Protocol paper: Multi-site, cluster-randomized clinical trial for optimizing functional outcomes of older cancer survivors after chemotherapy

BACKGROUND

Cancer survivors over the age of 65 have unique needs due to the higher prevalence of functional and cognitive impairment, comorbidities, geriatric syndromes, and greater need for social support after chemotherapy. In this study, we will evaluate whether a Geriatric Evaluation and Management-Survivorship (GEMS) intervention improves functional outcomes important to older cancer survivors following chemotherapy.

METHODS

A cluster-randomized trial will be conducted in approximately 30 community oncology practices affiliated with the University of Rochester Cancer Center (URCC) National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participating sites will be randomized to the GEMS intervention, which includes Advanced Practice Practitioner (APP)-directed geriatric evaluation and management (GEM), and Survivorship Health Education (SHE) that is combined with Exercise for Cancer Patients (EXCAP©®), or usual care. Cancer survivors will be recruited from community oncology practices (of participating oncology physicians and APPs) after the enrolled clinicians have consented and completed a baseline survey. We will enroll 780 cancer survivors aged 65 years and older who have completed curative-intent chemotherapy for a solid tumor malignancy within four weeks of study enrollment. Cancer survivors will be asked to choose one caregiver to also participate for a total up to 780 caregivers. The primary aim is to compare the effectiveness of GEMS for improving patient-reported physical function at six months. The secondary aim is to compare effectiveness of GEMS for improving patient-reported cognitive function at six months. Tertiary aims include comparing the effectiveness of GEMS for improving: 1) Patient-reported physical function at twelve months; 2) objectively assessed physical function at six and twelve months; and 3) patient-reported cognitive function at twelve months and objectively assessed cognitive function at six and twelve months. Exploratory health care aims include: 1) Survivor satisfaction with care, 2) APP communication with primary care physicians (PCPs), 3) completion of referral appointments, and 4) hospitalizations at six and twelve months. Exploratory caregiver aims include: 1) Caregiver distress; 2) caregiver quality of life; 3) caregiver burden; and 4) satisfaction with patient care at six and twelve months.

DISCUSSION

If successful, GEMS would be an option for a standardized APP-led survivorship care intervention.

TRIAL REGISTRATION

ClinicalTrials.govNCT05006482, registered on August 9, 2021.

250Efficacy of multi-electrode linear irreversible electroporation

Background

 We investigated the efficacy of linear irreversible electroporation (IRE) ablation in a porcine model. 

Methods

The study was performed in 6 pigs (weight 60-75kg). After median sternotomy and opening of the pericardium, a pericardial cradle was formed and filled with blood. A linear 7 polar 7F electrode catheter with 2.5mm electrodes and 2.5mm inter-electrode spacing was placed in good epicardial contact. A single IRE application was delivered using 50 Joules (J) at 1 site and 100 J at 2 other sites, in random sequence, using a standard monophasic defibrillator connected to all 7 electrodes connected in parallel. The pericardium and thorax were closed and after 3 weeks survival animals were euthanized. 82 histological sections from all 18 electroporation lesions were analyzed.

Results

A total of seven 50 J and fourteen 100 J epicardial IRE applications were performed. Mean peak voltages at 50 J and 100 J were 1079.2 V ± 81.1 and 1609.5 V ± 56.8, with a mean peak current of 15.4 A ± 2.3 and 20.2 A ± 1.7, respectively. Median depth of the 50J and 100J lesions were 3.2 mm (interquartile range [IQR], 3.1 – 3.6) and 5.5 mm (IQR, 4.6 – 6.6) (P < 0.001), respectively. Median lesion width of the 50J and 100J lesions were 3.9 mm (IQR, 3.7 – 4.8) and 5.4 mm (IQR, 5.0 - 6.3), respectively(P < 0.001).  Longitudinal sections showed continuous lesions for 100J lesions.

Conclusion

 Epicardial linear application of IRE pulses is effective in creating continuous deep lesions.

Ablation characteristics and lesion size Peak voltageV Peak currentA Peak resistanceΩ SlicesN Depthmm Widthmm 50 J 1079.2 ± 81.1 14.5 ± 2.3 71.8 ± 15.6 26 3.2 (3.1 - 3.6) 3.9 (3.7 - 4.8) 100J 1609.5 ± 56.8 20.2 ± 1.7 80.0 ± 9.5 56 5.5 (4.6 - 6.6) 5.4 (5.0 - 6.3) P-value† <0.001 <0.001 Data is displayed as mean ± SD or median (interquartile range) where appropriate.†assessed by general linear mixed models

Abstract Figure. Transversal histological sections

A graphene-like membrane with an ultrahigh water flux for desalination

An ultrathin nanoporous membrane which combines high water permeability and high salt rejection is the core of ultrafiltration technology. Recently, we reported the synthesis of a chemically robust and nanoporous two-dimensional conjugated aromatic polymer (2D-CAP) membrane. Due to its array of highly regular sub-nanometer pores and channels, the ultrathin 2D-CAP membrane can be potentially used in desalination. Herein, we used molecular dynamics simulations to analyze the transmembrane hydrodynamics of mono- and multi-layer 2D-CAP membranes as a function of layer number. The energy barriers to water and ions across these membranes were calculated to evaluate the potential of 2D-CAP to function as the ultimate RO membrane. Our simulation results show that the bilayer CAP membrane exhibits superior ion rejection (100%) and a water flux (1172 L m^-2 h^-1 bar^-1) with a performance that is three orders of magnitude higher than the commercial reverse osmosis membrane, which is three times higher than the theoretically reported monolayer nanoporous MoS₂ membrane (the state-of-the-art membrane reported for desalination). In addition, the 2D-CAP bilayer membrane is highly resistant to swelling even at a high water flux. The monolayer 2D-CAP membrane shows good ion selectivity between monovalent and divalent ions.

Construct validity and internal consistency reliability of the Malay version of the 21-item depression anxiety stress scale (Malay-DASS-21) among male outpatient clinic attendees in Johor

BACKGROUND

The 21-item English version of the Depression Anxiety Stress Scale (DASS-21) has been proposed as a method for assessing self-perceived depression, anxiety and stress over the past week in various clinical and nonclinical populations. Several Malay versions of the DASS-21 have been validated in various populations with varying success. One particular Malay version has been validated in various occupational groups (such as nurses and automotive workers) but not among male clinic outpatient attendees in Malaysia.

OBJECTIVE

To validate the Malay version of the DASS-21 (Malay-DASS-21) among male outpatient clinic attendees in Johor.

METHODS

A validation study with a random sample of 402 male respondents attending the outpatient clinic of a major public outpatient clinic in Johor Bahru and Segamat was carried out from January to March 2016. Construct validity of the Malay-DASS-21 was examined using Exploratory Factor Analysis (KMO = 0.947; Bartlett's test of sphericity is significant, p<0.001) through Principal Component Analysis and orthogonal (varimax) rotation with Kaiser Normalization to confirm the psychometric properties of the Malay-DASS- 21 and the internal consistency reliability using Cronbach's alpha.

RESULTS

Construct validity of the Malay-DASS-21 based on eigenvalues and factor loadings to confirm the three factor structure (depression, anxiety, and stress) was acceptable. The internal consistency reliability of the factor construct was very impressive with Cronbach's alpha values in the range of 0.837 to 0.863.

CONCLUSIONS

The present study showed that the Malay- DASS-21 has acceptable psychometric construct and high internal consistency reliability to measure self-perceived depression, anxiety and stress over the past week in male outpatient clinic attendees in Johor. Further studies are necessary to revalidate the Malay-DASS-21 across different populations and cultures, and using confirmatory factor analyses.

Modulation of Mcl-1 sensitizes glioblastoma to TRAIL-induced apoptosis

Glioblastoma (GBM) is the most aggressive form of primary brain tumour, with dismal patient outcome. Treatment failure is associated with intrinsic or acquired apoptosis resistance and the presence of a highly tumourigenic subpopulation of cancer cells called GBM stem cells. Tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) has emerged as a promising novel therapy for some treatment-resistant tumours but unfortunately GBM can be completely resistant to TRAIL monotherapy. In this study, we identified Mcl-1, an anti-apoptotic Bcl-2 family member, as a critical player involved in determining the sensitivity of GBM to TRAIL-induced apoptosis. Effective targeting of Mcl-1 in TRAIL resistant GBM cells, either by gene silencing technology or by treatment with R-roscovitine, a cyclin-dependent kinase inhibitor that targets Mcl-1, was demonstrated to augment sensitivity to TRAIL, both within GBM cells grown as monolayers and in a 3D tumour model. Finally, we highlight that two separate pathways are activated during the apoptotic death of GBM cells treated with a combination of TRAIL and R-roscovitine, one which leads to caspase-8 and caspase-3 activation and a second pathway, involving a Mcl-1:Noxa axis. In conclusion, our study demonstrates that R-roscovitine in combination with TRAIL presents a promising novel strategy to trigger cell death pathways in glioblastoma.

Molybdenum disulfide (MoS₂) as a broadband saturable absorber for ultra-fast photonics

The nonlinear optical property of few-layered MoS₂ nanoplatelets synthesized by the hydrothermal exfoliation method was investigated from the visible to the near-infrared band using lasers. Both open-aperture Z-scan and balanced-detector measurement techniques were used to demonstrate the broadband saturable absorption property of few-layered MoS₂. To explore its potential applications in ultrafast photonics, we fabricated a passive mode locker for ytterbium-doped fibre laser by depositing few-layered MoS₂ onto the end facet of optical fiber by means of an optical trapping approach. Our laser experiment shows that few-layer MoS₂-based mode locker allows for the generation of stable mode-locked laser pulse, centered at 1054.3 nm, with a 3-dB spectral bandwidth of 2.7 nm and a pulse duration of 800 ps. Our finding suggests that few-layered MoS₂ nanoplatelets can be useful nonlinear optical material for laser photonics devices, such as passive laser mode locker, Q-switcher, optical limiter, optical switcher and so on.

Mesoporous SnO2 agglomerates with hierarchical structures as an efficient dual-functional material for dye-sensitized solar cells

Mesoporous SnO(2) agglomerates with hierarchical structures and a high surface area were fabricated through a molten salt method. The SnO(2) demonstrated high photoelectric conversion efficiencies of 3.05% and 6.23% (with TiCl(4) treatment) in dye-sensitized solar cells, which are attributed to its dual functionality of providing high dye-loading and efficient light scattering.

α-Fe2O3 nanotubes-reduced graphene oxide composites as synergistic electrochemical capacitor materials

We present a facile approach for the fabrication of a nanocomposite comprising α-Fe(2)O(3) nanotubes (NTs) anchored on reduced graphene oxide (rGO) for electrochemical capacitors (ECs). The hollow tubular structure of the α-Fe(2)O(3) NTs presents a high surface area for reaction, while the incorporation of rGO provides an efficient two-dimensional conductive pathway to allow fast, reversible redox reaction. As a result, the nanocomposite materials exhibit a specific capacitance which is remarkably higher (~7 times) than α-Fe(2)O(3) NTs alone. In addition, the nanocomposites show excellent cycling life and large negative potential window. These findings suggest that such nanocomposites are a promising candidate as negative electrodes in asymmetrical capacitors with neutral electrolytes.

Large energy mode locking of an erbium-doped fiber laser with atomic layer graphene

We report on large energy pulse generation in an erbium-doped fiber laser passively mode-locked with atomic layer graphene. Stable mode locked pulses with single pulse energy up to 7.3 nJ and pulse width of 415 fs have been directly generated from the laser. Our results show that atomic layer graphene could be a promising saturable absorber for large energy mode locking.

An effective surface-enhanced Raman scattering template based on a Ag nanocluster-ZnO nanowire array

An effective surface-enhanced Raman scattering (SERS) template based on a 3D hybrid Ag nanocluster (NC)-decorated ZnO nanowire array was fabricated through a simple process of depositing Ag NCs on ZnO nanowire arrays. The effects of particle size and excitation energy on the Raman scattering in these hybrid systems have been investigated using rhodamine 6G as a standard analyte. The results indicate that the hybrid nanosystem with 150 nm Ag NCs produces a larger SERS enhancement factor of 3.2 x 10(8), which is much higher than that of 10 nm Ag NCs (6.0 x 10(6)) under 532 nm excitation energy. The hybrid nanowire arrays were further applied to obtain SERS spectra of the two-photon absorption (TPA) chromophore T7. Finite-difference time-domain simulations reveal the presence of an enhanced field associated with inter-wire plasmon coupling of the 150 nm Ag NCs on adjacent ZnO nanowires; such a field was absent in the case of the 10 nm Ag NC-coated ZnO nanowire. Such hybrid nanosystems could be used as SERS substrates more effectively than assembled Ag NC film due to the enhanced light-scattering local field and the inter-wire plasmon-enhanced electromagnetic field.

A comparison study of cerebral protection using Ginkgo biloba extract and Losartan on stroked rats

It has been well documented that oxidative stress is involved in stroke. Currently, many neuroprotective strategies have been targeted at molecules that are able to act as an oxidant to intervene with free-radical mediated apoptosis in the ischemic penumbra. In particular, natural products which contain antioxidant properties have undoubtedly efficacious for stroke treatment. In the current study, therapeutic effects of Ginkgo biloba extract (EGb) against cerebral protection in Wistar rats underwent middle cerebral artery occlusion (MCAO) was evaluated. A comparison study was conducted by using Losartan, an antihypertensive drug. Gene expression levels of pro-apoptotic genes (AT2 receptor, Fas, Bax and Bcl-xS) have shown to have significant reduction by EGb- and Losartan-treated groups as compared to vehicle group. Significant reduction of immunoreactivity of protein production of these genes, together with least nuclear green fluorescence observed in TUNEL, EGb, as an antioxidant drug, is concluded to have potent and promising therapeutic effect for stroke treatment.