Comparison of robotic and coblation tongue base resection for obstructive sleep apnoea

OBJECTIVES

To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection.

DESIGN

Retrospective case-control study.

SETTING

University-based tertiary care medical center.

PARTICIPANTS

Patients with obstructive sleep apnoea (OSA) who underwent endoscope-guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate-to-severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study.

MAIN OUTCOME MEASURES

All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared.

RESULTS

Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P < .0001) in the TORS group and from 45.6 to 16.2 events/h (P < .0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients.

CONCLUSIONS

Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.

Effects of diet complexity and multicarbohydrase supplementation on growth performance, nutrient digestibility, blood profile, intestinal morphology, and fecal score in newly weaned pigs

To study the effects of diet complexity and multicarbohydrase (MC) supplementation, 144 piglets (6.70 ± 0.81 kg of BW) weaned at 21 ± 2 d of age (1:1 male to female ratio) were assigned to 1 of 6 dietary treatments in a 3 × 2 factorial arrangement based on diet complexity (complex1, complex2, and simple) and MC addition (0 vs. 0.1% of MC). Diets were provided in a 2-phase feeding program with phase I (d 1 to 14) and phase II diets (d 15 to 28). Complex1 was formulated to mimic a conventional weaner diet with blood plasma, fish meal, dried whey, and skim milk powder, whereas complex2 partially or totally replaced these ingredients with various plant-based ingredients. The simple diet primarily comprised corn, wheat, and soybean meal. No interactions were found between diet complexity and MC supplementation ( > 0.10), except for apparent total tract digestibility (ATTD) of ash and globulin concentration on d 28 ( < 0.05). Pigs fed the complex1 diet had greater ( < 0.01) ADG, ADFI, and G:F than those fed the other diets during the first week after weaning. However, no differences in ADG or ADFI were observed for pigs fed the complex1 and simple diets throughout the 28-d experimental period ( > 0.10), whereas the complex2 diet led to lower ADG and ADFI compared with the complex1 diet ( < 0.05). Overall, G:F was greater for pigs fed the simple diet compared with those fed the complex1 diet ( < 0.01). Pigs fed the simple diet showed ATTD of DM, OM, GE, and ash comparable to those fed the complex1 diet on d 14 ( > 0.10). In contrast, greater ATTD of DM, OM, NDF, GE, and ash was observed ( < 0.05) in pigs fed the complex1 diet than in those fed the complex2 diet or the simple diet on d 28. The simple diet increased the lymphocyte proportion in serum compared with the complex1 diet ( < 0.01) on d 14. Pigs fed the complex1 diet had a greater ( < 0.05) ratio of villus height (VH) to crypt depth (CD) in the ileum compared with the other diets. The complex2 diet decreased ( < 0.05) the fecal score during 3 wk of the postweaning period compared with the complex1 diet. Dietary MC supplementation increased ( < 0.05) G:F during the overall experimental period, VH in the ileum, VH:CD ratio in the duodenum, and ATTD of DM and GE but it reduced fecal score ( < 0.05). In conclusion, feeding a simple diet resulted in BW comparable to feeding the complex1 diet, but it led to inferior intestinal morphology and ATTD of nutrients on d 28. Also, MC supplementation could be beneficial regardless of diet complexity.

Digestible, metabolizable, and net energy of camelina cake fed to growing pigs and additivity of energy in mixed diets

This experiment was conducted to determine the DE, ME, and NE contents of camelina cake (CC) and to test the hypothesis that dietary glucosinolates originating from CC will affect the additivity of energy in mixed diets containing different inclusion levels of corn, soybean meal (SBM), and CC. A total of 30 growing barrows ([Yorkshire × Landrace] × Duroc) with a mean BW of 16.8 kg (SD 1.4) were randomly allotted to 1 of 5 treatments with 6 replicates per treatment. Pigs were fed experimental diets for 16 d, including 10 d for adaptation and 6 d for total collection of feces and urine. The 5 experimental diets consisted of 3 corn-based diets to determine the DE, ME, and NE of the 3 ingredients (corn, SBM, and CC) and 2 mixed diets to test the additivity of DE, ME, and NE. The corn diet contained 97.52% corn; the SBM diet contained 67.52% corn and 30.0% SBM; the CC diet contained 67.52% corn and 30.0% CC; the Mixed diet 1 contained 67.52% corn, 20.0% SBM, and 10.0% CC; and the Mixed diet 2 contained 67.25% corn, 10.0% SBM, and 20.0% CC. Vitamins and minerals were included in the diets to meet or exceed the requirements for growing pigs (). Pigs were fed their assigned diets at 550 kcal ME/kg BW per day on the basis of BW on d 1, 5, and 10, which was close to ad libitum intake. Pigs had free access to water. Determined DE, ME, and NE contents of corn were 3,348, 3,254, and 2,579 kcal/kg, respectively; those of SBM were 3,626, 3,405, and 2,129 kcal/kg, respectively; and those of CC were 3,755, 3,465, and 2,383 kcal/kg, respectively. No differences between the predicted and determined DE, ME, and NE were observed in the 2 mixed diets. In conclusion, DE, ME, and calculated NE content of CC fed to growing pigs were 3,755, 3,465, and 2,383 kcal/kg (as-fed basis), respectively. In addition, additivity of DE, ME, and calculated NE was observed in the mixed diets containing corn, SBM, and CC, which indicates that dietary glucosinolates originating from up to 30% of CC inclusion do not affect DE, ME, and calculated NE of diets.

Atopic dermatitis is inversely associated with hepatitis B antigen positivity: a population-based cohort study

BACKGROUND

No clear association between hepatitis B virus (HBV) infection and atopic dermatitis (AD) has been established. Some studies have reported that subjects with HBV had an increased risk of atopy; other studies reported an inverse association between HBV seropositivity and allergic diseases.

OBJECTIVE

We evaluated the association between AD and hepatitis B antigen (HBsAg) positivity using Korean National Health and Nutrition Examination Survey data.

METHODS

In total, 14 776 participants aged >19 years were included in the analysis. Multiple logistic regression analyses were used to evaluate the odds ratio of HBsAg positivity in association with AD and asthma.

RESULTS

The prevalence of HBsAg positivity was lower in individuals with AD than in those without AD (mean [SE], 0.7% [0.4] vs. 3.7% [0.2]; P < 0.001). However, HBsAg positivity was not significantly associated with asthma (3.7% [0.2] vs. 2.8% [0.8]; P < 0.001). HBsAg positivity decreased the risk of AD significantly (OR = 0.223; 95% CI = 0.069-0.72).

CONCLUSIONS

This study demonstrates an inverse association between AD and HBsAg positivity using a nationwide, population-based, cross-sectional health examination and survey.

Effects of bone marrow on the microenvironment of the human pancreatic islet: A Protein Profile Approach

Stem cells are a new therapeutic modality that may support the viability and function of human organs and tissue. Our previous studies have revealed that human allogeneic bone marrow (BM) sustains pancreatic β cell function and survival. This paper examines whether BM creates a microenvironment that supports human pancreatic islets in vitro by evaluating 107 proteins in culture media from BM, islet, and islet/bone marrow (IB) with mass spectrometry. Proteins were considered up- or down-regulated if p-values < 0.05 and fold change was greater than 2 fold I VS. IB. In addition, proteins identified that were uniquely found in islets co-cultured with bone marrow, but not in islets or bone marrow. A 95% protein probability was used as a threshold. Twenty three proteins were upregulated, and sixteen proteins were downregulated. The function of each protein is listed based on the protein database, which include structural proteins (9 upregulated, 4 downregulated); anti-protease and anti-endopeptidase enzymes (8 upregulated); cation binding proteins (6 up-regulated). Six proteins were uniquely identified in islet co-cultured with bone marrow. Three are anti-proteases or anti-endopeptidases, and 1 is a structural protein. These findings suggest that BM, by changing culture media proteins, may be one of mechanisms to maintain human islet function and survival.

Influence of a ring-shaped pump beam on temperature distribution and thermal lensing in end-pumped solid state lasers

A simple method for reducing thermal lensing in an end-pumped solid state laser using a ring-shaped pump beam is reported. Analytical expressions for the temperature distribution and the thermal lensing focal length in a laser medium end-pumped by a beam with a ring-shaped intensity profile are derived. The results indicate that thermal effects including thermal lensing can be significantly reduced due to a more uniform temperature distribution. This approach has been applied to a Nd:YVO₄ amplifier operating at 1064 nm confirming that the brightness of the output beam can be remarkably improved at high power levels due to the better beam quality for the ring-shaped pumping compared to the conventional quasi-top-hat pumping. The prospects for power scaling and further improvement in laser performance will be discussed.

Unified neural field theory of brain dynamics underlying oscillations in Parkinson's disease and generalized epilepsies

The mechanisms underlying pathologically synchronized neural oscillations in Parkinson's disease (PD) and generalized epilepsies are explored in parallel via a physiologically-based neural field model of the corticothalamic-basal ganglia (CTBG) system. The basal ganglia (BG) are approximated as a single effective population and their roles in the modulation of oscillatory dynamics of the corticothalamic (CT) system and vice versa are analyzed. In addition to normal EEG rhythms, enhanced activity around 4 Hz and 20 Hz exists in the model, consistent with the characteristic frequencies observed in PD. These rhythms result from resonances in loops formed between the BG and CT populations, analogous to those that underlie epileptic oscillations in a previous CT model, and which are still present in the combined CTBG system. Dopamine depletion is argued to weaken the dampening of these loop resonances in PD, and network connections then explain the significant coherence observed between BG, thalamic, and cortical population activity around 4-8 Hz and 20 Hz. Parallels between the afferent and efferent connection sites of the thalamic reticular nucleus (TRN) and BG predict low dopamine to correspond to a reduced likelihood of tonic-clonic (grand mal) seizures, which agrees with experimental findings. Furthermore, the model predicts an increased likelihood of absence (petit mal) seizure resulting from pathologically low dopamine levels in accordance with experimental observations. Suppression of absence seizure activity is demonstrated when afferent and efferent BG connections to the CT system are strengthened, which is consistent with other CTBG modeling studies. The BG are demonstrated to have a suppressive effect on activity of the CTBG system near tonic-clonic seizure states, which provides insight into the reported efficacy of current treatments in BG circuits. Sleep states of the TRN are also found to suppress pathological PD activity in accordance with observations. Overall, the findings demonstrate strong parallels between coherent oscillations in generalized epilepsies and PD, and provide insights into possible comorbidities.

Net energy of hemp hulls and processed hemp hull products fed to growing pigs and the comparison of net energy determined via indirect calorimetry and calculated from prediction equations

An experiment was conducted to determine the NE of hemp hulls (HH), extruded HH (EHH), and a blended product of HH with pea (HHP) fed to growing pigs using indirect calorimetry (IC) and to determine effects of dietary fiber on heat production (HP) and fasting HP (FHP). Twenty-four growing barrows with an average initial BW of 22.9 ± 1.75 kg were individually housed in adjustable metabolism crates. Pigs were randomly allotted to 1 of 4 dietary treatments with 6 replicates per treatment. A corn-soybean meal basal diet was prepared. Three additional diets were formulated to contain a constant ratio of corn and soybean meal and each of the test ingredients. Pigs were fed experimental diets for 16 d including 10 d for adaptation and 6 d for total collection of feces and urine to determine DE and ME of experimental diets. Pigs were then moved into IC chambers to determine HP and FHP. The apparent total tract digestibility (ATTD) of DM was greater ( < 0.01) in the HHP diet than in the HH and EHH diets but less ( < 0.01) than in the basal diet. Similarly, the ATTD of GE in the basal diet was greater ( < 0.01) compared with the HH, EHH, and HHP diets. The DE, ME, and NE of the basal diet were greater ( < 0.01) than those of the HH, EHH, and HHP diets. No significant differences were observed for the HP (on average, 1,904 kcal/kg DM) and FHP (on average, 1,320 kcal/kg DM) among treatments. However, the retained energy of pigs fed the basal diet (1,763 kcal/kg DM) was greater ( < 0.05) than for those fed the HH (1,501 kcal/kg DM) and HHP (1,482 kcal/kg DM) diets. The NE:ME ratio tended to be greater ( ≤ 0.10) for the basal diet (0.85) than for the HH (0.82), EHH (0.82), and HHP (0.83) diets. The NE of HH, EHH, and HHP determined by the IC method were 2,375, 2,320, and 2,399 kcal/kg DM, respectively, whereas values calculated using published prediction equations were 2,308, 2,161, and 2,278 kcal/kg DM, respectively. However there was no difference between determined and predicted values. In conclusion, the NE of HH, EHH, and HHP determined using the IC method were 2,375, 2,320, and 2,399 kcal/kg DM, respectively, and these values were 2.9, 7.1, and 5.2% greater, respectively, than the predicted values, although no difference was observed between determined and predicted values. However, the HP values observed for the basal diet and the diets containing high dietary fiber in the form of HH, EHH, or HHP were similar.

Acute endophthalmitis after cataract surgery: 164 consecutive cases treated at a referral center in South Korea

PurposeTo identify prognostic factors in patients referred with endophthalmitis after cataract surgery, and to evaluate the efficacy of primary vitrectomy as an initial management.MethodsOver an eight-year study period, we retrospectively reviewed the medical records of 164 patients who were referred with endophthalmitis following cataract surgery. Treatment generally conformed to standard guidelines, although primary vitrectomy was performed in several eyes with a visual acuity of hand motion or better, depending on the patient's status. Using multivariate analysis, we analyzed outcomes to determine the effect on final visual outcome.ResultsA final visual acuity of ≥20/40 was achieved in 92/164 (56.1%) cases after treatment. Bacterial cultures showed bacterial growth in 89/164 cases (54.3%). Among the various baseline characteristics, old age (P=0.028), poor visual acuity at presentation (P=0.004), gram-negative bacterial infection (P=0.030), and short time between cataract surgery and signs of endophthalmitis (P=0.021) were associated with poor visual outcome. The visual outcome showed no significant difference, in terms of initial treatment feature, between the primary vitrectomy with intraocular antibiotics injection (IOAI) and IOAI-only groups. However, reintervention was significantly less frequent in the primary vitrectomy group than in the IOAI group (12.5 and 32.7%, respectively; P=0.002).ConclusionOld age, poor visual acuity at presentation, type of cultured organism (gram-negative bacteria), and early onset of endophthalmitis after cataract surgery were significantly related to poor visual outcome after endophthalmitis treatment. Primary vitrectomy may decrease the need for reintervention to control infection, although the treatment showed no benefits with regard to visual outcome.

Association of CMB305 or LV305-induced and baseline anti-NY-ESO-1 immunity with survival in recurrent cancer patients

3090

Background: The correlation of immune response (IR) and clinical benefit in patients (pts) who receive active immunotherapy remains controversial. CMB305 is an active immunotherapy designed to generate and expand anti-NY-ESO-1 T cells, consisting of LV305 (a DC targeting lentiviral vector encoding NY-ESO-1) and a boost (NY-ESO-1 recombinant protein plus GLA-SE, a TLR-4 agonist). Phase 1 studies of LV305 and CMB305 evaluated the IR and survival of pts with NY-ESO-1 positive tumors. Methods: 62 pts with recurrent NY-ESO-1 expressing (by IHC) solid tumors were enrolled in 2 Phase 1 trials (31 pts each: 43 sarcomas, 12 ovarian, 4 melanomas, and 3 NSCLC). Peripheral blood was assessed pre and post therapy for anti-NY-ESO-1 T cell responses (IFNγ ELISPOT) and antibodies (Ab) (ELISA) (n = 62), TCR-β CDR3 repertoire and conserved (public) TCR (n = 28), and antigen spreading (ELISA, ELISPOT) (n = 23). Relationship between progression-free survival (PFS), overall survival (OS) and up to 15 biomarkers were analyzed by the Kaplan-Meier method. Results: Preexisting anti-NY-ESO-1 T cells and Ab were identified in 34% and 40% of pts. LV305 and CMB305 induced (de novo or increased) anti-NY-ESO-1 T-cells in 51% and 65% pts, and anti-NY-ESO-1 Ab responses in 13% and 68% pts, respectively. LV305 and CMB305 induced antigen spreading in 17% and 36% pts. TCR clonality increased after CMB305 as compared to LV305. The TCRβ-CDR3 amino acid sequences of three NY-ESO-1 specific TCR clones in a patient with a > 2-year response were fully conserved in 20/28 patients. Biomarkers showing the strongest association with OS and PFS were pre-existing anti-NY-ESO-1 T-cell response and Ab, integrated IR (T cells and antibodies), and NY-ESO-1 expression level. Presence of public TCRs was associated with longer survival, particularly in pts with high ( > 50%) NY-ESO-1 expression. Conclusions: While LV305 and CMB305 are both immunogenic, CMB305 resulted in a stronger and broader integrated IR, including antigen spreading. The three identified survival variables, preexisting and treatment-induced NY-ESO-1 IR and the presence of public TCRs, warrant validation in randomized studies of CMB305.

Immune response, safety, and survival impact from CMB305 in NY-ESO-1+ recurrent soft tissue sarcomas (STS)

11006

Background: CMB305 is an active immunotherapy regimen designed to generate and expand anti-NY-ESO-1 T cells. It consists of LV305, a dendritic cell targeting lentiviral vector encoding NY-ESO-1, and a boost with G305, an NY-ESO-1 recombinant protein plus GLA-SE, a TLR-4 agonist. An LV305 phase 1 study demonstrated a 1-yr survival of 81% and induction of anti-NY-ESO-1 T cells in sarcoma patients (pts). This first-in-human study of CMB305 examined safety, immunogenicity, and efficacy in pts with NY-ESO-1 positive (+) solid tumors. Methods: Adults with previously treated NY-ESO-1+ sarcomas, NSCLC, ovarian cancer were enrolled in a 3+3 dose-escalation with an expansion phase 1 study. The CMB305 regimen included 4 intradermal injections of LV305 at 109 or 1010 vector genomes, alternating with 3 intramuscular G305 injections at 250 µg for 3 months, then bimonthly G305 injections up to 1 yr. Results: As of 31Dec2016, 25 pts with STS (15 synovial (SS), 8 myxoid/round cell liposarcoma (MRCL), 2 other) were evaluable for safety; 23 SS/MRCL pts were evaluable for immune response (IR) and efficacy. All SS and MRCL pts received prior therapy for locally advanced/metastatic disease, 67% > = 2 prior chemo regimens. No DLTs were observed; treatment related AEs were grade 1 and 2, except 1 pt with grade 3 SAE (prostatic pain). Of 11 SS/MRCL pts tested, 64% pts developed NY-ESO-1 specific T cells and 72% pts anti-NY-ESO-1 antibodies. T cell receptor sequencing indicated increased clonality, and antigen spreading after CMB305. Best response by immune related response criteria was stable disease in 8/15 (53%) SS pts and 6/8 (75%) MRCL pts. The 3 month PFS rate was 74% and 75% for SS and MRCL pts. Median survival has not been reached with 1-yr survival rate of 86% and 100% for SS and MRCL pts. Conclusions: CMB305 is safe, well tolerated, and demonstrates a survival rate that is favorable when compared with approved agents for recurrent STS. CMB305 resulted in a stronger and broader integrated IR than LV305, including antigen spreading. These data warrant further investigation of CMB305 as a monotherapy in a randomized clinical study in STS. A randomized study of CMB305 in combination with atezolizumab in SS/MRCL pts is ongoing. Clinical trial information: NCT02387125.

Nivolumab ± ipilimumab in pts with advanced (adv)/metastatic chemotherapy-refractory (CTx-R) gastric (G), esophageal (E), or gastroesophageal junction (GEJ) cancer: CheckMate 032 study

4014

Background: In the phase 3 ONO-12 study, 3rd- or later-line nivolumab (N) monotherapy prolonged OS vs placebo in Asian pts with adv G/GEJ cancer (median OS, 5.3 vs 4.1 mo; HR, 0.63; P < 0.0001; ASCO-GI 2017, Kang YK et al. J Clin Oncol. 2017;35 (suppl 4S) [abstract 2]). The phase 1/2 CheckMate 032 study showed favorable clinical activity of N ± ipilimumab (I) in Western pts with adv CTx-R G/E/GEJ cancer (NCT01928394). We report updated long-term follow-up data of G/E/GEJ pts in CheckMate 032. Methods: Pts received N 3 mg/kg Q2W (N3), N 1 mg/kg + I 3 mg/kg Q3W (N1+I3), or N 3 mg/kg + I 1 mg/kg Q3W (N3+I1). Primary endpoint was ORR. Secondary endpoints included DOR, OS, PFS, and safety. Efficacy in pts by PD-L1 status was assessed. Results: 160 heavily pretreated pts (79% had ≥ 2 prior Tx) were enrolled (N3, n = 59; N1+I3, n = 49; N3+I1, n = 52); 24% had PD-L1+ (≥ 1%) tumors. ORR was 12% in N3, 24% in N1+I3, and 8% in N3+I1. In pts with PD-L1 ≥ 1%, ORR was 19% (3/16) in N3, 40% (4/10) in N1+I3, and 23% (3/13) in N3+I1; in pts with PD-L1 < 1%, ORR was 12% (3/26), 22% (7/32), and 0% (0/30), respectively. Median DOR was 7.1 mo in N3, 7.9 mo in N1+I3, and NA in N3+I1. OS in all pts and in pts with PD-L1 ≥ 1% is in the Table. Grade 3–4 treatment-related AEs reported in ≥ 10% of pts in any treatment arm were diarrhea (N3, 2%; N1+I3, 14%; N3+I1, 2%), ALT increased (N3, 3%; N1+I3, 14%; N3+I1, 4%), and AST increased (N3, 5%; N1+I3, 10%; N3+I1, 2%). Conclusions: N ± I led to durable responses and long-term OS in heavily pretreated Western pts with adv G/E/GEJ cancer, which is consistent with the clinical activity observed in Asian pts in the ONO-12 study. Safety was consistent with prior reports. These data support ongoing investigation of N ± I in pts with adv G/E/GEJ cancer. Clinical trial information: NCT01928394. [Table: see text]

Three-dimensional imaging of dislocation dynamics during the hydriding phase transformation

Crystallographic imperfections significantly alter material properties and their response to external stimuli, including solute-induced phase transformations. Despite recent progress in imaging defects using electron and X-ray techniques, in situ three-dimensional imaging of defect dynamics remains challenging. Here, we use Bragg coherent diffractive imaging to image defects during the hydriding phase transformation of palladium nanocrystals. During constant-pressure experiments we observe that the phase transformation begins after dislocation nucleation close to the phase boundary in particles larger than 300 nm. The three-dimensional phase morphology suggests that the hydrogen-rich phase is more similar to a spherical cap on the hydrogen-poor phase than to the core-shell model commonly assumed. We substantiate this using three-dimensional phase field modelling, demonstrating how phase morphology affects the critical size for dislocation nucleation. Our results reveal how particle size and phase morphology affects transformations in the PdH system.

Standardized total tract digestibility of phosphorus in flaxseed meal fed to growing and finishing pigs without or with phytase supplementation

Two experiments were conducted to determine the apparent total tract digestibility (ATTD) and standardized total tract digestibility (STTD) of P in flaxseed meal (FM) and the effect of dietary microbial phytase on the digestibility of P in FM fed to growing and finishing pigs. In Exp. 1, eighteen growing barrows (26.6 ± 1.8 kg BW) were allotted to 1 of 3 experimental diets consisting of a diet containing 32% FM that was fed with or without phytase at 500 phytase units (FTU/kg and a P-free diet in a completely randomized design to give 6 replicates per diet. The experimental period lasted 12 d including first 7 d for adaptation and 5 d for total collection of feces. Pigs were fed their assigned diets at 4% of BW at the beginning of the experiment. The daily feed allowance was offered in 2 equal portions at 0800 and 1600 h. All experimental diets were provided in mash form. Results indicated that pigs fed the diets containing FM with dietary phytase had less ( < 0.05) fecal P concentration and daily P output than those fed the diets without phytase supplementation. Also, phytase supplementation increased ( < 0.05) the ATTD of P of the diets containing FM from 37.3% to 51.8% and STTD of P of the diets containing FM from 43.2% to 57.7%. The basal endogenous P losses (EPL) was calculated at 140 ± 11 mg/kg of DMI in growing pigs fed the P-free diet. In Exp. 2, eighteen finishing pigs (78.7 ± 2.4 kg BW) were randomly allotted to 1 of 3 dietary treatments. The experimental diets and procedures were similar to those described in Exp. 1. Similar to Exp. 1, pigs fed FM diets with phytase supplementation had less ( < 0.05) P concentration in feces than those fed diets without phytase supplementation. Also, daily P output was reduced ( = 0.08) when pigs were fed the FM diets with phytase compared to those fed the FM diets without phytase. The ATTD of P in FM diets was increased ( < 0.01) from 31.4% to 45.8%, whereas the STTD of P in FM diets was increased ( < 0.01) from 37.8% to 52.3% as a result of phytase supplementation. The basal EPL was calculated at 164 ± 19 mg/kg of DMI in finishing pigs fed the P-free diet. In conclusion, the ATTD and STTD of P in FM fed to growing pigs were 37.3% and 43.2%, respectively, whereas respective values for finishing pigs were 31.4%, and 37.8%, respectively. Also, dietary phytase supplementation improved both ATTD and STTD of P in FM for both stages of pigs by an average of 33%.

Atezolizumab (atezo) in patients with metastatic urothelial carcinoma (mUC): A 2-year clinical update from a phase Ia study

290

Background: Atezo (anti–PD-L1) has demonstrated safety and efficacy in a broad range of cancers and is approved in the United States for mUC previously treated with platinum-based chemotherapy. Here we report long-term results in mUC from Phase Ia study NCT01375842 (PCD4989g). Methods: Previously treated mUC patients received atezo 15 mg/kg or 1200 mg IV q3w. Enrollment in this Phase Ia expansion cohort initially required PD-L1–selected status and later opened to patients regardless of PD-L1 expression on tumor-infiltrating immune cells. The primary endpoint was safety/tolerability. Secondary endpoints included investigator-assessed RECIST v1.1 ORR (confirmed), DOR and OS. Results: 95 patients were safety evaluable (Table). Median age was 66 years, 76% were male and 80% had primary bladder tumors. 61% had ECOG PS 1. 52% received ≥ 3 prior systemic therapies for mUC (70% platinum). Median treatment duration was 3 months (range: 0-32 months); 24% were treated for ≥ 1 year. Treatment-related AEs occurred in 66% (all Grade) and 8% (Grade 3-4) of patients. No treatment-related deaths were reported. In 94 objective response–evaluable patients (follow-up ≥ 12 weeks), the ORR was 27% (95% CI: 18, 37%), and the CR rate was 10%; the SD rate was 19%. mDOR was 22.1 months (95% CI: 12.1, NE months) in all patients; 56% of responses (7/9 CRs and 7/16 PRs) were ongoing at the December 15, 2015 data cutoff. With a 24-month median follow-up duration (range: 1+ to 32 months), the 1-year OS rate was 47% (95% CI: 36, 58%), and the 2-year rate was 29% (19, 40%); mOS is in the Table. Updated clinical data with further follow-up and analyses by PD-L1 status will be presented. Conclusions: Long-term treatment with atezo was well tolerated, without new safety signals in heavily pre-treated mUC patients. The durability of responses, including CRs, along with extended OS, confirm atezo as a new standard for previously treated mUC patients. Clinical trial information: NCT01375842. [Table: see text]

Preoperative clinical features of reactivated of Graves' orbitopathy after orbital decompression

PurposeTo investigate the incidence and preoperative clinical features of reactivated Graves' orbitopathy (GO) after orbital decompression.MethodsThis study included patients with GO who underwent orbital decompression for disfiguring proptosis and not compressive optic neuropathy and received postoperative follow-up care for more than 12 months. Patients who experienced active inflammatory signs within 6 months of decompression were excluded from analysis. The demographic characteristics, ophthalmic manifestations, and biochemical parameters of the patients were analyzed for association with reactivation of GO by logistic regression analysis.ResultsOut of the 92 patients included in this study, seven (7.6%) experienced reactivation of GO after orbital decompression. The mean time interval between surgery and reactivation of GO was 36.3±14.3 weeks. Univariate logistic regression analysis identified age, existing smoking habits, and modified NOSPECS and Gorman scores as significant factors for the reactivation of GO. The results of multivariate logistic regression analysis revealed that smoking and modified NOSPECS and Gorman scores were associated with the reactivation of GO.ConclusionsQuitting smoking is important for the prevention of reactivation of GO after orbital decompression. Patients with severe symptoms, especially those with restrictive myopathy, should be carefully monitored for reactivation of GO after orbital decompression.

Ultrafast dynamics of localized magnetic moments in the unconventional Mott insulator Sr2IrO4

We report a time-resolved study of the ultrafast dynamics of the magnetic moments formed by the [Formula: see text] states in Sr2IrO4 by directly probing the localized iridium 5d magnetic state through resonant x-ray diffraction. Using optical pump-hard x-ray probe measurements, two relaxation time scales were determined: a fast fluence-independent relaxation is found to take place on a time scale of 1.5 ps, followed by a slower relaxation on a time scale of 500 ps-1.5 ns.

Prospective Study Evaluating Na18F PET/CT in Predicting Clinical Outcomes and Survival in Advanced Prostate Cancer

This prospective pilot study evaluated the ability of Na(18)F PET/CT to detect and monitor bone metastases over time and its correlation with clinical outcomes and survival in advanced prostate cancer.

METHODS

Sixty prostate cancer patients, including 30 with and 30 without known bone metastases by conventional imaging, underwent Na(18)F PET/CT at baseline, 6 mo, and 12 mo. Positive lesions were verified on follow-up scans. Changes in SUVs and lesion number were correlated with prostate-specific antigen change, clinical impression, and overall survival.

RESULTS

Significant associations included the following: SUV and prostate-specific antigen percentage change at 6 mo (P = 0.014) and 12 mo (P = 0.0005); SUV maximal percentage change from baseline and clinical impression at 6 mo (P = 0.0147) and 6-12 mo (P = 0.0053); SUV change at 6 mo and overall survival (P = 0.018); number of lesions on Na(18)F PET/CT and clinical impression at baseline (P < 0.0001), 6 mo (P = 0.0078), and 12 mo (P = 0.0029); and number of lesions on Na(18)F PET/CT per patient at baseline and overall survival (P = 0.017). In an exploratory analysis, paired (99m)Tc-methylene diphosphonate bone scans ((99m)Tc-BS) were available for 35 patients at baseline, 19 at 6 mo, and 14 at 12 mo (68 scans). Malignant lesions on Na(18)F PET/CT (n = 57) were classified on (99m)Tc-BS as malignant 65% of the time, indeterminate 25% of the time, and negative 10% of the time. Additionally, 69% of paired scans showed more lesions on Na(18)F PET/CT than on (99m)Tc-BS.

CONCLUSION

The baseline number of malignant lesions and changes in SUV on follow-up Na(18)F PET/CT significantly correlate with clinical impression and overall survival. Na(18)F PET/CT detects more bone metastases earlier than (99m)Tc-BS and enhances detection of new bone disease in high-risk patients.