The establishment of the general microexpression recognition ability and its relevant brain activity

Microexpressions are very transitory expressions lasting about 1/25∼1/2 s, which can reveal people's true emotions they try to hide or suppress. The PREMERT (pseudorandom ecological microexpression recognition test) could test the individual's microexpression recognition ability with six microexpression Ms (the mean of accuracy rates of a microexpression type under six expression backgrounds), and six microexpression SDs (the standard deviation of accuracy rates of this microexpression type under six expression backgrounds), but it and other studies did not explore the general microexpression recognition ability (the GMERA) or could not test the GMERA effectively. Therefore, the current study put forward and established the GMERA with the behavioral data of the PREMERT. The spontaneous brain activity in the resting state is a stable index to measure individual cognitive characteristics. Therefore, the current study explored the relevant resting-state brain activity of the GMERA indicators to prove that GMERA is an individual cognitive characteristic from brain mechanisms with the neuroimaging data of the PREMERT. The results showed that (1) there was a three-layer hierarchical structure in human microexpression recognition ability: The GMERA (the highest layer); recognition of a type of microexpression under different expression backgrounds (the second layer); and recognition of a certain microexpression under a certain expression background (the third layer). A common factor GMERA was extracted from the six microexpression types recognition in PREMERT. Four indicators of the GMERA were calculated from six microexpression Ms and six microexpression SDs, such as GMERAL (level of GMERA), GMERAF (fluctuation of GMERA), GMERAB (background effect of GMERA), and GMERABF (fluctuation of GMERAB), which had good parallel-forms reliability, calibration validity, and ecological validity. The GMERA provided a concise and comprehensive overview of the individual's microexpression recognition ability. The PREMERT was proved as a good test to measure the GMERA. (2) ALFFs (the amplitude of low-frequency fluctuations) in both eyes-closed and eyes-opened resting-states and ALFFs-difference could predict the four indicators of the GMERA. The relevant resting-state brain areas were some areas of the expression recognition network, the microexpression consciousness and attention network, and the motor network for the change from expression backgrounds to microexpression. (3) The relevant brain areas of the GMERA and different types of microexpression recognition belonged to the three cognitive processes, but the relevant brain areas of the GMERA were the "higher-order" areas to be more concise and critical than those of different types of microexpression recognition.

Low-Dose Enzalutamide in Metastatic Prostate Cancer-Longevity Over Conventional Survival Analysis

BACKGROUND

Enzalutamide is an important drug in the treatment of prostate cancer. Standard dosing often requires dose reduction because of side effects. There is no information on survival outcomes with lower doses. We investigated the impact of starting enzalutamide at ≤ 50% dose on metastatic prostate cancer outcomes including patients' longevity.

PATIENTS AND METHODS

Records of metastatic prostate cancer patients treated with enzalutamide at one center were retrospectively reviewed. Low-dose enzalutamide (≤80 mg/day) was compared with standard-dose (160 mg/day). The primary objective was to compute the restricted mean survival time (RMST - time scale) and restricted mean attained age (RMAA - age scale) using the Irwin method. Secondary objectives included overall survival (OS), progression-free survival (PFS), and PSA progression per PCWG3 criteria (PSA PFS). We used the logrank test and the ∆ difference between RMSTs for comparison.

RESULTS

Of 111 patients treated, 32 received a low-dose and 79 the standard-dose. Low-dose patients had less prior abiraterone or chemotherapy (28.1% vs. 65.8%, P < .001); more testosterone assessment (65.6% vs. 40.5%, P = .016); poorer ECOG performance status (48.3% score ≥2 vs. 26.6%; P = .040), more comorbidities (75.9% vs. 46.3%; P = .010)) including increased cardiovascular disease (51.7% vs. 21.4%, P = .004). Baseline PSA value and doubling time at start of enzalutamide and distribution of metastases were similar between the groups. OS and PFS did not differ between low-dose and standard-dose. Patients on low-dose had a better longevity with significantly longer RMAA, 89.1 years, versus standard-dose RMAA of 83.8 years (∆ = 5.3 years, P = .003, logrank P = .025). In a subgroup analysis by age at start of enzalutamide, <75 versus ≥75 years old, longevity was also better with low-dose in younger patients (∆ = 2.9 years, P = .034, and older, ∆ = 3.3 years, P = .011).

CONCLUSION

The longevity advantage and reduced adverse events seen in patients with prostate cancer treated with low-dose enzalutamide warrants further investigation.

Transcriptome and Metabolome Analyses Reveal Complex Molecular Mechanisms Involved in the Salt Tolerance of Rice Induced by Exogenous Allantoin

Allantoin is crucial for plant growth and development as well as adaptations to abiotic stresses, but the underlying molecular mechanisms remain unclear. In this study, we comprehensively analyzed the physiological indices, transcriptomes, and metabolomes of rice seedlings following salt, allantoin, and salt + allantoin treatments. The results revealed that exogenous allantoin positively affects the salt tolerance by increasing the contents of endogenous allantoin with antioxidant activities, increasing the reactive oxygen species (ROS)–scavenging capacity, and maintaining sodium and potassium homeostasis. The transcriptome analysis detected the upregulated expression genes involved in ion transport and redox regulation as well as the downregulated expression of many salt-induced genes related to transcription and post-transcriptional regulation, carbohydrate metabolism, chromosome remodeling, and cell wall organization after the exogenous allantoin treatment of salt-stressed rice seedlings. Thus, allantoin may mitigate the adverse effects of salt stress on plant growth and development. Furthermore, a global metabolite analysis detected the accumulation of metabolites with antioxidant activities and intermediate products of the allantoin biosynthetic pathway in response to exogenous allantoin, implying allantoin enhances rice salt tolerance by inducing ROS scavenging cascades. These results have clarified the transcript-level and metabolic processes underlying the allantoin-mediated salt tolerance of rice.

Hsa_circ_0008870 suppresses bone formation of growth plate through inhibition of miR-185-3p/ MAPK1 axis in idiopathic short stature

Idiopathic short stature (ISS) is the most common clinical cause of the short stature with an unclear aetiology and a lack of effective treatment. Circular RNAs have been shown to play a significant regulatory role through various signal transduction pathways in a variety of diseases in recent years. However, the role of circular RNAs on ISS is not yet well-understood and requires a special attention. The differentially expressed circular RNAs were screened by microarray chip analysis, and RT-qPCR was used to verify the expression of hsa_circ_0008870 in ISS patients. Subsequently, in vitro and in vivo experiments were conducted to determine the biological functions of hsa_circ_0008870 in ISS. The authors first confirmed that hsa_ circ_0008870 was downregulated in ISS children. Meanwhile, we also observed that the downregulated hsa_circ _0008870 significantly inhibited chondrocyte proliferation and endochondral ossification in vivo and in vitro. Mechanistically, hsa_circ_0008870 regulates MAPK1 expression by sponge miR-185-3p. This mechanism of action was further verified through rescue experiments. Finally, the authors revealed that the silencing of hsa_circ_0008870 induces low expression of MAPK1 by impairing the sponge action of miR-185-3p, thereby inhibiting chondrocyte proliferation, hypertrophy, and endochondral ossification, which results in a short stature phenotype. In addition to these, we also observed an interesting phenomenon that upregulated of miR-185-3p can in turn inhibit the expression of hsa_circ_0008870 in chondrocytes. This suggests that hsa_circ_0008870 could potentially serve as a therapeutic target for the treatment of ISS.

The dual effect of shellac on survival of spray-dried Lactobacillus rhamnosus GG microcapsules

Heat shock and hygroscopicity are two main factors that resulted in low viability of probiotics in spray-dried microcapsules during storage. Hydrophobic polyester shellac was combined with whey protein isolate (WPI) to solve this problem. The results suggested that although the survival rate after drying decreased from 20.63% to 0.01% with increased shellac to WPI ratio, the 1:1 shellac-WPI provided the best protection among all samples during storage. The consistence between moisture-adsorption-isotherm and bacterial inactivation constants confirmed the moisture barrier effect of shellac under moderate humidity. Single-droplet drying and differential scanning calorimeter revealed that shellac addition reduced the drying rate and glass transition temperature of microcapsules, which in turn decreased the membrane integrity and growth capability of the probiotics after drying. This study revealed the dual effect of hydrophobic material on instant and long-term survival of spray-dried probiotic microcapsules, which provided new sight to the design of composite wall materials.

The encapsulation strategy to improve the survival of probiotics for food application: From rough multicellular to single-cell surface engineering and microbial mediation

The application of probiotics is limited by the loss of survival due to food processing, storage, and gastrointestinal tract. Encapsulation is a key technology for overcoming these challenges. The review focuses on the latest progress in probiotic encapsulation since 2020, especially precision engineering on microbial surfaces and microbial-mediated role. Currently, the encapsulation materials include polysaccharides and proteins, followed by lipids, which is a traditional mainstream trend, while novel plant extracts and polyphenols are on the rise. Other natural materials and processing by-products are also involved. The encapsulation types are divided into rough multicellular encapsulation, precise single-cell encapsulation, and microbial-mediated encapsulation. Recent emerging techniques include cryomilling, 3D printing, spray-drying with a three-fluid coaxial nozzle, and microfluidic. Encapsulated probiotics applied in food is an upward trend in which "classic probiotic foods" (yogurt, cheese, butter, chocolate, etc.) are dominated, supplemented by "novel probiotic foods" (tea, peanut butter, and various dry-based foods). Future efforts mainly include the effect of novel encapsulation materials on probiotics in the gut, encapsulation strategy oriented by microbial enthusiasm and precise encapsulation, development of novel techniques that consider both cost and efficiency, and co-encapsulation of multiple strains. In conclusion, encapsulation provides a strong impetus for the food application of probiotics.

Cu2+-Ion-Substitution-Driven Microstructure and Microwave Dielectric Properties of Mg1-xCuxAl2O4 Ceramics

In this work, Cu-substituted MgAl₂O₄ ceramics were prepared via solid-state reaction. The crystal structure, cation distribution, and microwave dielectric properties of Mg_1-xCu_xAl₂O₄ ceramics were investigated. Cu²⁺ entered the MgAl₂O₄ lattice and formed a spinel structure. The substitution of Cu²⁺ ions for Mg²⁺ ions contributed to Al³⁺ ions preferential occupation of the octahedron and changed the degree of inversion. The quality factor (Qf) value, which is correlated with the degree of inversion, increased to a maximum value at x = 0.04 and then decreased. Ionic polarizability and relative density affected the dielectric constant (ε_r) value. The temperature coefficient of the resonant frequency (τ_f) value, which was dominated by the total bond energy, generally shifted to the positive direction. Satisfactory microwave dielectric properties were achieved in x = 0.04 and sintered at 1550 °C: ε_r = 8.28, Qf = 72,800 GHz, and τ_f = -59 ppm/°C. The Mg_1-xCu_xAl₂O₄ solid solution, possessing good performance, has potential for application in the field of modern telecommunication technology.

Delayed improvements in visual memory task performance among chronic schizophrenia patients after high-frequency repetitive transcranial magnetic stimulation

BACKGROUND

Cognitive impairments are core characteristics of schizophrenia, but are largely resistant to current treatments. Several recent studies have shown that high-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dor-solateral prefrontal cortex (DLPFC) can reduce negative symptoms and improve certain cognitive deficits in schizophrenia patients. However, results are inconsistent across studies.

AIM

To examine if high-frequency rTMS of the DLPFC can improve visual memory deficits in patients with schizophrenia.

METHODS

Forty-seven chronic schizophrenia patients with severe negative symptoms on stable treatment regimens were randomly assigned to receive active rTMS to the DLPFC (n = 25) or sham stimulation (n = 22) on weekdays for four consecutive weeks. Patients performed the pattern recognition memory (PRM) task from the Cambridge Neuropsychological Test Automated Battery at baseline, at the end of rTMS treatment (week 4), and 4 wk after rTMS treatment (week 8). Clinical symptoms were also measured at these same time points using the Scale for the Assessment of Negative Symptoms (SANS) and the Positive and Negative Syndrome Scale (PANSS).

RESULTS

There were no significant differences in PRM performance metrics, SANS total score, SANS subscores, PANSS total score, and PANSS subscores between active and sham rTMS groups at the end of the 4-wk treatment period, but PRM performance metrics (percent correct and number correct) and changes in these metrics from baseline were significantly greater in the active rTMS group at week 8 compared to the sham group (all P < 0.05). Active rTMS treatment also significantly reduced SANS score at week 8 compared to sham treatment. Moreover, the improvement in visual memory was correlated with the reduction in negative symptoms at week 8. In contrast, there were no between-group differences in PANSS total score and subscale scores at either week 4 or week 8 (all P > 0.05).

CONCLUSION

High-frequency transcranial magnetic stimulation improves visual memory and reduces negative symptoms in schizophrenia, but these effects are delayed, potentially due to the requirement for extensive neuroplastic changes within DLPFC networks.

Peripheral Interleukin-18 is negatively correlated with abnormal brain activity in patients with depression: a resting-state fMRI study

BACKGROUND

Interleukin-18 (IL-18) may participate in the development of major depressive disorder, but the specific mechanism remains unclear. This study aimed to explore whether IL-18 correlates with areas of the brain associated with depression.

METHODS

Using a case-control design, 68 subjects (34 patients and 34 healthy controls) underwent clinical assessment, blood sampling, and resting-state functional Magnetic Resonance Imaging (fMRI). The total Hamilton depression-17 (HAMD-17) score was used to assess depression severity. Enzyme-linked immunosorbent assay (ELISA) was used to detect IL-18 levels. Rest-state fMRI was conducted to explore spontaneous brain activity.

RESULTS

The level of IL-18 was higher in patients with depression in comparison with healthy controls. IL-18 was negatively correlated with degree centrality of the left posterior cingulate gyrus in the depression patient group, but no correlation was found in the healthy control group.

CONCLUSION

This study suggests the involvement of IL-18 in the pathophysiological mechanism for depression and interference with brain activity.

Image Segmentation for MR Brain Tumor Detection Using Machine Learning: A Review

Magnetic Resonance Imaging (MRI) has commonly been used to detect and diagnose brain disease and monitor treatment as non-invasive imaging technology. MRI produces three-dimensional images that help neurologists to identify anomalies from brain images precisely. However, this is a time-consuming and labor-intensive process. The improvement in machine learning and efficient computation provides a computer-aid solution to analyze MRI images and identify the abnormality quickly and accurately. Image segmentation has become a hot and research-oriented area in the medical image analysis community. The computer-aid system for brain abnormalities identification provides the possibility for quickly classifying the disease for early treatment. This article presents a review of the research papers (from 1998 to 2020) on brain tumors segmentation from MRI images. We examined the core segmentation algorithms of each research paper in detail. This article provides readers with a complete overview of the topic and new dimensions of how numerous machine learning and image segmentation approaches are applied to identify brain tumors. By comparing the state-of-the-art and new cutting-edge methods, the deep learning methods are more effective for the segmentation of the tumor from MRI images of the brain.

Deep neural network ensembles for detecting self-admitted technical debt

Effectively identifying self-admitted technical debt (SATD) from project source code comments helps developers quickly find and repay these debts, thereby reducing its negative impact. Previous studies used techniques based on patterns, text mining, natural language processing, and neural networks to detect SATD. Compared with these above, Convolutional Neural Networks (CNN) have the strong feature extraction ability. Deep network ensembles are demonstrated great potential for the task of sentences classification. In order to boost the performance of CNN-based SATD detecting, we propose a deep neural network ensemble contribute to ensemble learning in a simple yet effective way. Specifically, CNN, CNN-LSTM (convolutional neural network and long short-term memory), and DPCNN (Deep Pyramid Convolutional Neural Networks) are used as individual classifiers to diversify the deep network ensembles. In order to improve the explainability, we introduce attention to measure the contribution of feature words to SATD classification. 62,285 source code comments from 10 projects were used in our experiments. The results show that our approach can effectively reduce misjudgment and detect more SATD, especially for cross-project, so as to greatly improve the detection accuracy.

A phase I trial of elimusertib in combination with cisplatin or with cisplatin plus gemcitabine in advanced solid tumors with an emphasis on urothelial carcinoma

TPS3174

Background: Cisplatin, a well-established backbone of combination therapy of various advanced solid tumors, inhibits DNA synthesis by forming DNA cross-links and adducts. Despite the activity of cisplatin, tumor cells can either be refractory or develop resistance to treatment. Cisplatin has been demonstrated to cause cell cycle G2/M arrest, which may allow for DNA damage response (DDR) and repair. Ataxia telangiectasia mutated (ATM) and ataxia telangiectasia and Rad 3-related (ATR) protein kinases are key regulators of DDR, and contribute to maintaining genomic integrity in response to various exogenous and endogenous genotoxic insults like cytotoxic chemotherapy. In fact, cisplatin has been shown to transiently increase ATR expression. Inhibitors of ATR have been studied in combination with cisplatin both in vitro and in vivo, demonstrating enhanced activity. The oral small molecule ATR inhibitor elimusertib, which has been studied as a single agent in a Phase I study, has also demonstrated enhanced activity with cisplatin in vitro in lung cancer and bladder cancer cell lines. We sought to conduct a Phase I study evaluating the combination of elimusertib with cisplatin or with cisplatin and gemcitabine. Methods: In the first cohort, patients with histologically confirmed advanced solid tumors for which cisplatin-based therapy would be considered appropriate, who exhibit adequate organ function, and have received < 300 mg/m2 of cisplatin previously are treated with cisplatin on Day (D) 1 and with elimusertib on D2 & 9 of each 21-day cycle. The study follows a phase I queue (IQ) 3+3 dose escalation design, following standard practices for dose-limiting toxicity (DLT) impact on escalation, and when the maximum tolerated dose (MTD) is established with cisplatin alone, this will inform the first dose level of the next cohort, in which patients will be treated with cisplatin on D1, gemcitabine on D1 & 8, and elimusertib on D2 & 9 of each 21-day cycle. An expansion cohort will enroll urothelial carcinoma patients when the second MTD is established. The primary objective of the study is to evaluate the safety and MTD of elimusertib in combination with cisplatin, as well as in combination with cisplatin and gemcitabine. Secondary study objectives include evaluation of pharmacokinetics of elimusertib in these combinations, preliminary efficacy, and evaluating the association between ATM expression and responses to therapy. Currently, 6 patients have been enrolled to the first cohort of the study. Clinical trial information: NCT04491942.

Effects of Explanations in AI-Assisted Decision Making: Principles and Comparisons

Recent years have witnessed the growing literature in empirical evaluation of explainable AI (XAI) methods. This study contributes to this ongoing conversation by presenting a comparison on the effects of a set of established XAI methods in AI-assisted decision making. Based on our review of previous literature, we highlight three desirable properties that ideal AI explanations should satisfy — improve people’s understanding of the AI model, help people recognize the model uncertainty, and support people’s calibrated trust in the model. Through three randomized controlled experiments, we evaluate whether four types of common model-agnostic explainable AI methods satisfy these properties on two types of AI models of varying levels of complexity, and in two kinds of decision making contexts where people perceive themselves as having different levels of domain expertise. Our results demonstrate that many AI explanations do not satisfy any of the desirable properties when used on decision making tasks that people have little domain expertise in. On decision making tasks that people are more knowledgeable, the feature contribution explanation is shown to satisfy more desiderata of AI explanations, even when the AI model is inherently complex. We conclude by discussing the implications of our study for improving the design of XAI methods to better support human decision making, and for advancing more rigorous empirical evaluation of XAI methods.

Arbitrary active control of the Pancharatnam-Berry phase in a terahertz metasurface

Active phase-control metasurfaces show outstanding capability in the active manipulation of light propagation, while the previous active phase control methods have many constraints in the cost of simulation or the phase modulation range. In this paper, we design and demonstrate a phase controlled metastructure based on two circular split ring resonators (CSRRs) composed of silicon and Au with different widths, which can continuously achieve an arbitrary Pancharatnam-Berry (PB) phase between -π and π before or after active control. The PB phase of such a metasurface before active control is determined by the rotation angle of the Au-composed CSRR, while the PB phase after active control is determined by the rotation angle of the silicon-composed CSRR. And active control of the PB phase is realized by varying conductivity of silicon under an external optical pump. Based on this metastructure, active control of light deflection, metalens with arbitrary reconfigurable focal points and achromatic metalens under selective frequencies are designed and simulated. Moreover, the experimental results demonstrate that focal spots of metalens can be actively controlled by the optical pump, in accord with the simulated ones. Our metastructure implements a plethora of metasurfaces' active phase modulation and provides applications in active light manipulation.

Combining immune checkpoint inhibition plus tyrosine kinase inhibition as first and subsequent treatments for metastatic renal cell carcinoma

Background

Immune checkpoint inhibitor/tyrosine kinase inhibitor (ICI/TKI) combinations are a new standard of care for the initial treatment of metastatic renal cell carcinoma (mRCC). Their efficacy and toxicity beyond the first‐line setting remain poorly defined.

Methods

We retrospectively reviewed charts for 85 adults with mRCC of any histology receiving combination of ICI/TKI in any line of treatment at two academic centers as of 05/01/2020. We collected clinical, pathological, and treatment‐related variables. Outcomes including objective response rate (ORR), progression‐free survival (PFS), and toxicity were analyzed via descriptive statistics and the Kaplan–Meier method.

Results

Patients received pembrolizumab, nivolumab, avelumab, or nivolumab–ipilimumab, with concurrent use of sunitinib, axitinib, pazopanib, lenvatinib, or cabozantinib. Thirty‐three patients received first‐line ICI/TKI therapy, while 52 received ≥ second‐line ICI/TKI. The efficacy of ICI/TKI therapy decreased with increasing lines of treatment (ORR: 56.7%, 37.5%, 21.4%, and 21%; median PFS [mPFS]: 15.2, 14.2, 10.1, and 6.8 months, for first, second, third, and ≥ fourth line therapy, respectively). In the ≥ second‐line setting, ICI/TKI was most useful in patients who received ICI only, with an ORR of 50% and a mPFS of 9.1 months. Efficacy was limited in patients who received both TKI and ICI previously, with an ORR of 20% and a mPFS of 5.5 months. Overall, ≥ second‐line ICI/TKI was tolerable with 25 of 52 (52%) patients developing grade ≥3 adverse events.

Conclusions

ICI/TKI combination therapy is feasible and safe beyond the first‐line setting. Prior treatment history appears to impact efficacy but has a lesser effect on safety/tolerability.

Neutrophil-to-lymphocyte ratio is associated with carotid intraplaque neovascularization in asymptomatic carotid stenosis patients

BACKGROUND AND PURPOSE

Neutrophil-to-lymphocyte ratio (NLR) has been suggested as an available systemic inflammatory biomarker. This study aims to evaluate whether intraplaque neovascularization assessed by contrast-enhanced ultrasound (CEUS) is associated with NLR in asymptomatic carotid stenosis patients.

MATERIALS AND METHODS

One hundred and forty-four asymptomatic patients with carotid luminal stenosis >30% were assessed using contrast-enhanced ultrasound imaging. The contrast enhancement within the plaque was classified on a visual semiquantitative grading scale. The data collected included the patient's risk factors, laboratory results, cardiovascular disease history, and drug use history. Univariate and multivariate analyses were assessed to identify independent factors related to intraplaque neovascularization with adjustment for potential confounders.

RESULTS

Patients with CEUS grade 2 plaques had a higher level of LDL-C (p < .001), neutrophil count (p < .001), and blood glucose (p = .005), but lower level of lymphocyte count (p = .021). The presence of grade 2 plaques was significantly associated with high NLR values (OR 1.21, 95% CI 1.03-1.43, p = .017). Patients were divided into four groups according to the quartile of NLR values. Compared to the patients in the first quartile of NLR (<1.73), the patients in the fourth NLR quartile (≥3.38) were characterized by the most prevalence of CEUS grade 2 plaques (OR 4.55, 95% CI 1.69-12.25, p = .003). Multivariate logistic regression analysis after adjusting various variables demonstrated NLR remained an independent risk factor for the presence of CEUS grade 2 plaques.

CONCLUSION

Intraplaque neovascularization is significantly associated with NLR in asymptomatic carotid stenosis patients.

Salvage nivolumab and ipilimumab after prior anti-PD-1/PD-L1 therapy in metastatic renal cell carcinoma: A meta-analysis

Background

Salvage nivolumab and ipilimumab after prior anti‐PD‐1/PD‐L1 therapy is frequently used off‐label for clear cell metastatic renal cell carcinoma (mRCC). However, limited data are available to guide such therapy. We performed a meta‐analysis to characterize further the safety and efficacy of salvage nivolumab and ipilimumab.

Methods

We conducted a systematic review in accordance with PRISMA. Studies of salvage nivolumab and ipilimumab in patients with mRCC published in English before June 1, 2021 were included. We also included patients treated at the Ohio State University from 2012 to 2020 through a retrospective chart review. The included studies were further stratified into adaptive and standard groups based on their designs. We calculated objective response rate (ORR) and adverse events (AEs) via pooled data and quantitative synthesis using the Stata metaprop procedure. A conservative random effect model was used to combine values.

Results

A total of 7 studies and 310 patients were included. Salvage nivolumab and ipilimumab had an ORR of 14% (95% CI, 0.09–0.21) and median progression‐free survival ranged between 3.7 and 5.5 months. Four out of the seven studies were standard design, whereas the other three studies were adaptive. The ORR was numerically higher in the standard group compared with the adaptive group (21% and 9–10%, respectively). The responses to salvage nivolumab and ipilimumab did not correlate with the initial anti‐PD‐1/PD‐L1 responses (odds ratio = 1.45; p = 0.5). Grade ≥3 AEs occurred in 26% of the patients (95% CI, 0.19–0.33). There were no new safety signals observed in this study.

Conclusion

Salvage nivolumab and ipilimumab demonstrated moderate antitumor activity and a manageable safety profile in patients with mRCC who had prior anti‐PD‐1/PD‐L1 therapy.

Implication for Practice

Patients with metastatic renal cell carcinoma have limited treatment options after progressive disease on anti‐PD‐1/PD‐L1 therapy. The role of salvage nivolumab and ipilimumab in this patient population is poorly defined. The studies on this highly important and clinically relevant topic are limited by small sample sizes. The results from our meta‐analysis suggest that nivolumab and ipilimumab are feasible in the salvage setting with moderate efficacy and acceptable toxicity profile. The response rates differ with different treatment designs. This information will be beneficial to guide clinical decision‐making and accurately estimating toxicity.

Can Daytime Transcranial Direct Current Stimulation Treatment Change the Sleep Electroencephalogram Complexity of REM Sleep in Depressed Patients? A Double-Blinded, Randomized, Placebo-Controlled Trial

STUDY OBJECTIVES

The purpose of this study was to determine the effects of daytime transcranial direct current stimulation (tDCS) on sleep electroencephalogram (EEG) in patients with depression.

METHODS

The study was a double-blinded, randomized, controlled clinical trial. A total of 37 patients diagnosed with a major depression were recruited; 19 patients (13 females and 6 males mean age 44.79 ± 15.25 years) received tDCS active stimulation and 18 patients (9 females and 9 males; mean age 43.61 ± 11.89 years) received sham stimulation. Ten sessions of daytime tDCS were administered with the anode over F3 and the cathode over F4. Each session delivered a 2 mA current for 30 min per 10 working days. Hamilton-24 and Montgomery scales were used to assess the severity of depression, and polysomnography (PSG) was used to assess sleep structure and EEG complexity. Eight intrinsic mode functions (IMFs) were computed from each EEG signal in a channel. The sample entropy of the cumulative sum of the IMFs were computed to acquire high-dimensional multi-scale complexity information of EEG signals.

RESULTS

The complexity of Rapid Eye Movement (REM) EEG signals significantly decreased intrinsic multi-scale entropy (iMSE) (1.732 ± 0.057 vs. 1.605 ± 0.046, P = 0.0004 in the case of the C4 channel, IMF 1:4 and scale 7) after tDCS active stimulation. The complexity of the REM EEG signals significantly increased iMSE (1.464 ± 0.101 vs. 1.611 ± 0.085, P = 0.001 for C4 channel, IMF 1:4 and scale 7) after tDCS sham stimulation. There was no significant difference in the Hamilton-24 (P = 0.988), Montgomery scale score (P = 0.726), and sleep structure (N1% P = 0.383; N2% P = 0.716; N3% P = 0.772) between the two groups after treatment.

CONCLUSION

Daytime tDCS changed the complexity of sleep in the REM stage, and presented as decreased intrinsic multi-scale entropy, while no changes in sleep structure occurred. This finding indicated that daytime tDCS may be an effective method to improve sleep quality in depressed patients. Trial registration This trial has been registered at the ClinicalTrials.gov (protocol ID: TCHIRB-10409114, in progress).

The Mediating Role of Coping Style in the Relationship Between Sleep Quality and Burnout: A Cross-Sectional Study Among Psychiatric Nurses

BACKGROUND

Although sleep quality is clearly associated with job burnout as shown in the existing research, the mechanism underpinning such relationship remains undefined. This work, thus, aimed to assess the current situation of sleep quality and burnout in Chinese psychiatric nurses, and to analyze the relationships between sleep quality, burnout and coping style, in order to provide possible targets to enhance mental health and wellbeing among psychiatric nurses.

METHOD

This cross-sectional study was carried out in seven rehabilitation centers located in four different regions of China. The Pittsburgh Sleep Quality Index, the Epworth Sleeping Scale, the Maslach Burnout Inventory General Survey, and the Coping Style Questionnaire were distributed to 853 nurses in various mental hospitals, with a total of 664 participants being recruited in the final research.

RESULTS

The results of this current study showed a high prevalence of sleep disorders and burnout in Chinese psychiatric nurses. Moreover, emotional exhaustion (r = 0.456), cynicism (r = 0.323) and negative coping style (r = 0.191) in nurses were all positively correlated with total Pittsburgh Sleep Quality Index (PSQI) score, while professional efficacy (r = -0.079) and positive coping style (r = -0.140) were negatively correlated with total PSQI score. More interestingly, of all negative coping strategies, we found that self-blame had the most significant effect (β = 0.156).

CONCLUSIONS

The above results showed that coping style mediates the association of poor sleep quality with job burnout in Chinese psychiatric nurses. This study claimed that there is an urgent need to development the coping skills to sustain a healthy work life for nurses.