SimulConsult

<bold>Background:</bold> Multiple medical lasers have been used for central airway obstruction (CAO), Nd: YAG being the most common type. However, it has a deep tissue penetration (upto 1.5mm) with a risk of airway perforation, increased propensity for architectural distortion and airway scarring, and an inability to use in the vicinity of metal stents. The thulium laser (TL), used in urology, with a relatively lesser depth of penetration (0.25mm) helps overcome these drawbacks associated with Nd: YAG laser, and expands utility to metal stents. <bold>Methods:</bold> Bronchoscopic treatment with TL was performed in 27 consecutive patients with CAO amenable to bronchoscopic laser resection at our centre. The clinical details, computed tomography findings, degree of airway obstruction before and after procedure and complications were recorded. <bold>Results:</bold> 27 patients underwent 40 bronchoscopic procedures with TL application (1 procedure, n=18, 2 procedure, n=7, 3 procedure, n=1, 4 procedure n=1). 15 malignant, 6 benign and 6 endobronchial carcinoids were managed with a combination of laser vaporization and coagulation. Bleeding from highly vascular lesions like endobronchial carcinoid was effectively controlled with laser therapy. TL therapy was also effective for ablating tumour tissue and granulation in the vicinity of metallic stents as seen in four cases without complications. <bold>Conclusions:</bold> The thulium laser is a new generation, low penetration, precise laser, which is a safer and effective modality of treatment for CAO as compared to prior generation lasers. A low penetration allows use adjacent to metal stents, which offers significant advantage

BackgroundMetabolism is increasingly recognized as a key regulator of the function and phenotype of the primary cellular constituents of the atherosclerotic vascular wall, including endothelial cells, smooth muscle cells, and inflammatory cells. However, a comprehensive analysis of metabolic changes associated with the transition of plaque from a stable to a hemorrhaged phenotype is lacking.MethodsIn this study, we integrated two large mRNA expression and protein abundance datasets (BIKE, n = 126; MaasHPS, n = 43) from human atherosclerotic carotid artery plaque to reconstruct a genome-scale metabolic network (GEM). Next, the GEM findings were linked to metabolomics data from MaasHPS, providing a comprehensive overview of metabolic changes in human plaque.ResultsOur study identified significant changes in lipid, cholesterol, and inositol metabolism, along with altered lysosomal lytic activity and increased inflammatory activity, in unstable plaques with intraplaque hemorrhage (IPH+) compared to non-hemorrhaged (IPH−) plaques. Moreover, topological analysis of this network model revealed that the conversion of glutamine to glutamate and their flux between the cytoplasm and mitochondria were notably compromised in hemorrhaged plaques, with a significant reduction in overall glutamate levels in IPH+ plaques. Additionally, reduced glutamate availability was associated with an increased presence of macrophages and a pro-inflammatory phenotype in IPH+ plaques, suggesting an inflammation-prone microenvironment.ConclusionsThis study is the first to establish a robust and comprehensive GEM for atherosclerotic plaque, providing a valuable resource for understanding plaque metabolism. The utility of this GEM was illustrated by its ability to reliably predict dysregulation in the cholesterol hydroxylation, inositol metabolism, and the glutamine/glutamate pathway in rupture-prone hemorrhaged plaques, a finding that may pave the way to new diagnostic or therapeutic measures.

Abstract Nucleoside analogs such as gemcitabine have been widely used to treat many solid tumors. Despite their near universal use and well understood mechanisms of action, this class of chemotherapeutic agents has notable shortcomings including rapid metabolism, limited systemic exposure, acquired resistance, and dose-limiting toxicities. Albumin-based nanoparticles offer several advantages for drug delivery including direct tumor targeting, low risk of immunogenicity, and ease of synthesis and manufacturing. We have modified numerous nucleoside drugs of clinical significance to form new prodrugs and use nanoparticle encapsulation in an attempt to improve the therapeutic index of the parent drugs. Different prodrugs of gemcitabine were designed to evade drug resistance mechanisms, and methods were developed to form stable lyophilized nanoparticle formulations. Nanoparticles were characterized by particle size (~40-65 nm) and polydispersity, and dose-dependent effects on the proliferation of human tumor cell lines were compared to the response to the parent drug gemcitabine. To evaluate effects in vivo, nanoparticle formulations were dosed intravenously (IV) to immunocompromised mice bearing patient-derived xenografts (PDx). The prodrug JTX-836 (IC50=0.46 nM) was ~10x more potent against BxPC-3 pancreatic adenocarcinoma cells than the parent gemcitabine (IC50 = 5.2 nM) in vitro. IV dosing of JTX-836 albumin nanoparticle formulation improved tumor growth inhibition in PDx models of both pancreatic ductal adenocarcinoma (CTG-0282 TumorGraft, Champions Oncology) and ovarian cancer (CTG-1180, Champions Oncology) when compared to IV gemcitabine dosing. These results demonstrate the potential for nanoparticle encapsulation of prodrugs to improve the antitumor activity of existing nucleoside analog therapeutics and support continued development of albumin-based delivery of gemcitabine for the treatment of human cancer. Citation Format: Neil Raheja, Jason Kahana, Robin Jackman, Curtis Monnig. Novel prodrugs coupled with albumin nanoparticle encapsulation improves antitumor effects of the nucleoside analog gemcitabine [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P063.

The necessity to phase out chlorofluorocarbons (CFCs) and replace them with less environmentally harmful compounds has resulted in proliferation of the transition materials hydrochlorofluorocarbons (HCFC). In the end blends of HCFCs had to be made in order to match the essential properties of CFCs. The sheer number of all CFCs, HCFCs, fluorocarbons (HFCs) and hydrofluoroolefins (HFO) renders the task of listing all their properties impractical. The most commonly used agents have been fully characterized and their properties published. This chapter is a compilation of the properties of the most common and largest consumption volume CFCs, HCFCs, HFCs, HFOs and perfluorocarbons. Because different refrigerants possess different properties, the suitability of a refrigerant varies depending on the application.

The Al K alpha, 1486.6 eV, based x-ray photoelectron spectroscopy (XPS) of Fe 2p and Fe 3p for Fe(III) in Fe2O3 and Fe(II) in FeO is compared with theoretical predictions based on ab initio wavefunctions that accurately treat the final, core-hole, multiplets. The principal objectives of this comparison are to understand the multiplet structure and to evaluate the use of both the 2p and 3p spectra in determining oxidation states. In order to properly interpret the features of these spectra and to use the XPS to provide atomistic insights as well as atomic composition, it is necessary to understand the origin of the multiplet energies and intensities. The theoretical treatment takes into account the ligand field and spin-orbit splittings, the covalent mixing of ligand and Fe 3d orbitals, and the angular momentum coupling of the open shell electrons. These effects lead to the distribution of XPS intensity into a large number of final, ionic, states that are only partly resolved with energies spread over a wide range of binding energies. For this reason, it is necessary to record the Fe 2p and 3p XPS spectra over a wide energy range, which includes all the multiplets in the theoretical treatment as well as additional shake satellites. We also evaluate the effects of differing assumptions concerning the extrinsic background subtraction, to make sure our experimental spectrum may be fairly compared to the theory. We conclude that the Fe 3p XPS provides an additional means for distinguishing Fe(III) and Fe(II) oxidation states beyond just using the Fe 2p spectrum. In particular, with the use of the Fe 3p XPS, the depth of the material probed is about 1.5 times greater than for the Fe 2p XPS. In addition, a new type of atomic many-body effect that involves excitations into orbitals that have Fe f,ℓ = 3, symmetry has been shown to be important for the Fe 3p XPS.

In 2010, the U.S. Department of Energy created its first Energy Innovation Hub, which focuses on improving Light Water Reactors (LWRs) through Modeling and Simulation. This hub, named the Consortium for the Advanced Simulation of LWRs (CASL), attempts to characterize and understand LWR behavior under normal operating conditions and use any gained insights to improve their efficiency. In collaboration with North Carolina State University (NCSU), CASL has worked extensively on the thermal-hydraulic subchannel code Coolant Boiling in Rod Arrays—Three Field (COBRA-TF). The NCSU/CASL version of COBRA-TF has been rebranded as CTF. This document focuses on code verification test problems that ensure CTF converges to the correct answer for the intended application. The suite of code verification tests are mapped to the underlying conservation equations of CTF, and significant gaps are addressed. Convergence behavior and numerical errors are quantified for each of the tests. Tests that converge at the correct rate to the corresponding analytic solution are incorporated into the CTF automated regression suite. A new verification utility is created for this purpose, which enables code verification by generalizing the process. For problems that do not behave correctly, the results are reported but the problem is not included in the regression suite. In addition to verification studies, this document also quantifies the existing tests of constitutive models. A few existing gaps are addressed by adding new unit tests.

Purpose: Preplanned exploratory analyses were performed to identify biomarkers in circulating tumor cells (CTC) predictive of response to the topoisomerase 1 inhibitor etirinotecan pegol (EP).Experimental Design: The BEACON trial treated patients with metastatic breast cancer (MBC) with EP or treatment of physician's choice (TPC). Blood from 656 of 852 patients (77%) was processed with ApoStream to enrich for CTCs. A multiplex immunofluorescence assay measured expression of candidate response biomarkers [topoisomerase 1 (Top1), topoisomerase 2 (Top2), Ki67, RAD51, ABCG2, γH2AX, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)] in CTCs. Patients were classified as Top1 low (Top1Lo) or Top1 high (Top1Hi) based on median CTC Top1 expression. Correlation of CTC biomarker expression at baseline, cycle 2 day 1 (C2D1), and cycle 4 day 1 with overall survival (OS) was investigated using Cox regression and Kaplan-Meier analyses.Results: Overall, 98% of samples were successfully processed, of which 97% had detectable CTCs (median, 47-63 CTCs/mL; range, 0-2,020 CTCs/mL). Top1, Top2, and TUNEL expression was detected in 52% to 90% of samples; no significant associations with OS were observed in pretreatment samples for either group. EP-treated patients with low C2D1Top1+ CTCs had improved OS compared with those with higher positivity (14.1 months vs. 11.0 months, respectively; HR, 0.7; P = 0.02); this difference was not seen in TPC-treated patients (HR, 1.12; P = 0.48). Patients whose CTCs decreased from Top1Hi to Top1Lo at C2D1 had the greatest OS benefit from EP (HR, 0.57; P = 0.01).Conclusions: CTC Top1 expression following EP treatment may identify patients with MBC most likely to have an OS benefit. Clin Cancer Res; 24(14); 3348-57. ©2018 AACR.

“The objective of this study was to” test the effectiveness of an enhanced genomic report on patient-centered outcome domains including communication, engagement and satisfaction. “Study design utilized” a prospective, randomized, mixed-methods desctiptive study of a whole genome sequencing results report, GenomeCOMPASS™, that was accessed by providers through the electronic health record and by patients through the associated patient portal. “The study was set in” an integrated healthcare delivery system in central Pennsylvania. “Eighty-four” parents of 46 children with undiagnosed Intellectual Disability, Autism Spectrum Disorder and/or multiple congenital anomalies who had participated in a previous study offering whole genome sequencing for their affected child were invited to enroll. Fifty-two parents enrolled. Following a traditional genetics results informing visit, the study coordinator stratified families by diagnostic result and uninformative result and then randomized families within each group to an intervention arm to receive the GenomeCOMPASS™ report or to the usual care arm to receive a summary letter from the medical geneticist. A letter inviting enrollment included a baseline survey, which once returned, constituted enrollment. Surveys were administered at 3 months post-genetics visit. At 6 months, the usual care arm crossed over to receive the intervention and were administered an additional survey at 3 months. Qualitative interviews were conducted following survey completion to augment the survey data regarding the patient centered outcomes of interest. Patient reported outcomes including communication, engagement, empowerment and satisfaction. In the intervention arm, GenomeCOMPASS™ reports were released to 14 families (N = 28 parents) and of those 21 (75%) returned 3 month surveys. In the usual care arm, 12 families (N = 24 parents) received usual care summary letters and of those 20 (83%) returned 3 month surveys. At crossover, GenomeCOMPASS™ reports were released to 20 individuals and 15 (75%) returned 3 month surveys. Qualitative interviews were conducted with 5 individuals. Use of the GenomeCOMPASS™ report was reported by this small group of parents to improve communication with providers and non-health professionals such as educators and therapists and led to increased engagement and high satisfaction. Providers and others involved in the children’s care also endorsed the report’s effectiveness. Reports that addressed negative findings, i.e. uninformative results, were not found to be useful. Although the number of users was small, this study supports that customizable template reports may provide a useful and durable source of information that can support and enhance the information provided by genetics professionals in traditional face-to-face encounters. Trial registration: Clinicaltrials.gov (Record 2013–0594).