Along low gradient rivers in northern Australia, there is widespread gully erosion into unconfined alluvial deposits of active and inactive floodplains. On the Mitchell River fluvial megafan in ...northern Queensland, river incision and fan-head trenching into Pleistocene and Holocene megafan units with sodic soils created the potential energy for a secondary cycle of erosion. In this study, rates of alluvial gully erosion into incipiently-unstable channel banks and/or pre-existing floodplain features were quantified to assess the influence of land use change following European settlement. Alluvial gully scarp retreat rates were quantified at 18 sites across the megafan using recent GPS surveys and historic air photos, demonstrating rapid increases in gully area of 1.2 to 10 times their 1949 values. Extrapolation of gully area growth trends backward in time suggested that the current widespread phase of gullying initiated between 1880 and 1950, which is post-European settlement. This is supported by young optically stimulated luminescence (OSL) dates of gully inset-floodplain deposits, LiDAR terrain analysis, historic explorer accounts of earlier gully types, and archival records of cattle numbers and land management. It is deduced that intense cattle grazing and associated disturbance concentrated in the riparian zones during the dry season promoted gully erosion in the wet season along steep banks, adjacent floodplain hollows and precursor gullies. This is a result of reduced native grass cover, increased physical disturbance of soils, and the concentration of water runoff along cattle tracks, in addition to fire regime modifications, episodic drought, and the establishment of exotic weed and grass species. Geomorphic processes operating over geologic time across the fluvial megafan predisposed the landscape to being pushed by land used change across an intrinsically close geomorphic threshold towards instability. The evolution of these alluvial gullies is discussed in terms of their initiation, development, future growth, and stabilisation, and the numerous natural and anthropogenic factors influencing their erosion.
•Alluvial gully erosion into floodplains is widespread across northern Australia.•River incision into megafans creates the potential energy for new erosion cycles.•Air photo and OSL data demonstrate rapid gully expansion post-European settlement.•Cattle grazing increases erosion into incipiently-unstable floodplain features.•Natural and anthropogenic factors influence geomorphic thresholds and gully evolution.
This prospective multicenter study assessed the prognostic influence of the extent of resection when compared with biopsy only in a contemporary patient population with newly diagnosed glioblastoma.
...Histology, O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, and clinical data were centrally analyzed. Survival analyses were carried out with the Kaplan-Meier method. Prognostic factors were assessed with proportional hazard models.
Of 345 patients, 273 underwent open tumor resection and 72 biopsies; 125 patients had gross total resections (GTRs) and 148, incomplete resections. Surgery-related morbidity was lower after biopsy (1.4% versus 12.1%, P = 0.007). 64.3% of patients received radiotherapy and chemotherapy (RT plus CT), 20.0% RT alone, 4.3% CT alone, and 11.3% best supportive care as an initial treatment. Patients ≤60 years with a Karnofsky performance score (KPS) of ≥90 were more likely to receive RT plus CT (P < 0.01). Median overall survival (OS) (progression free survival; PFS) ranged from 33.2 months (15 months) for patients with MGMT-methylated tumors after GTR and RT plus CT to 3.0 months (2.4 months) for biopsied patients receiving supportive care only. Favorable prognostic factors in multivariate analyses for OS were age ≤60 years hazard ratio (HR) = 0.52; P < 0.001, preoperative KPS of ≥80 (HR = 0.55; P < 0.001), GTR (HR = 0.60; P = 0.003), MGMT promoter methylation (HR = 0.44; P < 0.001), and RT plus CT (HR = 0.18, P < 0.001); patients undergoing incomplete resection did not better than those receiving biopsy only (HR = 0.85; P = 0.31).
The value of incomplete resection remains questionable. If GTR cannot be safely achieved, biopsy only might be used as an alternative surgical strategy.
CNS embryonal tumours: WHO 2016 and beyond Pickles, J. C.; Hawkins, C.; Pietsch, T. ...
Neuropathology and applied neurobiology,
February 2018, 2018-02-00, 20180201, Letnik:
44, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Embryonal tumours of the central nervous system (CNS) present a significant clinical challenge. Many of these neoplasms affect young children, have a very high mortality and therapeutic strategies ...are often aggressive with poor long‐term outcomes. There is a great need to accurately diagnose embryonal tumours, predict their outcome and adapt therapy to the individual patient's risk. For the first time in 2016, the WHO classification took into account molecular characteristics for the diagnosis of CNS tumours. This integration of histological features with genetic information has significantly changed the diagnostic work‐up and reporting of tumours of the CNS. However, this remains challenging in embryonal tumours due to their previously unaccounted tumour heterogeneity. We describe the recent revisions made to the 4th edition of the WHO classification of CNS tumours and review the main changes, while highlighting some of the more common diagnostic testing strategies.
Cancer research has made great progress in the recent years. With the increasing number of options in diagnosis and therapy the implementation of tumorboards (TUBs) has become standard procedure in ...the treatment of cancer patients. Adherence tests on tumor board decisions are intended to enable quality assurance and enhancement for work in tumor boards in order to continuously optimize treatment options for cancer patients.
Subject of this study was the adherence of the recommendations made in three of 14 tumorboards, which take place weekly in the Center for Integrated Oncology (CIO) at the University Hospital Bonn. In total, therapy recommendations of 3815 patient cases were checked on their implementation. A classification into four groups has been made according to the degree of implementation. A second classification followed regarding the reasons for differences between the recommendation and the therapy which the patient actually received.
The study showed that 80.1% of all recommendations in the three TUBs were implemented. 8.3% of all recommendations showed a deviance. Most important reasons for the deviances were patient wish (36.5%), patient death (26%) and doctoral decision, due to the patient's comorbidities or side effects of the treatment (24.1%).Interestingly, deviance in all three tumor boards in total significantly decreased over time.
Aim of the study was to clarify the use of tumor boards and find approaches to make them more efficient. Based on the results efficiency might be optimized by increased consideration of patients` preferences, improved presentation of patient-related data, more detailed documentation and further structuring of the tumor board meetings.
The HIT-SIOP-PNET4 randomised trial for standard risk medulloblastoma (MB) (2001–2006) included 338 patients and compared hyperfractionated and conventional radiotherapy. We here report the long-term ...outcome after a median follow up of 7.8 years, including detailed information on relapse and the treatment of relapse. Data were extracted from the HIT Group Relapsed MB database and by way of a specific case report form. The event-free and overall (OS) survival at 10 years were 76 ± 2 % and 78 ± 2 % respectively with no significant difference between the treatment arms. Seventy-two relapses and three second malignant neoplasms were reported. Thirteen relapses (18 %) were isolated local relapses in the posterior fossa (PF) and 59 (82 %) were craniospinal, metastatic relapses (isolated or multiple) with or without concurrent PF disease. Isolated PF relapse vs all other relapses occurred at mean/median of 38/35 and 28/26 months respectively (p = 0.24). Late relapse, i.e. >5 years from diagnosis, occurred in six patients (8 %). Relapse treatment consisted of combinations of surgery (25 %), focal radiotherapy (RT 22 %), high dose chemotherapy with stem cell rescue (HDSCR 21 %) and conventional chemotherapy (90 %). OS at 5 years after relapse was 6.0 ± 4 %. In multivariate analysis; isolated relapse in PF, and surgery were significantly associated with prolonged survival whereas RT and HDSCR were not. Survival after relapse was not related to biological factors and was very poor despite several patients receiving intensive treatments. Exploration of new drugs is warranted, preferably based on tumour biology from biopsy of the relapsed tumour.
Aeolianite successions of low-gradient continental margins commonly show complex records of coastal dune deposition linked to a wide range of sea-level positions and climatic periods of the middle ...and late Pleistocene, recording both regional and broader-scale drivers of sediment production, coastal dune development and landform preservation. To better characterise the general pattern of sedimentation that occurs over Quaternary glacial–interglacial cycles on low-gradient, temperate carbonate continental shelves we examine the morphology, stratigraphy and age of aeolianite deposits in the Perth region, Western Australia. This includes an analysis of well-defined drowned coastal landforms preserved on the adjacent shelf. New and previously published optical ages provide a preliminary timeframe for the deposition of aeolianite in the Perth region and on Rottnest Island, 17 km offshore. An extensive aeolianite ridge near Perth, representing a former barrier, has Optically Stimulated Luminesence (OSL) ages that range from 120 ± 12 to 103 ± 10 ka (MIS 5e–5a in the context of associated age uncertainties). OSL ages for an exposure in the same ridge 2.5 km inland, record the onlap of much older aeolianite, OSL age 415 ± 70 ka, by shell-rich estuarine beds, OSL age 290 ± 30 ka. A further 5.5 km inland from the coast, two thick aeolianite units, separated by a well-developed palaeosol, have stratigraphically consistent OSL ages of 310 ± 30 and 155 ± 20 ka. In contrast, aeolianite units that form the northern coast of Rottnest Island have OSL ages of 77 ± 12 ka and 27 ± 5 ka. The new OSL ages and previously reported TL and U/Th ages indicate that the bulk of the island comprises dunes deposited around the end of the Last Interglacial sensu lato (MIS 5a–4) and during the Last Glacial (MIS 4–2), accumulating over a Last Interglacial coral reef and basal calcarenite. Drowned barrier and dune landforms preserved on the adjacent continental shelf reveal that barriers were formed during periods of intermediate sea level (e.g. MIS 3) and significant dune mobility occurred when the shelf was subaerially exposed. The pattern of shelf sedimentation discernible in the Perth region – large-scale coastal carbonate dune deposition during periods of high and intermediate sea level and reactivation during glacial lowstands – is largely consistent with published stratigraphic and age data for large-scale aeolianite deposits on other low-gradient carbonate shelves. Based on these data, a general model is proposed for the cycle of Quaternary sedimentation and landform evolution that occurs on these shelves, which are dynamic sedimentary environments with coastal landforms and sedimentary successions that are very sensitive to erosion and sediment reworking.
•We examine the age and stratigraphy of aeolianite around Perth, Western Australia.•OSL and TL ages indicate deposition during interglacial and glacial periods.•Coastal barriers developed on the shelf under intermediate sea levels (e.g. MIS 3).•Significant dune mobility occurred when the shelf was subaerially exposed.•Globally, similar records are common on low-gradient carbonate continental shelves.
The Hirntumorstudien (HIT)-LGG-1996 protocol offered a comprehensive treatment strategy for pediatric patients with low-grade glioma (LGG), ie, observation, surgery, adjuvant radiotherapy, and ...chemotherapy to defer the start of irradiation in young children. In this current study, we sought to determine clinical factors for progression and survival. Between October 1, 1996 and March 31, 2004, 1031 patients were prospectively recruited into an observation arm (n = 668) and a nonsurgical arm stratifying 12 months of vincristine-carboplatin chemotherapy (n = 216) and conventional radiotherapy/brachytherapy (n = 147) in an age-dependent manner. Median patient age was 6.9 years; 28 patients had diencephalic syndrome, 44 had dissemination, and 108 had neurofibromatosis type 1(NF-1). Main tumor location was the supratentorial midline (40.4%), and the main histology was pilocytic astrocytoma (67.9%). Following a median observation of 9.3 years, 10-year overall survival (OS) was 0.94 and 10-year event-free survival (EFS) was 0.47. Ten-year progression-free survival was 0.62 following radiotherapy and 0.44 following chemotherapy. Sixty-one of 216 chemotherapy patients received radiotherapy 0.3-8.7 years after initial diagnosis. By multivariate analysis, diencephalic syndrome and incomplete resection were found to be unfavorable factors for OS and EFS, age ≥11 years for OS, and supratentorial midline location for EFS. Dissemination, age <1 year, and nonpilocytic histology were unfavorable factors for progression following radiotherapy (138 patients); and diencephalic syndrome, dissemination, and age ≥11 years were unfavorable factors following chemotherapy (210 patients). NF-1 patients and boys experienced prolonged tumor stabilization with chemotherapy. A nationwide multimodal treatment strategy is feasible for pediatric LGG. Extended follow-up yielded results comparable to single-institution series for the treatment groups. Three-quarters of surviving chemotherapy patients have not yet received radiation therapy. Infants with or without diencephalic syndrome and dissemination bear the highest risk for death and progression following diagnosis or treatment.
This study describes synthesis and detailed characterization of 2D and 3D mesocrystalline films produced by self‐assembly of iron oxide (magnetite) truncated nanocubes. The orientational relations ...between nanocrystals within the superlattice are examined and atomistic models are introduced. In the 2D case, two distinct superstructures (i.e., translational order) of magnetite nanocubes can be observed with p4mm and c2mm layer symmetries while maintaining the same orientational order (with 100magnetite perpendicular to the substrate). The 3D structure can be approximated by a slightly distorted face‐centered cubic (fcc) superlattice. The most efficient space filling within the 3D superstructure is achieved by changing the orientational order of the nanoparticles and following the “bump‐to‐hollow” packing principle. Namely orientational order is determined by the shape of the nanoparticles with the following orientational relations: 001SL||310magnetite, 001SL||301magnetite, 001SL||100magnetite. Overall the presented data provide a fundamental understanding of a mesocrystal formation mechanism and their structural evolution. Structure, composition, and magnetic properties of the synthesised nanoparticles are also characterized.
Orientational relations in 2D and 3D mesocrystalline films produced by self‐assembly of iron oxide (magnetite) truncated nanocubes and their transition are described. Atomistic models for a detailed structure description of the mesocrystals are introduced. The most efficient space filling within the 3D superstructure is achieved by changing the nanoparticle orientational order following the “bump‐to‐hollow” packing principle.
In addition to the 4 histopathologically defined entities of medulloblastoma, 4 distinct genetically defined subgroups have been included in the World Health Organization classification of 2016. The ...smallest subgroup is the medulloblastoma with activated wingless pathway. The goal of this study was to identify a typical MR imaging morphology in a larger number of pediatric patients with wingless pathway medulloblastoma.
From January 2001 to October 2017, of 75 patients with histologically confirmed and molecularly subgrouped wingless pathway medulloblastomas recruited to the German Pediatric Brain Tumor (HIT) trials, 38 patients (median age, 12.8 ± 4.6 years at diagnosis; 24 63.2% female) had preoperative imaging that passed the entry criteria for this study. Images were rated by the local standardized imaging criteria of the National Reference Center of Neuroradiology. Additionally, a modified laterality score was used to determine tumor localization and extension.
Twenty-eight of 38 (73.7%) were primary midline tumors but with a lateral tendency in 39.3%. One extensively eccentric midline tumor was rated by the laterality score as in an off-midline position. Five tumors were found in the cerebellopontine angle; 3, in the deep white matter; and 2, in a cerebellar hemisphere. Leptomeningeal dissemination was rare (11.5%). In 60.5%, intratumoral blood-degradation products were found, and 26.3% showed cysts with blood contents.
According to our observations, wingless pathway medulloblastomas are not preferentially off-midline tumors as postulated in previous studies with smaller wingless pathway medulloblastoma cohorts. Dense intratumoral blood-degradation products and cysts with blood contents are frequently found and might help to differentiate wingless pathway medulloblastoma from other medulloblastoma subtypes.
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