo and accumulation bias, the high-resolution product is statistically downscaled from the native daily output of the polar regional climate model RACMO2.3 at 11 km. The data set includes all individual SMB components projected to a down-sampled version of the Greenland Ice Mapping Project (GIMP) digital elevation model and ice mask. The 1 km mask better resolves narrow ablation zones, valley glaciers, fjords and disconnected ice caps. Relative to the 11 km product, the more detailed representation of isolated glaciated areas leads to increased precipitation over the southeastern GrIS. In addition, the downscaled product shows a significant increase in runoff owing to better resolved low-lying marginal glaciated regions. The combined corrections for elevation and bare ice albedo markedly improve model agreement with a newly compiled data set of ablation measurements

Observations of Buried Lake Drainage on the Antarctic Ice Sheet.

Between 1992 and 2017, the Antarctic Ice Sheet (AIS) lost ice equivalent to 7.6 ± 3.9 mm of sea level rise. AIS mass loss is mitigated by ice shelves that provide a buttress by regulating ice flow from tributary glaciers. However, ice-shelf stability is threatened by meltwater ponding, which may initiate, or reactivate preexisting, fractures, currently poorly understood processes. Here, through ground penetrating radar (GPR) analysis over a buried lake in the grounding zone of an East Antarctic ice shelf, we present the first field observations of a lake drainage event in Antarctica via vertical fractures. Concurrent with the lake drainage event, we observe a decrease in surface elevation and an increase in Sentinel-1 backscatter. Finally, we suggest that fractures that are initiated or reactivated by lake drainage events in a grounding zone will propagate with ice flow onto the ice shelf itself, where they may have implications for its stability

A tipping point in refreezing accelerates mass loss of Greenland’s glaciers and ice caps

Melting of the Greenland ice sheet (GrIS) and its peripheral glaciers and ice caps (GICs) contributes about 43% to contemporary sea level rise. While patterns of GrIS mass loss are well studied, the spatial and temporal evolution of GICs mass loss and the acting processes have remained unclear. Here we use a novel, 1 km surface mass balance product, evaluated against in situ and remote sensing data, to identify 1997 (±5 years) as a tipping point for GICs mass balance. That year marks the onset of a rapid deterioration in the capacity of the GICs firn to refreeze meltwater. Consequently, GICs runoff increases 65% faster than meltwater production, tripling the post-1997 mass loss to 36±16 Gt−1, or ∼14% of the Greenland total. In sharp contrast, the extensive inland firn of the GrIS retains most of its refreezing capacity for now, buffering 22% of the increased meltwater production. This underlines the very different response of the GICs and GrIS to atmospheric warming

Evaluation of MODIS-derived estimates of the albedo over the Atacama Desert using ground-based spectral measurements

Surface albedo is an important forcing parameter that drives the radiative energy budget as it determines the fraction of the downwelling solar irradiance that the surface reflects. Here we report on ground-based measurements of the spectral albedo (350–2200 nm) carried out at 20 sites across a North–South transect of approximately 1300 km in the Atacama Desert, from latitude 18° S to latitude 30° S. These spectral measurements were used to evaluate remote sensing estimates of the albedo derived from the Moderate Resolution Imaging Spectroradiometer (MODIS). We found that the relative mean bias error (RMBE) of MODIS-derived estimates was within ± 5% of ground-based measurements in most of the Atacama Desert (18–27° S). Although the correlation between MODIS-derived estimates and ground-based measurements remained relatively high (R= 0.94), RMBE values were slightly larger in the southernmost part of the desert (27–30° S). Both MODIS-derived data and ground-based measurements show that the albedo at some bright spots in the Atacama Desert may be high enough (up to 0.25 in visible range) for considerably boosting the performance of bifacial photovoltaic technologies (6–12%)

Two cilengitide regimens in combination with standard treatment for patients with newly diagnosed glioblastoma and unmethylated MGMT gene promoter: results of the open-label, controlled, randomized phase II CORE study

Background Survival outcomes for patients with glioblastoma remain poor, particularly for patients with unmethylated O6-methylguanine-DNA methyltransferase (MGMT) gene promoter. This phase II, randomized, open-label, multicenter trial investigated the efficacy and safety of 2 dose regimens of the selective integrin inhibitor cilengitide combined with standard chemoradiotherapy in patients with newly diagnosed glioblastoma and an unmethylated MGMT promoter. Methods Overall, 265 patients were randomized (1:1:1) to standard cilengitide (2000 mg 2×/wk; n = 88), intensive cilengitide (2000 mg 5×/wk during wk 1−6, thereafter 2×/wk; n = 88), or a control arm (chemoradiotherapy alone; n = 89). Cilengitide was administered intravenously in combination with daily temozolomide (TMZ) and concomitant radiotherapy (RT; wk 1−6), followed by TMZ maintenance therapy (TMZ/RT→TMZ). The primary endpoint was overall survival; secondary endpoints included progression-free survival, pharmacokinetics, and safety and tolerability. Results Median overall survival was 16.3 months in the standard cilengitide arm (hazard ratio [HR], 0.686; 95% CI: 0.484, 0.972; P = .032) and 14.5 months in the intensive cilengitide arm (HR, 0.858; 95% CI: 0.612, 1.204; P = .3771) versus 13.4 months in the control arm. Median progression-free survival assessed per independent review committee was 5.6 months (HR, 0.822; 95% CI: 0.595, 1.134) and 5.9 months (HR, 0.794; 95% CI: 0.575, 1.096) in the standard and intensive cilengitide arms, respectively, versus 4.1 months in the control arm. Cilengitide was well tolerated. Conclusions Standard and intensive cilengitide dose regimens were well tolerated in combination with TMZ/RT→TMZ. Inconsistent overall survival and progression-free survival outcomes and a limited sample size did not allow firm conclusions regarding clinical efficacy in this exploratory phase II stud

Neonatal Oral Imitation in Patients with Severe Brain Damage

Background: Neonates reproduce facial movements in response to an adult model just after birth. This neonatal oral imitation usually disappears at about 2- to 3-months of age following the development of cortical control. There is controversy relating to the nature and neural basis of such neonatal imitation. To address this issue, we studied the relationship between oral imitation, primitive reflexes, and residual voluntary movement in patients with severe brain damage. Methods: Six male and six female patients with cerebral palsy, from 4 to 39 years, were included in this study. Oral imitation was examined when they were awake and looked at the experimenter. Patients were evaluated as performing oral imitation when they opened their mouth repeatedly without visual feedback regarding their own behavior in response to the experimenter’s oral movement. Tongue or lip protrusion was not examined because none of patients were able to do those behaviors due to their physical disability. Rooting and sucking reflexes were also investigated as representatives of primitive reflexes. Results: Six patients (50%) performed oral imitation. Mouth opening was not observed repeatedly in response to other facial expression without opening the mouth such as surprise or smile, excluding the possibility of nonspecific oral reaction. They exhibited little voluntary movement of their extremities. Half of them also manifested at least one primitive reflex. N

Wernicke's region--where is it

In this subject, the first question both logically and chronologically was and is: Can a lesion (focal damage) of the cerebrum cause a loss of language without causing a loss of intelligence? That is the original question, still debated hotly by many people. Much of the heat is attributable to the way in which the question is phrased. Suppose we phrase it relatively, as follows: Can a lesion of the cerebrum produce a deficit in language that is far in excess of the concomitant deficit in intelligence? Asked in this way, almost everyone would answer yes. There are worthy persons who are still arguing that anyone who has a loss of language from a cerebral lesion must have some accompanying loss of intelligence. Similarly, there are equally worthy persons recurrently showing us that intelligence can be preserved in spite of severe aphasia. Both parties are undoubtedly correct. But the force of either argument is largely dissipated when the question is rephrased in the relative way. Of course, how much intelligence is lost (or retained) depends upon how one goes about measuring intelligence; but with almost any measures, except those strictly linguistic, the answer will be yes. Indeed, if the answer were not yes, there would not be such a thing a