Adjuvant Abemaciclib Combined with Endocrine Therapy for High Risk Early Breast Cancer: Safety and Patient-Reported Outcomes From the monarchE Study

BACKGROUND

In monarchE, abemaciclib plus endocrine therapy (ET) as adjuvant treatment of hormone receptor-positive, human epidermal growth factor 2-negative, high risk, early breast cancer demonstrated a clinically meaningful improvement in invasive disease-free survival versus ET alone. Detailed safety analyses conducted at a median follow-up of 27 months and key patient-reported outcomes (PRO) are presented.

PATIENTS AND METHODS

The safety population included all patients who received at least one dose of study treatment (n=5591). Safety analyses included incidence, management, and outcomes of common and clinically relevant adverse events (AEs). Patient-reported health-related quality-of-life, ET symptoms, fatigue, and side effect burden were assessed.

RESULTS

The addition of abemaciclib to ET resulted in higher incidence of Grade≥3 AEs (49.7% vs 16.3% with ET alone), predominantly laboratory cytopenias (e.g., neutropenia [19.6%]) without clinical complications. Abemaciclib-treated patients experienced more serious adverse events (SAEs; 13.3% vs 7.8%). Discontinuation of abemaciclib and/or ET due to AEs occurred in 18.5% of patients, mainly due to Grade1/2 AEs (66.8%). AEs were managed with comedications (e.g., antidiarrheals), abemaciclib dose holds (61.7%), and/or dose reductions (43.4%). Diarrhea was generally low grade (Grade1/2: 77%); Grade2/3 events were highest in the first month (20.5%), most short-lived (≤7 days) and did not recur. Venous thromboembolic events (VTE) were higher with abemaciclib+ET (2.5%) vs ET (0.6%); in the abemaciclib arm, increased VTE risk was observed with tamoxifen vs AIs (4.3% vs 1.8%). PROs were similar between arms, including being 'bothered by side effects of treatment', except for diarrhea. At ≥3 months, most patients reporting diarrhea reported "a little bit" or "somewhat".

CONCLUSION

In patients with high risk EBC, adjuvant abemaciclib+ET has an acceptable safety profile and tolerability is supported by PRO findings. Most AEs were reversible and manageable with comedications and/or dose modifications, consistent with the known abemaciclib toxicity profile.

State-averaged CASSCF with polarizable continuum model for studying photoreactions in solvents: Energies, analytical nuclear gradients, and non-adiabatic couplings

This paper presents state-averaged complete active space self-consistent field in polarizable continuum model (PCM) for studies of photoreactions in solvents. The wavefunctions of the solute and the PCM surface charges of the solvent are optimized simultaneously such that the state-averaged free energy is variationally minimized. The method supports both fixed weights and dynamic weights where the weights are automatically adjusted based on the energy gaps. The corresponding analytical nuclear gradients and non-adiabatic couplings are also derived. Furthermore, we show how the new method can be entirely formulated in terms of seven basic operations, which allows the implementation to benefit from existing high-performance libraries on graphical processing units. Results demonstrating the accuracy and performance of the implementation are presented and discussed. We also apply the new method to the study of minimal conical intersection search and photoreaction energy pathways in solvents. Effects from the polarity of the solvents and different formulas of dynamic weights are compared and discussed.

Modification of PVC/CPE Blends with Coupling Agent and its Mechanism

In this thesis, the modification of PVC/CPE blends was investigated. Addition of aromatic diamines into PVC/CPE blends as a coupling agent, greatly increases the impact strength of the blends. At the same time, other mechanical properties such as the tensile and bending strength can be improved as well.

With the aid of solvent etching, the multiphase microstructure of the blends has been studied using a scanning electron microscope. The relationship between the microstructure and mechanical properties of the blends has been discussed.

It was shown that there were coupling and crosslinking reactions in the blends with coupling agents. The concentration of the reacted coupling agent was related to the mechanical properties of the blends quantitatively.

Using probability methods, the concentration of the coupled molecules formed in the blends can be calculated. The influence of the ratio of PVC to CPE on the coupling effectiveness can be predicted.

A novel methodology and strategy to detect low molecular aldehydes in beer based on charged microdroplet driving online derivatization and high resolution mass spectrometry

The concentration of aldehydes is one of the important indicators in the food quality and safety. To efficiently analyze the four aldehydes (methanal, ethanal, propanal and n-butanal) in beer, charged microdroplet driving online derivatization apparatus coupled with high resolution mass spectrometry was firstly developed. Utilizing the high-speed reaction accelerated by microdroplets, the offline derivative of aldehydes with 2,4-dinitrophenylhydrazine in bulk was transferred into online derivatization. The developed method featured acceptable linearities (R² ≥ 0.95), high sensitivities (LODs at ng mL^-1 level) and qualified precisions (RSDs ≤ 8.4 %) for target compounds. Four aldehydes with trace amount were successfully determined in beer. The results indicated that the novel online analytical strategy did not require complex sample preparation and could conduct simple, rapid, sensitive detection of small molecule aldehydes with high throughput in beer or even other food samples.

[C-reactive protein is associated with impaired working capacity in Chinese patients with ankylosing spondylitis in paid employment: the real-world evidence from Smart-phone SpondyloArthritis Management System]

To investigate the relationship between serum C-reactive protein (CRP) levels and work impairment in patients with ankylosing spondylitis (AS) based on real-world evidence. Outpatients with confirmed AS at Chinese PLA General Hospital were recruited consecutively by Smart-phone SpondyloArthritis Management System (SpAMS) from April 2016 to April 2018. The relationship between CRP and work productivity and activity impairment questionnaire (WPAI) were evaluated. Five hundred and fifty-one outpatients with AS in paid employment were recruited. The presenteeism, overall work impairment, and activity impairment rates increased by 1.4% (1.1%, 1.8%), 1.1% (0.5%, 1.6%), and 1.7% (1.3%, 2.1%), respectively, for every 10 mg/L increase in the CRP level (all P value<0.01). However, the CRP level was not associated with absenteeism after adjusting for covariates [0.5%(-0.4%, 1.0%),P>0.05]. There is a significant association between increased serum CRP levels at baseline and the previous 7-day work impairment in patients with AS. Higher CRP levels contribute to worse presenteeism, overall work impairment, and activity impairment rates, which suggests the necessity of monitoring CRP on treatment, and also indicates that anti-inflammatory therapy may be effective for improving work productivity.

The Effects of Bletilla striata Polysaccharides on Antioxidant and Immunomodulatory Activities of Mice In Vivo

Bletilla striata polysaccharide is a well-known antioxidant and immunomodulatory ingredient used in a variety of traditional Chinese medicine applications. A mouse aging model was constructed by intraperitoneal injection of D-galactose to explore the antioxidant and immunomodulatory effects of B. striata polysaccharides. B. striata polysaccharide was found to boost antioxidant capacity and retard aging in a subacutely aged mouse. In comparison to the cyclophosphamide alone group, the groups given 80 mg/kg and 160 mg/kg of B. striata polysaccharide showed considerably higher levels of total antioxidant capacity, superoxide dismutase, and catalase, with significantly lower malondialdehyde levels. To investigate the moderating effect of B. striata polysaccharide on immunological deficit, cyclophosphamide was injected into the abdominal cavity to create an immunocompromised mouse model. B. striata polysaccharide attenuated immunosuppressive effects of cyclophosphamide. The histological staining demonstrated that both liver and spleen cells in the control group were densely packed, with distinct nuclei and qualitative characteristics. The liver and spleen of the immunocompromised mice benefited significantly from 450 mg/kg B. striata polysaccharide. Taken together, B. striata polysaccharide exhibits an antioxidant and immunomodulatory effects in vivo.

Matrix stiffness regulates bone repair by modulating 12-lipoxygenase-mediated early inflammation

Lipid metabolism in macrophages has been increasingly emphasized in exerting an anti-inflammatory effect and accelerating fracture healing. 12-lipoxygenase (12-LOX) is expressed in several cell types, including macrophages, and oxidizes polyunsaturated fatty acids (PUFAs) to generate both pro- and anti-inflammatory lipid mediators, of which the n-3 PUFAs play an important part in tissue homeostasis/fibrosis. Although mechanical factor regulates the lipid metabolic axis of inflammatory cells, specifically matrix stiffness influences macrophages metabolic responses, little is known about how matrix stiffness affects the 12-LOX-mediated early inflammation in bone repair. In the present study, demineralized bone matrix (DBM) scaffolds with different matrix stiffness were constructed by controlling the duration of decalcification (0 h (control), 1 h (high), 12 h (medium), and 5 d (low)) to repair the defected rat skull. The expression of inflammatory cytokines and macrophages polarization were analyzed. The lipid metabolites and lipid mediators' biosynthesis by matrix stiffness-regulated were further detected. The results showed that the low matrix stiffness could polarize macrophages into an anti-inflammatory phenotype, promote the expression of anti-inflammatory cytokines and specialized pro-resolving lipid mediators (SPMs) biosynthesis beneficial for the osteogenesis of mesenchymal stem cells (MSCs). After treated with ML355, the expression of anti-inflammatory cytokines/proteins and SPMs biosynthesis in macrophages cultured on low-matrix stiffness scaffolds were repressed, and there were almost no statistical differences among all groups. Findings from this study support that matrix stiffness regulates bone repair by modulating 12-LOX-mediated early inflammation, which suggest a direct mechanical impact of matrix stiffness on macrophages lipid metabolism and provide a new insight into the clinical application of SPMs for bone regeneration.

Spatiotemporal distribution, source apportionment and combined pollution of antibiotics in natural waters adjacent to mariculture areas in the Laizhou Bay, Bohai Sea

The spatiotemporal distribution, source apportionment and combined pollution of 14 antibiotics in natural waters adjacent to mariculture farms of Laizhou Bay in the Bohai Sea were studied. The contribution proportion and quantity of each potential pollution source to antibiotics in natural water bodies were quantitatively described. The correlations between heavy metals and antibiotics and their underlying mechanisms in natural and aquaculture water environment were analyzed. Fourteen antibiotics were detected in natural water and sediment in the coastal area of Laizhou Bay. The maximum concentrations of sulfamethazine and trimethoprim in water reached tens or even hundreds of μg/L in winter. Trimethoprim was the main antibiotic in natural water bodies in winter and summer, and enrofloxacin was the principal antibiotic in sediments. Enrofloxacin, ciprofloxacin and oxytetracycline were detected in all underground water samples; thus, control of these antibiotics needs to be made a priority to mitigate groundwater contamination. PCA-MLR revealed that the potential sources of antibiotics in natural waters of Laizhou Bay include the mariculture wastewater (18.3%), the domestic sewage (63.3%) and the livestock wastewater (18.4%). Therefore, the antibiotic burden of Laizhou Bay was principally from the domestic sewage. In natural water, the concentration of Cu was positively correlated with antibiotics, which might be related to the common sources, the competitive adsorption in sediments and the easy complexation characteristic of Cu and antibiotics. Positive correlations among antibiotics and heavy metals were observed in mariculture sediments, while negative relationships were observed in natural sediments.

A diagrammatic approach for automatically deriving analytical gradients of tensor hyper-contracted electronic structure methods

We introduce a diagrammatic approach to facilitate the automatic derivation of analytical nuclear gradients for tensor hyper-contraction (THC) based electronic structure methods. The automatically derived gradients are guaranteed to have the same scaling in terms of both operation count and memory footprint as the underlying energy calculations, and the computation of a gradient is roughly three times as costly as the underlying energy. The new diagrammatic approach enables the first cubic scaling implementation of nuclear derivatives for THC tensors fitted in molecular orbital basis (MO-THC). Furthermore, application of this new approach to THC-MP2 analytical gradients leads to an implementation, which is at least four times faster than the previously reported, manually derived implementation. Finally, we apply the new approach to the 14 tensor contraction patterns appearing in the supporting subspace formulation of multireference perturbation theory, laying the foundation for developments of analytical nuclear gradients and nonadiabatic coupling vectors for multi-state CASPT2.

Sheathed in-situ room-temperature growth covalent organic framework solid-phase microextraction fiber for detecting ultratrace polybrominated diphenyl ethers from environmental samples

The extraction performance of solid-phase microextraction (SPME) fiber is significantly influenced by coating materials and fabricating process. It is urgently needed for fabricating robust SPME fiber with facile preparation methods. Herein, a novel polyimide (PI) @ covalent organic framework (COF) synthesized by 1,3,5-Tris (4-aminophenyl) benzene (TPB) and 2,5-dimethoxyterephthalaldehyde (DMTP) fiber, named PI@TPB-DMTP fiber, was successfully fabricated with facile method at room temperature. Firstly, a COF crystals TPB-DMTP was in situ grown on stainless steel fiber, where the COF crystals was synthesized by the Schiff-base reaction between TPB and DMTP. Subsequently, the COF coating was covered with an ultrathin layer of PI through a simple dip-coating method to improve the fiber stability. By coupled PI@TPB-DMTP SPME fiber with gas chromatography-negative chemical ion-mass spectrometry (GC-NCI-MS), a sensitive analytical method was established for the determination of ultratrace polybrominated diphenyl ethers (PBDEs) in water sample. To achieve the best efficiency and sensitivity for the analysis of PBDEs, six potential influencing factors in extraction step and desorption step were optimized. Under optimized conditions, the established method showed high enhancement factors of 1470-3555, wide linear range of 0.05-100 ng L^-1, low detection limits of 0.0083-0.0190 ng L^-1, good repeatability for intra-day in the range of 3.71%-7.62% and inter-day in the range of 5.12%-8.81%, good reproducibility in the range of 6.83%-9.21%. The satisfactory recovery was ranged from 79.2% to 117.3% in determining real water samples. The excellent experimental performance was mainly attributed to the large specific surface area of TPB-DMTP, as well as the high permeability of porous PI film. The results demonstrated that the COF-based fiber showed great potential for analysis of PBDEs in complex environmental samples.

[Efficacy of endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique]

Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.