Second surgery for progressive glioblastoma: a multi-centre questionnaire and cohort-based review of clinical decision-making and patient outcomes in current practice.

PURPOSE: Glioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. METHODS: Current practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. RESULTS: 234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p = 0.874). CONCLUSIONS: This is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

Indolocarbazole based polymer coated super adsorbent polyurethane sponges for oil/organic solvent removal.

The synthesis of an indolocarbazole-fluorene based conjugated polymer (ICZP6), by Sonogashira coupling reaction, has been presented. The ICZP6 has then been integrated with a nano iron oxide embedded polyurethane foam (ICZP6PUF) to develop a promising adsorbent for oil/organic contaminants in aqueous systems. The anchoring ability of ICZP6 on to iron oxide PU sponge switches on significant hydrophobicity within the whole molecular assembly. The cooperative effects of ICZP6-iron oxide- PU sponge system have been highlighted in terms of structural, microscopic and wettability characteristics. The heterogeneity and hierarchical porous structure of the system offer a high adsorption capability for different types of oils and organic contaminants in water, typically in the range of 100-240 gg-1. The performance of ICZP6PUF has been confirmed by the fast (within 5-10s) and choosy removal of selected oils and organic solvents from polluted water with the aid of an external magnetic field. The adsorbed materials (oil/organic solvents) can be separated from the adsorbent by simple mechanical squeezing without causing any structural deformation or performance deterioration; with a reusability of the system over 50 cycles. The adsorption isotherm has been found to fit well with the Langmuir model with R2 = 0.9484. To extent the scope of the ICZP6PUF hybrid, an integrative logic gate has been designed.