Second-line nivolumab in relapsed small-cell lung cancer: CheckMate 331☆

BACKGROUND

Patients with relapsed small-cell lung cancer (SCLC) have few treatment options and dismal survival. Phase I/II data show activity of nivolumab in previously treated SCLC.

PATIENTS AND METHODS

CheckMate 331 is a randomized, open-label, phase III trial of nivolumab versus standard chemotherapy in relapsed SCLC. Patients with relapse after first-line, platinum-based chemotherapy were randomized 1 : 1 to nivolumab 240 mg every 2 weeks or chemotherapy (topotecan or amrubicin) until progression or unacceptable toxicity. Primary endpoint was overall survival (OS).

RESULTS

Overall, 284 patients were randomized to nivolumab and 285 to chemotherapy. Minimum follow-up was 15.8 months. No significant improvement in OS was seen with nivolumab versus chemotherapy [median OS, 7.5 versus 8.4 months; hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.72-1.04; P = 0.11]. A survival benefit with nivolumab was suggested in patients with baseline lactate dehydrogenase ≤ upper limit of normal and in those without baseline liver metastases. OS (nivolumab versus chemotherapy) was similar in patients with programmed death-ligand 1 combined positive score ≥1% versus <1%. Median progression-free survival was 1.4 versus 3.8 months (HR, 1.41; 95% CI, 1.18-1.69). Objective response rate was 13.7% versus 16.5% (odds ratio, 0.80; 95% CI, 0.50-1.27); median duration of response was 8.3 versus 4.5 months. Rates of grade 3 or 4 treatment-related adverse events were 13.8% versus 73.2%.

CONCLUSION

Nivolumab did not improve survival versus chemotherapy in relapsed SCLC. No new safety signals were seen. In exploratory analyses, select baseline characteristics were associated with improved OS for nivolumab.

A Framework for Sequential Planning in Multi-Agent Settings

This paper extends the framework of partially observable Markov decision processes (POMDPs) to multi-agent settings by incorporating the notion of agent models into the state space. Agents maintain beliefs over physical states of the environment and over models of other agents, and they use Bayesian updates to maintain their beliefs over time. The solutions map belief states to actions. Models of other agents may include their belief states and are related to agent types considered in games of incomplete information. We express the agents' autonomy by postulating that their models are not directly manipulable or observable by other agents. We show that important properties of POMDPs, such as convergence of value iteration, the rate of convergence, and piece-wise linearity and convexity of the value functions carry over to our framework. Our approach complements a more traditional approach to interactive settings which uses Nash equilibria as a solution paradigm. We seek to avoid some of the drawbacks of equilibria which may be non-unique and do not capture off-equilibrium behaviors. We do so at the cost of having to represent, process and continuously revise models of other agents. Since the agent's beliefs may be arbitrarily nested, the optimal solutions to decision making problems are only asymptotically computable. However, approximate belief updates and approximately optimal plans are computable. We illustrate our framework using a simple application domain, and we show examples of belief updates and value functions.

Evidence for hypoxia-induced, programmed cell death of cultured neurons

Apoptosis, a form of cell death ("programmed" cell death) in which the nucleus and cytoplasm shrink and often fragment, serves to eliminate excessive or unwanted cells during remodeling of embryonic tissues, during organ involution, and in tumor regression. In acute pathological states, such as ischemia, the cells tend to swell and lyse--a process called necrosis. We hypothesize that the delayed neural death clinically associated with hypoxia may, in part, represent apoptosis. A tissue culture model of 24 hours of hypoxia was employed using sympathetic neurons. Pretreatment with an endonuclease inhibitor (aurintricarboxylic acid) decreased cell death by 53%, depolarizing conditions (55 mM potassium chloride) decreased cell death by 33%, and an RNA synthesis inhibitor (actinomycin D) by 26% (all have been shown to prevent apoptosis). Pretreatment with antisense c-myc had no effect. Fluorescent staining with propidium iodide (a DNA marker) demonstrated chromatin condensation and agarose gel electrophoresis demonstrated a DNA "ladder." These data suggest that apoptosis may play a role in hypoxic cell death and that in this paradigm, expression of c-myc is unnecessary. This would suggest a new approach to our understanding of hypoxia and open new strategies to lessen neuronal damage secondary to this process.

Two alpha-tubulin genes of Aspergillus nidulans encode divergent proteins

We have isolated and analyzed the tubA and tubB alpha-tubulin genes of Aspergillus nidulans. The nucleotide sequences of these genes predict polypeptides of 447 amino acids for tubA and 450 for tubB. The predicted amino acids sequences exhibit 28% divergence between the two polypeptides. This is the second known case of such high divergence between alpha-tubulins within the same species. The tubB gene is unique in that it codes for an extra glycine residue between what are usually the second and third amino acids. RNA blot analysis demonstrates that the tubA and tubB transcripts are each 1.8 kb long. The level of tubA transcript remains the same throughout the cell cycle. The level of tubB transcript does not change at any particular stage in the cell cycle but increases continuously during spore germination. The tubA gene was previously mapped to linkage group eight, and we have now mapped the tubB gene to linkage group four. Gene disruption in heterokaryons suggests that the phenotypic consequences of disruption are different for the tubA and tubB genes. Molecular disruption of tubA results in a block in nuclear division whereas in tubB it gives rise to abnormal cell and nuclear morphology.

Characterization and optimization of absorbing plasma-enhanced chemical vapor deposited antireflection coatings for silicon photovoltaics

We have optimized plasma-enhanced chemical vapor deposition (PECVD) of SiN-based antireflection (AR) coatings with special consideration for the short-wavelength (<600 nm) parasitic absorption in SiN. Spectroscopic ellipsometry was used to measure the dispersion relation for both the refractive index n and the extinction coefficient k, allowing a precise analysis of the trade-off between reflection and absorption in SiN-based AR coatings. Although we focus on photovoltaic applications, this study may be useful for photodetectors, IR optics, and any device for which it is essential to maximize the transmission of light into silicon. We designed and optimized various AR coatings for minimal average (spectrally) weighted reflectance (? R(w) ?) and average weighted absorptance (? A (w) ?), using the air mass 1.5 global solar spectrum. In most situations ? R (w) ? decreased with higher n, but ? A (w) ? increased because k increased with n. For the practical case of a single-layer AR coating for silicon under glass, an optimum refractive index of ~2.23 (at 632.8 nm) was determined. Further simulations revealed that a double-layer SiN stack with an n = 2.42 film underneath an n = 2.03 film gives the minimum total photocurrent loss. Similar optimization of double-layer SiN/SiO(2) coatings for silicon in air revealed an optimum of n = 2.28 for SiN. To determine the allowable tolerance in index and film thickness, we generated isotransmittance plots, which revealed more leeway for n values below the optimum than above because absorption begins to reduce photocurrent for high n values.

Population genetics of tandem repeats in centromeric heterochromatin: unequal crossing over and chromosomal divergence at the Responder locus of Drosophila melanogaster

The Responder (Rsp) locus in Drosophila melanogaster is the target locus of segregation distortion and is known to be comprised of a tandem array of 120-bp repetitive sequences. In this study, we first determined the large scale molecular structure of the Rsp locus, which extends over a region of 600 kb on the standard sensitive (cn bw) chromosome. Within the region, small Rsp repeat arrays are interspersed with non-Rsp sequences and account for 10-20% of the total sequences. We isolated and sequenced 32 Rsp clones from three different chromosomes. The main results are: (1) Rsp repeats isolated from the same chromosome are not more similar than those from different chromosomes. This implies either that there are more homologous exchanges at the Rsp locus than expected or, alternatively, that the second chromosomes of D. melanogaster have diverged from one another more recently at the centromeric heterochromatin than at the nearby euchromatin. (2) The repeats usually have a dimeric structure with an average difference of 16% between the left and right halves. The differences allow us to easily identify the products of unequal exchanges. Despite the large differences between the two halves, exchanges have occurred frequently and the majority of them fall within a 29-bp interval of identity between the two halves. Our data thus support the suggestion that recombination depends on short stretches of complete identity rather than long stretches of general homology. (3) Frequent unequal crossover events obscure the phylogenetic relationships between repeats; therefore, different parts of any single repeat could often have different phylogenetic histories. The high rate of unequal crossing over may also help explain the evolutionary dynamics of the Rsp locus.

Exploiting Model Equivalences for Solving Interactive Dynamic Influence Diagrams

We focus on the problem of sequential decision making in partially observable environments shared with other agents of uncertain types having similar or conflicting objectives. This problem has been previously formalized by multiple frameworks one of which is the interactive dynamic influence diagram (I-DID), which generalizes the well-known influence diagram to the multiagent setting. I-DIDs are graphical models and may be used to compute the policy of an agent given its belief over the physical state and others' models, which changes as the agent acts and observes in the multiagent setting. As we may expect, solving I-DIDs is computationally hard. This is predominantly due to the large space of candidate models ascribed to the other agents and its exponential growth over time. We present two methods for reducing the size of the model space and stemming its exponential growth. Both these methods involve aggregating individual models into equivalence classes. Our first method groups together behaviorally equivalent models and selects only those models for updating which will result in predictive behaviors that are distinct from others in the updated model space. The second method further compacts the model space by focusing on portions of the behavioral predictions. Specifically, we cluster actionally equivalent models that prescribe identical actions at a single time step. Exactly identifying the equivalences would require us to solve all models in the initial set. We avoid this by selectively solving some of the models, thereby introducing an approximation. We discuss the error introduced by the approximation, and empirically demonstrate the improved efficiency in solving I-DIDs due to the equivalences.

Temperature Mediated Morphological Transition during Drying of Spray Colloidal Droplets

Understanding how a tiny dilute evaporative colloidal spray droplet gets transformed into a microgranule with a characteristic morphology is crucial from scientific as well as technological points of view. In the present work, it is demonstrated that the morphology and the size distribution of the microcapsules can be tuned simply by adjusting the drying temperature. Shape and size of the capsules are quantified at four different drying temperatures. It is shown that the morphology transits gradually from sphere to toroid with increasing temperature keeping the average volume-fraction of the correlated nanoparticles nearly unaffected for the synthesized granules. A plausible mechanism for the chronological pathway of such morphological transformation is illustrated. Computer simulation corroborates the experimentally observed morphological transition. The variation in hollowness and buckling tendency of the capsules are elucidated by scattering and imaging techniques.

Monte Carlo Sampling Methods for Approximating Interactive POMDPs

Partially observable Markov decision processes (POMDPs) provide a principled framework for sequential planning in uncertain single agent settings. An extension of POMDPs to multiagent settings, called interactive POMDPs (I-POMDPs), replaces POMDP belief spaces with interactive hierarchical belief systems which represent an agent’s belief about the physical world, about beliefs of other agents, and about their beliefs about others’ beliefs. This modification makes the difficulties of obtaining solutions due to complexity of the belief and policy spaces even more acute. We describe a general method for obtaining approximate solutions of I-POMDPs based on particle filtering (PF). We introduce the interactive PF, which descends the levels of the interactive belief hierarchies and samples and propagates beliefs at each level. The interactive PF is able to mitigate the belief space complexity, but it does not address the policy space complexity. To mitigate the policy space complexity – sometimes also called the curse of history – we utilize a complementary method based on sampling likely observations while building the look ahead reachability tree. While this approach does not completely address the curse of history, it beats back the curse’s impact substantially. We provide experimental results and chart future work.

Quantitative model for Gal4p-mediated expression of the galactose/melibiose regulon in Saccharomyces cerevisiae

A mathematical model based on equilibrium binding between Gal4p and its specific DNA binding site has been developed. A model for GAL gene expression solely due to cooperativity, as a function of Gal4p concentration, has been developed for a gal80 mutant. The above model was extended to include other known regulatory molecules, namely Gal80p and Gal3p. Parameters determined from the above simulation were then used to represent a physiological status of gene expression in response to glucose (in terms of Gal4p concentration) and galactose in a wild-type strain. We demonstrate that in a wild-type strain glucose repression is more stringent due to cooperativity and autogenous regulation, while the induction response to galactose is only through autogenous regulation. The biological significance of autogenous regulation in Saccharomyces cerevisiae is discussed vis-a-vis the lactose operon of Escherichia coli.

Comparison of lea gratings with cardiff acuity cards for vision testing of preverbal children

Aims:

To create a normative data for lea grating (LG) in the Indian population and to compare LG with Cardiff Acuity Card (CAC).

Settings and Design:

Normative Data was acquired from normal children between 6 months-3 years coming to the ‘Immunisation Clinic’ and ‘Well-Baby Clinic’ at a Civil Hospital. To compare LG with CAC, normal and amblyopic children between 6 months-3 years were evaluated,

Materials and Methods:

Monocular and binocular visual acuity (VA) was measured using LG and then CAC. VA and time taken to perform the test were compared.

Statistical Analysis Used:

Pearson's Correlation Coefficient to compare VA and Student paired t-test (significance P<0.005) to compare time.

Results:

Two standard deviations of VA of 100 normal children overlapped with that published by Lea. Of the 30 amblyopic children aged 18.32 ± 10.5 months (2-36), 18 were females. VA was 0.95 ± 0.3 logMAR (0.7–1.2) and 1.0 ± 0.6 logMAR (0.5–2.1) binocularly and 1.32 ± 0.08 logMAR (0.2-0.6) and 1.15 ± 0.15 logMAR (0.88-1.48) monocularly on CAC and LG respectively. Pearson's correlation coefficient was 0.98 and 0.63 for binocular and monocular assessment respectively. Time taken to perform LG monocularly and binocularly was significantly less (P<0.001) than CAC.

Conclusion:

Normative data acquired in Indian pre-verbal children is similar to that published by Lea. Though VA by CAC is better than LG, the two tests are comparable.

Molecular analysis of the responder satellite DNA in Drosophila melanogaster: DNA bending, nucleosome structure, and Rsp-binding proteins

The Responder (Rsp) locus of Drosophila melanogaster, the target locus of segregation distortion, is a satellite DNA array. This repeat array imparts some fitness advantage to the chromosomes bearing it. In this paper, we report the following three related molecular properties of this satellite repeat: (1) Sequence-directed curvature--On a polyacrylamide gel, Rsp-containing fragments migrate slower than would be predicted on the basis of their physical sizes. The extent of migration retardation correlates with the size and position of the Rsp sequence in a DNA fragment, suggesting that Rsp DNA is bent. The bending is shown to be affected by a DNA-binding drug (Hoechst 33258). (2) Nucleosome structure--Nucleosomes associated with Rsp repeats have an unusual spacing pattern. Instead of being spaced at approximately 190-bp intervals as is the bulk chromatin, they are separated at approximately 240-bp intervals, roughly the size of a dimeric Rsp repeat. The nucleosomal structure in the Rsp region is preferentially disrupted by Hoechst 33258, whereas the bulk chromatin appears to be insensitive to the drug. (3) Rsp-DNA binding proteins--Gel mobility-shift assays using nuclear extracts from pupae and end-labeled Rsp repeat demonstrate the presence of three distinct DNA-protein complexes. Competition assays suggest that these complexes are specific to the Rsp sequence, and two of these nucleoprotein complexes seem to be influenced by the presence of Hoechst 33258. The observed complexes are formed by nonhistone proteins of somatic origin and may be related to the normal functions of Rsp, rather than to the germ-line segregation distortion activities.

Characterization of two Segregation distorter revertants: evidence that the tandem duplication is necessary for Sd activity in Drosophila melanogaster

Segregation Distorter (SD) is a naturally occurring system of meiotic drive in Drosophila melanogaster. Males heterozygous for an SD second chromosome and a normal homolog (SD+) transmit predominantly SD-bearing sperm. To accomplish this, the Segregation distorter (Sd) locus induces the dysfunction of those spermatids that receive the SD+ chromosome. Recently, P. A. Powers and B. Ganetzky isolated overlapping DNA clones spanning the region of DNA known to contain the Sd gene and identified a 5-kb tandem duplication that is present on all SD chromosomes examined, but is apparently absent from wild-type chromosomes. Here we report a molecular analysis of two spontaneous revertants from an Australian SD chromosome (SD-Arm28). Both of these revertants have lost the 5-kb tandem duplication along with the ability to distort transmission; the critical observation, however, is that they retain the DNA haplotype in the flanking regions (both proximally and distally) that is characteristic of the original SD-Arm28. We propose unequal sister chromatid exchange between the tandem repeats as the only plausible explanation for loss of a repeat while retaining flanking markers. This provides direct evidence that the tandem duplication is indeed necessary for the Sd phenotype. Further, we examined testes-specific levels of both RNA and protein for the nearby Topoisomerase 2 gene. Neither revealed a consistent difference between SD and SD+ strains. We also measured testes-specific levels of RNA using the tandem duplication itself as probe. Our results suggest that there is strong up-regulation of one or several 2.0-2.3-kb transcripts from the duplicated region in the testes of an SD strain.(ABSTRACT TRUNCATED AT 250 WORDS)

Craniotomy guidance using a stereo-video-based tracking system

In open intracranial neurosurgery, it is desirable to minimize exposure and to approach the target in the most accurate way possible. The VISLAN system described here employs a completely passive hand-held locator which is tracked by a video system and does not require a mechanical linkage nor cables. The system also tracks easily recognizable, constant, anatomical landmarks of the patient. By this means the initial registration of pre-operative imaging and the detection of, and correction for, patient movement can be accomplished. High-resolution MRI segmented interactively is used to define external surface and brain anatomy. Thus, a pre-operative patient representation (POPR) is planned. During the surgical procedure the patient's head is illuminated by structured light and stereo-video pictures obtained from two television cameras mounted above the head. The system is calibrated and registered with the POPR using a chamfered matching algorithm. The locator is also tracked in space by the video system, and its tip position shown in relation to the POPR on the video monitor.

Re-thinking sludge management within the Sustainable Development Goal 6.2

Sustainable Development Goal 6.2 of the Agenda 2030 is addressed to achieve access to adequate and equitable sanitation and hygiene for all. Further, one of the major principles underlying the Lisbon Charter is that sustainable and safe management of wastewaters are fundamental to the health of communities and their sustainable socio-economic development. Within this framework, the management of sewage sludge in a sustainable manner is one of the critical issues facing modern society, due to the growing rise of its production, increasing difficulties in properly locating treatment and disposal works, and complying with more stringent environmental quality requirements, thus requiring a re-thinking of its management. This paper discusses major concepts and principles for re-thinking the sludge management in order to achieve the above-mentioned objectives.

Nosocomial Herpes Encephalitis: rare but treatable with early MR diagnosis

Nosocomial/hospital acquired herpes encephalitis is rare and is usually undiagnosed in its early phase because of the non-specific clinical picture and low level of clinical and neuroimaging suspicion. There is a paucity of data in radiology literature for this entity, specifically in the settings of surgery and trauma. We describe two cases of nosocomial herpes simplex encephalitis to demonstrate the imaging clues that might lead to an early diagnosis of this disease.

Mutational analysis of the alpha subunit of the human interleukin-3 receptor

The alpha subunit of the human interleukin-3 receptor (IL-3R alpha) is a 70-kD glycoprotein member of the hematopoietin receptor superfamily. This protein associates with a beta subunit common to the receptors for IL-5 and granulocyte-macrophage colony-stimulating factor (GM-CSF) to form a high-affinity receptor for IL-3. To identify regions of IL-3R alpha critical for ligand binding and receptor function, cDNAs encoding mutant receptors were generated and expressed in COS cells along with the beta subunit. Mutant receptors lacking almost the entire cytoplasmic domain of IL-3R alpha [IL-3R alpha(CD)] or carrying a substitution of trp for leu in the membrane proximal leu-ser-x-trp-ser (LSXWS) box bound 125I-IL-3 with nearly the same affinity as wild-type IL-3R alpha. In contrast, a mutant lacking the entire "LSXWS" motif failed to bind 125I-IL-3 with high affinity despite showing surface expression. In addition, hybrid receptors composed of the first 104 amino acids (aa) of IL-3R alpha joined to aa 118 through 400 of the alpha subunit of the GM-CSF receptor (GM-R alpha) [IL-3R alpha/GM-R alpha] or the first 118 aa of GM-R alpha joined to aa 104 through 378 of IL-3R alpha [GM-R alpha/IL-3R alpha] failed to bind 125I-IL-3 in the presence of the beta subunit. A third hybrid receptor composed of the first 281 residues of IL-3R alpha fused to residues 306 through 379 of GM-R alpha [IL-3R alpha/GM-R alpha-DS] also failed to bind 125I-IL-3 in the presence of the beta subunit but, in contrast to the IL-3R alpha/GM-R alpha hybrid, demonstrated weak surface expression. Mutant receptors lacking the N-terminal 30 aa and the N-terminal 9 aa also did not bind 125I-IL-3 with high affinity, although both were expressed on the cell surface. These data suggest that although the cytoplasmic domain and the leucine residue of the "LSXWS" box are not critical for ligand binding or beta-subunit association, the "LSXWS" motif and amino-terminal sequences are important for these functions.

Urine Biochemical Parameters in Predicting Severity of SARS-CoV-2 Infection: an Experience in Tertiary Care Centre in Western India

BACKGROUND & OBJECTIVE

Coronavirus is an enveloped RNA virus that mainly causes respiratory infection. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal and oropharyngeal swab is the confirmatory diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection. The relationship between SARS-COV-2 and body fluid parameters is still not known. There have been few studies regarding the correlation between urine biochemical parameters and SARS-COV-2 infection. The aim of the study is to determine the importance of urinary biochemical parameters in SARS-COV-2 infection and whether these parameters can be used to predict the severity of the infection.

METHODS

This was a retrospective observational study consisting of total of 285 patients diagnosed with SARS-COV-2 infection. The patients were divided into three groups according to the severity of infection as mild (120 cases), moderate (110 cases) and severe (55 cases). During the study period 72 healthy persons were enrolled as controls. Analysis was done to find any relationship between various urine biochemical parameters and the severity of SARS-COV-2 infection.

RESULTS

Urinary occult blood (U. Blood) and Urinary protein (U. Pro) have higher positive rates in SARS-COV-2 patients as compared with healthy controls. Among the severities of SARS-COV-2 infection (mild, moderate and severe), both these parameters were significantly higher. Glucose (Glu) and Ketone (Ket) positivity rate was more in moderate cases of SARS-COV-2 than mild cases.

CONCLUSION

Urinary biochemical parameters are very useful in identification of SARS-COV-2 infection and also have the advantage in evaluating the progression in patients infected with SARS-COV-2. Among the different parameters, Urinary Occult Blood and Urinary protein are significant in the differentiation of SARS-COV-2 severity.

Cavernous haemangioma in the interpeduncular cistern: case report and review of literature

A rare case of a cavernous haemangioma in the interpeduncular cistern is reported. The patient, forty-five year old male presented with excruciating left sided trigeminal neuralgia and diplopia for the past one year. Examination revealed left third and fifth nerve paresis. Magnetic resonance imaging showed a well-defined, lobulated tumour in the interpeduncular cistern. The tumour was totally excised through a subtemporal route. Histology of the tumour revealed a cavernous haemangioma. Extracerebral location for a cavernous haemangioma is rare. An interpeduncular cavernous haemangioma has never been reported earlier in literature. The clinical and radiological features are discussed and relevant literature is briefly reviewed.