Meta-analysis of stomatitis in clinical studies of everolimus: incidence and relationship with efficacy.

BackgroundEverolimus, an oral mammalian target of rapamycin (mTOR) inhibitor, is used to treat solid tumors and tuberous sclerosis complex (TSC). Stomatitis, an inflammation of the mucous membranes of the mouth, is a common adverse event associated with mTOR inhibitors, including everolimus. We conducted a meta-analysis of data from seven randomized, double-blind phase 3 clinical trials of everolimus to determine the clinical impact of stomatitis on efficacy and safety.Patients and methodsData were pooled from the safety sets of solid tumor [breast cancer (BOLERO-2 and BOLERO-3), renal cell carcinoma (RECORD-1), carcinoid tumors (RADIANT-2), and pancreatic neuroendocrine tumors (RADIANT-3)] and TSC studies (EXIST-1 and EXIST-2). Data from solid tumor trials and TSC trials were analyzed separately.ResultsThe rate of stomatitis was 67% in the solid tumor trials (973/1455 patients) and 70% in the TSC trials (110/157 patients). Most stomatitis events were grade 1/2, with grade 3/4 events reported in only 9% (solid tumor trials) and 8% (TSC trials) of patients. Low TSC patient numbers prevented an in-depth evaluation of stomatitis and response. In the solid tumor trials, most first stomatitis episodes (89%; n = 870) were observed within 8 weeks of starting everolimus. Patients with stomatitis occurring within 8 weeks of everolimus initiation had longer progression-free survival (PFS) than everolimus-treated patients without stomatitis in BOLERO-2 {8.5 versus 6.9 months, respectively; hazard ratio (HR), 0.78 [95% confidence interval (CI), 0.62-1.00]} and RADIANT-3 [13.9 versus 8.3 months, respectively; HR, 0.70 (95% CI, 0.48-1.04)]. A similar trend was observed in RECORD-1 [HR, 0.90 (95% CI, 0.66-1.22)] and RADIANT-2 [HR, 0.87 (95% CI, 0.61-1.22)] but not in BOLERO-3 [HR, 1.01 (95% CI, 0.75-1.36)].ConclusionsStomatitis did not adversely affect PFS, supporting the administration of everolimus in accordance with standard management guidelines

Characteristics of membrane fouling by consecutive chemical cleaning in pressurized ultrafiltration as pre-treatment of seawater desalination

© 2015 Elsevier B.V. Chemical cleaning of membranes is one of the most important strategies in pressurized hollow fiber ultrafiltration (UF) as a pre-treatment for seawater desalination. Various physical cleaning strategies such as backwashing, aeration and air-scrubbing or chemically enhanced backwashing (CEB) have been investigated in order to remove foulants from the UF membrane. However, the limitation in their cleaning effects being found during long-term operation leads to the need of cleaning in place (CIP) for the recovery of membrane performance. In this study, we used oxalic acid and sodium hypochlorite as chemical cleaning agents. The cleaning in series of oxalic acid-sodium hypochlorite-oxalic acid showed the optimal cleaning efficiency and was applied for the consecutive chemical cleaning. The recovery efficiency of the CIP after first, second, third and fourth cleanings was 96.8%, 95.8%, 98.3% and 99.9%, respectively. It was almost fully recovered to the previous recovered value. However, membrane surface structure was deformed by contact with chemical cleaning agents during cleaning time, because, hydrophilic inorganic foulants are still adhered on the membrane surface even after several cleanings although hydrophobic organic foulants were removed easily by chemical cleaning. An improved CIP strategy should be developed to remove hydrophilic foulants for long-term operation of desalination plants

Characteristics of a population-based multiple sclerosis cohort treated with disease-modifying drugs in a universal healthcare setting

BACKGROUND: Relatively little is known about the use of disease-modifying drugs (DMDs) for multiple sclerosis (MS) in the population-based universal healthcare setting. This study aimed to describe the characteristics of a population-based cohort with MS and their DMD exposure in four Canadian provinces. METHODS: We identified all adults (aged ≥18 years) with MS using linked population-based health administrative data. Individuals were followed from the most recent of their first MS or demyelinating event or 1 January 1996(study entry), to the earliest of death, emigration, or 31 March 2018(study end). Cohort characteristics examined included sex, age, socioeconomic status, and comorbidity burden. RESULTS: Overall, 10,418/35,894 (29%) of MS cases filled a DMD prescription during the 22-year study period. Most were women (n = 7,683/10,418;74%), and 17% (n = 1,745/10,418) had some comorbidity (Charlson Comorbidity Index≥1) at study entry. Nearly 20% (n = 1,745/10,418) were aged ≥50 when filling their first DMD; the mean age was 39.6 years. CONCLUSIONS: Almost 1 in 6 people with MS had at least some comorbidity, and nearly 1 in 6 were ≥50 years old at the time of their first DMD. As these individuals are typically excluded from clinical trials, findings illustrate the need to understand the harms and benefits of DMD use in these understudied groups

Noncommutative geometry inspired black holes in higher dimensions at the LHC

When embedding models of noncommutative geometry inspired black holes into the peridium of large extra dimensions, it is natural to relate the noncommutativity scale to the higher-dimensional Planck scale. If the Planck scale is of the order of a TeV, noncommutative geometry inspired black holes could become accessible to experiments. In this paper, we present a detailed phenomenological study of the production and decay of these black holes at the Large Hadron Collider (LHC). Noncommutative inspired black holes are relatively cold and can be well described by the microcanonical ensemble during their entire decay. One of the main consequences of the model is the existence of a black hole remnant. The mass of the black hole remnant increases with decreasing mass scale associated with noncommutative and decreasing number of dimensions. The experimental signatures could be quite different from previous studies of black holes and remnants at the LHC since the mass of the remnant could be well above the Planck scale. Although the black hole remnant can be very heavy, and perhaps even charged, it could result in very little activity in the central detectors of the LHC experiments, when compared to the usual anticipated black hole signatures. If this type of noncommutative inspired black hole can be produced and detected, it would result in an additional mass threshold above the Planck scale at which new physics occurs.Comment: 21 pages, 7 figure

A direct examination of the dynamics of dipolarization fronts using MMS

Energy conversion on the dipolarization fronts (DFs) has attracted much research attention through the suggestion that intense current densities associated with DFs can modify the more global magnetotail current system. The current structures associated with a DF are at the scale of one to a few ion gyroradii, and their duration is comparable to a spacecraft's spin period. Hence, it is crucial to understand the physical mechanisms of DFs with measurements at a timescale shorter than a spin period. We present a case study whereby we use measurements from the Magnetospheric Multiscale (MMS) Mission, which provides full 3-D particle distributions with a cadence much shorter than a spin period. We provide a cross validation amongst the current density calculations and examine the assumptions that have been adopted in previous literature using the advantages of MMS mission (i.e., small-scale tetrahedron and high temporal resolution). We also provide a cross validation on the terms in the generalized Ohm's law using these advantageous measurements. Our results clearly show that the majority of the currents on the DF are contributed by both ion and electron diamagnetic drifts. Our analysis also implies that the ion frozen-in condition does not hold on the DF, while electron frozen-in condition likely holds. The new experimental capabilities allow us to accurately calculate Joule heating within the DF, which shows that plasma energy is being converted to magnetic energy in our event

An expression signature of the angiogenic response in gastrointestinal neuroendocrine tumours: correlation with tumour phenotype and survival outcomes.

BACKGROUND: Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are heterogeneous with respect to biological behaviour and prognosis. As angiogenesis is a renowned pathogenic hallmark as well as a therapeutic target, we aimed to investigate the prognostic and clinico-pathological role of tissue markers of hypoxia and angiogenesis in GEP-NETs. METHODS: Tissue microarray (TMA) blocks were constructed with 86 tumours diagnosed from 1988 to 2010. Tissue microarray sections were immunostained for hypoxia inducible factor 1α (Hif-1α), vascular endothelial growth factor-A (VEGF-A), carbonic anhydrase IX (Ca-IX) and somatostatin receptors (SSTR) 1–5, Ki-67 and CD31. Biomarker expression was correlated with clinico-pathological variables and tested for survival prediction using Kaplan–Meier and Cox regression methods. RESULTS: Eighty-six consecutive cases were included: 51% male, median age 51 (range 16–82), 68% presenting with a pancreatic primary, 95% well differentiated, 51% metastatic. Higher grading (P=0.03), advanced stage (P<0.001), high Hif-1α and low SSTR-2 expression (P=0.03) predicted for shorter overall survival (OS) on univariate analyses. Stage, SSTR-2 and Hif-1α expression were confirmed as multivariate predictors of OS. Median OS for patients with SSTR-2+/Hif-1α-tumours was not reached after median follow up of 8.8 years, whereas SSTR-2-/Hif-1α+ GEP-NETs had a median survival of only 4.2 years (P=0.006). CONCLUSION: We have identified a coherent expression signature by immunohistochemistry that can be used for patient stratification and to optimise treatment decisions in GEP-NETs independently from stage and grading. Tumours with preserved SSTR-2 and low Hif-1α expression have an indolent phenotype and may be offered less aggressive management and less stringent follow up

Quantum teleportation using active feed-forward between two Canary Islands

Quantum teleportation [1] is a quintessential prerequisite of many quantum information processing protocols [2-4]. By using quantum teleportation, one can circumvent the no-cloning theorem [5] and faithfully transfer unknown quantum states to a party whose location is even unknown over arbitrary distances. Ever since the first experimental demonstrations of quantum teleportation of independent qubits [6] and of squeezed states [7], researchers have progressively extended the communication distance in teleportation, usually without active feed-forward of the classical Bell-state measurement result which is an essential ingredient in future applications such as communication between quantum computers. Here we report the first long-distance quantum teleportation experiment with active feed-forward in real time. The experiment employed two optical links, quantum and classical, over 143 km free space between the two Canary Islands of La Palma and Tenerife. To achieve this, the experiment had to employ novel techniques such as a frequency-uncorrelated polarization-entangled photon pair source, ultra-low-noise single-photon detectors, and entanglement-assisted clock synchronization. The average teleported state fidelity was well beyond the classical limit of 2/3. Furthermore, we confirmed the quality of the quantum teleportation procedure (without feed-forward) by complete quantum process tomography. Our experiment confirms the maturity and applicability of the involved technologies in real-world scenarios, and is a milestone towards future satellite-based quantum teleportation

On dynamic network entropy in cancer

The cellular phenotype is described by a complex network of molecular interactions. Elucidating network properties that distinguish disease from the healthy cellular state is therefore of critical importance for gaining systems-level insights into disease mechanisms and ultimately for developing improved therapies. By integrating gene expression data with a protein interaction network to induce a stochastic dynamics on the network, we here demonstrate that cancer cells are characterised by an increase in the dynamic network entropy, compared to cells of normal physiology. Using a fundamental relation between the macroscopic resilience of a dynamical system and the uncertainty (entropy) in the underlying microscopic processes, we argue that cancer cells will be more robust to random gene perturbations. In addition, we formally demonstrate that gene expression differences between normal and cancer tissue are anticorrelated with local dynamic entropy changes, thus providing a systemic link between gene expression changes at the nodes and their local network dynamics. In particular, we also find that genes which drive cell-proliferation in cancer cells and which often encode oncogenes are associated with reductions in the dynamic network entropy. In summary, our results support the view that the observed increased robustness of cancer cells to perturbation and therapy may be due to an increase in the dynamic network entropy that allows cells to adapt to the new cellular stresses. Conversely, genes that exhibit local flux entropy decreases in cancer may render cancer cells more susceptible to targeted intervention and may therefore represent promising drug targets.Comment: 10 pages, 3 figures, 4 tables. Submitte

Characterization and System Identification of XY Flexural Mechanism Using Double Parallelogram Manipulator for High Precision Scanning

This article represents modeling of double parallelogram flexural manipulator derived from basic classical mechanics theory. Fourth order vibration wave equation is used for mathematical modeling and its performance is determined for step input and sinusoidal forced input. Static characterization of DFM is carried out to determine stiffness and force deflection characteristics over the entire motion range and dynamic characteristics is carried out using Transient response and Frequency response. Transient response is determined using step input to DFM which gives system properties such as damping, rise time and settling time. These parameters are then compared with theoretical model presented previously. Frequency response of DFM system gives characteristics of system with different frequency inputs which is used for experimental modeling of DFM device. Here, Voice Coil Motor is used as Actuator and optical encoder is used for positioning sensing of motion stage. It is noted that theoretical model is having 5% accuracy with experimental results. To achieve better position and accuracy, PID and LQR (Linear Quadratic Regulator) implementation was carried out on experimental model. PID gains are optimally tuned by using Ziegler Nichols approach. PID control is implemented experimentally using dSPACE DS1104 microcontroller and Control Desk software. Experimentally, it is observed that positioning accuracy is less than 5 μm. Further multiple DFM blocks are arranged for developing XY flexural mechanism and static characterization was carried out on it. The comparison of experimental and FEA results for X-direction and Y-direction is presented at end of paper