Efficacy of utidelone plus capecitabine versus capecitabine for heavily pretreated, anthracycline- and taxane-refractory metastatic breast cancer: final analysis of overall survival in a phase III randomised controlled trial

BACKGROUND

Primary analysis of the phase III trial BG01-1323L demonstrated that utidelone plus capecitabine significantly improved progression-free survival (PFS) and overall response rate (ORR) versus capecitabine alone in heavily-pretreated patients with metastatic breast cancer (MBC). Here, we report the final overall survival (OS) analysis and updates of other endpoints.

PATIENTS AND METHODS

In total, 405 patients were randomised 2:1 to receive utidelone (30 mg/m² IV daily, days 1-5, over 90 min) plus capecitabine (1000 mg/m² orally b.i.d., days 1-14) or capecitabine alone (1250 mg/m² orally b.i.d., days 1-14) every 21 days. The secondary endpoint, OS, was estimated using the Kaplan-Meier product-limit approach at a two-sided alpha level of 0.05 after the prespecified 310 death events had been reached. Exploratory analyses of the primary endpoint, PFS, and the secondary endpoint, ORR, were also done. Safety was analysed in patients who had at least one dose of study drug.

RESULTS

At the final OS analysis, the median duration of follow-up was 19.6 months in the utidelone plus capecitabine group and 15.4 months in the capecitabine alone group. In the intention-to-treat population, 313 deaths had occurred at data cut-off, 203 of 270 patients in the combination group and 110 of 135 in the monotherapy group. Median OS in the combination group was 19.8 months compared with 16.0 months in the monotherapy group [hazard ratio (HR) = 0.75, 95% confidence intervals (CI) 0.59-0.94, P = 0.0142]. The updated analysis of PFS and ORR showed that the combination therapy remained superior to monotherapy. Safety results were similar to those previously reported with respect to incidence, severity and specificity. No late-emerging toxicities or new safety concerns occurred.

CONCLUSIONS

For heavily-pretreated, anthracycline- and taxane-resistant MBC patients, utidelone plus capecitabine significantly improved OS versus capecitabine alone. These results support the use of utidelone plus capecitabine as a novel therapeutic regimen for patients with MBC.

MiR-99a suppressed cell proliferation and invasion by directly targeting HOXA1 through regulation of the AKT/mTOR signaling pathway and EMT in ovarian cancer

OBJECTIVE

Ovarian cancer (OC) is the third frequently tumor worldwide. MicroRNA-99a (miR-99a), acting as a tumor suppressor, has been reported to be downregulated in multiple tumors. We aimed at exploring the significant roles of miR-99a in ovarian cancer.

PATIENTS AND METHODS

Quantitative Real-time polymerase chain reaction (qRT-PCR) and Western blotting were applied to calculate the mRNA and protein levels of miR-99a and its target genes. Kaplan-Meier method was conducted to evaluate the overall survival of ovarian cancer patients. CCK8 and transwell assays were performed to measure the proliferative and invasive abilities.

RESULTS

miR-99a, acting as a prognosis predictor, was downregulated in ovarian cancer tissues and cell lines. miR-99a mediated the expression of homeobox A1 (HOXA1) through directly targeting to the 3'-untranslated region (3'-UTR) of its mRNA in ovarian cancer cell lines. miR-99a inhibited the proliferation of ovarian cancer by AKT/mTOR pathway in vitro and in vivo, and it suppressed the invasion-mediated epithelial-mesenchymal transition (EMT) through direct targeting to the 3'-UTR of HOXA1 mRNA.

CONCLUSIONS

miR-99a suppressed the proliferation through AKT/mTOR signaling pathway and the invasion-mediated EMT in ovarian cancer. The newly identified miR-99a/HOXA1/AKT/mTOR axis provides novel insight into the pathogenesis of ovarian cancer.

Intrinsic Mechanism for Anisotropic Magnetoresistance and Experimental Confirmation in Co_{x}Fe_{1-x} Single-Crystal Films

Using first-principles transport calculations, we predict that the anisotropic magnetoresistance (AMR) of single-crystal Co_{x}Fe_{1-x} alloys is strongly dependent on the current orientation and alloy concentration. An intrinsic mechanism for AMR is found to arise from the band crossing due to magnetization-dependent symmetry protection. These special k points can be shifted towards or away from the Fermi energy by varying the alloy composition and hence the exchange splitting, thus allowing AMR tunability. The prediction is confirmed by delicate transport measurements, which further reveal a reciprocal relationship of the longitudinal and transverse resistivities along different crystal axes.

[Survival time and related factors on HIV/AIDS patients in Guizhou province from 1995 to 2018]

Objective: To examine the survival time and related factors on HIV/AIDS patients in Guizhou province from 1995 to 2018. Methods: A retrospective cohort study was conducted to analyze the HIV/AIDS case from 1995 to 2018 in Guizhou province with data gathered from the "Chinese National Comprehensive HIV/AIDS Prevention and care Information system". Survival rate was calculated by life table and survival time was estimated by Kaplan-Meier. Related factors on survival time were analyzed by Cox regression model. Results: A total of 53 232 HIV/AIDS cases were included in the study, with the mortality rate as 8.53/100 person-years (14 210/166 679.18), median survival time as 10.20 (95%CI: 9.91-10.48) years, and survival rates of 1, 5, 10 and 20 years as 0.85, 0.68, 0.51, 0.36, 0.19 respectively. Results from the multivariate Cox regression analysis showed that factors as: being male (compared with females, aHR=0.757, 95%CI: 0.727-0.788), with antiviral treatment (ART) (compared with those without ART, aHR=0.173, 95%CI: 0.165-0.181), CD(4)<200 cells/μl[compared with CD(4)(+)T cells (CD(4)) ≥200 cells/μl, aHR=0.410, 95%CI: 0.387-0.435], age ≥45 (compared with age<45, aHR=1.506, 95%CI: 1.193-1.901), illiterate (compared with having high school education or above, aHR=0.904, 95%CI: 0.832-0.982), unmarried (compared with divorced or widowed, aHR=0.896, 95%CI: 0.848-0.946), through heterosexual transmission (compared with homosexual transmission, aHR=0.555, 95%CI: 0.487-0.632), ethnic minorities (compared with Hans, aHR=1.185, 95%CI: 1.114-1.262), and farmers/migrant workers (compared with domestic/unemployed,aHR=0.874, 95%CI: 0.834-0.916,) etc., were related to the survival time of HIV/AIDS, in Guizhou province. Conclusions: The mortality rate of HIV/AIDS in Guizhou province appeared relatively high, but with no obvious downward trend seen in the last years. Factors as being male, age ≥45, low education level, ethnic minorities, CD(4)<200 cells/μl were identified as related to the HIV/AIDS survival time. We would suggest that treatment and follow-up management programs should be strengthened to improve the quality of life among these patients.

Association study of SNCA gene polymorphisms with schizophrenia in a Chinese North Han population

OBJECTIVE

Previous studies suggested that the alpha-synapse protein (SNCA) gene and its coding product α-synuclein (α-Syn) may play a role in the pathogenesis of neurodegenerative diseases. The mutation of SNCA can influence the formation of nerve fibers and the function of dopaminergic neurons, and that may be related to addictive behavior, such as alcohol dependence. SNCA may overlap with the pathogenesis of schizophrenia and Parkinson's disease or alcohol dependence associated with the dopamine pathway. The aim was to determine the association between three SNCA SNPs (rs3822086C/T, rs11931074G/T, and rs356219A/G) and schizophrenia in a Chinese North Han population.

PATIENTS AND METHODS

A total of 878 subjects, with or without schizophrenia, were included in our study. DNA purification, Polymerase Chain Reaction (PCR) amplification, and subsequent restriction fragment length polymorphism (RFLP) analysis were manipulated to determine genotypes.

RESULTS

Between the schizophrenia group and healthy group, neither the genotype nor allele frequencies of rs3822086C/T, rs11931074G/T, or rs356219A/G differed significantly in either the total sample or the subgroups. In the haplotype analysis, the ATT and GTT haplotype frequencies differed significantly between the patients and controls in the total sample (χ2=6.052, p=0.0139; χ2=4.508, p=0.0337). In the female subgroup, the ATT haplotype frequency differed significantly between the patients and controls (χ2=4.219, p=0.04).

CONCLUSIONS

There was no association between SNCA polymorphisms and schizophrenia in the North Han Chinese population, and the ATT haplotype may be a susceptibility factor for schizophrenia.

Towed Overhauser marine magnetometer for weak magnetic anomaly detection in severe ocean conditions

A towed Overhauser marine geomagnetic magnetometer used for weak magnetic anomaly detection in severe ocean conditions is studied to investigate means to reduce the negative effect of dynamic behavior and magnetic noise associated with ocean waves. For the dynamic effect, a continuous polarization workflow is proposed to enhance the free-induction-decay signal, and then, a multi-angle pickup coil and a self-tracking programmable amplifier are used to further reduce the adverse effect caused by uncontrollable changes in the towfish attitude on the signal quality. Furthermore, to achieve adaptive suppression of magnetic noise in different ocean conditions and areas, a modified adaptive Kalman algorithm is assessed. In addition, an optimized Overhauser sensor and a towfish were developed. Overall, the experimental results show that the sensor can effectively suppress the dynamic effect and magnetic noise. Regarding the magnetic sensitivity, uncertainty and range are 12 pT/Hz^1/2@1Hz and 0.21 nT and 20 000 nT-100 000 nT, respectively. Moreover, underwater testing was performed to verify the function and the detection of the magnetic anomaly.

LncRNA HOTAIR participates in the development and progression of adrenocortical carcinoma via regulating cell cycle

OBJECTIVE

To explore the role of HOTAIR in the pathogenesis of adrenocortical carcinoma (ACC) and its underlying mechanism.

PATIENTS AND METHODS

Differentially expressed lncRNA (HOTAIR) in ACC was screened out from the GEO database. The survival analysis and ROC curve were performed according to HOTAIR expressions in ACC patients. The correlation between HOTAIR expression and clinical information of ACC patients was analyzed by chi-square test. The univariate and multivariate COX regression analysis was carried out to analyze the relationship between HOTAIR expression, disease-free survival (DFS) and overall survival (OS) of ACC patients. We then detected HOTAIR expression in 77 ACC tissues and 30 normal tissues by qRT-PCR (quantitative Real-time polymerase chain reaction). ACC cell lines were further screened out for the following in vitro experiments. After altering HOTAIR expression in ACC cells by plasmid transfection, proliferation and cell cycle were detected by Cell Counting Kit-8 (CCK-8) and colony formation assay, respectively. Finally, Western blot was utilized to detect expressions of cell cycle-related genes in ACC cells.

RESULTS

HOTAIR was overexpressed in ACC tissues than that of normal tissues. HOTAIR expression was remarkably increased in ACC with T3 and T4 stage than that of T1 and T2 stage. Moreover, HOTAIR expression was remarkably increased in ACC with stage III and IV than that of stage I and II. HOTAIR was an independent prognostic factor for DFS and OS of ACC patients. For in vitro experiments, inhibited proliferation and arrested cell cycle were observed in H295R cells transfected with si-HOTAIR. Opposite results were obtained after SW-13 cells were transfected with HOTAIR overexpression plasmid. Furthermore, expressions of cell cycle-related genes, including Cyclin D1, p-Rb and p-GSK3β were remarkably decreased after HOTAIR knockdown.

CONCLUSIONS

We demonstrated for the first time that HOTAIR is overexpressed in ACC and is a prognostic risk factor in ACC patients. HOTAIR participates in the development and progression of ACC via shortening cell cycle and promoting proliferation of ACC cells.

The use of external fixation for the management of acute and chronic Monteggia fractures in children

PURPOSE

The main objective of this study was to retrospectively evaluate the clinical and radiological outcomes of acute (AMF) and chronic Monteggia fractures (CMF) in children treated by closed or open reduction and external fixation (EF).

METHODS

This is a retrospective review of 26 patients with Monteggia fracture. Patients with AMF (time between trauma and surgery less than two weeks) were treated by closed reduction and EF of the ulna (Group A; 15 patients) while those with CMF (time between trauma and surgery more than three weeks) were managed by closed or open reduction and EF of the ulna (Group B; 11 patients). Clinical outcome was evaluated with radiography and the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). Complications were recorded in both groups.

RESULTS

No secondary displacement, wire migration, consolidation delays, nonunion, malunion or re-fracture was noted. However, one patient in Group A (6.7%) developed heterotopic ossification of the ulna; the final functional outcome was good (Quick DASH score: 18.2). One case of postoperative redislocation of the radial head was detected in Group B (9.1%). Two patients (7.6%) developed transient pin tract infection. Despite the fact that 16 out of 26 patients (six in Group A and ten in Group B) complained of the clinical appearance and/or had intermittent residual pain on the injured side, the results were essentially the same between the two groups of patients (p > 0.05).

CONCLUSION

EF is an alternative for the management of acute and chronic paediatric Monteggia fractures. It provides satisfactory radiological and clinical outcomes with relatively low rates of complications.

LEVEL OF EVIDENCE

IV.

Identification of key pathways and genes changes in pancreatic cancer cells (BXPC-3) after cross-talk with primary pancreatic stellate cells using bioinformatics analysis

Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant tumors with poor prognosis, and the interaction between activated pancreatic stellate cells (PSCs) and PDAC cells plays an important role in the development of PDAC. The aim of this study was to identify gene changes in BXPC-3 after cross-talk with PSCs and reveal their potential mechanisms. The gene expression profiling analysis of BXPC-3 was completed after co-culture with primary PSCs for 48 h. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were performed, and the differentially expressed genes (DEGs) were identified by Agilent GeneSpring GX software. In total, 3657 DEGs were identified in BXPC-3, including 1881 up-regulated genes and 1776 downregulated genes. GO analysis results showed that upregulated DEGs were significantly enriched in biological processes (BP), including peptide metabolic process, response to stress and electron transport chain; the downregulated DEGs were significantly enriched in biological processes, including signaling, multicellular organism development and anatomical structure development. KEGG pathway analysis revealed that 19 pathways were upregulated and 32 pathways were downregulated, and that upregulated DEGs were enriched in protein export and glutathione metabolism, while the downregulated DEGs were enriched in axon guidance and focal adhesion. The top 10 upregulated genes and the top 10 downregulated genes were identified. By constructing PPI network, we selected out 10 key genes (TP53, SRC, IL6, JUN, ISG15, CAD, STAT1, OAS3, OAS1, VIM) and significant pathways. The associated survival analysis was performed and the SRC, IL-6, ISG15, STAT1, OAS3, OAS1 and VIM were proved to be related to worse overall survival time of PDAC patients. In conclusion, the present study indicated that the identified DEGs promote our understanding of the molecular mechanisms underlying the interaction between pancreatic cancer cells and PSCs and might be used as molecular targets in the future to study the role of tumor microenvironment in the progression of PDAC.

Identification of key pathways and genes changes in pancreatic cancer cells (BXPC-3) after cross-talked with primary pancreatic stellate cells using bioinformatics analysis

Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant tumors with poor prognosis, and the interaction between activated pancreatic stellate cells (PSCs) and PDAC cells plays an important role in the development of PDAC. The aim of this study was to identify gene changes in BXPC-3 after cross-talked with PSCs and reveal their potential mechanisms. The gene expression profiling analysis of BXPC-3 was completed after co-cultured with primary PSCs for 48 h. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were performed, and the differentially expressed genes (DEGs) were identified by Agilent GeneSpring GX software. In total, 3657 DEGs were identified in BXPC-3, including 1881 up-regulated genes and 1776 downregulated genes. GO analysis results showed that up-regulated DEGs were significantly enriched in biological processes (BP), including peptide metabolic process, response to stress, and electron transport chain; the down-regulated DEGs were significantly enriched in biological processes, including signaling, multicellular organismal development, and anatomical structure development. KEGG pathway analysis revealed that 19 pathways were upregulated and 32 pathways were downregulated, and that up-regulated DEGs were enriched in protein export and glutathione metabolism, while the down-regulated DEGs were enriched in axon guidance and focal adhesion. The top 10 up-regulated genes, and the top 10 down-regulated genes were identified. By constructing PPI network, we selected out 10 key genes (TP53, SRC, IL6, JUN, ISG15, CAD, STAT1, OAS3, OAS1, VIM) and significant pathways. The associated survival analysis was performed and the SRC, IL-6, ISG15, STAT1, OAS3, OAS1 and VIM were proved to be related to worse overall survival time of PDAC patients. In conclusion, the present study indicated that the identified DEGs promote our understanding of the molecular mechanisms underlying the interaction between pancreatic cancer cells and PSCs and might be used as molecular targets in the future to study the role of tumor microenvironment in the progression of PDAC.

Identification of key pathways and gene changes in primary pancreatic stellate cells after cross-talk with pancreatic cancer cells (BXPC-3) using bioinformatics analysis

It is well known that as the king of cancer, pancreatic ductal adenocarcinoma (PDAC) has relatively malignant biological behavior and poor prognosis. The interaction between pancreatic stellate cells and PDAC cells promotes the development of PDAC. The aim of this study was to describe gene characteristics in pancreatic stellate cell (PSCs) after cross-talked with BXPC-3 and unravel their underlying mechanisms. The expression profiling analysis of genes in PSCs was completed after co-cultured with primary BXPC-3 for 48h. The Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analysis and gene ontology (GO) analysis were performed, and the differentially expressed genes (DEGs) were identified by Agilent GeneSpring GX program. In total, 1804 DEGs were filtered out in PSCs, including 958 up-regulated genes and 846 downregulated genes. GO analysis showed that the up-regulated DEGs were significantly enriched in biological processes (BP) such as defense response, immune system process and immune response; the down-regulated DEGs were significantly enriched in biological regulation and cytoskeleton organization. KEGG pathway analysis showed that 28 pathways were upregulated and 5 were downregulated. By constructing PPI network, we selected out 10 key genes (IL6，IL8, IL1B, BCL2, CCL2, CSF2, KIT, ICAM1, PTPRC and IGF1) and significant enriched pathways. In conclusion, the current study suggests that the filtered DEGs contribute to our understanding of the molecular mechanisms underlying the interaction between PSCs and pancreatic cancer cells, and might be used as molecular targets to further the study the role of tumor microenvironment in the progression of PDAC.

Role of multi-modality functional imaging in differentiation between benign and malignant thyroid 18F-fluorodeoxyglucose incidentaloma

PURPOSE

To evaluate the diagnostic performance of multi-modality functional imaging in differentiating malignant and benign thyroid ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) incidentaloma.

METHODS

This study included 87 patients with thyroid ¹⁸F-FDG incidentalomas detected by ¹⁸F-FDG- positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and diagnosed at surgery or biopsy, who received ¹⁸F-FDG-PET/CT, diffusion-weighted MR imaging (DWI) and ultrasound elastography (USE). The metabolic tumor volume (MTV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC) values and ultrasound elasticity scores of thyroid ¹⁸F-FDG incidentalomas were measured and compared in benign and malignant thyroid incidentalomas. The differences of malignant and benign thyroid incidentalomas were tested by χ² test, Fisher's exact test, t test, or Mann-Whitney U test. The diagnostic performance was evaluated and optimal cut-off values were determined in distinguishing malignant from benign thyroid incidentalomas by receiver operating characteristic curve analysis.

RESULTS

MTV, TLG and USE scores of malignant thyroid incidentalomas were significantly higher than benign; but ADC value was significantly lower. We defined the functional imaging parameters TLG < 2.48, ADC > 1.80 × 10^-3mm²/s, and USE score of 1 as markers of benign thyroid incidentalomas and each scored -1 point; TLG ≥ 2.48, ADC ≤ 1.80 × 10^-3mm²/s, and USE score of 4 as markers of malignancy and each scored 1 point. Combined multi-functional imaging parameters achieved the highest performance (84.6% sensitivity and 97.1% specificity) for distinguish malignant from benign thyroid incidentaloma with AUC 0.957 (95% CI 0.917, 0.997).

CONCLUSIONS

Functional imaging might help to distinguishing malignant from benign thyroid ¹⁸F-FDG incidentalomas, and combined multi-functional imaging parameters could improve it.

Epigallocatechin-3-gallate protected vanadium-induced eggshell depigmentation via P38MAPK-Nrf2/HO-1 signaling pathway in laying hens

It has been demonstrated that tea polyphenol (TP) epigallocatechin-3-gallate (EGCG) can confer protection against vanadium (V) toxicity in laying hens; however, our understanding of the molecular mechanisms beyond this effect are still limited. In this study, 360 hens were randomly assigned to the 3 groups to study whether the potential mechanism P38MAPK-Nrf2/HO-1 signaling pathway is involved in the protective effect of EGCG on eggshell pigmentation in vanadium challenged laying hens. Treatments included a control group, a 10 mg/kg V (V10), and a V10 plus 130 mg/kg of EGCG group (V10+EGCG130). Both eggshell color and protoporphyrin IX were decreased in the V10 group compared with the control diet, while EGCG130 treatment partially improved shell color and protoporphyrin IX (P < 0.05). The V10 exposure induced higher cell apoptosis rate and oxidative stress in birds as evidenced by the histological apoptosis status, decreased uterine glutathione-S transferase (GST) and high abundance of malondialdehyde (MDA) compared with the control group, whereas EGCG130 markedly alleviated oxidative stress via reducing MDA generation (P < 0.05). Dietary vanadium reduced ferrochelatase, NF-E2-related factor 2 (Nrf2), and heme oxygenase (HO-1) mRNA expression, while EGCG up-regulated Nrf2 and HO-1 expression (P < 0.05). Protein levels of Nrf2, HO-1 and phospho-p38 (P-P38) MAPK were reduced in V10 group, while dietary supplementation with 130 mg/kg EGCG markedly increased Nrf2, HO-1 and P-P38 MAPK protein levels in the uterus compared with the V10 group (P < 0.01). In conclusion, EGCG improved eggshell color and antioxidant system in V10-challenged hens, which seems to be associated with P38MAPK-Nrf2/HO-1 signaling pathway.

Calibration of vertical array tilt using snapping shrimp sound

Snapping shrimp are the dominant biological source of high-frequency (>2 kHz) ambient noise in warm coastal waters. In a recent experiment, the highly impulsive signals produced by shrimp snaps were recorded continually by a large-aperture vertical array (56 m) that was bottom-moored in 100-m deep shallow water. Assuming the array vertical, initial localization of individual snaps based on wavefront curvature along the array indicated that all snaps came from either above or beneath the flat seabed. By constraining all snaps to originate from the seabed, several hundred snaps within a radius of 500 m from the array over a 20-s window were detected successfully and localized in the three-dimensional space of time-of-arrival, range, and array tilt. Since the estimated array tilt for each snap is a projection of the absolute array tilt onto the nominal array-snap plane, the maximal tilt in the range and tilt domain corresponds to the absolute array tilt. Both simulations and data demonstrate that snapping shrimp can be exploited as a source of opportunity for calibration of vertical array tilt.