A new armchair carbon nanobelt synthesized by tuning the regioselectivity of the Scholl reaction of quinquephenyl

A new armchair carbon nanobelt is successfully synthesized by tuning the regioselectivity of the Scholl reaction of 1,1':2',1'':4'',1''':2''',1''''-quinquephenyl. This nanobelt exhibits a preferential binding affinity towards C70 over C60 as found from photoluminescence titration experiments.

An Organic Optoelectronic Synapse with Multilevel Memory Enabled by Gate Modulation

Artificial synaptic devices are emerging as contenders for next-generation computing systems due to their combined advantages of self-adaptive learning mechanisms, high parallel computation capabilities, adjustable memory level, and energy efficiency. Optoelectronic devices are particularly notable for their responsiveness to both voltage inputs and light exposure, making them attractive for dynamic modulation. However, engineering devices with reconfigurable synaptic plasticity and multilevel memory within a singular configuration present a fundamental challenge. Here, we have established an organic transistor-based synaptic device that exhibits both volatile and nonvolatile memory characteristics, modulated through gate voltage together with light stimuli. Our device demonstrates a range of synaptic behaviors, including both short/long-term plasticity (STP and LTP) as well as STP-LTP transitions. Further, as an encoding unit, it delivers exceptional read current levels, achieving a program/erase current ratio exceeding 105, with excellent repeatability. Additionally, a prototype 4 × 4 matrix demonstrates potential in practical neuromorphic systems, showing capabilities in the perception, processing, and memory retention of image inputs.

Synthesis, Structures and Properties of Trioxa[9]circulene and Diepoxycyclononatrinaphthalene

This article presents trioxa[9]circulene (3) as a novel member of hetero[n]circulenes. Its synthesis began with the synthesis of dimethoxydioxa[8]helicene (5) and used dimethoxydiepoxycyclononatrinaphthalene (4) as a key intermediate, despite the condensation reaction predominantly yielding a 1,4-addition byproduct. The structures and properties of 3-5 were extensively investigated using experimental and computational methods. Analysis of the crystal structures reveal elongation of the internal C-C bonds in the nine-membered ring of 3 compared to 4 and 5. Computational studies demonstrate the remarkable flexibility of trioxa[9]circulene's saddle-shaped polycyclic framework, while the other two compounds are rigid with large racemization barriers. Optically pure forms of 4 and 5 exhibit absorption and luminescence dissymmetry factors on the order of 10-2, with smaller values observed for compound 4. In the crystal structures, molecules of 3 stack to form columns with remarkable π-π overlap, and the π-π interactions of 4 exhibit short intermolecular C-to-C contacts. Consequently, the solution-processed film of 4 functioned as a p-type organic semiconductor in field effect transistors.

A novel approach to evaluation of tumor response for advanced pulmonary adenocarcinoma using the intertumoral heterogeneity response score

Treatment response and prognosis estimation in advanced pulmonary adenocarcinoma are challenged by the significant heterogeneity of the disease. The current Response Evaluation Criteria in Solid Tumors (RECIST) criteria, despite providing a basis for solid tumor response evaluation, do not fully encompass this heterogeneity. To better represent these nuances, we introduce the intertumoral heterogeneity response score (THRscore), a measure built upon and expanding the RECIST criteria. This retrospective study included patients with 3-10 measurable advanced lung adenocarcinoma lesions who underwent first-line chemotherapy or targeted therapy. The THRscore, derived from the coefficient of variation in size for each measurable tumor before and 4-6 weeks posttreatment, unveiled a correlation with patient outcomes. Specifically, a high THRscore was associated with shorter progression-free survival, lower tumor response rate, and a higher tumor mutation burden. These associations were further validated in an external cohort, confirming THRscore's effectiveness in stratifying patients based on progression risk and treatment response, and enhancing the utility of RECIST in capturing complex tumor behaviors in lung adenocarcinoma. These findings affirm the promise of THRscore as an enhanced tool for tumor response assessment in advanced lung adenocarcinoma, extending the RECIST criteria's utility.

Chemotherapy versus personalized therapy for EGFR mutant lung adenocarcinoma resistance to EGFR-tyrosine kinase inhibitors: a retrospective dual-center study

BACKGROUND

Advanced lung adenocarcinoma patients often develop resistance to EGFR tyrosine kinase inhibitors (EGFR-TKIs), leaving uncertainties regarding subsequent treatment strategies. Although personalized therapy targeting individual acquired resistances (ARs) shows promise, its efficacy has not been systematically compared with platinum-containing doublet chemotherapy, a widely accepted treatment after EGFR-TKIs failure.

METHODS

A retrospective dual-center study was conducted involving patients with advanced lung adenocarcinoma and EGFR mutations who developed resistance to EGFR-TKIs between January 2017 and December 2022. Eligible patients were adults aged 18 years or older with an Eastern Cooperative Oncology Group score of 0-1, normal organ function, and no prior chemotherapy. Patients were divided into the chemotherapy group (CG) or personalized therapy group (PG) based on the treatment received after disease progression. The primary endpoints were progression-free survival (PFS) and objective response rate (ORR).

RESULTS

Of the 144 patients enrolled, there were 53 patients in the PG and 91 patients in the CG. The PG acquired resistance to EGFR-TKIs through the MET amplification (27, 50%) and small cell lung cancer transformation (16, 30%) and 18% of them reported multiple resistance mechanisms. The ORR of the PG was similar to that of the CG (34% vs. 33%, P = 1.0) and the PFS of the PG patients was not statistically different from that of their CG counterparts [4.2 months (95% CI: 3.6-4.8 months) vs. 5.3 months (95% CI: 4.6-6.0 months), P = 0.77].

CONCLUSIONS

These findings suggest that the therapeutic efficacy of chemotherapy approximates to that of personalized therapy, which signifies that chemotherapy is still a reliable choice for patients who develop resistance to EGFR-TKIs and that further research is awaited to explore the benefit of personalized treatment.

Cyclodextrin Polymer-Loaded Micro-Ceramic Balls for Solid-Phase Extraction of Triazole Pesticides from Water

A citric acid cross-linked β-cyclodextrin (β-CD) polymer was synthesized and loaded on micro-ceramic balls to fabricate the solid-phase adsorbents (P-MCB) for adsorption and extraction of triazole pesticides from water. The stability of β-CD polymer and P-MCB was investigated in solutions with different pH values at different temperatures. The adsorption properties and the influence of kinetics, sorbent amount, pesticide concentration, and temperature on the adsorption capacity were evaluated. The results showed P-MCB had favorable adsorption of 15.98 mg/g flutriafol in 3.5 h. The equilibrium data followed the Freundlich equation, and the adsorption of flutriafol and diniconazole followed the second-order kinetics. The recovery rate of P-MCB for triazole pesticides in water was satisfactory, and the recovery rate was still 80.1%, even at the 10th cycle. The P-MCB had good stability, with a degradation rate of 0.2% ± 0.08 within 10 days, which could ensure extraction and recycling.

Rechallenge of immune checkpoint inhibitors in advanced non-small cell lung cancer

Immune checkpoint inhibitor (ICI) rechallenge in non-small cell lung cancer (NSCLC) is a promising therapeutic strategy. The situation for ICI rechallenge can be divided into three categories: adverse events (AEs); resistance to ICIs, and rechallenge becomes compulsive because of tumor relapse while the patients had completed a 2 year course of immunotherapy. However, these categories are still controversial and should be explored further. Through voting at the 6th Straits Summit Forum on Lung Cancer, in this study we summarize the consensus of 147 experts in ICI rechallenges. A total of 97.74% experts agreed to rechallenge; 48.87% experts rechallenge with the original drug, and the others rechallenge with a different drug; 40.3% agreed to rechallenge directly after progression; 88.06% experts agreed to ICI rechallenge with a combination regimen; and factors such as previous performance status score, PD-1 expression, and age should also be considered. Understanding the the clinical studies in ICI rechallenge could bring us one step closer to understanding the consensus. In patients with advanced NSCLC who have suffered recurrent or distant metastasis after immunotherapy, the option of rechallenge with ICIs is a promising treatment option.

Baseline C-reactive protein predicts efficacy of the first-line immune checkpoint inhibitors plus chemotherapy in advanced lung squamous cell carcinoma: a retrospective, multicenter study

AIMS

To investigate the predictive value of baseline C-reactive protein (CRP) levels on the efficacy of chemotherapy plus immune checkpoint inhibitors (ICI) in patients with advanced lung squamous cell carcinoma (LSCC).

MATERIALS AND METHODS

In this retrospective multicenter study spanning from January 2016 to December 2020, advanced LSCC patients initially treated with chemotherapy or a combination of chemotherapy and ICI were categorized into normal and elevated CRP subgroups. The relationship between CRP levels and treatment outcomes was analyzed using multivariate Cox proportional hazards models and multivariate logistic regression, focusing primarily on the progression-free survival (PFS) endpoint, and secondarily on overall survival (OS) and objective response rate (ORR) endpoints. Survival curves were generated using the Kaplan-Meier method, with the log-rank test used for comparison between groups.

RESULTS

Of the 245 patients evaluated, the 105 who received a combination of chemotherapy and ICI with elevated baseline CRP levels exhibited a significant reduction in PFS (median 6.5 months vs. 11.8 months, HR, 1.78; 95% CI: 1.12-2.81; p = 0.013) compared to those with normal CRP levels. Elevated CRP was identified as an independent risk factor for poor PFS through multivariate-adjusted analysis. However, among the 140 patients receiving chemotherapy alone, baseline CRP levels did not significantly influence PFS. Furthermore, within the combination therapy group, there was a notable decrease in the ORR (51% vs. 71%, p = 0.035), coupled with a significantly shorter OS (median 20.9 months vs. 31.5 months, HR, 2.24; 95% CI: 1.13-4.44; p = 0.033).

CONCLUSION

In patients with advanced LSCC, elevated baseline CRP levels were identified as an independent predictive factor for the efficacy of combination therapy with chemotherapy and ICI, but not in chemotherapy alone. This suggests that CRP may be a valuable biomarker for guiding treatment strategies.

[Diagnosis and treatment of intravenous leiomyomatosis]

Intravenous leiomyomatosis is a rare type of tumor that is histologically benign but biologically invasive. It originates from the smooth muscle of the uterine or the uterine vein. It can grow through the uterus and extend into the pelvic cavity, or grow along the veins without invading the wall of the venous vessel itself. The tumors are estrogen-dependent and can metastasize through the bloodstream. Thus, in addition to continuous growth, some tumors exhibit isolated growths in the venous system and heart chambers or show disseminated growth in the lungs, although distant metastasis to other regions usually do not occur. Currently, there is limited research on this disease, the majority of which are case reports, surgical experience summaries, and differentiation from ordinary gynecological myomas in terms of pathogenesis and radiological diagnostic experience. There are two main theories on the origin of the disease: uterine smooth muscle and smooth muscle of the uterine veins. Some studies have verified the role of estrogen, progesterone receptor-related pathways, and angiogenesis in the development of the disease. The clinical symptoms of this disease are varied, depending on the affected area. In the early stages, when the tumor only affects the pelvic cavity, patients show mild symptoms resulting from pelvic organ compression. When it progresses to the inferior vena cava and heart, patients show more complex symptoms resulting from venous return obstruction, cardiac obstruction, and hemodynamics appearing. Different institutions have proposed different disease staging and classification strategies for different clinical purposes. Some are based on the affected area of the lesion; others are based on the size of the tumor. Although surgery remains the main treatment for this disease, the specific surgical approach, adjuvant drug therapy, and prognosis still need further exploration.

Clinical definition of secondary resistance to immunotherapy in non-small cell lung cancer

Immune checkpoint inhibitors (PD-1/PD-L1 and CTLA-4 blockade) have revolutionized the treatment landscape in non-small cell lung cancer (NSCLC). Secondary resistance to immunotherapy (IO), which poses a substantial challenge in clinical settings, occurs in several initial responders. Currently, new treatment approaches have been extensively evaluated in investigational studies for these patients to tackle this difficult problem; however, the lack of consistency in clinical definition, uniform criteria for enrollment in clinical trials, and interpretation of results remain significant hurdles to progress. Thus, our expert panel comprehensively synthesized data from current studies to propose a practical clinical definition of secondary resistance to immunotherapy in NSCLC in metastatic and neoadjuvant settings. In addition to patients who received IO alone (including IO-IO combinations), we also generated a definition for patients treated with chemotherapy plus IO. This consensus aimed to provide guidance for clinical trial design and facilitate future discussions with investigators. It should be noted that additional updates in this consensus are required when new data is available.

Cerebrospinal fluid circulating tumor DNA contributes to the detection and characterization of leptomeningeal metastasis in non-small cell lung cancer

PURPOSE

Cerebrospinal fluid (CSF) has revealed the unique genetic characteristics of leptomeningeal metastasis (LM) from non-small cell lung cancer (NSCLC). However, the research in this area is still very limited.

METHODS

Patients with LM from NSCLC (n = 80) were retrospectively analyzed. Circulating tumor DNA (ctDNA) in CSF was tested by next-generation sequencing (NGS), with paired extracranial tissue or plasma samples included for comparison. An independent non-LM cohort (n = 100) was also analyzed for comparative purposes. Clinical outcomes were compared with Kaplan-Meier log-rank test and Cox proportional hazards methodologies.

RESULTS

An overwhelming 93.8% of patients carried druggable mutations in NSCLC LM, with EGFR (78.8%) being the most prevalent. Notably, 4 patients who tested negative for driver genes in extracranial samples surprisingly showed EGFR mutations in their CSF and subsequently benefited from targeted therapy. There was a clear difference in genetic profiles between CSF and extracranial samples, with CSF showing more driver gene detections, increased Copy Number Variations (CNVs), and varied resistance mechanisms among individuals. Abnormalities in cell-cycle regulatory molecules were highly enriched in LM (50.9% vs 31.0%, p = 0.017), and CDKN2A/2B deletions were identified as an independent poor prognostic factor for LM patients, with a significant reduction in median OS (p = 0.013), supported by multivariate analysis (HR 2.63, 95% CI 1.32-5.26, p = 0.006).

CONCLUSIONS

CSF-based ctDNA analysis is crucial for detecting and characterizing genetic alterations in NSCLC LM. The distinct genetic profiles in CSF and extracranial tissues emphasize the need for personalized treatment approaches.

Effects of intrathecal pemetrexed on the survival of patients with leptomeningeal metastasis from lung adenocarcinoma: a propensity score matching analysis

PURPOSE

To explore the impact of intrathecal pemetrexed (IP) on the survival of lung adenocarcinoma (LUAC) patients with leptomeningeal metastasis (LM).

METHODS

We analyzed patients with LUAC and LM who received systemic therapy after LM diagnosis at the Fujian Cancer Hospital between July 2018 and March 2022. Patients who underwent IP were assigned to the IP group; those without IP treatment were designated as the non-IP group. Propensity score matching (PSM) was performed between the two groups.

RESULTS

165 patients were enrolled: 83 and 82 in the IP and non-IP groups, respectively. After 1:1 PSM, we included 114 patients in the matched cohort. Median overall survival (OS) was 13.2 months (95% CI 10.8-15.6 months) in the IP group versus 10.1 months (95% CI 5.3-14.9 months) in the non-IP group (P = 0.488). Only Eastern Cooperative Oncology Group Performance Status (ECOG PS) was confirmed as an independent predictor for OS in the matched cohort (hazard ratio (HR) 2.03; P = 0.023). Multivariate competing-risks analysis showed that IP significantly correlated with central nervous system-related death (HR 0.31; P = 0.046). When stratified by ECOG PS, IP improved survival in patients with poor ECOG PS (PS = 2) (14.3 months vs. 1.6 months; P = 0.003).

CONCLUSIONS

Intrathecal pemetrexed did not enhance OS for the entire LUAC patient with LM compared to non-intrathecal chemotherapy. However, it exhibited the potential to reduce the risk of central nervous system-related mortality and improve survival in patients with poor ECOG PS.

Synthesis, Molecular Packing and Semiconductor Properties of V-Shaped N-Heteroacene Dimers

This article presents two groups of V-shaped π-scaffolds that consist of two N-heteroacene units fused with either a rigid or flexible eight-membered ring. These rigid and flexible N-heteroacene dimers were synthesized through the condensation of tetraphenylenetetraone with the corresponding diamine and the Pd-catalyzed cross-coupling of tetrabromodibenzo[a,e]cyclooctatetraene with the corresponding diamine, respectively. A comparison of electronic structures and properties of the two groups of V-shaped N-heteroacene dimers shows subtle difference between the rigid and flexible eight-membered ring linkers in forming extended π-systems. X-ray crystallography of these V-shaped molecules has revealed interesting π-π interaction modes, which are dependent on the central connecting units and substituting groups. These π-π interactions between the V-shaped π-scaffolds have enabled the molecules to function as organic semiconductors in solution-processed field effect transistors.

Genomic characterisation of de novo EGFR copy number gain and its impact on the efficacy of first-line EGFR-tyrosine kinase inhibitors for EGFR mutated non-small cell lung cancer

BACKGROUND

Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation generally respond well to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). However, genomic characterisation of de novo EGFR copy number gain (CNG) and its impact on the efficacy of first-line EGFR-TKIs remains unclear.

METHODS

This multicenter, retrospective and real-world study included two cohorts that enroled EGFR mutant NSCLC patients. EGFR CNG was tested by next-generation sequencing of untreated tissue specimens. Cohort 1 detected the impact of EGFR CNG on first-line EGFR-TKIs treatment, and cohort 2 explored the genomic characterisation.

RESULTS

Cohort 1 enroled 355 patients from four cancer centres between January 2013 and March 2022. The patients were divided into three groups, included the EGFR non-CNG, EGFR CNG, and EGFR uncertain-CNG. No significant difference in progression-free survival (PFS) was found between the three groups (10.0 months vs. 10.8 months vs. 9.9 months, respectively, p = 0.384). Furthermore, the overall response rate was not statistically significant in the EGFR CNG group compared to the EGFR non-CNG or uncertain arm (70.3% vs. 63.2% vs. 54.5%, respectively, p = 0.154). Cohort 2 included 7876 NSCLC patients with 16.4% showing EGFR CNG. Gene mutations such as TP53, IKZF1, RAC1, MYC, MET, CDKN2A/B and alterations of the metabolic-related and ERK signalling pathway were significantly associated with patients with EGFR CNG compared to those without.

CONCLUSIONS

De novo EGFR CNG had no effect on the efficacy of first-line EGFR-TKI treatment in EGFR mutant NSCLC patients, and tumours with EGFR CNG had more complex genomic profiles than those without.

Microparticles of Sericin-Dextran Conjugate for Improving the Solubility of Antiviral Drug

A novel sericin-dextran conjugate (SDC) and self-assembled microparticles has been prepared for improving solubility of atazanavir. Microparticles of SDC were assembled by the reprecipitation method. The size and morphology of SDC microparticles could be adjusted by the concentration and solvents. Low concentration was conducive to the preparation of microspheres. Heterogeneous microspheres could be prepared in ethanol with the range of 85-390 nm, and hollow mesoporous microspheres in propanol with an average particle size of 2.5-22 µm. The aqueous solubility of atazanavir was improved to 2.22 mg/mL in buffer solutions at pH 2.0 and 1.65 mg/mL at pH 7.4 by SDC microspheres. In vitro release of atazanavir from hollow microspheres of SDC exhibited a slower release, had the lowest linear cumulative release in basic buffer (pH 8.0), and the most rapid double exponential diphase kinetic cumulative release in acid buffer (pH 2.0).

Oxanorbornene-Fused Phenazine-Pyrene Scaffolds with Different Configurations

New molecular scaffolds of C-, Z- and box-shaped configurations are constructed by fusing phenazine and pyrene units with oxanorbornene. As revealed by X-ray crystallography, the C-shaped molecules exhibit two interesting π-π stacking modes of phenazine depending on the substituting groups, and the box-shaped molecule accommodates two chloroform molecules in the cavity and forms H-bonds with another four molecules of chloroform. The C- and Z-shaped molecules as a pair of diastereomers exhibit almost the same charge transfer absorption and emission including positive solvatochromism, indicating that the intramolecular charge transfer between pyrene (π-donor) and phenazine (π-acceptor) is not dependent on the overall molecular geometry.

An Oxanorbornene-Fused Nanocage Consisting of Hexaazatrinaphthylene and Pyrene Units

A new oxanorbornene-fused nanocage consisting of hexazatrinaphthylene and pyrene units was synthesized by condensation of three C-shaped tetraamine building blocks and two units of cyclohexanehexone. The structure of this D3h-symmetric...

CD8+ T cell/cancer-associated fibroblast ratio stratifies prognostic and predictive responses to immunotherapy across multiple cancer types

BACKGROUND

Cancer-associated fibroblasts (CAFs) within the tumor microenvironment (TME) are critical for immune suppression by restricting immune cell infiltration in the tumor stromal zones from penetrating tumor islands and changing their function status, particularly for CD8+ T cells. However, assessing and quantifying the impact of CAFs on immune cells and investigating how this impact is related to clinical outcomes, especially the efficacy of immunotherapy, remain unclear.

MATERIALS AND METHODS

The TME was characterized using immunohistochemical (IHC) analysis using a large-scale sample size of gene expression profiles. The CD8+ T cell/CAF ratio (CFR) association with survival was investigated in The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) lung cancer cohorts. The correlation between CFR and immunotherapeutic efficacy was computed in five independent cohorts. The correlation between CFR and objective response rates (ORRs) following pembrolizumab monotherapy was investigated in 20 solid tumor types. To facilitate clinical translation, the IHC-detected CD8/α-SMA ratio was applied as an immunotherapeutic predictive biomarker in a real-world lung cancer cohort.

RESULTS

Compared with normal tissue, CAFs were enriched in cancer tissue, and the amount of CAFs was overwhelmingly higher than that in other immune cells. CAFs are positively correlated with the extent of immune infiltration. A higher CFR was strongly associated with improved survival in lung cancer, melanoma, and urothelial cancer immunotherapy cohorts. Within most cohorts, there was no clear evidence for an association between CFR and programmed death-ligand 1 (PD-L1) or tumor mutational burden (TMB). Compared with TMB and PD-L1, a higher correlation coefficient was observed between CFR and the ORR following pembrolizumab monotherapy in 20 solid tumor types (Spearman's r = 0.69 vs. 0.44 and 0.21). In a real-world cohort, patients with a high CFR detected by IHC benefited considerably from immunotherapy as compared with those with a low CFR (hazard ratio, 0.37; 95% confidence interval, 0.19-0.75; p < 0.001).

CONCLUSIONS

CFR is a newly found and simple parameter that can be used for identifying patients unlikely to benefit from immunotherapy. Future studies are needed to confirm this finding.

Full genome characterization of a human-porcine reassortment G12P[7] rotavirus and its pathogenicity in piglets

In recent years, increasing numbers of cases of acute gastroenteritis caused by Group A rotavirus (RVA) G12 strains have been reported in humans from many countries around the world, but G12 RVA detection in animals is currently less reported. Pigs are an important animal reservoir of zoonotic RVs and a mixing vessel for RVs. In 2020, RVA infection cases in piglets increased in China, which attracted more attention. During an epidemiological survey, a new type of porcine G12P[7] strain (CN127) was detected in pig farms across several provinces. Complete genome analyses revealed that strain CN127 possessed a Wa-like backbone with a genotype constellation of G12-P[7]-I1-C1-M1-R1-A8-N1-T1-E1-H1. The A8 genotype is indicative of its porcine rotavirus origin. Sequence identities and phylogenetic analyses showed that the VP2, VP4, NSP1, NSP4 and NSP5 genes were most closely related to those of porcine rotaviruses, but the VP1, VP6, VP7 and NSP2-3 genes were most closely related to those of human rotaviruses. CN127 likely emerged due to genetic reassortment between porcine and human rotavirus. In vivo experiments showed that CN127 infection caused gastrointestinal tract lesions in piglets and histopathological changes in the lung, liver and mesenteric lymph nodes (MLNs). In the small intestine, RVA antigen was detected in the duodenum and jejunum but not in the ileum. In the extra-intestinal tissues, RVA antigen was detected in the lung but not in the MLNs. Viral RNA was detected in the intestinal and extra-intestinal tissues as well as blood. This study reveals that RVA G12P[7] may become an epidemic strain in China and also provides further evidence that cocirculating human and porcine strains could produce new genotype rotaviruses with high virulence in piglets.

[Development and Application of the First Carbon Ion Therapy System in China]

At present, heavy ion is an ideal radiation for cancer treatment, and carbon ion is used in the treatment of many kinds of cancer due to its higher relative biological effect value. In 2019, Wuwei heavy ion center built the first medical heavy ion accelerator-carbon ion radiotherapy system in China, and obtained the registration license from the National Medical Products Administration, and officially received cancer patients in March 2020. This study introduced the development and application of the first carbon ion radiotherapy system in China.

Robust Radical Cations of Hexabenzoperylene Exhibiting High Conductivity and Enabling an Organic Nonvolatile Optoelectronic Memory

Herein, we report robust π-conjugated radical cations resulting from the oxidation of hexabenzoperylene (HBP) derivatives, HBP-B and HBP-H, which have butyl and hexyl groups, respectively, attached to the same twisted double helicene π-backbone. The radical cation of HBP-B was successfully crystallized in the form of hexafluorophosphate, which exhibited conductivity as high as 1.32 ± 0.04 S cm^-1. Photochemical oxidation of HBP-H by molecular oxygen led to the formation of its radical cation in the solid state, as found with different techniques. This allowed the organic field effect transistor of HBP-H to function as a nonvolatile optoelectronic memory, with the memory switching contrast above 10³ and long-term stability without using a floating gate, an electret layer, or photochromic molecules.

The Scholl Reaction as a Powerful Tool for Synthesis of Curved Polycyclic Aromatics

The past decade has witnessed remarkable success in the synthesis of curved polycyclic aromatics through Scholl reactions which enable oxidative aryl-aryl coupling even in company with the introduction of significant steric strain. These curved polycyclic aromatics are not only unique objects of structural organic chemistry in relation to the nature of aromaticity but also play an important role in bottom-up approaches to precise synthesis of nanocarbons of unique topology. Moreover, they have received considerable attention in the fields of supramolecular chemistry and organic functional materials because of their interesting properties and promising applications. Despite the great success of Scholl reactions in synthesis of curved polycyclic aromatics, the outcome of a newly designed substrate in the Scholl reaction still cannot be predicted in a generic and precise manner largely due to limited understanding on the reaction mechanism and possible rearrangement processes. This review provides an overview of Scholl reactions with a focus on their applications in synthesis of curved polycyclic aromatics with interesting structures and properties and aims to shed light on the key factors that affect Scholl reactions in synthesizing sterically strained polycyclic aromatics.

Heterogeneity of tumor immune microenvironment and real-world analysis of immunotherapy efficacy in lung adenosquamous carcinoma

Lung adenosquamous carcinoma (ASC) is an uncommon histological subtype. We aimed to characterize the tumor immune microenvironment (TIME) in lung ASC and estimate patient response to immune checkpoint inhibitors (ICIs), which have never been systematically investigated. In cohort I, we collected 30 ASCs from a single center for analysis of TIME characteristics, including immuno-phenotyping, tumor mutation burden (TMB), T-cell receptor (TCR) repertoires, tumor-infiltrating lymphocytes (TILs), and immune checkpoint expression. Twenty-two (73.3%) patients were EGFR-positive. The TIME was defined by immune-excluded (60%) and immune-desert phenotype (40%). Strikingly, programmed cell death-ligand 1 (PD-L1) and programmed cell death-1 (PD-1) were predominantly expressed in squamous cell carcinoma components (SCCCs) versus adenocarcinoma components (ACCs), where enhanced CD4⁺ FOXP3⁺ regulatory T cell and attenuated CD57⁺ natural killer cell infiltration were present, consistent with a landscape of fewer innate immune cells, more immunosuppressive cells. SCCCs had higher TMB, higher TCR clonality, and lower TCR diversity than ACC. In cohort III, the efficacy of ICI-based therapy was estimated using a real-world data of 46 ASCs from 11 centers. Majority of 46 patients were driver genes negative and unknown mutation status, 18 (39%) and 18 (39%), respectively. The overall objective response rate of 28%, median progression-free survival of 6.0 months (95% confidence interval [CI] 4.3–7.7), and median overall survival of 24.7 months (95% CI 7.2–42.2) were observed in the ICI-based treatment. This work ascertains suppressive TIME in lung ASC and genetic and immuno-heterogeneity between ACCs and SCCCs. Lung ASC patients have a moderate response to ICI-based immunotherapy.

Sensitivity of gas sensors enhanced by functionalization of hexabenzoperylene in solution-processed monolayer organic field effect transistors

Solution-processed monolayer films consisting of unfunctionalized and functionalized hexabenzoperylenes in a single homogeneous phase have enabled highly sensitive detection of NH₃ and NO₂ on the basis of organic field effect transistors.

Tumor response heterogeneity, a powerful independent predictor of treatment outcome in advanced lung adenocarcinoma

e21146

Background: Tumor response heterogeneity (TRH) to treatment is common across different foci within the same cancer patient. However, the effect of heterogeneity on clinical outcome remains unclear. Here, we developed a quantitative assessment of TRH and explored the correlation of TRH with the clinical outcome. Methods: In this retrospective study, the main eligibility criteria were: patients with advanced lung adenocarcinoma, 3-10 measured foci, ECOG 0-1 and received first-line chemotherapy or targeted therapy. Percent change of the longest diameter in each measurable lesion were quantified with RECIST1.1. TRH score was the absolute value of the dispersion coefficient of the percentage value of each target lesion. Patients were randomly divided into a learning and a validation set. The optimal cutoff value of TRH score was identified according to progression free survival information in the discovery cohort. Then, we confirmed and analyzed the correlation of TRH scores with clinicopathological features in the validation cohort. The Next-generation sequencing was performed for mechanism exploration. Results: Between January 2016 and December 2020, 174 patients were enrolled, 101 (58.0%) treated with platinum-based doublet chemotherapy and 73 (42.0%) with targeted therapy. Median follow-up was 19.8 months (95% CI, 14.5 to 25.0). In the discovery cohort (n = 85), 0.46 was defined as the optimal cut-off point of TRH score. Patients with high TRH score had poor PFS (median PFS 4.5 months vs. 15.8 months, HR 4.43; 95% CI 2.14 to 9.16; P < 0.001) compared to those with low TRH score. In validation cohort (n = 89), high TRH score was confirmed to be associated with significantly shorter PFS (median PFS 5.1 months vs. 12.9 months, HR 2.69; 95% CI 1.59 to 4.55; P < 0.001). The median value of TRH score followed the order of PD, SD and PR ( P < 0.001). Patients with high TRH score had poor ORR (30.0% vs. 68.0%; Fisher's exact test, P < 0.001) compared with those with low TRH score. In all population, high TRH score was further confirmed as an independent biomarker for PFS by univariate and multivariate analysis. Moreover, TRH score were able to further distinguish the outcomes in PR and SD subgroup. In PR, high TRH score was associated with significantly shorter PFS in PR subgroup (HR 2.79; 95% CI 1.24 to 6.29; P < 0.001) and SD subgroup (HR 2.55; 95% CI 1.44 to 4.49; P = 0.002), respectively. Compared with low TRH score, high TRH score was associated with higher tumor mutation burden and high frequency variation of cell cycle signal pathway. Conclusions: TRH score, a novel parameter for evaluating tumor response heterogeneity, was a powerful independent predictor of outcome in advanced lung adenocarcinoma. The TRHscore further stratifies patients with the same RECIST assessment results and is a useful addition to the RECIST assessment system. Further prospective studies are warranted.

Tumor necrosis or cavity on baseline CT scan as a negative predictive biomarker for immune checkpoint inhibitors in advanced lung squamous cell carcinoma

e20556

Background: Current predictive biomarker for immune checkpoint inhibitors (ICIs) does not distinct according to histologic subtype. We hypothesize that necrosis or cavity on baseline CT scan in lung squamous cell carcinoma (LSCC) is predictive of treatment for ICIs. Methods: This was a multicenter retrospective analysis of patients with advanced LSCC. All eligible patients must had received either first-line chemotherapy only (chemotherapy group), or ICIs as monotherapy or combined with chemotherapy (ICIs group). Radiotherapy to thorax was not allowed. Baseline contrast-enhanced CT were reviewed by independent radiologist in each center. Radiologic finding was correlated with outcomes. Results: Total of 538 patients were eligible with 270 patients in the chemotherapy group and 268 patients in ICIs group. Baseline characteristics were well balanced. Tumor necrosis or cavity was identified in 111 (41.1%) in chemotherapy group and 99 (36.9%) in ICIs group. In chemotherapy group, there was no difference in PFS between patients with or without necrosis or cavity (5.33 vs 4.97 months, Hazard Ratio (HR) 1.05, 95% confidence interval (CI), 0.81-1.36, p= 0.726). In contrast, there was significant difference in PFS in ICIs group favoring patients without tumor necrosis or cavity (8.7 vs 6.5 months, HR 0.67, 95% CI 0.42–0.63, p< 0.001). Multivariate Cox analysis confirmed necrosis or cavity as an independent unfavorable predictive factor for PFS (HR 0.68; 95% CI, 0.51-0.9; p= 0.007). Conclusions: Tumor necrosis or cavity on baseline chest CT scan is a promising predictive biomarker for ICIs in LSCC, and this observation warrant further investigation.

A novel parameter reflecting the interaction between CD8+ T cells and cancer-associated fibroblasts

e20536

Background: Accumulating evidence reveal complicated crosstalk amongst cancer-related fibroblasts (CAFs) and immune cells in tumor microenvironment (TME). However, interaction within CAFs and immune cells, and their relationship with clinical outcomes remain largely undetermined. Methods: Interaction between CAFs and immune cells was evaluated by the CD8+ T cells/CAFs ratio (CFR), denoting great difference within single-sample gene-set enrichment analysis (ssGSEA) scores. Association of CFR with survival was examined in TCGA/GEO lung cancer and TCGA pan-cancer cohorts. Correlation between CFR and immunotherapeutic efficacy was determined in five independent cohorts including melanoma, lung cancer and urothelial cancer. orrelations between CFR and objective response rates (ORR) reported in the literature following pembrolizumab monotherapy were calculated in 20 TCGA cancer cohorts. To translate the in silico findings into clinical use, immunohistochemically-detected CD8/α-SMA ratio was used as prognostic and immuno-therapeutically predictive biomarker in two lung cancer cohorts. Furthermore, correlation within CFR, TMB, PD-L1, and molecular/genomic characteristics of CFR subgroups was also evaluated. Results: A moderately positive correlation existed between CAFs and immune cells infiltration in various cancer types. Higher immune cells/CAFs ratios indicated favorable prognosis regardless of distinct immune cells. Higher CFR, an independent risk factor and complementary factor to PD-L1 and TMB, was strongly associated with improved survival in melanoma, lung cancer and urothelial cancer immunotherapy cohorts (log-rank test, P < 0.05). Moreover, CFR averages across cancer types provided a higher correlation coefficient with the ORR following pembrolizumab monotherapy when compared to PD-L1 expression and TMB, r = 0.65 versus 0.36 and 0.31, respectively. Finally, in the clinical setting, CD8/α-SMA ratio was validated as an independent prognostic and predictive biomarker of immunotherapy efficacy in non-small cell lung cancer (HR, 0.21, 95% CI, 0.12-0.37, P < 0.001; HR, 0.37; 95% CI, 0.19-0.75; P < 0.001). Low CFR was associated with upregulation of hypoxia, TGF-β signaling, epithelial-mesenchymal transition and angiogenesis. Conclusions: CFR was a promising biomarker in the prediction of immunotherapeutic efficacy across various malignancies.

Synthesis, Aromatization and Cavitates of an Oxanorbornene-Fused Dibenzo[de, qr]tetracene Nanobox

Oxanorbornene-fused double-stranded macrocycles, represented by kohnkene, are not only synthetic precursors toward short segments of zigzag carbon nanotubes but also typical cavitands processing an intrinsic cavity. However, their capability to bind guest molecules in solution remained unexplored. Herein we report a new member of oxanorbornene-fused double-stranded macrocycles, which is named a nanobox herein because of its shape. Reductive aromatization of this oxanorbornene-fused nanobox leads to observation of a new zigzag carbon nanobelt by high resolution mass spectroscopy. The fluorescence titration and NMR experiments indicate that this nanobox encapsulates C₇₀ in solution with a binding constant of (3.2 ± 0.1) × 10⁶ M⁻¹ in toluene and a high selectivity against C₆₀ and its derivatives. As found from the X-ray crystallographic analysis, this nanobox changes the shape of its cross-section from a rhombus to nearly a square upon accommodating C₆₀.

A new oxanorbornene-fused nanobox encapsulated C₇₀ selectively in solution with a binding constant of (3.2 ± 0.1) × 10⁶ M⁻¹. Reductive aromatization of this nanobox led to observation of a new zigzag carbon nanobelt by mass spectroscopy.

Interfacial engineering of heterostructured Fe-Ni3S2/Ni(OH)2 nanosheets with tailored d-band center for enhanced oxygen evolution catalysis

The OER catalytic activities of Fe-Ni3S2 nanosheets can be well manipulated by tailoring the d band center positions via interfacial engineering strategy.

A Near-Infrared Absorbing and Emissive Quadruple Helicene Enabled by the Scholl Reaction of Perylene

Herein we report the synthesis, structural analysis, optical and chiroptical properties of a novel quadruple helicene, which has two [6] and two [7]helicene moieties fused in a contorted framework of 92 sp 2 carbon atoms.  It was synthesized by the Scholl reaction of a perylene-containing substrate with the formation of eight carbon-carbon bonds on the perylene unit in a single synthetic operation. Chemical oxidation of the quadruple helicene with tris(4-bromophenyl)ammoniumyl hexachloroantimonate resulted in an air-stable dication, which exhibits the same helicity in its four helicene moieties as unambiguously identified by single crystal X-ray crystallography. The quadruple helicene exhibits unusual near-infrared absorption and emission with absorption and emission maxima at 848 nm and 977 nm, respectively, and its isolated enantiomers exhibit electronic circular dichroism in the near-infrared and visible light regions.

In Situ Transformation of Metal-Organic Frameworks into Hollow Nickel-Cobalt Double Hydroxide Arrays for Efficient Water Oxidation

Developing earth-abundant electrocatalysts for efficient oxygen evolution reaction (OER) is of paramount significance for electrochemical water splitting. Herein, an efficient in situ etching-deposition growth strategy is employed to transform pristine two-dimensional (2D) Co-metal-organic frameworks into hollow Ni/Co double hydroxide arrays (denoted as Ni/Co-DH), which not only yields a larger surface area and exposes more active sites but also decreases the activation energy to the OER. With structural and compositional benefits, the Ni/Co-DH exhibits high performance with an overpotential of 229 mV at 10 mA cm^-2 and exceptional long-term stability of over 90 h in 1 M KOH medium for OER, comparable to most non-noble oxygen evolution catalysts reported so far. In addition, a two-electrode Ni/Co-DH∥Pt/C electrolyzer also requires a considerably low voltage of 1.58 V at 10 mA cm^-2 for overall water splitting. This study affords a rational strategy to develop water-alkali electrolyzers with great complexity for large-scale water-splitting systems.

Carbazole-Fused Polycyclic Aromatics Enabled by Regioselective Scholl Reactions

The synthesis of new carbazole-fused polycyclic aromatics with interesting geometry and useful properties was explored using Scholl reactions. As found from the Scholl reactions of substrates having two carbazole units linked at different positions through o-phenylene, oxidative coupling of carbazole units occurred in a regioselective manner with new carbon-carbon bonds preferably formed at C3 and C4 in N-alkyl carbazoles. A new N-containing aromatic bowl was characterized by single-crystal X-ray crystallography, and new p-type organic semiconductors exhibited field effect mobility of up to 0.070 cm²  V^-1  s^-1 in solution-processed thin-film transistors.

Serum Uric Acid Levels and Their Changes and Risk of Stroke: A 7-Year Prospective Cohort Study in Northwest China

INTRODUCTION

It is not clear whether serum uric acid (SUA) levels and their changes over time are associated with the risk of stroke. A 7-year prospective cohort study in northwest China was conducted to analyze effects of SUA and their changes on the risk of stroke.

METHODS

A total of 23,262 individuals without cardiovascular disease in the Jinchang cohort were followed up for an average of 5.26 years. The Cox proportional hazard model was used to estimate the hazard ratios (HRs) and 95% confidence interval (95% CI) of stroke incidence to SUA and relative changes in SUA. Sensitivity analysis was performed after controlling the effect of renal insufficiency.

RESULTS

Baseline SUA and relative changes in SUA were positively correlated with the incidence of stroke in both males and females (p for overall association <0.0001). Stroke risk increased by 4.6% per 10% increase in the relative change of SUA (HR = 1.046, 95% CI, 1.007-1.086). The fully adjusted regression analysis demonstrated that only the large gain (>30%) in SUA was associated with an increased risk of stroke by 36.5% (95% CI, 1.8-83.0%), compared with the reference group (participants within ±10% changes in SUA). The same trend was observed in people with normal baseline SUA. In the unadjusted model, the risk of stroke associated with elevated SUA was significantly higher in the hyperuricemia group than in the normal SUA group.

CONCLUSION

High initial SUA concentration and an increase in SUA concentration over time would increase the risk of stroke, and this means that there is no safe increase in SUA.

Design, Synthesis and Hydrogen Bonding of B3 N6 -[4]Triangulene

Replacement of the allylic C=C-C unit with a N-B-N unit at each of the three zigzag edges of [4]triangulene gives rise to B₃ N₆ -[4]triangulene, which is envisioned to represent a key structural unit of a new hypothetical boron carbon nitride (BC₄ N). A tert-butylated B₃ N₆ -[4]triangulene has been successfully synthesized by three-fold nitrogen-directed borylation, and the X-ray crystallographic analysis indicates that its slightly bent triangular polycyclic framework can be viewed as a 1,3,5-triphenylbenzene connected by three 4π-electron N-B-N units. The HN-B-NH moiety provides a dual hydrogen-bond donor, which forms H-bonds with halide or carboxylate anions in solution, and form DD-AA hydrogen-bond arrays with 2,7-di(tert-butyl)-pyrene-4,5,9,10-tetraone in the co-crystal. Moreover, the blue fluorescence of B₃ N₆ -[4]triangulene in solution is responsive to binding p-nitrobenzoate anion through hydrogen bonds.

FYN and CD247: key Genes for Septic Shock Based on Bioinformatics and Meta-Analysis

BACKGROUND

Septic shock is sepsis accompanied by hemodynamic instability and high clinical mortality.

MATERIAL AND METHODS

GSE95233, GSE57065, GSE131761 gene-expression profiles of healthy control subjects and septic shock patients were downloaded from the Gene-Expression Omnibus (GEO) database, and differences of expression profiles and their intersection were analysed using GEO2R. Function and pathway enrichment analysis was performed on common differentially expressed genes (DEG), and key genes for septic shock were screened using a protein-protein interaction network created with STRING. Also, data from the GEO database were used for survival analysis for key genes, and a meta-analysis was used to explore expression trends of core genes. Finally, high-throughput sequencing using the blood of a murine sepsis model was performed to analyse the expression of CD247 and FYN in mice.

RESULTS

A total of 539 DEGs were obtained (p < 0.05). Gene ontology analysis showed that key genes were enriched in functions, such as immune response and T cell activity, and DEGs were enriched in signal pathways, such as T cell receptors. FYN and CD247 are in the centre of the protein-protein interaction network, and survival analysis found that they are positively correlated with survival from sepsis. Further, meta-analysis results showed that FYN could be useful for the prognosis of patients, and CD247 might distinguish between sepsis and systemic inflammatory response syndrome patients. Finally, RNA sequencing using a mouse septic shock model showed low expression of CD247 and FYN in this model.

CONCLUSION

FYN and CD247 are expected to become new biomarkers of septic shock.

Intrapulmonic Cavity or Necrosis on Baseline CT Scan Serves as an Efficacy Predictor of Anti-PD-(L)1 Inhibitor in Advanced Lung Squamous Cell Carcinoma

Background

Predictive markers for guidance and monitoring of immunotherapy in lung squamous cell carcinoma (LSCC) are an interesting topic but have yet to be fully explored. A primary characteristic of LSCC is tumor necrosis that results in extensive immune suppression in patients. We sought to assess whether tumor necrosis or cavity on baseline CT could effectively predict the efficacy of immune checkpoint inhibitors (ICIs) in advanced LSCC.

Methods

Advanced LSCC cases undergoing pre-treatment chest CT imaging and receiving ICIs were retrospectively collected. All CT images were reviewed by an independent chest radiologist blinded to any previous diagnosis to confirm morphological alterations in necrosis or cavity. We performed Logistic regression and developed Cox proportional hazards models to assess the predictive performance of baseline necrosis or cavity characteristics in advanced LSCC. Survival estimates were observed using Kaplan–Meier curves.

Results

Ninety-three patients were eligible for analysis, predominantly consisting of patients with ECOG performance status of 0 or 1 (97.8%), male patients (95.7%), and heavy smokers (92.5%). Intrapulmonic necrosis or cavity on CT scan was present in 52.7% of all patients. Generally, the objective response rate (ORR) in patients with necrosis or cavity to ICI treatment was significantly worse versus those without (30.6% vs 54.5%, p = 0.020), with the subgroup ORRs as follows: ICI monotherapy (necrosis vs non-necrosis: 10.0% vs 36.8%, p =0.047) and ICI combination therapy (44.8% vs 68.0%, p =0.088). Multivariable analysis identified intrapulmonic necrosis or cavity at baseline as a major risk factor for advanced LSCC (HR 4.042, 95% CI1.149–10.908, p = 0.006). Multivariate Cox analysis showed that baseline necrosis or cavity and ICI monotherapy were unfavorable factors for progression-free survival (HR 1.729; 95% CI1.203–2.484, p =0.003).

Conclusion

LSCC patients with intrapulmonic cavity or necrosis on baseline CT scan may respond poorly to anti-PD-(L)1-treatment, monotherapy and combination therapy alike.

Erlotinib as a salvage treatment after gefitinib failure for advanced non-small-cell lung cancer patients with brain metastasis: A successful case report and review

RATIONALE

The guidelines recommended gefitinib as a first-line targeted treatment for stage IV non-small-cell lung cancer (NSCLC) patients with EGFR mutations. However, resistance to gefitinib ensues invariably and there is little evidence as for the effectiveness of subsequent salvage treatment for patients without T790m mutation. The case is to evaluate the efficacy of erlotinib, another EGFR-TKI, after failed first-line use of gefitinib.

PATIENT CONCERNS

We described a 55-year-old man with good performance status (PS).

DIAGNOSES

He was histopathologically diagnosed stage IV lung adenocarcinoma with EGFR mutations in November 2018.

INTERVENTIONS

He was administrated with gefitinib daily (250 mg) for activating epidermal growth factor receptor (EGFR) mutations (exon 19 deletions,19del), and combined with platinum-based dual-drug chemotherapy. During the target treatments, the optimal efficacy evaluation was partial remission (PR) with a 12-month progression-free survival (PFS) time. Later, the intracranial progression of the patient rendered the treatment change to erlotinib.

OUTCOMES

It is surprising that the tumor lesion in brain as well as lung relieved obviously. His progression-free survival (PFS)was nearly 11 months, and the overall survival (OS)was>36 months up to now. The adverse events were tolerable.

LESSIONS

This case manifests that re-biopsy of advanced or recurrent NSCLC is beneficial to make a better therapeutic regimen, and erlotinib can be used as a salvage treatment after gefitinib failure.

Effects of cold and hot temperature on metabolic indicators in adults from a prospective cohort study

BACKGROUND

Previous studies have found that exposed to low and high outdoor temperature was associated with cardiovascular diseases morbidity and mortality. The risk factors for cardiovascular disease include high blood lipid, high uric acid (UA) and high fasting plasma glucose (FPG). However, few studies have explored the effects of low and high temperature on these metabolic indicators.

OBJECTIVE

To explore the effect of low and high temperature on metabolic indicators in adults from northwest of China.

METHODS

Based on a prospective cohort study, a total of 30,759 individuals who participated in both baseline and first follow-up from 2011 to 2015 were selected in this study. The meteorological observation data and environmental monitoring data were collected in the same period. Associations between cold and hot temperature and blood lipid (total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C)), UA and FPG were conducted with mixed effect models after adjusting for confounding factors.

RESULTS

A nonlinear relationship between outdoor temperature and metabolic indicators was found. For the cold effects, each 5 °C decrease of mean temperature was associated with an increase of 5.07% (95% CI: 3.52%, 6.63%) in TG and 2.85% (95% CI: 2.18%, 3.53%) in UA, While a decrease of 3.38% (95% CI: 2.67%, 4.09%) in HDL-C and 1.26% (95% CI: 0.48%, 2.04%) in LDL-C. For the heat effects, each 5 °C increase in mean temperature was associated with 1.82% (95% CI: 0.89%, 2.76%), 0.56% (95% CI: 0.11%, 1.00%), 5.82% (95% CI: 4.58%, 7.06%), 9.02% (95% CI: 7.17%, 10.87%), 0.20% (95% CI: 0.01%, 0.40%), and 1.22% (95% CI: 0.19%, 2.24%) decrease in TC, TG, HDL-C, LDL-C, UA and FPG. Age, smoking, drinking, high-oil diet and hyperlipidemia might modify the association between mean temperature and metabolic indicators.

CONCLUSION

There was a significant effect of cold and hot temperature on metabolic indicators in a high altitude area of northwestern China. These results provide a basis for understanding the underlying mechanism of the influence of temperature on metabolic diseases.

The Risk and Influencing Factors of Hypertension in Jinchang Cohort

Background

To investigate the incidence and influencing factors of hypertension in Jinchang cohort.

Methods

A prospective cohort study was conducted to collect the baseline and follow-up information of 22,826 employees from 2011 to 2015 based on the Jinchang cohort platform. The incidence of hypertension in the cohort was calculated and the influencing factors were analyzed by Cox proportional risk model.

Results

The subjects were followed up for an average of 22 years, and the incidence density of hypertension was 56.31/1000 person-years. Multivariate Cox regression results showed that the main risk factors for hypertension in the population included age ≥40 years, alcohol consumption, high-salt diet, history of diabetes, family history of hypertension, overweight and obesity, baseline systolic blood pressure ≥110 mm Hg and diastolic blood pressure ≥75 mm Hg, and higher education levels (middle school, high school, and above) were a protective factor. The incidence of grade 1 hypertension was related to age, drinking, history of diabetes, family history of hypertension and baseline blood pressure levels, and the incidence of grades 2 and 3 hypertension was related to high-salt diet, family history of hypertension, overweight or obesity, and baseline blood pressure levels.

Conclusions

The Jinchang cohort has a higher risk of hypertension. Age, unhealthy lifestyle, history of diabetes, family history of hypertension, obesity, and baseline blood pressure are strongly associated with the onset of hypertension. There are differences in the risk factors for the occurrence of grades 1, 2, and 3 hypertension.

Immune heterogeneity in adenocarcinoma and squamous cell carcinoma components of lung adenosquamous carcinoma

e20523

Background: Lung adenosquamous carcinoma (ASC) is a relatively uncommon malignancy that comprised of both adenocarcinoma component (ACC) and squamous cell carcinoma component (SCCC). We have reported its genomic profile, evolutionary origin, and clinical management. Information of tumor immune microenvironment (TIME) of ASC, including tumor mutation burden (TMB), tumor-infiltrating lymphocytes (TILs), T cell receptors (TCR) repertoire, and PD-L1 status remains scarce. Methods: 28 Surgical ASCs were collected and identified by immunohistochemistry (IHC). ACC and SCCC were obtained separately by microdissection. Targeted sequencing was performed for the two components using a 1021-gene-panel independently. TMB of ACC and SCCC were independently calculated. TMB of ASC calculation was based on aggregation (removing duplicates) of non-synonymous mutations from both ACC and SCCC. TILs and PD-L1were examined by multiplex immunohistochemistry (mIHC). The infiltration level of immune cells in tumor, stroma, and total region (named by both tumor and stroma regions) was investigated. T cell receptor (TCR) repertoires were sequenced and clonality and Shannon index were calculated. Results: SCCC (7.2 mutations/Mb) had a higher TMB level than ACC (6.5 muts/Mb), indicating the immunogenic heterogeneity between the different pathological components. The TMB value of ACC and SCCC were modestly proportional (Spearman r = 0.56, p = 0.001), which was related to the clonal origin. SCCC TMB was lower than the archival LUSC (10.1 muts/Mb), and ACC TMB was similar to LUAD (4.3 muts/Mb). The TMB of ASC was higher than LUAD and close to LUSC. The nonidentical TIL level in ACC and SCCC showed infiltration heterogeneity. For tumor region, CD3+ total T cells, CD4+ T cells, CD8+ T cells, and PD1+ cells accounted for the most proportion of immune cells, with no differences between ACC and SCCC; FOXP3+ CD4+ Treg cells were more abundant in SCCC than ACC ( p = 0.047), as well as CD3+ LAG3+ T cell ( p = 0.029). For stroma region, ACC and SCCC had similar level of CD4+, CD8+, and PD-1 immune cell infiltration; the amount of FOXP3+ CD4 + Treg cells was also higher in SCCC than ACC, as well as CD3+ LAG3+ T cells. For the total region, FOXP3+ CD4 + Treg cells, CD3+ LAG3+ T cells, and PD-1+ T cells were enriched in SCCC compared with ACC, while CD57+ natural killer T (NKT) cells were accumulated with a marginally higher level in ACC ( p = 0.049). TCR repertoires sequencing revealed a lower Shannon’s diversity ( p = 0.029) but higher clonality ( p = 0.047) of SCCC compared with ACC. PD-L1 expression identified by mIHC in SCCC was significantly higher than ACC, in the tumor ( p < 0.001), stroma ( p < 0.001), and total regions ( p < 0.001). Conclusions: SCCC of ASC had higher levels of TMB, Treg cells, TCR clonality, and PD-L1, and similar level of CD3+, CD4+, and CD8+ TILs, comprehensively reflecting the intratumor heterogeneity of TIME.

Multiple combination therapy based on intrathecal pemetrexed in non-small cell lung cancer patients with refractory leptomeningeal metastasis

BACKGROUND

Leptomeningeal metastasis (LM) is a fatal complication, and its incidence is increasing in non-small cell lung cancer (NSCLC). Refractory LM (rLM) has become problematic due to the lack of uniform definition and standardized treatment guidelines. In this study, we assessed the efficacy and safety of multiple therapy based on intrathecal pemetrexed (IP) in patients with rLM in NSCLC.

METHODS

From March 2019 to June 2020, patients with cytologically confirmed rLM who received IP and systemic salvage therapy were retrospectively analyzed. Our objectives were to assess progression-free survival (PFS), overall survival (OS), clinical response, and safety. Clinical response was assessed by an investigator according to the Response Assessment in Neuro-Oncology (RANO) proposal criteria. We performed next generation sequencing (NGS) of cerebrospinal fluid (CSF) to explore the gene profile of rLM.

RESULTS

A total of 23 patients were enrolled, and the genetic status of the primary tissue was 16 epidermal growth factor receptor (EGFR) mutations (69.6%), two anaplastic lymphoma kinase (ALK) fusions (8.7%), one ROS proto-oncogene 1 (ROS1) fusion (4.3%), one Erb-B2 receptor tyrosine kinase 2 (ERBB2) mutation (4.3%), and three wild-type (13.0%). On the basis of IP therapy, 19 patients were rechallenged with tyrosine-kinase inhibitors (TKIs), 10 patients were treated with systemic chemotherapy, 10 patients were treated with antivascular therapy, one patient was treated with immunotherapy, and one patient was treated with whole-brain radiotherapy (WBRT). Thirteen patients received two or more of the aforementioned combination treatment modes. The median PFS (mPFS) was 9.6 months [95% confidence interval (CI): 3.4-15.8 months]. OS was not mature at the final follow-up. The clinical assessment was: response in eight patients (34.8%), stable in 11 patients (47.8%), worse in two patients (8.7%), and non-evaluable in two patients (8.7%). Adverse events (AEs) related to any component occurred in 14 patients (60.9%). The driver mutation status was highly consistent between the CSF and primary tumor samples (14/14), but we detected EGFR mutations in the CSF of two patients whose primary tumor samples tested wild-type.

CONCLUSIONS

IP-based multimodal therapy has significant efficacy and a controlled safety profile in patients with rLM in NCSLC.

Transformation of a cold to hot tumor and a durable response to immunotherapy in a patient with non-small cell lung cancer after chemoradiotherapy: a case report

Immune checkpoint inhibitors (ICIs) have become an important milestone in the treatment of non-small cell lung cancer (NSCLC). High expression of protein ligand 1 (PD-L1) and tumor mutation burden (TMB) can help to select the dominant population for immunotherapy, but the expression of PD-L1 does not seem to be unchanged. A 61-year-old man with adenocarcinoma of the lung experienced postoperative recurrence. PD-L1 expression was negative before recurrence, and TMB was stable by next-generation sequencing (NGS) test. However, after radiotherapy and chemotherapy, PD-L1 positive expression was found in a re-biopsy specimen, and NGS detection indicated the loss of immune negative predictive genes. The patient achieved a durable response to a posterior-line immunotherapy combined chemotherapy. The tumor microenvironment maybe changed after chemoradiotherapy, which provides an opportunity for patients to benefit from immunotherapy. The use of NGS in dynamic detection and PD-L1 expression may help monitor this change in the tumor microenvironment, the transition from cold to hot tumor. This case maybe provides new clinical evidence that a non-immuno-dominant population in the initial state can be converted to a population with the benefit of immunotherapy after chemoradiotherapy. However, patients who are initially unsuitable for immunotherapy may still need to undergo combined immunotherapy to achieve a clinical benefit.

Charging a Negatively Curved Nanographene and Its Covalent Network

This study explores a bottom-up approach toward negatively curved carbon allotropes from octabenzo[8]circulene, a negatively curved nanographene. Stepwise chemical reduction reactions of octabenzo[8]circulene with alkali metals lead to a unique highly reduced hydrocarbon pentaanion, which is revealed by X-ray crystallography suggesting a local view for the reduction and alkali metal intercalation processes of negatively curved carbon allotropes. Polymerization of the tetrabromo derivative of octabenzo[8]circulene by the nickel-mediated Yamamoto coupling reaction results in a new type of porous carbon-rich material, which consists of a covalent network of negatively curved nanographenes. It has a specific surface area of 732 m² g^-1 and functions as anode material for lithium ion batteries exhibiting a maximum capacity of 830 mAh·g^-1 at a current density of 100 mA·g^-1. These results indicate that this covalent network presents the key structural and functional features of negatively curved carbon allotropes.