Prognosis of glioblastoma patients improves significantly over time interrogating historical controls

BACKGROUND

Glioblastoma (GBM) is the most common devastating primary brain cancer in adults. In our clinical practice, median overall survival (mOS) of GBM patients seems increasing over time.

METHODS

To address this observation, we have retrospectively analyzed the prognosis of 722 newly diagnosed GBM patients, aged below 70, in good clinical conditions (i.e. Karnofsky Performance Status -KPS- above 70%) and treated in our department according to the standard of care (SOC) between 2005 and 2018. Patients were divided into two groups according to the year of diagnosis (group 1: from 2005 to 2012; group 2: from 2013 to 2018).

RESULTS

Characteristics of patients and tumors of both groups were very similar regarding confounding factors (age, KPS, MGMT promoter methylation status and treatments). Follow-up time was fixed at 24 months to ensure comparable survival times between both groups. Group 1 patients had a mOS of 19 months ([17.3-21.3]) while mOS of group 2 patients was not reached. The recent period of diagnosis was significantly associated with a longer mOS in univariate analysis (HR=0.64, 95% CI [0.51 - 0.81]), p < 0.001). Multivariate Cox analysis showed that the period of diagnosis remained significantly prognostic after adjustment on confounding factors (adjusted Hazard Ratio (aHR) 0.49, 95% CI [0.36-0.67], p < 0.001).

CONCLUSION

This increase of mOS over time in newly diagnosed GBM patients could be explained by better management of potentially associated non-neurological diseases, optimization of validated SOC, better management of treatments side effects, supportive care and participation in clinical trials.

Ibrutinib monotherapy for relapse or refractory primary CNS lymphoma and primary vitreoretinal lymphoma: Final analysis of the phase II 'proof-of-concept' iLOC study by the Lymphoma study association (LYSA) and the French oculo-cerebral lymphoma (LOC) network

BACKGROUND

Primary central nervous system lymphomas (PCNSLs) are mainly diffuse large B-cell lymphomas (DLBCLs) of the non-germinal centre B-cell subtype, with unmet medical needs. This study aimed to evaluate the efficacy and toxicity of ibrutinib in DLBCL-PCNSL PATIENTS AND METHODS: This prospective, multicentre, phase II study involved patients with relapse or refractory(R/R) DLBCL-PCNSL or primary vitreoretinal lymphoma. The treatment consisted of ibrutinib (560 mg/day) until disease progression or unacceptable toxicity occurred. The primary outcome was the disease control (DC) rate after two months of treatment (P0 < 10%; P1 > 30%).

RESULTS

Fifty-two patients were recruited. Forty-four patients were evaluable for response. After 2 months of treatment, the DC was 70% in evaluable patients and 62% in the intent-to-treat analysis, including 10 complete responses (19%), 17 partial responses (33%) and 5 stable diseases (10%). With a median follow-up of 25.7 months (range, 0.7-30.5), the median progression-free and overall survivals were 4.8 months (95% confidence interval [CI]; 2.8-12.7) and 19.2 months (95% CI; 7.2-NR), respectively. Thirteen patients received ibrutinib for more than 12 months. Two patients experienced pulmonary aspergillosis with a favourable (n = 1) or fatal outcome (n = 1). Ibrutinib was detectable in the cerebrospinal fluid (CSF). The clinical response to ibrutinib seemed independent of the gene mutations in the BCR pathway.

CONCLUSION

Ibrutinib showed clinical activity in the brain, the CSF and the intraocular compartment and was tolerated in R/R PCNSL. The addition of ibrutinib to standard methotrexate-base induction chemotherapy will be further evaluated in the first-line treatment.

CLINICAL TRIAL NUMBER

NCT02542514.

MR imaging of adult acute infectious encephalitis

BACKGROUND

Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis.

METHOD

We performed a literature review on PubMed on April 1, 2015 with the search terms "MRI" and "encephalitis".

RESULTS

We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections.

CONCLUSION

Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes).

Cerebral tumor or pseudotumor?

Pseudotumoral lesions are uncommon but important to identity lesions. They can occur during inflammatory diseases (systemic diseases, vasculitis, demyelinating diseases), infectious, and vascular diseases. Also, in a patient with a treated tumor, pseudo-progression and radionecrosis must be differentiated from the tumoral development. Diagnosis can be difficult on an MRI scan, but some MRI aspects in conventional sequences, diffusion, perfusion and spectroscopy can suggest the pseudotumoral origin of a lesion. Imaging must be interpreted according to the context, the clinic and the biology. The presence of associated intracranial lesions can orientate towards a systemic or infectious disease. A T2 hyposignal lesion suggests granulomatosis or histiocytosis, especially if a meningeal or hypothalamic-pituitary involvement is associated. Non-tumoral lesions are generally not hyperperfused. In the absence of a definitive diagnosis, the evolution of these lesions, whether under treatment or spontaneous, is fundamental.

Trigeminal neuralgia

Two different clinical entities, essential or secondary neuralgia, are associated with different pathologies. The pathways of CN V comprise the cervical spine, the brainstem, the root of the nerve and the three peripheral branches: V1, V2 and V3. The lesions responsible for neuralgia are neoplastic, vascular, inflammatory, malformative or post-traumatic. The examination protocol should explore the set of CN V pathways. Neurovascular compression is the main cause of essential neuralgia. It is investigated by T2-weighted inframillimetric volume. Two conditions are necessary to diagnose a neurovascular compression: localised on the root entry zone [(REZ), 2-6mm from the emergence of the pons] and perpendicularly. In the absence of neurovascular compression, thin slices and a gadolinium injection are necessary.

[Clinical case of the month. Ulnar artery aneurysm in a roofer]

A case of ulnar artery aneurysm in an independent roofer is reported. It is a rare disease often associated with the Hammer Hypothenar Syndrome specifically found in manual workers and athletes exposed to repetitive palmar trauma.

Sol-Gel Chemistry of Hydrogenosiliconates: The Role of Hypervalent Silicon Species

The hydrolysis of organic silicates ( mainly Si(OEt)4: [TEOS] and Si(OMe)4: [TMOS]) is the key reaction in sol gel process for preparation of silica. The mechanism of this reaction is not well known because of the competition taking place between hydrolysis itself and condensation reactions (homo or heterocondensations) but also because of redistribution reactions which take place competitively. Furthermore the competition between these steps depends also on the catalysis (acid,basic or nucleophilic) [1, 3].

29Si NMR and XPS Investigation of the Structure of Silicon Oxycarbide Glasses Derived from Polysiloxane Precursors

Two silicon oxycarbide glasses with different compositions (O/Si ratio 1.2 and 1.8) were prepared by pyrolysis at moderate temperature (900 °C) of polysiloxane precursors. Their structure was investigated using quantitative 29Si solid-state NMR and X-ray photoelectron spectroscopy (XPS). The environment of the silicon atoms in the oxycarbide phase corresponded to a purely random distribution of Si-O and Si-C bonds depending on the O/Si ratio of the glass only and not on the structure of the precursors. At the light of the NMR results, the Si2p XPS spectra of the glasses may be interpreted using the contribution of the five possible SiOxC4-x tetrahedra. The Cls spectra of these glasses indicated the presence of oxycarbide carbon in CSi4 tetrahedra, similar to carbide carbon, and graphitic-like excess carbon.

[Skin sensitisation profiles of outpatients with symptoms of respiratory allergies]

AIM

The main objective of the survey was to determine the frequency of the mono and polysensitizations in patients consulting for respiratory allergy, rhinitis or/and asthma. The secondary objectives were to evaluate the severity, the number and the type of the sensitizations, the frequency of the asthma or rhinitis as a function of the sensitizations, the evolution of the sensitizations with age, and identify the principal responsible pneumallergens.

PATIENTS AND METHODS

The multicentric survey included a patient questionnaire allowing the collection and anonymous treatment of data on socio-demographic characteristics, clinical symptoms, cutaneous tests and sensitizations.

RESULTS

A sample of 505 patients, mean age 24 years, consulting for rhinitis or asthma, monosensitized (36%) or polysensitized (64%), was evaluated. The percentage of polysensitized patients was similar in asthmatics, patients with rhinitis, and patients with both asthma and rhinitis (60%, 65%, and 63%, respectively). The mean number of the sensitizations was 2.4 for patients with asthma, 2.6 for those with rhinitis, and 2.6 for patients with both asthma and rhinitis. The greater the severity of the rhinitis or asthma, the higher the number of the sensitizations. Sensitizations to acarids, gramineae and cat were the most frequent. When practioners were asked about their intention to undertake desensitization in polysensitized patients, 52% of them replied positively.

CONCLUSION

Data collected during this survey showed that a large proportion of the patients who consulted for rhinitis or asthma were monosensitized (36%). Sensitization to acarids was the most frequent. Even in polysensitized patients, more than half the practioners said they would use desensitization.

PROACTA: a way to study the tendency to occur (TTO) of patient behaviours

Classical decision theory formulas have been combined with more recent theories from psycho-social origins (such as Rosenstock's health belief model, Fisbein's rational action theory, Bandura's concept of self-efficacy, Triandis' concern for the assessment of habits, etc.). A software, called PROACTA, enables simulations of actual cases. Currently, it is being tested in various backgrounds. It is orientated in order to help conceive intervening strategies, especially in the area of patient education. Examples of a case study are presented.

[Desire, knowledge..., belief, choice, ...and ability]

The evolution of various approaches to health education and additions from educational psychology have brought about a proposition of an easy-to-follow (thus useful) model for health educators based on five nouns: Desire, Knowledge, Belief, Choice, and Ability (Vouloir, Savoir, Se voir, Choisir et Pouvoir). 1. Desire creates the motivation which is essential to action, and can stem from: anticipating consequences; and/or an internal need to resolve problems; and/or external constraints; and/or an interest, reflecting a system of values. Motivation increases, of course, when more than one of the above factors comes into play and the effects are combined. 2. Knowledge is the cognitive competence which is acquired through direct experience, imitation of models, or "verbal apprenticeship" which provides the individual with a repertoire of effective solutions to various problems. 3. Belief concerns the concept of self-evaluation (or rather self-estime). An individual judges his/her capacity to act according to his/her capabilities, and the community according to its actual or potential human, financial and material resources. 4. An individual or community uses its "knowledge" to consider a series of possible solutions to a given problem and chooses the solution according to a base of preferences. In health, as elsewhere, all actions have positive and negative consequences. An example can be found in the alcohol/tobacco area: a certain positive image of smoking and drinking has been portrayed in many socio-cultural environments, and educational campaigns have had a difficult time convincing the public of the negative consequences of these actions. It is thus not surprising that the "balance" of the decision continues toward substance abuse. 5. After "desire, knowledge, belief and choice" have filtered potential solutions, the decisive step is left: the individual and/or community execute an action according to their ability to succeed.(ABSTRACT TRUNCATED AT 250 WORDS)

Intrinsic fasciotomy. When and why?

Major trauma to the upper extremity may lead to ischemic contracture of various muscle groups, sometimes including the intrinsic muscles of the hand. The clinical consequence of such necrotic fibrosis of the intrinsics is clawing of the digits with marked stiffness. After a short anatomical review of the fascias of the intrinsics, indications and operative techniques are discussed, in parallel with clinical cases. Intrinsic fasciotomy thus appears to be a major step in the prevention of digital clawing, when associated with early physiotherapy.