The phase III AXEPT study showed the noninferiority of modified capecitabine plus irinotecan (mXELIRI) with or without bevacizumab relative to fluorouracil, leucovorin, and irinotecan (FOLFIRI) with ...or without bevacizumab as a second‐line treatment for metastatic colorectal cancer. We evaluated the associations between the UGT1A1 genotype linked to adverse events—caused by irinotecan—and the efficacy and safety of mXELIRI and FOLFIRI. The UGT1A1 genotype was prospectively determined and patients were categorized into three groups according to WT (*1/*1), single heterozygous (SH; *28/*1 or *6/*1), and double heterozygous or homozygous (DHH; *28/*28, *6/*6, or *28/*6). Overall survival (OS), progression‐free survival, response rate, and safety were assessed. The UGT1A1 genotype was available in all 650 randomized patients (WT, 309 47.5%; SH, 291 44.8%; DHH, 50 7.7%). The median OS was 15.9, 17.7, and 10.6 months in the WT, SH, and DHH groups, respectively, with an adjusted hazard ratio (HR) of 1.53 (95% confidence interval CI, 1.12‐2.09; P = .008) for DHH vs WT or SH. The median OS in the mXELIRI and FOLFIRI arms was 18.1 vs 14.3 months (HR 0.80; 95% CI, 0.62‐1.03) in the WT group, 16.3 vs 18.3 months (HR 1.04; 95% CI, 0.79‐1.36) in the SH group, and 13.0 vs 9.1 months (HR 0.71; 95% CI, 0.39‐1.31) in the DHH group, respectively. Modified capecitabine plus irinotecan with or without bevacizumab could be a standard second‐line chemotherapy in terms of efficacy and safety regardless of the UGT1A1 genotype.
Capecitabine plus irinotecan (XELIRI) with or without bevacizumab is noninferior to fluorouracil, leucovorin, and irinotecan (FOLFIRI) with or without bevacizumab in terms of overall survival, regardless of UGT1A1 genotype. Additionally, modified XELIRI with or without bevacizumab showed a favorable tolerability profile that was comparable to that of FOLFIRI with or without bevacizumab among all UGT1A1 genotypes.
The phenomenological interplay in the segregation of phosphorus (P) and transition metal (TM) elements at grain boundaries (GBs) in steels has long been suspected to be the main contributor to temper ...embrittlement. However, many of the details remain unclear. Here, we investigate the segregation, co-segregation and cohesion effects of TMs (Co, Cr, Cu, Mn, Mo, Ni, Nb, Ti, V, W) along with P in various ferritic iron (α-Fe) GBs utilising density functional theory and simulations of kinetics. Our findings demonstrate that P is unlikely to cause intergranular fracture via weakened interfacial bonding when segregated by itself. Nevertheless, the stronger segregation binding of P compared to TMs can explain the ubiquitous presence of P segregated at GBs. We find that most P-TM interactions at ferritic GBs are repulsive and differ significantly from the corresponding interactions in the bulk. Due to the repulsive interactions and strong segregation binding of P, the enrichment of P over time at GBs leads to the depletion of prior-segregated cohesion-enhancing solutes at general GBs. Additionally, certain P-TM co-segregation combinations that are cohesion-lowering are energetically favoured at such GBs. We posit these mechanisms act in tandem as critical causalities of P-induced temper embrittlement in alloyed steels. Finally, we reveal a contradiction in the predicted cohesion effects of segregated P calculated in the Rice–Thomson–Wang theory of interfacial embrittlement compared to that as assessed by chemical bonding strength, calculated in the DDEC6 bond-order framework. These findings have important implications for GB engineering for interfacial cohesion.
Display omitted
The 2023 update of the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China, reflecting the latest ...advancements in evidence‐based medicine, healthcare resource availability, and precision medicine. These updates address the differences in epidemiological characteristics, clinicopathological features, tumor biology, treatment patterns, and drug selections between Eastern and Western gastric cancer patients. Key revisions include a structured template for imaging diagnosis reports, updated standards for molecular marker testing in pathological diagnosis, and an elevated recommendation for neoadjuvant chemotherapy in stage III gastric cancer. For advanced metastatic gastric cancer, the guidelines introduce new recommendations for immunotherapy, anti‐angiogenic therapy and targeted drugs, along with updated management strategies for human epidermal growth factor receptor 2 (HER2)‐positive and deficient DNA mismatch repair (dMMR)/microsatellite instability‐high (MSI‐H) patients. Additionally, the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer. The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice, particularly in the heterogeneous healthcare landscape of China, while maintaining a commitment to scientific rigor, impartiality, and timely revisions.
Thermal priming of reef corals can enhance their heat tolerance; however, the legacy effects of heat stress during parental brooding on larval resilience remain understudied. This study investigated ...whether preconditioning adult coral Pocillopora damicornis to high temperatures (29°C and 32°C) could better prepare their larvae for heat stress. Results showed that heat‐acclimated adults brooded larvae with reduced symbiont density and shifted thermal performance curves. Reciprocal transplant experiments demonstrated higher bleaching resistance and better photosynthetic and autotrophic performance in heat‐exposed larvae from acclimated adults compared to unacclimated adults. RNA‐seq revealed strong cellular stress responses in larvae from heat‐acclimated adults that could have been effective in rescuing host cells from stress, as evidenced by the widespread upregulation of genes involved in cell cycle and mitosis. For symbionts, a molecular coordination between light harvesting, photoprotection and carbon fixation was detected in larvae from heat‐acclimated adults, which may help optimize photosynthetic activity and yield under high temperature. Furthermore, heat acclimation led to opposing regulations of symbiont catabolic and anabolic pathways and favoured nutrient translocation to the host and thus a functional symbiosis. Notwithstanding, the improved heat tolerance was paralleled by reduced light‐enhanced dark respiration, indicating metabolic depression for energy saving. Our findings suggest that adult heat acclimation can rapidly shift thermal tolerance of brooded coral larvae and provide integrated physiological and molecular evidence for this adaptive plasticity, which could increase climate resilience. However, the metabolic depression may be maladaptive for long‐term organismal performance, highlighting the importance of curbing carbon emissions to better protect corals.
Display omitted
•GB character controls vulnerability to hydrogen segregation and embrittlement.•Low energy, highly coherent GBs minimise H-accumulation, embrittlement.•H-H interactions controls ...amount of H segregation, accumulation at a GB.•Bonding analysis reveals fundamental atomistic nature of H-embrittlement at GBs.
Here, the segregation and accumulation of hydrogen in Ni grain boundaries, and its effects on cohesion and tensile mechanical strength were studied by means of density functional theory simulations. Three model grain boundaries were considered: the Σ3(11¯1)110, Σ5(120)001 and Σ11(11¯0)113, as representatives for the highly coherent twin, high energy random high angle, and “special” low energy highly coherent grain boundaries, respectively. Hydrogen segregation was found to be favourable in the Σ5 and Σ11 grain boundaries, but not in the Σ3. Hydrogen accumulation studied via a comprehensive site-permutation analysis revealed the mechanisms for how H accumulation capacity varies as a function of grain boundary character. We show that the interfacial cohesion of boundaries can diminish by between 6.7–37.5% at varying levels of H-accumulation. The cohesion of the grain boundaries was analysed using a novel chemical bond-order based approach, enabling a quantitative atomistic determination of the fracture paths arising from hydrogen embrittlement. These simulations explain the details of why grain boundary character is the principal determinant of the likelihood of hydrogen segregation and accumulation, and hence their vulnerability to hydrogen-enhanced decohesion. This knowledge can be used in the design of thermomechanical processes to achieve grain boundary engineering for resistance to hydrogen embrittlement.
Urban street dusts were collected in commercial area (CA), traffic area (TA), educational area (EA), residential area (RA) and parks area (PA) of Chengdu, China, to investigate the concentrations of ...heavy metals (Pb, Zn, Cu, Ni, Cd and Cr), and analyzed to evaluated possible sources and health risk assessment. The average concentrations (mg/kg) of Pb (82.3), Zn (296), Cu (100), Cd (1.66) and Cr (84.3) in urban street dusts were all higher than the local soil background values. The concentrations of heavy metals in each functional area could be classified as follows: CA>TA>RA>EA>PA. Principal component analysis and Cluster analysis showed mainly derived from the mixed sources of nature and traffic (51.7%). The results of health risk assessment showed no non-carcinogenic and carcinogenic risks of the metals for inhabitants. However, higher concentrations and oral bioaccessibility of the heavy metals in the dusts from CA and TA, indicating there was more health risks to the inhabitants in than that in other functional areas.
Display omitted
•Heavy metal concentrations in street dust collected from 5 functional areas•Health risks were evaluated for the metals combined with oral bioaccessibility.•The highest total metal concentrations were found in commercial area.•Pb, Zn, Cu, Cd and Cr mainly originate from anthropogenic sources.
•Heavy metal concentrations in household dust collected from 6 urban districts.•Health risks were evaluated for the metals combined with oral bioaccessibility.•There was negative correlation between ...the metals concentrations and floor levels.
Display omitted
To investigate the characteristics of heavy metals (Cr, Cd, Pb, Zn, Cu and Ni) in household dust in urban household environment of Chengdu, China, 90 household dust samples were collected from 6 districts of the city. The information of houses and residents were also recorded during dust sampling to identify the correlations between heavy metals in household dust and the house attributes. And also the principal component analysis and cluster analysis for sources and impactor factors. The concentrations of Pb (123mg·kg−1), Zn (675mg·kg−1), Cu (190mg·kg−1), Cr (82.7mg·kg−1), Cd (2.37mg·kg−1) and Ni (52.6mg·kg−1) in household dust are in low or moderate levels when compare with that from other counties or areas. The heavy metals of household dust samples from Chengdu is higher concentrations than that in the street dust from Chengdu, except for Cr. Statistical analysis result showed traffic sources and corrosion of alloys are important factors contributing to the rise concentrations of heavy metals in household dust. In addition, there is negative correlation (p<0.05) between the heavy metals concentrations and floor levels. The ingestion is the important pathway for Pb, Zn, Cu and Ni via household dust exposure to the residents, and the dermal contact was identified as a main route for Cr and Cd in household dust exposure to the residents. There are minor non-carcinogenic and carcinogenic risks from the heavy metals in household dust for the residents in Chengdu.
Esophageal cancer poses diagnostic, therapeutic and economic burdens in high-risk regions. Artificial intelligence (AI) has been developed for diagnosis and outcome prediction using various features, ...including clinicopathologic, radiologic, and genetic variables, which can achieve inspiring results. One of the most recent tasks of AI is to use state-of-the-art deep learning technique to detect both early esophageal squamous cell carcinoma and esophageal adenocarcinoma in Barrett's esophagus. In this review, we aim to provide a comprehensive overview of the ways in which AI may help physicians diagnose advanced cancer and make clinical decisions based on predicted outcomes, and combine the endoscopic images to detect precancerous lesions or early cancer. Pertinent studies conducted in recent two years have surged in numbers, with large datasets and external validation from multi-centers, and have partly achieved intriguing results of expert's performance of AI in real time. Improved pre-trained computer-aided diagnosis algorithms in the future studies with larger training and external validation datasets, aiming at real-time video processing, are imperative to produce a diagnostic efficacy similar to or even superior to experienced endoscopists. Meanwhile, supervised randomized controlled trials in real clinical practice are highly essential for a solid conclusion, which meets patient-centered satisfaction. Notably, ethical and legal issues regarding the black-box nature of computer algorithms should be addressed, for both clinicians and regulators.
Drug combination is a common method for clinical disease treatment. Whether the combination of drugs is reasonable often affects the result of the disease treatment. Many methods have been used to ...evaluate interaction between drugs to date. Isobologram analysis has been mathematically proven and widely used to evaluate drug interactions. In this paper, the principle of isobologram analysis and its application in drug interaction evaluation are summarized. The applications of the similar cotoxicity coefficient and fractional inhibitory concentration index in the evaluation of drug interaction are also reviewed. This work is expected to evaluate the effect of formulations scientifically and provide scientific judgment standards for the development of formulations and clinical drug compatibility.Drug combination is a common method for clinical disease treatment. Whether the combination of drugs is reasonable often affects the result of the disease treatment. Many methods have been used to evaluate interaction between drugs to date. Isobologram analysis has been mathematically proven and widely used to evaluate drug interactions. In this paper, the principle of isobologram analysis and its application in drug interaction evaluation are summarized. The applications of the similar cotoxicity coefficient and fractional inhibitory concentration index in the evaluation of drug interaction are also reviewed. This work is expected to evaluate the effect of formulations scientifically and provide scientific judgment standards for the development of formulations and clinical drug compatibility.
PDF
