Microsurgical management of midbrain gliomas: surgical results and long-term outcome in a large, single-surgeon, consecutive series

OBJECTIVE The authors report on a large, consecutive, single-surgeon series of patients undergoing microsurgical removal of midbrain gliomas. Emphasis is put on surgical indications, technique, and results as well as long-term oncological follow-up. METHODS A retrospective analysis was performed of prospectively collected data from a consecutive series of patients undergoing microneurosurgery for midbrain gliomas from March 2006 through June 2022 at the authors' institution. According to the growth pattern and location of the lesion in the midbrain (tegmentum, central mesencephalic structures, and tectum), one of the following approaches was chosen: transsylvian (TS), extreme anterior interhemispheric transcallosal (eAIT), posterior interhemispheric transtentorial subsplenial (PITS), paramedian supracerebellar transtentorial (PST), perimedian supracerebellar (PeS), perimedian contralateral supracerebellar (PeCS), and transuvulotonsillar fissure (TUTF). Clinical and radiological data were gathered according to a standard protocol and reported according to common descriptive statistics. The main outcomes were rate of gross-total resection; extent of resection; occurrence of any complications; variation in Karnofsky Performance Status score at discharge, 3 months, and last follow-up; progression-free survival (PFS); and overall survival (OS). RESULTS Fifty-four patients (28 of them pediatric) met the inclusion criteria (6 with high-grade and 48 with low-grade gliomas [LGGs]). Twenty-two tumors were in the tegmentum, 7 in the central mesencephalic structures, and 25 in the tectum. In no instance did the glioma originate in the cerebral peduncle. TS was performed in 2 patients, eAIT in 6, PITS in 23, PST in 16, PeS in 4, PeCS in 1, and TUTF in 2 patients. Gross-total resection was achieved in 39 patients (72%). The average extent of resection was 98.0% (median 100%, range 82%-100%). There were no deaths due to surgery. Nine patients experienced transient and 2 patients experienced permanent new neurological deficits. At a mean follow-up of 72 months (median 62, range 3-193 months), 49 of the 54 patients were still alive. All patients with LGGs (48/54) were alive with no decrease in their KPS score, whereas 42 showed improvement compared with their preoperative status. CONCLUSIONS Microneurosurgical removal of midbrain gliomas is feasible with good surgical results and long-term clinical outcomes, particularly in patients with LGGs. As such, microneurosurgery should be considered as the first therapeutic option. Adequate microsurgical technique and anesthesiological management, along with an accurate preoperative understanding of the tumor's exact topographic origin and growth pattern, is crucial for a good surgical outcome

A G protein-coupled, IP3/protein kinase C pathway controlling the synthesis of phosphaturic hormone FGF23

Dysregulated actions of bone-derived phosphaturic hormone fibroblast growth factor 23 (FGF23) result in several inherited diseases, such as X-linked hypophosphatemia (XLH), and contribute substantially to the mortality in kidney failure. Mechanisms governing FGF23 production are poorly defined. We herein found that ablation of the Gq/11α–like, extralarge Gα subunit (XLαs), a product of GNAS, exhibits FGF23 deficiency and hyperphosphatemia in early postnatal mice (XLKO). FGF23 elevation in response to parathyroid hormone, a stimulator of FGF23 production via cAMP, was intact in XLKO mice, while skeletal levels of protein kinase C isoforms α and δ (PKCα and PKCδ) were diminished. XLαs ablation in osteocyte-like Ocy454 cells suppressed the levels of FGF23 mRNA, inositol 1,4,5-trisphosphate (IP3), and PKCα/PKCδ proteins. PKC activation in vivo via injecting phorbol myristate acetate (PMA) or by constitutively active Gqα-Q209L in osteocytes and osteoblasts promoted FGF23 production. Molecular studies showed that the PKC activation–induced FGF23 elevation was dependent on MAPK signaling. The baseline PKC activity was elevated in bones of Hyp mice, a model of XLH. XLαs ablation significantly, but modestly, reduced serum FGF23 and elevated serum phosphate in Hyp mice. These findings reveal a potentially hitherto-unknown mechanism of FGF23 synthesis involving a G protein–coupled IP3/PKC pathway, which may be targeted to fine-tune FGF23 levels

Pedestrian self-reports of factors influencing the use of pedestrian bridges

The study was designed to find out factors that influence use/non-use of pedestrian bridges. The use rate of five pedestrian bridges was observed in the central business district (CBD) of Ankara. After the observations, a survey was conducted among pedestrians using those bridges and crossing contrary to safe practice under them at street level (n = 408). In the present data, the use rate of pedestrian bridges varied from 6 to 63%. The frequent use of the bridge when crossing the road concerned, and seeing bridge use as time saving and safe in general were positively related to respondents' bridge use. Frequent visits to CBD decreased the likelihood of using the bridge. Other factors accounted only for a small proportion of variance in bridge use. The study suggests that bridge use or non-use is a habit and not coincidental behaviour. For increasing the pedestrians' bridge use, escalators seem to be a good solution, but traffic signals under a bridge may deteriorate the use rate. In addition, increasing the number of legs leading to the bridge may not increase the use rate. The use rate is likely to improve, if the safety benefits and convenience of using the bridge without considerable time loss are clearly visible to pedestrians

Oxytocin and social cognition in patients with schizophrenia: comparison with healthy siblings and healthy controls

Objective: There is substantial evidence from animal research indicating a key role of the neuropeptide oxytocin (OT) in the regulation of complex social cognition and behaviour. Social cognition is indispensable for social relationships for the whole of human society, and numerous studies have shown impaired social cognition in schizophrenia (SCH) and unaffected first-degree relatives also seem to be impaired, albeit to a lesser extent. Because of that, this study focuses on the role of OT in social cognition in SCH. Methods: Twenty-seven patients with SCH, 27 healthy siblings (HS) of these patients, and 27 psychologically healthy controls (HC) were included in the study. Blood samples were collected through a peripheral venous catheter. Differences in the socio-demographical and WAIS-R were tested by chi-square and one way-ANOVA. To explore the relationships between social cognition and blood samples we performed Pearson correlations. MANCOVA (gender and WAIS-R as covariates) test was performed to investigate the effect of gender on blood levels of OT and WAIS-R on social cognition. Results: Significant differences were found in neurocognitive and social cognitive capacity but not in OT levels. In the healthy control group, there was a positive correlation between blood OT levels and RMET. There is a statistically significant difference between high and low OT groups with regard to social cognition in all subtests of the RMET. Conclusions: In the current study, we found that patients had deficits in social cognition and neurocognition. Lower endogenous OT levels are also predictive for poor social cognitive functioning in HS and HC