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Introduction: In contrast to standard-of-care treatment of newly diagnosed glioblastoma, there is limited consensus on therapy upon disease progression. The role of resection for recurrent glioblastoma remains unclear. This study aimed to identify factors for overall survival (OS) and post-progression survival (PPS) as well as to validate an existing prediction model. Methods: This was a multi-centre retrospective study that reviewed consecutive adult patients from 2006 to 2019 that received a repeat resection for recurrent glioblastoma. The primary endpoint was PPS defined as from the date of second surgery until death. Results: 1032 glioblastoma patients were identified and 190 (18%) underwent resection for recurrence. Patients that had second surgery were more likely to be younger (<70 years) (adjusted OR: 0.3; 95% CI: 0.1–0.6), to have non-eloquent region tumours (aOR: 1.7; 95% CI: 1.1–2.6) and received temozolomide chemoradiotherapy (aOR: 0.2; 95% CI: 0.1–0.4). Resection for recurrent tumour was an independent predictor for OS (aOR: 1.5; 95% CI: 1.3–1.7) (mOS: 16.9 months versus 9.8 months). For patients that previously received temozolomide chemoradiotherapy and subsequent repeat resection (137, 13%), the median PPS was 9.0 months (IQR: 5.0–17.5). Independent PPS predictors for this group were a recurrent tumour volume of >50cc (aOR: 0.6; 95% CI: 0.4–0.9), local recurrence (aOR: 1.7; 95% CI: 1.1–3.3) and 5-ALA fluorescence-guided resection during second surgery (aOR: 1.7; 95% CI: 1.1–2.8). A National Institutes of Health Recurrent Glioblastoma Multiforme Scale score of 0 conferred an mPPS of 10.0 months, a score of 1–2, 9.0 months and a score of 3, 4.0 months (log-rank test, p-value < 0.05). Conclusion: Surgery for recurrent glioblastoma can be beneficial in selected patients and carries an acceptable morbidity rate. The pattern of recurrence influenced PPS and the NIH Recurrent GBM Scale was a reliable prognostication tool. [ABSTRACT FROM AUTHOR]

A case report of a 46-year-old African-American man with asymptomatic HIV disease explains treatment options and other services provided at an urban HIV clinic. Combination drug therapy is preferred over monotherapy, and the choice of drugs will depend on the patient's CD4 lymphocyte count. Clinic staff will provide patient education, psychological counseling, and assistance in finding a drug treatment program as well as housing and social services.

Mr Tan, a 39-year-old banker, visited your clinic complaining of difficulties in falling asleep. This started six months ago after he underwent an acrimonious divorce, and he was desperate for a permanent solution to his insomnia. He admitted to drinking half to one bottle of red wine every night with his dinner to help him relax after a long and stressful day at work. He also enjoyed drinking 'a few' nips of whiskey when socialising with his friends, about two to three times a month. Recently, he missed a day of work after having had a drinking session the night before and his boss had given him a stern warning. He denied having any low mood or anhedonia. He went to see you to take medical leave, as he felt too tired to concentrate on his work that day. [ABSTRACT FROM AUTHOR]

Protease inhibitors are best prescribed for patients who can live independently under moderate self-discipline and who are capable of managing combined therapies. AZT resistance usually occurs between 6 months and one year after beginning treatment, and repeated viral load testing can monitor this resistance. However, there is a wide variety of response to the HIV epidemic, and each client must be individually evaluated, preferably on a daily basis.

Background: The optimal timing of initiating adjuvant temozolomide (TMZ) chemoradiotherapy after surgery in patients with glioblastoma is contentious. This study aimed to determine whether the timing of adjuvant treatment affects their overall survival (OS)., Methods: Consecutive adult patients with histologically-confirmed newly diagnosed glioblastoma treated with adjuvant TMZ chemoradiotherapy across all neurosurgical centers in Hong Kong between 2006 and 2020 were analyzed. The surgery-to-chemoradiotherapy (S-CRT) interval was defined as the date of the first surgery to the date of initiation of adjuvant TMZ chemoradiotherapy., Results: Four hundred and forty-one patients were reviewed. The median S-CRT interval was 40 days (interquartile range [IQR]: 33-47) and the median overall survival (mOS) was 16.7 months (95% CI: 15.9-18.2). The median age was 58 years (IQR: 50-63). Multivariable Cox regression with restricted cubic splines identified a nonlinear relationship between the S-CRT interval and mOS. Post hoc analysis-derived S-CRT intervals revealed that early CRT (<5 weeks; adjusted hazard ratio [aHR]: 1.11; 95% CI 0.90-1.37) or late CRT (>9-12 weeks; aHR 1.07; 95% CI 0.67-1.71) were not significantly associated with OS. Subgroup analyses for the extent of resection (EOR) and p MGMT methylation status revealed no significant difference in treatment timing on OS., Conclusion: The timing of adjuvant TMZ chemoradiotherapy, if commenced within 12 weeks after glioblastoma diagnosis, did not influence OS regardless of EOR or p MGMT methylation status. Clinical judgment should be exercised in optimizing the timing of initiating adjuvant therapy., Competing Interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, and knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)

Mobile intertidal animals exhibit various strategies during emersion to mediate the impact of heat and desiccation, including behavioural adaptations such as moving to lower tidal levels and seeking thermal refuges, which can result in spatial partitioning between species within the intertidal environment. We tested whether the limpets Siphonaria guamensis (Heterobranchia) and Patelloida saccharina (Patellogastropoda) exhibited differential habitat use during tidal emersion by quantifying their abundance and size distribution in various habitats on two rocky shores on the west coast of Thailand. S. guamensis inhabited higher shore levels with hotter average rock temperatures when emersed as compared to P. saccharina . On one of the shores, large S. guamensis lived at higher tidal levels than smaller individuals, whereas large P. saccharina showed the reverse pattern, being found lower on the shore than smaller individuals. The abundance of S. guamensis was positively correlated to the shore slope, with more individuals found on vertical than horizontal rocks, while P. saccharina showed a negative relationship between abundance and algal cover. At the heights where they were most abundant, both species were more often found in bare rock habitats as opposed to crevices and areas dominated by oyster shells, despite the fact that bare rock was as hot as or even hotter than other microhabitats. The exact resting locations of the two species were, however, cooler than the mean temperature of the bare rock. In general, limpets did not exhibit a strong preference for any particular rock orientation, but S. guamensis on one shore was more abundant on east-facing rocks as compared to other aspects. As a result, although thermal stress appears to be a driver for habitat partitioning between species (occupying different tidal heights), temperature alone is unable to explain distribution patterns within species, as limpets were not adopting thermal refuges during tidal emersion. Variations in the physical environments may be mediated by species-specific morphological and/or physiological adaptations which determine the distribution of different limpet species on western Thailand rocky shores.