BackgroundProgrammed cell death protein 1 (PD-1) pathway blockade with immune checkpoint inhibitors (ICIs) is a standard therapy in advanced hepatocellular carcinoma (HCC) nowadays. No strategies to ...overcome ICI resistance have been described. We aimed to evaluate the use of ipilimumab and anti-PD-1 ICIs (nivolumab or pembrolizumab) combinations in patients with advanced HCC with progression on prior ICIs.MethodsPatients with advanced HCC with documented tumor progression on prior ICIs and subsequently received ipilimumab with nivolumab/pembrolizumab were analyzed. Objective response rate (ORR), median duration of response (DOR), time-to-progression (TTP), overall survival (OS), and treatment-related adverse events (TRAEs) were assessed.ResultsTwenty-five patients were included. The median age was 62 (range: 51–83). About 68% were of Child-Pugh (CP) Grade A and 48% had primary resistance to prior ICI. At median follow-up of 37.7 months, the ORR was 16% with a median DOR of 11.5 months (range: 2.76–30.3). Three patients achieved complete response. The median TTP was 2.96 months (95% CI: 1.61 to 4.31). Median OS was 10.9 months (95% CI: 3.99 to 17.8) and the 1 year, 2 year and 3 year survival rates were 42.4%, 32.3% and 21.6%, respectively. The ORR was 16.7% in primary resistance group and 15.4% in acquired resistance group (p=1.00). All responders were of CP A and Albumin-Bilirubin (ALBI) Grade 1 or 2. CP and ALBI Grades were significantly associated with OS (p=0.006 and p<0.001, respectively). Overall, 52% of patients experienced TRAEs and 12% experienced Grade 3 or above TRAEs.ConclusionsIpilimumab and nivolumab/pembrolizumab can achieve durable antitumor activity and encouraging survival outcomes with acceptable toxicity in patients with advanced HCC who had prior treatment with ICIs.
The synthesis and properties of the bridged piperidine (oxaazabicyclo) compounds 8, 9, and 11 are described. A conformational analysis of these structures is compared with the representative GPR119 ...ligand 1. These results and the differences in agonist pharmacology are used to formulate a conformation-based hypothesis to understand activation of the GPR119 receptor. We also show for these structures that the agonist pharmacology in rat masks the important differences in human pharmacology.
Aqueous phosphoric acid (85 wt %) is an effective, environmentally benign reagent for the deprotection of tert-butyl carbamates, tert-butyl esters, and tert-butyl ethers. The reaction conditions are ...mild and offer good selectivity in the presence of other acid-sensitive groups, including CBZ carbamates, azetidine, benzyl and methyl esters, TBDMS, and methyl phenyl ethers. The mildness of the reaction is further demonstrated in the synthesis of clarithromycin derivative, in which a tert-butyl ester is removed in the presence of cyclic carbamate, lactone, ketal, acetate ester, and epimerizable methyl ketone functionalities. The reaction preserves the stereochemical integrity of the substrates. The reactions are high yielding, and the workup is convenient.
A scaleable and highly regioselective C-4 bromination of 5-substituted oxazoles is described. The use of DMF as solvent played a critical role in significantly improving the C-4/C-2 bromination ...ratio. The resulting 4-bromooxazoles were shown to be good Suzuki–Miyaura coupling partners with arylboronic acids. Furthermore, a simple and convenient method that employs triethylamine efficiently purged residual levels of palladium and iron to less than 10 ppm.
Depressive and manic episodes within bipolar disorder (BD) and major depressive disorder (MDD) involve altered mood, sleep, and activity, alongside physiological alterations wearables can capture.
...Firstly, we explored whether physiological wearable data could predict (aim 1) the severity of an acute affective episode at the intra-individual level and (aim 2) the polarity of an acute affective episode and euthymia among different individuals. Secondarily, we explored which physiological data were related to prior predictions, generalization across patients, and associations between affective symptoms and physiological data.
We conducted a prospective exploratory observational study including patients with BD and MDD on acute affective episodes (manic, depressed, and mixed) whose physiological data were recorded using a research-grade wearable (Empatica E4) across 3 consecutive time points (acute, response, and remission of episode). Euthymic patients and healthy controls were recorded during a single session (approximately 48 h). Manic and depressive symptoms were assessed using standardized psychometric scales. Physiological wearable data included the following channels: acceleration (ACC), skin temperature, blood volume pulse, heart rate (HR), and electrodermal activity (EDA). Invalid physiological data were removed using a rule-based filter, and channels were time aligned at 1-second time units and segmented at window lengths of 32 seconds, as best-performing parameters. We developed deep learning predictive models, assessed the channels' individual contribution using permutation feature importance analysis, and computed physiological data to psychometric scales' items normalized mutual information (NMI). We present a novel, fully automated method for the preprocessing and analysis of physiological data from a research-grade wearable device, including a viable supervised learning pipeline for time-series analyses.
Overall, 35 sessions (1512 hours) from 12 patients (manic, depressed, mixed, and euthymic) and 7 healthy controls (mean age 39.7, SD 12.6 years; 6/19, 32% female) were analyzed. The severity of mood episodes was predicted with moderate (62%-85%) accuracies (aim 1), and their polarity with moderate (70%) accuracy (aim 2). The most relevant features for the former tasks were ACC, EDA, and HR. There was a fair agreement in feature importance across classification tasks (Kendall W=0.383). Generalization of the former models on unseen patients was of overall low accuracy, except for the intra-individual models. ACC was associated with "increased motor activity" (NMI>0.55), "insomnia" (NMI=0.6), and "motor inhibition" (NMI=0.75). EDA was associated with "aggressive behavior" (NMI=1.0) and "psychic anxiety" (NMI=0.52).
Physiological data from wearables show potential to identify mood episodes and specific symptoms of mania and depression quantitatively, both in BD and MDD. Motor activity and stress-related physiological data (EDA and HR) stand out as potential digital biomarkers for predicting mania and depression, respectively. These findings represent a promising pathway toward personalized psychiatry, in which physiological wearable data could allow the early identification and intervention of mood episodes.
Leachate, a toxic and complex liquid, is a growing problem for municipal solid waste landfills. This study investigated non-catalytic and homogeneous catalytic (1 g/L MoO
3
and CuO) wet oxidation ...(WO) for leachate treatment and examined the performance and reusability of the economical catalysts. Leachate was subjected to a 60-min WO at 180–240 °C. Catalysts’ performance was evaluated through a reduction in chemical oxygen demand (COD) and total nitrogen content (TN), production and degradation of volatile fatty acids (VFAs), colour change, and surface characterisation. The breakdown of organic matter, such as humic and fulvic substances, benefited from increased reaction time, temperature and the presence of the catalysts. The catalysts’ contribution to degradation was found to be greater with increasing temperature. A maximum reduction in COD and TN of approximately 50% was obtained at 240 °C with CuO. However, the catalysts experienced fouling, decreasing the performance by up to 50%, limiting its reusability.
We describe the development of a sentiment analysis system for customer service calls, starting with the data acquisition and labeling, and proceeding to the algorithmic information extraction and ...modeling process from both spoken words and their acoustic expression. The proposed system is based on the combination of multiple acoustic and lexical models in a late fusion approach. Acoustic aspects of sentiment are captured by utterance-level features based on aggregated openSMILE and raw cepstral features, and further augmented with an energy contour model. Lexical aspects are captured by back-off n-gram language models. These models are found to combine effectively, showing different strengths as pertains to positive and negative sentiment detection.
Multiple methods for the preparation of 3,5-dibromopyrazole are described. While 3,5-dibromopyrazole is readily available on a kilogram scale, an internal demand facilitated the need to expand the ...vendor pool, with an overall goal of lowering cost. To pursue this goal, we focused on developing synthetic methods in the operating temperature range of −20 to 120 °C to remove production process constraints and explored the option of a continuous flow procedure for regioselective dehalogenation of 3,4,5-tribromopyrazole. An alternative method that started with bromination of pyrazole-3-carboxylate ester, followed by one-pot saponification and decarboxylation, was found to be efficient as well.
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