Expansion Phase Research Articles

Critical Care Service Transformation at the ALERT Comprehensive Specialized Hospital, A Case Study.

BackgroundThe intensive care unit (ICU) is a specialized department within a hospital that provides care for critically ill patients requiring close monitoring, multidisciplinary intervention, and advanced life support. It is a resource-intensive healthcare service, with the patient outcome determined by the adequate utilization of human resources, supplies, technologies, and infrastructure. ALERT Hospital is one of the largest referral hospitals that provides critical care services for both adult and pediatric patients. This case study narrates the establishment and transformation of critical care services at ALERT Hospital over the last five years.ObjectiveTo describe the transformation of critical care services at ALERT Comprehensive Specialized Hospital from the beginning of the service to the current stateMethodsA descriptive case study design was applied to narrate critical care service transformation at ALERT Comprehensive Specialized Hospital. Data was gathered from desk reviews of the emergency department, ICU, quality directorate, hospital data management unit, and the annual audit report.ResultALERT Hospital provides services for about 4.2 million people, encompassing 22 health centers, 8 hospitals, and other private health facilities within its catchment area. The ALERT Trauma Center, established in 2015, had only 3 ICU beds with two functional mechanical ventilators and a few trained nurses, with an annual hospital and emergency patient flow of 328,242 and 13,642, respectively. The critical care service expansion at ALERT Hospital encountered various obstacles concerning infrastructure, personnel, and supplies. Therefore, the hospital administration and clinicians designed and implemented different strategies to transform the service into the current picture. Accordingly, after intensive facilitation of all requiredinputs a general ICU with seven beds and five mechanical ventilators was initially established in 2018. During the second phase of the service expansion in 2022, the hospital has established a large ICU with twelve beds, providing more specialized services for over 349 critical patients annually.

Cosmic expansion history analysis with Hubble parametrization in Qn gravity

In this paper, we propose a specialized parameterization for the Hubble parameter, inspired by [Formula: see text]CDM cosmology, to investigate the cosmic expansion history of the Universe. This parameterization is employed to analyze the universe’s late-time behavior within the context of [Formula: see text] gravity, where [Formula: see text] represents non-metricity. By using data from 57 Hubble data points, 1048 supernova (SNe) data points, and six Baryon Acoustic Oscillation (BAO) data points, we determine the optimal values for the model parameters. Additionally, we explore three distinct cosmological models based on the parameter [Formula: see text], specifically when it takes on the values of [Formula: see text], [Formula: see text] and [Formula: see text]. The results of our analysis indicate that our proposed parameterization, along with the associated models for different values of [Formula: see text], predicts an accelerated cosmic expansion phase.

Introduction of a terminal electron sink in chloroplasts decreases leaf cell expansion associated with higher proteasome activity and lower endoreduplication.

Foliar development involves successive phases of cell proliferation and expansion that determine the final leaf size, and is characterized by an early burst of reactive oxygen species generated in the photosynthetic electron transport chain (PETC). Introduction of the alternative PETC acceptor flavodoxin in tobacco chloroplasts led to a reduction in leaf size associated to lower cell expansion, without affecting cell number per leaf. Proteomic analysis showed that the biogenesis of the PETC proceeded stepwise in wild-type leaves, with accumulation of light-harvesting proteins preceding that of electron transport components, which might explain the increased energy and electron transfer to oxygen and reactive oxygen species build-up at this stage. Flavodoxin expression did not affect biogenesis of the PETC but prevented hydroperoxide formation through its function as electron sink. Mature leaves from flavodoxin-expressing plants were shown to contain higher levels of transcripts encoding components of the proteasome, a key negative modulator of organ size. Proteome profiling revealed that this differential accumulation was initiated during expansion and led to increased proteasomal activity, whereas a proteasome inhibitor reverted the flavodoxin-dependent size phenotype. Cells expressing plastid-targeted flavodoxin displayed lower endoreduplication, also associated to decreased organ size. These results provide novel insights into the regulation of leaf growth by chloroplast-generated redox signals, and highlight the potential of alternative electron shuttles to investigate the link(s) between photosynthesis and plant development.

Numerical Simulation Study on the Mechanics and Pore Characteristics of Tectonically Deformed Coal under Multi-Level and Multi-Cycle Loading and Unloading Conditions

Horizontal well cavern completion and stress release is considered a potential technique for efficient development of coalbed methane in tectonically deformed coal (TDC). Pulsating loading and unloading is a key technique for the controlled expansion of caverns and broader stress release within the reservoir. However, current understanding of the mechanical characteristics and pore network structure evolution of TDC under cyclic loading and unloading conditions is still limited. This paper employs numerical simulation methods to study the mechanical behavior and damage characteristics of TDC under cyclic loading and unloading. After obtaining a set of micromechanical parameters reflecting the behavior of TDC samples under triaxial compression in high-stress states, the effects of different stress gradients and cyclic amplitudes on the stress–strain curve, porosity changes, and crack propagation in TDC samples were analyzed. The study results indicate that under various cyclic loading and unloading conditions, the mechanical response characteristics of TDC samples are broadly similar, primarily divided into compression, slow expansion, and accelerated expansion phases. Under low unloading level conditions, the volume expansion of TDC samples is minimal. Also, at the same unloading level, the strain increment decreases with an increasing number of cycles. Correspondingly, under these conditions, the porosity and microcrack expansion in TDC are less than in high-stress gradient scenarios. Under the same unloading level but different amplitudes, the volume expansion rate at 50% unloading amplitude is higher than at 1 MPa unloading amplitude for TDC, with an increased number of crack expansions. Therefore, under cyclic loading conditions, the sensitivity of crack propagation within TDC samples to amplitude is greater than that to unloading level. Under actual pulsating excitation conditions, a low-amplitude, low-stress gradient pulsation method should be used to maintain the stability of horizontal well caverns, and gradually increase the cyclic amplitude to achieve the efficient extraction of coalbed methane in TDC reservoirs. The findings of this study can serve as an important reference for optimizing process parameters in cyclic pulsating stress release engineering for TDC.

Invading plants remain undetected in a lag phase while they explore suitable climates.

Successful alien species may experience a period of quiescence, known as the lag phase, before becoming invasive and widespread. The existence of lags introduces severe uncertainty in risk analyses of aliens as the present state of species is a poor predictor of future distributions, invasion success and impact. Predicting a species' ability to invade and pose negative impacts requires a quantitative understanding of the commonality and magnitude of lags, environmental factors and mechanisms likely to terminate lag. Using herbarium and climate data, we analysed over 5,700 time series (species × regions) in 3,505 naturalized plant species from nine regions in temperate and tropical climates to quantify lags and test whether there have been shifts in the species' climatic space during the transition from the lag phase to the expansion phase. Lags were identified in 35% of the assessed invasion events. We detected phylogenetic signals for lag phases in temperate climate regions and that annual self-fertilizing species were less likely to experience lags. Where lags existed, they had an average length of 40 years and a maximum of 320 years. Lengthy lags (>100 years) were more likely to occur in perennial plants and less frequent in self-pollinating species. For 98% of the species with a lag phase, the climate spaces sampled during the lag period differed from those in the expansion phase based on the assessment of centroid shifts or degree of climate space overlap. Our results highlight the importance of functional traits for the onset of the expansion phase and suggest that climate discovery may play a role in terminating the lag phase. However, other possibilities, such as sampling issues and climate niche shifts, cannot be ruled out.

Dynamical system method of viscous fluid in f(T) gravity theory

In this paper, using the recently introduced f(T) gravity framework, we have analyzed the viscous fluid cosmological model in FLRW cosmological model by assuming a specific form of the bulk viscosity coefficient as, ζ=ζ0+ζ1H+ζ2ḢH+H and a non-linear f(T) model particularly, f(T)=T−α−T where α is the model parameter. The bulk viscosity coefficients are estimated by using Hubble 31 data set. Using the phase space technique, we examine the asymptotic behaviour of our cosmological bulk viscous model. We found one stable critical point. Phase space analysis and the geometrical interpretations are given. We discover that according to our model, the Universe evolved from a matter-dominated decelerated phase (a past attractor) to a stable de-Sitter accelerated epoch (a future attractor). The evolution of EoS parameter shows the acceleration phase of the cosmic expansion whereas the negative behavior of viscosity-induced pressure indicates the accelerated expansion of the Universe. Additionally, the cosmic matter-energy density exhibits positive behavior. We look into how statefinder parameters behave for our model . We discover that the trajectory of our model starts at the quintessence and ends at the ΛCDM region. We use the Om diagnostic test, which reveals that our model displays quintessence behaviour. The energy condition criteria are analyzed, and we discover that SEC has been violated, whereas WEC, NEC and DEC satisfy the positivity criteria. Our f(T) cosmological model, with the influence of bulk viscosity successfully describes the expansion history of the Universe and provides a good fit to recent observational data.

A Pilot Study of the Combination of Entinostat with Capecitabine in Advanced Breast Cancer.

Breast cancer has an unacceptably high recurrence rate when any residual disease is found following neoadjuvant treatment of high-risk disease. Based on clinical data suggesting an adjuvant role for epigenetic modifying agents in breast cancer and preclinical data suggesting synergistic activity of entinostat combined with capecitabine, we conducted a phase I, open-label study of these agents in metastatic breast cancer (MBC). Both agents have published doses for use in combination therapy, but the agents had not previously been combined with each other in a human trial. A multisite phase I dose escalation study was performed at two academic centers. Patients with pretreated, HER2-negative MBC, and measurable disease were enrolled. Dual dose escalation was performed via a Bayesian partial order continual assessment method. Dose levels ranged from entinostat 3 mg to 5 mg and capecitabine 800 mg/m2 to 1000 mg/m2. Thirteen patients with MBC and a median of 4 lines of prior therapy were enrolled across four dose level combinations. The most common toxicities were neutropenia, thrombocytopenia, and palmar-plantar dysesthesia, which were expected toxicities. No new safety signals were observed. One dose-limiting toxicity was observed, which did not exceed a prespecified toxicity rate of 25%. The median treatment duration was 2.37 months. No partial nor complete responses were observed. The study was halted early prior to entering an expansion phase, due to drug supply limitations. The tested dosing combinations of entinostat and capecitabine are likely safe in heavily pretreated metastatic breast cancer. This study's clinical investigation of entinostat in breast cancer was halted, but drug development of this agent continues outside the US. There remains a need for postoperative adjuvant drug therapy for the subpopulation of breast cancer patients with high-risk residual cancer after curative therapy. This trial is registered with NCT03473639.

Single agent subcutaneous blinatumomab for advanced acute lymphoblastic leukemia.

Blinatumomab is a BiTE® (bispecific T-cell engager) molecule that redirects CD3+ T-cells to engage and lyse CD19+ target cells. Here we demonstrate that subcutaneous (SC) blinatumomab can provide high efficacy and greater convenience of administration. In the expansion phase of a multi-institutional phase 1b trial (ClinicalTrials.gov, NCT04521231), heavily pretreated adults with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) received SC blinatumomab at two doses: (1) 250 μg once daily (QD) for week 1 and 500 μg three times weekly (TIW) thereafter (250 μg/500 μg) or (2) 500 μg QD for week 1 and 1000 μg TIW thereafter (500 μg/1000 μg). The primary endpoint was complete remission/complete remission with partial hematologic recovery (CR/CRh) within two cycles. At the data cutoff of September 15, 2023, 29 patients were treated: 14 at the 250 μg/500 μg dose and 13 at 500 μg/1000 μg dose. Data from two ineligible patients were excluded. At the end of two cycles, 12 of 14 patients (85.7%) from the 250 μg/500 μg dose achieved CR/CRh of which nine patients (75.0%) were negative for measurable residual disease (MRD; <10-4 leukemic blasts). At the 500 μg/1000 μg dose, 12 of 13 patients (92.3%) achieved CR/CRh; all 12 patients (100.0%) were MRD-negative. No treatment-related grade 4 cytokine release syndrome (CRS) or neurologic events (NEs) were reported. SC injections were well tolerated and all treatment-related grade 3 CRS and NEs responded to standard-of-care management, interruption, or discontinuation. Treatment with SC blinatumomab resulted in high efficacy, with high MRD-negativity rates and acceptable safety profile in heavily pretreated adults with R/R B-ALL.

Calcareous Nannofossils and Paleoclimatic Evolution Across the Eocene‐Oligocene Transition at IODP Site U1509, Tasman Sea, Southwest Pacific Ocean

AbstractThe Eocene‐Oligocene transition (EOT; ∼34 Ma) was one of the most prominent global cooling events of the Cenozoic, coincident with the emergence of continental‐scale ice‐sheets on Antarctica. Calcareous nannoplankton experienced significant assemblage turnover at a time of long‐term surface ocean cooling and trophic conditions, suggesting cause‐effect relationships between Antarctic glaciation, broader climate changes, and the response of phytoplankton communities. To better evaluate the timing and nature of these relationships, we generated calcareous nannofossil and geochemical data sets (δ18O, δ13C and %CaCO3) over a ∼5 Myr stratigraphic interval recovered across the EOT from IODP Site U1509 in the Tasman Sea, South Pacific Ocean. Based on trends observed in the calcareous nannofossil assemblages, there was an overall decline of warm‐oligotrophic communities, with a shift toward taxa better adapted to cooler more eutrophic conditions. Assemblage changes indicate four distinct phases caused by temperature decrease and variations in paleocurrents: late Eocene warm‐oligotrophic phase, precursor diversity‐decrease phase, early Oligocene cold‐eutrophic phase, and a steady‐state cosmopolitan phase. The most prominent shift in the assemblages occurred during the ∼550 kyr‐long precursor diversity‐decrease phase, which has relatively high bulk δ18O and %CaCO3 values, and predates the phase of maximum glacial expansion (Earliest Oligocene Glacial Maximum–EOGM).

A phase 1, first-in-human, dose-escalation and expansion study of FX-909 in patients with advanced solid malignancies, including advanced urothelial carcinoma.

TPS709 Background: High Expression of Peroxisome proliferator-activated receptor gamma (PPARG), a nuclear receptor-family transcription factor, drives the initiation and development of UC in luminal molecular subtype tumors. Genetic profiling of UC has identified recurrent oncogenic alterations in the PPARG transcriptional complex, including focal amplification, missense mutations, and fusions in the heterodimeric partner of PPARG, the retinoid X receptor alpha (RXRA). High levels of PPARG expression and recurrent oncogenic alterations are observed in other solid malignancies including colorectal, gastroesophageal, pancreatic and lung cancers. FX-909 is an oral, first-in-class, new molecular agent that specifically, potently, and covalently modifies PPARG to mediate basal and ligand-activated transcription. Treatment of genetically defined UC xenografts with FX-909 has shown an 84% tumor growth inhibition (TGI) at a dose expected to be equivalent to 50 mg dose in humans, which is the starting dose in this clinical study. Methods: FX-909-CLINPRO-1 (NCT05929235) is a first-in-human, multicenter, open-label Phase 1 study to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and preliminary clinical activity of FX-909 given orally in patients with advanced solid malignancies. Patients enrolled in the trial must have ECOG performance status ≤2 and must be ≥ 18 years of age. Initially, FX-909 will be given once daily to patients with any advanced solid malignancy in a dose-escalation phase (Part A) utilizing a 3+3 design. Five dose cohorts of 3 to 6 patients are planned. At the time of submission, three patients are enrolled in Part A- cohort one, 50mg. Additional patients will be allowed to backfill to previously cleared dose levels that demonstrate therapeutically relevant exposures or evidence of clinical activity. Once a RP2D has been determined, a monotherapy expansion phase (Part B) will proceed in a Simon 2-stage design in patients with locally advanced (unresectable) or metastatic UC with measurable disease and tumors harboring defined genetic alterations in PPARG, RXRA and FGFR3 (Motley et al, 2022). In stage 1, up to 19 evaluable patients will be enrolled. If ≥4 objective responses are observed, enrollment will continue into Stage 2 with an additional 14 evaluable patients. One treatment cycle is 28 days. Dose expansion will evaluate the safety, PK/PD profile, and antitumor activity of FX-909 at the RP2D. Exploratory objectives include the evaluation patient selection biomarkers from tissue and blood samples. FX-909 clinical activity will be assessed using RECIST v1.1 criteria. The study is currently enrolling patients in the US. Clinical trial information: NCT05929235 .

Establishment of human cerebral organoid systems to model early neural development and assess the central neurotoxicity of environmental toxins.

JOURNAL/nrgr/04.03/01300535-202501000-00032/figure1/v/2024-05-14T021156Z/r/image-tiff Human brain development is a complex process, and animal models often have significant limitations. To address this, researchers have developed pluripotent stem cell-derived three-dimensional structures, known as brain-like organoids, to more accurately model early human brain development and disease. To enable more consistent and intuitive reproduction of early brain development, in this study, we incorporated forebrain organoid culture technology into the traditional unguided method of brain organoid culture. This involved embedding organoids in matrigel for only 7 days during the rapid expansion phase of the neural epithelium and then removing them from the matrigel for further cultivation, resulting in a new type of human brain organoid system. This cerebral organoid system replicated the temporospatial characteristics of early human brain development, including neuroepithelium derivation, neural progenitor cell production and maintenance, neuron differentiation and migration, and cortical layer patterning and formation, providing more consistent and reproducible organoids for developmental modeling and toxicology testing. As a proof of concept, we applied the heavy metal cadmium to this newly improved organoid system to test whether it could be used to evaluate the neurotoxicity of environmental toxins. Brain organoids exposed to cadmium for 7 or 14 days manifested severe damage and abnormalities in their neurodevelopmental patterns, including bursts of cortical cell death and premature differentiation. Cadmium exposure caused progressive depletion of neural progenitor cells and loss of organoid integrity, accompanied by compensatory cell proliferation at ectopic locations. The convenience, flexibility, and controllability of this newly developed organoid platform make it a powerful and affordable alternative to animal models for use in neurodevelopmental, neurological, and neurotoxicological studies.

THE USE OF GENERATIVE ARTIFICIAL INTELLIGENCE FOR CUSTOMER SERVICES

This study explores the use of artificial intelligence (AI) in e-government applications, focusing on the various phases of e-government expansion and advancement. The frameworks include providing information, enabling interaction, and facilitating transactions. The main source of improvement is the integration of AI into government services, enabling computer systems to learn, reason, and make human-like decisions. The use of generator AI is expected to result in more intelligent, precise, and efficient approaches, but it is essential for organizations to formulate plans that align with advancements and consequences of intelligent technology. The goal is to achieve development goals that enable the government to adopt smart generators in its applications.

A comparative study of two routinely used protocols for ex vivo erythroid differentiation

BackgroundErythropoiesis is a complex developmental process in which a hematopoietic stem cell undergoes serial divisions and differentiates through well-defined stages to give rise to red blood cells. Over the last decades, several protocols have been developed to perform ex vivo erythroid differentiation, allowing investigation into erythropoiesis and red cell production in health and disease. ResultsIn the current study, we compared the two commonly used protocols by assessing the differentiation kinetics, synchronisation, and cellular yield, using molecular and cellular approaches. Peripheral blood CD34+ cells were cultured in a two-phase (2P) or a four-phase (4P) liquid culture (LC) and monitored for 20 days. Both protocols could recapitulate all stages of erythropoiesis and generate reticulocytes, although to different extents. Higher proliferation and viability rates were achieved in the 4P-LC, with a higher degree of terminal differentiation and enucleation, associated with higher levels of the erythroid-specific transcription factors GATA-1, KLF-1, and TAL-1. Although the 2P-LC protocol was less efficient regarding terminal erythroid differentiation and maturation, it showed a higher yield of erythroid progenitors in the erythropoietin (EPO)-free expansion phase. ConclusionsWe provide data supporting the use of one protocol or the other to study the biological processes occurring in the early or late stages of erythroid differentiation, depending on the physiological process or pathological defect under investigation in a given study.

A phase 1 trial of combined MEK, STAT3 and PD-1 inhibition in metastatic pancreatic ductal adenocarcinoma (PDAC).

TPS713 Background: PDAC is characterized by its innate and acquired resistance to both MAPK pathway inhibition and immune checkpoint (e.g. PD-1/PD-L1) inhibition (ICI) via multiple mechanisms. In preclinical models of PDAC, combined MEK and STAT3 inhibition (MEKi+STAT3i) uncovers stromal plasticity by attenuating cancer-associated fibroblasts (CAF) with IL-6/CXCL1-secretory phenotypes while enriching for Ly6a/CD34-expressing CAF phenotypes with mesenchymal stem cell-like features. This remodeling of CAF heterogeneity is associated with a striking attenuation in and reprogramming of tumor-associated macrophages (TAMs) as well as enhanced trafficking of CD8 T cells, which exhibit a distinct effector and anti-apoptotic transcriptional program. The addition of MEKi+STAT3i to PD-1 blockade overcomes ICI resistance by significantly enhancing the recruitment, degranulating capacity, and functional cytotoxicity of CD8+ T-cells, thereby augmenting antitumor responses and dramatically improving survival in these models. Furthermore, a patient with refractory PDAC treated off-label with this combination achieved a meaningful response. Based on this strong rationale, a phase 1 trial was initiated to test the combination of MEKi+STAT3 and PD1 inhibition in patients with metastatic PDAC. Methods: NCT05440942 is an open-label, prospective, single-institution phase 1 trial testing the safety, preliminary efficacy, and biomarkers of response to the combination of trametinib (MEKi), ruxolitinib (JAK2/STAT3 inhibitor) and retifanlimab (PD-1 inhibitor) in patients with metastatic PDAC. Patients with metastatic PDAC who have had disease progression on at least one line of prior therapy, with good organ function, preserved performance status, and without major intercurrent illness are eligible. Patients must have an accessible lesion for biopsy and must be willing to undergo this research biopsy at baseline and on treatment. Part 1 of the study is a dose-escalation phase with 3 dose levels and a target dose of trametinib 2mg orally daily, ruxolitinib 15mg orally twice daily, and retifanlimab 500mg intravenously every 28 days. The dose escalation is being done using the novel Bayesian keyboard design and 9-15 patients will be treated to get to the potential maximum tolerated dose (MTD). Dose level 1 has been completed without any dose-limiting toxicities seen. Part 2 is an expansion phase which will accrue an additional 20 patients. All patients in part 1 and 2 will have core-needle biopsies pre-treatment and after 4 weeks. Serial blood samples will be collected at baseline and on treatment. Biopsies are being analyzed by multiparameter immune profiling using mass cytometry and bulk RNA sequencing; blood is being analyzed for circulating tumor DNA and immune profiling. These results will be correlated with clinical response to therapy to determine biomarkers of response and resistance. Clinical trial information: NCT05440942 .

First safety and efficacy data from phase Ib/IIa study of fostroxacitabine bralpamide (fostrox, MIV-818) in combination with lenvatinib in patients with hepatocellular carcinoma (HCC).

476 Background: Fostrox is an orally administered troxacitabine-based nucleotide prodrug in clinical development in combination with lenvatinib (NCT03781934). Fostrox is rapidly metabolized by human hepatocytes, directing high levels of the active metabolite to the liver. Phase I fostrox monotherapy demonstrated selective intra-tumoral activity in on-treatment liver biopsies. The anti-angiogenic activity of lenvatinib has the potential to synergize with fostrox by hypoxia-induced increase in the enzymatic generation of the active metabolite of fostrox in the tumor. Methods: In a phase Ib/IIa study with an inter-patient dose escalation 3+3 cohort design followed by a dose expansion phase, fostrox was administered orally QD for 5 days in 21-day cycles in combination with lenvatinib according to local prescription information. Patients (pts) with &lt;2 prior lines systemic treatment for advanced, unresectable HCC were recruited at 10 sites in Spain, South Korea and UK. Pts with histologically, radiologically, or cytologically confirmed HCC, Child-Pugh A, ≥18 years, ECOG PS ≤ 1 and adequate organ function were eligible. The primary objective was to assess safety and tolerability. Key secondary endpoints were ORR based on RECIST 1.1 and mRECIST. Exploratory endpoints included pharmacokinetics (PK) and pharmacodynamic effects of fostrox in combination with lenvatinib. Results: At interim data cut-off 18 pts (6 pts in Ib and 12 pts in IIa) were enrolled at fostrox QD doses of 20mg (3 pts) and 30mg (15 pts) in combination with lenvatinib. Median age was 63 years (range: 42-82). No DLTs and only 1 discontinuation of fostrox due to AEs with a median FU of 3.8 months, were observed. Most common grade 3/4 AEs were transient neutrophil count decrease, platelet count decrease and hypertension. No febrile neutropenia, bleeding events or proteinuria were reported. The safety profile was consistent with each individual agent. In phase Ib, central independent review based on RECIST 1.1 showed SD in 5/6 pts, while mRECIST showed CR in 1 pt, PR in 2 pts and SD in 2 pts. Updated phase Ib data and efficacy data from phase IIa by central independent review, together with PK for fostrox and lenvatinib, and liver biopsy biomarker data, will be presented. Conclusions: Fostrox in combination with lenvatinib, in pts with HCC who progressed on previous systemic treatment, had an acceptable safety and tolerability profile with promising interim efficacy results from the completely enrolled phase Ib/IIa study. Clinical trial information: NCT03781934 .

Predictive role of homologous recombination deficiency (HRD) for irinotecan in combination with venadaparib, a novel PARP1/2 inhibitor, as third- or fourth-line treatment in patients with advanced gastric cancer.

380 Background: Tumors with homologous recombination deficiency (HRD), including BRCA and ATM mutations, have shown to predict response to poly (adenosine diphosphate [ADP]–ribose) polymerase (PARP) inhibitors. The associations between treatment efficacy of PARP inhibitor-based regimen and mutations in BRCA (BRCAm) or ATM gene (ATMm) are not well known in previously treated advanced gastric cancer (GC). Combining PARP inhibitor and irinotecan is known to synergize cytotoxicity. The aim of this analysis was to evaluate the association of HRD and efficacy of irinotecan and venadaparib combined, in patients with metastatic GC who had failed at least 2 lines of therapy. Methods: MTT assays were performed in vitro to verify and characterize synergism between venadaparib and SN-38. Data were analyzed using the GraphPad Prism (version 9.5.1) and CompuSyn (version 1.0) software. Patients with at least two prior palliative treatments were enrolled in a multi-national phase Ib trial (NCT04725994). Tumor response was evaluated according to RECIST 1.1. Exploratory genomic analysis was included to assess the correlation between efficacy and HRD. Genomic analysis was conducted using ctDNA (GuardantOMNI Gene Panel version 1.0, Redwood City, CA) on Day 1 pre-dose. Results: In MTT assays, the combination of SN-38 and venadaparib exerted synergistic effect with combination indices (CI) ranging from 0.013 to 0.991 in SNU-638 (BRCA2m), SNU-668 (BRCA1m), AGS (low ATM) and SNU-484 (HR proficient) cells. We observe the synergistic effect between SN-38 and venadaparib remained consistent even at low concentrations of venadaparib (SN-38 IC50; without venadaparib → with 10 nM of venadaparib; SNU-638(1.72→0.28), SNU-668(10.7→1.5), AGS (0.62→0.049), SNU-484(2.25-&gt;0.38)). In the dose-finding part of the clinical study, 26 patients were enrolled, 13 had received two prior treatments and 13 had received three prior treatments. At data cut-off, median duration of follow-up (range) was 4.4 (1.3 – 23.7) months. Of the 26 patients enrolled, 5 (1 BRCA2m and 4 ATMm) had HRD (19.2%) and were treated with varying doses of irinotecan and venadaparib. In the five patients with HRD, an objective response rate (ORR) was 60% and median progression-free survival (mPFS) (95% CI) was not reached (1.2–21.5). Of the 26 patients enrolled, 11 received varying doses of venadaparib plus 100 mg/m2 of irinotecan, with an ORR of 36.4% and mPFS (95% CI) of 5.6 (3.5–not reached) months. Conclusions: Venadaparib in combination with irinotecan showed synergistic effect in vitro assays and promising clinical efficacy in the systemic treatment of refractory GC, particularly in patients with HRD. The dose expansion phase of the study is ongoing to investigate the optimal biological dose and patient selection strategies, in a randomized design. Clinical trial information: NCT04725994 .

Coformulated quavonlimab and pembrolizumab (pembro) in combination with lenvatinib (lenva) as first-line (1L) therapy for patients (pts) with advanced hepatocellular carcinoma (HCC): Phase 2 KEYSTEP-004 study.

484 Background: Combinations of a PD-1/L1 inhibitor with a CTLA-4 or VEGF inhibitor have been approved as 1L treatment options for pts with advanced HCC. The multicenter, phase 2 KEYSTEP-004 study (NCT04740307) was conducted to evaluate the coformulation of quavonlimab (CTLA-4 inhibitor) and pembro (PD-1 inhibitor) in combination with lenva (multi–tyrosine kinase inhibitor) as 1L treatment for pts with advanced HCC. Methods: Pts were ≥18 y of age, had histologically or radiographically confirmed HCC with no prior systemic therapy, and were not amenable to curative therapy; had Child-Pugh class A; and ECOG PS 0 or 1. The study consisted of a safety lead-in phase (approximately 6-20 pts) to evaluate the tolerability of the recommended phase 2 dose of lenva with a possibility of dose modification based on dose-limiting toxicities (DLTs) and an efficacy expansion phase (approximately 110 pts). In the safety lead-in phase, pts received a fixed-dose coformulation of quavonlimab 25 mg and pembro 400 mg IV Q6W in combination with lenva 8 mg (body weight [BW] &lt;60 kg) or 12 mg (BW ≥60 kg) PO QD. Allocation to the efficacy expansion phase was allowed if the doses of lenva were determined to be tolerable. Primary end points were ORR per RECIST v1.1 by BICR and safety. Secondary end points included DOR, DCR, and PFS per RECIST v1.1 by BICR and OS. Results: No DLTs were observed in the 6 pts enrolled in the safety lead-in phase. 115 pts in the safety lead-in phase or the efficacy expansion phase were treated with the fixed-dose coformulation of quavonlimab and pembro plus lenva 8 or 12 mg. 94 pts (81.7%) were male, median age was 64 y (range, 32-83), and 80 pts (69.6%) had AFP ≤400 ng/mL. As of the June 22, 2023, data cutoff date, median follow-up (time from first dose to database cutoff date or death) was 7.7 mo (range, 0.9-22.1), and 89 pts (77.4%) discontinued treatment, most commonly due to progressive disease (39.1%). Confirmed ORR was 37.4% (95% CI, 28.5-46.9), with 5 CRs (4.3%) and 38 PRs (33.0%). DCR was 79.1% (95% CI, 70.6-86.1). Median DOR was 10.6 mo (range, 1.2+ to 23.1+). Median PFS and OS were 8.2 mo (95% CI, 6.2-10.2) and 22.1 mo (95% CI, 15.5-not reached), respectively; 12-mo PFS and OS rates were 32.2% and 65.2%, respectively. Treatment-related adverse events (TRAEs) occurred in 109 pts (94.8%); most common (≥25%) were hypertension (35.7%) and diarrhea (27.8%). Grade 3-5 TRAEs occurred in 66 pts (57.4%); most common (≥5%) were hypertension (8.7%) and immune-mediated enterocolitis (7.0%). 8 pts (7.0%) died due to AEs; 2 were considered treatment related (acute respiratory failure and subarachnoid hemorrhage). Conclusions: The coformulation of quavonlimab and pembrolizumab in combination with lenvatinib demonstrated manageable safety; further investigation is warranted to understand the efficacy of this triplet as 1L treatment for advanced HCC. Clinical trial information: NCT04740307 .

DKN-01 plus bevacizumab and chemotherapy as second-line (2L) investigational therapy in advanced microsatellite stable (MSS) colorectal adenocarcinoma (CRC): DeFianCe trial.

104 Background: CRC is characterized by hyperactivation of the Wnt pathway where DKK1 plays a critical regulatory role. DKN-01 is an IgG4 monoclonal antibody that potently neutralizes DKK1. DKN-01 has immunomodulatory activity and stimulates a pro-inflammatory tumor microenvironment. Elevated DKK1 expression has been shown to correlate with fluorouracil (5FU) resistance in CRC tumors. 5FU-based combination therapies have demonstrated promising clinical activity in combination with DKN-01 in gastric cancer. In pre-clinical models of 5FU-resistant CRC, DKN-01 showed potent anti-tumor effects. Methods: DeFianCe (NCT05480306) is a Phase 2 randomized, open-label, two-part, multicenter study to evaluate efficacy and safety of DKN-01 plus FOLFIRI/FOLFOX and bevacizumab versus standard of care (SOC) [FOLFIRI/FOLFOX and bevacizumab] as 2L treatment of advanced MSS CRC patients (pts). The primary endpoint of the single arm Part A (DKN-01 + SOC) was safety and tolerability with secondary endpoints including overall response rate (ORR), progression-free survival (PFS) and overall survival. Retrospective analysis of tumoral DKK1 mRNA expression was measured centrally by in situ hybridization. Results: Thirty-three pts enrolled in Part A between Sept 2022-April 2023. As of 21 Aug 2023, median age 56 years (35, 84); 20 males. 29 pts had tumors with evaluable baseline DKK1 expression; 55% were DKK1-expressing (≥1% tumor cells). All patients had received prior 5FU-based therapies, 30 pts (91%) with oxaliplatin in combination and 17 pts (52%) had prior bevacizumab. 24 pts (73%) had RAS mutations (22 KRAS, 2 NRAS) and 23 pts (70%) had liver metastasis. 30 pts (91%) received DKN-01 + bevacizumab + FOLFIRI. 17 pts (52%) had ≥grade 3 treatment related adverse events (TRAE) with neutrophil count decreased, anemia and fatigue representing the most common. No pt discontinued DKN-01 due to a TRAE. Of the 27 response evaluable pts the ORR was 30% and the DCR was 93%: 8 PR, 17 SD and 2 PD. The median PFS has not been reached. Conclusions: DKN-01 in combination with SOC was well tolerated with promising preliminary activity (ORR 30% and DCR 93%) in the single arm Part A. PFS has not been reached and survival follow up is ongoing. Part B randomized expansion phase has begun and is enrolling an additional 130 pts. Tumoral DKK1 expression and correlation with clinical outcomes will be evaluated as an exploratory efficacy endpoint. Clinical trial information: NCT05480306 .

Mass transfer of chemical specie in acoustic cavitation bubble

In the present study, mass transfer across a gas–liquid interface of acoustic cavitation bubble is numerically investigated. The volume of fluid (VOF) method coupled with a continuous species transfer model is used to simulate the bubble dynamic behavior and mass transfer across the gas–liquid interface. Chemical species are transferred repeatedly between the liquid and gas phases in accordance with the bubble oscillation, and the chemical species are transferred into the bubble during an expansion phase, and to the outside of bubble during a compression phase. Time-averaged Sherwood number is decreased with an amplitude of sound pressure due to area effect and shell effect, and its value becomes negative at high pressure amplitude. Meanwhile, the instantaneous Sherwood number is largely varied in accordance with the bubble oscillation, and its magnitude becomes O(101) ∼ O(102).

Topological analysis, endogenous mechanisms, and supply risk propagation in the polycrystalline silicon trade dependency network

High-purity polycrystalline silicon, as a core raw material in the photovoltaic industry, has a trade structure whose robustness affects the supply security of the entire photovoltaic industry. Using social network analysis methods and dependence indicators, this study constructs a Polycrystalline Silicon Trade Dependency Network (PSTDN) from 1995 to 2019, and performs descriptive statistical analysis and trade community divisions on the network. The Temporal Exponential Random Graph Model (TERGM) is used to explore the factors influencing the formation of trade dependencies. Based on the cascading failure model, a Photovoltaic Multilayer Network Supply Risk Propagation Model (PMNSRPM) is constructed to study the risk propagation process of polycrystalline silicon supply interruption as a raw material in the photovoltaic industry. Finally, using the risk propagation range and dependency degree, the study measures the importance of nations comparatively. The results show that (1) the PSTDN exhibits reciprocity, geographical clustering, and weak network convergence; (2) the evolution of the PSTDN's community has gone through three stages: the rising expansion phase from 1995 to 2007, the crisis recession phase from 2008 to 2010, and the competitive contraction phase from 2010 to 2019; (3) the evolution of the PSTDN shows strong reciprocity effects, transitive effects, stabilization effects, and lag effects as endogenous mechanisms; (4) the average risk propagation range is continuously increasing along the supply chain, while there is no significant difference in the risk propagation rate along the supply chain. The risk propagation rate of different risk sources shows a long-tail effect, with the risk propagation rate of leading countries like the United States and China growing rapidly over time. The United States can infect China, but China cannot infect the United States and Western Europe; (5) The risk propagation range and the dependency degree present a positive correlation ranging between 0.5 and 0.7, which is not as highly positive as initially anticipated, and the correlation between them shows a downward trend. This study explores the statistical characteristics of the PSTDN, community evolution, and evolutionary factors, demonstrates the importance of polycrystalline silicon supply security for the production of the photovoltaic industry, quantifies the risk propagation capabilities of different countries, and identifies a group of countries that actually have a high risk propagation range but tend to be underestimated due to their low dependency degree in normal trade network. This can help enhance the early warning capabilities for photovoltaic supply security risks of various countries.