The combination of bevacizumab with chemotherapy is more beneficial in the metastatic setting rather than in the adjuvant setting for the treatment of HER2-negative breast cancer—a commentary on the E5103 randomized phase III clinical study

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Sensitivity and uncertainty analysis of a plant-wide model for carbon and energy footprint of wastewater treatment plants

This paper presents the sensitivity and uncertainty analysis of a mathematical model for Greenhouse gas (GHG) and energy consumption assessment from wastewater treatment plants (WWTPs). The model is able to simultaneously describe the main biological and physical-chemical processes in a WWTP. Specifically, the mathematical model includes the main processes of the water and sludge lines influencing the methane (CH4), nitrous oxide (N2O), and carbon dioxide (CO2) emissions. Further, the process energy demand and the energy recovery are also taken into account. The main objective of this paper is to analyze the key factors and sources of uncertainty influencing GHG emissions from WWTP at a plant-wide scale. The results show that influent fractionation has an important role on direct and indirect GHGs production and emission. Moreover, model factors related to the aerobic biomass growth show a relevant influence on GHGs in terms of power requirements. Thus, a good WWTP design and management aimed at limiting the GHG emission should carefully take into account the aeration system model to reduce GHG emission associated with electrical power demand. Also, the N2O emission associated with the effluent has the highest relative uncertainty bandwidth (1.7), suggesting one more need for a mechanistic model for N2O production in biological treatment

Nanoparticle albumin-bound paclitaxel: a big nano for the treatment of gastric cancer

Gastric cancer (GC) is the third cause of cancer-related death worldwide. Patients with unresectable GC can be treated with chemotherapy such as paclitaxel, which is a microtubule stabilizer. The use of nanoparticle albumin-bound paclitaxel (nab-ptx) avoids hypersensitivity reactions due to the absence of solvent needed to dissolve paclitaxel and it can be administered at higher doses. The ABSOLUTE randomized phase-3 clinical trial showed the non-inferiority of the nab-ptx used every week compared to the solvent-based paclitaxel used every week. This review describes the current advancements of the use of nab-ptx in GC in preclinical and clinical study investigations. The possibility of combining nab-ptx with other medications to improve response of patients to their specific molecular needs will also be debated

Lenvatinib for the treatment of renal cell carcinoma

Introduction: Renal cell carcinoma (RCC) accounts for 2\u20133% of all solid tumors. Expression of the receptor for the vascular endothelial growth factor (VEGF) is one of the most common features of RCC. Areas covered: Lenvatinib is a novel multi-kinase inhibitor that has been studied in several solid tumors. It has shown promising results in the treatment of RCC, especially when combined with everolimus, In this review, we summarize the available data of lenvatinib for the treatment of advanced/metastatic renal cell carcinoma. Expert opinion: Lenvatinib in combination with everolimus has provided encouraging results in both clinical and laboratory investigations showing that blocking angiogenesis and the mTOR signalling pathway could be a remarkable approach for treating RCC. As an additive to this type of approach it would be interesting in future clinical settings testing also the combination of lenvatinib and everolimus with immune-therapy

Updates on the CDK4/6 inhibitory strategy and combinations in breast cancer

Breast Cancer (BC) is the second most common type of cancer worldwide and displays the highest cancer-related mortality among women worldwide. Targeted therapies have revolutionized the way BC has been treated in recent decades, improving the life expectancies of millions of women. Among the different molecular pathways that have been of interest for the development of targeted therapies are the Cyclin-Dependent Kinases (CDK). CDK inhibitors are a class of molecules that already exist in nature and those belonging to the Cyclin dependent kinase inhibitors family INK4 that specifically inhibit CDK4/6 proteins. CDK4/6 inhibitors specifically block the transition from the G1 to the S phase of the cell cycle by dephosphorylation of the retinoblastoma tumor suppressor protein. In the past four years, the CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib, received their first FDA approval for the treatment of Hormone Receptor (HR)-positive and Human Epidermal growth factor Receptor 2 (HER2)-negative breast cancer after showing significant improvements in progression-free survival in the PALOMA-1, MONALEESA-2 and the MONARCH-2 randomized clinical trials, respectively. After the encouraging results from these clinical trials, CDK4/6 inhibitors have also been investigated in other BC subtypes. In HER2-positive BC, a combination of CDK4/6 inhibitors with HER2-targeted therapies showed promise in preclinical studies and their clinical evaluation is ongoing. Moreover, in triple-negative BC, the efficacy of CDK4/6 inhibitors has been investigated in combination with other targeted therapies or immunotherapies. This review summarizes the molecular background and clinical efficacy of CDK4/6 inhibitors as single agents or in combination with other targeted therapies for the treatment of BC. Future directions for ongoing clinical trials and predictive biomarkers will be further debated

Robotic multiquadrant colorectal procedures: A single-center experience and a systematic review of the literature

Purpose: Robotic surgery has been progressively implemented for colorectal procedures but is still limited for multiquadrant abdominal resections. The present study aims to describe our experience in robotic multiquadrant colorectal surgeries and provide a systematic review and meta-analysis of the literature investigating the outcomes of robotic total proctocolectomy (TPC), total colectomy (TC), subtotal colectomy (STC), or completion proctectomy (CP) compared to laparoscopy. Methods: At our institution 16 consecutive patients underwent a 2- or 3-stage totally robotic total proctocolectomy (TPC) with ileal pouch-anal anastomosis. A systematic review of the literature was performed to select studies on robotic and laparoscopic multiquadrant colorectal procedures. Meta-analyses were used to compare the two approaches. Results: In our case series, 14/16 patients underwent a 2-stage robotic TPC for ulcerative colitis with a mean operative time of 271.42 (SD:37.95) minutes. No conversion occurred. Two patients developed postoperative complications. The mean hospital stay was 8.28 (SD:1.47) days with no readmissions. Mortality was nil. All patients underwent loop-ileostomy closure, and functional outcomes were satisfactory. The literature appraisal was based on 23 retrospective studies, including 736 robotic and 9,904 laparoscopic multiquadrant surgeries. In the robotic group, 36 patients underwent STC, 371 TC, 166 TPC, and 163 CP. Pooled data analysis showed that robotic TC and STC had a lower conversion rate (OR = 0.17;95% CI, 0.04–0.82; p = 0.03) than laparoscopic TC and STC. The robotic approach was associated with longer operative time for TC and STC (MD = 104.64;95% CI, 18.42–190.87; p = 0.02) and TPC and CP (MD = 38.8;95% CI, 18.7–59.06; p = 0.0002), with no differences for postoperative complications and hospital stay. Reports on urological outcomes, sexual dysfunction, and quality of life were missing. Conclusions: Our experience and the literature suggest that robotic multiquadrant colorectal surgery is safe and effective, with low morbidity and mortality rates. Nevertheless, the overall level of evidence is low, and functional outcomes of robotic approach remain largely unknown. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022303016

Violence and vulnerability:Children’s strategies and the logic of violence in Burundi

This study explores how children in conflict-affected Burundi deal with violence in their everyday lives. Focusing on schools as a context in which children are prepared for further roles in society, child-centred, qualitative and mixed-methods research was conducted at 36 primary schools throughout Burundi. Findings reveal that children use a variety of strategies to deal with violence they encounter. These strategies reflect a learned 'logic of violence', matching dynamics of violence and vulnerability in society at large. Children's strategies are ultimately aimed at reducing vulnerability to (future) violence and indicative of the omnipresence of violence and uncertainty in Burundi. (C) 2019 The Authors. Children & Society published by National Children's Bureau and John Wiley & Sons LtdPublic Health and primary car

Immune-related pan-cancer gene expression signatures of patient survival revealed by NanoString-based analyses

The immune system plays a central role in the onset and progression of cancer. A better understanding of transcriptional changes in immune cell-related genes associated with cancer progression, and their significance in disease prognosis, is therefore needed. NanoString-based targeted gene expression profiling has advantages for deployment in a clinical setting over RNA-seq technologies. We analysed NanoString PanCancer Immune Profiling panel gene expression data encompassing 770 genes, and overall survival data, from multiple previous studies covering 10 different cancer types, including solid and blood malignancies, across 515 patients. This analysis revealed an immune gene signature comprising 39 genes that were upregulated in those patients with shorter overall survival; of these 39 genes, three (MAGEC2, SSX1 and ULBP2) were common to both solid and blood malignancies. Most of the genes identified have previously been reported as relevant in one or more cancer types. Using Cibersort, we investigated immune cell levels within individual cancer types and across groups of cancers, as well as in shorter and longer overall survival groups. Patients with shorter survival had a higher proportion of M2 macrophages and γδ T cells. Patients with longer overall survival had a higher proportion of CD8+ T cells, CD4+ T memory cells, NK cells and, unexpectedly, T regulatory cells. Using a transcriptomics platform with certain advantages for deployment in a clinical setting, our multi-cancer meta-analysis of immune gene expression and overall survival data has identified a specific transcriptional profile associated with poor overall survival

Distinct Hypothalamic Neurons Mediate Estrogenic Effects on Energy Homeostasis and Reproduction

SummaryEstrogens regulate body weight and reproduction primarily through actions on estrogen receptor-α (ERα). However, ERα-expressing cells mediating these effects are not identified. We demonstrate that brain-specific deletion of ERα in female mice causes abdominal obesity stemming from both hyperphagia and hypometabolism. Hypometabolism and abdominal obesity, but not hyperphagia, are recapitulated in female mice lacking ERα in hypothalamic steroidogenic factor-1 (SF1) neurons. In contrast, deletion of ERα in hypothalamic pro-opiomelanocortin (POMC) neurons leads to hyperphagia, without directly influencing energy expenditure or fat distribution. Further, simultaneous deletion of ERα from both SF1 and POMC neurons causes hypometabolism, hyperphagia, and increased visceral adiposity. Additionally, female mice lacking ERα in SF1 neurons develop anovulation and infertility, while POMC-specific deletion of ERα inhibits negative feedback regulation of estrogens and impairs fertility in females. These results indicate that estrogens act on distinct hypothalamic ERα neurons to regulate different aspects of energy homeostasis and reproduction

Impacts of physical parameterization on prediction of ethane concentrations for oil and gas emissions in WRF-Chem

Recent increases in natural gas (NG) production through hydraulic fracturing have called the climate benefit of switching from coal-fired to natural gas-fired power plants into question. Higher than expected levels of methane, non-methane hydrocarbons (NMHC), and NOx have been observed in areas close to oil and NG operation facilities. Large uncertainties in the oil and NG operation emission inventories reduce the confidence level in the impact assessment of such activities on regional air quality and climate, as well as in the development of effective mitigation policies. In this work, we used ethane as the indicator of oil and NG emissions and explored the sensitivity of ethane to different physical parameterizations and simulation setups in the Weather Research and Forecasting with Chemistry (WRF-Chem) model using the US EPA National Emission Inventory (NEI-2011). We evaluated the impact of the following configurations and parameterizations on predicted ethane concentrations: planetary boundary layer (PBL) parameterizations, daily re-initialization of meteorological variables, meteorological initial and boundary conditions, and horizontal resolution. We assessed the uncertainties around oil and NG emissions using measurements from the FRAPPÉ and DISCOVER-AQ campaigns over the northern Front Range metropolitan area (NFRMA) in summer 2014. The sensitivity analysis shows up to 57.3&thinsp;% variability in the normalized mean bias of the near-surface modeled ethane across the simulations, which highlights the important role of model configurations on the model performance and ultimately the assessment of emissions. Comparison between airborne measurements and the sensitivity simulations indicates that the model–measurement bias of ethane ranged from −14.9 to −8.2&thinsp;ppb (NMB ranged from −80.5&thinsp;% to −44&thinsp;%) in regions close to oil and NG activities. Underprediction of ethane concentration in all sensitivity runs suggests an actual underestimation of the oil and NG emissions in the NEI-2011. An increase of oil and NG emissions in the simulations partially improved the model performance in capturing ethane and lumped alkanes (HC3) concentrations but did not impact the model performance in capturing benzene, toluene, and xylene; this is due to very low emission rates of the latter species from the oil and NG sector in NEI-2011.</p