Comparing efficacy and safety of first-line treatment of metastatic renal cell carcinoma: A Bayesian network meta-regression analysis.

Background: This Bayesian network meta-regression analysis provides a head-to-head comparison of first-line therapeutic immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI) combinations for metastatic renal cell carcinoma (mRCC) using median follow-up time as covariate. Methods: We searched Six databases for a comprehensive analysis of randomised clinical trials (RCTs). Comparing progression free survival (PFS) and overall survival (OS) of different interventions at the same time node by Bayesian network meta-analysis. Bayesian network meta-regression analysis was performed on objective response rate (ORR), adverse events (AEs) (grade ≥ 3) and the hazard ratios (HR) associated with PFS and OS, with the median follow-up time as the covariate. Results: Eventually a total of 22 RCTs reporting 11,090 patients with 19 interventions. Lenvatinib plus Pembrolizumab (LenPem) shows dominance of PFS, and Pembrolizumab plus Axitinib (PemAxi) shows superiority in OS at each time point. After meta-regression analysis, for HRs of PFS, LenPem shows advantages; for HRs of OS, PemAxi shows superiority; For ORR, LenPem provides better results. For AEs (grade ≥ 3), Atezolizumab plus Bevacizumab (AtezoBev) is better. Conclusion: Considering the lower toxicity and the higher quality of life, PemAxi should be recommended as the optimal therapy in treating mRCC. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD4202236775.

Vortex formation time as an index of left ventricular filling efficiency: comparison between children volunteers and patients with tetralogy of Fallot.

Background: Vortex formation time (VFT) had been considered a useful marker for assessing diastolic performance. the VFT assessment of diastolic function using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has not been used in repair of tetralogy of Fallot (rTOF) patient. The aims of this study were as follows: (I) establish reference ranges for VFT measurements in healthy children and adolescents using 4D flow CMR imaging; and (II) analyze VFT parameters to assess diastole dysfunction in rTOF patients group. Methods: We acquired the CMR data was of 62 healthy participants (aged 6-18 years; male: 40, female: 22) and 20 patients with rTOF (aged 10-13 years; male: 15, female: 5) using 4D flow and cine sequence in routine chamber view. The VFT was calculated based on comparison of different algorithms from cine measurements (VFTvolume) and 4D flow measurements (VFTblood). Then, VFT measurements were compared to subject peak filling rate (PFR), age, and cardiac mass using simple linear regression and multiple regression analyses. Data were also categorized according to age for VFT and cardiac functional assessment comparisons between 3 age groups (Group 1: 6-9 years; Group 2: 10-13 years; Group 3: 14-18 years). The correlation of VFT and cardiac function parameters were analyzed in the rTOF group. Results: Normal mean value of VFTvolume and VFTblood were 4.25±0.92 and 3.77±1.11 in healthy children participants. The VFTvolume was correlated with VFTblood (r=0.61, P<0.001). There was a moderately significant correlation between VFTvolume and PFR (r=0.46, P<0.001) and between VFTblood and PFR (r=0.47, P<0.001), age (r=0.41, P=0.002) and left ventricular (LV) mass (r=0.48, P<0.001). Multiple regression analyses demonstrated that VFTvolume was independently associated with PFR (T=2.239; P<0.05) and VFTblood (T=4.361; P<0.001). There was a significant difference in VFTvolume between healthy controls and rTOF patients (5.44±1.93 vs. 4.27±0.88, P=0.018). Conclusions: The VFT measurements showed that the LV that had appropriate space to form the optimal vortex ring in normal children and adolescents aged 6-18 years old. The VFTvolume could potentially be helpful in improving our understanding of LV diastolic dysfunction in rTOF patients.

Optical fiber-based in vivo quantification of growth factor receptors.

BACKGROUND: Growth factor receptors such as epidermal growth factor receptor 1 and human epidermal growth receptor 2 (HER2) are overexpressed in certain cancer cells. Antibodies against these receptors (eg. cetuximab and transtuzumab [Herceptin]) have shown therapeutic value in cancer treatment. The existing methods for the quantification of these receptors in tumors involve immunohistochemistry or DNA quantification, both in extracted tissue samples. The goal of the study was to evaluate whether an optical fiber-based technique can be used to quantify the expression of multiple growth factor receptors simultaneously. METHODS: The authors examined HER2 expression using the monoclonal antibody trastuzumab as a targeting ligand to test their system. They conjugated trastuzumab to 2 different Alexa Fluor dyes with different excitation and emission wavelengths. Two of the dye conjugates were subsequently injected intravenously into mice bearing HER2-expressing subcutaneous tumors. An optical fiber was then inserted into the tumor through a 30-gauge needle, and using a single laser beam as the excitation source, the fluorescence emitted by the 2 conjugates was identified and quantified by 2-photon optical fiber fluorescence. RESULTS: The 2 conjugates bound to the HER2-expressing tumor competitively in a receptor-specific fashion, but they failed to bind to a similar cell tumor that did not express HER2. The concentration of the conjugate present in the tumor as determined by 2-photon optical fiber fluorescence was shown to serve as an index of the HER2 expression levels. CONCLUSIONS: These studies offer a minimally invasive technique for the quantification of tumor receptors simultaneously.

Design, synthesis, and biological functionality of a dendrimer-based modular drug delivery platform.

A modular dendrimer-based drug delivery platform was designed to improve upon existing limitations in single dendrimer systems. Using this modular strategy, a biologically active platform containing receptor mediated targeting and fluorescence imaging modules was synthesized by coupling a folic acid (FA) conjugated dendrimer with a fluorescein isothiocyanate (FITC) conjugated dendrimer. The two different dendrimer modules were coupled via the 1,3-dipolar cycloaddition reaction ("click" chemistry) between an alkyne moiety on the surface of the first dendrimer and an azide moiety on the second dendrimer. Two simplified model systems were also synthesized to develop appropriate "click" reaction conditions and aid in spectroscopic assignments. Conjugates were characterized by (1)H NMR spectroscopy and NOESY. The FA-FITC modular platform was evaluated in vitro with a human epithelial cancer cell line (KB) and found to specifically target the overexpressed folic acid receptor.