Comparative clinical outcomes and predictive biomarkers of sintilimab combinations vs. single therapy in cancer: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

This study aimed to compare the efficacy and safety between sintilimab combinations and single treatment in cancer patients, as well as identify biomarkers for selection of patients who might benefit from the combination treatments.

MATERIALS AND METHODS

A search of randomized clinical trials (RCTs) comparing sintilimab combinations vs. single treatment in different tumors according to the PRISMA guidelines was performed. Selected endpoints included completion response rate (CR), objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), major adverse effects (AEs), immune-related adverse events (irAEs). Subgroup analyses based on different combination regimens, tumor type and basic biomarkers were included.

RESULTS

Results reported from 11 RCTs involving 2,248 patients were included in this analysis. Pooled results indicated that both sintilimab plus chemotherapy and sintilimab plus targeted therapy significantly improved CR [RR=2.44, 95% CI (1.14, 5.20), p=0.021; RR=2.91, 95% CI (1.29, 6.57), p=0.010], ORR [RR=1.34, 95% CI (1.13, 1.59), p=0.001; RR=1.70, 95% CI (1.13, 2.56), p=0.011], PFS [HR=0.56, 95% CI (0.43, 0.69), p<0.001; HR=0.56, 95% CI (0.49, 0.64), p<0.001] and OS [HR=0.59, 95% CI (0.48, 0.70), p<0.001]. Subgroup analyses suggested that the sintilimab-chemotherapy group exhibited a superior PFS benefit than the chemotherapy alone group regardless of age, gender, EGOS PS, PD-L1 expression, smoking status, and clinical stage. There were no significant statistical differences in the incidence of any grade and grade 3 or worse AEs between the two groups [RR=1.00, 95% CI (0.91, 1.10), p=0.991; RR=1.06, 95% CI (0.94, 1.20), p=0.352]. While the incidence of any grade irAEs was higher with sintilimab plus chemotherapy as compared to chemotherapy alone (RR=1.24, 95% CI (1.01, 1.54), p=0.044), but no significant difference was found for grade 3 or worse irAEs (RR=1.11, 95% CI (0.60, 2.03), p=0.741).

CONCLUSIONS

Sintilimab combinations brought benefits to a greater number of patients at the cost of a mild increase of irAEs. PD-L1 expression may not be used as a predictive biomarker, composite biomarkers consisting of PD-L1 and MHC class II expression are worth to be explored to enlarge the patient population that benefits from sintilimab combinations.

[A deep learning segmentation model for detecting caries in molar teeth]

This study aimed to build a home use deep learning segmentation model to identify the scope of caries lesions. A total of 494 caries photographs of molars and premolars collected via endoscopy were selected. Subsequently, these photographs were labeled by physicians and underwent segmentation training by using DeepLabv3+, and then verification and evaluation were performed. The mean accuracy was 0.993, the sensitivity was 0.661, the specificity was 0.997, the Dice coefficient was 0.685, and the intersection over union (IoU) was 0.529. Therefore, the present deep learning segmentation model can identify and segment the scope of caries.

Proteome analysis of the liver in the Chinese fire-bellied newt Cynops orientalis

The Chinese fire-bellied newt, Cynops orientalis, belonging to Amphibia, Caudata, Salamandridae is a species endemic to China. The liver, which is an important digestive gland and the largest amphibian organ, has various functions, including detoxification, glycogen storage, protein synthesis, and hormone production. However, the newt liver has rarely been studied at the molecular level. We performed histomorphology and high-throughput proteomic analysis of the Chinese fire-bellied newt liver, using hematoxylin and eosin (H&E) staining and two-dimensional electrophoresis coupled with mass spectrometry. The H&E staining showed that the newt liver nuclei are large and round, are located in the lateral cytoplasm, and contain a large quantity of lipid droplets. Melanins were abundantly present throughout the hepatic parenchyma. The proteome analysis showed a total of 545 proteins detected in the newt liver. Furthermore, a gene ontology analysis suggested that these proteins were associated with metabolism, immune response, cellular homeostasis, etc. Among these, proteins with metabolic functions were found to be the most abundant and highly expressed. This supports the role of the liver as the metabolic center. The proteomic results provide new insights into the aspects of the liver proteomes of the Chinese fire-bellied newt. The identification of a more global liver proteome in the newt may provide a basis for characterizing and comparing the liver proteomes from other amphibian species.

A study on knowledge, attitudes and health behaviours regarding Alzheimer's disease among community residents in Tianjin, China

ACCESSIBLE SUMMARY

What is known on the subject? Several studies have measured the general public's knowledge and attitudes towards Alzheimer's disease; however, much of this work is based on western samples. Due to cultural differences, the western findings may be difficult to generalize to the Chinese general public. In addition, the few studies conducted in China were often restricted to a relatively narrow range of knowledge and attitudes. What this paper adds to existing knowledge? The general public had little knowledge of Alzheimer's disease, especially on the causes, symptoms and risk factors. In terms of attitudes, although the general public held positive attitudes towards persons with Alzheimer's disease, most of them were not sure whether or not to share a diagnosis of Alzheimer's disease with the patient. In daily life, only a low proportion of people kept mentally active. What are the implications for practice? A popularization of a wide range of knowledge about Alzheimer's disease needs to be undertaken, especially focusing on persons with low educational level and emphasizing the causes, symptoms and risk factors. Besides, there is a significant need to draw up evidence-based dietary and lifestyle guidelines for Alzheimer's disease risk reduction. Moreover, health promotion agencies should identify priority groups for Alzheimer's disease risk reduction initiatives, especially those with lower income, a lower level of knowledge on Alzheimer's disease and with chronic diseases.

AIM

The purpose of this descriptive correlational cross-sectional study was to assess the current level of knowledge, attitudes and health behaviours regarding Alzheimer's disease among community residents in Tianjin, China and to identify factors related to these attributes.

METHOD

A convenience sample of 140 community-dwelling adults aged 20-75 years was selected to complete a researcher-designed questionnaire about Alzheimer's disease-related knowledge, attitudes and health behaviours.

RESULTS

The findings revealed that 15.7% of the participants knew the risk factors for Alzheimer's disease. With regard to attitude, 138 participants (98.6%) believed that people with Alzheimer's disease should not be discriminated against, and 55.7% were not sure whether to share a diagnosis of Alzheimer's disease with the patient. In daily life, 28.6% of the participants pursued their interests and hobbies. A lower level of health behaviours was associated with lower income, presence of chronic diseases and a lower level of knowledge about Alzheimer's disease.

DISCUSSION

These findings provide a strong case for population-level risk reduction initiatives to be undertaken, especially among people with lower income, a lower level of knowledge on Alzheimer's disease and with chronic diseases.

Effects of hyper- and hypothyroid on expression of thyroid hormone receptor mRNA in rat myocardium

Thyroid dysfunction is classified into hyperthyroidism and congenital hypothyroidism (CH). Both hyperthyroidism and CH can cause heart lesions; however, the mechanisms involved remain unclear. The left ventricle was collected from eu-, hyper-, and hypothyroid rat. RNA was extracted and reverse-transcripted to cDNA. Real-time fluorescence quantitation-PCR was used to quantify the differential expression of thyroid hormone receptor (TR) subtype mRNA among eu-, hyper-, and hypothyroid rat myocardium. Here, we show that compared with the normal myocardium, TRalpha1 mRNA expression was upregulated by 51% (P<0.01), TRalpha2 mRNA expression was downregulated by 58% (P<0.01), and TRbeta1 mRNA expression remained unchanged in hyperthyroid rat myocardium (P>0.05). TRalpha1, TRalpha2, and TRbeta1 were expressed in normal and hypothyroid rat myocardium throughout the developmental process. In hypothyroid rats, myocardial TRalpha1 mRNA expression was generally downregulated and the expression peak appeared late. Myocardial TRalpha2 mRNA expression was generally upregulated and the expression peak appeared late. Myocardial TRbeta1 mRNA expression was generally downregulated and changed similarly with the control group. In addition, the hypogenetic myocardium can be seen in the hypothyroid rat by pathology study. Taken together, the abnormal expression of TR subtype mRNA may have a close relationship with the pathogenesis of CH and hyperthyroidism heart disease.

Effects of parathyroid hormone and estradiol on proliferation and function of human osteoblasts from fetal long bone. An in vitro study

The effect of parathyroid hormone (PTH) (0.01 nM-10 nM) and 17 beta-estradiol (E2, 1 nmol-10 nM) alone or in combination on 3H-thymidine incorporation, alkaline phosphatase and adenylate cyclase activities were investigated in human fetal osteoblasts using serum-free monolayer primary cultures. The results showed that PTH inhibited cell proliferation while E2 promoted it. On alkaline phosphatase activity, PTH showed a complex results while E2 were slightly inhibitory. PHT-E2 combination suggested that E2 could alter the effect of PTH alone, also potentiated the anabolic and antagonize the catabolic effects of PTH on bone formation.