HER2-positive advanced breast cancer treatment in 2020

HER2-positive breast cancer is an aggressive subtype identified in the 1980s. The development of therapies targeting the HER2 has improved outcomes. The current standard of care, established in 2012 is dual blockade with trastuzumab + pertuzumab as first-line followed by TDM-1 as second-line. Several suboptimal choices are available in third-line or more. In 2019 the presentation of several trials evaluating new drugs and regimens in third-line has re-opened questions about sequencing, treatment of triple positive disease and treatment choice after exposure to TDM-1. These include tucatinib, neratinib and trastuzumab-deruxtecan. Other agents – including other antibody drug conjugates and bispecific antibodies as well as combinations - will lead to further changes in coming years. Additionally, should the numerous putative biomarkers thus identified ever come into use at the clinic, choice of treatment and response evaluation may be substantially changed.     

A simulation study of three sequential methods for the comparison of two treatment groups when the response criterion is censored

Three recent sequential methods, group sequential analysis (GSA), the sequential probability ratio test (SPRT) and the triangular test (TT) are well suited to randomized clinical trials with a censored response criterion, as they do not require matched pairs of patients. We undertook a simulation study to investigate their statistical properties and to compare these three methods with the fixed-sample design. Our results suggest that the three methods have the expected statistical properties for size and power; they allow an important reduction of the average number of events before stopping, except with GSA when there is no treatment difference; the triangular test (closed design) appears the optimal design, as the variance of the number of events is smaller than with the sequential probability ratio test (open design) and analysis after every twenty new events does not alter the statistical properties of these sequential methods and enhances their usefulness.     

Carbohydrate moieties of procine 32 kDa enamelin

The structures of asparagine-linked oligosaccharides of porcine 32 kDa enamelin are reported. The oligosaccharides were released by N-oligosaccharide glycopeptidase digestion, and the reducing ends of the oligosaccharides were derivatized with a fluorescent reagent, 2-aminopyridine. The pyridylamino oligosaccharides were separated into eight kinds of oligosaccharides. The structures of these oligosaccharides were determined by a combination of a sequential exoglycosidase digestion and a two-dimensional suger mapping technique. The oligosaccharides consisted of fucose, galactose, mannose, N-acetylglucosamine, and N-acetylneuraminic acid, and were classified into two groups according to their core-sugar chain structures; one was a biantennary-type and the other was a triantennary-type oligosaccharide. The variation of the oligosaccharides in each of these groups was caused by the differences in the number, the site, and the mode of linkage of N-acetylneuraminic acid to the core-sugar chains.     

加替沙星序贯治疗下呼吸道细菌感染的药物经济学评价

目的对加替沙星序贯治疗下呼吸道细菌感染进行药物经济学评价。方法将69例下呼吸道细菌性感染患者，随机分为A组（34例）、B组（35例），其中A组采用加替沙星注射液400mg静脉滴注，每天1次，连用10天；B组先用加替沙星注射液400mg静脉滴注，每天1次，3—4天后改为口服400mg，每天1次，连用6—7天，然后对两种方案进行成本-效果分析。结果两组在临床疗效、不良反应发生率及细菌清除率方面差异无统计学意义（P〉0．05）；但A组的医疗费用却高于B组（P〈0．01）。结论加替沙星序贯疗法与单纯静脉滴注相比更安全，更经济合理。     

女性生殖道不同部位检测支原体的序贯试验分析

目的探讨解脲脲原体和人型支原体在女性生殖道的主要寄生部位.方法采用载量一致的标准无菌棉拭子分别于女性阴道穹窿和宫颈口采样,用法国生物梅里埃ID试剂进行解脲脲原体和人型支原体的培养鉴定及半定量计数,按照双向质反应开放型序贯试验设计,对检测结果进行比较分析.结果阴道穹窿部位标本中两种支原体的总阳性数和≥10^4ccu/ml半定量阳性数均高于宫颈口标本.结论对女性进行生殖道支原体感染的检测时应采集阴道穹窿标本,以提高检出率.     

遗传毒理学试验预测致癌物的成本效益分析

本文对检测致癌物的遗传毒理试验与动物致癌试验相结合的序贯判别方法进行成本-效益分析。结果表明,这种方法具有显著的社会经济效益。如忽略各遗传毒理试验间的不独立性,并设致癌性先验概率为0.1,则遗传毒理学试验次数可限制在5次左右。当受试物致癌性的后验概率小于0.03时判为非致癌物,大于0.7时判为致癌物。     

Interference between velocity-dependent and position-dependent force-fields indicates that tasks depending on different kinematic parameters compete for motor working memory

Humans demonstrate motor learning when exposed to changes in the dynamics of movement or changes in the visuomotor map. However, when two opposing dynamic transformations are learned in succession, the memory of the first is overwritten by learning of the second; the same is true for two opposing visuomotor rotations. This retrograde interference is not seen for all combinations of transformations, however. When a dynamic transformation is learned subsequent to a visuomotor rotation, the presence or absence of interference appears to depend crucially on the structure of the dynamic task: a force-field dependent on the position of the hand produces interference, whereas an inertial load applied lateral to the hand does not. To explain these results, it has been hypothesized that two transformations can be learned without interference if they depend on two different kinematic parameters of movement (such as position and velocity of the hand). Here we demonstrate, contrary to this hypothesis, interference between a dynamic transformation that depends on the position of the hand and one that depends on its velocity. However, the interference was found to be incomplete, supporting the view that the ability to retain motor memories for different tasks depends on the degree to which their representations conflict in working memory.     

Influence of synchronous and sequential stimulation on muscle fatigue

In acute experiments the sciatic nerve of the rat is electrically stimulated to induce fatigue in the medial Gastrocnemius muscle. Fatigue tests are carried out using intermittent stimulation of different compartments (sequential) or a single compartment (synchronous) of the sciatic nerve. The activation of different compartments is achieved by dividing nerve fibres into subbundles and placing them in separate grooves in a multigroove electrode. The aim of the investigation is to quantify the effect of sequential contra synchronised stimulation in reducing muscle fatigue, with no overlap between compartments. Overlap between two compartments is calculated using the combined and individual forces from both compartments. Sequential stimulation of two and three compartments is investigated. There is a significant decrease of fatigue in sequential stimulation compared to synchronous. After 2 min of intermittent stimulation the force time level is significantly increased in sequential stimulation, than in synchronous stimulation. The rate of force time decrease is significantly slower in sequential stimulation than in synchronous stimulation. With sequential stimulation it takes significantly longer before the maximal force time is reached than with synchronous stimulation.     

Sequential movement representations based on correlated neuronal activity

We tested the hypothesis that sequential movements are represented in the correlated activity of motor cortical neurons. We simultaneously recorded multiple single neurons in the motor cortex while monkeys performed a two-segment movement sequence. Before any movement began the correlated spike firing between pairs of neurons differed when these sequences were planned as whole (planned) as compared to when they were planned one segment at a time (unplanned) even when the firing rates of these neurons did not distinguish between the two conditions. Moreover, the correlation strength was significantly larger when the directional preferences of the neurons matched the direction of the final segment of the sequence. Our results suggest that spatially distributed groups of MI neurons form dynamic correlation structures that distinguish different forms of sequential action. Electronic Publication