Clinical features and treatment outcome of very elderly patients over 80 years old with multiple myeloma:comparison with patients in different age groups in the era of novel agents

We retrospectively analyzed the outcomes of 175 consecutive patients admitted to our hospital between April 2004 and June 2014, and identified 42 (24%), 80 (46%), and 53 (30%) patients 80, 66-79, and 65 years old, respectively. The median progression-free survival (PFS) and overall survival (OS) of the 80, 66-79, and 65 years old groups were 19.1, 26.3, and 54.3 months, and 31.9, 54.8, and 83.8 months, respectively. Patients 80 but not 79 years old with ECOG performance score (PS) 3 and/or Charlson comorbidity index (CCI) 5 showed significantly shorter survival. ECOG PS and CCI predicted the treatment outcome of patients 80 but did not predict 79 years old.</p

Tight junctions in Schwann cells of peripheral myelinated axons: a lesson from claudin-19–deficient mice

Tight junction (TJ)–like structures have been reported in Schwann cells, but their molecular composition and physiological function remain elusive. We found that claudin-19, a novel member of the claudin family (TJ adhesion molecules in epithelia), constituted these structures. Claudin-19–deficient mice were generated, and they exhibited behavioral abnormalities that could be attributed to peripheral nervous system deficits. Electrophysiological analyses showed that the claudin-19 deficiency affected the nerve conduction of peripheral myelinated fibers. Interestingly, the overall morphology of Schwann cells lacking claudin-19 expression appeared to be normal not only in the internodal region but also at the node of Ranvier, except that TJs completely disappeared, at least from the outer/inner mesaxons. These findings have indicated that, similar to epithelial cells, Schwann cells also bear claudin-based TJs, and they have also suggested that these TJs are not involved in the polarized morphogenesis but are involved in the electrophysiological “sealing” function of Schwann cells

Multiple myeloma with t(11;14)-associated immature phenotype has lower CD38 expression and higher BCL2 dependence

CD38 expression on myeloma cells is a critical factor affecting the early response to the anti-CD38 antibody daratumumab. However, factors affecting CD38 expression in untreated multiple myeloma are not fully elucidated. In this study, we found that CD38 expression was significantly lower in myeloma patients with the translocation t(11;14)-associated immature plasma cell phenotype, and particularly in those expressing B-cell-associated genes such as PAX5 and CD79A. CD138, a representative marker of plasmacytic differentiation, was also significantly lower in these patients, suggesting that CD38 expression may be associated with the differentiation and maturation stages of myeloma cells. Furthermore, the BCL2/BCL2L1 ratio, a response marker of the BCL2 inhibitor venetoclax, was significantly higher in patients with the immature phenotype expressing B-cell-associated genes. The BCL2/BCL2L1 ratio and CD38 expression were significantly negatively correlated. We also confirmed that patients with translocation t(11;14) expressing B-cell-associated genes were indeed less sensitive to daratumumab-mediated direct cytotoxicity but highly sensitive to venetoclax treatment in ex vivo assays. Moreover, all-trans-retinoic acid, which enhances CD38 expression and induces cell differentiation in myeloma cells, reduced B-cell marker expression and the BCL2/BCL2L1 ratio in myeloma cell lines, leading to reduced efficacy of venetoclax. Venetoclax specifically induces cell death in myeloma with t(11;14), although why patients with translocation t(11;14) show BCL2 dependence is unclear. These results suggest that BCL2 dependence, as well as CD38 expression, are deeply associated with the differentiation and maturation stages of myeloma cells. This study highlights the importance of examining t(11;14) and considering cell maturity in myeloma treatment strategies

Chondroitin sulfate N-acetylgalactosaminyltransferase-1 is required for normal cartilage development

CS (chondroitin sulfate) is a glycosaminoglycan species that is widely distributed in the extracellular matrix. To understand the physiological roles of enzymes involved in CS synthesis, we produced CSGalNAcT1 (CS N-acetylgalactosaminyltransferase 1)-null mice. CS production was reduced by approximately half in CSGalNAcT1-null mice, and the amount of short-chain CS was also reduced. Moreover, the cartilage of the null mice was significantly smaller than that of wild-type mice. Additionally, type-II collagen fibres in developing cartilage were abnormally aggregated and disarranged in the homozygous mutant mice. These results suggest that CSGalNAcT1 is required for normal CS production in developing cartilage

Nivolumab Versus Gemcitabine or Pegylated Liposomal Doxorubicin for Patients With Platinum-Resistant Ovarian Cancer: Open-Label, Randomized Trial in Japan (NINJA)

PURPOSE: This phase III, multicenter, randomized, open-label study investigated the efficacy and safety of nivolumab versus chemotherapy (gemcitabine [GEM] or pegylated liposomal doxorubicin [PLD]) in patients with platinum-resistant ovarian cancer. MATERIALS AND METHODS: Eligible patients had platinum-resistant epithelial ovarian cancer, received ≤ 1 regimen after diagnosis of resistance, and had an Eastern Cooperative Oncology Group performance score of ≤ 1. Patients were randomly assigned 1:1 to nivolumab (240 mg once every 2 weeks [as one cycle]) or chemotherapy (GEM 1000 mg/m2 for 30 minutes [once on days 1, 8, and 15] followed by a week's rest [as one cycle], or PLD 50 mg/m2 once every 4 weeks [as one cycle]). The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), overall response rate, duration of response, and safety. RESULTS: Patients (n = 316) were randomly assigned to nivolumab (n = 157) or GEM or PLD (n = 159) between October 2015 and December 2017. Median OS was 10.1 (95% CI, 8.3 to 14.1) and 12.1 (95% CI, 9.3 to 15.3) months with nivolumab and GEM or PLD, respectively (hazard ratio, 1.0; 95% CI, 0.8 to 1.3; P = .808). Median PFS was 2.0 (95% CI, 1.9 to 2.2) and 3.8 (95% CI, 3.6 to 4.2) months with nivolumab and GEM or PLD, respectively (hazard ratio, 1.5; 95% CI, 1.2 to 1.9; P = .002). There was no statistical difference in overall response rate between groups (7.6% v 13.2%; odds ratio, 0.6; 95% CI, 0.2 to 1.3; P = .191). Median duration of response was numerically longer with nivolumab than GEM or PLD (18.7 v 7.4 months). Fewer treatment-related adverse events were observed with nivolumab versus GEM or PLD (61.5% v 98.1%), with no additional or new safety risks. CONCLUSION: Although well-tolerated, nivolumab did not improve OS and showed worse PFS compared with GEM or PLD in patients with platinum-resistant ovarian cancer

Neural projections in planarian brain revealed by fluorescent dye tracing

The planarian brain has an inverted-U shaped structure with functional regionalization. To investigate how each region in the brain connects to each other, we traced neural projections by microinjection of fluorescence dye tracers. We found that external light and olfactory/taste signals received in the head region are conveyed in the main lobes (sponge region) of the brain. Chemosensory neurons distributed in the lateral branches project to the peripheral region of the sponge and visual neurons project to the medial region of the sponge. Parts of the sensory neurons project directly to the corresponding sensory neurons on the opposite side of the brain. However, all of the dye labeled brain neurons in the left and right lobes connect to each other via commissural neurons in the central region of the sponge. In addition to these observations, we detected regional differences in the planarian visual neurons. Posterior visual neurons have ipsilateral projection, but anterior visual neurons project to the contralateral side of the brain. A pair of longitudinal ventral nerve cords (VNC) connect to the brain on the ventral side, suggesting that they transmit signals which are integrated and processed in the brain. We also detected the direct connection of neurons in the brain and those of the pharynx, even though most pharynx neurons connect to VNC neurons. Here, we report for the first time on neural connections in the planarian central nervous system after overcoming technical difficulties specific to flatworms

MILP‐based security evaluation for AEGIS/Tiaoxin‐346/Rocca

Abstract In this paper, the security of Advanced Encryption Standard‐based authenticated encryption schemes, including AEGIS family, Tiaoxin‐346, and Rocca by mixed integer linear programming tools is examined. Specifically, for the initialisation phase of AEGIS, Tiaoxin‐346, and Rocca, the security against differential attacks and integral attacks is evaluated by estimating the lower bounds for the number of active S‐boxes and utilising division property, respectively. In addition to the estimations of initialisation phases, the security of the encryption phases of AEGIS, Tiaoxin‐346, and Rocca against distinguishing attacks on keystream is evaluated by exploiting integral properties. As a result, the authors show that the initialisation phases of AEGIS‐128/128L/256, Tiaoxin‐346, and Rocca are secure against differential attacks after 4/3/6, 5, and 6 rounds, respectively. Regarding integral attacks, the distinguisher is found on 6/6/7, 15, and 7 rounds in the initialisation phases of AEGIS‐128/128L/256, Tiaoxin‐346, and Rocca, respectively. Additionally, the integral distinguisher is presented on 2/2/4, 4, and 4 rounds in the encryption phases of AEGIS‐128/128L/256, Tiaoxin‐346, and Rocca, respectively. As far as it is known, this study’s results are the first distinguishing attacks on the keystream on AEGIS, Tiaoxin‐346, and Rocca without relying on weak keys