Glioblastoma multiforme (GBM) is a primary brain tumor with great lethality. Current standard of care with surgery, radiation therapy, and chemotherapy are ineffective in curing this disease. Recent advancements in biological therapies show promise in treating brain tumors. Areas covered: This article provides a review of: the peripheral activation of antigen presenting cells such as dendritic cells to stimulate T cells to recognize and destroy tumor cells within the brain; the ex vivo expansion and transfer of dendritic cells, T cells, and engineered T cells expressing chimeric antigen receptors to target cells bearing specific tumor antigens as well as monoclonal antibodies as immune check point inhibitors. Gene therapy approaches have also been utilized to employ viral vectors in transducing cells to express cytokines for activating immune responses to brain tumors. Finally, the article reviews engineering of viruses for oncolytic targeting and destruction of malignant tumors within the brain. Expert opinion: The ultimate goal of immune and viral approaches for treating malignant brain tumors is to cure this disease. Preclinical and clinical studies utilizing these biological therapeutic approaches for treating brain tumors have the potential to augment the current standard of care to provide potential curative therapies.
Background The implementation of enhanced recovery after surgery (ERAS) protocols has decreased the length of stay (LOS) and complications in colorectal procedures. However, little data has been published on the subset of patients undergoing loop ileostomy closure. We investigated the outcomes of loop ileostomy reversals prior to and after initiation of an ERAS protocol. Methods Patients undergoing ileostomy reversal over a 5-year period by 4 colorectal surgeons were studied and divided into pre-ERAS patients and ERAS patients in a retrospective, case-control study. Patient demographics, comorbidities, LOS, underlying disease process, index intra-abdominal procedure, readmission rate, and complications were evaluated. Results Overall, 208 patients were analyzed 149 pre-ERAS and 59 ERAS–with median LOS significantly lower in the ERAS group than the pre-ERAS group (50.8 hours vs. 96.1 hours, P < .0001). In subgroup analysis, the LOS was significantly lower if the index procedure performed was laparoscopic when comparing ERAS to pre-ERAS (49.9 hours vs. 96.6 hours, P < .001). ERAS did not confer a significant decrease in the LOS during ileostomy reversal with open index procedures (72.9 hours vs. 95.5 hours, P = .05). Conclusion Utilizing an ERAS protocol is safe and effective for loop ileostomy closure with a shorter LOS and no difference in complication rates or 30-day readmission rates.
The Early Permian in the onshore Perth Basin has experienced several significant discoveries in the last 8 years. Beginning with the play-opening Waitsia discovery (AWE), this was followed more recently by the Beharra Springs Deep (Beach Energy) and West Erregulla (Strike) discoveries. In addition, Late Permian sands (Dongara and Wagina sandstones) have long been recognised as excellent reservoirs in the basin. This study attempts to better understand the provenance of the Early and Late Permian sediments using automated Raman spectroscopy as a tool to identify variations in heavy mineral assemblages. Automated Raman spectroscopy analysis of heavy minerals minimises operator bias inherent in more traditional optical heavy mineral analyses. These data are integrated with publicly available chemostratigraphy data to enable a better understanding of sediment provenance variations with stratigraphy. In addition, publicly available detrital zircon geochronological data are incorporated to help further understand sediment sources. A transect of wells is investigated, from Arrowsmith-1 in the southernmost extent to Depot Hill-1 and Mt Horner-1 in the north. While the elemental (chemostratigraphy) data suggest some changes in sediment provenance through the Permian of the Perth Basin, the Raman heavy mineral data confirm a number of sediment provenance changes both at key formational boundaries (e.g. top Kingia sandstone) and complex sediment provenance variation within reservoir sandstone units. These results are integrated to demonstrate how sediment provenance holds the key to understanding controls on variable reservoir quality as well as understanding the early infill in this basin.
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