BACCHUS: A randomised non-comparative phase II study of neoadjuvant chemotherapy (NACT) in patients with locally advanced rectal cancer (LARC)

BACKGROUND

Chemoradiation (CRT) or short-course radiotherapy (SCRT) are standard treatments for locally advanced rectal cancer (LARC). We evaluated the efficacy/safety of two neoadjuvant chemotherapy (NACT) regimens as an alternative prior to total mesorectal excision (TME).

METHODS/DESIGN

This multi-centre, phase II trial in patients with magnetic resonance imaging (MRI) defined high-risk LARC (>cT3b, cN2+ or extramural venous invasion) randomised patients (1:1) to FOLFOX + Bevacizumab (Arm 1) or FOLFOXIRI + bevacizumab (Arm 2) every 14 days for 6 cycles prior to surgery. Patients were withdrawn if positron emission tomography (PET) standardised uptake value (SUV) after 3 cycles failed to decrease by >30% or increased compared to baseline. Primary endpoint was pathological complete response rate (pCR). Secondary endpoints included adverse events (AE) and toxicity. Neoadjuvant rectal (NAR) scores based on "T" and "N" downstaging were calculated.

FINDINGS

Twenty patients aged 18-75 years were randomised. The trial stopped early because of poor accrual. Seventeen patients completed all 6 cycles of NACT. One stopped due to myocardial infarction, 1 poor response on PET (both received CRT) and 1 committed suicide. 11 patients had G3 AE, 1 G4 AE (neutropenia), and 1 G5 (suicide). pCR (the primary endpoint) was 0/10 for Arm 1 and 2/10 for Arm 2 i.e. 2/20 (10%) overall. Median NAR score was 14·9 with 5 (28%), 7 (39%), and 6 (33%) having low, intermediate, or high scores. Surgical morbidity was acceptable (1/18 wound infection, no anastomotic leak/pelvic sepsis/fistulae). The 24-month progression-free survival rate was 75% (95% CI: 60%-85%).

INTERPRETATION

The primary endpoint (pCR rate) was not met. However, FOLFOXIRI and bevacizumab achieved promising pCR rates, low NAR scores and was well-tolerated. This regimen is suitable for testing as the novel arm against current standards of SCRT and/or CRT in a future trial.

Electrodegradation of naphthalenic amines: Influence of the relative position of the substituent groups, anode material and electrolyte on the degradation products and kinetics

The electrodegradation of the 4-aminonaphthalene-1-sulfonic acid (4AN1S), 5-aminonaphthalene-2-sulfonic acid (5AN2S) and 8-aminonaphthalene-2-sulfonic acid (8AN2S) was studied, using two electrode materials as anode, BDD and Ti/Pt/PbO₂, and two different electrolytes, sodium sulfate and sodium chloride. The highest COD removal rates were obtained at BDD: for 5AN2S and 8AN2S results were similar in both electrolytes; for 4AN1S, results were better in sodium chloride. The lowest COD removal rates were obtained at the system Ti/Pt/PbO₂-sodium sulfate, for all the studied amines. The dissolved organic carbon (DOC) removal was much higher at BDD for all the amines, in sulfate for 5AN2S and 8AN2S and in chloride for 4AN1S. Nitrogen removal was always almost irrelevant in sulfate medium but higher than 60%, after 6-h assays, in chloride. The highest combustion efficiencies were attained at the system BDD-sodium sulfate and were: 4AN1S-75%; 5AN2S-84%; 8AN2S-74%. HPLC results show that total degradation of the studied aminonaphthalene sulfonates is attained at both anode materials, utilizing any of the electrolytes, with a first order kinetics. However, kinetic constants obtained with the variation of the amines concentration in time are 10-40 times higher in chloride, being slightly higher at Ti/Pt/PbO₂ than at BDD. Regarding the presence of carboxylic acids during the degradation assays, it was observed that the electrolysis of the amines 5AN2S and 8AN2S always lead to higher amounts of oxalic acid and lower quantities of acetic acid than the electrolysis of the amine 4AN1S.

Immediate function dental implants inserted with less than 30N·cm of torque in full-arch maxillary rehabilitations using the All-on-4 concept: retrospective study

The aim of this retrospective clinical study was to evaluate the short-term implant success rate and marginal bone loss in full-arch fixed prosthetic maxillary rehabilitations supported by implants in immediate function with the All-on-4 treatment concept placed with insertion torque of <30N·cm or ≥30N·cm. This study included 83 patients (69 female, 14 male) with 332 implants placed (120 inserted with <30N·cm and 212 inserted with ≥30N·cm) who were treated between January 2010 and March 2013. Outcome measures were implant success and marginal bone loss at 1year of follow-up. Ten patients (12.0%; 13 implants inserted with <30N·cm and 27 implants with ≥30N·cm) were lost to follow-up. The cumulative implant success rate was 97.5% at the patient level, and 98.3% for implants inserted with <30N·cm and 97.5% for implants inserted with ≥30N·cm. The mean±standard deviation marginal bone loss at 1year was 1.14±0.38mm for implants inserted with <30N·cm and 1.39±0.49mm for implants inserted with ≥30N·cm (significant difference; P<0.001, Wilcoxon signed rank test). These results indicate that implants with insertion torques of <30N·cm may render comparable success rates and marginal bone loss at 1year compared to implants inserted with insertion torques of ≥30N·cm.

Carotid sinus nerve electrical stimulation in conscious rats attenuates systemic inflammation via chemoreceptor activation

Recent studies demonstrated a critical functional connection between the autonomic (sympathetic and parasympathetic) nervous and the immune systems. The carotid sinus nerve (CSN) conveys electrical signals from the chemoreceptors of the carotid bifurcation to the central nervous system where the stimuli are processed to activate sympathetic and parasympathetic efferent signals. Here, we reported that chemoreflex activation via electrical CSN stimulation, in conscious rats, controls the innate immune response to lipopolysaccharide attenuating the plasma levels of inflammatory cytokines such as tumor necrosis factor (TNF), interleukin 1β (IL-1β) and interleukin 6 (IL-6). By contrast, the chemoreflex stimulation increases the plasma levels of anti-inflammatory cytokine interleukin 10 (IL-10). This chemoreflex anti-inflammatory network was abrogated by carotid chemoreceptor denervation and by pharmacological blockade of either sympathetic - propranolol - or parasympathetic - methylatropine – signals. The chemoreflex stimulation as well as the surgical and pharmacological procedures were confirmed by real-time recording of hemodynamic parameters [pulsatile arterial pressure (PAP) and heart rate (HR)]. These results reveal, in conscious animals, a novel mechanism of neuromodulation mediated by the carotid chemoreceptors and involving both the sympathetic and parasympathetic systems.

Preparation, characterization and environmental applications of Sr1 - x (La,Bi) x TiO3 perovskites immobilized on Ni-foam: photodegradation of the Acid Orange 7

The Sr_1 - x La _x TiO₃ (0 ≤ x ≤ 0.4) and Sr_1 - x Bi _x TiO₃ (0 ≤ x ≤ 0.3) perovskites were prepared via solid state reaction by partially replacing the Sr²⁺ ions in the SrTiO₃ structure by La³⁺ or Bi³⁺ ions, characterized and utilized as photocatalysts immobilized in Ni-foam substrate in the degradation of the azo dye Acid Orange 7 (AO7). For both perovskite families, the XRD data reveal the existence of a predominant well-crystallized phase, belonging to a cubic perovskite in a Pm3m space group, with the presence of other minority phases. The characteristic dimension and the volume of the cell decrease with the introduction in the SrTiO₃ lattice of the La³⁺ or Bi³⁺ ions. The grain size of the Sr_1 - x La _x TiO₃ samples is around 100 nm and slightly lower for the Sr_1 - x Bi _x TiO₃ samples. Regarding the utilization of the prepared perovskite powders deposited over the Ni-foam substrates as catalysts in the photodegradation of AO7 solutions, the results show an improvement in the performance of the films of the substituted perovskite when compared to the SrTiO₃ perovskite, being the best results obtained with Sr_0.9Bi_0.1TiO₃.