A Randomized, Double-Blinded, Phase II Trial of Gemcitabine and Nab-Paclitaxel Plus Apatorsen or Placebo in Patients with Metastatic Pancreatic Cancer: The RAINIER Trial.

Lessons learnedThe addition of the heat shock protein 27 (Hsp27)-targeting antisense oligonucleotide, apatorsen, to a standard first-line chemotherapy regimen did not result in improved survival in unselected patients with metastatic pancreatic cancer.Findings from this trial hint at the possible prognostic and predictive value of serum Hsp27 that may warrant further investigation.BackgroundThis randomized, double-blinded, phase II trial evaluated the efficacy of gemcitabine/nab-paclitaxel plus either apatorsen, an antisense oligonucleotide targeting heat shock protein 27 (Hsp27) mRNA, or placebo in patients with metastatic pancreatic cancer.MethodsPatients were randomized 1:1 to Arm A (gemcitabine/nab-paclitaxel plus apatorsen) or Arm B (gemcitabine/nab-paclitaxel plus placebo). Treatment was administered in 28-day cycles, with restaging every 2 cycles, until progression or intolerable toxicity. Serum Hsp27 levels were analyzed at baseline and on treatment. The primary endpoint was overall survival (OS).ResultsOne hundred thirty-two patients were enrolled, 66 per arm. Cytopenias and fatigue were the most frequent grade 3/4 treatment-related adverse events for both arms. Median progression-free survival (PFS) and OS were 2.7 and 5.3 months, respectively, for arm A, and 3.8 and 6.9 months, respectively, for arm B. Objective response rate was 18% for both arms. Patients with high serum level of Hsp27 represented a poor-prognosis subgroup who may have derived modest benefit from addition of apatorsen.ConclusionAddition of apatorsen to chemotherapy does not improve outcomes in unselected patients with metastatic pancreatic cancer in the first-line setting, although a trend toward prolonged PFS and OS in patients with high baseline serum Hsp27 suggests this therapy may warrant further evaluation in this subgroup

The impacts of environmental warming on Odonata: a review

Climate change brings with it unprecedented rates of increase in environmental temperature, which will have major consequences for the earth's flora and fauna. The Odonata represent a taxon that has many strong links to this abiotic factor due to its tropical evolutionary history and adaptations to temperate climates. Temperature is known to affect odonate physiology including life-history traits such as developmental rate, phenology and seasonal regulation as well as immune function and the production of pigment for thermoregulation. A range of behaviours are likely to be affected which will, in turn, influence other parts of the aquatic ecosystem, primarily through trophic interactions. Temperature may influence changes in geographical distributions, through a shifting of species' fundamental niches, changes in the distribution of suitable habitat and variation in the dispersal ability of species. Finally, such a rapid change in the environment results in a strong selective pressure towards adaptation to cope and the inevitable loss of some populations and, potentially, species. Where data are lacking for odonates, studies on other invertebrate groups will be considered. Finally, directions for research are suggested, particularly laboratory studies that investigate underlying causes of climate-driven macroecological patterns

Behavioral Treatment of CPR Anxiety: A Case Study

Abstract: A 23-year-old mother with a previously documented psychiatric history experienced extreme anxiety regarding the potential need to resuscitate her infant from recurrent life-threatening apnea. Before discharge on a home monitor, the mother was treated with systematic desensitization and response prevention techniques for cardiopulmonary resuscitation (CPR) anxiety Following 4 days of therapy, the mother successfully completed the CPR training course. At 4-month follow-up, the mother reported that she was able to use CPR successfully and could respond to apnea alarms within 10 seconds Implications of this technique for other health care concerns are discussed. Article: The infant with interrupted apnea of unknown etiology, often labeled interrupted infantile apnea (11A) or idiopathic apnea, presents a complicated medical and psychological problem for the health care team. The infant is typically found limp, pale and/or cyanotic, and not breathing. Initial attempts to revive the infant are often made by auditory or manual stimulation, followed by rushing the infant to a hospital emergency room where a description of the apneic event is obtained by an emergency room physician. Infantile apnea has been linked to a multitude of causes including prematurity, infection, hypoglycemia, metabolic imbalance, drug toxicity, seizure disorder, gastroesophageal reflux, congenital anomalies, and upper airway obstruction. Because of this varied etiology, a comprehensive medical evaluation is necessary to search for treatable disorders. At the University of Oklahoma Health Sciences Center, the work-up typically includes a medical and family history, physical examination, blood gases, serum electrolytes, glucose, cultures, toxicological analysis, electroencephalogram (EEG), electrocardiogram, and radiographic examinations of the lower and upper respiratory tract. Since these tests are usually negative, an overnight sleep study is then performed. The sleep study includes a 12-hour continuous polygraphic recording of sleep state, nasal airflow, and chest wall movement Simultaneous continuous esophageal pH monitoring and ventilatory response to carbon dioxide inhalation are performed to identify gastroesophageal reflux and aberrant chemoreceptor function, respectively

CSR, co-optation and resistance: the emergence of new agnostic relations between business and civil society

This article examines the theoretical implications of the changing relationships between NGOs and businesses that have emerged as a response to the evolving agenda around CSR and sustainable development. In particular, it focuses upon examining whether greater engagement from non-governmental organisations (NGOs) in this area reflects a process of appropriation and co-optation of protest by the business community. To examine this process, the article considers two forms of appropriation—appropriation of language and appropriation via participation—as a basis for discussion. While co-optation pressures are identified within both areas, the article argues that co-optation is identified almost as an inevitable outcome of engagement without significant consideration of the ability of movements to identify and respond to these processes. In identifying an alternative approach, the article utilises Mouffe’s framework of agonistic pluralism. Mouffe’s framework, it is argued, provides an understanding of the way in which agonistic relationships are emerging between NGOs and businesses while highlighting the continuance of conflict between parties struggling to influence the contested interpretations of responsible business

Homeschooling and the criticism of school: hybridisms and educational (dis)continuities

Desde os anos 1960, o homeschooling apresenta dinâmicas de crescimento atualizadas nos diagnósticos da crise do capitalismo e dos sistemas educativos. Por ser praticado por famílias próximas do progressismo libertário, do cristianismo conservador ou de outras inspirações axiológicas, a abordagem investigativa presente neste texto pressupôs romper com uma visão unívoca e alheia à sua diversidade e aos diferentes graus de (in)formalidade dos quotidianos educativos de crianças e de jovens que caracterizam este fenómeno educativo. Procura-se captar as especificidades do ensino doméstico (ED) em Portugal e a sua crescente expressão social e educacional e reflete-se sobre os sentidos das aprendizagens que ele encerra. Conclui-se que o ED parece ser contrário aos horizontes formativos da criança segundo o interesse da sociedade, sendo omisso sobre o seu papel na emancipação dos sujeitos. Confrontam-se a escola e o seu modo de funcionamento a partir do racional do ED, à procura de novas epistemologias e de novas linhas de pesquisa.Since the 1960s, homeschooling has shown growth dynamics updated by the diagnosis of the crisis of capitalism and of educational systems. Because it is practiced by families close to libertarian progressivism, conservative Christianity, or other axiological inspirations, this paper’s approach sought to break with a univocal conception alien to its diversity and to the different degrees of (in)formality of the children’s and young people’s educational daily lives inherent to this educational practice. Therefore, this paper seeks to understand the specificities of Portuguese homeschooling and its increasing social and educational expression, and to reflect on the meanings of the learning it entails. Being unclear about its role on the emancipation of the subjects, homeschooling seems to be contrary to the educational horizons of the child according to the interests of the whole society. This paper confronts school and its way of functioning with the homeschooling rationale in order to search for new epistemologies and new lines of research.info:eu-repo/semantics/publishedVersio

Phase 1 Expansion Cohort of Ramucirumab Plus Pembrolizumab in Advanced Treatment-Naive NSCLC

INTRODUCTION: Data of first-line ramucirumab plus pembrolizumab treatment of programmed death-ligand 1 (PD-L1)-positive NSCLC (cohort E) are reported (NCT02443324). METHODS: In this multicenter, open-label phase 1a/b trial, patients received ramucirumab 10 mg/kg and pembrolizumab 200 mg every 21 days for up to 35 cycles. PD-L1 positivity was defined as tumor proportion score (TPS) greater than or equal to 1%. Exploratory NanoString biomarker analyses included three T-cell signatures (T-cell-inflamed, Gajewski, and effector T cells) and CD274 gene expression. RESULTS: Cohort E included 26 patients. Treatment-related adverse events of any grade occurred in 22 patients (84.6%). Treatment-related adverse events of grade greater than or equal to 3 were reported in 11 patients (42.3%); the most frequent was hypertension (n = 4, 15.4%). Objective response rate was 42.3% in the treated population and 56.3% and 22.2% for patients with high (TPS ≥ 50%) and lower levels (TPS 1%-49%) of PD-L1 expression, respectively. Median progression-free survival (PFS) in the treated population was 9.3 months, and 12-month and 18-month PFS rates were 45% each. Median PFS was not reached in patients with PD-L1 TPS greater than or equal to 50% and was 4.2 months in patients with PD-L1 TPS 1% to 49%. Median overall survival was not reached in the treated population, and 12-month and 18-month overall survival rates were 73% and 64%, respectively. Biomarker data suggested a positive association among clinical response, three T-cell signatures, CD274 gene expression, and PD-L1 immunohistochemistry. CONCLUSIONS: First-line therapy with ramucirumab plus pembrolizumab has a manageable safety profile in patients with NSCLC, and the efficacy signal seems to be strongest in tumors with high PD-L1 expression

Ramucirumab in combination with pembrolizumab in treatment-naïve advanced gastric or gej adenocarcinoma: Safety and antitumor activity from the phase 1a/b jvdf trial

Ramucirumab (anti-VEGFR2) plus pembrolizumab (anti-PD1) demonstrated promising antitumor activity and tolerability among patients with previously treated advanced cancers, supporting growing evidence that combination therapies modulating the tumor microenvironment may expand the spectrum of patients who respond to checkpoint inhibitors. Here we present the results of this combination in first-line patients with metastatic G/GEJ cancer. Twenty-eight patients (≥18 years) with no prior systemic chemotherapy in the advanced/metastatic setting received ramucirumab (8 mg/kg days 1 and 8) plus pembrolizumab (200 mg day 1) every 3 weeks as part of JVDF phase 1a/b study. The primary endpoint was safety. Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and overall survival (OS). Tumors were PD-L1-positive (combined positive score ≥ 1) in 19 and-negative in 6 patients. Eighteen patients experienced grade 3 treatment-related adverse events, most commonly hypertension (14%) and elevated alanine/aspartate aminotransferase (11% each), with no grade 4 or 5 reported. The ORR was 25% (PD-L1-positive, 32%; PD-L1-negative, 17%) with duration of response not reached. PFS was 5.6 months (PD-L1-positive, 8.6 months; PD-L1-negative, 4.3 months), and OS 14.6 months (PD-L1-positive, 17.3 months; PD-L1-negative, 11.3 months). Acknowledging study design limitations, ramucirumab plus pembrolizumab had encouraging durable clinical activity with no unexpected toxicities in treatment-naïve biomarker-unselected metastatic G/GEJ cancer, and improved outcomes in patients with PD-L1-positive tumors