Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation

PURPOSE

To review the outcomes of patients with low-grade glioma diagnosed by modern imaging and treated at a center where postponing radiotherapy was common practice.

METHODS

We reviewed the records of patients (age > or = 18 years) with pathologically confirmed supratentorial low-grade fibrillary astrocytoma, oligodendroglioma, and mixed glioma treated at a regional cancer center in Canada between 1979 and 1995.

RESULTS

Median survival for the entire group (N = 167; mean age 40.6 years) was 10.5 years with 5- and 10-year survival rates of 72% and 50%, respectively. Median progression-free survival was 4.9 years with 5- and 10-year progression-free rates of 50% and 12%, respectively. Overall and progression-free survivals were longer for patients with an oligodendroglioma or mixed glioma than with astrocytoma (median 13 v 7.5 years, P = .003; progression-free 5.6 v 4.4 years, p = .054). Age at diagnosis < or = 40 years, seizures at presentation, minimal residual tumor after surgery, Karnofsky performance status > or = 70, and oligodendroglioma or mixed glioma pathology were associated with significantly longer median survival on univariate and multivariate analyses. Radiotherapy deferred until tumor progression (v immediate radiotherapy) was associated with longer survival on univariate analysis, but an imbalance in other variables accounted for this advantage such that timing of radiotherapy was not an independent (favorable or adverse) prognostic factor on multivariate analysis.

CONCLUSION

Patients with low-grade glioma diagnosed by modern imaging can be expected to live a long time; timing of radiotherapy may be a less important determinant of survival than nontreatment variables and residual tumor bulk.

Artificial ‘spin ice’ in a geometrically frustrated lattice of nanoscale ferromagnetic islands

Frustration, defined as a competition between interactions such that not all of them can be satisfied, is important in systems ranging from neural networks to structural glasses. Geometrical frustration, which arises from the topology of a well-ordered structure rather than from disorder, has recently become a topic of considerable interest. In particular, geometrical frustration among spins in magnetic materials can lead to exotic low-temperature states, including 'spin ice', in which the local moments mimic the frustration of hydrogen ion positions in frozen water. Here we report an artificial geometrically frustrated magnet based on an array of lithographically fabricated single-domain ferromagnetic islands. The islands are arranged such that the dipole interactions create a two-dimensional analogue to spin ice. Images of the magnetic moments of individual elements in this correlated system allow us to study the local accommodation of frustration. We see both ice-like short-range correlations and an absence of long-range correlations, behaviour which is strikingly similar to the low-temperature state of spin ice. These results demonstrate that artificial frustrated magnets can provide an uncharted arena in which the physics of frustration can be directly visualized.

Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis

PURPOSE

Three databases were pooled and analyzed to determine which groupings of prognostic factors best predicted overall survival for patients with low-grade gliomas treated with surgery and immediate or delayed radiotherapy.

METHODS AND MATERIALS

Databases of patients with low-grade gliomas compiled at the London Regional Cancer Centre (LRCC), the Norwegian Radium Hospital (NRH), and the University of California, San Francisco (UCSF) were merged. Inclusion criteria for the pooled analysis included: age > or =18 years and histologically confirmed low-grade (World Health Organization Grade II) supratentorial fibrillary astrocytoma, oligodendroglioma or mixed oligoastrocytoma. Factors analyzed for prognostic significance included: age at diagnosis, gender, seizures at presentation, presence of enhancement on computed tomography (CT) or magnetic resonance imaging (MRI), Karnofsky Performance Status (KPS) at diagnosis, histology, extent of surgical resection, timing of radiotherapy, and treating institution. Univariate and multivariate analysis of overall survival for these factors was performed. Recursive partitioning was performed to generate prognostic groups using these factors.

RESULTS

From the combined databases, 401 patients were eligible for analysis. Median survival for the entire group was 95 months/7.9 years. On univariate analysis age 18-40, presence of seizures at presentation, KPS > or =70, treating institution, and absence of contrast enhancement were associated with improved overall survival. On multivariate analysis, these factors remained independent predictors of improved overall survival. Recursive partitioning analysis yielded four prognostic groups with statistically different median survivals (MS): Group I (n = 41: KPS <70, age >40) MS 12 months; Group II (n = 34: KPS > or =70, age >40, enhancement present) MS 46 months; Group III (n = 138: KPS <70, age 18-40 or KPS > or =70 age >40, no enhancement) MS 87 months; Group IV (n = 188: KPS > or =70, age 18-40) MS 128 months.

CONCLUSION

Clusters of pretreatment prognostic factors described subgroups of low-grade glioma patients with divergent overall survivals. Consideration of these prognostic subgroups may be important when considering timing of interventions for these patients and in the stratification of patients for clinical trials.

Efficacy of the echinocandin caspofungin against disseminated aspergillosis and candidiasis in cyclophosphamide-induced immunosuppressed mice

The in vivo efficacy of the echinocandin antifungal caspofungin acetate (caspofungin; MK-0991) was evaluated in models of disseminated aspergillosis and candidiasis in mice with cyclophosphamide (CY)-induced immunosuppression. Caspofungin is a 1, 3-beta-D-glucan synthesis inhibitor efficacious against a number of clinically relevant fungi including Aspergillus and Candida species. Models of CY-induced transient or chronic leukopenia were used with once daily administration of therapy initiated 24 h after microbial challenge. Caspofungin was effective in treating disseminated aspergillosis in mice that were transiently leukopenic (significant prolongation of survival at doses of > or =0.125 mg/kg of body weight and a 50% protective dose [PD(50)] of 0.245 mg/kg/day at 28 days after challenge) or chronically leukopenic (50 to 100% survival at doses of > or =0.5 mg/kg and PD(50)s ranging from 0.173 to 0.400 mg/kg/day). Caspofungin was effective in the treatment and sterilization of Candida infections in mice with transient leukopenia with a 99% effective dose based on reduction in log(10) CFU of Candida albicans/gram of kidneys of 0.119 mg/kg and 80 to 100% of the caspofungin-treated mice having sterile kidneys at caspofungin doses from 0.25 to 2.0 mg/kg. In Candida-infected mice with chronic leukopenia, caspofungin was effective at all dose levels tested (0.25 to 1.0 mg/kg), with the log(10) CFU of C. albicans/gram of kidneys of caspofungin-treated mice being significantly lower (>99% reduction) than that of sham-treated mice from day 4 to day 28 after challenge. Also, 70 to 100% of the caspofungin-treated, chronic leukopenic mice had sterile kidneys at caspofungin doses of 0.5 to 1.0 mg/kg from day 8 to 28 after challenge. Sterilization of Candida infections by caspofungin in the absence of host leukocytes provides compelling in vivo evidence for fungicidal activity against C. albicans. Further human clinical trials with caspofungin against serious fungal infections are in progress.

Drug-induced aseptic meningitis: diagnosis and management

Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction with numerous agents. It is a diagnosis of exclusion, and clinical signs and CSF findings vary greatly. The body of evidence regarding DIAM is largely in the form of anecdotal case reports and must be interpreted carefully bearing this in mind. The major categories of causative agents are nonsteroidal anti-inflammatory drugs, antimicrobials, intravenous immunoglobulin, intrathecal agents, vaccines and a number of other less frequently reported agents. There appears to be an association between DIAM and connective tissue disease, particularly systemic lupus erythematosus, and ibuprofen. There are 2 major proposed mechanisms for DIAM. The first involves direct irritation of the meninges by intrathecal administration of the drug, and the second involves immunological hypersensitivity to the drug, most likely type III and type IV hypersensitivity. Recognition and diagnosis of DIAM is important, as it is treatable by withdrawal of the drug and recurrence is prevented. The outcome of DIAM is generally good, usually without long term sequelae. This article describes the case reports of DIAM in the current literature and discusses the diagnosis and management of this rare complication.

Polylactide-poly(dimethylsiloxane)-polylactide triblock copolymers as multifunctional materials for nanolithographic applications

Highly immiscible block copolymers are attractive materials for applications in nanolithography due to their ability to self-assemble on length scales that are difficult to access by conventional lithography. The incorporation of inorganic domains into such block copolymers provides etch contrast that can potentially reduce processing times and costs in nanolithographic applications. We explored thin films of polylactide-poly(dimethylsiloxane)-polylactide (PLA-PDMS-PLA) triblock copolymers as multifunctional nanolithographic templates. We demonstrate the formation of well-ordered arrays of hexagonally packed PDMS cylinders oriented normal to the substrate, the orthogonal etchability of these cylinders and the PLA matrix, and the formation of etch-resistant domains that can be used as pattern transfer masks.

Kondo physics in non-local metallic spin transport devices

The non-local spin-valve is pivotal in spintronics, enabling separation of charge and spin currents, disruptive potential applications and the study of pressing problems in the physics of spin injection and relaxation. Primary among these problems is the perplexing non-monotonicity in the temperature-dependent spin accumulation in non-local ferromagnetic/non-magnetic metal structures, where the spin signal decreases at low temperatures. Here we show that this effect is strongly correlated with the ability of the ferromagnetic to form dilute local magnetic moments in the NM. This we achieve by studying a significantly expanded range of ferromagnetic/non-magnetic combinations. We argue that local moments, formed by ferromagnetic/non-magnetic interdiffusion, suppress the injected spin polarization and diffusion length via a manifestation of the Kondo effect, thus explaining all observations. We further show that this suppression can be completely quenched, even at interfaces that are highly susceptible to the effect, by insertion of a thin non-moment-supporting interlayer.

Coercivity enhancement in exchange biased systems driven by interfacial magnetic frustration

We report the temperature and cooling field dependence of the coercivity of exchange biased MnF(2)/Fe bilayers. When the antiferromagnetic surface is in a state of maximum magnetic frustration and the net exchange bias is zero, we observe a strong enhancement of the coercivity, which is proportional to the exchange coupling between the layers. Hence, the coercivity can be tuned in a reproducible and repeatable fashion in the same sample. We propose that a frustrated interface provides local energy minima which effectively pin the propagating domain walls in the ferromagnet, leading to an enhanced coercivity.

Direct measurement of the low-temperature spin-state transition in LaCoO3

LaCoO3 exhibits an anomaly in its magnetic susceptibility around 80 K associated with a thermally excited transition of the Co3+-ion spin. We show that electron energy-loss spectroscopy is sensitive to this Co3+-ion spin-state transition, and that the O K edge prepeak provides a direct measure of the Co3+ spin state in LaCoO3 as a function of temperature. Our experimental results are confirmed by first-principles calculations, and we conclude that the thermally excited spin-state transition occurs from a low to an intermediate spin state, which can be distinguished from the high-spin state.

Optimization of long-range order in solvent vapor annealed poly(styrene)-block-poly(lactide) thin films for nanolithography

Detailed experiments designed to optimize and understand the solvent vapor annealing of cylinder-forming poly(styrene)-block-poly(lactide) thin films for nanolithographic applications are reported. By combining climate-controlled solvent vapor annealing (including in situ probes of solvent concentration) with comparative small-angle X-ray scattering studies of solvent-swollen bulk polymers of identical composition, it is concluded that a narrow window of optimal solvent concentration occurs just on the ordered side of the order-disorder transition. In this window, the lateral correlation length of the hexagonally close-packed ordering, the defect density, and the cylinder orientation are simultaneously optimized, resulting in single-crystal-like ordering over 10 μm scales. The influences of polymer synthesis method, composition, molar mass, solvent vapor pressure, evaporation rate, and film thickness have all been assessed, confirming the generality of this behavior. Analogies to thermal annealing of elemental solids, in combination with an understanding of the effects of process parameters on annealing conditions, enable qualitative understanding of many of the key results and underscore the likely generality of the main conclusions. Pattern transfer via a Damascene-type approach verified the applicability for high-fidelity nanolithography, yielding large-area metal nanodot arrays with center-to-center spacing of 38 nm (diameter 19 nm). Finally, the predictive power of our findings was demonstrated by using small-angle X-ray scattering to predict optimal solvent annealing conditions for poly(styrene)-block-poly(lactide) films of low molar mass (18 kg mol(-1)). High-quality templates with cylinder center-to-center spacing of only 18 nm (diameter of 10 nm) were obtained. These comprehensive results have clear and important implications for optimization of pattern transfer templates and significantly advance the understanding of self-assembly in block copolymer thin films.

Intergranular giant magnetoresistance in a spontaneously phase separated perovskite oxide

We present small-angle neutron scattering data proving that, on the insulating side of the metal-insulator transition, the doped perovskite cobaltite La(1-x)Sr(x)CoO(3) phase separates into ferromagnetic metallic clusters embedded in a nonferromagnetic matrix. This induces a hysteretic magnetoresistance, with temperature and field dependence characteristic of intergranular giant magnetoresistance (GMR). We argue that this system is a natural analog to the artificial structures fabricated by depositing nanoscale ferromagnetic particles in a metallic or insulating matrix; i.e., this material displays a GMR effect without the deliberate introduction of chemical interfaces.

Composite block polymer-microfabricated silicon nanoporous membrane

Block polymers offer an attractive route to densely packed, monodisperse nanoscale pores. However, their fragility as thin films complicates their use as membranes. By integrating a block polymer film with a thin (100 microm) silicon substrate, we have developed a composite membrane providing both nanoscale size exclusion and fast transport of small molecules. Here we describe the fabrication of this membrane, evaluate its mechanical integrity, and demonstrate its transport properties for model solutes of large and small molecular weight. The ability to block large molecules without hindering smaller ones, coupled with the potential for surface modification of the polymer and the microelectromechanical system style of support, makes this composite membrane an attractive candidate for interfacing implantable sensing and drug-delivery devices with biological hosts.

Protecting the poor under cost recovery: the role of means testing

In African health sectors, the importance of protecting the very poor has been underscored by increased reliance on user fees to help finance services. This paper presents a conceptual framework for understanding the role means testing can play in promoting equity under health care cost recovery. Means testing is placed in the broader context of targeting and contrasted with other mechanisms. Criteria for evaluating outcomes are established and used to analyze previous means testing experience in Africa. A survey of experience finds a general pattern of informal, low-accuracy, low-cost means testing in Africa. Detailed household data from a recent cost recovery experiment in Niger, West Africa, provides an unusual opportunity to observe outcomes of a characteristically informal means testing system. Findings from Niger suggest that achieving both the revenue raising and equity potential of cost recovery in sub-Saharan Africa will require finding ways to improve informal means testing processes.

Co1-xFexS2: a tunable source of highly spin-polarized electrons

In the emerging field of spin-electronics ideal ferromagnetic electron sources would not only possess a high degree of spin polarization, but would also offer control over the magnitude of this polarization. We demonstrate here that a simple scheme can be utilized to control both the magnitude and the sign of the spin polarization of ferromagnetic CoS2, which we probe with a variety of techniques. The position of the Fermi level is fine-tuned by solid solution alloying with the isostructural diamagnetic semiconductor FeS2, leading to tunable spin polarization of up to 85%.

Persistent optically induced magnetism in oxygen-deficient strontium titanate

Strontium titanate (SrTiO3) is a foundational material in the emerging field of complex oxide electronics. Although its bulk electronic and optical properties are rich and have been studied for decades, SrTiO3 has recently become a renewed focus of materials research catalysed in part by the discovery of superconductivity and magnetism at interfaces between SrTiO3 and other non-magnetic oxides. Here we illustrate a new aspect to the phenomenology of magnetism in SrTiO3 by reporting the observation of an optically induced and persistent magnetization in slightly oxygen-deficient bulk SrTiO3-δ crystals using magnetic circular dichroism (MCD) spectroscopy and SQUID magnetometry. This zero-field magnetization appears below ~18 K, persists for hours below 10 K, and is tunable by means of the polarization and wavelength of sub-bandgap (400-500 nm) light. These effects occur only in crystals containing oxygen vacancies, revealing a detailed interplay between magnetism, lattice defects, and light in an archetypal complex oxide material.

Non-lift-off block copolymer lithography of 25 nm magnetic nanodot arrays

Although nanolithographic techniques based on self-assembled block copolymer templates offer tremendous potential for fabrication of large-area nanostructure arrays, significant difficulties arise with both the lift-off and etch processes typically used for pattern transfer. These become progressively more important in the limit of extreme feature sizes. The few techniques that have been developed to avoid these issues are quite complex. Here, we demonstrate successful execution of a nanolithographic process based on solvent annealed, cylinder-forming, easily degradable, polystyrene-b-polylactide block copolymer films that completely avoids lift-off in addition to the most challenging aspects of etching. We report a "Damascene-type" process that overfills the polystyrene template with magnetic metal, employs ion beam milling to planarize the metal surface down to the underlying polystyrene template, then exploits the large etch rate contrast between polystyrene and typical metals to generate pattern reversal of the original template into the magnetic metal. The process is demonstrated via formation of a large-area array of 25 nm diameter ferromagnetic Ni(80)Fe(20) nanodots with hexagonally close-packed order. Extensive microscopy, magnetometry, and electrical measurements provide detailed characterization of the pattern formation. We argue that the approach is generalizable to a wide variety of materials, is scalable to smaller feature sizes, and critically, minimizes etch damage, thus preserving the essential functionality of the patterned material.

Perpendicular magnetization and generic realization of the Ising model in artificial spin ice

We have studied frustrated kagome arrays and unfrustrated honeycomb arrays of magnetostatically interacting single-domain ferromagnetic islands with magnetization normal to the plane. The measured pairwise spin correlations of both lattices can be reproduced by models based solely on nearest-neighbor correlations. The kagome array has qualitatively different magnetostatics but identical lattice topology to previously studied artificial spin ice systems composed of in-plane moments. The two systems show striking similarities in the development of moment pair correlations, demonstrating a universality in artificial spin ice behavior independent of specific realization in a particular material system.

Drug treatment of scleroderma

Scleroderma or systemic sclerosis is a rare condition with many clinical manifestations including Raynaud's phenomenon. As with many other rarely encountered diseases, drug therapy for scleroderma is often empirical with little evidence in the form of randomised controlled trials to aid drug choice. Raynaud's phenomenon has been recognised for well over 100 years. A considerable number of clinical trials in this area have demonstrated unequivocally the use of nifedipine as a gold standard. Large studies have also demonstrated the efficacy of iloprost. However, this drug is not as yet licensed for scleroderma in the UK or elsewhere. This presents an additional problem as information regarding the use and administration of unlicensed drugs is often sparse and post-marketing surveillance to assess safety is not routinely performed. When looking at the other distinct conditions encountered by a patient with scleroderma it becomes evident that trials are often retrospective or limited in patient numbers. Studies investigating the use of methotrexate, antithymocyte globulin and cyclophosphamide in patients with scleroderma have been very small and in some cases not well designed. The major work on penicillamine was a retrospective trial. Again these drugs are not licensed for use in scleroderma. Drug therapy for pulmonary hypertension secondary to scleroderma closely follows that outlined for primary pulmonary hypertension. In the US there is a patient registry for primary pulmonary hypertension that has enabled well designed, large-scale studies to demonstrate the benefits of epoprostenol in severe primary pulmonary hypertension. Hence, research in this area has progressed considerably over the last decade. Clearly, a considerable amount of work is being carried out to elucidate new treatment regimens for scleroderma, however, evaluation of these studies is proving to be a difficult process. Designated hospital centres for scleroderma (there are currently 2 in the UK), better markers of disease activity and methods to measure improvement or deterioration in affected organs, should enable research into aetiology, disease progression and treatment to be carried out on a larger scale resulting, hopefully, in more conclusive answers.

High conductance 2D transport around the Hall mobility peak in electrolyte-gated rubrene crystals

We report the observation of the Hall effect at hole densities up to 6×10¹³ cm⁻² (0.3  holes/molecule) on the surface of electrolyte-gated rubrene crystals. The perplexing peak in the conductance as a function of gate voltage is confirmed to result from a maximum in mobility, which reaches 4  cm² V⁻¹ s⁻¹ at 2.5×10¹³ cm⁻². Measurements to liquid helium temperatures reveal that this peak is markedly asymmetric, with bandlike and hopping-type transport occurring on the low density side, while unconventional, likely electrostatic-disorder-affected transport dominates the high density side. Most significantly, near the mobility peak the temperature coefficient of the resistance remains positive to as low as 120 K, the low temperature resistance becomes weakly temperature dependent, and the conductance reaches within a factor of 2 of e²/h, revealing conduction unprecedentedly close to a two-dimensional metallic state.

Asymmetric magnetization reversal in exchange-biased hysteresis loops

Polarized neutron reflectometry is used to probe the in-plane projection of the net-magnetization vector M--> of polycrystalline Fe films exchange coupled to twinned (110) MnF (2) or FeF (2) antiferromagnetic (AF) layers. The magnetization reversal mechanism depends upon the orientation of the cooling field with respect to the twinned microstructure of the AF, and whether the applied field is increased to (or decreased from) a positive saturating field; i.e. , the magnetization reversal is asymmetric. The reversal of the sample magnetization from one saturated state to the other occurs via either domain wall motion or magnetization rotation on opposite sides of the same hysteresis loop.

Impact of severity and type of depression on quality of life in cases identified in the community

BACKGROUND

The impact of different levels of depression severity on quality of life (QoL) is not well studied, particularly regarding ICD-10 criteria. The ICD classification of depressive episodes in three levels of severity is also controversial and the less severe category, mild, has been considered as unnecessary and not clearly distinguishable from non-clinical states. The present work aimed to test the relationship between depression severity according to ICD-10 criteria and several dimensions of functioning as assessed by Medical Outcome Study (MOS) 36-item Short Form general health survey (SF-36) at the population level.

METHOD

A sample of 551 participants from the second phase of the Outcome of Depression International Network (ODIN) study (228 controls without depression and 313 persons fulfilling ICD criteria for depressive episode) was selected for a further assessment of several variables, including QoL related to physical and mental health as measured with the SF-36.

RESULTS

Statistically significant differences between controls and the depression group were found in both physical and mental markers of health, regardless of the level of depression severity; however, there were very few differences in QoL between levels of depression as defined by ICD-10. Regardless of the presence of depression, disability, widowed status, being a woman and older age were associated with worse QoL in a structural equation analysis with covariates. Likewise, there were no differences according to the type of depression (single-episode versus recurrent).

CONCLUSIONS

These results cast doubt on the adequacy of the current ICD classification of depression in three levels of severity.