Targeting STAT3 in tumor-associated antigen-presenting cells as a strategy for kidney and bladder cancer immunotherapy

Introduction

Immune checkpoint blockade (ICB) improved clinical outcomes in renal and bladder cancer patients, but the response rates remain limited especially in metastatic disease. While STAT3 transcription factor is well-known master regulator of tumor immune evasion, little is known about the role of STAT3 in the resistance of renal or bladder cancers to immunotherapy.

Methods

To better understand immune alterations associated with ICB resistance, we assessed blood biomarkers in renal cancer patients classified as responders or non-responders to first line nivolumab/ipilimumab immunotherapy.

Results

We observed that non-responders showed elevated levels of proinflammatory mediators, such as IL-1RA, IL-6, IL-8 and to lesser extent IL-10, which are associated with STAT3 activation and tumor immunosuppression. In addition, we found STAT3 activation primarily in circulating myeloid immune cells such as tolerogenic MDSCs. To assess whether STAT3 inhibition within these cell subsets can promote antitumor immune responses and/or enhance sensitivity to ICB in vivo, we used an original antisense oligonucleotide (ASO) strategy for myeloid-cell selective STAT3 knockdown (CpG-STAT3ASO). Our results in syngeneic models of renal and bladder cancers in mice demonstrated potent antitumor activity of CpG-STAT3ASO alone in contrast to PD1 blockade alone in both models. The CpG-STAT3ASO/anti-PD1 combination improved therapeutic efficacy especially against bladder tumors. Therapeutic efficacy correlated with activation of dendritic cells (DCs) and M1 macrophages in the tumor microenvironment, reduced percentages of regulatory T cells (Tregs) and the expansion of CD8 T cells in both tumor models.

Discussion/Conclusion

Our study underscores the potential of using myeloid-cell targeted CpG-STAT3 inhibitors for genitourinary cancer therapy to disrupt tolerogenic signaling, restore immune cell activity and sensitivity to immune checkpoint inhibitors and/or T cell-based immunotherapies.

Patient perception of pre-pregnancy care and family planning among reproductive-age female diabetes mellitus patients in a primary care clinic in Penang, Malaysia

INTRODUCTION

Pre-pregnancy care (PPC) is an important part of diabetic care among females in the reproductive age group, as it improves feto-maternal outcomes.

OBJECTIVE

We aimed to assess female diabetic patients' perception of PPC and family planning prior to PPC care.

METHODS

This was an observational, cross-sectional survey performed from June 2019 to September 2019, using universal sampling of registered female diabetic patients who fit the inclusion criteria prior to integrated PPC care. A self-administered questionnaire was used to assess patients' perception of PPC.

RESULTS

A total of 67 patients were recruited for the study. Only 39.4% (n=26) of the patients had heard of PPC. In our study, Code 1 contraception included those methods with a Pearl index of ≤9. Code 2 & 3 contraception included those methods with a Pearl index of >9. Only one-third of patients, 29.9% (n=20), were using Code 1 contraception, although the majority, 79.1% (n=53), felt that they had completed their family. 45 patients (68.2%) felt that they were at risk of developing complications if they were to become pregnant, and 46 patients (69.7%) felt that their health condition was not suitable for another pregnancy. However, only 31.1% (n=14) and 34.8% (n=16) of these patients were using Code 1 contraception, respectively. There were 30 patients (65.2%) who perceived that their health was not suitable for another pregnancy but were only using Code 2 or 3 contraception.

CONCLUSION

The patients' perception of PPC was poor. Patients had an inadequate knowledge of the effectiveness of their current contraceptive practice in relation to their intentions for further pregnancy and their self-perceived risk in case of future conception. We suggest that integration of PPC into routine follow-ups for other high-risk medical diseases, such as hypertension, heart disease, and epilepsy, be considered in future practice.

Angina after anaphylaxis treatment

Anaphylaxis is a life-threatening emergency, and adrenaline is the mainstay treatment for this condition. However, there have been a few reported cases of patients experiencing cardiovascular complications, such as myocardial infarction and coronary vasospasm, after its use. We highlight such a case in a young, healthy patient and the important differentials to consider.

[Interpretation of clinical practice guideline for anorectal day surgery 2019 edition]

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.

Dose estimation by chromosome aberration analysis and micronucleus assays in victims accidentally exposed to (60)Co radiation

The objective of this study was to assess the radiation exposure levels in victims of a (60)Co radiation accident using chromosome aberration analysis and the micronucleus assay. Peripheral blood samples were collected from three victims exposed to (60)Co 10 days after the accident and were used for the chromosome aberration and micronucleus assays. After in vitro culture of the lymphocytes, the frequencies of dicentric chromosomes and rings (dic+r) and the numbers of cytokinesis blocking micronuclei (CBMN) in the first mitotic division were determined and used to estimate radiation dosimetry. The Poisson distribution of the frequency of dic+r in lymphocytes was used to assess the uniformity of the exposure to (60)Co radiation. Based on the frequency of dic+r in lymphocytes, estimates of radiation exposure of the three victims were 5.61 Gy (A), 2.48 Gy (B) and 2.68 Gy (C). The values were estimated based on the frequencies of CBMN, which were 5.45 Gy (A), 2.78 Gy (B) and 2.84 Gy (C). The estimated radiation dosimetry demonstrated a critical role in estimating the radiation dose and facilitating an accurate clinical diagnosis. Furthermore, the frequencies of dir+r in victims A and B deviated significantly from a normal Poisson distribution. Chromosome aberration analysis offers a reliable means for estimating biological exposure to radiation. In the present study, the micronucleus assay demonstrated a high correlation with the chromosome aberration analysis in determining the radiation dosimetry 10 days after radiation exposure.

Two recurrent neural networks for local joint torque optimization of kinematically redundant manipulators

This paper presents two neural network approaches to real-time joint torque optimization for kinematically redundant manipulators. Two recurrent neural networks are proposed for determining the minimum driving joint torques of redundant manipulators for the eases without and with taking the joint torque limits into consideration, respectively. The first neural network is called the Lagrangian network and the second one is called the primal-dual network. In both neural-network-based computation schemes, while the desired accelerations of the end-effector for a specific task are given to the neural networks as their inputs, the signals of the minimum driving joint torques are generated as their outputs to drive the manipulator arm. Both proposed recurrent neural networks are shown to be capable of generating minimum stable driving joint torques. In addition, the driving joint torques computed by the primal-dual network are shown never exceeding the joint torque limits.

The internet and suicide: A double-edged tool

Many physicians are unaware of the power of the internet. In an era of an empowered public and patients, the internet may be a more powerful determinant of health-seeking behaviour than medical opinion. In the same way, it may provide more information for self-harm than was ever available to the public domain in the past. The internet is effective across cultural and geographical boundaries. In addition to reporting and romanticising suicide, it has a significant impact in assisting and promoting suicide. It provides services and information ranging from general information to online orders of prescription drugs or other poisons that bypass government regulations and custom controls. This bridges the gaps of locality and accessibility, which previously formed a natural divide in selecting the means of suicide. In addition to these negative effects, there is a vast potential to harness these properties to a beneficial effect. The wide acceptance of the internet makes it a powerful tool for recognition of the at-risk individual, for preventing suicide and supporting survivors, with chat rooms taking the place of telephone help lines. In an information age, it is vital for physicians to use all available means of informing and empowering the public and patients. The internet also has a role in training, providing accessible self-help sites for suicidal persons and web-based prevention services, all of which remain sadly under-utilised. The challenge to physicians of the 21st century is to harvest the internet in a beneficial manner.

A discrete-time Lagrangian network for solving constrained quadratic programs

A discrete-time recurrent neural network which is called the discrete-time Lagrangian network is proposed in this letter for solving convex quadratic programs. It is developed based on the classical Lagrange optimization method and solves quadratic programs without using any penalty parameter. The condition for the neural network to globally converge to the optimal solution of the quadratic program is given. Simulation results are presented to illustrate its performance.

Urbanisation in China: a review of its causal mechanisms and spatial relations

This article reviews "the forces underpinning Chinese urbanization.... This paper is divided into two main parts. The first addresses the (non-spatial) causal mechanisms between 1949 and 1977. Neither the ideological, the class, nor the economic formulation has touched on the more systemic mechanisms related to the socialist state and the shortage economy. This paper attempts to redress the imbalance by examining the advantages of combining Kornai's shortage model with Foucault's concept of governmentality. By drawing on concepts of spatial contingency, spatial boundary and locality effects, the second part of the paper argues that spatial relations do play significant roles in revealing Chinese urbanisation policies and patterns."