Overall survival from tebentafusp versus nivolumab plus ipilimumab in first-line metastatic uveal melanoma: a propensity score-weighted analysis

BACKGROUND

Tebentafusp demonstrated a superior overall survival (OS) benefit [hazard ratio (HR) 0.51] compared to investigator's choice (82% pembrolizumab) in a randomized, phase III trial (IMCgp100-202; N = 378) in untreated metastatic uveal melanoma (mUM). The 1-year OS rates for tebentafusp and pembrolizumab were 73% and 59%, respectively. In the single-arm GEM1402 (N = 52), the 1-year OS rate for nivolumab plus ipilimumab (N+I) in mUM was 52%. Due to limitations in conducting randomized trials in mUM, we compared OS on tebentafusp or pembrolizumab (IMCgp100-202) to N+I (GEM1402) in untreated mUM using propensity scoring methods.

PATIENTS AND METHODS

Analyses were adjusted using propensity score-based inverse probability of treatment weighting (IPTW), balancing age, sex, baseline lactate dehydrogenase (LDH), baseline alkaline phosphatase, disease location, Eastern Cooperative Oncology Group status, and time from primary diagnosis to metastasis. OS was assessed using IPT-weighted Kaplan-Meier and Cox proportional hazard models. Sensitivity analyses using alternative missing data and weights methods were conducted.

RESULTS

The primary IPTW analysis included 240 of 252 patients randomized to tebentafusp from IMCgp100-202 and 45 of 52 N+I-treated patients from GEM-1402. Key baseline covariates, including LDH, were generally well balanced before weighting. The IPTW-adjusted OS favored tebentafusp, HR 0.52 [95% confidence interval (CI) 0.35-0.78]; 1-year OS was 73% for tebentafusp versus 50% for N+I. Sensitivity analyses showed consistent superior OS for tebentafusp with all IPTW HRs ≤0.61. IPTW analysis of pembrolizumab versus N+I showed no significant difference in OS (HR 0.72; 95% CI 0.50-1.06).

CONCLUSIONS

Tebentafusp was previously shown to provide an OS benefit compared to checkpoint inhibitors or chemotherapy in untreated mUM. Propensity score analysis demonstrated a similar OS benefit for tebentafusp compared with N+I. These data further support tebentafusp as the standard of care in previously untreated human leukocyte antigen (HLA)-A∗02:01+ adult patients with mUM.

Improved Feedback Quantizer with Discrete Space Vector

The use of advanced modulation and control schemes for power converters, such as a Feedback Quantizer and Predictive Control, is widely studied in the literature. This work focuses on improving the closed-loop modulation scheme called Feedback Quantizer, which is applied to a three-phase voltage source inverter. This scheme has the natural behavior of mitigating harmonics at low frequencies, which are detrimental to electrical equipment such as transformers. This modulation scheme also provides good tracking for the voltage reference at the fundamental frequency. On the other hand, the disadvantage of this scheme is that it has a variable switching frequency, creating a harmonic spectrum in frequency dispersion, and it also needs a small sampling time to obtain good results. The proposed scheme to improve the modulation scheme is based on a Discrete Space Vector with virtual vectors to obtain a better approximation of the optimal vectors for use in the algorithm. The proposal improves the conventional scheme at a high sampling time (200 μs), obtaining a THD less than 2% in the load current, decreases the noise created by the conventional scheme, and provides a fixed switching frequency. Experimental tests demonstrate the correct operation of the proposed scheme.

Nanostructured Cellulose-Based Aerogels: Influence of Chemical/Mechanical Cascade Processes on Quality Index for Benchmarking Dye Pollutant Adsorbents in Wastewater Treatment

(1) Background: Nanostructured cellulose has emerged as an efficient bio-adsorbent aerogel material, offering biocompatibility and renewable sourcing advantages. This study focuses on isolating (ligno)cellulose nanofibers ((L)CNFs) from barley straw and producing aerogels to develop sustainable and highly efficient decontamination systems. (2) Methods: (Ligno)cellulose pulp has been isolated from barley straw through a pulping process, and was subsequently deconstructed into nanofibers employing various pre-treatment methods (TEMPO-mediated oxidation process or PFI beater mechanical treatment) followed by the high-pressure homogenization (HPH) process. (3) Results: The aerogels made by (L)CNFs, with a higher crystallinity degree, larger aspect ratio, lower shrinkage rate, and higher Young's modulus than cellulose aerogels, successfully adsorb and remove organic dye pollutants from wastewater. (L)CNF-based aerogels, with a quality index (determined using four characterization parameters) above 70%, exhibited outstanding contaminant removal capacity over 80%. The high specific surface area of nanocellulose isolated using the TEMPO oxidation process significantly enhanced the affinity and interactions between hydroxyl and carboxyl groups of nanofibers and cationic groups of contaminants. The efficacy in adsorbing cationic dyes in wastewater onto the aerogels was verified by the Langmuir adsorption isotherm model. (4) Conclusions: This study offers insights into designing and applying advanced (L)CNF-based aerogels as efficient wastewater decontamination and environmental remediation platforms.

Antibacterial Aerogels-Based Membranes by Customized Colloidal Functionalization of TEMPO-Oxidized Cellulose Nanofibers Incorporating CuO

An innovative colloidal approach is proposed here to carry out the customized functionalization of TEMPO-Oxidized Cellulose Nanofibers (CNF) incorporating non-noble inorganic nanoparticles. A heterocoagulation process is applied between the delignified CNF and as-synthetized CuO nanoparticles (CuO NPs) to formulate mixtures which are used in the preparation of aerogels with antibacterial effect, which could be used to manufacture membranes, filters, foams, etc. The involved components of formulated blending, CNF and CuO NPs, were individually obtained by using a biorefinery strategy for agricultural waste valorization, together with an optimized chemical precipitation, assisted by ultrasounds. The optimization of synthesis parameters for CuO NPs has avoided the presence of undesirable species, which usually requires later thermal treatment with associated costs. The aerogels-based structure, obtained by conventional freeze-drying, acted as 3D support for CuO NPs, providing a good dispersion within the cross-linked structure of the nanocellulose and facilitating direct contact of the antibacterial phase against undesirable microorganisms. All samples showed a positive response against Escherichia coli and Staphylococcus aureus. An increase of the antibacterial response of the aerogels, measured by agar disk diffusion test, has been observed with the increase of CuO NPs incorporated, obtaining the width of the antimicrobial "halo" (nwhalo) from 0 to 0.6 and 0.35 for S. aureus and E. coli, respectively. Furthermore, the aerogels have been able to deactivate S. aureus and E. coli in less than 5 h when the antibacterial assays have been analyzed by a broth dilution method. From CNF-50CuO samples, an overlap in the nanoparticle effect produced a decrease of the antimicrobial kinetic.

Special Issue "Lignocellulosic Biomass II"

As a result of human population growth, the availability of residual lignocellulosic materials from agriculture, forestry, food- and wood-processing industries, and other waste streams is continuously increasing [...].

Boosting functional properties of active-CMC films reinforced with agricultural residues-derived cellulose nanofibres

The search for packaging alternatives that reduce the presence of non-biodegradable plastics in water is a focus of much research today. This fact, together with the increasing demand for active packaging capable of prolonging the shelf life of foodstuffs and the rise in the use of natural biopolymers such as cellulose, motivate the present work. This work evaluates CMC films loaded with gallic acid reinforced with (ligno)cellulose nanofibres from various agricultural residues as candidates for use in active food packaging. The first stage of the study involved the evaluation of different nanofibres as the reinforcing agent in CMC films. Increasing proportions of nanofibres (1, 3, 5 and 10% w/w) from horticultural residues (H) and nanofibres from vine shoots (V), containing residual lignin (LCNF) and without it (CNF), and obtained by mechanical (M) or chemical (T) pretreatment, were studied. The results of this first stage showed that the optimum reinforcement effect was obtained with 3% H-MCNF or 3% V-MCNF, where up to 391% and 286% improvement in tensile strength was achieved, respectively. These films offered slightly improved UV-light blocking ability (40-55% UV-barrier) and water vapor permeability (20-30% improvement) over CMC. Next, bioactive films were prepared by incorporating 5 and 10% wt of gallic acid (GA) over the optimised formulations. It was found that the joint addition of cellulose nanofibres and GA enhanced all functional properties of the films. Mechanical properties improved to 70%, WVP to 50% and UV light blocking ability to 70% due to the synergistic effect of nanofibres and GA. Finally, the bioactive films exhibited potent antioxidant activity, 60-70% in the DPPH assay and >99% in the ABTS assay and high antimicrobial capacity against S. aureus.

Bioactive Absorbent Chitosan Aerogels Reinforced with Bay Tree Pruning Waste Nanocellulose with Antioxidant Properties for Burger Meat Preservation

As a transition strategy towards sustainability, food packaging plays a crucial role in the current era. This, carried out in a biorefinery context of agricultural residues, involves not only obtaining desirable products but a comprehensive utilization of biomass that contributes to the circular bioeconomy. The present work proposes the preparation of bioactive absorbent food pads through a multi-product biorefinery approach from bay tree pruning waste (BTPW). In a first step, chitosan aerogels reinforced with lignocellulose and cellulose micro/nanofibers from BTPW were prepared, studying the effect of residual lignin on the material's properties. The presence of micro/nanofibers improved the mechanical performance (up to 60%) in addition to increasing the water uptake (42%) when lignin was present. The second step was to make them bioactive by incorporating bay leaf extract. The residual lignin in the micro/nanofibers was decisive, since when present, the release profiles of the extract were faster, reaching an antioxidant power of more than 85% after only 30 min. Finally, these bioactive aerogels were used as absorbent pads for fresh meat. With the use of the bioactive aerogels (with ≥2% extract), the meat remained fresh for 10 days as a result of delayed oxidation of the food during storage (20% metmyoglobin proportion).

Nanocellulose from Spanish Harvesting Residues to Improve the Sustainability and Functionality of Linerboard Recycling Processes

The hornification processes undergone by the fibers in the paper industry recycling processes lead to the loss of properties of the final products, which exhibit poor mechanical properties. Among the most promising solutions is the reinforcement of secondary fibers with cellulose nanofibers. The present work addresses two important issues: the efficient production of cellulose nanofibers from scarcely exploited agricultural wastes such as horticultural residues and vine shoots, and their application as a reinforcement agent in recycled linerboard recycling processes. The effect of the chemical composition and the pretreatment used on the nanofibrillation efficiency of the fibers was analyzed. Chemical pretreatment allowed a significantly higher nanofibrillated fraction (45−63%) than that produced by mechanical (18−38%), as well as higher specific surface areas (>430 m2/g). The application of the nanofibers as a reinforcing agent in the recycled linerboard considerably improved the mechanical properties (improvements of 15% for breaking length, 220−240% for Young’s modulus and 27% for tear index), counteracting the loss of mechanical properties suffered during recycling when using chemically pretreated cellulose nanofibers from horticultural residues and vine shoots. It was concluded that this technology surpasses the mechanical reinforcement produced by conventional mechanical refining used in the industry and extends the number of recycling cycles of the products due to the non-physical modification of the fibers.

Monitoring of Thermal Comfort and Air Quality for Sustainable Energy Management inside Hospitals Based on Online Analytical Processing and the Internet of Things

There is a need to ensure comfortable conditions for hospital staff and patients from the point of view of thermal comfort and air quality so that they do not affect their performance. We consider the need for hospital employees and patients to enjoy conditions of greater well-being during their stay. This is understood as a comfortable thermal sensation and adequate air quality, depending on the task they are performing. The contribution of this article is the formulation of the fundamentals of a system and platform for monitoring thermal comfort and Indoor Air Quality (IAQ) in hospitals, based on an Internet of Things platform composed of a low-cost sensor node network that is capable of measuring critical variables such as humidity, temperature, and Carbon Dioxide (CO₂). As part of the platform, a multidimensional data model with an On-Line Analytical Processing (OLAP) approach is presented that offers query flexibility, data volume reduction, as well as a significant reduction in query response times. The experimental results confirm the suitability of the platform's data model, which facilitates operational and strategic decision making in complex hospitals.

Cellulose nanofibers/PVA blend polymeric beads containing in-situ prepared magnetic nanorods as dye pollutants adsorbents

Magnetic beads were developed from polyvinyl alcohol and different amounts of cellulose nanofibers (CNF) by in-situ preparation of iron oxide nanoparticles in an alkaline aqueous medium at room temperature. The CNF were isolated from wheat straw, whereas the magnetic nanoparticles (MNPs) precursors were simple iron salts. The complete characterization of all the obtained materials was conducted, and among some other outstanding results it showed that all the components were strongly interacting via hydrogen bonding, while the nano-rods and husks like MNPs were effectively acting as crosslinking dots. All the prepared materials had good magnetic responses, and they were able to remove not only cationic, but also anionic dye pollutants from aqueous model solutions.

FCS-MPC with Nonlinear Control Applied to a Multicell AFE Rectifier

The use of controlled power converters has been extended for high power applications, stacking off-the-shelve semiconductors, and allowing the implementation of, among others, AC drives for medium voltages of 2.3 kV to 13.8 kV. For AC drives based on power cells assembled with three-phase diode rectifiers and cascaded H-bridge inverters, a sophisticated input multipulse transformer is required to reduce the grid voltage, provide isolation among the power cells, and compensate for low-frequency current harmonics generated by the diode-based rectifiers. However, this input multipulse transformer is bulky, heavy, and expensive and must be designed according to the number of power cells, not allowing total modularity of the AC drives based on cascade H-bridges. This study proposes and evaluates a control strategy based on a finite control set-model predictive control that emulates the harmonic cancellation performed by an input multipulse transformer in a cascade H-bridge topology. Hence, the proposed method requires conventional input transformers and replaces the three-phase diode rectifiers. As a result, greater modularity than the conventional multicell converter and improved AC overall input current with a THD as low as 2% with a unitary displacement power factor are achieved. In this case, each power cell manages its own DC voltage using a nonlinear control strategy, ensuring stable system operation for passive and regenerative loads. The experimental tests demonstrated the correct performance of the proposed scheme.

Cellulose Nanofiber-Based Aerogels from Wheat Straw: Influence of Surface Load and Lignin Content on Their Properties and Dye Removal Capacity

Water pollution is one of the most serious problems worldwide. Nanocellulose-based aerogels usually show excellent adsorption capacities due to their high aspect ratio, specific surface area and surface charge, making them ideal for water purification. In this work, (ligno)cellulose nanofibers (LCNFs/CNFs) from wheat straw residues were obtained using two types of pre-treatments: mechanical (Mec) and TEMPO-mediated oxidization (TO), to obtain different consistency (0.2, 0.4, 0.6 and 0.8) bioaerogels, and their adsorption capacities as dye removers were further studied. The materials were characterized in terms of density, porosity and mechanical properties. An inversely proportional relationship was observed between the consistencies of the aerogels and their achieved densities. Despite the increase in density, all samples showed porosities above 99%. In terms of mechanical properties, the best results were obtained for the 0.8% consistency LCNF and CNF-Mec aerogels, reaching 67.87 kPa and 64.6 kPa for tensile strength and Young’s modulus, respectively. In contrast, the adsorption capacity of the aerogels was better for TEMPO-oxidized aerogels, reaching removal rates of almost 100% for the CNF-TO5 samples. Furthermore, the residual lignin content in LCNF-Mec aerogels showed a great improvement in the removal capacity, reaching rates higher than 80%, further improving the cost efficiency of the samples due to the reduction in chemical treatments.

Paving the Way for a Green Transition in the Design of Sensors and Biosensors for the Detection of Volatile Organic Compounds (VOCs)

The efficient and selective detection of volatile organic compounds (VOCs) provides key information for various purposes ranging from the toxicological analysis of indoor/outdoor environments to the diagnosis of diseases or to the investigation of biological processes. In the last decade, different sensors and biosensors providing reliable, rapid, and economic responses in the detection of VOCs have been successfully conceived and applied in numerous practical cases; however, the global necessity of a sustainable development, has driven the design of devices for the detection of VOCs to greener methods. In this review, the most recent and innovative VOC sensors and biosensors with sustainable features are presented. The sensors are grouped into three of the main industrial sectors of daily life, including environmental analysis, highly important for toxicity issues, food packaging tools, especially aimed at avoiding the spoilage of meat and fish, and the diagnosis of diseases, crucial for the early detection of relevant pathological conditions such as cancer and diabetes. The research outcomes presented in the review underly the necessity of preparing sensors with higher efficiency, lower detection limits, improved selectivity, and enhanced sustainable characteristics to fully address the sustainable manufacturing of VOC sensors and biosensors.

Lignocellulose Nanofibre Obtained from Agricultural Wastes of Tomato, Pepper and Eggplants Improves the Performance of Films of Polyvinyl Alcohol (PVA) for Food Packaging

Films formulated with polyvinyl alcohol (PVA) (synthetic biopolymer) were reinforced with lignocellulose nanofibres (LCNF) from residues of vegetable production (natural biopolymer). The LCNF were obtained by mechanical and chemical pre-treatment by 2,2,6,6-tetramethylpiperidine-1-oxyl radical (TEMPO) and added to the polyvinyl alcohol (polymer matrix) with the aim of improving the properties of the film for use in food packaging. The mechanical properties, crystallinity, thermal resistance, chemical structure, antioxidant activity, water barrier properties and optical properties (transparency and UV barrier), were evaluated. In general, with the addition of LCNF, an improvement in the studied properties of the films was observed. In terms of mechanical properties, the films reinforced with 7% LCNF TEMPO showed the best results for tensile strength, Young’s modulus and elongation at break. At the same LCNF proportion, the thermal stability (T_max) increased between 5.5% and 10.8%, and the antioxidant activity increased between 90.9% and 191.8%, depending on the raw material and the pre-treatment used to obtain the different LCNF. Finally, a large increase in UV blocking was also observed with the addition of 7% LCNF. In particular, the films with 7% of eggplant LCNF showed higher performance for Young’s modulus, elongation at break, thermal stability and UV barrier. Overall, results demonstrated that the use of LCNF generated from agricultural residues represents a suitable bioeconomy approach able to enhance film properties for its application in the development of more sustainable and eco-friendly food packaging systems.

SEOM clinical guideline for the management of cutaneous melanoma (2020)

Melanoma affects about 6000 patients a year in Spain. A group of medical oncologists from Spanish Society of Medical Oncology (SEOM) and Spanish Multidisciplinary Melanoma Group (GEM) has designed these guidelines to homogenize the management of these patients. The diagnosis must be histological and determination of BRAF status has to be performed in patients with stage ≥ III. Stage I–III resectable melanomas will be treated surgically. In patients with stage III melanoma, adjuvant treatment with immunotherapy or targeted therapy is also recommended. Patients with unresectable or metastatic melanoma will receive treatment with immunotherapy or targeted therapy, the optimal sequence of these treatments remains unclear. Brain metastases require a separate consideration, since, in addition to systemic treatment, they may require local treatment. Patients must be followed up closely to receive or change treatment as soon as their previous clinical condition changes, since multiple therapeutic options are available.

Incidence of venous thromboembolic events in cancer patients receiving immunotherapy: a single-institution experience

BACKGROUND

Cancer and cancer therapies have been associated with an increased incidence of venous thromboembolic events (VTE). However, the incidence of VTE in patients on immunotherapy has not been well characterized. The aim of this study was to assess the incidence of VTE in cancer patients receiving immunotherapy and ascertain its prognostic utility.

MATERIALS AND METHODS

We conducted a single-institution retrospective study, including all cancer patients treated with anti-Programmed cell Death 1 (PD-1), anti-Programmed cell Death Ligand-1 (PD-L1), anti-Cytotoxic T-Lymphocyte-Associated Protein 4 (CTLA4), a combination of anti-PD-1/anti-PD-L1 and anti-CTLA4 or a combination including any of these drugs with chemotherapy, antiangiogenic agents or both between June 2013 and April 2019 at La Paz University Hospital, Madrid (Spain).

RESULTS

We selected 229 patients. VTE occurred in 16 of 229 patients (7%). VTE occurred more frequently in patients with lung cancer followed by melanoma. Female sex and melanoma were independently associated with an increased risk of VTE. 12 of 16 VTE (75%) were symptomatic. Progressive disease to immunotherapy [HR 31.60 (95% CI 11.44-87.22), p = 0.00], lung cancer [HR 2.55 (95% CI 1.34-4.86), p = 0.00] and melanoma [HR 2.42 (1.20-4.86), p = 0.01] were independently associated with shorter OS. VTE occurrence was not independently associated with shorter OS [HR 1.33 (95% CI 0.63-2.80), p = 0.44].

CONCLUSIONS

The incidence of VTE in cancer patients receiving immunotherapy in our study appeared to be similar to the incidence previously reported in other series of cancer patients treated with systemic therapies. VTE occurrence did not correlate with the prognosis. Further and prospective studies are needed to derive definitive conclusions.

Biorefinery Approach for Aerogels

According to the International Energy Agency, biorefinery is "the sustainable processing of biomass into a spectrum of marketable bio-based products (chemicals, materials) and bioenergy (fuels, power, heat)". In this review, we survey how the biorefinery approach can be applied to highly porous and nanostructured materials, namely aerogels. Historically, aerogels were first developed using inorganic matter. Subsequently, synthetic polymers were also employed. At the beginning of the 21st century, new aerogels were created based on biomass. Which sources of biomass can be used to make aerogels and how? This review answers these questions, paying special attention to bio-aerogels' environmental and biomedical applications. The article is a result of fruitful exchanges in the frame of the European project COST Action "CA 18125 AERoGELS: Advanced Engineering and Research of aeroGels for Environment and Life Sciences".

Bicuspid aortic valve: prompt identification of high-risk groups in a heterogeneous disease

Background

Bicuspid aortic valve (BAV) is a congenital heart disease that can be associated with aortic and/or valve complications. Although most BAV are predisposed to progressive calcification, little is known on variables related to significant valvular dysfunction. BAV is a heterogeneous disease, therefore it is important to identify high-risk groups for a closer follow- up and timely intervention.

Objective

Identify the main determinants of primary cardiovascular events (aortic valve replacement, aortic surgery and death) in a cohort of adults with BAV.

Methods

We included 325 consecutive patients with non-syndromatic BAV (2010–2019) referred to our hospital (3rd level). Clinical information was prospectively collected. All patients underwent serial echocardiograms and Cardiac CT was available in 125 patients (38%). We performed univariate and multivariate analyses and Kaplan-Meyer survival analysis with log-rank test. A p-value <0.05 was considered significant.

Results

325 patients (44.4±15.3 years, 73% men), right–left coronary cusp fusion (RL) in 79%,and presence of raphe in 77%. 100 patients (31.2%) had significant aortic valve dysfunction and 103 (31.7%) had aortic dialatation (>40mm) at the onset of the follow-up. Twenty-nine patients required cardiac surgery (8.9%, mainly symptomatic severe aortic stenosis with aortic valve replacement)and 3 died (1%) during a follow-up of 6.3±1.2 years. Patients with at least 2 of the following determinants at baseline: aortic valve prolapse, aortic valve calcification >1, age >50 years and/or aorta >45mm had higher risk of major cardiovascular events during follow-up (Chi2 for log rank test=27,229 p=0,000005).

Conclusions

In this study population of young adults with BAV we observed a high incidence of events related to the BAV. Age>50 years, aortic valve calcification, aortic valve prolapse and aortic dilatation were independently associated with primary cardiac events. Despite significant BAV heterogeneity, the identification of risk factors may help to stratify the risk of valvular dysfunction, aortic dilatation and major cardiovascular events.

BAV: Risk factors for cardiac surgery

Funding Acknowledgement

Type of funding source: None

Study on the Macro and Micromechanics Tensile Strength Properties of Orange Tree Pruning Fiber as Sustainable Reinforcement on Bio-Polyethylene Compared to Oil-Derived Polymers and Its Composites

Agroforestry creates value but also a huge amount of waste outside its value chain. Tree pruning is an example of such a low value waste, that is typically discarded or incinerated in the fields or used to recover energy. Nonetheless, tree prunings are rich in wood fibers that can be used as polymer reinforcement. Although there are some bio-based polymers, the majority of industries use oil-based ones. The election of the materials is usually based on a ratio between properties and cost. Bio-based polymers are more expensive than oil-based ones. This work shows how a bio-polyethylene matrix can be reinforced with fibers from orange tree prunings to obtain materials with notable tensile properties. These bio-based materials can show a balanced cost due to the use of a cheap reinforcement with an expensive matrix. The matrix used showed a tensile strength of 18.65 MPa, which reached 42.54 MPa after the addition of 50 wt.% of reinforcement. The obtained values allow the use of the studied composite to replace polypropylene and some of its composites under tensile loads.

Bevacizumab in recurrent ovarian cancer: could it be particularly effective in patients with clear cell carcinoma?

PURPOSE

Treatment of recurrent ovarian carcinoma is a challenge, particularly for the clear cell (CCC) subtype. However, there is a preclinical rationale that these patients could achieve a benefit from antiangiogenic therapy. To assess this hypothesis, we used the growth modulation index (GMI), which represents an intrapatient comparison of two successive progression-free survival (PFS).

METHODS

We conducted a retrospective real-world study performed on 34 patients with recurrent ovarian cancer, treated with bevacizumab-containing regimens from January 2009 to December 2017. The primary endpoint was GMI. An established cut-off > 1.33 was defined as a sign of drug activity.

RESULTS

73.5% of patients had high-grade serous ovarian carcinoma (HGSOC), and 17.7% had CCC; 70.6% of patients received carboplatin/gemcitabine/bevacizumab, and 29.4% received weekly paclitaxel/bevacizumab. According to histological subtype, the overall response rate and median PFS were 52% and 14 months for HGSOC and 83.3% and 20 months for CCC, respectively. The overall population median GMI was 0.99; it was 0.95 and 2.36 for HGSOC and CCC, respectively. CCC subtype was significantly correlated with GMI > 1.33 (odds ratio 41.67; 95% confidence interval 3.6-486.94; p = .03).

CONCLUSION

Adding bevacizumab to chemotherapy in recurrent CCC is associated with a remarkable benefit in this cohort. The efficacy of antiangiogenic drugs in CCC warrants further prospective evaluation.

Valorization of Hemp Core Residues: Impact of NaOH Treatment on the Flexural Strength of PP Composites and Intrinsic Flexural Strength of Hemp Core Fibers

Hemp core is a lignocellulosic residue in the production chain of hemp strands. Huge amounts of hemp core are gathered annually in Europe (43,000 tons) with no major application end. Such lignocellulosic wastes have potential as filling or reinforcing material to replace synthetic fibers and wood fibers in polymer composites. In this study, hemp core biomass was treated under different NaOH concentrations and then defibrated by means of Sprout Waldron equipment to obtain single fibers. Polypropylene matrix was reinforced up to 50 wt.% and the resulting hemp core fibers and the flexural properties were investigated. The results show that the flexural strength of composites increased with the intensity of NaOH treatment. The effect of NaOH was attributed to the removal of extractives and lignin in the fiber cell wall leading to improved interfacial adhesion characteristics. Besides, a methodology was established for the estimation of the intrinsic flexural strength of hemp core fibers. The intrinsic flexural strength of hemp core fibers was calculated to be 940 MPa for fibers treated at 10 wt.% of NaOH. In addition, a relationship between the lignin content and the intrinsic strength of the fibers was established.

Feasibility of Barley Straw Fibers as Reinforcement in Fully Biobased Polyethylene Composites: Macro and Micro Mechanics of the Flexural Strength

Awareness on deforestation, forest degradation, and its impact on biodiversity and global warming, is giving rise to the use of alternative fiber sources in replacement of wood feedstock for some applications such as composite materials and energy production. In this category, barley straw is an important agricultural crop, due to its abundance and availability. In the current investigation, the residue was submitted to thermomechanical process for fiber extraction and individualization. The high content of holocellulose combined with their relatively high aspect ratio inspires the potential use of these fibers as reinforcement in plastic composites. Therefore, fully biobased composites were fabricated using barley fibers and a biobased polyethylene (BioPE) as polymer matrix. BioPE is completely biobased and 100% recyclable. As for material performance, the flexural properties of the materials were studied. A good dispersion of the reinforcement inside the plastic was achieved contributing to the elevate increments in the flexural strength. At a 45 wt.% of reinforcement, an increment in the flexural strength of about 147% was attained. The mean contribution of the fibers to the flexural strength was assessed by means of a fiber flexural strength factor, reaching a value of 91.4. The micromechanical analysis allowed the prediction of the intrinsic flexural strength of the fibers, arriving up to around 700 MPa, and coupling factors between 0.18 and 0.19, which are in line with other natural fiber composites. Overall, the investigation brightness on the potential use of barley straw residues as reinforcement in fully biobased polymer composites.

Is the fast-track process efficient and safe for older adults admitted to the emergency department?

BACKGROUND

The efficiency of the fast-track (FT) process in the management of patients in Emergency Departments is well demonstrated, but there is a lack of research focused on older adults. The aim of our study was to verify whether the FT process is efficient and safe for older adults admitted to ED.

METHODS

Observational case-control single-centre study.

RESULTS

Five hundred four cases and 504 controls were analysed. The mean age was 75 years, and there was a predominance of women. In total 96% of subjects were classified with a "less-urgent" tag. The length of stay was significantly lower in the fast-track group than in the control group (median 178 min, interquartile range 184 min, and 115 min, interquartile range 69 min, respectively, p < 0.001), as well as the time spent between the ED physician's visit and patient discharge (median 78 min, interquartile range 120 min, and median 3 min, interquartile range 6 min, respectively, p < 0.001). There weren't any increases in the number of unplanned readmissions within 48 h, 7 days and 30 days.

CONCLUSIONS

The fast-track appears to be an efficient and safe strategy to improve the management of older adults admitted to the ED with minor complaints.

Lignin: A Biopolymer from Forestry Biomass for Biocomposites and 3D Printing

Biopolymers from forestry biomass are promising for the sustainable development of new biobased materials. As such, lignin and fiber-based biocomposites are plausible renewable alternatives to petrochemical-based products. In this study, we have obtained lignin from Spruce biomass through a soda pulping process. The lignin was used for manufacturing biocomposite filaments containing 20% and 40% lignin and using polylactic acid (PLA) as matrix material. Dogbones for mechanical testing were 3D printed by fused deposition modelling. The lignin and the corresponding biocomposites were characterized in detail, including thermo-gravimetric analysis (TGA), differential scanning calorimetry (DSC), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction analysis (XRD), antioxidant capacity, mechanical properties, and scanning electron microscopy (SEM). Although lignin led to a reduction of the tensile strength and modulus, the reduction could be counteracted to some extent by adjusting the 3D printing temperature. The results showed that lignin acted as a nucleating agent and thus led to further crystallization of PLA. The radical scavenging activity of the biocomposites increased to roughly 50% antioxidant potential/cm², for the biocomposite containing 40 wt % lignin. The results demonstrate the potential of lignin as a component in biocomposite materials, which we show are adequate for 3D printing operations.

PVA/(ligno)nanocellulose biocomposite films. Effect of residual lignin content on structural, mechanical, barrier and antioxidant properties

Nanocelluloses with and without residual lignin were isolated from wheat straw. In addition, the effect of TEMPO-mediated oxidation on the production of lignin-containing nanocellulose was studied. The different nanocelluloses were used as reinforcing agent in Poly(vinyl alcohol) films. The morphology, crystallinity, surface microstructure, barrier properties, light transmittance, mechanical and antioxidant properties were evaluated. The translucency of films was reduced by the addition of nanocellulose, however, the ability to block UV-light increased from 10% for PVA to >50% using lignin-containing nanocellulose, and 30% for lignin-free samples. The mechanical properties increased considerably, however, for loads higher than 5% a negative trend was observed presumptively due to a clustering of nanocellulose components in PVA matrix. The barrier properties of the films were improved with the use of nanocellulose, especially at small amounts (1-3%). The antioxidant capacity of films was increased up to 10% using lignin-containing nanocellulose compared to 4.7% using PVA.

Nanocellulose-Based Inks-Effect of Alginate Content on the Water Absorption of 3D Printed Constructs

2,2,6,6-tetramethylpyperidine-1-oxyl (TEMPO) oxidized cellulose nanofibrils (CNF) were used as ink for three-dimensional (3D) printing of porous structures with potential as wound dressings. Alginate (10, 20, 30 and 40 wt%) was incorporated into the formulation to facilitate the ionic cross-linking with calcium chloride (CaCl2). The effect of two different concentrations of CaCl2 (50 and 100 mM) was studied. The 3D printed hydrogels were freeze-dried to produce aerogels which were tested for water absorption. Scanning Electronic Microscopy (SEM) pictures demonstrated that the higher the concentration of the cross-linker the higher the definition of the printed tracks. CNF-based aerogels showed a remarkable water absorption capability. Although the incorporation of alginate and the cross-linking with CaCl2 led to shrinkage of the 3D printed constructs, the approach yielded suitable porous structures for water and moisture absorption. It is concluded that the 3D printed biocomposite structures developed in this study have characteristics that are promising for wound dressings devices.

Abstract P5-12-14: A pilot study of metabolomics biomarkers in breast cancer tumors treated with neoadjuvant therapy

Introduction

Breast cancer is one of the most prevalent cancers in the world. Traditionally, early breast cancer treatment is based on surgery and, after surgery, hormone treatment or chemotherapy. However, the neoadjuvant treatment is increasingly used. Metabolomics is the most recent “omics” which allows quantify metabolites into blood patient samples. Coupled with computational analyses it could be possible to study differential metabolomics patterns and associate them with neoadjuvant response.

Material and methods

Blood plasma samples from patients with breast cancer treated with neoadjuvant chemotherapy were used to perform metabolomics experiments. One sample before the treatment (basal) and one sample after the chemotherapy (post-treatment) were analyzed and clinical data regarding response (complete response or partial response) was also collected. Metabolomics experiments were performed using liquid chromatography coupled with mass-spectrometry. Bayesian network and class comparison analyses were used to establish differential metabolic patterns between conditions. Additionally, a response prediction model based on logistic regression was build using metabolomics data from basal samples.

Results and discussion

A network showing the relationships between metabolites was build. Comparing metabolite measurements between complete response and partial response tumors in basal samples, 19 metabolites showed a differential quantification between both types of responses. Moreover, one of these metabolites is linoleic acid, previously described as a biomarker of complete response in neoadjuvant treatment in breast cancer. Using these 19 differential metabolites, a response predictive model was build. According to this model, it is possible to predict response to neoadjuvant treatment based on the amount of one metabolite, still only identified by its mass and charge. On the other hand, comparing basal and post-treatment samples, the network showed differential metabolomics patterns. These differential metabolites could be used as predictive biomarkers of response.

Conclusion

This study is a proof of concept that using a new “omics” technique such as metabolomics in blood samples, coupled with computational analyses, it is possible to identify differential metabolomics patterns between complete and partial response or basal and post-treatment samples and design predictive models of response These results could facilitate in the future the implementation of blood-based tests into the clinical routine.

Citation Format: Zamora P, Trilla-Fuertes L, Zapater-Moros A, Gámez-Pozo A, Prado-Vázquez G, Ferrer-Gómez M, Díaz- Almirón M, López Vacas R, Espinosa E, Fresno Vara JA. A pilot study of metabolomics biomarkers in breast cancer tumors treated with neoadjuvant therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-12-14.

Abstract P2-02-13: Computational metabolism modeling predicts risk of relapse in breast cancer patients

Introduction

Breast cancer is one of the most prevalent cancers in the world. In previous works we observed differences in glucose metabolism between breast cancer subtypes, suggesting that metabolism plays an important role in this disease. Flux Balance Analysis (FBA) is widely used to study metabolic networks, allowing predicting growth rates or the rate of production of a given metabolite.

Material and methods

Proteomics data from 96 breast cancer tumors were obtained applying a high-throughput proteomics approach to routinely archive formalin-fixed, paraffin-embedded tumor tissue. Proteomics tumor data were analyzed using the human metabolic reconstruction Recon2 and FBA. The tumor growth rate for each tumor was calculated. In order to analyze fluxes from the different metabolic pathways, flux activities were calculated as the sum of the fluxes of each reaction in each pathway defined in the Recon2. Then, flux activities were used to build prognostic models.

Results and discussion

Using the results obtained from FBA in the proteomics dataset, flux activities were calculated for each pathway. Employing these flux activities, a prognostic signature was built. Flux activities of vitamin A, tetrahydrobiopterin metabolism and beta-alanine metabolism pathways split our population into a low and a high risk group (p=0.044).

Conclusion

Vitamine A, beta-alanine and tetrahydrobiopterin metabolism flux activities could be used to predict relapse risk. Flux activities is a method proposed in a previous work to study response against drugs that now also demonstrated its utility in summarizing FBA data and is associated with prognosis.

Citation Format: Zamora P, Trilla-Fuertes L, Gámez-Pozo A, Prado-Vázquez G, Zapater-Moros A, Ferrer-Gómez M, Díaz- Almirón M, López Vacas R, Espinosa E, Fresno Vara JA. Computational metabolism modeling predicts risk of relapse in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-02-13.

HIV Disease Progression: Overexpression of the Ectoenzyme CD38 as a Contributory Factor?

Despite abundant evidence associating CD38 overexpression and CD4 T cell depletion in HIV infection, no causal relation has been investigated. To address this issue, a series of mechanisms are proposed, supported by evidence from different fields, by which CD38 overexpression can facilitate CD4 T cell depletion in HIV infection. According to this model, increased catalytic activity of CD38 may reduce CD4 T cells' cytoplasmic nicotin-amide adenine dinucleotide (NAD), leading to a chronic Warburg effect. This will reduce mitochondrial function. Simultaneously, CD38's catalytic products ADPR and cADPR may be transported to the cytoplasm, where they can activate calcium channels and increase cytoplasmic Ca2+ concentrations, further altering mitochondrial integrity. These mechanisms will decrease the viability and regenerative capacity of CD4 T cells. These hypotheses can be tested experimentally, and might reveal novel therapeutic targets. Also see the video abstract here https://youtu.be/k1LTyiTKPKs.

[The importance of semiology and biochemistry in the diagnostic management of a peroxisomal biogenesis disorder]

INTRODUCTION

Peroxisomal biogenesis disorders are due to mutations in the PEX genes, which code for peroxins that are required for peroxisomal biogenesis. Clinically, they are expressed as a Zellweger syndrome spectrum, and there is a wide phenotypic variety. They are diagnosed biochemically, and confirmation is molecular. The aim of this illustrative case is to highlight the importance of the clinical features and biochemical testing in the management of a peroxisomal disease.

CASE REPORT

A 3-year-old boy with neonatal hypotonia, overall developmental delay and failure to thrive and a pattern of hypomyelinating leukodystrophy in brain resonance. The suspected diagnosis was a disorder affecting the biogenesis of the peroxisomes due to having found a variant with an uncertain meaning in PEX5. The clinical features, the biochemical studies and critical analysis, however, made this diagnosis unlikely. Emphasis is placed on the management that must be applied when a Zellweger syndrome spectrum is suspected.

CONCLUSION

In the case reported here, a peroxisomal biogenesis disorder was suspected owing to an exome sequencing which, on being critically analysed together with the clinical features and the biochemical findings, made a peroxisomal disease very unlikely. In cases of clinical suspicion, backed up by neuroimaging, the main diagnostic management must be based on the biochemistry analysis. Although confirmation is molecular, these tests must be interpreted with caution.