Toripalimab (anti-PD-1) versus High-Dose Interferon-α2b as Adjuvant Therapy in Resected Mucosal Melanoma: A Phase II Randomized Trial

BACKGROUND

No standard of care for mucosal melanoma (MM) in the adjuvant setting has been established. Meanwhile, relapse-free survival (RFS) is only about five months after surgery alone. This phase II trial aimed to compare toripalimab vs. high-dose interferon-α2b (HDI) as an adjuvant therapy for resected MM.

PATIENTS AND METHODS

From July 2017 to May 2019, 145 patients with resected MM were randomized (1:1) to receive HDI (N = 72) or toripalimab (N = 73) for one year until disease relapse/distant metastasis, unacceptable toxicity, or withdrawal of consent. The primary endpoint was RFS. The secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), and safety.

RESULTS

After a median follow-up of 26.3 months, the numbers of RFS, OS, and DMFS events were 51 vs. 46, 33 vs. 29, and 49 vs. 44 in the toripalimab arm and the HDI arm, respectively. The median RFS were 13.6 (95%CI: 8.31-19.02) months and 13.9 (95%CI: 8.28-19.61) months in the toripalimab arm and HDI arm, respectively. The DMFS was not significantly different between the two arms (HR: 1.00, 95%CI: 0.65-1.54). The median OS was 35.1 months (95%CI: 27.93-NR) in the toripalimab arm, with no significant difference in all-cause death (HR: 1.11, 95% CI: 0.66-1.84) for the two arms. The median sums of the patients' actual infusion doses were 3672 mg and 1054.5 MIU in the toripalimab arm and HDI arm, respectively. The incidence of treatment-emergent adverse events with a grade ≥ 3 was much higher in the HDI arm than in the toripalimab arm (87.5% vs. 27.4%).

CONCLUSION

Toripalimab showed a similar RFS and a more favorable safety profile than HDI, both better than historical data, suggesting that toripalimab might be the better treatment option. However, additional translational studies and better treatment regimens are still warranted to improve the clinical outcome of MM.

Application of combined multimodal neuroimaging and video-electroencephalography in intractable epilepsy patients for improved post-surgical outcome prediction

AIM

To investigate the ability of a multidisciplinary approach that combines multimodal neuroimaging with video-electroencephalography (v-EEG) to predict post-surgical outcomes in patients with intractable epilepsy, and explore prognostic predictors for these patients.

MATERIALS AND METHODS

Fifty-eight patients with intractable epilepsy who underwent surgery between March 2016 and October 2019 were reviewed retrospectively. Demographic, clinical, v-EEG, neuroimaging, surgical, and regular follow-up seizure outcome data were collected. Forty-six patients with a follow-up of at least 12 months were graded by Engel scores. Univariate and multivariate analyses were applied to explore prognostic factors that could predict post-surgical seizure outcomes.

RESULTS

Of the 58 patients, 28 were males. The median age was 27 years, the median age at first seizure was 11 years, and the median duration of seizures was 10 years. The Kaplan-Meier log-rank test showed that regardless of whether the follow-up duration was considered, epilepsy type, v-EEG, PET/CT, image post-processing methods, and a multidisciplinary approach that combined multimodal imaging with v-EEG were all correlated with seizure outcomes. Multivariate analysis found that the multidisciplinary approach was an independent predictor of post-surgical outcomes in patients with intractable epilepsy (hazard ratio = 11.400, 95% confidence interval = 2.249-57.787, p=0.003).

CONCLUSIONS

The present study showed that the multidisciplinary approach could provide independent prognostic information for patients with intractable epilepsy undergoing surgery. This approach has strong potential for the easier selection of patients to undergo surgical treatment and accurate prognostication.

Comparative molecular dynamics study on interaction of acetamide and glycerol with phospholipid bilayer

BACKGROUND

The exact mechanisms that acetamide and glycerol interact with cell membrane remains a matter of debate.

OBJECTIVE

To investigate the microscopic interactions of acetamide and glycerol with phospholipid bilayers at various temperatures.

MATERIALS AND METHODS

Molecular dynamics simulations of a hydrated dipalmitoyl-phosphatidylcholine (DPPC) bilayer in the presence of glycerol and acetamide were performed. The system contains 128 lipids and about 700 cryoprotectant molecules, and simulations extended to 15 ns.

RESULT

When compared to glycerol, acetamide shows a stronger affinity with water rather than the lipid bilayer.

CONCLUSION

The knowledge of the mixing dynamics of present system helps to develop better cryoprotective formulas and to propose more optimal cooling/warming protocols.

Implication of microglia in ketamine-induced long-term cognitive impairment in murine pups

BACKGROUND

Ketamine, a non-competitive N-methyl-D-aspartate receptor (NMDAR) antagonist, is widely applicable to anesthesia, analgesia, and sedation. However, the function and mechanisms of ketamine in the long-term learning and memory function of neonatal mice are unclear.

OBJECTIVE

The present study aims to investigate whether long-term learning and memory function will be affected by multiple ketamine exposures in the early development period.

METHODS

The mRNA and protein levels were measured by RT-qPCR and western blot, respectively. The Morris Water Maze test was performed to assess spatial learning and memory.

RESULTS

We identified that neonatal exposure to ketamine downsized the positive neurons for microtubule-associated protein doublecortin (DCX) and Ki67 in hippocampal dentate gyrus at the juvenile and late adolescence stages. Double-labeling tests demonstrated that the counts of Iba1⁺ cells and Ki67⁺ cells were pronouncedly diminished with exposure to ketamine. Further, qPCR assays to screen the key factors predisposing the populations and maturation of microglia exhibited remarkable decline of CX3CR1 mRNA levels in ketamine group versus the control group. The close relation of microglia to synaptic plasticity was depicted by the significantly downregulated synaptic plasticity-related proteins NR2B and PSD-95 subsequent to multiple exposures to ketamine. Finally, we found that both the protein and mRNA levels of BDNF were markedly decreased in ketamine group versus the control group.

CONCLUSION

We found that multiple exposures to ketamine in neonatal mice lead to spatial learning and memory dysfunction. The alterations of microglial development and function are the possible mechanisms of long-term learning and memory impairment.

A zero-inflated non-negative matrix factorization for the deconvolution of mixed signals of biological data

A latent factor model for count data is popularly applied in deconvoluting mixed signals in biological data as exemplified by sequencing data for transcriptome or microbiome studies. Due to the availability of pure samples such as single-cell transcriptome data, the accuracy of the estimates could be much improved. However, the advantage quickly disappears in the presence of excessive zeros. To correctly account for this phenomenon in both mixed and pure samples, we propose a zero-inflated non-negative matrix factorization and derive an effective multiplicative parameter updating rule. In simulation studies, our method yielded the smallest bias. We applied our approach to brain gene expression as well as fecal microbiome datasets, illustrating the superior performance of the approach. Our method is implemented as a publicly available R-package, iNMF.

[An analysis of insomnia and its influencing factors in patients with acute coronary syndrome]

Objective: To investigate the current situation of insomnia in patients with acute coronary syndrome (ACS), and analyze the influencing factors of insomnia in the ACS patients, so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients. Methods: This is a multicenter and prospective observational study. A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015. The baseline social demographic information, sleep quality questionnaire, general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9), short-form 12 health survey questionnaire(SF-12), and enhancing recovery in coronary heart disease patients social inventory(ESSI) were completed within 7 days after admission. Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients. Results: A total of 741 subjects with valid questionnaires were collected, including 510 males (68.8%) and 231 females (31.2%). Among them, 487 (65.7%) subjects had at least one insomnia symptom: 308 (41.6%) subjects had difficulty in falling asleep, 369 (49.8%) subjects were easy to wake at night, 116 (15.7%) subjects woke up earlier than they expected, 74 (10.0%) subjects experienced both woke up earlier and difficulty in falling asleep, and 53 (7.2%) subjects woke up earlier, woke up at night and had difficulty in falling asleep at the same time. Logistic regression analyses showed that before admission physical activity (OR =0.636, 95%CI 0.411-0.984), depression (OR=1.908, 95%CI 1.101-3.305) and low social support (OR=0.278, 95%CI 1.198-3.301) were independent factors of insomnia in ACS patients. Conclusions: Nearly 2/3 ACS patients have symptoms of insomnia. Difficulty in falling asleep and easy to wake up at night are the most common manifestations. Physical activity, depression and social support independently are associated with insomnia.

Different subsets of haematopoietic cells and immune cells in bone marrow between young and older donors

Young donors are reported to be associated with better transplant outcomes than older donors in allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the mechanism is still unclear. The current study compared the different subsets of haematopoietic stem cells (HSCs) and their progenitors as well as immune cells in bone marrow (BM) between young and older donors. The frequencies of HSCs, multipotent progenitors (MPPs) and myeloid progenitors, including common myeloid progenitors (CMPs) and megakaryocyte-erythroid progenitors (MEPs), were decreased, whereas those of lymphoid progenitors, including multi-potent lymphoid progenitors (MLPs) and common lymphoid progenitors (CLPs), were increased in the BM of young donors compared with in that of older donors. Lower reactive oxygen species (ROS) levels were observed in BM HSCs and six progenitor lines in young donors. Furthermore, young donors demonstrated higher frequencies of naive T cells and immune suppressor cells, such as alternative macrophages (M2) and lower frequencies of memory T cells and immune effectors, including T helper-1 and T cytotoxic-1 cells, in BM than older donors. Multivariate analysis demonstrated that donor age was independently correlated with BM HSC frequency. Although further validation is required, our results suggest that the differences in the frequency and immune differentiation potential of HSCs in BM between young donors and older donors may partly explain the different outcomes of allo-HSCT.

LncRNA LUCAT1 promotes rowth, migration, and invasion of oral squamous cell carcinoma by upregulating PCNA

OBJECTIVE

Recent studies have revealed the important role of long noncoding RNAs (lncRNAs) in the progression of tumorigenesis. This study aims to identify how lncRNA LUCAT1 functions in the progression of OSCC (oral squamous cell carcinoma).

PATIENTS AND METHODS

Relative expression of lncRNA LUCAT1 in both OSCC cells and 50 paired tissue samples was detected by quantitative Real-time polymerase chain reaction (qRT-PCR). Moreover, biological function of LUCAT1 in OSCC was identified by performing transwell assay, wound healing assay and proliferation assay in vitro. The underlying mechanism was explored by qRT-PCR and Western blot.

RESULTS

LUCAT1 expression was remarkably downregulated in OSCC tissues when compared with that in adjacent normal samples. Moreover, proliferation, invasion and migration of OSCC cells were inhibited after knockdown of LUCAT1 in vitro. Knockdown of LUCAT1 downregulated PCNA in OSCC cells at mRNA and protein level in vitro. Besides, PCNA expression in OSCC tissues was positively correlated with the expression of LUCAT1.

CONCLUSIONS

Knockdown of LUCAT1 could inhibit migration, invasion and proliferation capacities of OSCC cells through downregulating PCNA, which may offer a new therapeutic intervention for OSCC patients.

LncRNA MEG3 promotes proliferation and differentiation of osteoblasts through Wnt/β-catenin signaling pathway

OBJECTIVE

We aimed at detecting the expression of long non-coding ribonucleic acid (lncRNA) maternally expressed 3 (MEG3) in the serum of fracture patients, and at investigating its impacts on the proliferation and differentiation of osteoblasts and the specific molecular mechanism of action.

PATIENTS AND METHODS

The serum samples of 48 fracture patients diagnosed in our hospital (Fracture group) and 30 healthy people receiving physical examination (Health group) were collected. The expression level of serum lncRNA MEG3 in Fracture group and Health group was measured via reverse transcription-polymerase chain reaction (RT-PCR). Furthermore, a small interfering RNA (siRNA) was applied to construct mouse osteoblast cell line MC3T3-E1 with a stable knockout of MEG3. The growth status of the cell was observed, and the impacts of MEG3 knockout on the osteoblast proliferation were determined using cell counting kit-8 (CCK-8), a proliferation activity detection kit. Meanwhile, 5-ethynyl-2'-deoxyuridine (EdU) staining was applied to detect the proportion of EdU positive cells in the osteoblasts in Control group and MEG3 knockout group (MEG3 siRNA group). In addition, RT-PCR was performed to measure the messenger RNA (mRNA) levels of differentiation-related genes. Finally, RT-PCR and Western blotting assay were adopted to analyze the expression of the Wnt/β-catenin signaling pathway.

RESULTS

The expression of serum lncRNA MEG3 in fracture patients was increased markedly (p<0.05). Results of in-vitro cell experiment indicated that intervention with MEG3 siRNA could obviously promote the proliferation and differentiation of osteoblast cell line MC3T3-E1. The results of RT-PCR and Western blotting assay revealed that the role of MEG3 in promoting differentiation and proliferation might be mediated by the activation of the Wnt/β-catenin signaling pathway in osteoblasts.

CONCLUSIONS

LncRNA MEG3 can promote the proliferation and differentiation of osteoblasts by activating the Wnt/β-catenin signaling pathway, so it is expected to become a new target for accelerating the fracture healing.

LncRNA LUCAT1 promotes rowth, migration, and invasion of oral squamous cell carcinoma by upregulating PCNA

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "LncRNA LUCAT1 promotes rowth, migration, and invasion of oral squamous cell carcinoma by upregulating PCNA, by Y. Kong, Y. Feng, Y.-Y. Xiao, S.-C. Liu, X.-G. Li, Q.-L. Yang, W.-H. Chu, J.-G. Liu, published in Eur Rev Med Pharmacol Sci 2019; 23 (11): 4770-4776- DOI: 10.26355/eurrev_201906_18059-PMID: 31210306" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/18059.

Impact of the extent of axillary surgery in patients with N2-3 disease in the de-escalation era: a propensity score-matched study

BACKGROUND

Reduction of surgeries in axillary has been proved feasible in breast cancer with negative and limited involved axillary lymph nodes. However, for women with a heavy axillary burden, the extent of dissection is still arguable.

PATIENTS AND METHODS

From a total of 7042 patients with breast cancer who underwent surgical treatments between 2008 and 2014, 692 (9.85%) patients with the axillary staging of N2-3M0 were classified into Level I-II dissection group and Level I-III dissection group. 203 pairs of patients were matched by the propensity score.

RESULTS

The positive rate of level-III lymph nodes is 62.4% in patients who underwent Level I-III dissection. There are 67 (22.1%) patients who experienced rise in staging from N2 to N3 due to level-III dissection. With a median follow-up of 62.4 months, no significant difference was observed in RFS (P = 0.897), MFS (P = 0.610) and OS (P = 0.755) between level I-II group and level I-III group. The same results were observed in the independent analysis of neoadjuvant and non-neoadjuvant subgroups. The binary regression model showed the positivity of level-III is only associated with involved lymph nodes in level-II.

CONCLUSION

Additional level-III dissection has a limited impact on survival but still valuable in an accurate stage. The reduction of surgeries in axillary should be treated with discretion in breast cancer patients with a heavy axillary burden.