PARP inhibitors as maintenance therapy in newly diagnosed advanced ovarian cancer: a meta-analysis

BACKGROUND

Up to 70% of patients with advanced ovarian cancer have a relapse after primary therapy. New agents and approaches are urgently needed to avoid or slow down this recurrence.

OBJECTIVES

To investigate the efficacy of PARP inhibitors (PARPis) as maintenance treatment in patients with newly diagnosed advanced ovarian cancer.

SEARCH STRATEGY

PubMed, MEDLINE, EMBASE, Cochrane Library and Web of Science databases.

SELECTION CRITERIA

All randomised clinical trials (RCTs) that compared PARPis with placebo as first-line maintenance therapy in ovarian cancer.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data. Pooled hazard ratio (HR) and risk ratio (RR) with 95% confidence interval (CI) were calculated.

MAIN RESULTS

PARPis were associated with significant improvement of progression-free survival (PFS) in advanced epithelial ovarian cancer (AeOC) (HR = 0.53, 95% CI 0.40-0.71; P < 0.0001). The benefit was not only in women with BRCA mutations (HR = 0.35, 95% CI 0.29-0.42; P < 0.00001) and homologous recombination deficiency (HRD) (HR = 0.43, 95% CI 0.32-0.60; P < 0.00001), but also in those with nonmutated BRCA (HR = 0.72, 95% CI 0.63-0.82; P < 0.00001) and even non-HRD (HR = 0.83, 95% CI 0.70-0.99; P = 0.04).

CONCLUSIONS

PARP inhibitors are effective as maintenance therapy among patients with newly diagnosed advanced ovarian cancer after platinum-based chemotherapy, regardless of BRCA mutation or HRD status.

TWEETABLE ABSTRACT

PARPis provide a significant PFS benefit as first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer.

Hollow mesoporous silica with a hierarchical shell from in situ synergistic soft-hard double templates

Traditional methods for the construction of hollow particles with a hierarchical shell mainly rely on complicated chemical routes and removal of the templates. Herein, hollow mesoporous silica particles with a sphere-on-sphere (SOS) structure were successfully synthesized via a one-pot method using a novel "in situ synergistic soft-hard double template" strategy, that is, styrene (St) droplets as a soft template and in situ polymerized PS nano-domains as a hard template. The pre-hydrolysate derived from the silica precursor methyltriethoxysilane could anchor on the surface of the St droplets due to its amphiphilicity and then continue hydrolysis-condensation to form the mesoporous silica shell (MSS). Subsequently, MSS was used as a nanoreactor, and some of the in situ polymerized PS chains in the nanoreactor migrated to the outer surface of MSS due to the action of strong capillary force in the mesoporous channels, while some of the siloxane oligomers migrated to the surface due to their apparent interfacial activity, resulting in the hierarchical appearance of SOS. Furthermore, other intriguing hollow silica particles with a hollow sphere-on-sphere (HOS) structure were obtained by calcining the obtained SOS particles. The application of the as-prepared SOS and HOS particles showed their potential in the superhydrophobicity and detoxification fields, respectively.

Enhanced therapeutic index of an antimicrobial peptide in mice by increasing safety and activity against multidrug-resistant bacteria

The rising prevalence of antibiotic resistance underscores the urgent need for novel antimicrobial agents. Antimicrobial peptides (AMPs) are potentially effective therapeutics that disrupt bacterial membranes regardless of resistance to traditional antibiotics. We have developed engineered cationic AMPs (eCAPs) with broad activity against multidrug-resistant (MDR) bacteria, but stability remains an important concern. Therefore, we sought to enhance the clinical utility of eCAP WLBU2 in biological matrices relevant to respiratory infection. A designed substitution of d-Val for l-Val resulted in increased resistance to protease enzymatic degradation. We observed multiple gains of functions such as higher activity against bacteria in biofilm mode of growth, significantly lower toxicity to erythrocytes and white blood cells compared to WLBU2, with increased safety in mice. Direct airway delivery revealed a therapeutic index of >140 for the selected enantiomer compared to that of <35 for WLBU2. The data warrant clinical exploration by aerosolized delivery to mitigate MDR-related respiratory infection.

[Risk factors of anastomotic leakage after robotic surgery for low and mid rectal cancer]

Objective: To investigate the risk factors associated with anastomotic leakage after robotic surgery in mid-low rectal cancer. Methods: A retrospective case-control study method was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) pathologically confirmed rectal cancer; (3) distance <10 cm from tumor to anal margin; (4) robotic anterior rectal resection. Patients with previous history of colorectal cancer surgery, distant metastases or other malignant tumors, undergoing emergency surgery, with severe abdominal adhesions or those receiving combined organ resection were excluded. Based on the above criteria, 636 patients undergoing robotic radical sphincter-preserving surgery for mid-low rectal cancer in Zhongshan Hospital from January 2015 to December 2018 were included in this study, including 398 males (62.6%) and 238 females (37.4%) with a mean age of (61.9±11.3) years. Sixty-eight cases (10.7%) received neoadjuvant chemoradiotherapy. Amony the 636 included patients, 123(19.3%) underwent natural orifice specimen extraction surgery (NOSES) and 15 (2.3%) underwent preventive stoma. According to the cirteria developed by the International Rectal Cancer Research Group in 2010, the anastomotic leakage was classified as grade A (no requirement of intervention), B (requirement of intervention), and C (requirement of operation). Logistic regression was used to analyze the relationship between anastomotic leakage and clinicopathological factors. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results: Anastomotic leakage occurred in 38 cases (6.0%). The grading of anastomotic leakage was grade A in 13 cases (2.0%), grade B in 19 cases (3.0%), and grade C in 6 cases (0.9%). The 3-year disease-free survival rate of patients with anastomotic leakage and without anastomotic leakage was 83.5% and 83.6% respectively (P=0.862); the 3-year overall survival rate of the two group was 85.1% and 87.5% respectively (P=0.296). The results of univariate logistic regression analysis showed that male (P=0.011), longer operation time (P=0.042), distance ≤5 cm from tumor to anal margin (P=0.012), more intraoperative blood loss (P=0.048) were associated with anastomotic leakage (all P<0.05). NOSES was not associated with anastomotic leakage (P=0.704). Multivariate analysis confirmed that male (OR=3.03, 95%CI: 1.37 to 7.14, P=0.010), operation time ≥180 minutes (OR=2.04, 95%CI: 1.03 to 3.99, P=0.040), distance ≤5 cm from tumor to anal margin (OR=2.56, 95%CI:1.28 to 5.26, P=0.008) were independent risk factors for anastomotic leakage. Conclusion: Male, short distance from tumor to anal margin, and long operation time are independent risk factors for anastomotic leakage in patients undergoing robotic mid-low rectal cancer radical surgeries. These patients need to be cautiously treated during surgery.

Umifenovir treatment is not associated with improved outcomes in patients with coronavirus disease 2019: a retrospective study

Objectives

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Umifenovir (Arbidol®) is an antiviral drug being used to treat influenza in Russia and China. This study aimed to investigate the effectiveness and safety of umifenovir for COVID-19.

Methods

A retrospective study was performed in a non-intensive care unit (ICU) ward in Jinyintan Hospital from 2 February 2020 to 20 March 2020. COVID-19 was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of pharyngeal swab specimens. The confirmed patients were divided into the umifenovir group and the control group according to the use of umifenovir. The main outcomes were the rate of negative pharyngeal swab tests for SARS-CoV-2 within 1 week after admission and the time for the virus to turn negative. The negativity time of SARS-CoV-2 was defined as the first day of a negative test if the nucleic acid of SARS-CoV-2 was negative for two consecutive tests.

Results

A total of 81 COVID-19 patients were included, with 45 in the umifenovir group and 36 in the control group. Baseline clinical and laboratory characteristics were comparable between the two groups. Thirty-three out of 45 (73%) patients in the umifenovir group tested negative for SARS-CoV-2 within 7 days after admission, the number was 28/36 (78%) in the control group (p 0.19). The median time from onset of symptoms to SARS-CoV-2 turning negative was 18 days (interquartile range (IQR) 12–21) in the umifenovir group and 16 days (IQR 11–21) in the control group (p 0.42). Patients in the umifenovir group had a longer hospital stay than patients in the control group (13 days (IQR 9–17) vs 11 days (IQR 9–14), p 0.04). No deaths or severe adverse reactions were found in both groups.

Discussion

Umifenovir might not improve the prognosis or accelerate SARS-CoV-2 clearance in non-ICU patients. A randomized control clinical trial is needed to assess the efficacy of umifenovir.

A novel approach toward Snowman-like polymer/SiO2 hybrid nanoparticles via gas-driving

For the first time, we report an interesting transition from conventional core-shell polymer/SiO2 particles to self-stable snowman-like particles, which can be achieved by adding a low-boiling point oil-soluble monomer because the volatile monomer not only plays a lubrication role, but also acts as a gas "motor" to drive the silica precursor polycondensate migration.

Macroinfauna responses and recovery trajectories after an oil spill differ from those following saltmarsh restoration

Given the severity of injuries to biota in coastal wetlands from the Deepwater Horizon oil spill (DWH) and the resulting availability of funding for restoration, information on impacted salt marshes and biotic development of restored marshes may both help inform marsh restoration planning in the near term and for future spills. Accordingly, we performed a meta-analysis to model a restoration trajectory of total macroinfauna density in constructed marshes (studied for ~30 y), and with a previously published restoration trajectory for amphipods, we compared these to recovery curves for total macroinfauna and amphipods from DWH impacted marshes (over 8.5 y). Total macroinfauna and amphipod densities in constructed marshes did not consistently reach equivalency with reference sites before 20 y, yet in heavily oiled marshes recovery occurred by 4.5 y post spill (although it is unlikely that macroinfaunal community composition fully recovered). These differences were probably due to initial conditions (e.g., higher initial levels of belowground organic matter in oiled marshes) that were more conducive to recovery as compared to constructed marshes. Furthermore, we found that amphipod trajectories were distinctly different in constructed and oiled marshes as densities at oiled sites exceeded that of reference sites by as much as 20x during much of the recovery period. Amphipods may have responded to the rapid increase and high biomass of benthic microalgae following the spill. These results indicate that biotic responses after an oil spill may be quantitatively different than those following restoration, even for heavily oiled marshes that were initially denuded of vegetation. Our dual trajectories for oil spill recovery and restoration development for macroinfauna should help guide restoration planning and assessment following the DWH as well as for restoration scaling for future spills.

Abstract WMP71: Parent Artery Plaque in Acute Lacunar Stroke: A Prospective, Multicenter, Observational Study

Purpose: We aimed to investigate the prevalence and clinical relevance of the parent artery plaque in acute lacunar stroke.

Methods: This prospective, multi-center, observational study included patients with first-ever ischemic stroke within 72 hours of symptom onset. Patients were evaluated by three-dimensional T1-weighted high-resolution magnetic resonance imaging (HR-MRI) and conventional MRI sequences. We examined the presence of intracranial plaque, infarction patterns, and infarct volumes in all the patients with acute lacunar stroke. The outcome measurement was 90-day poor functional outcome (modified Rankin Scale >2).

Results: Of the 756 patients included, 341(45.1%) patients had an acute lacunar stroke. There were 201 (58.9%, 201/341) patients with an infarct in deep basal ganglia area. Among them, 64 (31.8%, 64/201) patients had middle cerebral artery (MCA) plaques identified on HR-MRI. The patients with MCA plaque had a similar infarct volume ( 0.93ml vs. 0.88ml , p =0.9) with those without MCA plaque. However, they more likely had an infarct involving posterior limb of internal capsule (42.2%, 27/64 vs. 25.5%, 35/137, p =0.017 ) and had a higher prevalence of cerebral microbleed (68.8%, 44/64 vs. 40.1%, 55/137, p <0.001 ), and moderate to severe perivascular spaces in basal ganglia (BG-PVS)(57.8%, 37/64vs.35.0%, 48/137, p =0.002) . After adjusting for age and National Institute of Health Stroke Scale (NIHSS) at admission, the presence of MCA plaque was independently associated with 90-day poor functional outcome (OR:3.44, [95% CI,1.26-9.42]). There were 102 (29.9%, 102/341) patients with an infarct in pons. Among them, 66 (64.7%, 66/102) patients had basilar artery (BA) plaques. Patients with BA plaque had a higher prevalence of moderate to severe BG-PVS (42.4%, 28/66 vs. 22.2%, 8/36, p =0.041). There were no differences between the patients with and without BA plaque regarding infarction volume and 90-day functional outcome.

Conclusions: Parent artery plaque is common in patients with acute lacunar stroke. We propose the deep basal ganglia area infarct with MCA plaque as a unique lacunar stroke subtype with poor prognosis. Our data did not show the presence of BA plaque have an effect on the lacunar stroke prognosis.

Design of stroke imaging package study of intracranial atherosclerosis: a multicenter, prospective, cohort study

Background

Intracranial atherosclerosis (ICAS) is a major cause of stroke worldwide. However, much remains unknown regarding its underlying pathophysiology. High-resolution magnetic resonance imaging (HR-MRI) can clearly display intracranial vessel wall lesions in vivo. The aim of stroke imaging package study of ICAS (SIPS-ICAS) study is to explore the stroke mechanisms of symptomatic ICAS, the dynamic changes under aggressive medical treatment and their associations with clinical events using conventional MRI sequences plus HR-MRI.

Methods

This is a multicenter, prospective, cohort study recruiting first-ever acute ischemic stroke patients attributed to intracranial large artery stenosis (>50% or occlusion). Subjects undergo a pre-designed stroke imaging packages at baseline and are recommended to receive aggressive medical treatments. Participants will be followed up for functional outcome, stroke recurrence, and death events at 3, 6 and 12 months and retake HR-MRI imaging at 6 months.

Results

Enrollment began in November 2018 and 96 patients have been enrolled as of September 2019.

Conclusions

The SIPS-ICAS study will provide insights into the pathophysiology of ICAS and identify specific imaging markers for risk stratification and prognosis prediction. At the same time, the feasibility and validity of the new stroke imaging package including HR-MRI will be assessed, which is promising for clinical routine use.

Light Dark Matter Search with Ionization Signals in XENON1T

We report constraints on light dark matter (DM) models using ionization signals in the XENON1T experiment. We mitigate backgrounds with strong event selections, rather than requiring a scintillation signal, leaving an effective exposure of (22±3) tonne day. Above ∼0.4  keV_{ee}, we observe <1  event/(tonne day keV_{ee}), which is more than 1000 times lower than in similar searches with other detectors. Despite observing a higher rate at lower energies, no DM or CEvNS detection may be claimed because we cannot model all of our backgrounds. We thus exclude new regions in the parameter spaces for DM-nucleus scattering for DM masses m_{χ} within 3-6  GeV/c^{2}, DM-electron scattering for m_{χ}>30  MeV/c^{2}, and absorption of dark photons and axionlike particles for m_{χ} within 0.186-1  keV/c^{2}.

Search for Light Dark Matter Interactions Enhanced by the Migdal Effect or Bremsstrahlung in XENON1T

Direct dark matter detection experiments based on a liquid xenon target are leading the search for dark matter particles with masses above ∼5  GeV/c^{2}, but have limited sensitivity to lighter masses because of the small momentum transfer in dark matter-nucleus elastic scattering. However, there is an irreducible contribution from inelastic processes accompanying the elastic scattering, which leads to the excitation and ionization of the recoiling atom (the Migdal effect) or the emission of a bremsstrahlung photon. In this Letter, we report on a probe of low-mass dark matter with masses down to about 85  MeV/c^{2} by looking for electronic recoils induced by the Migdal effect and bremsstrahlung using data from the XENON1T experiment. Besides the approach of detecting both scintillation and ionization signals, we exploit an approach that uses ionization signals only, which allows for a lower detection threshold. This analysis significantly enhances the sensitivity of XENON1T to light dark matter previously beyond its reach.

High-Rubidium-Formamidinium-Ratio Perovskites for High-Performance Photodetection with Enhanced Stability

Formamidinium lead trihalide perovskites have emerged as promising photovoltaic materials owing to their superior absorption coefficient properties. However, one big challenge is the material phase stability and thermal stability at high temperature. In this work, a large quantity of rubidium (Rb) ions is incorporated into formamidinium (FA) perovskite thin films to improve the material phase stability and thermal stability. Photodiodes based on optimized FA_0.7Rb_0.3PbI₃ perovskites deliver a high responsivity of 0.43 A W^-1, a detectivity of >10¹² Jones, a relatively large linear dynamic range of 125 dB, and an ultrafast response speed of approximately 300 ns. Moreover, these photodiodes present lower dark current and higher photocurrent after baking at high temperature. These results are very promising for photodetection at high operational temperature. In addition, the high-ratio rubidium-incorporated perovskite films may have great potential in fabricating other high-performance optoelectronic devices, i.e., light-emitting diodes and solar cells with excellent phase stability and high temperature thermostability.

[Mediating effect of resilience on nursing occupational risk and job performance in nurses]

Objective: To analyze Nursing Occupational Risk, the relationship between resilience and job performance, and investigate the mediating effects of resilience on Nursing Occupational Risk and job performance. Methods: 406 nurses from33 clinical departments of Chengdu first-class hospital were recruited by randomsampling method. Thier Nursing Occupational Risk, resilience and job performance were interviewed by nursing occupational risk assessment questionnaire, the Scale of medical staff resilience and the job performance questionnaire, and analyze the relationship between variables. Results: The clinical nurses＇ resilience is 82.98±10.05, the clinical nurses' job performance is 145.79±23.55; here was a positive correlation between clinical nurses' resilience and job performance (P<0.05) ; three variable of resilience can explain 33.2% of the variation of clinical nurses job performance; in the highest the Nursing Occupational risk, resilience served to mediate the relationship between Nursing Occupational Risk and job performance, which was 56.77% of the total effect respective. Conclusion: resilience are closely related to job performance. Resilience plays mediating role in the relationships between Nursing Occupational Risk and job performance, three dimensions of resilience can predict nurses' job performance. Improving the resilience of nurses can effectively improve their job performance.

[Clinicopathological significance of Golgi phosphoprotein 3 expression in papillary thyroid carcinoma]

Objective: To investigate the expression of Golgi phosphoprotein 3 (GOLPH3) in papillary thyroid carcinoma (PTC) and its relationship with clinicopathological characteristics of PTC and American Thyroid Association (ATA) risk of recurrence stratification. Methods: The mRNA expression level of GOLPH3 in PTC tissues and the matched adjacent noncancerous tissues from 30 cases of PTC undergoing surgical operation in Fujian Provincial Hospital between March 2017 and April 2018 was detected by reverse transcription-quantitative PCR (RT-qPCR). The protein expression of GOLPH3 in PTC tissues and the matched adjacent noncancerous tissues of 135 cases of PTC between January 2013 and April 2018 was measured by immunohistochemistry. The correlation between the expression of GOLPH3 in PTC and clinicopathologic characteristics and ATA risk of recurrence stratification was analyzed. Results: The mRNA level of GOLPH3 in PTC tissues was significantly higher than that in adjacent noncancerous tissues (7.53±1.32 vs 3.64±1.44, P<0.001). The protein expression level of GOLPH3 in PTC tissues was significantly higher than that in adjacent noncancerous tissues [66(30, 95) vs 34(20, 72), P<0.001]. The expression of GOLPH3 was significantly correlated to the tumor size (P=0.026), extrathyroid invasion (P=0.016), lymph node metastasis (P=0.001) and TNM stage (P=0.027) in PTC. Multivariate logistic regression analysis showed that GOLPH3 expression was independently correlated to tumor size (OR=3.58, 95%CI: 1.19-15.46, P=0.017) and lymph node metastasis (OR=7.28, 95%CI: 2.43-10.08, P=0.002). The expression of GOLPH3 was positively correlated to ATA risk of recurrence stratification (P=0.041). Conclusions: Overexpression of GOLPH3 is associated with the development of PTC and poor prognosis in patients with PTC. Detection of GOLPH3 expression can help evaluate proliferative and metastatic potential of PTC, as well as the risk of postoperative recurrence in patients with PTC.

Multi-omics Analyses Reveal Synergistic Carbohydrate Metabolism in Streptococcus mutans-Candida albicans Mixed-Species Biofilms

Candida albicans, a major opportunistic fungal pathogen, is frequently found together with Streptococcus mutans in dental biofilms associated with severe childhood caries (tooth decay), a prevalent pediatric oral disease. However, the impact of this cross-kingdom relationship on C. albicans remains largely uncharacterized. Here, we employed a novel quantitative proteomics approach in conjunction with transcriptomic profiling to unravel molecular pathways of C. albicans when cocultured with S. mutans in mixed biofilms. RNA sequencing and iTRAQ (isobaric tags for relative and absolute quantitation)-based quantitative proteomics revealed that C. albicans genes and proteins associated with carbohydrate metabolism were significantly enhanced, including sugar transport, aerobic respiration, pyruvate breakdown, and the glyoxylate cycle. Other C. albicans genes and proteins directly and indirectly related to cell morphogenesis and cell wall components such as mannan and glucan were also upregulated, indicating enhanced fungal activity in mixed-species biofilm. Further analyses revealed that S. mutans-derived exoenzyme glucosyltransferase B (GtfB), which binds to the fungal cell surface to promote coadhesion, can break down sucrose into glucose and fructose that can be readily metabolized by C. albicans, enhancing growth and acid production. Altogether, we identified key pathways used by C. albicans in the mixed biofilm, indicating an active fungal role in the sugar metabolism and environmental acidification (key virulence traits associated with caries onset) when interacting with S. mutans, and a new cross-feeding mechanism mediated by GtfB that enhances C. albicans carbohydrate utilization. In addition, we demonstrate that comprehensive transcriptomics and quantitative proteomics can be powerful tools to study microbial contributions which remain underexplored in cross-kingdom biofilms.