Improved prognostication of renal cell carcinoma using an integrated staging system

PURPOSE

To integrate stage, grade, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) into a clinically useful tool capable of stratifying the survival of renal cell carcinoma (RCC) patients.

PATIENTS AND METHODS

The medical records of 661 patients undergoing nephrectomy at University of California Los Angeles between 1989 and 1999 were evaluated. Median age was 61 years, male-to-female ratio was 2.2:1, and median follow-up was 37 months. Survival time was the primary end point assessed. Sixty-four possible combinations of stage, grade, and ECOG PS were analyzed and collapsed into distinct groups. The internal validity of the categorized was challenged by a univariate analysis and a multivariate analysis testing for the accountability of each UCLA Integrated Staging System (UISS) category against independent variables shown to have impact on survival.

RESULTS

Combining and stratifying 1997 tumor-node-metastasis stage, Fuhrman's grade and ECOG PS resulted in five survival stratification groups designated UISS, and numbered I to V. The projected 2- and 5-year survival for the UISS groups are as follows for the groups: I, 96% and 94%; II, 89% and 67%; III, 66% and 39%; IV, 42% and 23%; and V, 9% and 0%, respectively. UISS accounted for the significant variables in the variate analysis.

CONCLUSION

A novel system for staging and predicting survival for RCC integrating clinical variables is offered. UISS is simple to use and is superior to stage alone in differentiating patients' survival. Our data suggests that UISS is an important prognostic tool for counseling patients with various stages of kidney cancer. Further prospective large-scale validation with external data is awaited.

Urinary calcium excretion in healthy school children

Two hundred and twenty Argentinian primary school children (122 boys, 98 girls, aged 6-13 years) were studied to establish reference values of 24-h urinary calcium excretion (UCa) and calcium/creatinine ratio (Ca/Cr) in 24-h urine collections and in first-morning urine samples. Mean UCa excretion was 2.05 +/- 1.40 mg/kg per day and the 95th percentile was 4.74 mg/kg per day. UCa excretion was higher in boys than girls (2.33 +/- 1.47 and 1.70 +/- 1.24 mg/kg per day respectively, P < 0.001). Statistically significant differences were found between the 6- to 9-year and the 10- to 13-year age groups (2.37 +/- 1.49 vs. 1.73 +/- 1.25 mg/kg per day, P < 0.001). Mean Ca/Cr ratios in 24-h collections and in first-morning urine samples were 0.129 +/- 0.086 and 0.105 +/- 0.079 for the group overall (P < 0.001). The Ca/Cr ratio in the first-morning urine sample correlated poorly with the 24-h calcium excretion, suggesting that the Ca/Cr ratio in first-morning urine samples cannot replace the 24-h measurement.

Broadly reactive antibodies against a gp120 V3 loop multi-epitope polypeptide neutralize different isolates of human immunodeficiency virus type 1 (HIV-1)

A gene encoding for a novel multi-epitope polypeptide (TAB4) was synthesized and expressed in Escherichia coli. The protein was composed of 15 amino acid fragments derived from the V3 loop of HIV-1 isolates MN, IIIB, RF, JY1, BRVA and LR150, joined by five-amino-acid linkers. Immunogenicity of TAB4 in rabbits was studied, and the antibody response against individual peptides investigated. TAB4 was shown to be immunogenic in Complete Freund's Adjuvant in a dose-dependent manner, and was able to elicit a humoral response against all V3 epitopes included on the protein. Sera from some of the animals were able to neutralize the replication of viral strain MN, and in one case IIIB, with moderate titers. Some sera also neutralized several Cuban clinical strains, isolated in peripheral blood mononuclear cells, after one round of amplification in MT4 cells.

Study of different coupling agents in the conjugation of a V3-based synthetic MAP to carrier proteins

The conjugation of synthetic peptides to carrier proteins is a widely used method for immunological studies. Different coupling agents have been described to form the conjugate with carrier proteins. In this paper, we demonstrate that the antibody response toward V3-based synthetic MAPs derived from HIV-1, JY1 isolate, conjugated to two different carrier proteins using either m-maleimidobenzoyl-N-hydroxysuccinimide ester (MBS) or beta-maleimidopropionic acid N-hydroxysuccinimide ester (MPS), or succinic anhydride (SA) show different behaviors. An excellent anti-JY1 response without a strong response to the coupling agent is observed in the case of succinic anhydride spacer. In contrast, MBS produces total abrogation of the antibody response with a high response toward the coupling agent.

A prime-boost regime that combines Montanide ISA720 and Alhydrogel to induce antibodies against the HIV-1 derived multiepitope polypeptide TAB9

A phase I clinical trial with the HIV-1-derived multi-epitope polypeptide (MEP) TAB9 in the oil adjuvant Montanide ISA720 (M-ISA720) was recently performed. Although severe local reactions were reported after the second and third injections of this vaccine candidate, the first inoculation was well tolerated. In this article we evaluated a prime-boost regime consisting of one inoculation of TAB9 in M-ISA720 followed by a booster with the same antigen in aluminum hydroxide. This combination of adjuvants elicited similar antibody levels in rabbits than the traditional two-dose schedule with M-ISA720. A control group injected three times with TAB9 in aluminum hydroxide developed markedly lower antibody titers. These results showed that although oil adjuvants are better than alum for priming the immune system for antibody production against TAB9, both kinds of adjuvants can be equally effective in booster immunizations. Therefore, by using the more reactogenic oil adjuvant only for priming, we should be able to eliminate the undesirable reactions characteristic of these compounds while achieving equivalent levels of specific antibodies.

Multivalent DNA-based immunization against hepatitis B virus with plasmids encoding surface and core antigens

The immune response against hepatitis B surface and core antigens was evaluated by either coinoculation or independent intramuscular administration of pAEC compact DNA immunization vectors carrying their genes. The pAEC vectors bear just the essential elements for mammalian expression and bacterial amplification. Balb/c mice were immunized with 100 microg of each construct, either alone or in combination. In spite of lacking known immunostimulatory sequences (e.g., AACGTT), significant cellular (proliferative) and humoral immune responses were raised against both antigens. Coadministration of both plasmids maintained the immune response against the two antigens, without interference between them. Modulation of the antigen expression and further immune response, by using the Kozak's translation initiation sequence, was also analyzed. No differences due to its presence or absence were observed.

Immunogenicity comparison of a multi-antigenic peptide bearing V3 sequences of the human immunodeficiency virus type 1 with TAB9 protein in mice

The multiple antigenic peptide system (MAP) has been proposed as a novel and valuable approach for eliciting antibodies for peptides and developing synthetic vaccines. Multi-epitope polypeptides (MEP) have also been developed as an alternative to the recombinant approach for vaccines. The V3 loop from the HIV type 1 (HIV-1) external glycoprotein (gp120) contains the principal neutralization domain (PND). Antibodies against this region neutralize HIV-1 in vitro and in vivo. In this work, a novel presentation of di-epitope MAP was synthesized. A monomeric MAP carrying two identical JY1 V3 sequences as B-cell epitopes and the 830-843 region of tetanus toxoid as a T-helper cell epitope was synthesized. This basic structure was covalently linked to produce a four-JY1-branched homodimer (JY1-MAP4). Additionally, six different monomeric MAPs, bearing four copies of V3 from isolates LR150, JY1, RF, MN, BRVA and IIIB, were synthesized. These monomers were conveniently linked among themselves to produce homodimeric and heterodimeric MAPs of eight V3 branches (V3-MAP8). JY1-MAP8 elicited higher antibody titers in Balb/c mice than JY1-MAP4. The immunogenicity of two different, hexavalent V3-MAP8 mixtures and the MEP TAB9, which tandems the same six V3 sequences in a single molecule, were compared. The antibody response against the mixtures of the heterodimeric MAP showed a wider recognition pattern of the V3 region, while the homodimeric cocktail showed an intermediate pattern. Antibodies elicited by TAB9 recognized only the JY1, LR150 peptides. These results emphasize the influence of V3 epitope presentation upon the characteristics of the antibody response generated.

All-optical recreation of naturalistic neural activity with a multifunctional transgenic reporter mouse

Determining which features of the neural code drive behavior requires the ability to simultaneously read out and write in neural activity patterns with high precision across many neurons. All-optical systems that combine two-photon calcium imaging and targeted photostimulation enable the activation of specific, functionally defined groups of neurons. However, these techniques are unable to test how patterns of activity across a population contribute to computation because of an inability to both read and write cell-specific firing rates. To overcome this challenge, we make two advances: first, we introduce a genetic line of mice for Cre-dependent co-expression of a calcium indicator and a potent soma-targeted microbial opsin. Second, using this line, we develop a method for read-out and write-in of precise population vectors of neural activity by calibrating the photostimulation to each cell. These advances offer a powerful and convenient platform for investigating the neural codes of computation and behavior.

Improved prognostication of renal cell carcinoma using an integrated staging system

PURPOSE

To integrate stage, grade, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) into a clinically useful tool capable of stratifying the survival of renal cell carcinoma (RCC) patients.

PATIENTS AND METHODS

The medical records of 661 patients undergoing nephrectomy at University of California Los Angeles between 1989 and 1999 were evaluated. Median age was 61 years, male-to-female ratio was 2.2:1, and median follow-up was 37 months. Survival time was the primary end point assessed. Sixty-four possible combinations of stage, grade, and ECOG PS were analyzed and collapsed into distinct groups. The internal validity of the categorized was challenged by a univariate analysis and a multivariate analysis testing for the accountability of each UCLA Integrated Staging System (UISS) category against independent variables shown to have impact on survival.

RESULTS

Combining and stratifying 1997 tumor-node-metastasis stage, Fuhrman's grade and ECOG PS resulted in five survival stratification groups designated UISS, and numbered I to V. The projected 2- and 5-year survival for the UISS groups are as follows for the groups: I, 96% and 94%; II, 89% and 67%; III, 66% and 39%; IV, 42% and 23%; and V, 9% and 0%, respectively. UISS accounted for the significant variables in the variate analysis.

CONCLUSION

A novel system for staging and predicting survival for RCC integrating clinical variables is offered. UISS is simple to use and is superior to stage alone in differentiating patients' survival. Our data suggests that UISS is an important prognostic tool for counseling patients with various stages of kidney cancer. Further prospective large-scale validation with external data is awaited.

Dissociating instructive from permissive roles of brain circuits with reversible neural activity manipulations

Neuroscientists rely on targeted perturbations and lesions to causally map functions in the brain1. Yet, since the brain is highly interconnected, manipulation of one area can impact behavior through indirect effects on many other brain regions, complicating the interpretation of such results2,3. On the other hand, the often-observed recovery of behavior performance after lesion can cast doubt on whether the lesioned area was ever directly involved4,5. Recent studies have highlighted how the results of acute and irreversible inactivation can directly conflict4-6, making it unclear whether a brain area is instructive or merely permissive in a specific brain function. To overcome this challenge, we developed a three-stage optogenetic approach which leverages the ability to precisely control the temporal period of regional inactivation with either brief or sustained illumination. Using a visual detection task, we found that acute optogenetic inactivation of the primary visual cortex (V1) suppressed task performance if cortical inactivation was intermittent across trials within each behavioral session. However, when we inactivated V1 for entire behavioral sessions, animals quickly recovered performance in just one to two days. Most importantly, after returning these recovered animals to intermittent cortical inactivation, they quickly reverted to failing on optogenetic inactivation trials. These data support a revised model where the cortex is the default circuit that instructs perceptual performance in basic sensory tasks. More generally, this novel, temporally controllable optogenetic perturbation paradigm can be broadly applied to brain circuits and specific cell types to assess whether they are instructive or merely permissive in a brain function or behavior.

Plasmid DNA-recombinant Opc protein complexes for nasal DNA immunization

The nasal mucosa may provide a simple, non-invasive route to deliver DNA encoding genes that stimulate a specific immune response. Based on this, a new approach using pCMVbeta-gal plasmid DNA complexed to the Opc meningococcal outer membrane protein was assayed for. Optimal conditions of interaction were established between recombinant Opc protein and pCMVbeta-gal plasmid DNA. Complexes were fully characterized by electrophoresis analysis, DNAse resistance assay and transmission electron microscopy. DNA-protein complexes were also evaluated in in vitro transfection experiments. After the characterisation of complexes, Balb/c mice were intranasal (i.n.) and intramuscularly (i.m.) immunized. The humoral immune response against beta-galactosidase was measured by ELISA. The proliferative response in the spleen lymph nodes was also measured. Complexes administered by i.n. route induced both systemic and mucosal antibody responses. This behavior was not observed with the naked DNA. Finally, a lymphoproliferative response specific to beta-galactosidase induced by DNA-protein complexes was also detected.

Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts

BACKGROUND AND OBJECTIVES

Intracranial epidermoid cysts are rare, slow-growing but highly recurrent tumors with incompletely understood symptoms, progression, complications, and outcomes. The aim of the study was to characterize the symptomatology, surgical management, and long-term outcomes of these tumors.

METHODS

This single-center retrospective analysis identified patients with pathologically confirmed intracranial epidermoid cysts from 1989 to 2023. Demographic and clinical variables were collected at diagnosis, before and after each resection, and at the latest follow-up. Differences across time points were evaluated using analysis of variance with post hoc Tukey's honestly significant difference tests and Pearson χ2 test with posthoc Bonferroni-corrected z-tests for independent proportions (significance: P ≤ .05). Kaplan-Meier, Cox regression, and multivariate logistic regression analyses were used to investigate predictors for recurrence-free survival and 30-day readmission following first surgery, respectively.

RESULTS

Of 146 patients in the final cohort, the average age at diagnosis was 40.3 years, and 52.1% of patients were female. The mean maximum tumor dimension at presentation was 4.3 cm. Most presenting symptoms were significantly reduced at the latest follow-up, including headaches (presentation: 40.4%/latest follow-up: 8.8%, P < .001), vertigo/nausea/vomiting (33.1%/3.7%, P < .001), ataxia/incoordination (22.8%/4.4%, P < .001), and seizures (11.8%/2.9%, P < .005). Similarly, significant improvements were observed in cranial nerve (CN) II deficits (11.0%/3.7%, P = .020) and CN V (11.8%/3.7%, P = .012) and CN VIII excitatory symptoms (11.8%/2.9%, P = .005). Following the first resection, 12.5% of patients were readmitted within 30 days; lumbar drain placement was associated with higher odds of readmission (adjusted odds ratio [95% CI] = 8.26 [1.29-88.19]). Evidence of tumor remnant on the immediate postoperative MRI was associated with a shorter time to recurrence following the first surgery (P = .023).

CONCLUSION

The clinical progression of intracranial epidermoid cysts is marked by a spectrum of troublesome presenting symptoms and a notable tendency for recurrence, particularly following subtotal resection. Nevertheless, symptomatic improvement is the rule even if reoperations are needed, and mortality is exceedingly rare.

Histidinemia en niños preescolares con trastornos de la comunicación oral

Los trastornos de la comunicación oral en el niño son causa frecuente de asistencia a la consulta de Logopedia y Foniatría, donde el especialista debe realizar el examen clínico funcional en busca de posible etiología para imponer el tratamiento rehabilitador. Dentro de estos trastornos se encuentran los trastornos específicos del lenguaje y del habla, donde no se conoce la causa. La histidinemia se asocia frecuentemente con trastornos de la comunicación oral. Se realizó un estudio analítico de casos y controles. Se estudiaron 27 niños con trastornos de la comunicación (casos) y 102 controles. A todos se les determinó los niveles de histidina en suero mediante un método ultramicroanalítico. Presentaron niveles elevados de histidina el 29,6% para los casos y en los controles solo el 1%, determinándose que la diferencia en los niveles de histidina es significativa entre los niños con TEL y los controles mientras que los niños con dislalia no se diferencian significativamente ni de los controles, ni de los niños con TEL. Los resultados obtenidos muestran que la probabilidad de encontrar concentraciones de histidina elevadas en los niños con trastornos de la comunicación oral es más alta que en el grupo control.

Calcified Meningiomas Demonstrate Equivocal Grade, Proliferation, and Immediate Surgical Outcomes

BACKGROUND/OBJECTIVE

Meningioma calcification is thought to predict reduced growth potential and aggression. However, historical studies have primarily focused on correlating calcification in small meningiomas (diameter less than 2.5 cm) rather than analyzing characteristics of calcified meningiomas across all sizes. In this study, we investigate the pathologic and clinical implications of meningioma calcification.

METHODS

We utilized a historical database of 342 consecutive newly diagnosed intracranial meningiomas with preoperative computed tomography and magnetic resonance imaging scans treated at a single institution from 2005 to 2019. We correlated the presence of calcification with patient demographics, grade, Mindbomb Homolog-1 index, location, volume, Simpson grade, and recurrence using both univariate and multivariate generalized linear models.

RESULTS

On univariate analysis, no single variable correlated with tumor calcification. Notably, neither tumor 2021 World Health Organization grade (P = 0.91) nor Mindbomb Homolog-1 index (P = 0.62) predicted calcification. After accounting for demographic characteristics and tumor volume and location, there was no significant association between 2021 World Health Organization grade (P = 0.52) and Mindbomb Homolog-1 index (P = 0.54) and calcification. Calcification had no influence on resection grade (P = 0.59) or recurrence (P = 0.80).

CONCLUSIONS

In this series, calcified meningiomas exhibited similar 2021 World Health Organization tumor grading distribution, proliferation indexes, and immediate surgical outcomes compared to their noncalcified counterparts. These findings question the historical role of using meningioma calcification as an independent guide to their management.

Robust fault reconstruction using sliding mode observers with nonlinear nominal systems

This paper is concerned with fault reconstruction based on sliding mode observers; its contribution is twofold: on the one hand, it develops a novel sliding mode observer whose nominal system is nonlinear, thus relaxing former limitations on the subject, namely, rank restrictions, linear outputs, and conservative bounds; on the other hand, based on the referred sliding mode observer, a novel robust fault reconstruction scheme is constructed which can solve a variety of problems that former methodologies cannot treat. Nonlinearities are cast as convex expressions, which enables obtaining design conditions in the form of linear matrix inequalities. Examples are provided to compare the proposal with former methodologies, thus highlighting the contributions.

[Neonatal hypoglycemia: glucose gel efficacy in the treatment of early hypoglycemia in newborns with risk factors. Randomized clinical trial]

Hypoglycemia is the most frequent metabolic disorder in newborns; the administration of 40% glu cose gel in the oral mucosa could be as effective in its correction as the administration of formula milk, not interfering with breastfeeding.

OBJECTIVE

To evaluate the efficacy of 40% glucose gel com pared with formula milk in the treatment of early asymptomatic hypoglycemia in newborns with risk factors.

PATIENTS AND METHOD

Randomized clinical trial, non-inferiority, conducted in a private hos pital. Newborns attended in rooming-in with the following risk factors were included: late preterm, large and small for gestational age at term, and children of diabetic mothers. In the presence of hy poglycemia, one group received 40% glucose gel (A) in the oral mucosa and another group received formula milk (B). Therapeutic failure was considered as persistence or repetition of hypoglycemia in the first 48h of life.

RESULTS

866 NBs with risk factors were registered over 36 month; 278 (32.1 %) presented hypoglycemia; 105 NBs in group A and 115 in group B completed the study. 75 (71 %) NBs in group A and 104 (90,4 %) in group B achieved hypoglycemia correction. After analyzing the trends obtained, it was decided to discontinue the study.

CONCLUSIONS

The administration of 40% glucose gel was not equivalent to the administration of formula milk in the treatment of early asymptomatic hypoglycemia in newborns with risk factors.

Design, fabrication, and testing of a new soft-pouch robot with 6 degrees of freedom to expand the reach of open and endonasal skull base approaches

OBJECTIVE

Most robots currently used in neurosurgery aid surgeons in placing spinal hardware and guiding electrodes and biopsy probes toward brain targets. These robots are inflexible, cannot turn corners, and exert excessive force when dissecting and retracting brain tissue, limiting their applicability in cranial base surgery. In this study, the authors present a novel soft-pouch robot prototype driven by compressed air and capable of gentle tissue manipulation. The robot is manufactured with technology developed by the authors, with multiple bidirectional bending points and a miniature camera running through the robot's central channel.

METHODS

A soft, pneumatically driven pouch manipulator was created using a novel rapid and scalable system (integrated multilayer pouch robots with inkjet-patterned thin films). Made from 4 layers of thin, low-density polyethylene films, the manipulator has a thin deflated profile (152 µm) and contains 5 independent bidirectional joints with 50° range in each direction, as well as a wrapping end-effector. The robot carries a camera through its central channel. Four cadaveric models were used to demonstrate the robotic prototype being maneuvered inside different anatomical structures during simulated endonasal and posterior fossa approaches, with a manually positioned robot base and manually controlled air pressures.

RESULTS

The robot is a pneumatically driven, soft-continuum manipulator with 12 control inputs and 6 independently controllable degrees of freedom. This design enables in-plane obstacle avoidance and orientation control. The robot is trapezoidal-shaped, with a total weight of 0.4 g, a 10-mm-wide distal end, and a length of 138 mm. The variable production cost (materials cost) of the manipulator is approximately $1. The manipulator is maneuvered to enter the maxillary sinus and through the endonasal corridor, demonstrating its potential use for anterior skull base approaches. It is also successfully maneuvered around the pons in a simulated retrosigmoid approach.

CONCLUSIONS

This robot offers a promising solution for safely maneuvering through narrow surgical windows encountered during skull base approaches. The multiple bending points of the robot, combined with its passive deformation capacity, allow it to turn around immovable structures, expanding the reach of surgical openings. The cost-effectiveness, rapid production, and scalability of the robot represent additional advantages.

Balanced bidirectional optogenetics reveals the causal impact of cortical temporal dynamics in sensory perception

Whether the fast temporal dynamics of neural activity in brain circuits causally drive perception and cognition remains one of most longstanding unresolved questions in neuroscience 1-6 . While some theories posit a 'timing code' in which dynamics on the millisecond timescale is central to brain function, others instead argue that mean firing rates over more extended periods (a 'rate code') carry most of the relevant information. Existing tools, such as optogenetics, can be used to alter temporal structure of neural dynamics 7 , but they invariably change mean firing rates, leaving the interpretation of such experiments ambiguous. Here we developed and validated a new approach based on balanced, bidirectional optogenetics that can alter temporal structure of neural dynamics while mitigating effects on mean activity. Using this new approach, we found that selectively altering cortical temporal dynamics substantially reduced performance in a sensory perceptual task. These results demonstrate that endogenous temporal dynamics in the cortex are causally required for perception and behavior. More generally, this new bidirectional optogenetic approach should be broadly useful for disentangling the causal impact of different timescales of neural dynamics on behavior.

Longitudinal profiling of IDH-mutant astrocytomas reveals acquired RAS-MAPK pathway mutations associated with inferior survival

Background

Isocitrate dehydrogenase (IDH)-mutant astrocytomas represent the most frequent primary intraparenchymal brain tumor in young adults, which typically arise as low-grade neoplasms that often progress and transform to higher grade despite current therapeutic approaches. However, the genetic alterations underlying high-grade transformation and disease progression of IDH-mutant astrocytomas remain inadequately defined.

Methods

Genomic profiling was performed on 205 IDH-mutant astrocytomas from 172 patients from both initial treatment-naive and recurrent post-treatment tumor specimens. Molecular findings were integrated with clinical outcomes and pathologic features to define the associations of novel genetic alterations in the RAS-MAPK signaling pathway.

Results

Likely oncogenic alterations within the RAS-MAPK mitogenic signaling pathway were identified in 13% of IDH-mutant astrocytomas, which involved the KRAS, NRAS, BRAF, NF1, SPRED1, and LZTR1 genes. These included focal amplifications and known activating mutations in oncogenic components (e.g. KRAS, BRAF), as well as deletions and truncating mutations in negative regulatory components (e.g. NF1, SPRED1). These RAS-MAPK pathway alterations were enriched in recurrent tumors and occurred nearly always in high-grade tumors, often co-occurring with CDKN2A homozygous deletion. Patients whose IDH-mutant astrocytomas harbored these oncogenic RAS-MAPK pathway alterations had inferior survival compared to those with RAS-MAPK wild-type tumors.

Conclusions

These findings highlight novel genetic perturbations in the RAS-MAPK pathway as a likely mechanism contributing to the high-grade transformation and treatment resistance of IDH-mutant astrocytomas that may be a potential therapeutic target for affected patients and used for future risk stratification.