Selective RET kinase inhibition for patients with RET-altered cancers

Background

Alterations involving the RET kinase are implicated in the pathogenesis of lung, thyroid and other cancers. However, the clinical activity of multikinase inhibitors (MKIs) with anti-RET activity in RET-altered patients appears limited, calling into question the therapeutic potential of targeting RET. LOXO-292 is a selective RET inhibitor designed to inhibit diverse RET fusions, activating mutations and acquired resistance mutations.

Patients and methods

Potent anti-RET activity, high selectivity, and central nervous system coverage were confirmed preclinically using a variety of in vitro and in vivo RET-dependent tumor models. Due to clinical urgency, two patients with RET-altered, MKI-resistant cancers were treated with LOXO-292, utilizing rapid dose-titration guided by real-time pharmacokinetic assessments to achieve meaningful clinical exposures safely and rapidly.

Results

LOXO-292 demonstrated potent and selective anti-RET activity preclinically against human cancer cell lines harboring endogenous RET gene alterations; cells engineered to express a KIF5B-RET fusion protein -/+ the RET V804M gatekeeper resistance mutation or the common RET activating mutation M918T; and RET-altered human cancer cell line and patient-derived xenografts, including a patient-derived RET fusion-positive xenograft injected orthotopically into the brain. A patient with RET M918T-mutant medullary thyroid cancer metastatic to the liver and an acquired RET V804M gatekeeper resistance mutation, previously treated with six MKI regimens, experienced rapid reductions in tumor calcitonin, CEA and cell-free DNA, resolution of painful hepatomegaly and tumor-related diarrhea and a confirmed tumor response. A second patient with KIF5B-RET fusion-positive lung cancer, acquired resistance to alectinib and symptomatic brain metastases experienced a dramatic response in the brain, and her symptoms resolved.

Conclusions

These results provide proof-of-concept of the clinical actionability of RET alterations, and identify selective RET inhibition by LOXO-292 as a promising treatment in heavily pretreated, multikinase inhibitor-experienced patients with diverse RET-altered tumors.

On three-dimensional Gerstner-like equatorial water waves

This paper reviews some recent mathematical research activity in the field of nonlinear geophysical water waves. In particular, we survey a number of exact Gerstner-like solutions which have been derived to model various geophysical oceanic waves, and wave-current interactions, in the equatorial region. These solutions are nonlinear, three-dimensional and explicit in terms of Lagrangian variables.This article is part of the theme issue 'Nonlinear water waves'.

Prediction of the free-surface elevation for rotational water waves using the recovery of pressure at the bed

This paper considers the pressure-streamfunction relationship for a train of regular water waves propagating on a steady current, which may possess an arbitrary distribution of vorticity, in two dimensions. The application of such work is to both near shore and offshore environments, and in particular, for linear waves we provide a description of the role which the pressure function on the seabed plays in determining the free-surface profile elevation. Our approach is shown to provide a good approximation for a range of current conditions.This article is part of the theme issue 'Nonlinear water waves'.

Stability of a flow down an incline with respect to two-dimensional and three-dimensional disturbances for Newtonian and non-Newtonian fluids

Squire's theorem, which states that the two-dimensional instabilities are more dangerous than the three-dimensional instabilities, is revisited here for a flow down an incline, making use of numerical stability analysis and Squire relationships when available. For flows down inclined planes, one of these Squire relationships involves the slopes of the inclines. This means that the Reynolds number associated with a two-dimensional wave can be shown to be smaller than that for an oblique wave, but this oblique wave being obtained for a larger slope. Physically speaking, this prevents the possibility to directly compare the thresholds at a given slope. The goal of the paper is then to reach a conclusion about the predominance or not of two-dimensional instabilities at a given slope, which is of practical interest for industrial or environmental applications. For a Newtonian fluid, it is shown that, for a given slope, oblique wave instabilities are never the dominant instabilities. Both the Squire relationships and the particular variations of the two-dimensional wave critical curve with regard to the inclination angle are involved in the proof of this result. For a generalized Newtonian fluid, a similar result can only be obtained for a reduced stability problem where some term connected to the perturbation of viscosity is neglected. For the general stability problem, however, no Squire relationships can be derived and the numerical stability results show that the thresholds for oblique waves can be smaller than the thresholds for two-dimensional waves at a given slope, particularly for large obliquity angles and strong shear-thinning behaviors. The conclusion is then completely different in that case: the dominant instability for a generalized Newtonian fluid flowing down an inclined plane with a given slope can be three dimensional.

Staff attitudes towards people with intellectual disabilities in Japan and the United States

BACKGROUND

Staff attitudes may affect choices available to persons with intellectual disabilities (ID). This study examined attitudes towards people with ID among staff working with people with ID in Japan and the United States.

METHOD

Attitudes of staff working with people with ID in Japan and the United States were compared using the Community Living Attitudes Scale, Intellectual Disabilities Form. Responses were examined via multivariate analysis of variance.

RESULTS

In unadjusted analyses, Japanese staff exhibited a greater tendency towards Sheltering and Exclusion of people with ID and lower endorsement of Empowerment and Similarity of people with ID. After controlling for covariates, the country effect was no longer significant for Sheltering and Exclusion. Age and education were significantly associated with attitudes in the adjusted model.

CONCLUSIONS

While attitudes in Japan appeared less supportive of community inclusion of people with ID, some of the differences between countries were attributable to other staff characteristics such as age and education. Findings provide new information about how attitudes of staff in each country compare with each other.

Near-field acoustic streaming jet

A numerical and experimental investigation of the acoustic streaming flow in the near field of a circular plane ultrasonic transducer in water is performed. The experimental domain is a parallelepipedic cavity delimited by absorbing walls to avoid acoustic reflection, with a top free surface. The flow velocities are measured by particle image velocimetry, leading to well-resolved velocity profiles. The theoretical model is based on a linear acoustic propagation model, which correctly reproduces the acoustic field mapped experimentally using a hydrophone, and an acoustic force term introduced in the Navier-Stokes equations under the plane-wave assumption. Despite the complexity of the acoustic field in the near field, in particular in the vicinity of the acoustic source, a good agreement between the experimental measurements and the numerical results for the velocity field is obtained, validating our numerical approach and justifying the planar wave assumption in conditions where it is a priori far from obvious. The flow structure is found to be correlated with the acoustic field shape. Indeed, the longitudinal profiles of the velocity present a wavering linked to the variations in acoustic intensity along the beam axis and transverse profiles exhibit a complex shape strongly influenced by the transverse variations of the acoustic intensity in the beam. Finally, the velocity in the jet is found to increase as the square root of the acoustic force times the distance from the origin of the jet over a major part of the cavity, after a strong short initial increase, where the velocity scales with the square of the distance from the upstream wall.

Wireless sensor networks to study, monitor and manage cattle in grazing systems

Monitoring and management of grazing livestock production systems can be enhanced with remote monitoring technologies collecting information with high temporal and spatial detail. However, the potential benefits of such technologies have yet to be realised and challenges still exist with hardware, and data analysis and interpretation. The objective of this paper was to propose analytical methods and demonstrate the value of remotely collected liveweight (LW) and behaviour of beef cattle grazing tropical pastures. Three remote weighing systems were set up at the water troughs to capture LW of three groups of 20 animals for 341 days. LW data reflected short-term effects following the first rain event (>50 mm) at the end of the dry season, which resulted in LW losses of 22 ± 8.8 kg of LW at a rate of –1.54 ± 0.46 kg/day (n = 60). This period was followed by a peak daily LW change (LWC) of +2 kg/day. The remote weighing system also captured longer environmental effects related to seasonal changes in forage quality and quantity with highest LWC during the wet season and weight loss during the dry season. Effects of management on LW and LWC were observed as a result of moving animals to paddocks with more edible forage during the dry season when the negative trend in LWC was reversed after rotating animals. Behavioural monitoring indicated that resting and ruminating took place at camping sites, and foraging resulted in grazing hotspots. Remotely collected LW data captured both short- and long-term temporal changes associated with environmental and management factors, whereas remote monitoring collars captured the spatial distribution of behaviours in the landscape. Wireless sensor networks have the ability to provide data with sufficient detail in real-time making it possible for increased understanding of animal biology and early management interventions that should result in increased production, animal welfare and environmental stewardship.

Three-dimensional continuation study of convection in a tilted rectangular enclosure

A continuation method developed from a three-dimensional spectral finite element code is used to study natural convection in a tilted rectangular cavity. The cavity has its length equal to two times the side of its square cross section and it contains a fluid with a Prandtl number Pr = 1. A detailed bifurcation diagram is first obtained in the case without inclination in order to get the sequence of the different branches of solutions and determine the stable solutions. The focus is then put on the stable solutions in the inclined cavity, when the tilt occurs around its longest axis. The subtle changes induced by the tilt on the convective system are clarified. Three different stable solutions are obtained: the longitudinal roll L- solution (with the same sense of rotation as the inclination angle), which develops smoothly from zero Rayleigh number on the leading branch; the longitudinal roll L+ solution (with a sense of rotation opposite to the inclination angle), which is on a disconnected branch and is stabilized beyond a secondary bifurcation point; the oblique roll O ± solutions (corresponding to transverse roll solutions perturbed by the longitudinal flow induced by the tilt), which quickly appear beyond saddle-node points on new disconnected branches. The domain of existence of these stable solutions is eventually obtained and described in the Rayleigh number-inclination parameter space. Finally, the Nusselt number is determined as a function of the inclination at a constant Rayleigh number for the different stable solutions. The Nusselt number is maximum at an inclination of 49.55° for the leading longitudinal roll L- solution.

Stability of two-layer shear-thinning film flows

The stability of a two-layer film flow of non-Newtonian fluids is studied with a linear temporal approach. Shear-thinning fluids are considered, which follow the four-parameter inelastic Carreau model. A modified Orr-Sommerfeld equation system is obtained, which is solved by using a spectral Tau collocation method based on Chebyshev polynomials. The effects of density and viscosity stratification are considered, as well as the influence of the shear-thinning properties of the fluid. It is found that, when the viscosity is stronger in the upper layer, the base flow and the stability properties are almost not influenced by the change of the shear-thinning properties in this upper layer. In the other situations, the shear-thinning properties have an influence on the different instabilities, the long-wave surface instability and the short- and long-wave interface instabilities.

Idiopathic omental bleeding

Omental bleeding without any evidence of trauma, aneurysms, or other pathology has been rarely described in the literature. We report a case of a 24 year-old female on aspirin/acetaminophen/caffeine for migraines who presented with abdominal pain and tachycardia. Computed tomography angiography revealed active extravasation in the right lower quadrant. During exploratory laparotomy, a small bleeding artery within the greater omentum was suture ligated, and two liters of fresh and clotted blood were evacuated. The patient recovered successfully. We review the diagnosis and management of this rare condition.

Instabilities in the Rayleigh-Bénard-Eckart problem

This study is a linear stability analysis of the flows induced by ultrasound acoustic waves (Eckart streaming) within an infinite horizontal fluid layer heated from below. We first investigate the dependence of the instability threshold on the normalized acoustic beam width H(b) for an isothermal fluid layer. The critical curve, given by the critical values of the acoustic streaming parameter, A(c), has a minimum for a beam width H(b) ≈ 0.32. This curve, which corresponds to the onset of oscillatory instabilities, compares well with that obtained for a two-dimensional cavity of large aspect ratio [A(x) = (length/height) = 10]. For a fluid layer heated from below subject to acoustic waves (the Rayleigh-Bénard-Eckart problem), the influence of the acoustic streaming parameter A on the stability threshold is investigated for various values of the beam width H(b) and different Prandtl numbers Pr. It is shown that, for not too small values of the Prandtl number (Pr > Pr(l)), the acoustic streaming delays the appearance of the instabilities in some range of the acoustic streaming parameter A. The critical curves display two behaviors. For small or moderate values of A, the critical Rayleigh number Ra(c) increases with A up to a maximum. Then, when A is further increased, Ra(c) undergoes a decrease and eventually goes to 0 at A = A(c), i.e., at the critical value of the isothermal case. Large beam widths and large Prandtl numbers give a better stabilizing effect. In contrast, for Prandtl numbers below the limiting value Pr(l) (which depends on H(b)), stabilization cannot be obtained. The instabilities in the Rayleigh-Bénard-Eckart problem are oscillatory and correspond to right- or left-traveling waves, depending on the parameter values. Finally, energy analyses of the instabilities at threshold have indicated that the change of the thresholds can be connected to the modifications induced by the streaming flow on the critical perturbations.

Instabilities in a cylindrical cavity heated from below with a free surface. I. Effect of Biot and Marangoni numbers

Convective instabilities in a cylindrical cavity heated from below, with a free surface at the top, are numerically investigated using a spectral-element code. Both buoyancy and surface tension forces are taken into account, and heat exchange is considered at the upper surface. This configuration corresponds to the Bénard-Marangoni situation. The primary thresholds associated with azimuthal eigenmodes and corresponding to the onset of convection are first given as a function of the aspect ratio of the cavity A (radius/height), the Biot number Bi, and the Marangoni number Ma. Particular attention is paid to the influence of the Biot and Marangoni numbers: a stabilizing surface tension effect (Ma>0) induces an increase of the primary thresholds, which is magnified for small values of Bi, but may also change the flow structure by creating counter-rotating rolls near the free surface. The nonlinear evolution of the convection beyond its onset is given through bifurcation diagrams for A=1.5. Two different branches of axisymmetric solutions, either with upflow or downflow at the center, emerge at the onset. The destabilization of these solutions and the further dynamical evolution of the flow has been highlighted for widely varying Biot numbers.

Instabilities in a cylindrical cavity heated from below with a free surface. II. Effect of a horizontal magnetic field

The effect of a constant and uniform horizontal magnetic field on the flow in a cylindrical cavity heated from below, with a free surface at the top, is numerically investigated. The azimuthal modes, which usually trigger convection in a cylinder, are changed by the horizontal magnetic field to oriented modes, either parallel or perpendicular to the magnetic field direction. The corresponding primary thresholds increase with the Hartmann number Ha. This increase, however, depends on the structure of the modes and is the weakest for the parallel modes and the strongest for the perpendicular modes. The changes that affect the evolution of the primary thresholds with the aspect ratio for nonzero Ha are also emphasized. The nonlinear evolution of the convection with a horizontal magnetic field is presented through bifurcation diagrams for different values of the Prandtl number Pr. For Pr=1 and small values of Ha, the structuring effect of the horizontal magnetic field, which involves modifications of the flow structures and bifurcation points, is put into light. Results are finally shown for smaller Pr values corresponding to liquid metals.