Diagnosis and New Treatment Modalities for Glioblastoma: Do They Improve Patient Survival?

Central nervous system (CNS) malignances include tumors of the brain and spinal cord. Taking into account the cell type where they originate from, there are almost 120 different types of CNS tumors. Benign tumors are not aggressive and normally do not invade other organs; however, they require surgical removal before they alter the surrounding brain functions. Primary malignant brain tumors commonly include astrocytomas, oligodendrogliomas, and ependimomas, where astrocytomas represent around 76%. The World Health Organization (WHO) has defined four histological grades of astrocytomas that range from the less aggressive tumors (grade I) to highly malignant tumors (grade IV). These grade IV tumors, also called glioblastoma (GBM), are the most aggressive of the primary malignant brain tumors. Patients with GBM have a median survival of 12 to 15 months. Current treatment for GBM includes surgery, radiotherapy and chemotherapy. Although there have been some advances in diagnosis and treatment, there is still no optimal treatment available for GBMs. In this review, we will discuss the approaches for GBM diagnosis and treatment, with a special emphasis to post-treatment imaging, and whether novel targeted therapies have impacted the survival of GBM patients. In addition, we will discuss clinical trials and the future of GBM diagnosis and treatment.

Qualidade espermática de sêmen de cães naturalmente infectados por leishmania sp / Semen quality of dogs naturally infected by leishmania sp

Avaliaram-se alterações espermáticas associadas à infecção por leishmaniose no sêmen de cães naturalmente infectados, utilizando-se, durante oito semanas consecutivas, ejaculados de seis cães soronegativos e seis cães soropositivos. As amostras foram colhidas uma vez por semana e avaliadas quanto ao volume, concentração, motilidade, vigor, morfologia espermática, integridade da cromatina, avaliação simultânea da integridade da membrana plasmática, acrossoma e potencial mitocondrial. Concomitantemente foram dosadas a proteína total do plasma seminal e sanguíneo. A leishmaniose visceral causou aumento dos defeitos maiores e menores nos espermatozoides dos animais acometidos pelo estágio moderado a severo da doença. Em estágios mais avançados da enfermidade, a integridade das membranas acrossomal e plasmática foi afetada negativamente. Não foi possível estabelecer um critério quanto à avaliação do potencial mitocondrial. A incidência de alterações morfológicas nos animais acometidos não promoveu aumento de injurias à cromatina. Todos os animais com leishmaniose apresentaram hiperproteinemia do sêmen.

The spermatic changes associated with the natural infection in dogs by Leishmania sp was evaluated during eight consecutive weeks, using ejaculates of six seronegative and six seropositive dogs. The samples were collected once a week and evaluated for volume, concentration, motility, vigor, sperm morphology, chromatin integrity, simultaneous evaluation of the plasmatic membrane integrity, acrosome, and mitochondrial potential. The total proteins of the seminal plasma and blood were measured. The visceral leishmaniasis caused increase of major and minor defects in spermatozoa of animals attacked by moderate to severe stages of the disease. In more advanced stages of the illness, the acrosomal and plasmatic membranes integrity was adversely affected. It was not possible to establish a pattern refering the evaluation of the mitochondrial potential. The incidence of morphological changes in the seropositive animals did not promote an increase of injuries to the chromatin. All animals with leishmaniasis presented hyperproteinemia of the semen.

Deficiencia aislada de ACTH: una causa infrecuente de fracaso adrenal crónico / Isolated ACTH deficiency: a rare cause of chronic adrenal failure

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Wheat gluten phenolic acids: occurrence and fate upon mixing.

Ferulic acid (FA, 4.9-17.7 microg/100 mg), sinapic acid (SA, 1.4-3.5 microg/100 mg), and traces of p-coumaric acid and vanillic acid were detected after saponification of six wheat glutens from industrial and pilot-scale origins. FA and SA occurred mostly as soluble-bound and insoluble-bound forms according to their extractability by acetone/methanol/water (7:7:6, v/v/v). The major part of FA (50-95%) was found in the unextractable fraction, whereas SA was mostly extractable (64-85%). The carbohydrate contents of the glutens were determined also after acid hydrolysis. The highest levels of glucose, arabinoxylan, and FA were obtained from the unextractable fractions of the pilot-scale extracted glutens, probably in relation with a lower efficiency of washing during extraction compared to industrial processes. On the other hand, SA compounds were in similar concentrations in all samples, suggesting their involvement in specific interactions during gluten protein agglomeration. Saponification of the soluble-bound phenolic acids released mainly glucose, whereas a beta-glucosidase treatment had no effect. FA and SA extractability, especially that of soluble-bound ones, decreased strongly in overmixed gluten/water doughs. These low molecular weight conjugates of phenolic acids could be involved in the dough breakdown phenomenon.

[Double oriface mitral valve: severe mitral regurgitation secondary to chord rupture]. / Doble orificio valvular mitral: insuficiencia severa secundaria a rotura de cuerdas.

Double orifice mitral valve is a rare congenital malformation. Most commonly it is associated with other cardiac diseases, usually in children. The echocardiographic technique has allowed a noninvasive and more frequent detection of this entity. The isolated occurrence of this anomaly is exceptional. We present the case of a 68-year-old male with double orifice mitral valve presented with severe mitral regurgitation secondary to chords rupture, without any other congenital malformations.

[Medical rhabdomyolysis in the elderly]. / Rabdomiólisis médica en el anciano.

BACKGROUND: To investigate the characteristics of medical rhabdomyolysis (RM) in the elderly, as well as differences compared with those observed in younger patients. PATIENTS AND METHODS: Prospective study of 56 elderly patients (> or = 65 years) with RM and 73 younger patients (> 7 years and < 65 years) with RM for 43 months. The RM characteristics were analyzed in the elderly group (ERM) and compared with those in the younger group (YRM). RESULTS: Fifty-six elderly patients with RM (38 males and 18 females, with a mean age of 76.3 +/- 7.6 years; range: 65-92 years) and 73 younger patients (57 males and 16 females, with a mean age of 37.9 +/- 15.6 years; range: 13-63 years), made up the 129 patients in the study. The most common cause for RM in the ERM was muscle compression due to immobilization and the multicausative group, both with 9 (16%) cases, followed by respiratory infection with 8 (14.2%) cases. In the YRM, the most common cause was physical exertion with 15 patients (20.5%) and multicausative with 18 patients (24.6%). Myalgia predominated in the YRM group, with 25 vs. 9 (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.0-7.3; p < 0.05). Acute renal failure (ARF) occurred in 13 patients in the ERM group compared with 4 in the YRM group (OR: 5.2; 95% CI: 1.4-23; p < 0.01). In the logistic regression analysis an association was found between hypoalbuminemia and ARF for the ERM group. In the presence of ARF, both ERM and YRM had decreased serum calcium levels, deeper in YRM and more prolonged in the ERM. Six patients in the ERM died, and four of them had developed ARF. In contrast, none of the two deceased patients in the YRM had the complication of ARF. CONCLUSION: Almost half of cases of RM occur in elderly patients, which is mostly due to muscle compression and infections, particularly in the respiratory tract. Symptoms are usually mild and the development of ARF is more common than in younger patients, and its presence is associated with hypoalbuminemia. Hypocalcemia associated with ARF was less deep in the elderly, but more persistent than in younger patients. Most deceased patients in the elderly group previously developed ARF.