Physiological and biochemical differences in diapause and non-diapause pupae of Sericinus montelus (Lepidoptera: Papilionidae)

The swallowtail butterfly, Sericinus montelus Gray, is endemic to East Asia, has high ornamental value but faces an increased risk of extinction. To understand the overwintering strategies of this species, the dynamic changes in supercooling point (SCP) and water and biochemical contents of diapause-destined and non-diapause S. montelus pupae were investigated. The SCP of laboratory-reared diapause pupae was as low as -26°C compared to -24°C in diapause pupae in the field. Although there was no significant difference in total water content between diapause-destined and non-diapause pupae, the free water of diapause-destined pupae was significantly lower, and the bound water was significantly higher, than that of non-diapause pupae. Lipid, glycogen, and protein contents of diapause-destined pupae showed a downward trend, whereas the total sugar content showed the opposite trend after pupation. The glycogen content decreased rapidly during the initial stage of pupation, whereas the lipid content decreased significantly after 30 days of pupation, suggesting that diapause-destined pupae deplete glycogen stores during the pre-diapause period and then switch to using lipids during the diapause maintenance phase. Trehalose levels in diapause-destined pupae increased significantly and remained high after pupation. Meanwhile, the trehalose content of overwintering pupae during the diapause maintenance period was significantly higher than that of diapause termination pupae in the field. These results suggest that trehalose is the main cryoprotectant for overwintering pupae. Thus, diapausing S. montelus pupae appear to be freeze avoidant, accumulate trehalose as a cryoprotectant, and reduce the free water content to decrease the SCP, enhancing their cold tolerance.

Portable diagnostic package for Thomson scattering and optical emission spectroscopy on Princeton field-reversed configuration 2 (PFRC 2)

An Advanced Research Projects Agency-Energy funded diagnostic system has been deployed to the Princeton field-reversed configuration 2 (PFRC-2) device, located at Princeton Plasma Physics Laboratory. The Portable Diagnostic Package (PDP), designed at Oak Ridge National Laboratory, allows for the measurement of Thomson Scattering (TS) for electron density and temperature and Optical Emission Spectroscopy (OES) for ion temperature, impurity density, and ion velocity. A tunable spectrometer on the PDP with three gratings provides the flexibility to measure low (1 eV) and high (1000 eV) electron temperature ranges from TS. Additionally, using a second spectrometer, the OES diagnostic can survey light emission from various ion excitation levels for wide wavelength ranges. The electron density (<2 × 10¹⁹ m^-3) of plasmas generated in PFRC-2 has been below the PDP TS discrimination threshold, which has made TS signal detection challenging against a high-background of laser stray light. The laser stray light was iteratively reduced by making modifications to the entrance and exit geometry on PFRC-2. Rayleigh scattering experiments on PFRC have yielded the TS discrimination sensitivity to be >1 × 10²⁰ m^-3 for the PDP. A recently implemented narrow-band notch spectral filter that masks the second harmonic 532 nm Nd:YAG laser wavelength has increased the system's TS light discrimination sensitivity 65 times compared to the instance when the notch filter was not implemented. The hardware implementation including design changes to the flight tubes and Brewster windows will be discussed, along with results from Rayleigh and rotational Raman scattering sensitivity analyses, which were used to establish a quantitative figure of merit on the system performance. The Raman scattering calibration with the notch filter has improved the PDP electron density threshold to 1 ± 0.5 × 10¹⁸ m^-3.

Implementation of a portable diagnostic system for Thomson scattering measurements on an electrothermal arc source

To fulfill the increasing needs of diagnostic support for researchers in plasma technology, a portable diagnostic package (PDP) equipped for both laser Thomson scattering (TS) and optical emission spectroscopy has been designed and constructed at Oak Ridge National Laboratory (ORNL), aiming to measure the temperature and number density of electrons and temperatures of ions in plasma devices. The PDP has been initially implemented on a high density and low temperature electrothermal arc source (ET-arc) at ORNL to test its TS capability. TS from the plasmas in the ET-arc has been obtained using the PDP. The electron temperature and number density were determined from TS spectra. These results were then compared to measurements from previous studies on the ET-arc. The TS diagnostic measured 0.8 ± 0.1, 1.3 ± 0.2, and 0.7 ± 0.1 eV and (4.4 ± 0.5) × 10²¹, (5.9 ± 0.7) × 10²¹, and (4.3 ± 0.5) x 10²¹ m^-3, respectively, from three lines of sight that transect the plasma column.

Novel Stimuli-Responsive Spiropyran-Based Switch@HOFs Materials Enable Dynamic Anticounterfeiting

Developing smart fluorescent materials having very advanced levels, showing dynamic displays of encrypted messaging, remains a huge challenge. In this paper, we present a unique method based on combining a common photochromic molecule spiropyran (SP) with hydrogen-bonded organic frameworks (HOFs), which allows for reversible switching of SP in solid states and shows dynamic displays of encrypted information. With the irradiation time extended, the fluorescence emission undergo an evident transformation from yellow-green to orange to red, because of the fluorescence resonance energy transfer (FRET) process between the unique HOFs and merocyanine (MC) isomer. By doping with polydimethylsiloxane (PDMS), we obtained free-standing membranes with high flexibility and mechanical strength, which can be reversibly and repeatedly bent and folded at angles of >90°. Notably, the comparison of fatigue resistance between SP2/PDMS (can be used for no more than 5 times) and SP2 ⊂ HOF2/PDMS (can be used for more than 100 times) further proved the importance of HOFs. This composite system has many advantages: (1) it has diverse dynamic fluorescence emission and visible colors regulated by ultraviolet radiation with high contrast and can be reversibly converted; (2) these changes in behavior can be achieved by simple UV illumination; and (3) compared with previous work, this work not only shows the dynamic fluorescence emission, but also shows the dynamic information during the decryption.

P11.75.B Survival benefit of radiotherapy and surgery in patients with lung cancer brain metastases with poor prognosis factors

Background

Radiotherapy and surgery are the standard treatments for lung cancer brain metastases (BMs). However, limitted studies focused on the treatments for patients with lung cancer BMs with poor prognosis factors. The purpose of this study was to investigate the effects of radiotherapy and surgery in patients with lung cancer BMs with poor prognosis factors, providing reference for clinical strategies.

Material and Methods

We analyzed retrospectively 714 patients with lung cancer BMs. A 1:1 propensity score matching (PSM) was performed to balance potential confounders. Analyses of overall survival (OS) and risk factors for OS were assessed by log-rank test and Cox proportional hazard model.

Results

Age ≥65 years, Karnofsky Performance Scale (KPS) score ≤70, anaplastic large-cell lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) wild type, extracranial metastases, non-surgery and non-radiotherapy led to poor prognosis. Patients were stratified according to these factors. Radiotherapy and surgery showed no survival benefit in patients with aged ≥65 years or pretreatment KPS score ≤70 before and after PSM. Before PSM, whole brain radiotherapy (WBRT) improved the OS and predicted good prognosis in patients with ALK/EGFR wild type or extracranial metastases. WBRT also predicted good prognosis in patients with non-surgery. Stereotactic radiosurgery (SRS) improved the OS and predicted good prognosis in patients with ALK/EGFR wild type or non-surgery. WBRT plus SRS improved the OS and predicted good prognosis in patients with extracranial metastases or non-surgery. WBRT plus SRS also predicted good prognosis in patients with ALK/EGFR wild type. Surgery improved the OS and predicted good prognosis in patients with non-radiotherapy. After PSM, SRS improved the OS and predicted good prognosis in patients with non-surgery. WBRT plus SRS improved the OS and predicted good prognosis in patients with non-surgery or extracranial metastases. WBRT plus SRS also predicted good prognosis in patients with ALK/EGFR wild type. Surgery improved the OS of patients with non-radiotherapy. We defined that the treatment would provide significant survival benefit if it both prolonged the OS and predicted good prognosis. Meanwhile, the results after PSM were more convincing than the results before PSM.

Conclusion

Radiotherapy has significant survival benefit in patients with lung cancer BMs with poor prognosis factors, including patients with ALK/EGFR wild type or extracranial metastases or non-surgery. Surgery only has significant survival benefit in patients with non-radiotherapy.

A Machine-Learning Based Approach for Predicting Older Adults' Adherence to Technology-Based Cognitive Training

Adequate adherence is a necessary condition for success with any intervention, including for computerized cognitive training designed to mitigate age-related cognitive decline. Tailored prompting systems offer promise for promoting adherence and facilitating intervention success. However, developing adherence support systems capable of just-in-time adaptive reminders requires understanding the factors that predict adherence, particularly an imminent adherence lapse. In this study we built machine learning models to predict participants' adherence at different levels (overall and weekly) using data collected from a previous cognitive training intervention. We then built machine learning models to predict adherence using a variety of baseline measures (demographic, attitudinal, and cognitive ability variables), as well as deep learning models to predict the next week's adherence using variables derived from training interactions in the previous week. Logistic regression models with selected baseline variables were able to predict overall adherence with moderate accuracy (AUROC: 0.71), while some recurrent neural network models were able to predict weekly adherence with high accuracy (AUROC: 0.84-0.86) based on daily interactions. Analysis of the post hoc explanation of machine learning models revealed that general self-efficacy, objective memory measures, and technology self-efficacy were most predictive of participants' overall adherence, while time of training, sessions played, and game outcomes were predictive of the next week's adherence. Machine-learning based approaches revealed that both individual difference characteristics and previous intervention interactions provide useful information for predicting adherence, and these insights can provide initial clues as to who to target with adherence support strategies and when to provide support. This information will inform the development of a technology-based, just-in-time adherence support systems.

Sieve tube structural variation in Austrobaileya scandens and its significance for lianescence

Lianas combine large leaf areas with slender stems, features that require an efficient vascular system. The only extant member of the Austrobaileyaceae is an endemic twining liana of the tropical Australian forests with well-known xylem hydraulics, but the vascular phloem continuum aboveground remains understudied. Microscopy analysis across leaf vein orders and stems of Austrobaileya scandens revealed a low foliar xylem:phloem ratio, with isodiametric vascular elements along the midrib, but tapered across vein orders. Sieve plate pore radii increased from 0.08 µm in minor veins to 0.12 µm in the petiole, but only to 0.20 µm at the stem base, tens of metres away. In easily bent searcher branches, phloem conduits have pectin-rich walls and simple plates, whereas in twining stems, conduits were connected through highly angled and densely porated sieve plates. The hydraulic resistance of phloem conduits in the twisted and elongated stems of A. scandens is large compared with trees of similar stature; phloem hydraulic resistance decreases from leaves to stems, consistent with the efficient delivery of photoassimilates from sources under Münch predictions. Sink strength of a continuously growing canopy might be stronger than in self-supporting understory plants, favoring resource allocation to aerial organs and the attainment of vertical stature.

Conversion Surgery Following Immunochemotherapy in Initially Unresectable Locally Advanced Esophageal Squamous Cell Carcinoma-A Real-World Multicenter Study (RICE-Retro)

PURPOSE

The present study sets out to evaluate the feasibility, safety, and effectiveness of conversion surgery following induction immunochemotherapy for patients with initially unresectable locally advanced esophageal squamous cell carcinoma (ESCC) in a real-world scenario.

MATERIALS AND METHODS

In this multi-center, real-world study (NCT04822103), patients who had unresectable ESCC disease were enrolled across eight medical centers in China. All patients received programmed death receptor-1 (PD-1) inhibitor plus chemotherapy every 3 weeks for at least two cycles. Patients with significant relief of cancer-related clinical symptoms and radiological responsive disease were deemed surgical candidates. Feasibility and safety profile of immunochemotherapy plus conversion surgery, radiological and pathological tumor responses, as well as short-term survival outcomes were evaluated. Moreover, data of an independent ESCC cohort receiving induction chemotherapy (iC) were compared.

RESULTS

One hundred and fifty-five patients were enrolled in the final analysis. Esophagectomy was offered to 116 patients, yielding a conversion rate of 74.8%. R0 resection rate was 94%. Among the 155 patients, 107 (69.0%) patients experienced at least one treatment-related adverse event (TRAE) and 45 (29.0%) patients reported grade 3 and above TRAEs. Significant differences in responsive disease rate were observed between iC cohort and induction immunochemotherapy (iIC) cohort [objective response rate: iIC: 63.2% vs. iC: 47.7%, p = 0.004; pathological complete response: iIC: 22.4% vs. iC: 6.7%, p = 0.001). Higher anastomosis fistula rate was observed in the iC group (19.2%) compared with the iIC group (4%). Furthermore, Significantly higher event-free survival was observed in those who underwent conversion surgery.

CONCLUSION

Our results supported that conversion surgery following immunochemotherapy is feasible and safe for patients with initially unresectable locally advanced ESCC. Both radiological and pathological response rates were significantly higher in the iIC cohort compared with those in the traditional iC cohort.

Assessing the use of prescription drugs and dietary supplements in obese respondents in the National Health and Nutrition Examination Survey

Introduction

Obesity is a common disease and a known risk factor for many other conditions such as hypertension, type 2 diabetes, and cancer. Treatment options for obesity include lifestyle changes, pharmacotherapy, and surgical interventions such as bariatric surgery. In this study, we examine the use of prescription drugs and dietary supplements by the individuals with obesity.

Methods

We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2003–2018. We used multivariate logistic regression to analyze the correlations of demographics and obesity status with the use of prescription drugs and dietary supplement use. We also built machine learning models to classify prescription drug and dietary supplement use using demographic data and obesity status.

Results

Individuals with obesity are more likely to take cardiovascular agents (OR = 2.095, 95% CI 1.989–2.207) and metabolic agents (OR = 1.658, 95% CI 1.573–1.748) than individuals without obesity. Gender, age, race, poverty income ratio, and insurance status are significantly correlated with dietary supplement use. The best performing model for classifying prescription drug use had the accuracy of 74.3% and the AUROC of 0.82. The best performing model for classifying dietary supplement use had the accuracy of 65.3% and the AUROC of 0.71.

Conclusions

This study can inform clinical practice and patient education of the use of prescription drugs and dietary supplements and their correlation with obesity.

Learning global dependencies based on hierarchical full connection for brain tumor segmentation

BACKGROUND AND OBJECTIVE

Because the appearance, shape and location of brain tumors vary greatly among different patients, brain tumor segmentation (BTS) is extremely challenging. Recently, many studies have used attention mechanisms to solve this problem, which can be roughly divided into two categories: the spatial attention based on convolution (with or without channel attention) and self-attention. Due to the limitation of convolution operations, the spatial attention based on convolution cannot learn global dependencies very well, resulting in poor performance in BTS. A simple improvement idea is to directly substitute it with self-attention, which has an excellent ability to learn global dependencies. Since self-attention is not friendly to GPU memory, this simple substitution will make the new attention mechanism unable to be applied to high-resolution low-level feature maps, which contain considerable geometric information and are also important for improving the performance of attention mechanism in BTS.

METHOD

In this paper, we propose a hierarchical fully connected module, named H-FC, to learn global dependencies. H-FC learns local dependencies at different feature map scales through fully connected layers hierarchically, and then combines these local dependencies as approximations of the global dependencies. H-FC requires very little GPU memory and can easily replace spatial attention module based on convolution operation, such as Attention Gate and SAM (in CBAM), to improve the performance of attention mechanisms in BTS.

RESULTS

Adequate comparative experiments illustrate that H-FC performs better than Attention Gate and SAM (in CBAM), which lack the ability to learn global dependencies, in BTS, with improvements in most metrics and a larger improvement in Hausdorff Distance. By comparing the amount of calculation and parameters of the model before and after adding H-FC, it is prove that H-FC is light-weight.

CONCLUSION

In this paper, we propose a novel H-FC to learn global dependencies. We illustrate the effectiveness of H-FC through experiments on BraTS2020 dataset. We mainly explore the influence of the region size and the number of steps on the performance of H-FC. We also confirm that the global dependencies of low-level feature maps are also important to BTS. We show that H-FC is light-weight through a time and space complexity analysis and the experimental results.

Pan-cancer analysis of IDH1 and IDH2 genomic alterations to reveal a complex molecular landscape

e15116

Background: As a crucial enzyme involved in cell aerobic metabolism of the tricarboxylic acid cycle, IDH also plays important role in cancer biology. Somatic point mutations in IDH1/2 contribute to oncogenesis by promoting the production and secretion of an oncometabolite, the D-2-hydroxybutyrate, which could alter cellular metabolism and epigenetic regulation. However, data regarding the status and prevalence of IDH1 and IDH2 mutations in pan-cancer from Chinese cancer patients is limited. Methods: Ranging from Jan 14, 2020, to Oct 25, 2021, genomic DNA extracted from 5419 blood or tissue samples involving more than 22 solid tumors types were analyzed by NGS assay to investigate the landscape of IDH1/2 mutations and hotspots. Results: IDH mutations were identified in 205 cases (3.78%), of which 145 cases (2.68%) were from the IDH1 mutations group and 63 cases (1.16%) from the IDH2 mutations group. IDH1 mutations predominantly occurred in CNS tumors, melanoma, and endometrial cancer (with mutation frequencies of 26.09%, 7.41%, 5.26%, respectively), whereas IDH2 mutations occurred commonly in endometrial cancer (5.26%) and gastric cancer (2.90%). Among the 56 mutation sites found in IDH1, Y208(19.46%), R132(16.11%), and R20(12.08%) were the three major IDH1 mutations. M397, which accounts for 33.33% of all IDH2 mutation sites, was the most significantly mutated subtypes, followed by T146(4.76%). Conclusions: Compared with IDH2, IDH1 is more frequently mutated in terms of cancer species as well as shows higher mutation frequency, and our findings implicate mutations in IDH in the pathogenesis of cancers, especially CNS tumors.

The landscape of KDM5A mutations and hotspots in Chinese patients with solid tumors

e15115

Background: As a kind of histone modification enzyme, Lysine-specific demethylase can eliminate di- and tri-methyl groups from lysine 4 of histone. A growing number of shreds of evidence demonstrate that the disfunction of KDM5A relates closely to the initiation and progression of various diseases, particularly cancers, including but not limited to breast cancer, prostate cancer, glioblastoma, etc. However, research on the mutation spectrum of KDM5A in Chinese cancer patients is lacking. Methods: Ranging from Jan 14, 2020, to Oct 25, 2021, genomic DNA extracted from 5419 blood or tissue samples involving more than 22 solid tumors types were analyzed by NGS assay to investigate the landscape of KDM5A mutations and hotspots. Results: KDM5A somatic mutations existed in approximately 6.50% of all samples and almost all kinds of screened cancer types, among which, endometrial cancer comes first with the highest mutational frequency up to 21.05%, followed by the esophagus and esophagogastric junction cancer (18.18%) and bladder cancer (12.50%). Further analysis was conducted to explore mutational hotspots in KDM5A. Although almost 150 mutation sites existing in KDM5A had been identified in our research, the most prominent mutational hotspots are G1200, T30, M766, occupying 19.63%, 17.51%, and 6.37% of all SNV and Indel KDM5A mutations, respectively. Conclusions: Our study partially disclosed the panorama of the KDM5A mutational landscape in Chinese patients with solid tumors for the first time. Further studies with larger samples and populations are much needed to enhance our understanding of this enzyme in cancer biology.

Classifying Drug Ratings Using User Reviews with Transformer-Based Language Models

Drug review websites such as Drugs.com provide users' textual reviews and numeric ratings of drugs. These reviews along with the ratings are used for the consumers for choosing a drug. However, the numeric ratings may not always be consistent with text reviews and purely relying on the rating score for finding positive/negative reviews may not be reliable. Automatic classification of user ratings based on textual review can create a more reliable rating for drugs. In this project, we built classification models to classify drug review ratings using textual reviews with traditional machine learning and deep learning models. Traditional machine learning models including Random Forest and Naive Bayesian classifiers were built using TF-IDF features as input. Also, transformer-based neural network models including BERT, Bio_ClinicalBERT, RoBERTa, XLNet, ELECTRA, and ALBERT were built using the raw text as input. Overall, Bio_ClinicalBERT model outperformed the other models with an overall accuracy of 87%. We further identified concepts of the Unified Medical Language System (UMLS) from the postings and analyzed their semantic types stratified by class types. This research demonstrated that transformer-based models can be used to classify drug reviews based solely on textual reviews.

Selective effects of perinatal estrogen on proliferation and new neurons in hippocampus and piriform cortex of rats at weaning

BACKGROUND

A recent report links heightened prenatal amniotic estrogen levels to an increased risk of autism spectrum disorder (ASD). In this study, we examined the developmental effects of perinatal estrogen treatment on stem cell activity in weaned rats.

METHODS

Sprague-Dawley rats received ethinyl estradiol (EE2, 10µg/kg/day) or vehicle orally from gestational day 6 until parturition. Offspring were then treated with the same daily dose from postnatal days (PNDs) 1-21. The effects of perinatal estrogen treatment on stem cell activities in the subgranular zone (SGZ) of the hippocampus and the piriform cortex were evaluated in male and female rat pups.

RESULTS

EE₂ treatment increased the total Ki67-immunoreactive (Ki67-ir) cell counts in the SGZ of males and females (p<0.05). However, no treatment or sex differences were detectable in the density of the doublecortin (DCX)-immunoreactive (DCX-ir) deposits in the hippocampus. In the piriform cortex, no treatment or sex differences were detected in Ki67-ir cell counts. However, the EE₂ treatment significantly reduced the DCX-ir cell count in male, but not female rats (male EE₂ group=29₂±22/mm², male vehicle group=402±19/mm², female EE² group=34₂±15/mm², female vehicle group=331±9/mm²).

CONCLUSIONS

Perinatal estrogen treatment increased hippocampal Ki67-ir cell counts in both sexes and selectively reduced DCX-ir cell counts in the piriform cortex of males. These data suggest that exposure to abnormally high levels of estrogens early in life may have an impact on neural cell development. Alterations in development so early in life may have long-term cognitive impact.

Dynamic Anticounterfeiting Through Novel Photochromic Spiropyran-Based Switch@Ln-MOF Composites

Fluorescent materials presenting unique color changes in response to external stimuli have wide applications in information storage and anticounterfeiting. However, developing intelligent fluorescent materials with high security levels and dynamically displaying encrypted information is still a challenge. Herein, we report a new method for constructing excellent fluorescent materials by loading the photochromic molecule spiropyran into a lanthanide metal-organic framework. Controlling the isomerization of the spiropyran unit regulates the fluorescence resonance energy transfer (FRET) mechanism between the spiropyran acceptor and the lanthanide donor, leading to an exceptional reversible absorption/luminescence modulation ability. As the irradiation time is extended, the fluorescent color changes continuously from yellow-greenish to orange and then to red through the FRET process within 60 s. This composite system has great potential in anticounterfeiting because of the following advantages: (1) the materials have different fluorescence emissions and optical colors regulated by ultraviolet radiation, which is convenient for designing complex anticounterfeiting patterns; (2) the system can be repeatedly verified quickly and exhibit dynamic fluorescence color within 60 s, having great potential in advanced anticounterfeiting, where time is key in encryption/decryption. These unique advantages will greatly enhance the reliability of anticounterfeiting measures and increase the difficulty of anticounterfeiting.

[The efficacy and prognostic factors of immunotherapy in advanced non-small cell lung cancer patients with different driver gene mutations]

Objective: To explore the efficacy and prognostic factors of immunotherapy in advanced non-small cell lung cancer (NSCLC) patients with different driver gene mutations. Methods: Medical records of advanced NSCLC patients who harbored driver gene mutations (EGFR, KRAS, ALK and etc.) and received PD-1 inhibitors in Henan Cancer Hospital from April 2016 to May 2021 were collected. Treatment patterns, progression free survival (PFS), overall survival (OS) and prognostic factors of patients with driver gene mutations were estimated. Results: A total of 120 patients were included. There were 70 males and 50 females, with a median age [M(Q₁,Q₃)] of 57 (50, 65) years. Of these, 52 patients harbored KRAS mutations, 42 patients harbored EGFR mutations, 16 patients harbored ERBB2 mutations, 5 patients harbored MET mutations or amplifications, 5 patients harbored ROS-1 mutations, 2 patients harbored BRAF mutations, and the last 2 patients harbored ALK and RET mutations, respectively. The PFS and OS [M (95%CI)] were 6.4 (5.1-7.8) and 31.2 (22.0-40.3) months in 120 participated patients. Patients with KRAS mutations showed the greatest survival benefit from Immune checkpoint inhibitors (ICIs) with the PFS of 9.7 (4.8-14.6) months and OS of 31.2 (19.4-50.6) months. They mostly received the first-line (34.6%, 18/52) and second-line (38.5%, 20/52) ICIs. The PFS and OS of EGFR mutant patients were 3.9 (1.8-6.1) months and 18.0 (12.1-23.8) months, respectively. They tended to receive ICIs after resistance to EGFR-tyrosine kinase inhibitors (TKIs), and the proportion of second-, third-, fourth or further-line drugs was 38.1% (16/42), 11.9% (5/42), and 47.6% (20/42), respectively. PD-L1 expression level (negative vs ≥50% positive: HR=3.710, 95%CI: 1.372-10.031, P=0.010; 1%-49% positive vs ≥50% positive: HR=2.738, 95%CI: 0.841-8.912, P=0.094), age (every additional year: HR=0.957, 95%CI: 0.933-0.982, P=0.001) and different driver mutations status (EGFR vs KRAS: HR=2.676, 95%CI: 1.317-5.436, P=0.006; ERBB2 vs KRAS: HR=3.411, 95%CI: 1.493-7.792, P=0.004; other mutations vs KRAS: HR=0.727, 95%CI: 0.322-1.643, P=0.444) were prognostic factors for PFS. While PD-L1 expression level (negative vs ≥50% positive: HR=2.305, 95%CI: 0.748-7.103, P=0.146; 1%-49% positive vs ≥50% positive: HR=1.286, 95%CI: 0.337-4.913, P=0.713), and treatment lines of ICIs (first-line vs ≥ third-line: HR=0.322, 95%CI: 0.114-0.914, P=0.033; second-line vs ≥ third-line: HR=0.375, 95%CI: 0.178-0.789, P=0.010) were prognostic factors for OS. Conclusions: KRAS mutant NSCLC patients mostly receive ICIs at the front line, and have best survival benefits from immunotherapy. While EGFR mutant NSCLC patients tend to receive ICIs at the back line, and obtain reasonable survival benefits. PD-L1 expression level, age, and different driver mutations status are prognostic factors for PFS, and PD-L1 expression level and treatment lines of ICIs are prognostic factors for OS.

Understanding Information Needs and Barriers to Accessing Health Information Across All Stages of Pregnancy: Systematic Review

BACKGROUND

Understanding consumers' health information needs across all stages of the pregnancy trajectory is crucial to the development of mechanisms that allow them to retrieve high-quality, customized, and layperson-friendly health information.

OBJECTIVE

The objective of this study was to identify research gaps in pregnancy-related consumer information needs and available information from different sources.

METHODS

We conducted a systematic review of CINAHL, Cochrane, PubMed, and Web of Science for relevant articles that were published from 2009 to 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Program. A descriptive data analysis was performed on these articles. Based on the review result, we developed the Pregnancy Information Needs Ontology (PINO) and made it publicly available in GitHub and BioPortal.

RESULTS

A total of 33 articles from 9 countries met the inclusion criteria for this review, of which the majority were published no earlier than 2016. Most studies were either descriptive (9/33, 27%), interviews (7/33, 21%), or surveys/questionnaires (7/33, 21%); 20 articles mentioned consumers' pregnancy-related information needs. Half (9/18, 50%) of the human-subject studies were conducted in the United States. More than a third (13/33, 39%) of all studies focused on during-pregnancy stage; only one study (1/33, 3%) was about all stages of pregnancy. The most frequent consumer information needs were related to labor delivery (9/20, 45%), medication in pregnancy (6/20, 30%), newborn care (5/20, 25%), and lab tests (6/20, 30%). The most frequently available source of information was the internet (15/24, 63%). PINO consists of 267 classes, 555 axioms, and 271 subclass relationships.

CONCLUSIONS

Only a few articles assessed the barriers to access to pregnancy-related information and the quality of each source of information; further work is needed. Future work is also needed to address the gaps between the information needed and the information available.