Surgeon experience in glioblastoma surgery of the elderly : a multicenter, retrospective cohort study

Purpose To assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis. Methods GBM patients aged≥65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantifed in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous fve years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity). Results 198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0–12.0); median EOR was 89.4%. Surgery-related morbidity afected 19.7% patients. No correlations of lifetime surgeon experience with OS (P=.693), EOR (P=.693), and surgery-related morbidity (P=.435) were identifed. Adjuvant therapy was associated with improved OS (PConclusion Less experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial forgenerating a treatment beneft for this cohort.Peer reviewe

Carbonaceous aerosol composition in air masses influenced by large-scale biomass burning: a case study in northwestern Vietnam

We investigated concentrations of organic carbon (OC), elemental carbon (EC), and a wide range of particle-bound organic compounds in daily sampled PM2.5 at the remote Pha Din (PDI) - Global Atmosphere Watch (GAW) monitoring station in northwestern Vietnam during an intense 3-week sampling campaign from 23 March to 12 April 2015. The site is known to receive trans-regional air masses during large-scale biomass burning (BB) episodes. BB is a globally widespread phenomenon and BB emission characterization is of high scientific and societal relevance. Emissions composition is influenced by multiple factors (e.g., fuel and thereby vegetation type, fuel moisture, fire temperature, available oxygen). Due to regional variations in these parameters, studies in different world regions are needed. OC composition provides valuable information regarding the health- and climate-relevant properties of PM2.5. Yet, OC composition studies from PDI are missing in the scientific literature to date. Therefore, we quantified 51 organic compounds simultaneously by in situ derivatization thermal desorption gas chromatography and time-of-flight mass spectrometry (IDTD-GC-TOFMS). Anhydrosugars, methoxyphenols, nalkanes, fatty acids, polycyclic aromatic hydrocarbons, oxygenated polycyclic aromatic hydrocarbons, nitrophenols, and OC were used in a hierarchical cluster analysis highlighting distinctive patterns for periods under low, medium, and high BB influence. The highest particle phase concentration of the typical primary organic aerosol (POA) and possible secondary organic aerosol (SOA) constituents, especially nitrophenols, were found on 5 and 6 April. We linked the trace gas mixing ratios of methane (CH4), carbon dioxide (CO2), carbon monoxide (CO), and ozone (O-3) to the statistical classification of BB events based on OA composition and found increased CO and O-3 levels during medium and high BB influence. Likewise, a backward trajectory analysis indicates different source regions for the identified periods based on the OA clusters, with cleaner air masses arriving from the northeast, i.e., mainland China and the Yellow Sea. The more polluted periods are characterized by trajectories from the southwest, with more continental recirculation of the medium cluster and more westerly advection for the high cluster. These findings highlight that BB activities in northern Southeast Asia significantly enhance the regional organic aerosol loading and also affect the carbonaceous PM2.5 constituents and the trace gases in northwestern Vietnam. The presented analysis adds valuable data on the carbonaceous and chemical composition of PM2.5, in particular of OC, in a region of scarce data availability, and thus offers a reference dataset from Southeast Asian large-scale BB for future studies. Such a reference dataset may be useful for the evaluation of atmospheric transport simulation models, or for comparison with other world regions and BB types, such as Australian bush fires, African savannah fires, or tropical peatland fires

Risks and Benefits of Glioblastoma Resection in Older Adults : A Retrospective Austrian Multicenter Study

OBJECTIVE: To assess the prognostic profile, clinical outcome, treatment-associated morbidity, and treatment burden of elderly patients with glioblastoma (GBM) undergoing microsurgical tumor resection as part of contemporary treatment algorithms. METHODS: We retrospectively identified patients with GBM >= 65 years of age who were treated by resection at 2 neuro-oncology centers. Survival was assessed by Kaplan-Meier analyses; log-rank tests identified prognostic factors. RESULTS: The study population included 160 patients (mean age, 73.1 +/- 5.1 years), and the median contrastenhancing tumor volume was 31.0 cm(3). Biomarker analyses revealed 0(6)-methylguanine-DNA methyltransferase-promoter methylation in 62.7% and wild-type isocitrate dehydrogenase in 97.5% of tumors. The median extent of resection (EOR) was 92.3%, surgical complications were noted in 10.0% of patients, and the median postoperative hospitalization period was 8 days. Most patients (60.0%) received adjuvant radio-/chemotherapy. The overall treatment-associated morbidity was 30.6%. The median progression-free and overall survival were 5A months (95% confidence interval [Cl], 4.6-6.4 months) and 10.0 months (95% CI, 7.9-11.7 months). The strongest predictors for favorable outcome were patient age = 80% (P = 0.0179), postoperative modified Rankin Scale score CONCLUSIONS: Clinical outcome for elderly patients with GBM remains limited. Nonetheless, the observed treatment-associated morbidity and treatment burden were moderate in the patients, and patient age and performance status remained the strongest predictors for survival. The risks and benefits of tumor resection in the age of biomarker-adjusted treatment concepts require further prospective evaluation.Peer reviewe

Chaperoning epigenetics: FKBP51 decreases the activity of DNMT1 and mediates epigenetic effects of the antidepressant paroxetine

Epigenetic processes, such as DNA methylation, and molecular chaperones, including FK506-binding protein 51 (FKBP51), are independently implicated in stress-related mental disorders and antidepressant drug action. FKBP51 associates with cyclin-dependent kinase 5 (CDK5), which is one of several kinases that phosphorylates and activates DNA methyltransferase 1 (DNMT1). We searched for a functional link between FKBP51 (encoded by FKBP5) and DNMT1 in cells from mice and humans, including those from depressed patients, and found that FKBP51 competed with its close homolog FKBP52 for association with CDK5. In human embryonic kidney (HEK) 293 cells, expression of FKBP51 displaced FKBP52 from CDK5, decreased the interaction of CDK5 with DNMT1, reduced the phosphorylation and enzymatic activity of DNMT1, and diminished global DNA methylation. In mouse embryonic fibroblasts and primary mouse astrocytes, FKBP51 mediated several effects of paroxetine, namely, decreased the protein-protein interactions of DNMT1 with CDK5 and FKBP52, reduced phosphorylation of DNMT1, and decreased the methylation and increased the expression of the gene encoding brain-derived neurotrophic factor (Bdnf). In human peripheral blood cells, FKBP5 expression inversely correlated with both global and BDNF methylation. Peripheral blood cells isolated from depressed patients that were then treated ex vivo with paroxetine revealed that the abundance of BDNF positively correlated and phosphorylated DNMT1 inversely correlated with that of FKBP51 in cells and with clinical treatment success in patients, supporting the relevance of this FKBP51-directed pathway that prevents epigenetic suppression of gene expression