Glioblastoma (GBM) is the most common primary brain tumor, carrying a very poor prognosis, with median overall survival at about 12 to 15 months despite surgical resection, chemotherapy with temozolomide (TMZ), and radiation therapy. GBM recurs in the vast majority of patients, with recurrent tumors commonly displaying increase in resistance to standard of care chemotherapy, TMZ, as well as radiotherapy. One of the most commonly cited mechanisms of chemotherapeutic and radio-resistance occurs via the glucose-regulated protein 78 (GRP78), a well-studied mediator of the unfolded protein response (UPR), that has also demonstrated potential as a biomarker in GBM. Overexpression of GRP78 has been directly correlated with malignant tumor characteristics, including higher tumor grade, cellular proliferation, migration, invasion, poorer responses to TMZ and radiation therapy, and poorer patient outcomes. GRP78 expression is also higher in GBM tumor cells upon recurrence. Meanwhile, knockdown or suppression of GRP78 has been shown to sensitize cells to TMZ and radiation therapy. In light of these findings, various novel developing therapies are targeting GRP78 as monotherapies, combination therapies that enhance the effects of TMZ and radiation therapy, and as treatment delivery modalities. In this review, we delineate the mechanisms by which GRP78 has been noted to specifically modulate glioblastoma behavior and discuss current developing therapies involving GRP78 in GBM. While further research is necessary to translate these developing therapies into clinical settings, GRP78-based therapies hold promise in improving current standard-of-care GBM therapy and may ultimately lead to improved patient outcomes.

Ice hockey helmets are required to be impact tested while mounted to a surrogate 50th percentile adult male headform. However, head shape and size can vary substantially from user to user. Furthermore, the contact area between a headform and helmet interior has been identified as an important factor affecting the protective capabilities of a helmet. The objective of this study was to compare quantitative measures of head shapes between three 50th percentile adult male headforms and a sample of adult human subjects who wore a medium-sized helmet. Using three-dimensional models of the human subjects and headforms, head shape was quantified by assessing radial distances in two transverse planes of the head and by using principal component analysis to determine the largest components of fit. Notable differences were found between the headforms and human subjects. The headforms were smaller than the human subjects, demonstrating smaller radial distances for the entire head. The principal components of head shape were overall size and roundness of the head. The results of this study demonstrate the headforms are not representative of the sample median.

International standards organizations require ice hockey helmets to be impact tested while mounted to a surrogate headform, with anthropometrics of a 50th percentile male. However, human head shapes are not identical, nor are there consistent guidelines for fitting a helmet to the ordinary user. The interaction between head shape and helmet fit impacts helmet safety: the contact area between a headform and helmet interior has been identified as a critical determinant of protection afforded by a helmet. The objective of this study was to compare quantitative measures of helmet fit between an adult male sample and three 50th percentile male headforms. This study recruited 42 adult male participants who wore a medium-sized ice hockey helmet (560–600 mm interior circumference) in an attempt to compare their quantitative helmet fit to those of three 50th percentile adult male headforms. Through three-dimensional modeling, fit was quantified by assessing dimensional differences in two transverse cross-sectional planes of the head and using principal component analysis to determine the largest components of fit. Significant differences were found between the headforms and the participants’ heads in anthropometrics and dimensional differences. The headforms were smaller than the participants’ heads, demonstrating average gapping with the interior of the helmet. The principal components of fit extracted included mediolateral deformation, gapping/compression at the rear aspect of the head-helmet interface, and general congruence of the head shape to the helmet liner. These findings demonstrated a vast discrepancy between helmet fit on the 50th percentile headforms and the ordinary helmet user.

Glioblastoma (GBM) is the most common and aggressive primary adult brain tumor, with an estimated annual incidence of 17,000 new cases in the United States. Current treatments for GBM include chemotherapy, surgical resection, radiation therapy, and antiangiogenic therapy. However, despite the various therapeutic options, the five-year survival rate remains at a dismal 5%. Temozolomide (TMZ) is the first line chemotherapy drug for GBM; however, poor TMZ response is one of the main contributors to the dismal prognosis. Long non-coding RNAs (lncRNAs) are non-protein coding transcripts greater than 200 nucleotides that have been implicated to mediate various GBM pathologies, including chemoresistance. In this review, we aim to frame the TMZ response in GBM via exploration of the lncRNAs mediating three major mechanisms of TMZ resistance: 1) regulation of the DNA damage response, 2) maintenance of glioma stem cell identity, and 3) exploitation of hypoxia-associated responses.

BACKGROUND Radiation-induced glioblastoma (GBM) in patients previously treated for craniopharyngioma is a rare phenomenon. To the authors’ knowledge, only seven cases have previously been documented in the literature. OBSERVATIONS Herein, the authors report a case of a patient presenting with a new diagnosis of multifocal GBM 15 years after having received adjuvant radiotherapy for a craniopharyngioma. Magnetic resonance imaging revealed an extensive enhancing infiltrative lesion in the right frontal lobe as well as two satellite lesions in the contralateral frontal lobe. Histopathology on biopsy was consistent with GBM. LESSONS Even though this case is rare, it is nevertheless important to recognize GBM as a potential side effect of radiation. Long-term follow-up in postradiation craniopharyngioma patients is crucial for early detection.