Chemotherapy for advanced gastric cancer.

Gastric cancer is the fifth most common cancer worldwide. In "Western" countries, most people are either diagnosed at an advanced stage, or develop a relapse after surgery with curative intent. In people with advanced disease, significant benefits from targeted therapies are currently limited to HER-2 positive disease treated with trastuzumab, in combination with chemotherapy, in first-line. In second-line, ramucirumab, alone or in combination with paclitaxel, demonstrated significant survival benefits. Thus, systemic chemotherapy remains the mainstay of treatment for advanced gastric cancer. Uncertainty remains regarding the choice of the regimen. To assess the efficacy of chemotherapy versus best supportive care (BSC), combination versus single-agent chemotherapy and different chemotherapy combinations in advanced gastric cancer. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and Embase up to June 2016, reference lists of studies, and contacted pharmaceutical companies and experts to identify randomised controlled trials (RCTs). We considered only RCTs on systemic, intravenous or oral chemotherapy versus BSC, combination versus single-agent chemotherapy and different chemotherapy regimens in advanced gastric cancer. Two review authors independently identified studies and extracted data. A third investigator was consulted in case of disagreements. We contacted study authors to obtain missing information. We included 64 RCTs, of which 60 RCTs (11,698 participants) provided data for the meta-analysis of overall survival. We found chemotherapy extends overall survival (OS) by approximately 6.7 months more than BSC (hazard ratio (HR) 0.3, 95% confidence intervals (CI) 0.24 to 0.55, 184 participants, three studies, moderate-quality evidence). Combination chemotherapy extends OS slightly (by an additional month) versus single-agent chemotherapy (HR 0.84, 95% CI 0.79 to 0.89, 4447 participants, 23 studies, moderate-quality evidence), which is partly counterbalanced by increased toxicity. The benefit of epirubicin in three-drug combinations, in which cisplatin is replaced by oxaliplatin and 5-FU is replaced by capecitabine is unknown.Irinotecan extends OS slightly (by an additional 1.6 months) versus non-irinotecan-containing regimens (HR 0.87, 95% CI 0.80 to 0.95, 2135 participants, 10 studies, high-quality evidence).Docetaxel extends OS slightly (just over one month) compared to non-docetaxel-containing regimens (HR 0.86, 95% CI 0.78 to 0.95, 2001 participants, eight studies, high-quality evidence). However, due to subgroup analyses, we are uncertain whether docetaxel-containing combinations (docetaxel added to a single-agent or two-drug combination) extends OS due to moderate-quality evidence (HR 0.80, 95% CI 0.71 to 0.91, 1466 participants, four studies, moderate-quality evidence). When another chemotherapy was replaced by docetaxel, there is probably little or no difference in OS (HR 1.05; 0.87 to 1.27, 479 participants, three studies, moderate-quality evidence). We found there is probably little or no difference in OS when comparing capecitabine versus 5-FU-containing regimens (HR 0.94, 95% CI 0.79 to 1.11, 732 participants, five studies, moderate-quality evidence) .Oxaliplatin may extend (by less than one month) OS versus cisplatin-containing regimens (HR 0.81, 95% CI 0.67 to 0.98, 1105 participants, five studies, low-quality evidence). We are uncertain whether taxane-platinum combinations with (versus without) fluoropyrimidines extend OS due to very low-quality evidence (HR 0.86, 95% CI 0.71 to 1.06, 482 participants, three studies, very low-quality evidence). S-1 regimens improve OS slightly (by less than an additional month) versus 5-FU-containing regimens (HR 0.91, 95% CI 0.83 to 1.00, 1793 participants, four studies, high-quality evidence), however since S-1 is used in different doses and schedules between Asian and non-Asian population, the applicability of this finding to individual populations is uncertain. Chemotherapy improves survival (by an additional 6.7 months) in comparison to BSC, and combination chemotherapy improves survival (by an additional month) compared to single-agent 5-FU. Testing all patients for HER-2 status may help to identify patients with HER-2-positive tumours, for whom, in the absence of contraindications, trastuzumab in combination with capecitabine or 5-FU in combination with cisplatin has been shown to be beneficial. For HER-2 negative people, all different two-and three-drug combinations including irinotecan, docetaxel, oxaliplatin or oral 5-FU prodrugs are valid treatment options for advanced gastric cancer, and consideration of the side effects of each regimen is essential in the treatment decision. Irinotecan-containing combinations and docetaxel-containing combinations (in which docetaxel was added to a single-agent or two-drug (platinum/5-FUcombination) show significant survival benefits in the comparisons studied above. Furthermore, docetaxel-containing three-drug regimens have increased response rates, but the advantages of the docetaxel-containing three-drug combinations (DCF, FLO-T) are counterbalanced by increased toxicity. Additionally, oxaliplatin-containing regimens demonstrated a benefit in OS as compared to the same regimen containing cisplatin, and there is a modest survival improvement of S-1 compared to 5-FU-containing regimens.Whether the survival benefit for three-drug combinations including cisplatin, 5-FU, and epirubicin as compared to the same regimen without epirubicin is still valid when second-line therapy is routinely administered and when cisplatin is replaced by oxaliplatin and 5-FU by capecitabine is questionable. Furthermore, the magnitude of the observed survival benefits for the three-drug regimens is not large enough to be clinically meaningful as defined recently by the American Society for Clinical Oncology (Ellis 2014). In contrast to the comparisons in which a survival benefit was observed by adding a third drug to a two-drug regimen at the cost of increased toxicity, the comparison of regimens in which another chemotherapy was replaced by irinotecan was associated with a survival benefit (of borderline statistical significance), but without increased toxicity. For this reason irinotecan/5-FU-containing combinations are an attractive option for first-line treatment. Although they need to be interpreted with caution, subgroup analyses of one study suggest that elderly people have a greater benefit form oxaliplatin, as compared to cisplatin-based regimens, and that people with locally advanced disease or younger than 65 years might benefit more from a three-drug regimen including 5-FU, docetaxel, and oxaliplatin as compared to a two-drug combination of 5-FU and oxaliplatin, a hypothesis that needs further confirmation. For people with good performance status, the benefit of second-line chemotherapy has been established in several RCTs

Population differences in associations of serotonin transporter promoter polymorphism (5HTTLPR) di- and triallelic genotypes with blood pressure and hypertension prevalence

Based on prior research finding the 5HTTLPR L allele associated with increased cardiovascular reactivity to laboratory stressors and increased risk of myocardial infarction, we hypothesized that the 5HTTLPR L allele will be associated with increased blood pressure (BP) and increased hypertension prevalence in 2 large nationally representative samples in the United States and Singapore. Methods Logistic regression and linear models tested associations between triallelic (L′S′, based on rs25531) 5HTTLPR genotypes and hypertension severity and mean systolic and diastolic blood pressure (SBP and DBP) collected during the Wave IV survey of the National Longitudinal Study of Adolescent to Adult Health (Add Health, N = 11,815) in 2008–09 and during 2004–07 in 4196 Singaporeans. Results In US Whites, L′ allele carriers had higher SBP (0.9 mm Hg, 95% CI = 0.26-1.56) and greater odds (OR = 1.23, 95% CI = 1.10-1.38) of more severe hypertension than those with S′S′ genotypes. In African Americans, L′ carriers had lower mean SBP (−1.27 mm Hg, 95% CI = −2.53 to −0.01) and lower odds (OR = 0.78, 95% CI = 0.65-0.94) of more severe hypertension than those with the S′S′ genotype. In African Americans, those with L′L′ genotypes had lower DBP (−1.13 mm Hg, 95% CI = −2.09 to −0.16) than S′ carriers. In Native Americans, L′ carriers had lower SBP (−6.05 mm Hg, 95% CI = −9.59 to −2.51) and lower odds of hypertension (OR = 0.34, 95% CI = 0.13-0.89) than those with the S′S′ genotype. In Asian/Pacific Islanders those carrying the L′ allele had lower DBP (−1.77 mm Hg, 95% CI = −3.16 to −0.38) and lower odds of hypertension (OR = 0.68, 95% CI = 0.48-0.96) than those with S′S′. In the Singapore sample S′ carriers had higher SBP (3.02 mm Hg, 95% CI = 0.54-5.51) and DBP (1.90 mm Hg, 95% CI = 0.49-3.31) than those with the L′L′ genotype. Conclusions These findings suggest that Whites carrying the L′ allele, African Americans and Native Americans with the S′S′ genotype, and Asians carrying the S′ allele will be found to be at higher risk of developing cardiovascular disease and may benefit from preventive measures

Plasma Wakefield Acceleration with a Modulated Proton Bunch

The plasma wakefield amplitudes which could be achieved via the modulation of a long proton bunch are investigated. We find that in the limit of long bunches compared to the plasma wavelength, the strength of the accelerating fields is directly proportional to the number of particles in the drive bunch and inversely proportional to the square of the transverse bunch size. The scaling laws were tested and verified in detailed simulations using parameters of existing proton accelerators, and large electric fields were achieved, reaching 1 GV/m for LHC bunches. Energy gains for test electrons beyond 6 TeV were found in this case.Comment: 9 pages, 7 figure

The energy dependence of ptp_t angular correlations inferred from mean-ptp_{t} fluctuation scale dependence in heavy ion collisions at the SPS and RHIC

We present the first study of the energy dependence of $p_t$ angular correlations inferred from event-wise mean transverse momentum fluctuations in heavy ion collisions. We compare our large-acceptance measurements at CM energies $\sqrt{s_{NN}} =$ 19.6, 62.4, 130 and 200 GeV to SPS measurements at 12.3 and 17.3 GeV. $p_t$ angular correlation structure suggests that the principal source of $p_t$ correlations and fluctuations is minijets (minimum-bias parton fragments). We observe a dramatic increase in correlations and fluctuations from SPS to RHIC energies, increasing linearly with $\ln \sqrt{s_{NN}}$ from the onset of observable jet-related fluctuations near 10 GeV.Comment: 10 pages, 4 figure

Direct Reaction Measurements Using GODDESS

GODDESS is a coupling of the charged-particle detection system ORRUBA to the gamma-ray detector array Gammasphere. This coupling has been developed in order to facilitate the high-resolution measurement of direct reactions in normal and inverse kinematics with stable and radioactive beams. GODDESS has been commissioned using a beam of 134Xe at 10 MeV/A, in a campaign of stable beam measurements. The measurement demonstrates the capabilities of GODDESS under radioactive beam conditions, and provides the first data on the single-neutron states in 135Xe, including previously unobserved states based on the orbitals above the N=82 shell closure

Longitudinal Double-Spin Asymmetry and Cross Section for Inclusive Jet Production in Polarized Proton Collisions at √s = 200 GeV

We report a measurement of the longitudinal double-spin asymmetry ALL and the differential cross section for inclusive midrapidity jet production in polarized proton collisions at √s=200  GeV. The cross section data cover transverse momenta

Two-particle correlations on transverse momentum and momentum dissipation in Au-Au collisions at sqrt(sNN) = 130 GeV

Measurements of two-particle correlations on transverse momentum pt for Au–Au collisions at GeV are presented. Significant large-momentum-scale correlations are observed for charged primary hadrons with 0.15 ≤ pt ≤ 2 GeV/c and pseudorapidity |η| ≤ 1.3. Such correlations were not observed in a similar study at lower energy and are not predicted by theoretical collision models. Their direct relation to mean-pt fluctuations measured in the same angular acceptance is demonstrated. Positive correlations are observed for pairs of particles which have large pt values while negative correlations occur for pairs in which one particle has large pt and the other has much lower pt. The correlation amplitudes per final state particle increase with collision centrality. The observed correlations are consistent with a scenario in which the transverse momentum of hadrons associated with initial-stage semi-hard parton scattering is dissipated by the medium to lower pt

The energy dependence of p\u3csub\u3et\u3c/sub\u3e angular correlations inferred from mean-p\u3csub\u3et\u3c/sub\u3e fluctuation scale dependence in heavy ion collisions at the SPS and RHIC

We present the first study of the energy dependence of pt angular correlations inferred from event-wise mean transverse momentum pt fluctuations in heavy ion collisions. We compare our large-acceptance measurements at CM energies , 62.4, 130 and 200 GeV to SPS measurements at 12.3 and 17.3 GeV. pt angular correlation structure suggests that the principal source of pt correlations and fluctuations is minijets (minimum-bias parton fragments). We observe a dramatic increase in correlations and fluctuations from SPS to RHIC energies, increasing linearly with from the onset of observable jet-related pt fluctuations near 10 GeV

Scaling Properties of Hyperon Production in Au + Au Collisions at √sNN = 200 GeV

We present the scaling properties of Λ, Ξ, and Ω in midrapidity Au+Au collisions at the Brookhaven National Laboratory Relativistic Heavy Ion Collider at sNN−−−−√=200  GeV. The yield of multistrange baryons per participant nucleon increases from peripheral to central collisions more rapidly than that of Λ, indicating an increase of the strange-quark density of the matter produced. The strange phase-space occupancy factor γs approaches unity for the most central collisions. Moreover, the nuclear modification factors of p, Λ, and Ξ are consistent with each other for

Direct Observation of Dijets in Central Au+Au Collisions at √sNN=200 GeV

The STAR Collaboration at the Relativistic Heavy Ion Collider reports measurements of azimuthal correlations of high transverse momentum (pT) charged hadrons in Au+Au collisions at higher pT than reported previously. As pT is increased, a narrow, back-to-back peak emerges above the decreasing background, providing a clear dijet signal for all collision centralities studied. Using these correlations, we perform a systematic study of dijet production and suppression in nuclear collisions, providing new constraints on the mechanisms underlying partonic energy loss in dense matter